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Thyroid follicular nodular disease (non-toxic multinodular goiter), the commonest thyroid disorder, can be managed with different surgical methods, including total thyroidectomy (TT), near-total thyroidectomy (NTT), subtotal thyroidectomy (STT), and Dunhill operation (DO). This systematic review and meta-analysis aimed to provide an update on the role of TT versus NTT, STT, or DO in MNG concerning goiter recurrence, thyroid cancer incidence, and reported complications. We conducted a systematic literature search in Medline, EMBASE, and CENTRAL. We included randomized controlled trials (RCTs) that compared TT to partial thyroidectomy (NTT, STT, or DO) in the management of multinodular goiter (MNG). The following outcomes, goiter recurrence, cancer incidence, and adverse events (hypoparathyroidism and recurrent laryngeal nerve injury), were evaluated. We used the risk ratio (RR) to represent the dichotomous outcome. Subgroup analysis was performed based on the different types of partial thyroidectomy (NTT, STT, and DO). A total of 7 RCTs that included 1909 individuals were deemed eligible. TT showed significantly better results compared to PT in terms of goiter recurrence (RR = 0.05, 95% CI 0.02 to 0.13, P = 0.001; I2 = 0%), whereas it showed similar results compared to PT in terms of thyroid cancer incidence (RR = 1.09, 95% CI 0.76 to 1.57, P = 0.63; I2 = 0%). PT was significantly better than TT concerning transient adverse events (RR = 2.18, 95% CI 1.64 to 2.89, P = 0.001: I2 = 63%). This meta-analysis showed that TT has a lower risk of goiter recurrence. TT is comparable to PT in terms of persistent adverse events but has a higher risk for transient adverse events. [ABSTRACT FROM AUTHOR]

Background: Globally, a rising trend has been observed in the prevalence of thyroid disorders, with many demographic and geographic factors influencing its epidemiology. Nonetheless, some cases often go undetected due to the inconsistent and non-specific nature of the clinical symptoms. Therefore, we aimed to determine the trend and relationship between various pathological findings in thyroid disease patients and their demographic factors to aid clinicians in making a prompt diagnosis and treatment plan. Methods: A descriptive correlational study was conducted from January 2020 to May 2022 at Jinnah Postgraduate Medical Center, Karachi. We collected data via random sampling from 258 patients suffering from thyroid disorders. We evaluated baseline patient characteristics, along with, thyroid scan and fine needle aspiration cytology (FNAC) reports, and local thyroid gland examination findings. Results: Out of 258 participants, 192 (74.4%) were females, whereas 66 (25.6%) were males, giving a female: male ratio of 2.9: 1. On local examination, 167 (64.7%) were found to have a solitary nodule, 79 (30.6%) had multinodular goiter. Findings revealed that benign follicular lesions had the highest prevalence (35.3%). Moreover, among the cancerous growth, papillary carcinoma presented the highest cases (12.4%). Of 258 cases, 24 patients had non-surgical interventions, while most (234) had surgical interventions. Total thyroidectomy was the most common procedure opted for by 45.3% (n = 117) of the participants, followed by lobectomy 70 (27.1%), near total thyroidectomy 43 (13.2%), modified radical neck dissection 5 (1.9%). Conclusion: Our study showed that nearly all thyroid-related pathologies were more prevalent amongst females than males, with the majority having an acute to sub-acute clinical presentation. Multinodular goiter was a prominent finding indicating a greater need for screening tools and access to healthcare facilities, especially in rural areas, to allow future studies to compare provinces accurately. Plain Language Summary: Trends of Pathological Findings in Patients with Thyroid Diseases The thyroid gland plays a critical role in the body's developmental and metabolic processes. There has been a worldwide rise in thyroid related diseases. This has been attributed to different factors including geography, smoking, genetics etc. However, often due to the non specific nature of disease, the condition often goes undiagnosed until an advanced disease stage, often causing complications. In this study, we aimed to assess the trends and relationship between the different clinical and pathological findings in thyroid disease patients from Pakistan. About 9.7% of our patients were suffering from hypothyroid while a 28.7% suffered from hyperthyroidism while a remaining majority of 61.6% individuals remained euthyroid. Ultrasound findings showed that 96.8% patients has a thyroid mass/nodule or goiter with the highest proprtion of these individuals being found in the middle age (30-50 years) group. Further majority of the diseased population comprised of females. A greater proportion of our patient population required surgical intervention with total thyroidectomy being the most common procedure (45.3%). It is of great importance to continue researching modern trends, presentation and management protocols for thyroid disease, adding to the existing literature. [ABSTRACT FROM AUTHOR]

Background: Hypoparathyroidism with hypocalcemia is the most frequent complication after thyroid surgery. Many risk factors have been involved in the development of this complication, with conflicting results. Incidental parathyroidectomy (IP) may be a frequent cause of postoperative hypocalcemia. In this study, we have evaluated the risk factors associated with the IP in a single-center cohort of patients undergoing thyroid surgery. Patients and methods: The incidence and the risk factors for IP were evaluated in 799 patients scheduled for surgical treatment for thyroid disease between January 2018 and December 2023. Parathyroid hormone levels and serum calcium levels, together with the histological specimens, were evaluated in all patients. Results: Post-operative temporary hypocalcemia was present in 239 (29.9%) patients. A total of 144 patients (21.9%) had an incidental parathyroidectomy. Younger patients (<40 years) had the highest risk of having an incidental parathyroidectomy (RR 1.53 (95% CI 1.084–2.161), OR 1.72 (95% CI 1.091–2.710), p = 0.014). Moreover, thyroid cancer (RR 1.4 (95 CI 1.114–1.882) OR 1.68 (95% CI 1.145–2.484), p < 0.05) and the neck dissection (RR 1.75 (95% CI 1.409–2.198) OR 2.38 (95% CI 1.644–3.460), p < 0.001) were strongly associated with the risk of incidental parathyroidectomy. Conclusions: Younger female patients with thyroid cancer and neck dissection were at the highest risk of incidental parathyroidectomy. A meticulous surgical dissection, together with imaging methods for the detection of the parathyroid glands, may reduce the incidence of this complication. [ABSTRACT FROM AUTHOR]

Background and Objectives: As the global aging population grows, the incidence of thyroidectomy in elderly patients is increasing. This study aimed to evaluate the surgical outcomes of thyroidectomy in patients aged 80 years and older. Materials and Methods: All patients aged 80 years and older who underwent thyroidectomies at our hospital between January 2015 and December 2022 were reviewed in this retrospective cohort study. Collected data consisted of patients' clinical characteristics, functional status, compression symptoms, preoperative assessments, perioperative outcomes, postoperative complications (such as bleeding events, recurrent laryngeal nerve injury, hypocalcemia), pathological findings, readmission, and follow-up outcomes. Results: Seventeen patients were included in this study, with female predominance (82.4%). The mean age was 85.6 ± 4.8 years. Fourteen patients (82.4%) exhibited compression-related symptoms as surgical indications. Based on pathological reports, patients were categorized into benign (12/17, 70.6%) and malignancy (5/17, 29.4%) groups. The benign group had a shorter operation time compared with the malignancy group (164.3 ± 32.0 min vs. 231.0 ± 79.1 min, p = 0.048). No major postoperative complications developed. The median postoperative follow-up duration was 28 months (range: 2–91 months). Thirteen patients (76.5%) were alive at the end of the study period. Conclusions: Despite potential age-related risks, thyroidectomy is feasible for carefully selected patients aged 80 years and older. It provides benefits not only in terms of oncological curative treatment but also in improving the quality of life, such as compressive symptoms and wound condition. [ABSTRACT FROM AUTHOR]

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Thyroid abscess is extremely rare, usually associated with an immunocompromised state, pre-existing thyroid diseases such as malignancy, or a branchial cyst. It is generally caused by Methicillin-resistant Staphylococcus aureus. Here, we report a rare intrathyroid abscess in an immunocompetent patient with pre-existing multinodular goiter due to an uncommon causative agent Escherichia coli (E. coli). She was treated initially with intravenous antibiotics and supportive measures, later incision and drainage of the abscess, and right hemithyroidectomy.

