Thyroid hormones modulate uric acid metabolism in patients with recent onset subclinical hypothyroidism by improving insulin sensitivity.

Some evidence suggests a relationship between thyroid dysfunction and uric acid (UA) metabolism, but the potential influential role of thyroid hormones on UA metabolism is still debated. This report was designed to evaluate the influential role of levothyroxine (L-T4) replacement therapy on circulating levels of UA in patients with recent onset post-thyroidectomy subclinical hypothyroidism. Circulating levels of thyroid hormones, UA and other metabolic parameters were assessed in 155 recently thyroidectomized patients (131 females, mean age 51.1 ± 12.7 years) at baseline (5-7 day after surgery) and after 2 months under replacement therapy with L-T4. At baseline, circulating levels of thyroid hormones were indicative of a subclinical hypothyroidism (TSH 8.2 ± 5.1 mU/mL, FT3 2.1 ± 0.7 pg/mL, FT4 9.2 ± 3.4 pg/mL). The mean serum UA concentration was 5.0 ± 1.3 mg/dL, while the prevalence of hyperuricemia, defined by serum UA levels > 6 mg/dL, was 22.6%. Serum UA levels at baseline were significantly correlated with HOMA-IR index (r = 0.475, p < 0.0001). After 2 months under the replacement therapy with L-T4, both serum UA levels (- 1.2 ± 0.9 mg/dL, p < 0.0001 vs. baseline) and HOMA-IR (- 0.3 ± 1.5 mmol/L, p = 0.0328 vs. baseline) significantly decreased. Multivariate regression analysis revealed that changes in HOMA-IR explained 23% of the variations of serum UA levels under L-T4 replacement therapy (ß = 0.295, p < 0.0001, R2 = 0.230). Our study suggests that thyroid hormones could modulate UA metabolism in patients with recent onset subclinical hypothyroidism likely by improving insulin sensitivity.

Efficacy of continuous neuromonitoring in thyroid surgery: preliminary report of a single-center experience.

BACKGROUND: The continuous intraoperative nerve monitoring (CIONM) technique seems to be acknowledged as a useful tool to prevent impending nerve injury, because it constantly provides valuable real-time information. Aim of the study is to evaluate the impact of the CIONM technique on functional outcome i.e., recurrent laryngeal nerve (RLN) palsy, compared to the traditional surgical procedure. METHODS: From January to December 2016, 197 patients who underwent thyroid surgery were included in this retrospective study: 94 patients had CIONM procedure and 103 traditional technique, according to the order of the operating room list. RESULTS: A total of 8 patients showed a damage to left or right vocal cord: 3 patients after CIONM procedure, and 5 patients after traditional surgical procedure. After matching for propensity score, 188 patients were eventually considered and 7 RLN palsy were identified: 3 in CIONM and 4 in traditional surgical procedure. The analysis performed on the matched propensity score sample showed a non-significant difference between the two procedures. CONCLUSIONS: In our experience no significant differences in functional outcomes were found between the use of CIONM and the standard technique.

Morbidity from minimally invasive video-assisted thyroidectomy: a general review.

Minimally invasive video-assisted thyroidectomy (MIVAT) is known and used worldwide, it combines the advantages associated with endoscopic magnification with those due with traditional surgery. In selected patients, it should be considered a safe and valid alternative. Indeed, a lot of comparative studies have demonstrated the advantages of MIVAT in terms of low rate of complications, reduced postoperative pain, improved cosmetic results and higher patient satisfaction over traditional surgery. Anyway, for obtaining the best results, with similar or even less complication rate than traditional surgery, surgeons should be well trained, acquired confidence with a smaller surgical incision and with the use of endoscopic instruments.

"The final countdown": Is intraoperative, intermittent neuromonitoring really useful in preventing permanent nerve palsy? Evidence from a meta-analysis.

BACKGROUND: The aim of our research was to explore the specific role of intermittent intraoperative neuromonitoring (IONM) versus visualization alone in preventing permanent nerve palsy in thyroid surgery. METHODS: A systematic review was conducted by searching electronic databases using specific keywords and completed by hand search. The article selection process was carried out by 2 independent investigators using well-defined inclusion and exclusion criteria. Articles evaluating the role of IONM versus visualization alone in preventing recurrent laryngeal nerve palsy were evaluated for inclusion. The relative risk with a confidence interval of 95% was estimated for nonrandomized studies, and risk difference was estimated for randomized control studies. Subgroup meta-analyses were carried out stratifying the studies on the basis of the design and the definition of permanent injury. The heterogeneity among the studies was evaluated with Higgins' Index. RESULTS: A total of 14 articles were included; of these, 10 were nonrandomized studies and 4 were randomized control studies. With regard to the meta-analyses, including nonrandomized studies that defined as permanent an injury persisting for 6 months or 12 months after thyroid surgery, the overall relative risks were, respectively, 0.79 (confidence interval 95%, 0.60-1.05) and 0.75 (confidence interval 95%, 0.43-1.30). As for the meta-analysis including randomized control studies, the risk difference was 0.00 (confidence interval 95%, -0.01 to 0.00). No heterogeneity was found in any of the analyses conducted (Higgins' Index = 0%). CONCLUSION: Our results show that the use of IONM does not prevent permanent nerve palsy; no significant benefit of IONM over visualization alone in reducing the rate of recurrent laryngeal nerve injuries could be proven. In conclusion, IONM should not be considered the standard care in preventing recurrent laryngeal nerve palsy.

