Effect of parathyroidectomy on patients with tertiary hyperparathyroidism [retrospective study]

The aim of this work was to study the effect of parathyroidectomy on patients with tertiary hyperparathyroidism. A total number of 10 patients with tertiary hyperparathyroidism manifestations underwent parathyroidctomy, where the patients with adenoma of parathyroid gland underwent excision of adenoma or multiple adenoma, and patients with hyperplasia of parathyroid gland underwent total parathyroidectomy and implantation of a part of one parathyroid gland into the sternomastoid muscle. There were significant changes in clinical and labortatory values between pre- and post-operative measures in both types of patients [adenoma and hyperplasia] where there were significant decrease in serum cacium, serum alkaline phosphatase and parathyroid hormone [P.T.H] and great changes in preoperative manifestations. From this study we can concluded that the optimal treatment of tertiay hyperparathyroidism is surgical excision of edenoma or adenomas, or total parathyroidectomy and transplantation of a part of one gland into the sternomastoid muscle in case of hyperplasia of parathyroid gland

Prognostic value of sentinel lymph node and local thyroid lymphocyte infiltration in differentiated thyroid carcinoma

The aim of this work is to investigate the prevalence, significance and prognostic value of lymphocytic infiltration and SLN associated to differentiated thyroid carcinoma. Our study included 50 patients with preoperative diagnosis of differentiated thyroid carcinoma by FNAC and Trucut needle biopsy, there age ranged from 17 to 55 years with mean age [36 year]. They were 35 females and 15 males. Absence of clinically palpable draining cervical lymph node was the main exclusion criterion in selection of our patients.Our patients were subjected to peroperative injection of patent blue dye intra tumoral, detection and resection of SLN and stained lymphatic channels, resection of samples from jugular lymph nodes [non stained] as NSLNs. Then total thyroidectomy was done. In our study, SLNs staining occurred in 37/50 patients with DTC [74%], 28 of which in patients with PTC 28/33 [84.8%], 5 in patients with FTC 5/13 [38.4%] and 4 in patients with follicular variants of PTC 4/4 [100%] mapping failure occurred in 13/50 patients [26%].22 patients revealed the SLN biopsy from which 18 patients show -ve NSLN and 4 patients with +ve NSLNs [false +ve]. 15 patients revealed -ve SLN biopsy from them 10 patients show -ve NSLNs and 5 patients show +ve NSLN [false -ve SLNI. The accuracy of SLN biopsy needs further investigation before it can be recommended in the routine management of the thyroid neoplasia. The onus must fall on the endocrine surgeon to define clearly the direct therapeutic relevance of occult nodal disease if SLN biopsy is to become a standard of care in thyroid cancer