Multinodular goiter (MNG) is a chronic benign nodular enlargement of the thyroid gland. It presents as an anterior painless neck mass, potentially progressing to exert pressure on the trachea and esophagus and giving rise to compressive symptoms. MNG is a common thyroid gland disorder; however, retropharyngeal goiter is considered rare with few reported cases. We report the cases of two patients who presented to our institution with MNG with retropharyngeal extension: a 62-year-old female patient who presented with a progressive anterior neck mass with dilated neck veins; and a 49-year-old male who presented with a painless anterior neck mass. Both patients successfully underwent total thyroidectomy with an uneventful postoperative recovery. The clinical presentation of MNG with retropharyngeal extension varies with patients; hence, a high index of suspicion is of the utmost significance. While the retropharyngeal extension does not cause compressive symptoms, it should raise the suspicion of a large retrosternal component.

(1) Background: After thyroid malignancy is ruled out, treatment options for multinodular goiter patients include surgery, levothyroxine suppressive therapy, and 131-I therapy. Surgery effectively reduces goiter size but carries risks of surgical and anesthetic complications. 131-I therapy is the only nonsurgical alternative, but its effectiveness diminishes with goiter size and depends on iodine sufficiency. This study aimed to assess the efficacy and safety of 0.1 mg rhTSH as an adjuvant to a fixed dose of 131-I therapy in patients with a recurrence of large multinodular goiter, several years after the initial thyroidectomy. (2) Methods: 14 patients (13 females and 1 male), aged 59.14 ± 15.44 (range, 35–78 years) received 11mciu of 131-I, 24 h after the administration of 0.1 mg rhTSH. The primary endpoint was the change in thyroid volume (by ultrasound measurements) as well as in the diameter of the predominant nodule during a follow-up period of 10 years. Secondary endpoints were the alterations in thyroid function and potential adverse effects. (3) Results: A significant decrease in the volume of initial thyroid remnants (32.16 ± 16.66 mL) was observed from the first reevaluation (at 4 months, 23.12 ± 11.59 mL) as well as at the end of the follow-up period (10 years, 12.62 ± 8.76 mL), p < 0.01. A significant reduction in the dominant nodule was also observed (from 31.71 ± 10.46 mm in the beginning to 26.67 ± 11.05 mm). (4) Conclusions: Further investigation is needed since this approach could be attractive in terms of minimizing the potential risks of reoperation in these patients. [ABSTRACT FROM AUTHOR]

Background: Total thyroidectomy for hyperthyroidism is typically followed by overnight admission to monitor for complications including thyrotoxicosis. Outpatient thyroid surgery is increasingly common, but its safety in patients with hyperthyroidism has not been well studied. Methods: This retrospective study reviewed 183 patients with hyperthyroidism who underwent total thyroidectomy from 2015 to 2022 at one urban, academic center. The main outcomes were rates of thyroid storm, surgical complications, and 30‐day ED visits and readmissions. Results: Among 183 patients with hyperthyroidism (mean age, 45 ± 14.5 years; 82.5% female), there were no cases of thyroid storm and complications included recurrent laryngeal nerve (RLN) palsy (7.0%), symptomatic hypocalcemia (4.4%), and hematoma (1.6%). ED visits were present in 1.1% and no patients were readmitted. Conclusion: Total thyroidectomy was not associated with thyroid storm and <6% of patients required inpatient management. Ambulatory total thyroidectomy for hyperthyroidism warrants further consideration through identification of predictive factors for postoperative complications. [ABSTRACT FROM AUTHOR]

Multinodular goiter (MNG) is a chronic benign nodular enlargement of the thyroid gland. It presents as an anterior painless neck mass, potentially progressing to exert pressure on the trachea and esophagus and giving rise to compressive symptoms. MNG is a common thyroid gland disorder; however, retropharyngeal goiter is considered rare with few reported cases. We report the cases of two patients who presented to our institution with MNG with retropharyngeal extension: a 62-year-old female patient who presented with a progressive anterior neck mass with dilated neck veins; and a 49-year-old male who presented with a painless anterior neck mass. Both patients successfully underwent total thyroidectomy with an uneventful postoperative recovery. The clinical presentation of MNG with retropharyngeal extension varies with patients; hence, a high index of suspicion is of the utmost significance. While the retropharyngeal extension does not cause compressive symptoms, it should raise the suspicion of a large retrosternal component. [ABSTRACT FROM AUTHOR]

Background: With innovative treatment options such as radiofrequency ablation (RFA) for thyroid nodules, new complications are being identified. It is important to define and delineate complications in order to counsel patients appropriately about treatment options and their associated risks and benefits. Methods: A 46‐year‐old male presented with a left thyroid nodule (6.5 cm). Fine needle aspiration results were benign. He started to develop intermittent dyspnea and underwent one RFA procedure. Approximately 6 days post‐RFA, the neck area was raised and red with blister. The skin overlying the blister underwent eventual dehiscence with fluid spillage. Several months later, MRI imaging showed substernal extension with tracheal deviation. Results: A left thyroid lobectomy was performed with cutaneous excision and successful closure of a fistula. Conclusions: This is the first reported case of a thyroid nodule rupture following RFA which manifested into a thyro‐cutaneous fistula and required surgical intervention. [ABSTRACT FROM AUTHOR]

Background: DICER1, a cancer predisposition syndrome (CPS), seems to escape timely diagnosis in pediatric patients. Case report 1: A 16-year-old female patient was referred to the endocrinology ward due to a large goiter. Her medical history indicated normal sexual maturation, with menarche occurring at 13.5 years. Over the past 2.5 years, she had developed pronounced androgenic symptoms, including a deepened male voice; facial, back, and neckline acne; hirsutism; and menstrual irregularities leading to secondary amenorrhea. A thyroid ultrasound identified a multinodular goiter (MNG) with cystic–solid lesions containing calcifications. An abdominal ultrasound identified a 5.7 × 6.9 cm solid mass in the right adnexal region, displacing the uterus to the left. Histopathological examination confirmed a Sertoli–Leydig cell tumor. The patient was subjected to a total thyroidectomy. Histopathology revealed benign follicular cell-derived neoplasms. Thyroid follicular nodular disease (TFND) was diagnosed bilaterally. DNA analysis using NGS, confirmed via the Sanger method, revealed a pathogenic heterozygotic variant c.2953C>T [p.Gln985*] in exon 18 of the DICER1 gene. Case report 2: A 12-year-old male patient was admitted to the pediatric surgery unit due to a 33 mL goiter. A month prior to his admission, the patient discovered a palpable nodule in his neck, accompanied by hoarseness. An ultrasound revealed MNG. Molecular analysis revealed a pathogenic heterozygotic variant c.2782C>T [p.Gln928*] in exon 17 of the DICER1 gene. Subsequently, a total thyroidectomy was performed, and histopathological examination revealed TFND bilaterally. Conclusions: Recent advances in genetic evaluation and in histological approaches indicate that MNG/TFND, although rare in the pediatric population, when accompanied by characteristic ultrasound and histopathological features, and by additional features such as androgenization, may warrant assessment also of the DICER1 gene within CPS molecular panel screening. [ABSTRACT FROM AUTHOR]

This paper describes an example of radical surgical treatment of a patient with a giant retrosternal goiter complicated by compression of the organs of the neck and mediastinum. Considering all the risks and possible complications, we should take into account the fact that enlarged thyroid (T) body with retrosternal location can cause displacement and stenosis of the trachea and esophagus, and dislocation of large vessels and nerves of the mediastinum. This anatomical specificity is an imminent threat to successful treatment, and it also carries a certain risk of asphyxia and sudden death of the patient. In this clinical case, radical surgical treatment in this patient included sequential mobilization in two pleural cavities, and then the total removal of T through the traditional surgical access. The anesthetic complexity to support the surgical intervention involved both difficult intubation due to tracheal stenosis, and also the required separate ventilation of the lungs to visualize anatomical structures and mobilize a multinodular formation in two pleural cavities. Standard methods of artificial lung ventilation could be ineffective and even dangerous in this case due to the location and size of the tumor. We focused our attention on high-frequency ventilation (HFV), the best method of respiratory support during surgeries for tracheal and bronchial pathologies. The main task of the anesthetic team in this clinical case was to prevent the development of hypercapnia and hypoxia during intubation of the stenotic tracheal segment, and then adequate ventilation of the lungs with reduced area of proper gas exchange due to bilateral surgical pneumothorax. Thus, the full treatment was carried out due to the only safe method of compensating lung ventilation with anesthesia by HFV. The applied HFV method creates an adequate gas exchange in the lungs due to the small ventilation volume and high frequency of respiratory cycles per minute. HFV both prevented the development of threatening complications during intubation of the stenotic tracheal area and ensured an adequate gas exchange during successive thoracoscopic stages of thyroid tumor mobilization.

