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1.
J Biomed Opt ; 30(Suppl 1): S13702, 2025 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-39034960

RESUMEN

Significance: Near-infrared autofluorescence (NIRAF) utilizes the natural autofluorescence of parathyroid glands (PGs) to improve their identification during thyroid surgeries, reducing the risk of inadvertent removal and subsequent complications such as hypoparathyroidism. This study evaluates NIRAF's effectiveness in real-world surgical settings, highlighting its potential to enhance surgical outcomes and patient safety. Aim: We evaluate the effectiveness of NIRAF in detecting PGs during thyroidectomy and central neck dissection and investigate autofluorescence characteristics in both fresh and paraffin-embedded tissues. Approach: We included 101 patients diagnosed with papillary thyroid cancer who underwent surgeries in 2022 and 2023. We assessed NIRAF's ability to locate PGs, confirmed via parathyroid hormone assays, and involved both junior and senior surgeons. We measured the accuracy, speed, and agreement levels of each method and analyzed autofluorescence persistence and variation over 10 years, alongside the expression of calcium-sensing receptor (CaSR) and vitamin D. Results: NIRAF demonstrated a sensitivity of 89.5% and a negative predictive value of 89.1%. However, its specificity and positive predictive value (PPV) were 61.2% and 62.3%, respectively, which are considered lower. The kappa statistic indicated moderate to substantial agreement (kappa = 0.478; P < 0.001 ). Senior surgeons achieved high specificity (86.2%) and PPV (85.3%), with substantial agreement (kappa = 0.847; P < 0.001 ). In contrast, junior surgeons displayed the lowest kappa statistic among the groups, indicating minimal agreement (kappa = 0.381; P < 0.001 ). Common errors in NIRAF included interference from brown fat and eschar. In addition, paraffin-embedded samples retained stable autofluorescence over 10 years, showing no significant correlation with CaSR and vitamin D levels. Conclusions: NIRAF is useful for PG identification in thyroid and neck surgeries, enhancing efficiency and reducing inadvertent PG removals. The stability of autofluorescence in paraffin samples suggests its long-term viability, with false positives providing insights for further improvements in NIRAF technology.


Asunto(s)
Imagen Óptica , Glándulas Paratiroides , Espectroscopía Infrarroja Corta , Tiroidectomía , Humanos , Glándulas Paratiroides/cirugía , Glándulas Paratiroides/metabolismo , Masculino , Femenino , Persona de Mediana Edad , Imagen Óptica/métodos , Adulto , Espectroscopía Infrarroja Corta/métodos , Adhesión en Parafina/métodos , Anciano , Cáncer Papilar Tiroideo/cirugía , Cáncer Papilar Tiroideo/patología , Cáncer Papilar Tiroideo/metabolismo , Receptores Sensibles al Calcio/metabolismo , Receptores Sensibles al Calcio/análisis
2.
Front Endocrinol (Lausanne) ; 15: 1417449, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38952390

RESUMEN

Contrast-enhanced ultrasonography (CEUS) has been established as a diagnostic tool for assessing microvascularization, essential for understanding angiogenesis in neoplastic development. AIM: This study assesses the effectiveness of CEUS as a supplementary tool to TIRADS in enhancing the ultrasound-based diagnosis of thyroid cancer. METHODS AND MATERIALS: Over one year, 157 nodules in 133 patients, with predominantly solid thyroid nodules, were examined using ultrasound and CEUS and underwent thyroidectomy, allowing for a comparison of ultrasound findings with pathological reports. RESULTS: Thyroid cancer was identified in 31.21% (49/157) of cases. Significant CEUS high-risk features included inhomogeneous enhancement, enhancement defects, and complete hypoenhancement (AUC 0.818, 0.767, 0.864 respectively). Nodules exhibiting any of these features were classified as high-risk in CEUS. The diagnostic performance of TIRADS improved when combined with CEUS, with AUC increasing from 0.707 to 0.840 and improved sensitivity. CONCLUSION: The integration of CEUS with TIRADS significantly enhances the diagnostic accuracy and specificity in identifying thyroid cancer. This combination proves to be a more effective method for risk stratification and diagnosis, highlighting the value of CEUS as an adjunctive tool in thyroid cancer evaluation.


Asunto(s)
Medios de Contraste , Neoplasias de la Tiroides , Nódulo Tiroideo , Ultrasonografía , Humanos , Nódulo Tiroideo/diagnóstico por imagen , Nódulo Tiroideo/patología , Masculino , Femenino , Ultrasonografía/métodos , Neoplasias de la Tiroides/diagnóstico por imagen , Neoplasias de la Tiroides/patología , Persona de Mediana Edad , Adulto , Anciano , Tiroidectomía
3.
Georgian Med News ; (349): 89-92, 2024 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-38963209

RESUMEN

Thyroxine, a key regulator of metabolic pathways, plays a pivotal role in glucose metabolism and the maintenance of glucose homeostasis. In clinical practice, L-thyroxine replacement therapy is commonly prescribed for patients with hypothyroidism. However, the specific effects of L-thyroxine and thyroidectomy (TX) on glucose levels remain an area of interest and investigation. In this study, 20 rats were divided into two groups (n=10 per group). The TX group (male and female rats) underwent thyroidectomy for 4 weeks. After 4 weeks, male and female thyroidectomized rats received L-thyroxine (10 µg/100 g/day, intraperitoneally) for 4 weeks. The rats' weights were monitored weekly post-surgery. Compared to the initial level, thyroidectomy resulted in weight loss, whereas L-thyroxine replacement therapy normalized the weight loss induced by thyroidectomy. Additionally, thyroidectomy led to impaired glucose levels, which were restored to normal levels with L-thyroxine treatment. These findings underscore the impact of thyroid function on glucose metabolism and highlight the potential therapeutic role of L-thyroxine.


