Rika Miyabe

Hashimoto’s Thyroiditis

Goiters were often associated with iodine deficiency in European mountain areas, with some goiters being quite disfiguring. However, some goiters seem not to be related to iodine deficiency. One of the types of goiter that are unrelated to iodine deficiency is the disease described by Hakaru Hashimoto in 1912. Hashimoto described it as a special characteristic of a new type of lymphomatous thyroid tumor in Japan, and this entity was recognized as an autoimmune disease of the thyroid many years later. Hashimoto published his article in a German journal because that was the scientific language of the time, and he thought that writing in German would make the work more widely available around the world. Patients with Hashimoto’s thyroiditis are usually asymptomatic, and some patients develop goiters with or without hypothyroidism. The goiters and hypothyroidism usually respond to treatment with thyroid hormone. The dose of thyroid hormone must be carefully titrated because there may be autonomous thyroid function resulting from thyroid-stimulating antibodies despite the hypothyroid state.

Three-dimensional ultrasonography before minimally invasive focused parathyroidectomy: The importance of coronal images

PurposeTo evaluate the usefulness of three-dimensional (3D) ultrasonography (US) as a noninvasive preoperative localization procedure before performing minimally invasive focused parathyroidectomy in patients with primary hyperparathyroidism (pHPT).MethodsSeventy-six patients with a solitary adenoma detected by US underwent minimally invasive focused parathyroidectomy. The value of 3D US was assessed by dividing patients into a 2D group and a 3D group. Age, the preoperative serum intact parathyroid hormone (PTH) level, operative time, length of skin incision, and weight of the resected specimen were compared between the groups, and multivariate analysis of the operative time was performed.ResultsThere were no significant differences between the 2D group and the 3D group in age, the preoperative intact PTH level, length of skin incision, or weight of the resected specimen, but the mean operative time was significantly longer in the 2D group (P < 0.01). Multivariate analysis revealed that 3D US and the weight of the resected specimen were correlated with the operative time (P < 0.05).ConclusionThe coronal images obtained by 3D US assist in the precise localization of parathyroid masses in patients with pHPT undergoing minimally invasive focused parathyroidectomy for a solitary adenoma.

Cervical approach by lifting the superior sternum for mediastinal parathyroid adenoma.

We report our experience with sternum lifting method in 5 patients with a retrosternal large parathyroid gland around an innominate vein. There were 2 men and 3 women aged 35 to 81 years. All patients showed a retrosternal large parathyroid gland around an innominate vein. Under general anesthesia, the patient is placed in a supine position with the neck extended. About 3 to 4 cm cervical incision is made above the sternal notch. Two hooks are placed at both sternoclavicular junctions. After the sternum is retracted upward, the anterior mediastinum can now be well visualized with the surgeon at the head of the table. When the direct vision is not clear, using the video imaging provides the physician with a clear, magnified view of the area under deep sternum. All patients underwent complete cervical excision using our method without any complications. The average operative time was 61 minutes and blood loss was minimal. Excellent postoperative outcomes were observed. The patients had no pain or other complications. All patients were discharged 4 days after the surgery. We believe that cervical excision using our method is a better alternative in those patients with anterior mediastinal parathyroid glands around an innominate vein.