Preoperative ultrasonography parathyroid gland mapping can improve identification of normal parathyroid gland during thyroidectomy: A propensity score-matched case-control study.

BACKGROUND: Accurate intraoperative identification of normal parathyroid glands (PTGs) is vital to avoid hypocalcemia post total thyroidectomy. Although ultrasonography (US) has been shown to identify normal PTGs, the significance of preoperative US PTG mapping in this context is not well studied. This study evaluated the impact of preoperative US PTG mapping on intraoperative identification of normal PTGs during total thyroidectomy. METHODS: The study involved 161 consecutive patients who underwent total thyroidectomy between January 2020 and June 2022. These included patients without preoperative US PTG mapping (group 1, n = 91) and those with the mapping (group 2, n = 70). Propensity score matching yielded 61 matched patients from each group. We developed a preoperative US PTG mapping technique combining US identification of normal PTGs with their localization on thyroid CT images. The intraoperative detectability of normal PTGs during thyroid surgery and detectability of normal PTGs by the preoperative US mapping were assessed by the number of PTGs identified per patient and by location. RESULTS: In the matched cohort, group 2 demonstrated a higher median number of identified PTGs (3 vs. 2, p = 0.011), a greater proportion of patients with three or more identified PTGs (65.5% vs. 44.3%, p = 0.018), and a higher ratio of identified to expected PTGs (70.5% vs. 60.2%, p = 0.011) than group 1. In group 2, the median number of normal PTGs identified preoperatively was 3, with at least one identified in 95.7% of patients, two or more in 84.3%, three or more in 52.9%, and four or five in 24.3%. CONCLUSIONS: Preoperative US PTG mapping identified two or more normal PTGs in the majority of adult patients undergoing total thyroidectomy. Those with preoperative mapping showed a higher number of intraoperatively identified normal PTGs, including inferior PTGs, compared to those without. This technique appears to enhance the intraoperative identification of normal PTGs, thereby potentially improving surgical outcomes in total thyroidectomy.

Ultrasound malignancy risk stratification of thyroid nodules based on the degree of hypoechogenicity and echotexture.

OBJECTIVES: The ultrasound (US) lexicon of nodule echogenicity and echotexture is one of the major differences among various risk stratification systems of thyroid nodules. This study aimed to stratify the US malignancy risk of thyroid nodules based on their degree of hypoechogenicity and echotexture. MATERIAL AND METHODS: This retrospective study included a total of 2255 consecutive thyroid nodules (≥ 1 cm) with final diagnoses (malignancy rate, 13%) from 2011 to 2016. Thyroid nodules were stratified according to the US degree of hypoechogenicity (mild, moderate, or marked hypoechogenicity) and echotexture (homogeneous vs. heterogeneous). The calculated malignancy risk was compared between each category. RESULTS: There was no significant difference of malignancy risk between the homogeneous markedly hypoechoic and moderately hypoechoic nodules (p ≥ .18). However, the malignancy risks of markedly and moderately hypoechoic nodules were significantly higher than those of mildly hypoechoic nodules (p < .001). Heterogeneous predominantly hypoechoic thyroid nodules showed a significantly higher malignancy risk than predominantly iso- or hyperechoic thyroid nodules (p < .001). There were no significant differences of malignancy risk between heterogeneous predominantly hypoechoic and homogeneous hypoechoic nodules according to the degree of hypoechogenicity (p ≥ .12) and between heterogeneous predominantly iso- or hyperechoic nodules and homogeneous iso- or hyperechoic thyroid nodules (p = .36). CONCLUSIONS: The malignancy risk of nodule hypoechogenicity is stratified as mild vs. moderate to marked hypoechogenicity, and the malignancy risk of nodules with heterogeneous echotexture is stratified by the predominant echogenicity of the nodules. KEY POINTS: • Thyroid nodule echogenicity is categorized as marked, moderate, or mild hypoechogenicity and iso- or hyperechogenicity with the reference standard of adjacent thyroid tissue and anterior neck muscles. • The malignancy risk of thyroid nodule echogenicity is stratified as iso- or hyperechoic vs. mild vs. moderate or marked hypoechogenicity. • The malignancy risk of nodules with heterogeneous echotexture is stratified by the predominant echogenicity.

Total cholesterol, high density lipoprotein and triglyceride for cardiovascular disease in elderly patients treated with metformin.

Metformin reduces total cholesterol level, low density lipoprotein cholesterol (LDL-C) level, blood glucose level and increases high density lipoprotein cholesterol (HDL-C) level associated with cardiovascular disease. We evaluated effect of metformin on lipid profile in Korean patients with type 2 diabetes aged 64 years or older. We retrospectively examined 307 outpatients treated with metformin in a hospital setting with a follow-up period of 4.7 years. Metformin was not associated with the improvement in total cholesterol level (adjusted mean difference; 30.6 mg/dl, 95% CI: 24.9 to 36.4) and HDL-C level (adjusted mean difference; 2.6 mg/dl, 95% CI: 0.09 to 4.64) but may be associated with improvement in triglyceride level (adjusted mean difference; 41.5 mg/dl, 95% CI: 24.7 to 58.3). In comparison to the placebo groups (Kooy et al., 2009), there was a 1.5-fold decrease in triglyceride level and a 2-fold decrease in HDL-C level in our study. The frequency of Scr level that increased above the defined level [Scr ≥ 1.5 mg/dl for male, ≥1.4 mg/dl for female] was 6.7% [mean difference of elevated Scr: -0.9 mg/dl, 95% CI: -0.41 to -1.44, p < 0.002]. To confirm the efficacy of metformin use on triglyceride level and HDL-C level associated with the risk of cardiovascular disease in patient with diabetes, further placebo-controlled investigations are required.