Asunto(s)
Glucemia , Tiroidectomía , Tiroxina , Pérdida de Peso , Tiroidectomía/efectos adversos , Animales , Tiroxina/sangre , Femenino , Masculino , Pérdida de Peso/efectos de los fármacos , Ratas , Glucemia/metabolismo , Glucemia/efectos de los fármacos , Hipotiroidismo/tratamiento farmacológico , Factores Sexuales
4.
Front Endocrinol (Lausanne) ; 15: 1359875, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38966212

RESUMEN

Background: The diffuse sclerosing variant (DSV) is among the aggressive variants of papillary thyroid carcinoma (PTC) and is more prevalent in pediatric patients than in adult patients. Few studies have assessed its characteristics owing to its low incidence. We aimed to evaluate the relationship between recurrence and age in the DSV of PTC. Methods: We retrospectively reviewed patients diagnosed with the DSV or conventional PTC (cPTC) after surgery at a medical center between May 1988 and January 2019. We compared the clinico-pathological characteristics and surgical outcomes of the DSV and cPTC groups and between adult and pediatric patients with DSV. Results: Among the 24,626 patients, 202 had the DSV, and 24,424 were diagnosed with cPTC. The recurrence rate was significantly higher in the DSV group than in the cPTC group. In the DSV group, the recurrence rate was significantly higher in the pediatric patient group than in the adult patient group. Moreover, the association between recurrence and age group showed different patterns between the DSV and cPTC groups with restricted cubic splines (RCS). While both RCS curves showed a U-shaped distribution, the RCS curve tended to be located within the younger age group. Conclusions: This study demonstrated that pediatric patients with DSV are at a greater risk for recurrence compared with adult patients; moreover, the pattern of recurrence risk according to age is different from that of cPTC.


Asunto(s)
Recurrencia Local de Neoplasia , Cáncer Papilar Tiroideo , Neoplasias de la Tiroides , Humanos , Femenino , Masculino , Cáncer Papilar Tiroideo/patología , Cáncer Papilar Tiroideo/cirugía , Recurrencia Local de Neoplasia/patología , Recurrencia Local de Neoplasia/epidemiología , Estudios Retrospectivos , Neoplasias de la Tiroides/patología , Neoplasias de la Tiroides/cirugía , Neoplasias de la Tiroides/epidemiología , Niño , Adulto , Adolescente , Factores de Edad , Persona de Mediana Edad , Adulto Joven , Preescolar , Pronóstico , Tiroidectomía , Anciano , Estudios de Seguimiento , Relevancia Clínica
5.
BMC Cancer ; 24(1): 810, 2024 Jul 07.
Artículo en Inglés | MEDLINE | ID: mdl-38972977

RESUMEN

BACKGROUND AND AIMS: The recurrence of papillary thyroid carcinoma (PTC) is not unusual and associated with risk of death. This study is aimed to construct a nomogram that combines clinicopathological characteristics and ultrasound radiomics signatures to predict the recurrence in PTC. METHODS: A total of 554 patients with PTC who underwent ultrasound imaging before total thyroidectomy were included. Among them, 79 experienced at least one recurrence. Then 388 were divided into the training cohort and 166 into the validation cohort. The radiomics features were extracted from the region of interest (ROI) we manually drew on the tumor image. The feature selection was conducted using Cox regression and least absolute shrinkage and selection operator (LASSO) analysis. And multivariate Cox regression analysis was used to build the combined nomogram using radiomics signatures and significant clinicopathological characteristics. The efficiency of the nomogram was evaluated by receiver operating characteristic (ROC) curves, calibration curves and decision curve analysis (DCA). Kaplan-Meier analysis was used to analyze the recurrence-free survival (RFS) in different radiomics scores (Rad-scores) and risk scores. RESULTS: The combined nomogram demonstrated the best performance and achieved an area under the curve (AUC) of 0.851 (95% CI: 0.788 to 0.913) in comparison to that of the radiomics signature and the clinical model in the training cohort at 3 years. In the validation cohort, the combined nomogram (AUC = 0.885, 95% CI: 0.805 to 0.930) also performed better. The calibration curves and DCA verified the clinical usefulness of combined nomogram. And the Kaplan-Meier analysis showed that in the training cohort, the cumulative RFS in patients with higher Rad-score was significantly lower than that in patients with lower Rad-score (92.0% vs. 71.9%, log rank P < 0.001), and the cumulative RFS in patients with higher risk score was significantly lower than that in patients with lower risk score (97.5% vs. 73.5%, log rank P < 0.001). In the validation cohort, patients with a higher Rad-score and a higher risk score also had a significantly lower RFS. CONCLUSION: We proposed a nomogram combining clinicopathological variables and ultrasound radiomics signatures with excellent performance for recurrence prediction in PTC patients.


Asunto(s)
Aprendizaje Automático , Recurrencia Local de Neoplasia , Nomogramas , Cáncer Papilar Tiroideo , Neoplasias de la Tiroides , Ultrasonografía , Humanos , Cáncer Papilar Tiroideo/diagnóstico por imagen , Cáncer Papilar Tiroideo/patología , Cáncer Papilar Tiroideo/cirugía , Masculino , Femenino , Recurrencia Local de Neoplasia/diagnóstico por imagen , Recurrencia Local de Neoplasia/patología , Persona de Mediana Edad , Neoplasias de la Tiroides/diagnóstico por imagen , Neoplasias de la Tiroides/patología , Neoplasias de la Tiroides/mortalidad , Ultrasonografía/métodos , Adulto , Tiroidectomía , Estudios Retrospectivos , Curva ROC , Anciano , Estimación de Kaplan-Meier
6.
Front Endocrinol (Lausanne) ; 15: 1339191, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38974575

RESUMEN

Background and purpose: Thyroid papillary carcinoma (PTC) had a high possibility of recurrence after surgery, and thyroid stimulating hormone (TSH) suppression and radioactive iodine (131I) were used for postoperative therapy. This study explored the potential mechanism of lymph node metastasis (LNM) and aimed to develop differentiated treatments for PTC. Method: This study explored the risk factors of lymph node metastasis in PTC by analyzing the clinical information of 2073 cases. The Cancer Genome Atlas Thyroid Cancer (TCGA-THCA) and the Gene Expression Omnibus (GEO) databases of gene expression were analyzed to identify the interrelationships between gene expression to phenotype. Results: Analyzing clinical data, we found that male gender, younger age, larger tumor size, and extra-thyroidal extension (ETE) were risk significant risk factors for lymph node metastasis(P<0.05). Conversely, thyroid function parameters such as TSH, FT3, FT4, TSH/FT3, and TSH/FT4 didn't correlate with LNM(P>0.05), and TSH levels were observed to be higher in females(P<0.05). Gene expression analysis revealed that SLC5A5 was down-regulated in males, younger individuals, and those with lymph node metastasis, and a lower level of SLC5A5 was associated with a worse disease-free survival(P<0.05). Additionally, our examination of single-cell RNA sequencing (scRNA-seq) data indicated that SLC5A5 expression was reduced in tumors and lymph node metastasis samples, correlating positively with the expression of TSHR. Conclusion: The impact of TSH on PTC behavior remained unclear, while the capacity for absorbing 131I in dependence on SLC5A5 showed variations across different genders and ages. We conclude that postoperative treatment of PTC should take into account the differences caused by gender and age.


