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When Is It Minimally Invasive?
ORIGINAL ARTICLE Incision Length for Standard Thyroidectomy and Parathyroidectomy When Is It Minimally Invasive? Laurent Brunaud, MD; Rasa Zarnegar, MD; Nobuyuki Wada, MD; Philip Ituarte, PhD; Orlo H. Clark, MD; Quan-Yang Duh, MD Hypothesis: Current techniques for open conven- parathyroidectomy (PϽ.001). It was 4.1 cm for bilateral tional thyroidectomy or parathyroidectomy have evolved parathyroid exploration, but was reduced to 3.2 and 2.8 to enable a shorter incision (main proposition), and the cm for unilateral (PϽ.001) and focal (PϽ.001) explora- length of the incision is influenced by objective factors. tions, respectively. By multiple regression analysis, thy- roid specimen volume and patient body mass index were Design: Case series. independent predictors of incision length in thyroidec- tomy. Extent of exploration and resident training level Setting: University referral center. were independent predictors of incision length in parathyroidectomy. Patients and Intervention: Retrospective study of the most recent 200 primary consecutive routine thyroid and Conclusions: Current techniques for open conven- parathyroid operations (excluding neck dissections). tional thyroidectomy or parathyroidectomy have evolved to enable a shorter incision. Thyroid volume, patient body Main Outcome Measures: The length of incision was mass index, extent of the planned parathyroid explora- routinely measured with a ruler before the incision. tion, and the resident clinical training stage are impor- Univariate and multivariate analysis was performed to dis- tant variables for incision length in open operation and tinguish variables affecting length of incision. should be taken into account when minimally invasive thyroidectomy and parathyroidectomy are evaluated. Results: Mean length of the incision was 5.5 cm for to- tal thyroidectomy, 4.6 cm for lobectomy, and 3.5 cm for Arch Surg. -
Thyroid Disease Update
10/11/2017 Thyroid Disease Update • Donald Eagerton M.D. Disclosures I have served as a clinical investigator and/or speakers bureau member for the following: Abbott, Astra Zenica, BMS, Boehringer Ingelheim, Eli Lilly, Merck, Novartis, Novo Nordisk, Pfizer, and Sanofi Aventis Thyroid Disease Update • Hypothyroidism • Hyperthyroidism • Thyroid Nodules • Thyroid Cancer 1 10/11/2017 2 10/11/2017 Case 1 • 50 year old white female is seen for follow up. Notices cold intolerance, dry skin, and some fatigue. Cholesterol is higher than prior visits. • Family history; Mother had history of hypothyroidism. Sister has hypothyroidism. • TSH = 14 (0.30- 3.3) Free T4 = 1.0 (0.95- 1.45) • Weight 70 kg Case 1 • Next step should be • A. Check Free T3 • B. Check AntiMicrosomal Antibodies • C. Start Levothyroxine 112 mcg daily • D. Start Armour Thyroid 30 mg q day • E. Check Thyroid Ultrasound Case 1 Next step should be • A. Check Free T3 • B. Check AntiMicrosomal Antibodies • C. Start Levothyroxine 112 mcg daily • D. Start Armour Thyroid 30 mg q day • E. Check Thyroid Ultrasound 3 10/11/2017 Hypothyroidism • Incidence 0.1- 2.0 % of the population • Subclinical hypothyroidism in 4-10% of the adult population • 5-8 times higher in women An FT4 test can confirm hypothyroidism 13 • In the presence of high TSH and FT4 levels in relation to the thyroid function TSH, low FT4 (free thyroxine) usually signalsTSH primary hypothyroidism12 Overt Mild Mild Overt Euthyroidism FT4 Hypothyroidism Thyrotoxicosis* Thyrotoxicosis vs. hyperthyroidism¹ While these terms are often used interchangeably, thyrotoxicosis (toxic thyroid), describes presence of too much thyroid hormone, whether caused by thyroid overproduction (hyperthyroidism); by leakage of thyroid hormone into the bloodstream (thyroiditis); or by taking too much thyroid hormone medication. -
