Role of pre-operative vitamin D supplementation to reduce post-thyroidectomy hypocalcemia; Cohort study.

INTRODUCTION: Hypocalcaemia after thyroidectomy is observed with increasing frequency, often resulting in prolonged hospital stay with increased use of resources, delayed return to work and reduced quality of life. The administration of vitamin D is essential in the therapy of postoperative hypocalcaemia. What has not been examined so far is whether and how routine preoperative vitamin D prophylaxis can help to prevent postoperative hypocalcaemia. MATERIALS AND METHODS: This is a prospective cohort study which was conducted from June 2016 to July 2017 at a tertiary care hospital. One hundred and two patients with thyroid disease who were admitted for thyroid surgery were interviewed and underwent physical examination and laboratory investigations. The patients enrolled in the study were randomly assigned to either the Interventional group (Pre-operative Vitamin D Supplementation) or the control group (placebo). The work is reported in line with the standards set by STROCCS criteria [1]. RESULTS: Out of 102 patients there were 89 females (87.25%) and 13 males (12.7%) with a mean age of 39.35 ±â€¯7.01 years. In the test group 45 (88.2%) patients had no clinical hypocalcemia, 5 (9.82%) had latent while 1 (2%) patient had overt hypocalcemic symptoms. In placebo group 37 (72.5%) had no clinical hypocalcemia, 10 (19.6%) had latent and 4 (7.8%) had overt hypocalcemic symptoms. (P-value<0.05). CONCLUSION: As the general population is deficient in Vitamin D, a prophylactic vitamin D dose given in immediate preoperative period can significantly reduce acute symptomatic postoperative hypocalcemia in patients undergoing thyroid surgery.

Association of Preoperative Serum Thyroid-stimulating Hormone Levels with Thyroid Cancer in Patients with Nodular Thyroid Disease.

The aim of the current study was to determine the frequency of carcinoma thyroid among patients presenting with goiter and its association with preoperative serum thyroid-stimulating hormone (TSH) levels. A total of 73 (n = 73) adult patients of either gender with solitary solid cold nodule and multinodular goiter with predominant solid cold nodule were analyzed. All surgically resected samples were sent for histopathology. The frequency of thyroid cancer and its subtypes was noted and tested for association with preoperative serum TSH values. Thyroid cancer was diagnosed in 26% (n = 19) of the patients. In patients with thyroid cancer (n = 19), 73.7% (n = 14) were diagnosed with papillary thyroid cancer and 26.3% (n = 5) were diagnosed with follicular thyroid cancer. Presence of thyroid cancer was found to be significantly associated with preoperative higher mean TSH values (P < 0.05). Higher preoperative serum TSH levels may be useful in predicting thyroid cancer in nodular thyroid disease. Further studies are recommended with different cutoff values of serum TSH and its association with the development and progression of thyroid cancer.

Gastric perforation without generalized peritonitis; A very rare complication after necrosectomy for necrotizing pancreatitis.

Gastric perforation is a very rare complication of necrotizing pancreatitis. We present an interesting case of gastric perforation after necrosectomy for necrotizing pancreatitis without generalized peritonitis. Abdominal drain was seen inside the stomach on endoscopy and there were no clinical features of generalized peritonitis even after 10 days of surgery. Patient was re-explored. The drain was removed and stomach was primarily repaired. The patient recovered uneventfully and was discharged home on 6(th) post operative day. On follow-up visit after one month patient was doing very well and had no complications.

Risk Factors Associated with Thyroid Carcinoma in North Pakistan.

BACKGROUND: Epidemiological data on thyroid cancer and associated risk factors are scarce in our setting. The present study was therefore designed to gather data which could be helpful in providing insights to thyroid physicians and surgeons for better management of affected patients. PURPOSE: To determine the frequency of carcinoma thyroid among patients presenting with goiter and its association with TSH, Tg/ATg and other demographic factors. MATERIALS AND METHODS: A total of 73 adult patients of either gender with solitary solid cold nodules and/or multi-ndoular goiter (MNG) with predominant solid cold nodules were enrolled. All surgically resected samples were sent for histopathology. The frequency of thyroid cancer and its subtypes was noted and tested for association with gender, age (< or ≥40 years), recent increase in swelling size, TSH, Tg and ATg. RESULTS: Thyroid cancer was diagnosed in 26% (n=19) of the patients, 14 (73.7%) being diagnosed with papillary thyroid cancer and 5 (26.3%) with follicular thyroid cancer. No other subtypes were noted. Presence of thyroid cancer was significantly associated with recent increase in swelling size and higher TSH Values mean TSH values (P<0.05). No significant association was found with gender, age, Tg and ATg values (P>0.05). CONCLUSIONS: Overall percentage of thyroid cancer in our study sample was found to be 26%, with a predominance of papillary over follicular lesions. Rates were significantly higher in patients who had history of recent increase in swelling size and higher and higher pre-surgery TSH values.