Asunto(s)
Metástasis Linfática , Cáncer Papilar Tiroideo , Neoplasias de la Tiroides , Humanos , Masculino , Femenino , Cáncer Papilar Tiroideo/patología , Cáncer Papilar Tiroideo/genética , Cáncer Papilar Tiroideo/cirugía , Cáncer Papilar Tiroideo/terapia , Neoplasias de la Tiroides/patología , Neoplasias de la Tiroides/cirugía , Neoplasias de la Tiroides/genética , Neoplasias de la Tiroides/terapia , Neoplasias de la Tiroides/metabolismo , Persona de Mediana Edad , Adulto , Radioisótopos de Yodo/uso terapéutico , Factores Sexuales , Factores de Edad , Simportadores/genética , Simportadores/metabolismo , Tiroidectomía , Factores de Riesgo , Tirotropina/sangre , Recurrencia Local de Neoplasia/genética , Recurrencia Local de Neoplasia/patología , Anciano , Pronóstico
7.
J Coll Physicians Surg Pak ; 34(7): 828-831, 2024 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-38978249

RESUMEN

OBJECTIVE: To determine the sensitivity and specificity of intact parathyroid hormone (iPTH) levels in predicting hypocalcaemia after thyroidectomy. STUDY DESIGN: A descriptive cross-sectional study. Place and Duration of the Study: Department of General Surgery, Shifa International Hospital and Shifa Foundation, Islamabad, from May 2021 to 2022. METHODOLOGY: The sample size was calculated to be 205 with consecutive non-probability sampling. Serum iPTH levels and serum calcium levels were measured postoperatively at 6 hours and 24 hours and recorded in a proforma for analysis. After collection, the data were entered and analysed using SPSS version 24.0. RESULTS: Among 205 patients, 157 (76.6%) were females and 48 (23.4%) were males. At 6 hours postoperatively, 121 (59%) patients had normal iPTH levels and 123 (60%) patients had normal serum calcium levels (p = 0.15). At 24-hour, 130 (63.4%) patients had normal iPTH levels and 92 (44.9%) patients had normal serum calcium levels (p = 0.001). Overall, 8 (3.9%) patients developed symptomatic hypocalcaemia (p = <0.001). The sensitivity and specificity of iPTH levels at ≤15 pg/ml were 100% and 70%, respectively, but at 24 pg/ml cut-off level, the specificity increased to 90% with sensitivity of 100%. CONCLUSION: Low serum iPTH levels at 6 hours after surgery can predict hypocalcaemia in patients undergoing thyroidectomy, even if serum calcium levels appear normal at that time. KEY WORDS: Parathyroid hormone, Serum calcium, Hypocalcaemia, Total thyroidectomy, Calcium homeostasis.


Asunto(s)
Calcio , Hipocalcemia , Hormona Paratiroidea , Complicaciones Posoperatorias , Valor Predictivo de las Pruebas , Tiroidectomía , Humanos , Hipocalcemia/etiología , Hipocalcemia/sangre , Hipocalcemia/diagnóstico , Tiroidectomía/efectos adversos , Femenino , Hormona Paratiroidea/sangre , Masculino , Estudios Transversales , Adulto , Persona de Mediana Edad , Calcio/sangre , Periodo Posoperatorio , Complicaciones Posoperatorias/sangre , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/etiología , Sensibilidad y Especificidad , Anciano
8.
Zhonghua Yi Xue Za Zhi ; 104(26): 2409-2416, 2024 Jul 09.
Artículo en Chino | MEDLINE | ID: mdl-38978364

RESUMEN

Objective: To compare the efficacy of gasless robotic surgery through transaxillary approach and open surgery for papillary thyroid carcinoma (PTC). Methods: The data of patient undergoing robotic surgery through transaxillary approach and traditional open surgery for PTC at the Sun Yat-sen Memorial Hospital, Sun Yat-sen University, from November 2016 to June 2023 were retrospectively analyzed. A 1∶1 propensity score matching (PSM) was performed to balance age, sex, extent of surgery, tumor size, capsule invasion, and multifocality. Surgical data, postoperative pathological data, complications, postoperative 2-month visual analog scale (VAS) scores for aesthetics, and follow-up data were compared between the two groups. Results: A total of 728 PTC patients were included. There were 339 patients in the robotic group, among which 262 were female (77.3%) and 77 were male (22.7%), with the age of [M (Q1, Q3)] 39 (32, 46) years and a body mass index (BMI) of 22.8 (20.7, 25.0) kg/m². Meanwhile, 389 patients were in the open group, among which 290 were female (74.6%) and 99 were male (25.4%), with the age of 47 (38, 55) years and a BMI of 23.2 (21.3, 25.5) kg/m2. Further analysis after PSM (there were 264 cases in both groups) showed that in the subtotal thyroidectomy and central neck dissection (LT+CCND) subgroup, the robotic group had longer operative time, higher blood loss, and greater drainage volume compared with the open group [100 (80, 130) min vs 60 (50, 80) min; 10 (10, 20) ml vs 10 (10, 20) ml; 103 (69, 145) ml vs 75 (57, 98) ml; all P<0.001], and the central lymph node metastasis rate was higher in the robotic group [45.6% (57/125) vs 31.8% (47/148), P=0.019]. In the total thyroidectomy and central neck dissection (TT+CCND) subgroup, the robotic group also had longer operative time, higher blood loss, and greater drainage volume compared with the open group [150 (110, 180) min vs 85 (75, 100) min; 20 (10, 20) ml vs 10 (10, 20) ml; 155 (107, 206) ml vs 90 (70, 120) ml; all P<0.001]. The incidence of chest skin numbness at 3 months postoperatively was higher in the robotic group compared with the open group (12.9% vs 0, P<0.001), while there were no statistically significant differences in other postoperative complications (all P>0.05). The VAS score at 2 months postoperatively was higher in the robotic group compared with the open group [9 (9, 9) vs 8 (7, 9), P<0.001]. Three cases of contralateral lobe recurrence occurred in the open group, while there were no case of recurrence in the robotic group. The 5-year overall survival rate was 100.0% in both the robotic and open groups, and there was no statistically significant difference in the 5-year disease-free survival rate between the robotic and open groups (100.0% vs 98.6%, P=0.068). Conclusion: Gasless robotic surgery through transaxillary approach for total thyroidectomy or lobectomy in the treatment of PTC is safe, feasible, and effective, with good cosmetic outcomes and comparable efficacy to traditional surgery.


