Pelvic pain and papillary thyroid carcinoma: case report.

Usually differentiated thyroid cancer has a good prognosis and only rarely shows distant metastasis at diagnosis above all the papillary carcinoma. We present the case of a female patient of 66 years old affected by a papillary thyroid carcinoma with a bone metastasis as initial presenting symptom; she was hospitalized for pelvic pain and motor weakness and treated for severe osteoporosis. The patient was submitted to pelvis X-Ray that showed an area of bone loss and cortical irregularities of the right acetabulum, which was compatible with secondary neoplastic lesion but no primary tumor was found. The bone biopsy showed "papillary thyroid carcinoma, follicular variant", so the patient was candidated to a total thyroidectomy.

Thyroidectomy for differentiated carcinoma in older patients on a short stay basis.

BACKGROUND: Total thyroidectomy is the treatment of choice for thyroid cancer and for selected benign thyroid conditions. The aging of the general population and the improvements in surgical technique induced an extension of the surgical indications to major thyroid surgery to older patients also on a short stay basis. METHODS: From January 2004 to December 2006, 152 patients affected by thyroid carcinoma underwent total thyroidectomy on a short stay basis. We divided our series in 2 groups of patients according to the age (> or < of 65 yrs) and considered the outcome analysing several factors including: ASA score, mean operative time, mean hospital stay, tumour size, and post-operative complications. RESULTS: The groups consisted of: 115 pts with a mean age of 46.81 +/- 11.63 years and 37 pts with a mean age of 74.53 +/- 3.71 years for the younger and older group respectively. The differences in ASA score and hospital stay were statistically significant between the groups (P < 0.007 and P < 0.004); neither postoperative haemorrage nor permanent hypocalcemia was observed. One permanent paralysis of the recurrent laryngeal nerve was noted at 12 months follow up; transient hypocalcemia, which resolved in all cases within 30 days from surgery, was reported in 23 and in 7 patients in the younger and older group respectively. CONCLUSIONS: Although a longer length of stay was noted in the older group and possibly related to a higher ASA score and a worse preoperative airways condition, total thyroidectomy for differentiated thyroid carcinoma may be safely carried out in older patients on a short stay basis if performed by an expert staff and in the setting of a multidisciplinary and exhaustive preoperative assessment.

Association between primary hyperparathyroidism and thyroid disease. Role of preoperative PTH.

BACKGROUND: The association between patients with surgically treatable thyroid disease and patients affected by PHPT is not just accidental. MATERIALS: We report 591 patients who underwent total thyroidectomy in our center. Data, collected during the preoperative period according to our protocol for candidates to total thyroidectomy, included: type of thyroid disease, sex, age, type of surgical procedure, preoperative PTH and plasmatic calcium level. Calcium plasmatic level has been monitored at 24 hours after surgery on day 6 and monthly for 6 months. RESULTS: On 591 cases, PTH above the normal range were present in 19.1% (113 patients), all asymptomatic for PHPT 30 were males (26.6%) and 83 females (73.4%), with a mean age of 62.97 +/- 12.51 years and 57.38 +/- 15.09 years ( p = 0.19). The mean preoperative PTH and calcium plasmatic level were 104.4 +/- 21.96 pg/ml and 119.7 +/- 37.93 pg/ml (p = 0.39) and 9.21 +/- 0.59 mg/dL e 9.37 +/- 0.87 mg/dl (p = 0.45) respectively. Intraoperative exploration proved a pathological parathyroid gland in 12 on 113 cases. In 9 of the 12 patients with parathyroid adenoma, hypocalcaemia developed. It resolved in 7 days for 4 patients and within 30 days for the others. No hypocalcaemia has been recorded at a 6 months follow up for the 97 considered (4 were lost at follow up). CONCLUSION: Preoperative PTH measurement for all patients undergoing total thyroidectomy may offer a concrete tool to screen and identify the above-described category of patients, with no additional cost for further radiological investigations, because this class of patients will be submitted to bilateral cervical exploration associated with a total thyroidectomy.

[Hypocalcemia after thyroidectomy: analysis on 804 treated patients]. / L'ipocalcemia post-tiroidectomia Analisi prospettica su 803 pazienti operati.

BACKGROUND: Hypocalcemia is a possible sequela of thyroidectomy; the causes are not fully understood. METHODS: We analyzed 804 patients (594 total thyroidectomy, 209 emithyroidectomy) treated in our Institute from January 1995 to December 2000. Serum calcium, ionized calcium, parathyroid hormone (PTH), fosforemia were screened pre- and postoperatively. RESULTS: Hypocalcemia, defined by a serum calcium less than 7.5 mg/dL, occurred in 126 patients (21.2%). In 90.6% of these patients the serum calcium was normal at seven days after thyroidectomy. In two patients we have registered at 180 days after thyroidectomy a permanent hypoparathyroidism. CONCLUSIONS: Several factors are important in the incidence of postthyroidectomy hypocalcemia but the inadvertent excision of parathyroid gland, ischemia and injury are the major causes of lowering of serum calcium concentration.

[Post-thyroidectomy hypocalcemia: clinical and laboratory findings]. / Ipocalcemia post-tiroidectomia: modificazioni cliniche e di laboratorio.

Hypocalcaemia is a possible sequela of thyroidectomy, the causes of which are not fully understood. Today, correct surgical technique is the most important factor in decreasing the incidence of hypocalcaemia. We analysed 1223 patients (930 total thyroidectomies, 293 hemi-thyroidectomies) treated in our institute from January 1995 to July 2003. Serum calcium, ionized calcium, parathyroid hormone and phosphoraemia were screened pre- and postoperatively. Hypocalcaemia, as defined by a serum calcium concentration below 8.5 mg/dL, occurred in 241 patients (25.1%). In 90.9% of these patients, serum calcium was normal 7 days after thyroidectomy. In three patients we registered permanent hypoparathyroidism 180 days after thyroidectomy. We found a statistically significant difference in the incidence of hypocalcaemia between patients treated for benign disease and those treated for malignant disease with a greater incidence in the latter group (P < 0.05). Several factors are important in determining the incidence of post-thyroidectomy hypocalcaemia but the inadvertent excision of the parathyroid gland, ischaemia and injury are the main causes of the lowering of serum calcium concentrations.