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  • 1
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    Online Resource
    Is it time to reconsider lobectomy in low‐risk paediatric thyroid cancer?
    Wiley ; 2017
    In:  Clinical Endocrinology Vol. 86, No. 4 ( 2017-04), p. 591-596
    Details
    In: Clinical Endocrinology, Wiley, Vol. 86, No. 4 ( 2017-04), p. 591-596
    Abstract: Current guidelines recommend total thyroidectomy for nearly all children with well‐differentiated thyroid cancer ( WDTC ). These guidelines, however, derive from older data accrued prior to current high‐resolution imaging. We speculate that there is a subpopulation of children who may be adequately treated with lobectomy. Design Retrospective analysis of prospectively maintained database. Patients Seventy‐three children with WDTC treated between 2004 and 2015. Measurements We applied two different risk‐stratification criteria to this population. First, we determined the number of patients meeting American Thyroid Association ( ATA ) ‘low‐risk’ criteria, defined as disease grossly confined to the thyroid with either N0/Nx or incidental microscopic N1a disease. Second, we defined a set of ‘very‐low‐risk’ histopathological criteria, comprising unifocal tumours ≤4 cm without predefined high‐risk factors, and determined the proportion of patients that met these criteria. Results Twenty‐seven (37%) males and 46 (63%) females were included in this study, with a mean age of 13·4 years. Ipsilateral‐ and contralateral multifocality were identified in 27 (37·0%) and 19 (26·0%) of specimens. Thirty‐seven (51%) patients had lymph node metastasis (N1a = 18/N1b = 19). Pre‐operative ultrasound identified all cases with clinically significant nodal disease. Of the 73 patients, 39 (53·4%) met ATA low‐risk criteria and 16 (21·9%) met ‘very‐low‐risk’ criteria. All ‘very‐low‐risk’ patients demonstrated excellent response to initial therapy without persistence/recurrence after a mean follow‐up of 36·4 months. Conclusions Ultrasound and histopathology identify a substantial population that may be candidates for lobectomy, avoiding the risks and potential medical and psychosocial morbidity associated with total thyroidectomy. We propose a clinical framework to stimulate discussion of lobectomy as an option for low‐risk patients.
    Type of Medium: Online Resource
    ISSN: 0300-0664 , 1365-2265
    URL: Issue
    URL: Article
    DOI: 10.1111/cen.2017.86.issue-4
    DOI: 10.1111/cen.13287
    RVK:
    XA 10000
    Language: English
    Publisher: Wiley
    Publication Date: 2017
    detail.hit.zdb_id: 2004597-9
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  • 2
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    Online Resource
    Etiology and Pathophysiology of Hypoparathyroidism: A Narrative Review
    Wiley ; 2022
    In:  Journal of Bone and Mineral Research Vol. 37, No. 12 ( 2022-12), p. 2586-2601
    Details
    In: Journal of Bone and Mineral Research, Wiley, Vol. 37, No. 12 ( 2022-12), p. 2586-2601
    Abstract: The approach utilized a systematic review of the medical literature executed with specifically designed criteria that focused on the etiologies and pathogenesis of hypoparathyroidism. Enhanced attention by endocrine surgeons to new knowledge about parathyroid gland viability are reviewed along with the role of intraoperative parathyroid hormone (ioPTH) monitoring during and after neck surgery. Nonsurgical etiologies account for a significant proportion of cases of hypoparathyroidism (~25%), and among them, genetic etiologies are key. Given the pervasive nature of PTH deficiency across multiple organ systems, a detailed review of the skeletal, renal, neuromuscular, and ocular complications is provided. The burden of illness on affected patients and their caregivers contributes to reduced quality of life and social costs for this chronic endocrinopathy. © 2022 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).