Asunto(s)
Axila , Procedimientos Quirúrgicos Robotizados , Cáncer Papilar Tiroideo , Neoplasias de la Tiroides , Tiroidectomía , Humanos , Procedimientos Quirúrgicos Robotizados/métodos , Masculino , Femenino , Cáncer Papilar Tiroideo/cirugía , Adulto , Estudios Retrospectivos , Neoplasias de la Tiroides/cirugía , Persona de Mediana Edad , Tiroidectomía/métodos , Resultado del Tratamiento , Tempo Operativo , Puntaje de Propensión
9.
Endocrinol Diabetes Nutr (Engl Ed) ; 71(6): 246-252, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38986628

RESUMEN

INTRODUCTION: Some epidemiological data suggest that there may be an inverse relationship between cholesterol levels and the risk of thyroid cancer in the overall population. The present study was aimed to evaluate the lipid profile specifically in subjects with Bethesda category IV thyroid nodules, and compare whether there were any differences between those with benign and malignant nodules. METHODS: Single-centre, retrospective study on 204 subjects treated by partial or total thyroidectomy for excision of a Bethesda category IV thyroid nodule, who had undergone a blood lipid profile test in the 12 months prior to surgery. In addition to lipid measures, other demographic, clinical, biochemical and ultrasound data were collected. RESULTS: Seventy-five subjects (36.8%) were diagnosed with thyroid carcinoma in the definitive histopathological examination. Patients with thyroid cancer had lower levels of total cholesterol, LDL-cholesterol and non-HDL-cholesterol than subjects with benign thyroid diseases. There were no differences in HDL-cholesterol, triglycerides or total cholesterol/HDL-cholesterol ratio. There were no differences either between groups in other clinical, biochemical and ultrasound variables, including the use of lipid-lowering drugs. In multivariate analysis, only LDL-cholesterol was independently associated with malignancy. Subjects with follicular carcinoma showed the lowest cholesterol levels, while those with papillary carcinoma had intermediate values between the group with follicular carcinoma and the group with benign thyroid diseases. CONCLUSIONS: In subjects with cytologically indeterminate Bethesda category IV thyroid nodules, levels of total cholesterol, non-HDL-cholesterol and, particularly, LDL-cholesterol are lower among those with malignant nodules.


Asunto(s)
Colesterol , Neoplasias de la Tiroides , Nódulo Tiroideo , Humanos , Nódulo Tiroideo/sangre , Nódulo Tiroideo/patología , Nódulo Tiroideo/cirugía , Masculino , Estudios Retrospectivos , Femenino , Colesterol/sangre , Persona de Mediana Edad , Neoplasias de la Tiroides/sangre , Neoplasias de la Tiroides/patología , Neoplasias de la Tiroides/cirugía , Adulto , Carcinoma Papilar/sangre , Carcinoma Papilar/patología , Carcinoma Papilar/cirugía , Adenocarcinoma Folicular/sangre , Adenocarcinoma Folicular/patología , Adenocarcinoma Folicular/cirugía , Tiroidectomía , Anciano
10.
Rev Assoc Med Bras (1992) ; 70(7): e20240001, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-39045933

RESUMEN

OBJECTIVE: Thyroidectomy is a relatively uncommon procedure in pediatric patients. We aimed to review our 20-year experience of thyroid surgery. METHODS: A total of 39 patients who underwent thyroid surgery from 2003 to 2023 were retrospectively evaluated. All patients were followed preoperatively and postoperatively by our institutional multidisciplinary board. Patients were divided into two groups based on their pathologies: benign and malignant. RESULTS: In total, 39 patients (27 girls and 12 boys) underwent 47 thyroid surgeries (total thyroidectomy in 19 patients and subtotal thyroidectomy in 20 patients, with 8 of them having completion thyroidectomy). Notably, 20 (51%) patients had benign and 19 (49%) patients had malignant pathologies. Median age at operation was 157 (9-223) months in the benign group and 182 (1-213) months in the malignant group. In the benign group, 12 (60%) patients had colloidal goiter and 8 (40%) patients had other conditions. In the malignant group, 12 (63%) patients had papillary thyroid carcinoma, 3 (16%) patients had follicular thyroid carcinoma, 2 (11%) had medullary thyroid carcinoma, and 2 patients had other thyroid malignancies. Overall permanent complication rate was 2 out of 39 (5%), which was similar for both groups (1 hypocalcemia in each group). The median follow-up was 38 months (1-179 months) with no local recurrence or distant metastasis. CONCLUSION: Pediatric thyroidectomies are performed on a heterogeneous group of pediatric patients due to a diverse group of pathologies. A multidisciplinary approach is required for proper initial management and surgical strategy with decreased complication rate and event-free survival of these patients in experienced tertiary centers.


Asunto(s)
Neoplasias de la Tiroides , Tiroidectomía , Humanos , Femenino , Masculino , Tiroidectomía/métodos , Niño , Estudios Retrospectivos , Preescolar , Adolescente , Neoplasias de la Tiroides/cirugía , Neoplasias de la Tiroides/patología , Resultado del Tratamiento , Lactante , Carcinoma Papilar/cirugía , Carcinoma Papilar/patología , Enfermedades de la Tiroides/cirugía , Complicaciones Posoperatorias/epidemiología , Factores de Tiempo
11.
Minerva Endocrinol (Torino) ; 49(2): 125-131, 2024 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-39028208

