Current Issue : April-June Volume : 2025 Issue Number : 2 Articles : 5 Articles
Objective: To determine the cancer risk in thyroid nodules using ACR TI-RADS. Methods: A retrospective analysis of all thyroid biopsies was performed over a 3-year period (2021 to 2023). Variables including gender, age, history of thyroid cancer or neck irradiation, nodule size and location, TR level, and sonographic features such as punctate echogenic foci (PEF), a very hypoechoic appearance, taller-than-wide shape, and suspected extrathyroidal extension were analyzed. Results: A total of 1140 nodules were assessed in 993 patients, including 740 females (74.5%) and 253 males (25.5%). The mean patient age was 57.1 ± 15.4 years. Variables significantly associated with nodule malignancy included (1) younger age, (2) a prior history of thyroid cancer or neck irradiation, (3) a higher TR level, (4) a taller-than-wide shape in nodules <1 cm, (5) PEF, (6) a very hypoechoic appearance, and (5) suspected extrathyroidal extension (p < 0.05). Gender, nodule location and size were not associated with a higher cancer risk (p > 0.05). Malignancy was found in 40.7% of TR5, 4.8% of TR4, 0.3% of TR3, and 0% of TR1 and 2 nodules. The odds ratios (ORs) for cancer were as follows: TR4 or 5, OR = 19; PEF, OR = 11; a very hypoechoic appearance, OR = 13.3; and suspected extrathyroidal extension, OR = 27.2 (p < 0.01). Conclusions: Higher TR levels, PEF, a very hypoechoic appearance, and suspected extrathyroidal extension are important features for predicting cancer risk. These findings affirm the effectiveness of ACR TI-RADS in nodule risk stratification....
Background: Hoarseness due to recurrent laryngeal nerve (RLN) injury is the most feared complication of thyroid surgery. Scars and anatomical changes caused by previous surgeries make finding the RLN during redo thyroid surgeries difficult. We aimed to analyze the results of the inferior-to-superior dissection technique that we applied to find the RLN in redo surgeries. Methods: We analyzed the results of 40 consecutive redo thyroidectomy cases in which the inferior-to-superior nerve dissection technique was used to identify the RLN. We compared this cohort with primary thyroidectomies using a lateral-to-medial approach to determine the reliability of this technique. Results: Most patients were women (80%), and the mean age was 48.1 years. The ASA score was mostly 2. In total, 25% of the patients had a preoperative diagnosis of malignancy. A total of 8 of the patients underwent unilateral surgery and 32 underwent bilateral surgeries. Two patients had previous recurrent laryngeal nerve paralysis (RLNP), but one of them underwent contralateral surgery. Permanent recurrent laryngeal nerve paralysis developed in only 2 of 71 RLNs at risk (2.8%). Complications classified as Clavien-Dindo 3 and above were observed in 12.5% of our patients during the early postoperative period. The transient hypocalcemia rate was 7.5%, and the permanent hypocalcemia rate was 5%. A 2.8% unilateral RLPN rate was detected, but bilateral RLNP was not observed. All of the complications were not observed to be statistically different among those who underwent primary thyroidectomy. Conclusions: The inferior-to-superior nerve dissection approach is a beneficial technique in redo thyroidectomy for preserving RLNP. Surgeons should keep this technique in mind to prevent hoarseness....
Thyroidectomy has been post-operatively managed by hormone replacement therapy in order to satisfy the reference ranges of thyroid stimulating hormone (TSH) and thyroxine (T4) levels. While medication and standardized reference ranges have proven to be effective, many patients continue to report unintentional weight gain despite adequate amounts of treatment and levels of TSH and T4. Physicians, over the years, have become complacent to these “normal” ranges, and have ignored the metabolic consequences that are affecting thyroidectomy patients. This paper aims to redefine the approach to post-thyroidectomy clinical care by challenging the current standardized hormonal range values, exploring the gaps in thyroid hormone conversion, investigating the metabolic pathways of T3, considering the influence of inflammatory markers, and proposing the future for patient-centered management....
Background: Frozen shoulder (FS), or adhesive capsulitis, is a disabling condition characterized by pain and restricted shoulder mobility. Aims: This study investigates the relationship between metabolic biomarkers—liver enzymes and thyroid function—and pain and shoulder functionality in patients with FS. Methods: A total of 32 patients (22 women and 10 men) were included in this cross-sectional study. Participants underwent clinical evaluations and blood tests to assess metabolic biomarkers, including aspartate aminotransferase (AST), alanine aminotransferase (ALT), gamma-glutamyl transferase (GGT), and thyroid-stimulating hormone (TSH). Pain and functionality were measured using the Shoulder Pain and Disability Index (SPADI). Correlation and multiple regression analyses were performed to assess the associations between biomarkers, pain, and functionality. Results: Significant negative correlations were found between AST (r = −0.528, p = 0.029), ALT (r = −0.533, p = 0.027), GGT (r = −0.602, p = 0.011), and TSH (r = −0.556, p = 0.017) with total pain scores. A significant negative correlation was also observed between TSH and SPADI scores (r = −0.511, p = 0.039). Multiple regression analysis showed that GGT (β = −0.335, p = 0.008) and TSH (β = −0.298, p = 0.014) were the strongest predictors of pain. These findings suggest that metabolic biomarkers, particularly liver enzymes and thyroid function, play a significant role in the pathophysiology of frozen shoulder. The results highlight the importance of assessing these biomarkers for better understanding and managing pain and functionality in patients with FS. Conclusions: Further research is needed to explore the underlying mechanisms and potential therapeutic targets....
Thyroid function plays a seminal role in the growth and development of children, and alterations in signaling pathways which interfere with the biosynthesis, transport, and metabolism of thyroid hormones might impact on the skin of such patients: this review explores the relationship between different thyroid disorders and dermatological manifestations with a particular focus on the pediatric population. Common cutaneous conditions associated with thyroid dysfunction may include chronic urticaria, vitiligo, and alopecia, which can be early harbingers of an underlying endocrine disruption. This review also highlights the growing cognizance of a “thyroid–skin axis”, with thyroid hormones influencing many physiologic processes within the skin such as keratinocyte proliferation, hair growth, and epidermal differentiation. A precocious recognition of abnormal dermatological signs can be crucial in pediatric patients for a timely diagnosis before any development of complications and for personalized treatments of an underlying thyroid disorder, which can even be symptomless at an initial phase. Despite the lack of standardized guidelines for managing dermatologic manifestations occurring in thyroid diseases, a regular screening to identify endocrine dysfunction is recommended in those children who present chronic urticaria, vitiligo, or alopecia, though further research is needed to decipher mechanisms involved in the thyroid-skin partnership and develop more targeted management approaches....
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