Endocrine Surgery Goals and Objectives
Lenox Hill Hospital Department of Surgery Endocrine Surgery Goals and Objectives Medical Knowledge and Patient Care: Residents must demonstrate knowledge and application of the pathophysiology and epidemiology of the diseases listed below for this rotation, with the pertinent clinical and laboratory findings, differential diagnosis and therapeutic options including preventive measures, and procedural knowledge. They must show that they are able to gather accurate and relevant information using medical interviewing, physical examination, appropriate diagnostic workup, and use of information technology. They must be able to synthesize and apply information in the clinical setting to make informed recommendations about preventive, diagnostic and therapeutic options, based on clinical judgement, scientific evidence, and patient preferences. They should be able to prescribe, perform, and interpret surgical procedures listed below for this rotation. All Residents are expected to understand: 1. Normal physiology and anatomy of the thyroid glands. 2. Normal physiology and anatomy of the parathyroid glands. 3. Normal physiology and anatomy of the adrenal glands 4. Normal physiology of the pancreatic neuroendocrine cells. 5. Normal physiology of the pituitary gland. Disease-Based Learning Objectives: Hyperfunctioning Thyroid and Hypothyroid State: 1. Physiology of Grave’s disease and toxic goiter. 2. Management of a patient in hyperthyroid storm. 3. Medical and surgical treatment options for hyperthyroidism. 4. Physiology of Hashimoto’s thyroiditis and hypothyroidism. Thyroid Neoplasm: 1. Workup of a cold thyroid nodule. 2. Surgical management of papillary, follicular, medullary, and anaplastic thyroid carcinoma. 3. Adjuvant therapy for thyroid neoplasms. 4. Postoperative medical management and long-term follow-up of thyroid cancer. Hyperparathyroidism: 1. Diagnosis and work-up of hypercalcemia and primary, secondary, and tertiary hyperparathyroidism. -
HP Layout 1-21-04 to Print
Winter 2004 Department of Surgery healthpoints NewYork-Presbyterian ALL THE POSSIBILITIES OF MODERN MEDICINEE DIABETES Knowledge is Power ALSO IN THIS ISSUE: in a Complex Disease Approximately 17 million people in the United States have the disease. While an estimated 11.1 million have been diagnosed, 5.9 million people remain unaware that POSITRON EMISSION they have the condition. It is the fifth leading cause of death by disease in the U.S.— TOMOGRAPHY (PET) contributing to the deaths of more than 210,000 Americans each year. And its origin Approved for the Fight remains a mystery. Against Thyroid Cancer Diabetes is a complex disease which results from the body’s inability to create or page 2 properly use insulin. A hormone produced by the pancreas, insulin helps the body convert sugar, starches, and other food into energy. If the body doesn’t make enough insulin or if the insulin doesn’t work the way it should, glucose (sugar) cannot enter into the body’s cells. Instead, ISLET CELL glucose remains in the TRANSPLANTATION bloodstream, raising the The Search for a Cure blood sugar level and for Type 1 Diabetes ultimately causing page 7 diabetes. The signs of diabetes are often subtle, which can make detection of the disease a greater AIDING THE HEART challenge. Some Medicare Approves common symptoms LVADs as Destination include excessive thirst, Diabetes strikes people of all ages, races, and genders. Therapy frequent urination, page 8 unusual weight loss, increased fatigue, slow wound healing, extreme hunger, and blurry vision. However, individuals who experience none of these signs may still have diabetes. -
Analysis of the Role of Thyroidectomy and Thymectomy in the Surgical Treatment of Secondary Hyperparathyroidism
