Thyroidectomy in children and adolescents: a systematic review.

Background: Thyroid surgery in pediatric population is not as common as that in adults, although they share the same indications, techniques and complications. This review aims to evaluate the surgical management of thyroid disease in patients under 18 years old. Methods: We conducted a bibliographic search in the international literature. Data from the identified studies such as demographics, indication for surgery, type of procedure, complications and length of hospital stay were recorded. A retrospective review study of all patients under 18 years old who underwent thyroidectomy was performed. Results: We included 37 retrospective studies and a total of 12,728 patients. Thyroidectomy was more common in female patients and the mean age was approximately 14 years old. The leading indication for surgery was benign thyroid pathology. Due to the surgical treatments' safety and effectiveness in young patients, total and subtotal thyroidectomy, whether for malignancies or benign diseases, is becoming more popular today. The most often occurring complication of pediatric thyroid surgery is hypoparathyroidism. Despite the high likelihood of recurrence of pediatric malignancies, overall survival rates of pediatric thyroid cancer are excellent. Conclusions: Thyroidectomy performed by high-volume thyroid surgeons in children and adolescents is considered an efficient and safe method of treatment of thyroid disease.

Buried bumper syndrome: A critical analysis of endoscopic release techniques.

Buried bumper syndrome (BBS) is the situation in which the internal bumper of the gastrostomy tube, due to prolonged compression of the tissues between the external and the internal bumper, migrates from the gastric lumen into the gastric wall or further, into the tract outside the gastric lumen, ending up anywhere between the stomach mucosa and the surface of the skin. This restricts liquid food from entering the stomach, since the internal opening is obstructed by gastric mucosal overgrowth. We performed a comprehensive search of the PubMed literature to retrieve all the case-reports and case-series referring to BBS and its management, after which we focused on the endoscopic techniques for releasing the internal bumper to re-establish the functionality of the tube. From the "push" and the "push and pull T" techniques to the most sophisticated-using high tech instruments, all 10 published techniques have been critically analysed and the pros and cons presented, in an effort to optimize the criteria of choice based on maximum efficacy and safety.

The Role of Vitamin D in Kidney Transplantation Outcomes: A Systematic Review.

The aim of this systematic review is to assess the impact of vitamin D on the outcomes of kidney transplantation and investigate whether its deficiency is associated with a negative impact. Methods: We conducted a systematic literature search in PubMed, Scopus and Cochrane databases, as well as gray literature. Ultimately, 16 articles with an average of 255.75 patients were included in this review. These articles compared the long-term outcomes of vitamin D deficiency and/or vitamin D supplementation therapy on kidney transplant recipients by assessing various parameters. Results: Most of the included studies showed a negative effect of vitamin D deficiency on kidney transplantation by being associated with a worse graft function, higher incidence of acute rejection episodes, higher incidence of proteinuria and lower overall graft and patient survival rate. Conclusions: We suggest that patients awaiting kidney transplantation have a careful evaluation in order to assess their vitamin D status and the optimal supplementation therapy. Regular follow-up of vitamin D levels post-transplant is also suggested. Prospective studies will be needed to establish the positive effects of vitamin D supplementation therapy on kidney transplant outcomes.

Retrosternal goiter masquerading as type II respiratory failure. A case report.

INTRODUCTION AND IMPORTANCE: Retrosternal Goiter (RG) represents a challenging clinical entity for surgeons. Although the vast majority of cases are successfully operated via a cervical access, there still remains a small minority that require an extra-cervical approach, even in experienced hands. Factors that shift the odds towards an extra-cervical approach are mainly related to the anatomic characteristics of the retrosternal mass. CASE PRESENTATION: We herein report a case of RG presenting as type 2 respiratory failure without a palpable neck mass, in an 81-year-old female. Despite her history of subtotal thyroidectomy for Graves' disease, the patient's chest x-ray showed a central mediastinal mass shifting the trachea to the left. The retrosternal mass extended below the aortic arch, and carina on computed tomography. It also extended into the posterior mediastinum. All these anatomical features of the RG along with the patient's previous neck surgery were in favor of an extra-cervical approach. Nevertheless, a cervical approach was attempted, and was concluded successfully. CONCLUSION: CT plays a key role in determining the likelihood of requiring an extra-cervical approach in RG. Even if the odds seem to be in favor of an extra-cervical approach, an attempt to remove the goiter through a cervical incision should always be made by an experienced surgeon, using all available techniques, and taking all required precautions, on account of less risk of surgical and aesthetic damage obtained with this approach.