Abstract Background The surgical management of multinodular goiter is the treatment of choice for the majority of cases. There is controversy between radical resection with the lifelong thyroxine substitution and function-preserving resection with the risk for recurrence, and the complications associated with total thyroidectomy. Objective The aim of the present study was to compare the outcome of total thyroidectomy (TT) in comparison with subtotal thyroidectomy (ST) as regards hypocalcemia, transient nerve injury, and recurrence rate. Patients and methods This study included published English medical articles in the last 20 years, concerning the treatment of multinodular goiter. Results Meta-analysis was for the evaluation of surgical outcomes after surgical management of multinodular goiter including total thyroidectomy versus subtotal thyroidectomy by comparing the TT versus ST in our study including 23 studies included of the total number of patients (4485) who underwent subtotal thyroidectomy versus the total number of patients (7116) who underwent total thyroidectomy; a comparison was done as regards postoperative complications including RLN injury (transient or permanent), rate of recurrence, need for reoperation, and incidence of postoperative hypocalcemia. The incidence of RLN injury is lower in ST compared to TT, and its recurrence is much lower in TT than in ST. Conclusion This meta-analysis showed that the advantages of total thyroidectomy include adequate eradication of the disease, prevention of recurrent goiter, and avoidance of the need for completion surgery in case of occult malignancy, but it is associated with higher morbidity (postoperative thyroidectomy complications: RLN palsy and hypoparathyroidism) and the need for lifelong replacement therapy (L-thyroxin supplementation).

Background: Hypoparathyroidism with hypocalcemia is the most frequent complication after thyroid surgery. Many risk factors have been involved in the development of this complication, with conflicting results. Incidental parathyroidectomy (IP) may be a frequent cause of postoperative hypocalcemia. In this study, we have evaluated the risk factors associated with the IP in a single-center cohort of patients undergoing thyroid surgery. Patients and methods: The incidence and the risk factors for IP were evaluated in 799 patients scheduled for surgical treatment for thyroid disease between January 2018 and December 2023. Parathyroid hormone levels and serum calcium levels, together with the histological specimens, were evaluated in all patients. Results: Post-operative temporary hypocalcemia was present in 239 (29.9%) patients. A total of 144 patients (21.9%) had an incidental parathyroidectomy. Younger patients (p = 0.014). Moreover, thyroid cancer (RR 1.4 (95 CI 1.114–1.882) OR 1.68 (95% CI 1.145–2.484), p < 0.05) and the neck dissection (RR 1.75 (95% CI 1.409–2.198) OR 2.38 (95% CI 1.644–3.460), p < 0.001) were strongly associated with the risk of incidental parathyroidectomy. Conclusions: Younger female patients with thyroid cancer and neck dissection were at the highest risk of incidental parathyroidectomy. A meticulous surgical dissection, together with imaging methods for the detection of the parathyroid glands, may reduce the incidence of this complication.

parapharyngeal space can have a mass of thyroid origin following metastasis from the thyroid or ectopic thyroid tissue. The extension of multinodular goiter into the parapharyngeal space is rare. A 54-year-old female presented with a 5-month history of neck mass and dyspnea. On examination, a large mass was seen on the right side of the neck which was bulging into the right parapharngeal. In the sonography, a large 50 × 57 mm cyst seen at the upper end of the right lobe of the thyroid. Computed tomography (CT) identified a 46 × 56 mm lesion medial to the right carotid sheath with a mass effect on the parapharyngeal space from the posterolateral aspect and appeared to be an exophytic cystic nodule arising from the upper pole of the right thyroidal lobe. The patient underwent total thyroidectomy, and the final pathology of multinodular goiter was reported. The spread of masses of the thyroid origin to the parapharyngeal space should be considered one of the differential diagnoses of these space masses. [ABSTRACT FROM AUTHOR]

Background and Objectives: As the global aging population grows, the incidence of thyroidectomy in elderly patients is increasing. This study aimed to evaluate the surgical outcomes of thyroidectomy in patients aged 80 years and older. Materials and Methods: All patients aged 80 years and older who underwent thyroidectomies at our hospital between January 2015 and December 2022 were reviewed in this retrospective cohort study. Collected data consisted of patients’ clinical characteristics, functional status, compression symptoms, preoperative assessments, perioperative outcomes, postoperative complications (such as bleeding events, recurrent laryngeal nerve injury, hypocalcemia), pathological findings, readmission, and follow-up outcomes. Results: Seventeen patients were included in this study, with female predominance (82.4%). The mean age was 85.6 ± 4.8 years. Fourteen patients (82.4%) exhibited compression-related symptoms as surgical indications. Based on pathological reports, patients were categorized into benign (12/17, 70.6%) and malignancy (5/17, 29.4%) groups. The benign group had a shorter operation time compared with the malignancy group (164.3 ± 32.0 min vs. 231.0 ± 79.1 min, p = 0.048). No major postoperative complications developed. The median postoperative follow-up duration was 28 months (range: 2–91 months). Thirteen patients (76.5%) were alive at the end of the study period. Conclusions: Despite potential age-related risks, thyroidectomy is feasible for carefully selected patients aged 80 years and older. It provides benefits not only in terms of oncological curative treatment but also in improving the quality of life, such as compressive symptoms and wound condition.

The focal point of thyroidectomy surgery has always been to reduce the incidence of inadvertent damage to the recurrent laryngeal nerve(RLN). The intracapsular thyroidectomy is one such technique with minimum chance of injuring the nerve. To compare retrospectively the surgical outcomes between the two methods of thyroidectomy—coventional thyroidectomy Vs intracapsular thyroidectomy. Materials and methods—55 cases of benign thyroid disease for whom thyroidectomy was performed in our hospital between the period of 2019–2022 were compared retrospectively. Out of these 34 cases had undergone intracapsular thyroidectomy and 21 cases underwent routine extracapsular thyroidectomy. The surgical outcomes including operation time, pain, postoperative infection, postoperative hypocalcemia, postoperative recurrent laryngeal nerve paralysis and mean hospital stay were analyzed. The mean operating time were very low in the intracapsular limb as compared to the other group. The pain and the mean hospital stay was also far lesser for the intracapsular limb. Both cohorts had no incidence of hypocalcemia. The incidence of recurrent laryngeal nerve palsy was very low in the intracapsular cohort (only 1 case of temporary unilateral RLN palsy), whereas it was higher in the routine extracapsular cohort (5 cases of permanent palsy). The risk of having vocal cord palsy (left/right) is 1.172 times more with conventional/standard thyroidectomy as compared to intracapsular thyroidectomy. Intracapsular technique is a much more rewarding method to perform thyroidectomy, without the risk of the recurrent laryngeal nerve palsy as compared to routine thyroidectomy. [ABSTRACT FROM AUTHOR]

