Sung Tae Seo

Transient and permanent hypocalcemia after total thyroidectomy: Early predictive factors and long-term follow-up results

BACKGROUND Post-thyroidectomy hypocalcemia is among the most common complications of total thyroidectomy. The purpose of this study was to evaluate early predictive factors and long-term changes in intact parathyroid hormone (iPTH) levels in patients with transient and permanent hypocalcemia after total thyroidectomy. PATIENTS AND METHODS A total of 349 consecutive patients who underwent total thyroidectomy with or without neck dissection between 2009 and 2011 were reviewed. PTH, total calcium (Ca), and ionized Ca (iCa) levels were evaluated at 1 hour, and 1, 3, 5, and 7 days, and 1, 3, 6, and 12 months postoperatively. Biochemical profiles at 1 hour after total thyroidectomy in patients with transient and permanent hypocalcemia were compared. Patients with postoperative hypocalcemia were followed for 12 months. RESULTS Lesser preoperative serum levels of Ca and more extensive surgery were significantly associated with postoperative hypocalcemia (P < .05). The absolute level and relative decline (%) in iPTH at 1 hour were the most reliable predictors of postoperative hypocalcemia according to the receiver operating characteristics curve, with a threshold of 10.42 pg/mL and 70%. Sensitivity and specificity of the predictors were 83.4% (95% CI, 76.4-89.1), 100% (95% CI, 84.6-100.0), 84.1 (95% CI, 77.2-89.7), and 95.5% (95% CI, 77.2-99.9), respectively. Parathyroid function recovered in the first month after total thyroidectomy in 78 of 99 patients (79%) with transient hypocalcemia. However, 46 of 61 patients (74%) with a subnormal iPTH level at 3 months after surgery had permanent hypocalcemia. CONCLUSION Mean postoperative PTH level and the mean relative decline in PTH measured 1 hour postoperatively were the most reliable predictors of postoperative or permanent hypocalcemia.

Recurrence in regional lymph nodes after total thyroidectomy and neck dissection in patients with papillary thyroid cancer

BACKGROUND We investigated the risk factors of the regional lymph node (LN) recurrence in papillary thyroid cancer (PTC) patients underwent thyroidectomy and neck dissection according to the clinicopathologic features, preoperative clinical nodal status and the recurrence in previously dissected or undissected compartment of the neck. METHODS A retrospective analysis was performed on 297 patients who underwent total thyroidectomy and LN dissection between 2004 and 2010. Patients with and without regional recurrence were compared by the various clinicopathological factors. Recurrence-free survival rates were estimated by the Kaplan-Meier and Cox regression method. RESULTS With a median follow-up of 53 months, 22 (7.4%) patients developed regional LN recurrence. Initial LN metastasis and tumor size ⩾1 cm were independent predictive factors for regional recurrence. In patients without preoperative clinical LN, Tumor size ⩾1 cm and extrathyroidal extension were significant risk factors for regional recurrence. In cases with preoperative clinical LN, there was no specific significant factor for recurrence. Tumor size ⩾1 cm, capsular invasion, extrathyroidal extension, and lymphovascular invasion were significant risk factors of regional recurrence in previously dissected compartments. Tumor size ⩾1 cm and extrathyroidal extension were significant predictive factors of regional recurrence in previously undissected compartments. CONCLUSIONS Tumor size and LN metastasis were independent predictors of regional LN recurrence in PTC patients after total thyroidectomy and central neck dissection. Patients with tumor size >1 cm or extrathyroidal extension were more likely to have tumor recur both within the previously dissected field as well as the un-dissected compartments.

Sinonasal organized hematoma: Clinical features of seventeen cases and a systematic review.

Organized hematoma (OH) is a rare non‐neoplastic disease. We studied the clinical characteristics of 17 patients with sinonasal OH and those of 75 cases in the English literature.

Dermoid cyst of the parotid gland.

A35-year-old man presented with a five-year history of a slowly enlarging soft tissue mass in the right parotid gland. Physical examination showed a soft, non-tender mass, 4 3 cm in diameter, in the superior portion of the parotid gland. Facial nerve function was normal. Fine-needle aspiration cytology revealed anucleated squamous cells and keratin debris (Fig 1). CT scans showed a cystic mass of the superficial lobe extending to the deep lobe of the right parotid gland (Fig 2). A right parotidectomy was performed and the cystic mass was excised completely. Surgical specimen revealed a cystic mass filled with keratinous material. Pathologic examination revealed a cyst lined by stratified squamous epithelium with underlying sebaceous glands, which was diagnostic of dermoid cyst. Postoperative course was uneventful with normal facial nerve function. The patient was followed-up without recurrence for one year. This report was approved by an institutional review board.

Pediatric aggressive giant cell granuloma of nasal cavity.

Highlights • We learned a significant lesson about diagnosis & treatment through very interesting experience in the aggressive change after the first surgery.• We have to consider complete resection of indefinite GCG as a means of the high priority, despite younger age.• Pediatric aggressive GCG is the first published a pediatric case of GCG occurring in the nasal cavity with intracranial invasion.