Postoperatively determined high-risk histopathologic features in papillary thyroid carcinoma initially eligible for thyroid lobectomy: a game changer.

PURPOSE: Recent clinical practice guidelines consider thyroid lobectomy a viable alternative for low-risk papillary thyroid carcinoma PTC measuring 1-4 cm in size. We aimed to assess the likelihood of finding postoperatively determined high-risk histopathologic features that would lead to the recommendation of completion thyroidectomy. METHODS: A retrospective review of patients who underwent total thyroidectomy for PTC measuring 1-4 cm in size between Jan 2012 and Jan 2018 was conducted. Patients with pre-operative high-risk characteristics were excluded: history of radiation exposure, positive family history, clinically suspicious cervical lymphadenopathy, and gross extrathyroidal extension (ETE). A hypothetical group of 245 patients remained eligible for lobectomy. The pathology specimens from the cancer-containing lobes were evaluated for high-risk features: aggressive histology, capsular and/or vascular invasion, microscopic ETE, and multifocality. A subgroup analysis was performed with 2 cm being the cut-off size. RESULTS: The average age was 39 years with 73% being females. Mean cancer size was 16 mm. Evaluation of the cancer-containing lobe for high-risk features revealed: aggressive histology (33%), ETE (12%), capsular invasion (33%), vascular invasion (17%), and ipsilateral multifocality (30%). The cumulative risk of having ≥1 high-risk feature mandating completion thyroidectomy was 59%. The risk was considerably higher for lesions ≤2 cm compared to larger lesions (64% vs.48%; p = 0.049; RR = 1.3). CONCLUSIONS: A considerable proportion of patients initially eligible for lobectomy have high-risk features that only become evident at pathology. Therefore, a comprehensive approach is advocated to determine the extent of surgery for PTC incorporating patient preferences regarding risks and benefits.

What are the real rates of temporary hypoparathyroidism following thyroidectomy? It is a matter of definition: a systematic review.

INTRODUCTION: Post-operative hypoparathyroidism is the most encountered complication of thyroid surgery and is classified as temporary or permanent. However, its incidence varies greatly in the literature ranging from 0.5% to 65%. This can be mainly attributed to the different definition of hypoparathyroidism used in each study and especially to the different time cutoff applied to distinguish temporary from permanent hypoparathyroidism. METHODS: We conducted a systematic literature search in PubMed, Scopus, Cochrane and GoogleScholar databases, as well as grey literature. Ultimately, 45 articles with 23,164 patients in total were included in this review. These articles used either the cutoff of six or twelve post-operative months to distinguish temporary from permanent hypoparathyroidism. RESULTS: The overall incidence of permanent hypoparathyroidism diagnosed at 6 months post-operatively was 4.11% and 4.08% at 12 months post-operatively. There was no statistically significant difference between the two groups (p = 0.92). CONCLUSIONS: We suggest that adhering to the current guidelines that recommend diagnosing temporary hypoparathyroidism when recovery is made within 6 months after surgery is important when conducting future research in order to narrow the gap that exists currently in the literature, as well as when deciding to put patients on long-term calcium supplements.

Do surgeons really know how to perform neuromonitoring in thyroid surgery? An awareness study.

BACKGROUND: The aim of this questionnaire-based observational study is to examine the awareness of endocrine surgeons regarding the use of intraoperative neuromonitoring (IONM) techniques in thyroid surgeries. METHODS: A survey project based on a structured questionnaire was conducted during the 14th Spring Meeting of the Greek Society of Endocrine Surgeons (GSES). The questionnaire consisted of 14 items and was handed to all participants-by the key speaker-during the neuromonitoring session. RESULTS: In the 14th spring meeting of GSES there were 205 delegates present. Among them there were 35 residents and 6 medical students. The surgeons being potential responders were 119. In the session of IONM, there were 83 eligible surgeons present and the questionnaire was answered voluntarily by 59 of them (71.08%). The responders' group consisted of 26 members of the GSES and 33 non-members. CONCLUSIONS: Most of the participants believed that there are many benefits in the use of IONM such as anatomically identifying the branches of the laryngeal nerve, monitoring their functionality or offering to patients' greater confidence to the surgery. Attention should be paid not to abandon the conventional techniques for identifying the laryngeal nerve, as IONM may not always be available. Evidence is needed to establish the proper indications for its application.