Am J Otolaryngol 40 (2019) 67–69 Contents lists available at ScienceDirect Am J Otolaryngol journal homepage: www.elsevier.com/locate/amjoto Analysis of the role of thyroidectomy and thymectomy in the surgical ☆ treatment of secondary hyperparathyroidism T Mateus R. Soares, Graziela V. Cavalcanti, Ricardo Iwakura, Leandro J. Lucca, Elen A. Romão, ⁎ Luiz C. Conti de Freitas Division of Head and Neck Surgery, Department of Ophthalmology, Otolaryngology, Head and Neck Surgery, Ribeirao Preto Medical School, University of Sao Paulo, Brazil ARTICLE INFO ABSTRACT Keywords: Purpose: Parathyroidectomy can be subtotal or total with an autograft for the treatment of renal hyperpar- Parathyroidectomy athyroidism. In both cases, it may be extended with bilateral thymectomy and total or partial thyroidectomy. Hyperparathyroidism Thymectomy may be recommended in combination with parathyroidectomy in order to prevent mediastinal Thymectomy recurrence. Also, the occurrence of thyroid disease observed in patients with hyperparathyroidism is poorly Thyroidectomy understood and the incidence of cancer is controversial. The aim of the present study was to report the ex- perience of a single center in the surgical treatment of renal hyperparathyroidism and to analyse the role of thyroid and thymus surgery in association with parathyroidectomy. Materials and methods: We analysed parathyroid surgery data, considering patient demographics, such as age and gender, and surgical procedure data, such as type of hyperparathyroidism, associated thyroid or thymus surgery, surgical duration and mediastinal recurrence. Histopathological results of thyroid and thymus samples were also analysed. Results: Medical records of 109 patients who underwent parathyroidectomy for secondary hyperparathyroidism were reviewed. On average, thymectomy did not have impact on time of parathyroidectomy (p = 0.62) even when thyroidectomy was included (p = 0.91). -
Use of Dexmedetomidine in a Parturient with Multiple Endocrine Neoplasia Type 2A Undergoing Adrenalectomy and Thyroidectomy
PRACTICE CASE REPORT Use of Dexmedetomidine in a Parturient With Multiple Endocrine Neoplasia Type 2A Undergoing Adrenalectomy and Thyroidectomy: A Case Report Amanda L. Faulkner, MD, Eric Swanson, MD, Thomas L. McLarney, MD, Cortney Y. Lee, MD, and Annette Rebel, MD * * * † * 08/15/2018 on BhDMf5ePHKav1zEoum1tQfN4a+kJLhEZgbsIHo4XMi0hCywCX1AWnYQp/IlQrHD3yRlXg5VZA8uqNuqWFo8dRhJiNZRTFLkCeIa0nEMHM2KbYm37VRaE3A== by https://journals.lww.com/aacr from Downloaded Dexmedetomidine is a selective α2-agonist, frequently used in perioperative medicine as anes- thesia adjunct. The medication carries a Food and Drug Administration pregnancy category C Downloaded designation and is therefore rarely used for parturients undergoing nonobstetric surgery. We are reporting the use of dexmedetomidine in the anesthetic management of a parturient undergoing minimally invasive unilateral adrenalectomy for pheochromocytoma during the second trimester from https://journals.lww.com/aacr of pregnancy. Additionally, because of the multiple endocrine neoplasia type 2A constellation with diagnosis of medullary thyroid cancer, the patient underwent a total thyroidectomy 1 week after the adrenalectomy. (A&A Practice. XXX;XXX:00–00.) exmedetomidine is a selective α2-agonist, fre- CASE REPORT by BhDMf5ePHKav1zEoum1tQfN4a+kJLhEZgbsIHo4XMi0hCywCX1AWnYQp/IlQrHD3yRlXg5VZA8uqNuqWFo8dRhJiNZRTFLkCeIa0nEMHM2KbYm37VRaE3A== quently used in perioperative medicine. It has A 34-year-old gravida 3 para 2 woman (body weight, 61 Dfound favor in this setting because of its sedative kg; -
Surgical Indications and Techniques for Adrenalectomy Review