First-pass perfusion of non-small-cell lung cancer (NSCLC) with 64-detector-row CT: a study of technique repeatability and intra- and interobserver variability.

PURPOSE: This study was done to prospectively assess the repeatability and intra- and interobserver variability of first-pass perfusion with 64-detector-row computed tomography (CT) in non-small-cell lung cancer (NSCLC) with a maximum diameter of up to 8 cm. MATERIALS AND METHODS: Twelve patients with NSCLC underwent 64-detector-row first-pass CT perfusion (CTP) of the whole tumour. Two different techniques were used according to lesion size (cine mode; sequential mode). After 24 h, each study was repeated to assess repeatability. Lesion blood volume (BV), blood flow (BF), mean transit time (MTT) and peak enhancement intensity (PEI) were automatically calculated by two chest radiologists in two different reading sessions. Intra- and interobserver variability was also assessed. RESULTS: The first-pass CTP technique was repeatable and precise with within-subject coefficient of variation (WCV) of 9.3, 16.4, 11.2 and 14.9 %, respectively, for BV, BF, MTT and PEI. High intra- and interobserver agreement was demonstrated for each perfusion parameter, with Cronbach's α coefficients and intraclass correlation coefficients ranging from 0.99 to 1. Precision of measurements was slightly better for intraobserver analysis with WCV ranging between 1.05 and 3.03 %. CONCLUSIONS: Non-small-cell lung cancer first-pass perfusion performed with 64-detector-row CT showed good repeatability and high intra- and interobserver agreement for all perfusion parameters and may be considered a reliable and robust tool for assessing tumour vascularisation.

A rare case of primary thymic Hodgkin lymphoma in an elderly patient detected by 18F-FDG PET/CT.

We report a rare case of thymic Hodgkin lymphoma that occurred in an elderly patient and detected by 18F-FDG PET/CT. A 77-year-old woman with fever of unknown origin underwent 18F-FDG PET/CT scanning, which showed an area of increased radiopharmaceutical uptake in a mediastinal mass corresponding to a thymic lesion at CT scan. On the basis of the PET/CT findings, the patient was referred to surgery with the clinical suspicious of a thymoma. Histological examination demonstrated the presence of a primary thymic Hodgkin lymphoma instead.

Thirty-five-year follow-up analysis of clinical and pathologic outcomes of thymoma surgery.

BACKGROUND: The impact of myasthenia gravis on patients with thymoma is still controversial when perioperative and long-term outcomes are analyzed. With the unique opportunity of a 35-year follow-up in a single institution, thymomatous myasthenia gravis cohort, we investigated the influence of early and long-term clinical predictors. METHODS: We reviewed a surgical series of 317 (1972 to 2007) patients with thymoma: clinical and pathologic features were analyzed as prognostic factors matched against the short- and long-term survival and recurrence rates. RESULTS: Male to female ratio was 153:164; median age, 49 years. Myasthenia gravis coexisted in 276 patients (87.1%). Thymomas were classified according to the Masaoka (42.0% stage I, 32.2% stage II, 21.5% stage III, and 4.4% stage IV) and the World Health Organization (3.5% type A, 9.5% type AB, 19.2% type B1, 57.7% type B2, 8.2% type B3, and 1.9% thymic carcinoma) staging systems. The resection was complete in 295 patients (93.1%). Operative mortality and morbidity were respectively 1.6% and 7.6%. No differences were recorded in postoperative outcome stratifying for myasthenia gravis or comorbidities. Mean follow-up was 144.7 +/- 104.4 months. The overall 5-, 10-, 20-, and 30-year survival rates were 89.9%, 84.1%, 73%, and 58.6%, respectively. The completeness of resection (p < 0.001), the Masaoka staging (p = 0.010), and the World Health Organization classification (p < 0.001) all significantly influenced the long-term survival (univariate analysis). Only completeness of resection was significantly correlated with a better prognosis (p < 0.001) in multivariate analysis. Masaoka staging (p < 0.001) and World Health Organization classification (p < 0.001) significantly correlated with the disease-free survival in the univariate and multivariate analyses as significant prognostic factors (Masaoka, p < 0.001; World Health Organization, p = 0.011). Myasthenia gravis patients showed a better prognosis in terms of long-term survival (p = 0.046) and disease-free survival (p = 0.012) in the univariate analysis. CONCLUSIONS: We confirm the evidence that the clinical staging and the histologic classification influence long-term survival. The presence of myasthenia gravis was not significantly related to operative outcome, but prolongs both long-term survival and disease-free survival.