Preoperative Vitamin D Deficiency is a Risk Factor for Postthyroidectomy Hypoparathyroidism: A Systematic Review and Meta-Analysis of Observational Studies.

CONTEXT: Whether preoperative vitamin D deficiency (VDD) contributes to postoperative hypoparathyroidism (hypoPT) risk is unknown. OBJECTIVE: This work aimed to meta-analyze the best available evidence regarding the association between preoperative vitamin D status and hypoPT risk. METHODS: A comprehensive literature search was conducted in PubMed, CENTRAL, and Scopus databases, up to October 31, 2020. Study selection included patients undergoing thyroidectomy with preoperative vitamin D status and postoperative hypoPT data. Two researchers independently extracted data from eligible studies. Data were expressed as risk ratio (RR) with 95% CI. The I2 index was employed for heterogeneity. RESULTS: Thirty-nine studies were included in the quantitative analysis (61 915 cases with transient and 5712 with permanent hypoPT). Patients with VDD demonstrated a higher risk for transient hypoPT compared with those with preoperative vitamin D sufficiency (RR 1.92, 95% CI, 1.50-2.45, I2 = 85%). These results remained significant for patients with preoperative 25-hydroxyvitamin D concentrations less than or equal to 20 ng/mL (mild VDD; RR 1.46, 95% CI, 1.10-1.94, I2 = 88%) and less than or equal to 10 ng/mL (severe VDD; RR 1.98, 95% CI 1.42-2.76, I2 = 85%). The risk of permanent hypoPT was increased only in cases with severe VDD (RR 2.45, 95% CI, 1.30-4.63, I2 = 45%). No difference was evident in subgroup analysis according to study design or quality. CONCLUSION: Patients with preoperative VDD are at increased risk of transient hypoPT following thyroidectomy. The risk for permanent hypoPT is increased only for those with severe VDD.

The effect of intraoperative autofluorescence monitoring on unintentional parathyroid gland excision rates and postoperative PTH concentrations-a single-blind randomized-controlled trial.

PURPOSE: Intraoperative imaging of parathyroid glands (PGs) has been developed in order to reduce the risk of unintentional parathyroidectomy during total thyroidectomy. This novel modality is based on their intrinsic characteristic of autofluorescence (AF) after near-infrared light exposure. The aim of this study was to assess the effect of this method on the risk of unintentional PG excision (total or partial) during total thyroidectomy. METHODS: This was a single-blind, randomized-controlled trial including adult patients who underwent scheduled total thyroidectomy between December 2019 and March 2020. These patients were randomly allocated to two groups: one in which near-infrared autofluorescence imaging (NIRAF) was applied (NIR group) and one without NIRAF (NONIR group). Hormonal and biochemical assessment was performed pre- and 24-h postoperatively. AF findings and the number of PGs autotransplanted were recorded. RESULTS: One-hundred and eighty patients were eligible. Unintentional (total or partial) PG excision rates during total thyroidectomy in the NONIR (n = 90) and NIR (n = 90) groups were 28.9% [95% confidence interval (CI) 19.8-39.4%] and 14.4% (95% CI 7.7-22.1%), respectively (p = 0.02). Furthermore, NIR reduced the risk of parathyroid tissue presence in the specimen sent for pathology (relative risk 0.51, 95% CI 0.28-0.92; p = 0.02). However, the number of PGs identified by NIR could not predict the risk of postoperative hypoparthyroidism. CONCLUSIONS: NIRAF imaging during total thyroidectomy led to a significant reduction in PG excision rates. However, this modality did not result in the reduction of postoperative hypoparathyroidism or hypocalcemia risk.

MicroRNAs in Papillary Thyroid Cancer: What Is New in Diagnosis and Treatment.