THE MEDICAL BULLETIN OF SISLI ETFAL HOSPITAL DOI: 10.14744/SEMB.2019.05578 Med Bull Sisli Etfal Hosp 2020;54(1):8–22 Review Surgical Indications and Techniques for Adrenalectomy Mehmet Uludağ,1 Nurcihan Aygün,1 Adnan İşgör2 1Department of General Surgery, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey 2Department of General Surgery, Bahcesehir University Faculty of Medicine, Istanbul, Turkey Abstract Indications for adrenalectomy are malignancy suspicion or malignant tumors, non-functional tumors with the risk of malignancy and functional adrenal tumors. Regardless of the size of functional tumors, they have surgical indications. The hormone-secreting adrenal tumors in which adrenalectomy is indicated are as follows: Cushing’s syndrome, arises from hypersecretion of glucocorticoids produced in fasciculata adrenal cortex, Conn’s syndrome, arises from an hypersecretion of aldosterone produced by glomerulosa adrenal cortex, and Pheochromocytomas that arise from adrenal medulla and produce catecholamines. Sometimes, bilateral adre- nalectomy may be required in Cushing's disease due to pituitary or ectopic ACTH secretion. Adenomas arise from the reticularis layer of the adrenal cortex, which rarely releases too much adrenal androgen and estrogen, may also develop and have an indication for adrenalectomy. Adrenal surgery can be performed by laparoscopic or open technique. Today, laparoscopic adrenalectomy is the gold standard treatment in selected patients. Laparoscopic adrenalectomy can be performed transperitoneally or retroperitoneoscopi- cally. Both approaches have their advantages and disadvantages. In the selection of the surgery type, the experience and habits of the surgeon are also important, along with the patient’s characteristics. The most common type of surgery performed in the world is laparoscopic transabdominal lateral adrenalectomy, which most surgeons are more familiar with. -
Pituitary Apoplexy After Subtotal Thyroidectomy In
CASE REPORT Pituitary Apoplexy after Subtotal Thyroidectomy in an Acromegalic Patient with a Large Goiter Kazunobu Kato, Masakazu Nobori*, Yoshihiro Miyauchi, Motoki Ohnisi, Shyoji Yoshida, Shigeru Oya**, Shin Tomita** and Tomoshige Kino*** A case of pituitary apoplexy occurring after subtotal thyroidectomy in an acromegalic woman with a large adenomatous goiter is described. The patient had severe apnea because the large goiter was causing airway compression. Prior to the planned hypophysectomy, a subtotal thyroidectomy was performed to relieve tracheal stenosis. Shortly after the operation, the patient developed a headache that lasted for several days. The serum levels of growth hormoneand somatomedin-C spontaneously normalized seventeen days after this episode and have remained normal for two years. Pituitary apoplexy was thought to have caused the observed results without deterioration of the pituitary function. (Internal Medicine 35: 472-477, 1996) Key words: acromegaly, thyroid goiter, airway obstruction, diabetes mellitus Introduction and noticed enlargement of her hands. In February 1991, thirst and general fatigue developed and she consulted a local physi- Pituitary apoplexy is an uncommonevent, sometimes fatal, cian and was found to have diabetes mellitus and an abnormal but sometimes it induces complete reversal of acromegaly. It mass adjacent to the right side of the trachea, according to chest occurs in various situations, such as during the course of drug X-ray films. The patient, an unmarried desk clerk, was referred therapy for pituitary adenoma,during pregnancy, or after to us, with the complaint ofdyspnea that was moresevere lying cholecystectomy. However,there are no reports documenting down than in the sitting position. She had excessive nocturnal pituitary apoplexy after thyroidectomy. -
Ese-Ensat-Acc-Guidelines-13-5-2018