Thyroid disorders are the most common endocrine disorder affecting the general population. Diseases of the thyroid glands present with either an alteration of hormone secretion or as an enlargement of the thyroid gland. They vary from non-neoplastic to neoplastic lesions. The prevalence and pattern of these disorders depend on the factors like age, sex and geographic patterns. The aim of the study is to determine the histomorphological features of thyroid lesions in thyroidectomy specimens in patients who underwent thyroidectomy in tertiary care hospital. This is a retrospective study, conducted in tertiary care centre attached to government hospital. All thyroidectomy specimens received in the Department of Pathology, from January 2021 to January 2023 were included in the study. The patients who underwent thyroidectomy in view of thyroid swelling, over a period of 2 years, were selected. Data was collected from histopathological examinations done on the thyroidectomy specimens. Different histomorphological patterns were observed on microscopy. The thyroid lesions were classified into Neoplastic and Non-neoplastic based on histomorphological features and the data was segregated according to this and analysed. There was a total of 194 specimens, of which 175 were from female and 19 were from male patients. Maximum number of thyroid lesions were seen in the age group of 30–50 years. Among 194 patients, 52 (26.8%) were found to have neoplastic lesions, of whom, 25 (12.8%) patients had benign and 27(14%) patients had malignant lesion. 141(72.7%) patients had non neoplastic conditions. One patient had lymphoproliferative disorder (0.5%). In Neoplastic lesions, Among Benign lesions, Follicular adenoma was found be present in 25 patients. In malignant lesions, Papillary carcinoma was the most commonly found lesion (25 cases, 12.9%). 141(73%) patients had Non neoplastic conditions. Most commonly occurring Non neoplastic lesions were Nodular goiter (50 cases, 25.8%) followed by Colloid goiter (34cases, 17.5%), Multinodular goiter (33 cases, 17%), Hashimoto's thyroiditis (5 cases, 2.6%). Followed by Chronic lymphocytic thyroiditis (4 cases, 2.1%). The frequency of carcinoma is more common in females amongst the total thyroid lesions. Papillary carcinoma was the most frequent malignancy (12.9%) among the thyroidectomy specimens. Papillary carcinoma was the commonest malignant lesion with female preponderance whereas, nodular goiter and colloid goiter were the commonest non neoplastic lesions with female preponderance. [ABSTRACT FROM AUTHOR]

(1) Background: After thyroid malignancy is ruled out, treatment options for multinodular goiter patients include surgery, levothyroxine suppressive therapy, and 131-I therapy. Surgery effectively reduces goiter size but carries risks of surgical and anesthetic complications. 131-I therapy is the only nonsurgical alternative, but its effectiveness diminishes with goiter size and depends on iodine sufficiency. This study aimed to assess the efficacy and safety of 0.1 mg rhTSH as an adjuvant to a fixed dose of 131-I therapy in patients with a recurrence of large multinodular goiter, several years after the initial thyroidectomy. (2) Methods: 14 patients (13 females and 1 male), aged 59.14 ± 15.44 (range, 35–78 years) received 11mciu of 131-I, 24 h after the administration of 0.1 mg rhTSH. The primary endpoint was the change in thyroid volume (by ultrasound measurements) as well as in the diameter of the predominant nodule during a follow-up period of 10 years. Secondary endpoints were the alterations in thyroid function and potential adverse effects. (3) Results: A significant decrease in the volume of initial thyroid remnants (32.16 ± 16.66 mL) was observed from the first reevaluation (at 4 months, 23.12 ± 11.59 mL) as well as at the end of the follow-up period (10 years, 12.62 ± 8.76 mL), p < 0.01. A significant reduction in the dominant nodule was also observed (from 31.71 ± 10.46 mm in the beginning to 26.67 ± 11.05 mm). (4) Conclusions: Further investigation is needed since this approach could be attractive in terms of minimizing the potential risks of reoperation in these patients.

Background: Thyroid nodules are one of the most common diseases encountered in surgical practice. Predicting malignancy in patients with multinodular goiters (MNGs) becomes difficult due to the presence of multiple nodules. Targeting the nodule which might be malignant is of utmost importance. The task becomes difficult due to the presence of many different ultrasound scoring systems. This study aims to evaluate ultrasound characteristics and thyroid stimulating hormone (TSH) levels in predicting malignancy in patients with benign goiters and follicular neoplasia. Materials and methods: Our study was a prospective observational study that was conducted between April 2021 and September 2022. Patients aged 18 years and above with fine needle aspiration cytology (FNAC) suggestive of MNGs and follicular neoplasia were included in the study. Analysis of the variables was done by using statistical analysis in a social science application. Results: The final analysis was conducted on 106 patients who met the inclusion criteria. Ultrasound of the thyroid detected microcalcifications in 8.5% of patients, hypervascularity in 33%, solid components in 40.6%, and hypoechoic areas in 47.2% of the patients. The study showed that a TSH value of greater than 1.88 mIU/mL and solid components in ultrasonograph (USG) have high sensitivity and specificity in predicting malignancy. Conclusion: This study shows that ultrasound characteristics of microcalcifications, hypervascularity, solid component, and TSH level greater than 1.88 mIU/mL are statistically significant and can be fairly used for predicting malignancy in benign goiter and follicular neoplasia. The presence of these features may warrant a surgical excision to confirm the diagnosis, even if the FNAC is reported as benign. [ABSTRACT FROM AUTHOR]

To present a case of a new pathogenic variant of DICER1. 13-year-old female with non-toxic multinodular goiter and ovarian Sertoli–Leydig cell tumor, in whom a pineal parenchymal tumor of intermediate differentiation was diagnosed. Next-generation sequencing revealed a new germline mutation in the DICER1 gene (exon 16, c2488del [pGlu830Serfs*2] in heterozygosis), establishing the diagnosis of DICER1 syndrome. Mutations in the DICER1 gene cause genetic predisposition to a wide spectrum of benign or malignant tumors from childhood to adulthood. [ABSTRACT FROM AUTHOR]

Background and Objective: Papillary thyroid carcinoma (PTC) can be affected by underlying diseases. There is controversy about whether PTC and Hashimoto's thyroiditis are connected. The present study was conducted to evaluate the effect of Hashimoto's thyroiditis on papillary thyroid carcinoma. Methods: This retrospective study was conducted on 100 cases of total thyroidectomy (TT) referred to pathology centers of public and private hospitals of Kurdistan Region, Iraq, from 2019 to 2021. Data about histopathological findings such as pathology diagnosis, Hashimoto's thyroiditis (HT), toxic goiter, multinodular goiter (MNG), diagnosis based on the physician’s report and FNAC (fine needle aspiration cytology) results were collected and compared. Findings: Out of 100 TT cases examined, 41 cases were diagnosed as HT, 22 cases of PTC were identified, 11 of which were associated with HT background. Out of 100 TT, non-toxic goiter was found in 54 cases and toxic goiter in 5 cases. The most common indication for TT was multinodular goiter, which was found among 10 cases of PTC. There was a significant association between HT and PTC (p=0.036) with Odds ratio of 1.87 (95% CI: 1.19-2.82). FNAC was malignant or suspicious for PTC in 7 cases and histological diagnosis was malignant in 5 cases. Fourteen surgeries were performed depending on the radiological findings of suspicious nodules with the diagnosis of thyroid cancer in 6 cases‎. Conclusion: The results of the study showed a potential relationship between Hashimoto's thyroiditis and papillary thyroid carcinoma.

Introduction: Immune checkpoint inhibitors (ICI) are used to treat cancers including metastatic melanomas and can induce endocrine side effects. The thyroid is frequently affected with classically transient thyrotoxicosis followed by hypothyroidism. The evolution of thyroid nodules and goiters under ICI therapy is poorly described. Case presentation: A 72-year-old male presenting with hyperthyroidism due to a toxic nodule in a multinodular goiter (MNG) started ICI therapy combining ipilimumab and nivolumab to treat metastatic melanoma. After an initial worsening of thyrotoxicosis, treated with carbimazole, he developed profound hypothyroidism, persisting after carbimazole discontinuation, needing a long-term levothyroxine supplementation. Ultrasound control performed 6 months after ICIs treatment initiation revealed diffuse thyroid atrophy with involution of all nodules. 123I-scintigraphy confirmed a destructive mechanism. Discussion: The evolution of MNG and toxic nodules is poorly described in patients treated with ICI since systematic US evaluations are lacking. We describe for the first time a toxic nodule cured by ICI therapy inducing destructive thyroiditis. Conclusion: Pre-existing nodules and MNG, even if toxic, are not a contraindication for ICI treatment provided the patients are carefully monitored.

