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We aimed to find and compare the efficacy of ultrasonography (US), technetium-99m methoxyisobutylisonitrile parathyroid scintigraphy (MIBI-S), and single-photon emission computed tomography-computed tomography (SPECT-CT) in detecting the localization of parathyroid adenomas in patients with primary hyperparathyroidism.In total, 348 patients were included in this study. Preoperative parathyroid imaging with US, MIBI-S, and SPECT-CT was evaluated and compared with operative findings. The results of the imaging methods were compared with pathology and operation reports.In 318 patients (91.3%), one of the imaging methods was able to localize the lesion correctly. US detected the localization of the parathyroid lesions correctly in 268 patients (77%), whereas SPECT-CT and MIBI-S were correct in 254 (73%) and 209 (60%) patients, respectively. There was a statistically significant relationship between the parathyroid hormone (PTH) level and 3 imaging methods' success rates (P.05). The PTH cut-off value, which best determined the correct localization, was 152.5 pg/mL for US, 143 pg/mL for MIBI-S, and 143 pg/mL for SPECT-CT. It was observed that the correct localization rate for parathyroid lesions increased with higher PTH levels.In our study population, US was more successful, in most cases, than other imaging methods in localizing parathyroid lesions but SPECT-CT was more accurate in localizing mediastinal lesions. In addition, it was found that preoperative PTH levels affect the accuracy of imaging methods.

For thyroid nodules ≥4 cm, the accuracy of fine-needle aspiration biopsy (FNAB) is controversial and the approach is unclear. We aimed to compare FNAB and operation of thyroid nodules and to determine the accuracy of FNAB.All total thyroidectomies performed between January 2015 and December 2021 were evaluated. In the study, 301 patients were included. Euthyroid patients with preoperative thyroid ultrasound, FNAB results and operation results were recorded retrospectively.The nodule size was4 cm in 79.1% of the patients, and ≥4 cm in 20.9%. In patients with nodule size ≥4 cm, 50.8% of FNAB results were reported as benign, and 43.7% of these patients were found to be malignant at the end of the operation. In nodules4 cm, 36.8% of the patients whose FNAB results were found to be benign were malignant. False-negativity rate was found to be quite high in ≥4 cm nodules.For thyroid nodules, diagnostic lobectomy may be necessary because the false-negative rate of FNAB was high, especially in nodules ≥4 cm. In addition, intermediate results, such as AUS/FN, have a higher risk of malignancy in nodules of ≥4 cm compared to nodules of4 cm.

Background The clinical management of Bethesda III category thyroid nodules has some undefined points and differs among centers and conflicting malignancy rates are present in the literature. The aim of this study was to investigate the Bethesda category III thyroid nodule outcomes in our centers, to determine malignancy rates and also to evaluate clinical and sonographic features which may help to predict malignancy. Methods This retrospective study included 333 patients with thyroid nodules who had Bethesda category III on fine needle aspiration (FNA) in three tertiary medical centers of Turkey. Results Among 333 patients, 302 had appropriate follow up. Eighteen patients received thyroidectomy after the first FNA, with a malignancy rate of 38.89% (7/18) and 284 patients received a second FNA. After the second FNA, thyroidectomy was performed in 80 patients and 41 patients needed the third FNA. Thirteen thyroidectomies were performed after the third FNA. Totally 111 patients received thyroidectomy with a malignancy rate of 48.65% (54/111) among patients with surgery and the lower bound was detected as 17.88% (54/302). Of these patients the malignancy rates of patients receiving thyroidectomy with two and three FNAs were 47.50% (38/80) and 69.23% (9/13), respectively. Hypoechogenicity, microcalcification, and irregular margin were found as good predictors for malignancy. Conclusion We demonstrated that the malignancy rate was 48.65% in patients receiving thyroidectomy. We showed a higher malignancy rate than the traditionally rate of 5%-15%. This study showed that repeat FNAs decrease the rate of unnecessary surgery performed for benign lesions by increasing the rate of malignancy detection. WOS:000668543500001 2-s2.0-85109019440 PubMed: 34196509

Background: Hyperthyroidism is characterized by excess hormone secretion from the thyroid gland. Anti-thyroid drugs (ATDs), surgery, and radioactive iodine can be used in treatment. Plasmapheresis is a rapid and effective treatment option in cases where rapid euthyroidism is needed to be obtained due to complications of thyrotoxicosis and major adverse effects of ATDs. Material and method: We present patients receiving plasmapheresis to provide immediate euthyroidism due to severe hyperthyroidism, adverse effects of ATDs, or non-thyroid surgery from January 2012 to December 2016. Results: This study included 18 patients. The etiology of hyperthyroidism was TDG in seven patients, TDMNG in two, TA in two, TMNG in four, and one patient had AIT. Plasmapheresis was performed to achieve euthyroidism before surgery in two patients. The mean plasmapheresis session was 5.35. The mean number of sessions needed for patients with TDG and TDMNG was 4, whereas it was 6.5 for patients with TA and TMNG (p = 0.07). The decrease of mean free thyroxine and free triiodothyronine were 57 % and 73 %, respectively (p < 0.001). After plasmapheresis, total thyroidectomy was performed in 14 patients. Euthyroidism was achieved with RAI in one patient and with medical therapy in three patients. Conclusions: Plasmapheresis therapy is a reliable and effective treatment option for patients who cannot use ATDs because of their adverse events and those with hyperthyroidism that does not resolve with these drugs, or to achieve euthyroidism before total thyroidectomy, RAI or non-thyroid emergency surgery. However, it cannot be used widely because it is expensive and invasive. WOS:000564554400031 2-s2.0-85081956708 PubMed: 32201205

Primary Thyroid lymphoma is an uncommon malignancy, which can rarely cause severe dyspnea. Its commonly difficultly diagnosed and rapid diagnosis and management may be lifesaving. Here we report a case presented with sudden thyroid growth and severe dyspnea, who was diagnosed as primary thyroid lymphoma. A 70-year-old woman applied with fatigue, rapidly enlarged goitre and severe progressive dyspnea. She had severe hypoxemia with an artery oxygen saturation of 59.2% and arterial PO2 of 33.9 mmHg. The ultrasound of the neck showed an enlarged thyroid gland with a mass in the left lobe. After admission to the hospital her dyspnea worsened and oxygen and bronchodilator treatment gave no benefit. IV methylprednisolone was administered, and the patient’s symptoms partially improved. Meanwhile in spite of supportive therapy, the patient underwent urgent surgery for acute airway obstruction and thyroidectomy was performed. After surgery the diagnosis was high grade diffuse large B-cell non-Hodgkin’s lymphoma.