European Society of Endocrinology Clinical Practice Guidelines on the Management of Adrenocortical Carcinoma in Adults, in collaboration with the European Network for the Study of Adrenal Tumors Martin Fassnacht1,2*, Olaf M. Dekkers3,4,5, Tobias Else5, Eric Baudin7,8, Alfredo Berruti9, Ronald R. de Krijger10, 11, 12, 13, Harm R. Haak14,15, 16, Radu Mihai17, Guillaume Assie19, 20, Massimo Terzolo20* 1 Dept. of Internal Medicine I, Div. of Endocrinology and Diabetes, University Hospital, University of Würzburg, Würzburg, Germany 2 Comprehensive Cancer Center Mainfranken, University of Würzburg, Würzburg, Germany 3 Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, the Netherlands 4 Department of Clinical Endocrinology and Metabolism, Leiden University Medical Centre, Leiden, the Netherlands 5 Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark 6 Department of Internal Medicine, Division of Metabolism, Endocrinology and Diabetes, University of Michigan, Ann Arbor, MI, USA 7 Endocrine Oncology and Nuclear Medicine, Institut Gustave Roussy, Villejuif, France 8 INSERM UMR 1185, Faculté de Médecine, Le Kremlin-Bicêtre, Université Paris Sud, Paris, France 9 Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, Medical Oncology, University of Brescia at ASST Spedali Civili, Brescia, Italy. 10 Dept. of Pathology, Erasmus MC University Medical Center, Rotterdam, The Netherlands 11 Dept. of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands 12 Dept. of Pathology, Reinier de Graaf Hospital, Delft, The Netherlands 13 Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands 14 Department of Internal Medicine, Máxima Medical Centre, Eindhoven/Veldhoven, the Netherlands 15 Maastricht University, CAPHRI School for Public Health and Primary Care, Ageing and Long-Term Care, Maastricht, the Netherlands 16 Department of Internal Medicine, Division of General Internal Medicine, Maastricht University Medical Centre+, Maastricht, the Netherlands. -
Endocrine Emergencies
Endocrine Emergencies • Neuroendocrine response to Critical illness • Thyroid storm/Myxedema Coma • Adrenal Crisis/Sepsis • Hyper/Hypocalcemia • Hypoglycemia • Hyper and Hyponatremia • Pheochromocytoma crises CASE 76 year old man presents with urosepsis and is Admitted to MICU. He has chronic renal insufficiency. During his hospital course, he is intubated and treated With dopamine. Thyroid studies are performed for Inability to wean from ventilator. What labs do you want? Assessment of Thyroid Function • Hormone Levels: Total T4, Total T3 • Binding proteins: TBG, (T3*) Resin uptake • Free Hormone Levels: TSH, F T4, F T3, Free Thyroid Index, F T4 by Eq Dialysis • Radioactive Iodine uptake (RAIU); primarily for DDx of hyperthyroidism • Thyroid antibodies; TPO, Anti-Thyroglobulin, Thyroid stimulating immunoglobulins, Th receptor antibodies Labs: T4 2.4 ug/dl (5-12) T3U 40% (25-35) FTI 1.0 (1.2-4.2) FT4 0.6 (0.8-1.8) TSH 0.2 uU/ml (.4-5.0) Non-thyroidal illness • Hypothesis: NTI vs 2° Hypothyroidism –RT3 ↑ in NTI and ↓ in Hypothyroidism • Hypothesis: NTI vs Hyperthyroidism – TT3 ↓ in NTI and in ↑ Hyperthyroidism • 75 year old woman with history of hypothyroidism is found unresponsive in her home during a cold spell in houston. No heat in the home. • Exam: T° 95, BP 100/60, P 50, RR 8 • Periorbital edema, neck scar, no rub or gallop, distant heart sounds, crackles at bases, peripheral edema • ECG: Decreased voltage, runs of Torsade de pointes • Labs? Imaging? • CXR: cardiomegaly • Glucose 50 • Na+ 120, K+ 4, Cl 80, HCO3¯ 30 • BUN 30 Creat 1.4 • ABG: pH 7.25, PCO2 75, PO2 80 • CK 600 • Thyroid studies pending • Management: Manifestations of Myxedema Coma • Precipitated by infection, iatrogenic (surgery, sedation, diuretics) • Low thyroid studies • Hypothermia • Altered mental status • Hyponatremia • ↑pCO2 • ↑CK • ↑Catecholamines with ↑vascular resistance • Cardiac: low voltage, Pericardial effusion, impaired relaxation with ↓C.O. -