Abstract Background The debate on whether or not there is a difference in the incidence of thyroid cancer between the patients with Solitary thyroid Nodule (STN) and Multinodular Goiter (MNG) has been constantly present for the last few decades. With newer studies yielding mixed results, it was imperative to systematically compile all available literature on the topic. Methods PubMed/MEDLINE, Cochrane Central, ScienceDirect, GoogleScholar, International Clinical Trials registry, and reference lists of the included articles were systematically searched for article retrieval. No filter was applied in terms of time, study design, language or country of publication. Rigorous screening as per PRISMA guidelines was undertaken by 2 independent reviewers in order to identify the articles that were most relevant to the topic. Results Twenty-two studies spanning from 1992 to 2018 were included in this analysis and encompassed 50,321 patients, 44.2% of which belonged to the STN subgroup and 55.37% to the MNG subgroup. MNG was found to be associated with a significantly lower risk of thyroid cancer (OR = 0.76; 95% CI 0.61–0.96) when compared with STN. Papillary carcinoma was the most frequently occurring carcinoma across both groups, followed by follicular and medullary carcinomas. A subgroup analysis was performed to assess the efficacy of the two most commonly employed diagnostic tools i.e. surgery and fine needle aspiration cytology (FNAC), however it yielded nonsignificant results, indicating a comparable usefulness of the two. Another subgroup analysis run on the basis of the presumed iodine status of the participants also yielded nonsignificant results. Conclusion There is a higher incidence of thyroid cancer among patients of STN, however, given the low quality of existing evidence on the topic, it is crucial to conduct larger studies that can establish association with a greater precision.

Background and Objectives: Vaspin is a novel adipocytokine. Various studies have shown that vaspin is associated with many types of cancer. This study aims to determine the association of vaspin rs2236242 gene polymorphism with vaspin level in women with papillary thyroid cancer (PTC) and Multinodular goiter (MNG). Methods: In this case-control study participants were 134 women. They were divided into three groups; PTC (n=49), MNG (n=30) and control (n=55). Ten milliliter peripheral blood samples were taken from participants, 5 ml was used for DNA extraction and 5 ml for preparation of serum. The vaspin level was measured by Sandwich ELISA kit. The genotype determination of vaspin rs2236242 polymorphism was done using the tetra primer-amplification refractory mutation system/polymerase chain reaction method. Results: There were no significant difference in serum vaspin level among the three groups. There was no significant association between genotypes of vaspin rs2236242 polymorphism and serum vaspin level in any groups. Logistic regression analysis showed that the difference in the frequency of the genotypes of rs2236242 polymorphism in the MNG group was significant compared to the control group. The TA genotype showed a protective effect against PTC and MNG (P

Abstract Background Gene silence via methylation of the CpG islands is cancer's most common epigenetic modification. Given the highly significant role of NIS in thyroid cancer (TC) differentiation, this cross-sectional study aimed to investigate the DNA methylation pattern in seven CpG islands (CpG1-7 including +846, +918, +929, +947, +953, +955, and +963, respectively) of the NIS promoter in patients diagnosed with papillary (PTC), follicular (FTC), and multinodular goiter (MNG). Additionally, a systematic review of the literature was conducted to compare our results with studies concerning methylation of the NIS gene promoter. Methods Thyroid specimens from 64 patients met the eligibility criteria, consisting of 28 PTC, 9 FTC, and 27 benign MNG cases. The mRNA of NIS was tested by qRT-PCR. The bisulfite sequencing PCR (BSP) technique was performed to evaluate the promoter methylation pattern of the NIS gene. Sequencing results were received in chromatograph, FASTA, SEQ, and pdf formats and were analyzed using Chromas. The methylation percentage at each position and for each sample was calculated by mC/(mC+C) formula for all examined CpGs; following that, the methylation percentage was also calculated at each CpG site. Besides, a literature search was conducted without restricting publication dates. Nine studies met the eligibility criteria after removing duplicates, unrelated articles, and reviews. Results NIS mRNA levels decreased in tumoral tissues of PTC (P = 0.04) and FTC (P = 0.03) patients compared to their matched non-tumoral ones. The methylation of NIS promoter was not common in PTC samples, but it was frequent in FTC (P

Management options for benign, autonomously functioning, and malignant thyroid nodules were limited to surgery or targeting by radioactive iodine before the availability of radiofrequency ablation (RFA). Despite being a relatively new technique, RFA may be favored for patients of high surgical risk, and for those who wish to avoid hypothyroidism. Although insurance coverage for the procedure can be a significant barrier, several groups of investigators have shown improved quality of life for RFA compared to surgery, due to the less invasive nature and favorable risk profile. Hyperthyroidism due to transient thyroiditis is a known risk of RFA, secondary to direct trauma and subsequent thyroid hormone release. Here we present a case of an adult with large, symptomatic, multinodular goiter, with no prior history of thyroid autoimmunity, who underwent RFA with successful volume reduction of two nodules, but who developed acute hyperthyroidism due to Graves disease eight weeks after RFA. Larger studies evaluating the risks of RFA should evaluate for incident hyperthyroidism, specifically for Graves disease/thyroid autoimmunity, as this could represent an additional risk of the procedure. [ABSTRACT FROM AUTHOR]

Background: DICER1, a cancer predisposition syndrome (CPS), seems to escape timely diagnosis in pediatric patients. Case report 1: A 16-year-old female patient was referred to the endocrinology ward due to a large goiter. Her medical history indicated normal sexual maturation, with menarche occurring at 13.5 years. Over the past 2.5 years, she had developed pronounced androgenic symptoms, including a deepened male voice; facial, back, and neckline acne; hirsutism; and menstrual irregularities leading to secondary amenorrhea. A thyroid ultrasound identified a multinodular goiter (MNG) with cystic–solid lesions containing calcifications. An abdominal ultrasound identified a 5.7 × 6.9 cm solid mass in the right adnexal region, displacing the uterus to the left. Histopathological examination confirmed a Sertoli–Leydig cell tumor. The patient was subjected to a total thyroidectomy. Histopathology revealed benign follicular cell-derived neoplasms. Thyroid follicular nodular disease (TFND) was diagnosed bilaterally. DNA analysis using NGS, confirmed via the Sanger method, revealed a pathogenic heterozygotic variant c.2953C>T [p.Gln985*] in exon 18 of the DICER1 gene. Case report 2: A 12-year-old male patient was admitted to the pediatric surgery unit due to a 33 mL goiter. A month prior to his admission, the patient discovered a palpable nodule in his neck, accompanied by hoarseness. An ultrasound revealed MNG. Molecular analysis revealed a pathogenic heterozygotic variant c.2782C>T [p.Gln928*] in exon 17 of the DICER1 gene. Subsequently, a total thyroidectomy was performed, and histopathological examination revealed TFND bilaterally. Conclusions: Recent advances in genetic evaluation and in histological approaches indicate that MNG/TFND, although rare in the pediatric population, when accompanied by characteristic ultrasound and histopathological features, and by additional features such as androgenization, may warrant assessment also of the DICER1 gene within CPS molecular panel screening.