RESUMEN

BACKGROUND: Thyroid Imaging Reporting and Data Systems (TIRADSs) have demonstrated high performance in risk stratification of thyroid nodules (TNs). However, further improvements are needed in view of the ongoing project of an international TIRADS. Even if thyroid-stimulating hormone (TSH) measurement is traditionally used to assess the thyroid function, several papers have reported that higher TSH levels are associated with the presence of differentiated thyroid carcinoma (DTC). The present study aimed to investigate the role of TSH levels as improvement factor of American College of Radiology (ACR-), European Thyroid Association (EU-), and Korean Society (K-)TIRADS. METHODS: Patients undergoing thyroidectomy were reviewed and TNs were re-assessed according to TIRADSs. Different TSH subgroups were attained. Histology was the reference standard. DTC risk of relapse was assessed according to American Thyroid Association guidelines. RESULTS: The study series included 97 patients with 39.2% cancer prevalence. ACR-, EU-, and K-TIRADS indicated fine-needle aspiration cytology (FNAC) in 78.9%, 81.6%, and 92.1% of cases, respectively. All high-risk DTC had FNAC indication according to the three TIRADSs. The cancer rate was significantly lower in patients with TSH<0.4 mIU/L (P=0.04). The receiver operating characteristic (ROC) curve analysis showed that the best TSH cut-off to detect DTC patient was >1.3 mIU/L with Area Under the Curve (AUC)=0.70. Combining TSH data with TIRADS, the sensitivity of ACR-, EU-, and K-TIRADS increased to 92.1% 89.5%, and 94.7%, respectively. Conversely, the rate of unnecessary FNAC raised. At multivariate analysis, gender, TSH, and TIRADS were independent predictors of cancer. CONCLUSIONS: Even if TIRADSs are strongly reliable to stratify the risk of malignancy of TNs, measuring TSH can further improve our sensitivity in detecting DTC.


Asunto(s)
Neoplasias de la Tiroides , Nódulo Tiroideo , Tiroidectomía , Tirotropina , Humanos , Neoplasias de la Tiroides/sangre , Neoplasias de la Tiroides/diagnóstico , Neoplasias de la Tiroides/patología , Neoplasias de la Tiroides/cirugía , Tirotropina/sangre , Masculino , Femenino , Persona de Mediana Edad , Adulto , Nódulo Tiroideo/sangre , Nódulo Tiroideo/patología , Nódulo Tiroideo/diagnóstico , Nódulo Tiroideo/cirugía , Nódulo Tiroideo/diagnóstico por imagen , Biopsia con Aguja Fina , Anciano , Estudios Retrospectivos , Medición de Riesgo/métodos , Sensibilidad y Especificidad
12.
Int J Pediatr Otorhinolaryngol ; 182: 112021, 2024 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-38959761

RESUMEN

INTRODUCTION: Postoperative hypocalcaemia is common after thyroidectomy. This study aimed to evaluate whether a standardised post-thyroidectomy protocol using prophylactic calcium and calcitriol reduces hypocalcaemia incidence after total thyroidectomy in children and adolescents. METHODS: A cohort children and adolescents ≤18 years of age undergoing total thyroidectomy between January 2016 and October 2022 in one institution were retrospectively identified and divided into pre-protocol and post-protocol groups. The primary outcome measure was hypocalcaemia (total serum calcium of <2.0 mmol/L; ionised serum calcium of 0.9 mmol/L). Secondary outcome measures were the occurrence of hypercalcaemia (serum Calcium >2.7 mmol/L; ionised calcium >1.31 mmol/L), length of hospitalisation and number of postoperative blood tests. RESULTS: There were 22 patients in each group (mean age 11.8; SD 4.3 years, female 36 %). The rate of hypocalcaemia was significantly higher in the pre-protocol group than the post-protocol group (54 % vs 13.6 %, p = 0.010). Patients in the pre-protocol group had more inpatient blood tests (mean 5.4; SD 3.2) than the post-protocol group (mean 3.3; SD 1.8, p = 0.011), although the total postoperative blood test count was similar between the groups. Six (13.6 %) patients developed hypercalcaemia. The rate of hypercalcaemia was similar between groups (pre-protocol 2, 9.1 %; post-protocol 4, 18.1 %; p = 0.664). Length of hospitalisation was similar between groups. CONCLUSION: Our standardized protocol decreased hypocalcemia and inpatient blood tests after total thyroidectomy in children. Future research should explore if incorporating preoperative calcium and calcitriol treatment, along with intraoperative PTH levels for risk management, can further reduce hypocalcemia rates in paediatric patients.


Asunto(s)
Calcitriol , Calcio , Protocolos Clínicos , Hipocalcemia , Complicaciones Posoperatorias , Tiroidectomía , Humanos , Hipocalcemia/prevención & control , Hipocalcemia/etiología , Hipocalcemia/epidemiología , Hipocalcemia/sangre , Tiroidectomía/efectos adversos , Tiroidectomía/métodos , Femenino , Niño , Masculino , Adolescente , Estudios Retrospectivos , Calcio/sangre , Calcitriol/uso terapéutico , Complicaciones Posoperatorias/prevención & control , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/sangre , Complicaciones Posoperatorias/diagnóstico , Hormonas y Agentes Reguladores de Calcio/uso terapéutico
13.
Langenbecks Arch Surg ; 409(1): 217, 2024 Jul 17.
Artículo en Inglés | MEDLINE | ID: mdl-39017727

