Helmi Khadra

Safety of same-day thyroidectomy: Meta-analysis and systematic review

BACKGROUND Performance of thyroid surgery as a same day surgery procedure has been a controversial topic. This study aimed to compare the safety and efficacy of outpatient thyroid surgery with inpatient thyroid surgery by meta-analysis of current literature. METHODS Articles were identified from the following keyword searches: outpatient thyroidectomy/thyroid surgery, same day thyroidectomy/thyroid surgery. Outcomes included perioperative complications including recurrent laryngeal nerve (RLN) injury, hypocalcemia, and readmissions. Data were extracted following review of appropriate studies by authors and random effects models were used. RESULTS 34 potentially relevant publications were identified and 14 studies fulfilled the predetermined inclusion criteria, totaling 10,478 patients, 4,565 of whom were discharged the same day following thyroid surgery. There was no difference in malignancy rate between the two groups (95% CI, 0.84-2.31; P=0.196). Inpatient group were 2.23 times (95% CI, 1.36-3.36; P=0.001) more likely to develop transient RLN injury and 2.32 times (95% CI, 1.06-5.06; P=0.034) more likely to have documented transient hypocalcemia compared to outpatients. Inpatient groups were 2.10 times (95% CI, 1.33-3.33; P=0.002) more likely to have documented other complications. The two groups also had similar readmission rates (95% CI, 0.71-1.41; P=1.000). CONCLUSIONS Our meta-analysis suggests that discharging selective patients the same day after a thyroid surgery is as safe, feasible, and efficacious as admitting them for observation. Admitting patients after thyroid surgery is associated with higher reported risk of complications.

Different surgical approaches in parathyroid adenoma resections

Three patients were referred to our clinic for the management of a persistent symptomatic primary hyperparathyroidism. Pre-operative imageological localization revealed evidence of an adenoma. Here we are presenting three videos demonstrating the different surgical approaches of parathyroid adenoma resection, with the use of an intraoperative gamma probe and nerve monitoring.

Risk and survival of patients with medullary thyroid cancer: National perspective

BACKGROUND Medullary thyroid carcinoma (MTC) is a neuroendocrine tumor account for 1-2% of thyroid cancer. In this study, we aim to examine the characteristics and survival of patients with MTC. METHODS A retrospective cohort study utilizing the National Cancer Data Base, 2004-2014. The study population included adults with either MTC (cases) or with differentiated thyroid cancer (DTC) (controls). RESULTS A total of 2,776 MTC and 171,631 DTC patients were included. The median follow-up time for MTC was 55.5 months (interquartile range: 31.2-84.6 months). As compared to DTC, patients with MTC were more likely to be ≥ 45-year old, male, and Black (p < 0.001). Neck dissection improved survival in patients with stage III [HR: 0.26, 95%CI: (0.10, 0.64), p = 0.004]. In patients with stages I and II, neck dissections did not add significant survival benefit to thyroidectomy [stage I, HR: 1.00, 95%CI: (0.54, 1.86), p = 0.99],[stage 2, HR: 0.72, 95%CI: (0.40, 1.29), p = 0.27]. However, neck dissections upgraded staging to N1A and N1B in 17.7% and 14.3% of patients with clinically N0 neck, respectively. In stage IV, thyroidectomy with neck dissection had the highest 5-year survival (84.9%), but this was not significantly different from thyroidectomy alone (84.1%); Patients who had thyroidectomy and EBRT with or without neck dissection had a lower survival than thyroidectomy alone (p < 0.01). CONCLUSIONS Neck dissection performed on patients with clinically N0 neck, is important for accurate staging and associate with improved survival in advanced stages. Thyroidectomy and neck dissection in stage IV not only have palliative role but also add survival advantage.

Can Suspicious Ultrasound Features Predict BRAFV600E Status in Papillary Thyroid Cancer

Background: Papillary thyroid carcinoma (PTC) can be predicted from certain suspicious ultrasound (US) features of thyroid nodules. The aim of this study was to examine if these suspicious features can predict the more aggressive PTC associated with B-type Raf kinase (BRAFV600E) mutation. Methods: This was a retrospective review of prospectively collected data on patients with PTC and known BRAFV600E status. All patients underwent preoperative US by the same surgeon who performed all the operations. We divided patients into BRAFV600E positive and negative groups. All ultrasonographic data were collected including nodule size, echogenicity, solid or cystic nature, presence of calcifications, irregular margins, and internal vascularity. Results: Of 141 patients with PTC, BRAFV600E mutation was detected in 48 (34.0%) patients. There was no significant difference in nodule size (2.06 cm ± 1.37 vs. 2.15 cm ±1.55, p = 0.75) between BRAFV600E positive and negative groups. BRAFV600E positivity was associated with higher rates of hypoechogenicity (57.5% vs. 36.6, p = 0.02), calcifications (48.9 vs. 19.4%, p < 0.01), and irregular margins (21.3 vs. 6.5%, p < 0.01). There was no significant difference in the noncystic nature or internal vascularity between BRAFV600E positive and negative groups. The presence of all suspicious US features is associated with a positive predictive value of 100.0%. In the absence of all suspicious features, the negative predictive value was 84.2%. When suspicious lymph nodes (LNs) detected by preoperative US were compared, there was no significant difference between BRAFV600E positive and negative groups (30.6 vs. 21.7%, p = 0.35). Conclusion: The presence of multiple suspicious US findings of thyroid nodules can predict the BRAFV600E mutation status of papillary thyroid cancer nodules. The highest accuracy overall (93.2%) was achieved by combining calcification, irregular margins, and hypoechogenicity with extrathyroidal extension and LN metastasis. Future multi-institutional studies are warranted to help surgeons with risk stratification and operative planning for patients with papillary thyroid cancer.

Does sedation offer better outcomes than local anaesthesia for thyroid FNA in adult patients

To examine the potential benefits of sedation in adults undergoing fine needle aspiration (FNA) of thyroid nodules.

Do anticoagulation medications increase the risk of haematoma in ultrasound-guided fine needle aspiration of thyroid lesions?

A feared complication of thyroid fine needle aspiration (FNA) is bleeding diathesis and haematoma at the biopsy site. Patients are often advised to discontinue antithrombotic/anticoagulant (AT/AC) medications prior to the procedure. The aim of this study was to examine the risk of bleeding in patients on AT/AC medications undergoing cervical ultrasound (US)‐guided FNA.