Background: Hypoparathyroidism is one of the most common complications after thyroidectomy. This study evaluated the incidence and potential risk factors for postoperative hypoparathyroidism after thyroid surgical procedures in a single high-volume center. Methods: In this retrospective study, in all patients undergoing thyroid surgery from 2018 to 2021, a 6 h postoperative parathyroid hormone level (PTH) was evaluated. Patients were divided into two groups based on 6 h postoperative PTH levels (≤12 and >12 pg/mL). Results: A total of 734 patients were enrolled in this study. Most patients (702, 95.6%) underwent a total thyroidectomy, while 32 patients underwent a lobectomy (4.4%). A total of 230 patients (31.3%) had a postoperative PTH level of <12 pg/mL. Postoperative temporary hypoparathyroidism was more frequently associated with female sex, age < 40 y, neck dissection, the yield of lymph node dissection, and incidental parathyroidectomy. Incidental parathyroidectomy was reported in 122 patients (16.6%) and was correlated with thyroid cancer and neck dissection. Conclusions: Young patients undergoing neck dissection and with incidental parathyroidectomy have the highest risk of postoperative hypoparathyroidism after thyroid surgery. However, incidental parathyroidectomy did not necessarily correlate with postoperative hypocalcemia, suggesting that the pathogenesis of this complication is multifactorial and may include an impaired blood supply to parathyroid glands during thyroid surgery. [ABSTRACT FROM AUTHOR]

Objectives: Thyroglobulin, produced exclusively by thyroid follicular cells, serves as a specific tumor marker for the follow-up of differentiated thyroid cancer (DTC) patients after thyroidectomy. However, its role as a predictor of malignancy in patients with thyroid nodules is controversial. We assessed the potential role of preoperative serum thyroglobulin concentration to predict DTC in patients without a preoperative diagnosis of malignancy who underwent partial or total thyroidectomy. Methods: This retrospective study included patients with a preoperative diagnosis of benign multinodular goiter (MNG) or a thyroid nodule with indeterminate cytology (INC) (Bethesda system categories III/IV) who underwent partial or total thyroidectomy between January 2014 and May 2019. We compared the patients' demographic, clinical, imaging, and biochemical data according to their final diagnosis: DTC or benign thyroid nodular disease. Further statistical analysis included odds ratio calculation and receiver operating characteristic (ROC) curve analysis. Results: Of 131 patients who met inclusion and exclusion criteria, the indication for surgery was benign MNG in 69 patients and a thyroid nodule with INC in 62 patients. A final diagnosis of DTC was reported in 18 of the 69 benign MNG patients (26%) and in 30 of the 62 thyroid nodule with INC patients (48%). The preoperative measurements of nodule diameter and serum thyroid-stimulating hormone and thyroglobulin concentrations did not significantly differ between patients with a final diagnosis of DTC and those with benign histology. Conclusions: Preoperative serum thyroglobulin alone is insufficient to differentiate between malignant and benign thyroid nodular disease. [ABSTRACT FROM AUTHOR]

Thyroid disease and hyperparathyroidism (HPT) are among the most common endocrine disorders. Thyroid hormones play an important role in bone and calcium metabolism. The rate of HPT is greater in patients with thyroid disease than in the general medical population. Simultaneous occurrence of hyperthyroidism and hyperparathyroidism in the same patient is a rare combination. The clinical manifestations of hyperthyroidism may overshadow the more subtle and varied symptoms and signs of primary hyperparathyroidism. It poses difficult diagnostic and therapeutic problems. Both diseases, however, may have a profound influence on calcium metabolism. The resulting disturbances in thyrotoxicosis may simulate hyperparathyroidism. Contrariwise, the diagnosis of an associated parathyroid adenoma may be missed, or unnecessarily delayed because hypercalcemia is known to occur in hyperthyroidism. The coexistence of thyroiditis and thyroid nodules with parathyroid disorders is also known. Graves' disease (GD) and primary hyperparathyroidism (PHPT) are two common endocrine disorders. However the co- occurrence of hyperthyroidism and primary hyperparathyroidism (PHPT) is rare. However, the link between the two disorders remains unclarified. Hypercalcemia in Graves' hyperthyroidism should warrant a thorough investigation for concomitant primary hyperparathyroidism. Concomitant thyroid nodular disease and hyperparathyroidism (PHPT) disease has been also documented. PHPT is also reported in patients with thyroid malignancy. We hereby report a rare case of a patient who presented with coexistence of Hyperparathyroidism and Multinodular Goiter with Hashimotos Thyroiditis and Hyperthyroidism. [ABSTRACT FROM AUTHOR]

Objective: To determine the frequency of post-operative asymptomatic hypocalcaemia in patients with total and subtotal thyroidectomy. Study Design: Cross-sectional study. Setting: Department of Surgery, Sheikh Zayed Hospital, Rahim Yar Khan. Period: 1st July 2021 to 30th April 2022. Material & Methods: One hundred and Sixteen post thyroidectomy male and female patients of age 18-50 years were included in the study using consecutive sampling technique and two groups were formed. Group-A included those patients who underwent total thyroidectomy and in Group-B patients underwent sub-total thyroidectomy. Samples for serum calcium levels were collected in gel tube before and 24 hours after surgery. Post-operative Hypocalcemia was defined by serum total calcium < 8.5 mg/dL 24 hours after surgery. Patients with symptomatic post-operative hypocalcemia following total or subtotal thyroidectomy or hypocalcemia due to any other reason or systemic disease e.g. renal disease and pregnant females were excluded by history and medical record. Data was analyzed using SPSS 20. Results: In Group A the Mean age was 30.94 ±9.6 years, while those in Group B were 31.59± 11.03 years. In Group A 62 (35.63%) and in 30 (17.245%) of Group B patients respectively were identified with asymptomatic hypocalcemia. A statistically significant difference was seen in both groups. 0.00 is the probability value. Conclusion: When compared to sub-total thyroidectomy, the frequency of asymptomatic hypocalcaemia was substantially higher following total thyroidectomy. Asymptomatic hypocalcaemia after complete or partial thyroidectomy might affect both men and women equally. After subtotal or total thyroidectomy, both younger and older age groups had an equal likelihood of developing asymptomatic hypocalcaemia. [ABSTRACT FROM AUTHOR]

Background and Objective: Papillary thyroid carcinoma (PTC) can be affected by underlying diseases. There is controversy about whether PTC and Hashimoto's thyroiditis are connected. The present study was conducted to evaluate the effect of Hashimoto's thyroiditis on papillary thyroid carcinoma. Methods: This retrospective study was conducted on 100 cases of total thyroidectomy (TT) referred to pathology centers of public and private hospitals of Kurdistan Region, Iraq, from 2019 to 2021. Data about histopathological findings such as pathology diagnosis, Hashimoto's thyroiditis (HT), toxic goiter, multinodular goiter (MNG), diagnosis based on the physician's report and FNAC (fine needle aspiration cytology) results were collected and compared. Findings: Out of 100 TT cases examined, 41 cases were diagnosed as HT, 22 cases of PTC were identified, 11 of which were associated with HT background. Out of 100 TT, non-toxic goiter was found in 54 cases and toxic goiter in 5 cases. The most common indication for TT was multinodular goiter, which was found among 10 cases of PTC. There was a significant association between HT and PTC (p=0.036) with Odds ratio of 1.87 (95% CI: 1.19-2.82). FNAC was malignant or suspicious for PTC in 7 cases and histological diagnosis was malignant in 5 cases. Fourteen surgeries were performed depending on the radiological findings of suspicious nodules with the diagnosis of thyroid cancer in 6 cases. Conclusion: The results of the study showed a potential relationship between Hashimoto's thyroiditis and papillary thyroid carcinoma. [ABSTRACT FROM AUTHOR]

Background & Objective: Coexistence of follicular epithelial and bilateral parafollicular cells derivative of carcinomas in Hashimoto’s thyroiditis and multinodular goiter background are a very rare event. Of course, all benign and malignant thyroid lesions are more prevalent in iodine deficient areas. It seems that the context for identifying the pathways influencing thyroid carcinogenesis especially coincidence form has not yet been fully understood and needs further investigation. Here, we present a case with the synchronous occurrence of papillary thyroid carcinoma and medullary thyroid carcinoma in Hashimoto’s thyroiditis and multinodular goiter background.Case presentation: A 54-year-old woman complained of a painless mass in the anterior region of the neck. The physical examination of the patient revealed multiple nodules in her thyroid gland. In ultrasound findings, she had thyroid enlargement associated with multiple isoechoic and hypoechoic nodules in both lobes. Thyroid fine needle aspiration results suggested the diagnosis of medullary thyroid carcinoma in Hashimoto’s thyroiditis and multinodular goiter background. The frozen sections, permanent sampling, and IHC examination showed the coexistence of papillary thyroid carcinoma with bilateral medullary thyroid carcinoma in Hashimoto's disease and multinodular goiter background.Conclusion: Studies debated about the risk factors of these pathologies including the same environmental issues or mutations in genomes and they emphasized surgeons should be aware of these lesions for diagnosis and interventional treatments. Following up the Hashimoto’s thyroiditis and multinodular goiter is required for detecting occult malignancies, and hence the right management and treatment should be performed.

