ABSTRACT
The optimal surgical approach for differentiated thyroid cancer remains controversial, with debate regarding the comparative risks of upfront total thyroidectomy versus staged completion thyroidectomy following the initial lobectomy. This study aimed to assess the complication rates associated with these two strategies and identify the optimal timing for completion thyroidectomy using a multi-dimensional analysis of four cohorts: an institutional series (n = 148), the National Surgical Quality Improvement Program (NSQIP) database (n = 39,992), the TriNetX repository (n > 30,000), and a pooled literature review (10 studies, n = 6015). Institutional data revealed higher overall complication rates with total thyroidectomy (18.3%) compared to completion thyroidectomy (6.8%), primarily due to increased temporary hypocalcemia (10% vs. 0%, p = 0.004). The NSQIP analysis demonstrated that total thyroidectomy was associated with a 72% increased risk of transient hypocalcemia (p < 0.001) and a 25% increased risk of permanent hypocalcemia (p < 0.001). TriNetX data confirmed these findings and identified obesity and concurrent neck dissection as risk factors for complications. A meta-analysis showed that total thyroidectomy increased the rates of transient (RR = 1.63) and permanent (RR = 1.23) hypocalcemia (p < 0.001). Institutional and TriNetX data suggested that performing completion thyroidectomy between 1 and 6 months after the initial lobectomy minimized permanent complication rates compared to delays beyond 6 months. In conclusion, for differentiated thyroid cancer, total thyroidectomy is associated with higher risks of transient and permanent hypocalcemia compared to staged completion thyroidectomy. However, performing completion thyroidectomy within 1-6 months of the initial lobectomy may mitigate the risk of permanent complications. These findings can inform personalized surgical decision-making for patients with differentiated thyroid cancer.
ABSTRACT
Objective This study investigates the prevalence and risk of thyroid disturbances in pregnant women with pre-existing diabetes mellitus (DM) or gestational diabetes mellitus (GDM) in a tertiary hospital setting in Riyadh, SA. This research's findings may help identify potential risk factors associated with thyroid disturbances during pregnancy and facilitate early diagnosis for at-risk pregnant women. Subjects and methods A retrospective cross-sectional study was conducted at an endocrinology clinic between October 2018 and December 2021 to evaluate the electronic records of pregnant women with DM or GDM who had documented normal thyroid function before pregnancy. Results Three hundred ninety-six files that met the selection criteria were deeply investigated and analyzed. The analysis showed that 378 (95.5%) patients were of Saudi nationality, and the mean age in years ± SD for the selected patients was 34.23 ± 5.468. The prevalence of obesity was 63.7%, with a mean body mass index (BMI) of 32.78 ± 6.78 kg/m2. The patients in this study were categorized into three groups based on their type of DM: 57 were diagnosed with type 1 DM (14.4%), 120 with type 2 DM (30.3%), and 219 with GDM (55.3%). The study identified 43 patients (10.85%) with subclinical hypothyroidism and 74 (18.69%) with hypothyroidism. Among the remaining patients, thyroid function was within the normal range for 264 (66.67%). The study also identified eight patients (2.02%) with subclinical hyperthyroidism and seven (1.77%) with hyperthyroidism. The prevalence of thyroid dysfunction was reported at 33.4%, with most of the dysfunction observed in the GDM group (20.7%). By comparison, the type 1 DM and type 2 DM groups presented a lower prevalence of thyroid dysfunction, accounting for only 4.1% and 8.6%, respectively. Conclusions Hypothyroidism, both clinical and subclinical, is more prevalent among patients with GDM than individuals with type 1 and type 2 DM. Research suggests a greater risk of developing hypothyroidism in patients with an increased BMI and among those older during pregnancy.
ABSTRACT
OBJECTIVES: This study aims to assess COVID-19 vaccine acceptance, uptake, and hesitancy among parents and caregivers of children in Saudi Arabia during the initial rollout of pediatric COVID-19 vaccination. METHODS: An electronic survey was used to collect data from participants who visited a COVID-19 vaccine center. The survey included demographic data, COVID-19 vaccine status among participants and their children, and reasons for vaccine acceptance or rejection. The Vaccine Hesitancy Scale (VHS) tool was also employed to assess vaccine hesitancy and attitudes toward the COVID-19 vaccine and routine childhood vaccination. Multivariate binary regression analysis was used to identify predictors of actual COVID-19 vaccine uptake among children. RESULTS: Of the 873 respondents included in the analysis, 61.5% were parents and 38.5% were other caregivers. Of the participants, 96.9% had received the COVID-19 vaccine. Six hundred and ninety-four participants accepted the vaccine for their children, with the main reasons being an endorsement by the Saudi Ministry of Health (60%) and the importance of going back to school (55%). One hundred and seventy-nine participants would not vaccinate their children, with the most common reasons being fear of adverse effects (49%) and inadequate data about vaccine safety (48%). Factors such as age, COVID-19 vaccination status, self-rated family commitment level, attitudes toward routine children's vaccines, and participants' generalized anxiety disorder (GAD7) score did not significantly correlate with children's COVID-19 vaccination status. Parents were less likely to vaccinate their children compared to other caregivers, and participants with a higher socioeconomic status were more likely to vaccinate their children. CONCLUSION: Vaccine acceptance and uptake were high during the initial pediatric COVID-19 vaccination rollout in Saudi Arabia. Still, the ongoing endorsement of the Ministry of Health and healthcare authorities should continue to advocate for better vaccine uptake in children.