RESUMEN

BACKGROUND: We conducted a systematic review and meta-analysis to evaluate the role of High Energy Devices (HEDs) versus conventional clamp and tie technique in thyroidectomy. This work is endorsed by the Italian Society of Surgical Endoscopy (Italian Society of Endoscopic Surgery and new technologies-SICE) in the broader project on the evaluation of the role of HEDs in different surgical settings with the full health technology assessment report. MEHODS: Inclusion criteria were adult patients (≥ 18 years old) undergoing Thyroidectomy/Parathyroidectomy conducted with High Energy Devices (as ultrasonic (US), radiofrequency (RF), and hybrid energy (H-US/RF)) in the setting of thyroid surgery (both partial and total) for benign and malign diseases. However, some variability was found in included studies and described in the text. This systematic review and meta-analysis were performed according to the Cochrane handbook for systematic reviews, and the recommendations of the 2020 updated Preferred Reporting Items for Systematic reviews and Meta-analyses (PRISMA) guidelines were pursuit. Selection of abstracts was performed in Ryyan system by 2 independent reviewers, and doubts were solved by another independent reviewer. At the end of literature research, Randomized controlled trials and observational studies were included. Risk of Bias was assessed with ROB2 for RCTs, and New Castle Ottawa Scale for Observational studies. RESULTS: The literature search yielded 47 studies, including 29 RCTs and 18 observational studies. Meta-analysis was performed for 29 randomized clinical trials. Outcomes included in the comparison between High Energy Devise and conventional technique groups were operative time, operative blood loss, overall post-operative drainage volume, length of stay, complications, and costs. HED significantly reduced operative time (28 studies, 3097patients; MD -128.8; 95% CI -34.4 to -23.20; I2 = 96%, p < 0.00001, Random-effect), intra-operative blood loss (13 studies, 642 vs 519 patients; SMD -0.82; 95% CI -1.33 to -0.32; I2 = 93%, p < 0.00001, Random-effect), LOS (22 studies, 2808 vs 2789 patients; MD -0.38, 95% CI -0.59 to -0.17; I2 = 98%, p < 0.00001 Random-effect), and healthcare costs (8 studies, 1138 vs 1129 patients, SMD 1.05; 95% CI -0.06 to 2.16; I2 = 99%, p < 0.00001 Random-effect). The rate of overall intraoperative complications was significantly different between both groups (25 studies, 2804 vs 2775 patients; RR 0.88, 95% CI 0.80 to 0.97; I2 = 38%, p = 0.03 Random-effect), but the sensitivity analysis did not find a statistically significant difference (6 studies, 605 vs 594 patients, RR; 95% CI to; I2 = 0%, p = 0.50, Random-effect). There was no difference in the subgroup analysis for the occurrence of transient and permanent RLN palsy, nor hematoma formation and hypocalcaemia. DISCUSSION: Though findings of our systematic review and metanalysis are limited by heterogeneous data, surgeons, hospital managers, and policymakers should note that the use of High Energy Devices compared to conventional clamp and tie technique have reduced operative times, intra-operative blood loss, length of stay, and hospital costs in patients underwent to tyroid surgery. Future work must explore issues of equity to mitigate barriers to patient access to safe thyroid surgical care and define better this initial results.


Asunto(s)
Tiroidectomía , Humanos , Tiroidectomía/métodos , Tiroidectomía/efectos adversos , Tiroidectomía/instrumentación , Enfermedades de la Tiroides/cirugía , Paratiroidectomía/métodos
14.
Front Endocrinol (Lausanne) ; 15: 1402447, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-39022344

RESUMEN

Background: Hypoparathyroidism is the most common complication for patients who undergo total thyroidectomy (TT) with bilateral central lymph node dissection (BCLND). The objective of this retrospective study was to investigate the relationship between parathyroid autotransplantation (PA) and postoperative hypoparathyroidism. Materials and Methods: Four hundred and sixty-five patients with papillary thyroid carcinoma (PTC) who underwent TT with BCLND (including prophylactic and therapeutic BCLND) by the same surgeon were enrolled in this retrospective study. They were divided into five groups based on the number of PAs. Group 0 was defined as no PA, while Group 1, 2, 3, and 4 were considered as 1, 2, 3, and 4 PAs during TT with BCLND, respectively. Results: Transient and permanent hypoparathyroidism occurred in 83 (17.8%) and 2 (0.4%) patients who underwent TT and BCLND, respectively. The incidence of transient hypoparathyroidism increased gradually with an increase in the number of PAs. Compared with the previous group, Groups 2 and 3 had significantly more cases of transient hypoparathyroidism (p=0.03 and p=0.04, respectively). All cases of permanent hypoparathyroidism occurred in the patients without PA. Compared with Group 0, there were more removed central lymph nodes (RCLNs) in patients with one PA. Furthermore, Group 2 had more metastatic central lymph nodes(MCLNs) and RCLNs than Group 1.The number of PAs was the only identified risk factor for transient hypoparathyroidism after the multivariate logistic regression analysis. The median parathyroid hormone level recovered to the normal range within 1 month after surgery. Conclusion: With an increasing number of PAs, the possibility of transient hypoparathyroidism also increases in patients with PTC who undergo TT and BCLND. Considering the rapid recovery of transient hypoparathyroidism in 1 month, two PAs during TT and BCLND could be a good choice, leading to an increase in the central lymph node yield and no permanent hypoparathyroidism. However, this conclusion should be validated in future multicenter prospective studies.


Asunto(s)
Hipoparatiroidismo , Disección del Cuello , Glándulas Paratiroides , Complicaciones Posoperatorias , Cáncer Papilar Tiroideo , Neoplasias de la Tiroides , Tiroidectomía , Trasplante Autólogo , Humanos , Hipoparatiroidismo/etiología , Hipoparatiroidismo/epidemiología , Masculino , Femenino , Tiroidectomía/efectos adversos , Tiroidectomía/métodos , Glándulas Paratiroides/trasplante , Glándulas Paratiroides/cirugía , Trasplante Autólogo/efectos adversos , Estudios Retrospectivos , Adulto , Persona de Mediana Edad , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/epidemiología , Neoplasias de la Tiroides/cirugía , Disección del Cuello/efectos adversos , Cáncer Papilar Tiroideo/cirugía , Estudios de Seguimiento , Adulto Joven
15.
Am J Case Rep ; 25: e944579, 2024 Jul 19.
Artículo en Inglés | MEDLINE | ID: mdl-39028689

RESUMEN

BACKGROUND Massive chylous leakage represents a rare yet potentially life-threatening complication following neck dissection, and its occurrence is even less common in the context of endoscopic thyroid surgery. Chylous leakage poses significant clinical management challenges, encompassing prolonged hospitalization, nutritional deficiencies, electrolyte imbalances, and the potential for infection. It is imperative for surgeons to remain vigilant and proactive in recognizing and managing chylous leakage to mitigate its potential impact on patient outcomes. CASE REPORT A 37-year-old woman presented with a thyroid nodule, and subsequent fine-needle aspiration biopsy confirmed the diagnosis of papillary thyroid carcinoma. She then underwent endoscopic thyroidectomy with central lymph node dissection via a bilateral areola approach and experienced significant postoperative chylous leakage. Various conservative management strategies were used to treat the leak, including fasting, parenteral nutrition, maintenance of electrolyte balance, and continuous infusion of somatostatin. After failure of a series of conservative treatments, the patient underwent a reoperation to address the leak via the initial approach. After identification of the leak site, the residual end of the lymphatic vessel was clamped with a biological clamp, and no further chylous leakage was observed. The drainage was removed 4 days after the second operation, and the patient was discharged on the fifth day. During follow-up, no abnormalities were observed. CONCLUSIONS Managing significant chylous leakage poses a challenge for surgeons. This complication is rare following endoscopic thyroidectomy with central lymph node dissection, and there remains a lack of experience in effective prevention and treatment. We aim to raise awareness through our case report.