Background: A very large number of carcinoma thyroid gland arise from a pre-existing adenoma or multinodular goiters surgical removal of a thyroid nodule or multiple nodules of thyroid gland is a challenge for surgeons to prevent cancer. Aim of the study :To find out the prevalence of malignancy in nodular thyroid swelling in relation to age, sex, comorbidities dietary habits and environmental factors. Method: Study of 80 cases of nodular thyroid swelling has been done during period from January 2021to August 2022 On in patient admitted to M.K.C.G Medical College and Hospital, Berhampur. Detailed history, clinical examination, relevant investigations, surgical management and histopathological reports were collected and analysed using software package for stastistical analysis (SPSS 20). Results: Out of 80 patients with thyroid swelling, thyroid malignancies constitute 3% occurrence of carcinoma thyroid was maximum in 5th decade of life. Male: Female ratio is 3:1. Malingnancy in long standing solitary thyroid nodule was almost 4.3% and in MNG was 3.6% which was almost close. Most common histopathological type was papillary carcinoma thyroid (56%) followed by follicular carcinoma thyroid (26%) followed by benign swelling . Conclusion: Prevalence of carcinoma thyroid is higher in elderly females with long nodular swelling and comorbidities. [ABSTRACT FROM AUTHOR]

Objective: To determine the frequency of post-operative asymptomatic hypocalcaemia in patients with total and subtotal thyroidectomy. Study Design: Cross-sectional study. Setting: Department of Surgery, Sheikh Zayed Hospital, Rahim Yar Khan. Period: 1st July 2021 to 30th April 2022. Material & Methods: One hundred and Sixteen post thyroidectomy male and female patients of age 18-50 years were included in the study using consecutive sampling technique and two groups were formed. Group-A included those patients who underwent total thyroidectomy and in Group-B patients underwent sub-total thyroidectomy. Samples for serum calcium levels were collected in gel tube before and 24 hours after surgery. Post-operative Hypocalcemia was defined by serum total calcium < 8.5 mg/dL 24 hours after surgery. Patients with symptomatic post-operative hypocalcemia following total or subtotal thyroidectomy or hypocalcemia due to any other reason or systemic disease e.g. renal disease and pregnant females were excluded by history and medical record. Data was analyzed using SPSS 20. Results: In Group A the Mean age was 30.94 ±9.6 years, while those in Group B were 31.59± 11.03 years. In Group A 62 (35.63%) and in 30 (17.245%) of Group B patients respectively were identified with asymptomatic hypocalcemia. A statistically significant difference was seen in both groups. 0.00 is the probability value. Conclusion: When compared to sub-total thyroidectomy, the frequency of asymptomatic hypocalcaemia was substantially higher following total thyroidectomy. Asymptomatic hypocalcaemia after complete or partial thyroidectomy might affect both men and women equally. After subtotal or total thyroidectomy, both younger and older age groups had an equal likelihood of developing asymptomatic hypocalcaemia. [ABSTRACT FROM AUTHOR]

Background: The debate on whether or not there is a difference in the incidence of thyroid cancer between the patients with Solitary thyroid Nodule (STN) and Multinodular Goiter (MNG) has been constantly present for the last few decades. With newer studies yielding mixed results, it was imperative to systematically compile all available literature on the topic. Methods: PubMed/MEDLINE, Cochrane Central, ScienceDirect, GoogleScholar, International Clinical Trials registry, and reference lists of the included articles were systematically searched for article retrieval. No filter was applied in terms of time, study design, language or country of publication. Rigorous screening as per PRISMA guidelines was undertaken by 2 independent reviewers in order to identify the articles that were most relevant to the topic. Results: Twenty-two studies spanning from 1992 to 2018 were included in this analysis and encompassed 50,321 patients, 44.2% of which belonged to the STN subgroup and 55.37% to the MNG subgroup. MNG was found to be associated with a significantly lower risk of thyroid cancer (OR = 0.76; 95% CI 0.61–0.96) when compared with STN. Papillary carcinoma was the most frequently occurring carcinoma across both groups, followed by follicular and medullary carcinomas. A subgroup analysis was performed to assess the efficacy of the two most commonly employed diagnostic tools i.e. surgery and fine needle aspiration cytology (FNAC), however it yielded nonsignificant results, indicating a comparable usefulness of the two. Another subgroup analysis run on the basis of the presumed iodine status of the participants also yielded nonsignificant results. Conclusion: There is a higher incidence of thyroid cancer among patients of STN, however, given the low quality of existing evidence on the topic, it is crucial to conduct larger studies that can establish association with a greater precision. [ABSTRACT FROM AUTHOR]

Background: Gene silence via methylation of the CpG islands is cancer's most common epigenetic modification. Given the highly significant role of NIS in thyroid cancer (TC) differentiation, this cross-sectional study aimed to investigate the DNA methylation pattern in seven CpG islands (CpG1-7 including +846, +918, +929, +947, +953, +955, and +963, respectively) of the NIS promoter in patients diagnosed with papillary (PTC), follicular (FTC), and multinodular goiter (MNG). Additionally, a systematic review of the literature was conducted to compare our results with studies concerning methylation of the NIS gene promoter. Methods: Thyroid specimens from 64 patients met the eligibility criteria, consisting of 28 PTC, 9 FTC, and 27 benign MNG cases. The mRNA of NIS was tested by qRT-PCR. The bisulfite sequencing PCR (BSP) technique was performed to evaluate the promoter methylation pattern of the NIS gene. Sequencing results were received in chromatograph, FASTA, SEQ, and pdf formats and were analyzed using Chromas. The methylation percentage at each position and for each sample was calculated by mC/(mC+C) formula for all examined CpGs; following that, the methylation percentage was also calculated at each CpG site. Besides, a literature search was conducted without restricting publication dates. Nine studies met the eligibility criteria after removing duplicates, unrelated articles, and reviews. Results: NIS mRNA levels decreased in tumoral tissues of PTC (P = 0.04) and FTC (P = 0.03) patients compared to their matched non-tumoral ones. The methylation of NIS promoter was not common in PTC samples, but it was frequent in FTC (P < 0.05). Significant differences were observed in the methylation levels in the 4th(+ 947), 6th(+ 955), and 7th(+ 963) CpGs sites in the forward strand of NIS promoter between FTC and MNG tissues (76.34 ± 3.12 vs 40.43 ± 8.42, P = 0.004, 69.63 ± 3.03 vs 23.29 ± 6.84, P = 0.001 and 50.33 ± 5.65 vs 24 ± 6.89, P = 0.030, respectively). There was no significant correlation between the expression and methylation status of NIS in PTC and FTC tissues. Conclusion: Perturbation in NIS promoter's methylation individually may have a potential utility in differentiating MNG and FTC tissues. The absence of a distinct methylation pattern implies the importance of other epigenetic processes, which may alter the production of NIS mRNA. In addition, according to the reversibility of DNA methylation, it is anticipated that the design of particular targeted demethylation medicines will lead to a novel cancer therapeutic strategy. [ABSTRACT FROM AUTHOR]