Hyperparathyroidism
HYPERPARATHYROIDISM Edited by Gonzalo Díaz-Soto and Manuel Puig-Domingo Hyperparathyroidism Edited by Gonzalo Díaz-Soto and Manuel Puig-Domingo Published by InTech Janeza Trdine 9, 51000 Rijeka, Croatia Copyright © 2012 InTech All chapters are Open Access distributed under the Creative Commons Attribution 3.0 license, which allows users to download, copy and build upon published articles even for commercial purposes, as long as the author and publisher are properly credited, which ensures maximum dissemination and a wider impact of our publications. After this work has been published by InTech, authors have the right to republish it, in whole or part, in any publication of which they are the author, and to make other personal use of the work. Any republication, referencing or personal use of the work must explicitly identify the original source. As for readers, this license allows users to download, copy and build upon published chapters even for commercial purposes, as long as the author and publisher are properly credited, which ensures maximum dissemination and a wider impact of our publications. Notice Statements and opinions expressed in the chapters are these of the individual contributors and not necessarily those of the editors or publisher. No responsibility is accepted for the accuracy of information contained in the published chapters. The publisher assumes no responsibility for any damage or injury to persons or property arising out of the use of any materials, instructions, methods or ideas contained in the book. Publishing Process Manager Romana Vukelic Technical Editor Teodora Smiljanic Cover Designer InTech Design Team First published April, 2012 Printed in Croatia A free online edition of this book is available at www.intechopen.com Additional hard copies can be obtained from [email protected] Hyperparathyroidism, Edited by Gonzalo Díaz-Soto and Manuel Puig-Domingo p. -
Hormonally Active Adrenocortical Carcinoma in a 24-Year Old Woman
ACS Case Reviews in Surgery Vol. 1, No. 1 Hormonally active adrenocortical carcinoma in a 24-year old woman AUTHORS: CORRESPONDENCE AUTHOR: AUTHOR AFFILIATIONS: Wachtel H1-4, Sadow PM2,4, Stathatos N3,4, Dr. Carrie Lubitz, MD, FACS 1 Massachusetts General Hospital, Dept. of Surgery, Lubitz CC1,4 Massachusetts General Hospital Div. of General & Endocrine Surgery, Boston, MA Yawkey Center for Outpatient Care, 7B 2 Massachusetts General Hospital, Dept. of 55 Fruit Street Pathology, Boston, MA Boston, MA 02114 3 Massachusetts General Hospital, Dept. of Phone: 617-643-9473 Medicine, Div. of Endocrinology, Boston, MA Fax: 617-724-3895 4 Harvard Medical School, Boston, MA Email: [email protected] Background Adrenal tumors are common and frequently identified incidentally; adrenalectomy is indicated for functional tumors, masses ≥4 cm, and cases where malignancy is suspected. Summary A 24-year old previously healthy woman presented with a six-month history of weight gain, amenorrhea, hirsutism, acne, and hypertension. Biochemical evaluation revealed hypercortisolism and elevated DHEA-S. Abdominal imaging demonstrated an 11 cm right adrenal mass, abutting the right hepatic lobe, right kidney, and inferior vena cava. The patient underwent open right adrenalectomy for the presumptive diagnosis of hormonally active adrenocortical carcinoma (ACC). The tumor was able to be mobilized from surrounding structures without requiring resection of adjacent organs. Pathological exam demonstrated a 728 g, 16.5 cm ACC with extensive necrosis, and Ki67 proliferation index of 35% and large vessel vascular invasion. Postoperatively, the symptoms of hypercortisolism, virilization, and hypertension resolved. The patient is currently undergoing adjuvant mitotane therapy and has no evidence of disease six months after surgery.