Asunto(s)
Quilo , Endoscopía , Complicaciones Posoperatorias , Neoplasias de la Tiroides , Tiroidectomía , Humanos , Femenino , Adulto , Tiroidectomía/efectos adversos , Neoplasias de la Tiroides/cirugía , Endoscopía/efectos adversos , Escisión del Ganglio Linfático/efectos adversos , Cáncer Papilar Tiroideo/cirugía , Disección del Cuello/efectos adversos
16.
Khirurgiia (Mosk) ; (7): 85-91, 2024.
Artículo en Ruso | MEDLINE | ID: mdl-39008701

RESUMEN

OBJECTIVE: To evaluate the effectiveness of prevention of recurrent laryngeal nerve injury depending on thyroid gland lesion and extent of surgery. MATERIAL AND METHODS: There were 2412 thyroid surgeries between 2000 and 2020. Patients were divided into the main group (1689 patients) and the control group (729 patients). Patients with nodular thyroid gland lesions prevailed in both groups (987 (58.4%) and 415 (56.9%), respectively). All ones underwent atraumatic extrafascial desection and thyroid resection (ultrasonic scalpel). RESULTS. T: He upper laryngeal nerve injury occurred in 35 cases (1.4%). The number of surgeries with thyroid remnant preservation was significantly lower in the main group. The number of procedures with subtotal thyroid resection and thyroidectomy increased by 2.4 times (from 414 to 1010 operations, p<0.05). CONCLUSION: Improvement of surgical treatment of thyroid gland lesions consisting in new operative technique of recurrent laryngeal nerve isolation using ultrasonic scalpel reduces the incidence of recurrent laryngeal nerve injury from 2.3% to 1%. At the same time, the number of extended procedures in the main group significantly exceeded that in the control group (by 2.5 times).


Asunto(s)
Traumatismos del Nervio Laríngeo Recurrente , Glándula Tiroides , Tiroidectomía , Humanos , Traumatismos del Nervio Laríngeo Recurrente/prevención & control , Traumatismos del Nervio Laríngeo Recurrente/etiología , Masculino , Tiroidectomía/métodos , Tiroidectomía/efectos adversos , Femenino , Persona de Mediana Edad , Adulto , Glándula Tiroides/cirugía , Complicaciones Posoperatorias/prevención & control , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/epidemiología , Enfermedades de la Tiroides/cirugía , Federación de Rusia/epidemiología
17.
Med Sci Monit ; 30: e942619, 2024 Jul 08.
Artículo en Inglés | MEDLINE | ID: mdl-38973140

RESUMEN

BACKGROUND Completion thyroidectomy (CTx) is performed following hemithyroidectomy (HTx) when the risk of malignancy persists or is discovered postoperatively. Different surgical approaches, including CTx after HTx (CTx-HTx), total thyroidectomy (TTx), and revision surgery after TTx (RTx-TTx), offer varying risks and benefits, including pathological outcomes and complication rates. Understanding the predictors and rates of malignancy in these procedures is crucial for optimizing surgical management of thyroid disorders. MATERIAL AND METHODS This retrospective study analyzed data from January 2014 to October 2019, including 60 patients each in the CTx-HTx and TTx groups, and 47 in the RTx-TTx group. The CTx-HTx group was subdivided based on benign or malignant findings in CTx specimens. Clinicodemographic data and pathological features such as tumor type, size, side, capsular and vascular invasion, extrathyroidal spread, multifocality, and lymph node metastasis were reviewed. RESULTS Age and sex distributions were similar across groups. In the CTx-HTx group, 76.7% of specimens were benign and 23.3% malignant. No significant predictors of malignancy were found between the benign and malignant subgroups in univariate and multivariable analyses. In the TTx group, 75.0% of initial lobes and 13.3% of contralateral lobes were malignant. TTx was associated with a significant postoperative decrease in calcium and longer hospital stays. Multivariable analysis identified TTx as an independent risk factor for hypocalcemia. CONCLUSIONS Reducing overtreatment in thyroid cancer may involve limiting CTx after HTx and considering more conservative initial surgeries, particularly when indications for TTx are not definitive.


Asunto(s)
Complicaciones Posoperatorias , Neoplasias de la Tiroides , Tiroidectomía , Humanos , Neoplasias de la Tiroides/cirugía , Neoplasias de la Tiroides/patología , Masculino , Femenino , Tiroidectomía/métodos , Tiroidectomía/efectos adversos , Estudios Retrospectivos , Persona de Mediana Edad , Adulto , Complicaciones Posoperatorias/etiología , Resultado del Tratamiento , Reoperación , Anciano
18.
Langenbecks Arch Surg ; 409(1): 204, 2024 Jul 04.
Artículo en Inglés | MEDLINE | ID: mdl-38963576

RESUMEN

PURPOSE: Our study aimed to compare the effectiveness and complications of the transoral endoscopic thyroidectomy submental vestibular approach (TOETSMVA) versus the transoral endoscopic thyroidectomy vestibular approach (TOETVA) or conventional open thyroidectomy (COT) in patients with early-stage papillary thyroid carcinoma (PTC). METHODS: We searched online databases up to January 2024. The outcomes were analyzed using RevMan 5.4 and inverse variance. RESULTS: Seven studies (two RCTs and five retrospective cohort studies) were included. We established higher significance differences for TOETSMVA in comparison with TOETVA in terms of all primary outcomes; operation time, hospital stay, number of resected lymph nodes [MD -21.05, 95% CI= -30.98, -11.12; p < 0.0001], [MD -1.76, 95% CI= -2.21, -1.32, p < 0.00001], [MD -2.99, 95% CI= -19.75, 13.76, p < 0.73], [MD -0.83, 95% CI = -1.19 to -0.47; p < 0.00001], respectively, except the drainage volume, it showed no difference [MD -2.99, 95% CI= -19.75, 13.76, p < 0.73]. In secondary outcomes, it was favored only in mandibular numbness and return to normal diet outcomes. Additionally, TOETSMVA compared with COT showed a significant difference in drainage volume, pain, cosmetic effect, and satisfaction score. CONCLUSIONS: TOETSMVA showed a significant improvement compared to the TOETVA in operation time, hospital stay, number of resected lymph nodes, mandibular numbness, and return to normal diet but did not show a difference in drainage volume. However, TOETSMVA was better in cosmetic effect, drainage volume, satisfaction, and pain scores compared with COT. Further RCTs with larger sample size, multicentral, and longer follow-up are necessary to evaluate the limitations.