Context: Kelch-like ECH-associated protein 1 (KEAP1) is associated with nuclear factor erythroid-2 related factor 2 (NRF2) and promotes NRF2 degradation in normal conditions. Genetic abnormality in KEAP1 is a rare disease and presents with familial multinodular goiter., Objective: This study assessed the clinical and molecular findings concerning nodular formation in the thyroid gland of patients harboring KEAP1 germline mutations., Methods: Next-generation sequencing analysis targeting goiter-associated genes was performed on 39 patients with familial multinodular goiter. The expression of NRF2-targeted genes from surgical thyroid specimens of patients with KEAP1 mutations were analyzed using a whole transcript expression array and immunohistochemistry., Results: We found five probands with pathogenic heterozygous mutations in KEAP1 (p.Q86*, p.L136P, p.V411fs, p.R415C, and p.R483H), which had no meaningful concomitance with mutations of other goiter-associated genes in germline and somatic levels. Their common histopathological features showed multinodular goiters in the entire thyroid gland with few degenerative lesions or complications of malignancy and slow proliferation indicating < 1% at the Ki-67 labeling index. Among 42 NRF2-targeted genes, antioxidant genes were most frequently upregulated (11/12) in the nodule, followed by detoxification genes (6/11). Immunohistochemical analysis showed relatively high expression of glutathione peroxidase 2 and NAD(P)H quinone oxidoreductase 1 (representative NRF2-targeted genes) in the nodules of various patients harboring KEAP1 mutations., Conclusion: KEAP1 germline heterozygous mutations exert excessive NRF2 activity in the thyroid gland and may confer cytoprotective effects even under abundant reactive oxygen species associated with thyroid hormone production, resulting in thyroid hyperplasia with scarce degradation., (© The Author(s) 2024. Published by Oxford University Press on behalf of the Endocrine Society.)

Abstract Background Fine-needle aspiration cytology (FNAC) is a basic diagnostic tool for thyroid nodules. However, 15–30% of nodules are cytologically indeterminate. Midkine (MK), a pleiotropic growth factor, is often upregulated in patients with cancers. This study aimed to evaluate the role of MK and its ratios in fine-needle aspirates (FNA) for predicting thyroid malignancy. Methods This retrospective study included patients with thyroid nodules who underwent preoperative FNA and/or thyroidectomy between April 2017 and September 2017. MK levels in FNA washout were measured by enzyme-linked immunosorbent assay, and thyroglobulin (TG) and free thyroxine (FT4) levels in FNA washout were measured by chemiluminescent immunometric assays. Results A total of 217 patients with 242 nodules were included in this study. The concentrations of TG, FT4, MK/TG, MK/FT4, and FT4/MK were significantly different between papillary thyroid carcinomas and benign thyroid nodules. Both MK/TG and MK/FT4 ratios were positively correlated with maximum tumor diameter, extrathyroidal extension, and T and N stages. The area under the curve for MK/TG was 0.719 with a cutoff value of 55.57 ng/mg, while the area under the curve for MK/FT4 was 0.677 with a cutoff value of 0.11 μg/pmol. FNAC in combination with MK/FT4 had a higher sensitivity (95% vs. 91%) and accuracy (96% vs. 92%) than FNAC alone for cytologically indeterminate specimens, those of unknown significance, or those suspected of malignancy. Conclusions MK/FT4 and MK/TG may have diagnostic utility for evaluation of papillary thyroid carcinomas, particularly for cytologically indeterminate thyroid nodules.

Surgical excision of substernal thyroid goiters (STG) can be challenging while minimizing postoperative morbidity. Postoperative complication rates associated with transcervical and transthoracic approaches (i.e., partial or total sternotomy) for STG compared to multinodular goiters (MNG) limited to the neck (i.e., non-substernal) remains unclear. This study examines postoperative morbidity related to surgical approaches in the removal of STG and MNG. A retrospective review of prospectively collected data of 988 patients with STG and non-substernal MNG from a single institution between 2010 and 2021 was performed. Patients were stratified by STG and conventional non-substernal MNG limited to the neck excised by transcervical and transthoracic approach. Postoperative complications including neck hematoma requiring return to the operating room, permanent recurrent laryngeal nerve injury and hypocalcemia, and transient or temporary recurrent laryngeal nerve injury and hypocalcemia were identified. Demographics including age, sex, and race, among others, were analyzed. Of the 988 cases, there were 887 (90%) MNG and 101 (10%) STG. Of the STG cohort, 11 (11%) required a partial sternotomy and 4 (4%) required a total sternotomy. Permanent complication rates for non-substernal MNG and STG patients were 1.5% and 0.9%, respectively. Only transient or temporary hypocalcemia rates were statistically different between the STG and MNG cohorts (9.9% versus 3.8%, P < 0.001). Regardless of transcervical or transthoracic approach, postoperative complications associated with the surgical removal of STG are low in the hands of experienced, high-volume thyroid surgeons. [ABSTRACT FROM AUTHOR]

Anaplastic thyroid carcinoma (ATC) Is a very rare and extremely aggressive disease with a very poor prognosis. Several risk factors have been hypothesized, but there is no clear-cut literature data on it. We reviewed the literature concerning risk factors for ATC and analyzed the institutional database from 2005 to 2022. In total, 15 papers were suitable for review, while the retrospective data collection search, conducted on our institutional database, provided 13 results. In our experience, in agreement with literature data, ATC seems to be a neoplasm peculiar to old age (in our database, mean age is 72 years), with a higher prevalence in subjects with a low level of education and a long history of multinodular goiter (MNG). The role of cigarette smoking and blood group, hypothesized on some literature data, was more uncertain, although the small sample size evaluated probably had a great influence on these results. The higher incidence of the disease in individuals with a history of MNG could suggest more aggressive choices in the treatment of a benign disease, in contrast to current practice. However, this may be a highly questionable point considering that ATC accounts for no more than 2% of all thyroid neoplasms in surgical departments, even those dedicated to endocrine neck surgery. Further studies are therefore necessary for a step forward in this direction. [ABSTRACT FROM AUTHOR]

Yanglin Ni,1 Xuan Zhou,2 Ling Wu,3 Ping Wu,3 Ying Liu,3 Yinnan Li,3 Li Cai,3 Xueshu Fu,3 Chunhua Zhang3 1Department of Gynaecology, Huai’an Hospital of Traditional Chinese Medicine, Huai’an, Jiangsu Province, People’s Republic of China; 2MyGenostics Inc., Beijing, People’s Republic of China; 3Department of Gynaecology, Huai’an Maternal and Child Health Hospital, Huai’an, Jiangsu Province, People’s Republic of ChinaCorrespondence: Chunhua ZhangDepartment of Gynaecology, Huai’an Maternal and Child Health Hospital, Huai’an, Jiangsu Province, People’s Republic of ChinaTel +8613952326117Email hafyzch@yeah.netIntroduction: DICER1 syndrome is a rare tumor predisposition syndrome caused by germline DICER1 mutation, which is related to a variety of benign and malignant diseases. Our report is the first described case of these three disease phenotypes of DICER1 syndrome. The female patient with a novel germline DICER1 nonsense mutation (c.1088_1089delCTinsAA p.F363X) in exon 8 that was inherited from her mother. In addition to germline DICER1 mutation, two different hotspot somatic DICER1 mutations were detected in her ovarian tissue and goiter tissue. Our report will expand the report of DICER1 mutations in DICER1-syndrome-related diseases and provide case references for further research in the future.Conclusion: When the related disease phenotype appears in childhood, it should be considered whether it is DICER1 syndrome. Genetic testing can help diagnose DICER1 syndrome and develop related surveillance strategies. Awareness of the DICER1 syndrome may result in early recognition of these rare pediatric tumors and appropriate therapeutic management.Keywords: case report, DICER1, Sertoli-Leydig cell tumor, multinodular goiter, cystic nephroma