INTRODUCTION: Papillary thyroid cancer (PTC) accounts for up to 80% of thyroid malignancies. New diagnostic and therapeutic options are suggested including innovative molecular methods. MicroRNAs (miRNAs) are nonprotein coding single-stranded RNAs that regulate many cell processes. The aim of the present study is to review the deregulated miRNAs associated with PTCs. METHODS: A bibliographic research was conducted, resulting in 272 articles referred to miRNAs and PTC. Regarding our exclusion criteria, 183 articles were finally included in our review. RESULTS: A remarkably large number of miRNAs have been found to be deregulated during PTC manifestation in the literature. The deregulated miRNAs are detected in tissue samples, serum/plasma, and FNA samples of patients with PTC. These miRNAs are related to several molecular pathways, involving genes and proteins responsible for important biological processes. MiRNA deregulation is associated with tumor aggressiveness, including larger tumor size, multifocality, extrathyroidal extension, lymphovascular invasion, lymph node and distant metastasis, and advanced tumor node metastasis stage. CONCLUSION: MiRNAs are proposed as new diagnostic and therapeutic tools regarding PTC. They could be essential biomarkers for PTC diagnosis applied in serum and FNA samples, while their contribution to prognosis is of great importance.

Comparing LigasureTM Exact dissector with other energy devices in total thyroidectomy: a pilot study.

BACKGROUND: Hemostasis is fundamental in thyroid surgery. The aim of this randomized active comparator-controlled study was to compare the effectiveness of LigasureTM Exact to previously existing sealing devices in patients undergoing thyroidectomy. METHODS: A total of 180 patients were randomly allocated into 4 groups according to the hemostatic device used: Focus Harmonic Scalpel® (FHS), LigasureTM Small Jaw (LSJ), Thunderbeat® (TB), and LigasureTM Exact (LE). We recorded epidemiologic and biochemical data, operative difficulty, postoperative vocal alteration and pain, complications, operating time, grams of gland excised per minute, and hospitalization. RESULTS: Differences (P<0.001) were observed concerning duration of surgery, operative difficulty and quantity of gland removed per minute. Concerning duration of surgery it is shorter for LE followed by TB and then by both FHS and LSJ. Concerning the quantity of thyroid removed per minute LE leads, followed by FHS and TB. The least amount of gland removed per minute is by LSJ. Finally, operative difficulty was less for LE, while it was equal for all other three devices. CONCLUSIONS: Energy devices are now frequently used in thyroidectomy. Comparing these devices seems to qualify them as equal concerning post-operative complications, hemostasis, and acute inflammatory reaction. However, LigasureTM Exact Dissector seems to have better results concerning duration of surgery, quantity of thyroid tissue removed per minute and intraoperative difficulty.

Energy-based devices in thyroid surgery-an overview.

In the mid-20th century Theodor Kocher standardized the conventional clamp-and-tie thyroidectomy, and a procedure that was banned or prohibited for so long was labeled as "extremely safe and efficient". Ever since, innovations and refinements in the field of thyroid surgery have focused on improving patient clinical outcome profiles, and offering patients procedures that are tailored to their concerns and desires without compromising the concepts of safety and efficacy. This led to a paradigm shift in thyroid surgery and the introduction of minimal access thyroid procedures. Unsurprisingly, this paralleled the constant technological evolution in surgical devices. Advanced energy-based devices were introduced into thyroid surgery more than a decade ago. Initially, their introduction was surrounded by sckepticism, and was considered a double-edged sword equally giving accolade and criticism. Ultimately, they have proved to be very useful in thyroid surgery, and pivotal to its evolution. In experienced hands, thyroid surgery performed using an advanced energy-based device is considered 'at least' as safe and effective as its conventional clamp-and-tie counterpart. Furthermore, it offers additional advantages that meet the best interest of the patient, surgeon, health care facility, and the society. This article provides an overview on the introduction of innovative technology into thyroid surgery.

Vitamin D and Acute Kidney Injury: A Two-Way Causality Relation and a Predictive, Prognostic, and Therapeutic Role of Vitamin D.

Background: Acute kidney injury (AKI) constitutes a multi-factorially caused condition, which significantly affects kidney function and can lead to elevated risk of morbidity and mortality. Given the rising scientific evidence regarding vitamin D's (VitD's) multisystemic role, the connection between AKI and VitD is currently being studied, and the complex relation between them has started to be unraveled. Methods: A systematic review had been conducted to identify the pathogenetic relation of VitD and AKI and the potential role of VitD as a biomarker and therapeutic-renoprotective factor. Results: From 792 articles, 74 articles were identified that fulfilled the inclusion criteria. Based on these articles, it has been found that not only can VitD disorders (VitD deficiency or toxicity) cause AKI but, also, AKI can lead to great disruption in the metabolism of VitD. Moreover, it has been found that VitD serves as a novel biomarker for prediction of the risk of developing AKI and for the prognosis of AKI's severity. Finally, animal models showed that VitD can both ameliorate AKI and prevent its onset, suggesting its renoprotective effect. Conclusion: There is a complex two-way pathogenetic relation between VitD disorders and AKI, while, concomitantly, VitD serves as a potential novel predictive-prognostic biomarker and a treatment agent in AKI therapy.