Asunto(s)
Cirugía Endoscópica por Orificios Naturales , Cáncer Papilar Tiroideo , Neoplasias de la Tiroides , Tiroidectomía , Humanos , Tiroidectomía/métodos , Cáncer Papilar Tiroideo/cirugía , Cáncer Papilar Tiroideo/patología , Neoplasias de la Tiroides/cirugía , Neoplasias de la Tiroides/patología , Cirugía Endoscópica por Orificios Naturales/métodos , Estadificación de Neoplasias , Tempo Operativo , Resultado del Tratamiento
19.
BMC Endocr Disord ; 24(1): 112, 2024 Jul 15.
Artículo en Inglés | MEDLINE | ID: mdl-39004697

RESUMEN

BACKGROUND: Radioactive iodine (RAI) therapy is the standard treatment approach after total thyroidectomy in patients with papillary thyroid carcinoma (PTC). We aimed to identify predictive factors of response to the treatment in intermediate and high-risk patients with PTC. In addition, the impact of multiple RAI treatments was explored. METHODS: In a 3-year retrospective study, data from intermediate and high-risk patients with PTC who received RAI therapy following total thyroidectomy, were analyzed by the end of year-one and year-three. Demographic data, tumor size, capsular/vascular invasion, extrathyroidal extension, local or distant metastasis, initial dose and cumulative dose of RAI, serum thyroglobulin(Tg), antithyroglobulin antibody(TgAb), and imaging findings were investigated. Patients with an excellent response to a single dose of RAI treatment, after three years of follow-up were classified as the "Responder group". Excellent response was defined as stimulated serum Tg less than 1 ng/ml, or unstimulated serum Tg less than 0.2 ng/ml in TgAb-negative patients with negative imaging scans. RESULTS: 333 patient records with a complete data set were analyzed in this study. After three years of initial treatment, 271 patients were non-responders (NR) and 62 were responders (R). At baseline, the median pre-ablation serum Tg level was 5.7 ng/ml in the NR group, and 1.25 ng/ml in the R group (P < 0.001). TSH-Stimulated serum Tg greater than 15.7 ng/ml, was associated with response failure even after multiple RAI therapy, AUC: 0.717(0.660-0.774), sensitivity: 52.5%, specificity: 89.47%, P < 0.001. On the other hand, multiple RAI therapy was associated with excellent response in 16.2% of the patients. The chance of ER was decreased by 74% if initial post-operation ultrasound imaging confirmed the presence of locoregional involvement, OR 0.26, (95% CI: 0.12-0.55), P < 0.001. CONCLUSION: Stimulated serum Tg and locoregional involvement after total thyroidectomy are predictive factors of non-response to RAI therapy in intermediate and high-risk patients with PTC. In addition, a minority of patients achieve excellent response after multiple RAI therapy.


Asunto(s)
Radioisótopos de Yodo , Cáncer Papilar Tiroideo , Neoplasias de la Tiroides , Tiroidectomía , Humanos , Radioisótopos de Yodo/uso terapéutico , Masculino , Femenino , Estudios Retrospectivos , Persona de Mediana Edad , Neoplasias de la Tiroides/radioterapia , Neoplasias de la Tiroides/patología , Neoplasias de la Tiroides/cirugía , Neoplasias de la Tiroides/sangre , Adulto , Cáncer Papilar Tiroideo/radioterapia , Cáncer Papilar Tiroideo/patología , Cáncer Papilar Tiroideo/cirugía , Cáncer Papilar Tiroideo/sangre , Estudios de Seguimiento , Pronóstico , Anciano , Tiroglobulina/sangre , Resultado del Tratamiento , Adulto Joven , Factores de Riesgo , Carcinoma Papilar/radioterapia , Carcinoma Papilar/patología , Carcinoma Papilar/cirugía
20.
S D Med ; 77(6): 266-269, 2024 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-39013099

RESUMEN

BACKGROUND: Pseudocholinesterase (butyrylcholinesterase) deficiency is an acquired or inherited condition in which decreased plasma levels of the pseudocholinesterase enzyme lead to an inability to metabolize the neuromuscular blocking agents succinylcholine and mivacurium, prolonging their paralytic effects. This often results in delayed extubation and additional intensive care requirements in the postoperative period. CASE DESCRIPTION: We describe a case of suspected pseudocholinesterase deficiency in a previously healthy 59-year-old female who underwent a left thyroid lobectomy and isthmusectomy. The patient received 120 mg of succinylcholine chloride before intubation. The patient did not meet extubation criteria following the completion of the procedure approximately two hours after receiving succinylcholine chloride. The patient was transferred to the ICU for respiratory support and for the medication to clear from the patient's system. The patient regained muscle control approximately four hours after receiving succinylcholine chloride and was extubated without complication. The patient shared post-extubation that she had a blood relative with the diagnosis of pseudocholinesterase deficiency. CONCLUSION: Pseudocholinesterase deficiency is rare but can result in potentially serious complications following the administration of succinylcholine chloride, mivacurium, or ester local anesthetics due to reduced metabolism and subsequently increased pharmacodynamic effects. Given the widespread use of succinylcholine chloride as a neuromuscular blocking agent, such as in this case, providers must be aware of the presentation, pathophysiology, diagnosis, and management. Additionally, this case demonstrates the importance of thoroughly inquiring about any personal or family history of anesthetic complications during a preoperative assessment.


Asunto(s)
Butirilcolinesterasa , Errores Innatos del Metabolismo , Succinilcolina , Tiroidectomía , Humanos , Femenino , Persona de Mediana Edad , Butirilcolinesterasa/deficiencia , Tiroidectomía/métodos , Succinilcolina/efectos adversos , Succinilcolina/administración & dosificación , Errores Innatos del Metabolismo/cirugía , Errores Innatos del Metabolismo/diagnóstico , Fármacos Neuromusculares Despolarizantes/efectos adversos , Apnea
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