Do Near-Infrared Intra-Operative Findings Obtained Using Indocyanine Green Correlate with Post-Thyroidectomy Parathyroid Function? the Icgpredict Study.

OBJECTIVE: Postoperative hypoparathyroidism (hypoPT) still remains a significant complication after thyroidectomy. Intra-operative imaging modalities, such as near-infrared fluorescence using indocyanine green (ICG), may assist in identifying and preserving the parathyroid glands (PGs). The purpose of this study was to test the association between the intra-operative ICG staining scoring system and 24-hour postoperative parathyroid hormone (PTH) levels, as well as its capability for intra-operative PG identification. METHODS: This was a prospective study, recruiting patients scheduled for total thyroidectomy by the same surgical team, from December 2018 to April 2019. Intra-operative angiography was performed after infusion of ICG solution (5 mg). Two minutes later, images were acquired using the near-infrared system. RESULTS: Sixty patients fulfilled the eligibility criteria. The percentage of temporary postoperative hypoPT (defined as PTH <14 pg/mL) was 11.66%. No association between intra-operative ICG staining score (expressed as the number of PGs scoring <2 per patient) and 24-hour postoperative PTH (r = 0.011; P = .933) or serum calcium concentrations (r = 0.127; P = .335) was observed. There was also no correlation between the location of PGs scoring ≤2 and postoperative PTH (P = .257) or serum calcium levels (P = .950). Moreover, with regard to secondary endpoint, ICG correctly identified PGs in 98.3% of cases. ICG score was not affected by age, gender, duration of operation, or thyroid gland pathology. No allergic reactions attributed to ICG administration were observed. CONCLUSION: The intra-operative ICG staining scoring system did not predict 24-hour postoperative PTH and serum calcium levels. However, this modality may assist in intra-operative PG identification during a total thyroidectomy.

Should total thyroidectomies be performed by high-volume endocrine surgeons? A cost-effectiveness analysis.

PURPOSE: The increased experience of a thyroid surgeon reduces the risk of postoperative complications. However, whether it is also cost-effective is currently unknown. The aim of the present study was to compare cost-effectiveness of high-volume (HVS) with low-volume surgeons (LVS) when performing a total thyroidectomy. METHODS: This was a retrospective study, comparing the mean cost of a total thyroidectomy per patient, between HVS and LVS. This included the cost of surgical procedure and pre- and post-operative inpatient hospitalization. A threshold of 25 thyroidectomies/year was used to discriminate between HVS and LVS. RESULTS: Four-hundred and forty-one patients were classified into HVS and 342 into the LVS group. With regard to surgical complications, higher rates of temporary hypoparathyroidism and endangered airway were observed in the LVS than in the HVS group. The estimated total cost per patient was higher in the LVS compared with the HVS group [€1721 ± 396 ($1910 ± 439) versus €979 ± 68 ($1086 ± 487); p < 0.0001]. This cost remained higher when sub-analysis was performed for each surgical stage, involving either surgical procedure or pre- and post-operative inpatient hospitalization. Differences between LVS and HVS mainly involved the cost in surgical procedure (23% attributed to occupation of the operating room) and postoperative inpatient hospitalization (45% of the total thyroidectomy cost). CONCLUSION: Total thyroidectomy performed by a HVS seems to be cost-effective compared with the one conducted by LVS. This is mostly attributed to the lower rates of surgical complications, such as postoperative hypoparathyroidism and airway obstruction.

Endoscopic repair of anastomotic leakage after low anterior resection for rectal cancer: A systematic review.

INTRODUCTION: Anastomotic leakage (AL) after low anterior resection for rectal cancer is a severe complication. Except for re-operation, several endoscopic options have been proposed for the minimal invasive treatment of AL, including the endoluminal vacuum devices, tissue sealants and Over-The-Scope-Clip (OTSC) technique. The aim of the present review is to evaluate the effect of alternative treatment options for AL repair, by means of endoscopy. METHOD: A bibliographic search was performed in the international literature. Ten case reports and series were finally included, reporting 75 cases of endoscopic repair of AL. A descriptive statistical analysis and a systematic review were performed. RESULTS: The patients' mean age was 65.84 ± 9.92 years (95% CI: 61.70-68.76), the male-to-female ratio being 1.5:1. The mean diameter of the cavity was 5.17 ± 3.32 cm (95% CI: 4.03-6.31). The mean time until the diagnosis was 44.15 ± 105.91 days (95% CI: 13.39-74.90). Vacuum-assisted closure therapy was the most common technique (52%), followed by fibrin glue (25.3%) and OTSC (22.7%). As supplementary therapy, OTSC was applied in 8.3%, vacuum-assisted closure in 25%, endoclips in 4.2%, while fibrin glue was the most frequently used (62.5%). CONCLUSION: Endoscopic management of AL after low anterior resection is considered as an alternative to surgical treatment with promising results.

Proper handling of the pyramidal lobe in minimal access thyroid procedures.

The thyroid gland is a butterfly-shaped gland located in the lower part of the anterior surface of the neck between the fifth cervical and the first thoracic vertebra. Usually, it consists of two lateral, almost symmetrical lobes, the connective isthmus and the pyramidal lobe. The pyramidal lobe is a conical or cylindrical projection of the gland's parenchyma that extends superiorly to the thyroid cartilage or the hyoid bone. Most often, it originates from the isthmus and it is located to the left of the middle line. It can be absent in up to 50% of the cases. From the time of Theodor Kocher who performed the first classic thyroidectomies, we are now entering the era of minimal access thyroid surgery where new techniques are devised in order to provide a better cosmetic result. The presence of the pyramidal lobe is a classic example of an anatomic variation of the thyroid gland that plays an important role in the completeness of a total thyroidectomy, especially when the procedure is carried out for an autoimmune or malignant disease. The pyramidal lobe can also increase the complexity of minimal access procedures that are nowadays applied for the removal of the thyroid gland. The purpose of this article is to outline the importance of the pyramidal lobe in minimal access thyroid surgery.

Richter's hernia in a 5-mm trocar site.

We present an unusual case of a trocar site incision hernia at a 5-mm trocar port occurring approximately 2 weeks post-operatively after a laparoscopic cholecystectomy. The patient, in her mid-60s, reported diffuse abdominal pain, constipation, nausea and vomiting. An abdominal X-ray demonstrated dilated small bowel loops with gas-fluid levels. Abdominal computed tomography revealed the small bowel herniation through the 5-mm port site. Laparotomy confirmed a Richter's hernia of the small bowel in the fascia defect. This case highlights the necessity to examine and investigate any complaint post-operatively and deliberate its possible significance. Furthermore, it demonstrates that, even during a normal recovery period for a patient without any underlying disease or risk factors, a rare complication could still develop in a delayed fashion multiple days post-operatively from a laparoscopic procedure. High clinical suspicion is essential in order to avoid further deterioration of the patient condition and optimal treatment.

Parathyroid cysts: A review of 359 patients reported in the international literature.

BACKGROUND: Parathyroid cysts are lesions that represent 1-5% of neck masses. They are subdivided into two categories: functioning and non-functioning.The aim of the present review is to give a detailed account of all reported cases of parathyroid cysts in the literature and to analyze statistically the available data. METHODS: A bibliographic research was performed from 1905 until 2016. A database with the patients' characteristics was made and analyzed statistically. RESULTS: A total of 218 articles were found, reporting 359 cases of cysts. Mean age of patients was 49.24 y/o and the male/female ratio was 1:1.85. The most common locations were left thyroid lobe (113/358 patients, 31.6%), and superior mediastinum (69/358 patients, 19.3%), while the most common symptoms were neck mass (148/355 patients, 41.7%), compressive symptoms (73/355 patients, 206%) and hyperparathyroidism (62/355 patients, 17.5%). Non-functioning cysts were more frequent (220/357 patients, 61.6%). Regarding dimensions, mean diameter was 4.88 cm. Ultrasound and FNA are used for their diagnosis, while cystic fluid analysis may help the differential diagnosis. Recurrences were mentioned in 27/97 patients (27.8%) with available data. No deaths due to parathyroid cysts were mentioned in the literature. CONCLUSION: Parathyroid cysts should be taken into consideration in case of parathyroid dysfunction or asymptomatic neck mass. The surgeon's careful manipulations on the cyst are crucial for a definitive treatment.