    Type of Medium: Online Resource
    ISSN: 0884-0431 , 1523-4681
    URL: Issue
    URL: Article
    DOI: 10.1002/jbmr.v37.12
    DOI: 10.1002/jbmr.4714
    RVK:
    XA 52230
    Language: English
    Publisher: Wiley
    Publication Date: 2022
    detail.hit.zdb_id: 2008867-X
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  • 3
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    A Population‐Based Analysis of Outpatient Thyroidectomy: Safe and Under‐Utilized
    Wiley ; 2021
    In:  The Laryngoscope Vol. 131, No. 11 ( 2021-11), p. 2625-2633
    Details
    In: The Laryngoscope, Wiley, Vol. 131, No. 11 ( 2021-11), p. 2625-2633
    Abstract: Performance of thyroidectomy on an outpatient basis has gained popularity although many jurisdictions have not shifted their practice despite a strong safety profile. We sought to assess the uptake and safety of outpatient thyroidectomy in Ontario. Study Design Retrospective cohort study. Methods This was a population‐based retrospecive cohort of adult patients undergoing hemithyroidectomy or total thyroidectomy between 1993 and 2017 in Ontario, Canada. Outpatient surgery was defined as discharge home on the same day of surgery. Outcomes of interest include 30‐day all cause death, hematoma, emergency department use, and readmission. To adjust for confounding, propensity scores were calculated. Logistic regression models with inverse probability of treatment weighting (IPTW) were then used to estimate the exposure‐outcome relationship. Results The final cohort consisted of 81,199 patients: 8,442 underwent same day surgery and 72,757 were admitted. The proportion of patients undergoing outpatient thyroidectomy increased overtime (2.3% in 1993–1994 to 17.8% in 2016–2017). Factors associated with higher odds of outpatient thyroidectomy included: younger age, less material deprivation, less comorbidities, and higher surgeon volume. The absolute number of deaths (≤5) and hematomas (64, 0.8%) in the outpatient cohort was low. After IPTW adjustment, patients with outpatient management had lower odds of neck hematoma (OR 0.73[95CI% 0.58–0.93)], but higher odds of emergency department use (OR 1.67[95%CI 1.56–1.79] ). Conclusions Outpatient thyroidectomy is not associated with an increased mortality risk. Less than one in five patients undergo outpatient thyroidectomy in Ontario, despite a well‐established safety profile. Level of Evidence 3 Laryngoscope , 131:2625–2633, 2021
    Type of Medium: Online Resource
    ISSN: 0023-852X , 1531-4995
    URL: Issue
    URL: Article
    DOI: 10.1002/lary.v131.11
    DOI: 10.1002/lary.29816
    Language: English
    Publisher: Wiley
    Publication Date: 2021
    detail.hit.zdb_id: 2026089-1
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  • 4
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    Online Resource
    De novo thyroid cancer following solid organ transplantation—A 25‐year experience at a high‐volume institution with a review of the literature
    Wiley ; 2017
    In:  Journal of Surgical Oncology Vol. 115, No. 2 ( 2017-02), p. 105-108
    Details
    In: Journal of Surgical Oncology, Wiley, Vol. 115, No. 2 ( 2017-02), p. 105-108
    Abstract: We investigated the rate, stage, and prognosis of thyroid cancer in patients after solid‐organ transplantations, and compared this to the general population. Methods We performed a retrospective review of patients who developed thyroid cancer after a solid‐organ transplantation between January 1988 and December 2013 at a high volume transplant center. Standardized Incidence Ratio's (SIR) were calculated. Additionally, a systematic review of the literature was performed. Results A total of 10,428 patients underwent solid organ transplantation. Eleven patients (11.4 per 100,000 person‐years) developed thyroid cancer: six men and five women with a mean age at diagnosis of thyroid cancer of 58 years. Ten patients underwent surgery and had stage I thyroid cancer. One patient had recurrent disease after a mean follow‐up time of 78 months. The SIR varied between 0.75 and 2.3. Seventeen studies were included in the systematic review with a SIR ranging from 2.5 to 35. Conclusion Rate of thyroid cancer is not significantly higher in patients who underwent solid organ transplantation compared to general population. Stage at presentation and prognosis also appear to be similar to that of the general population. Post‐transplant screening for thyroid cancer remains debatable; however, when thyroid cancer is discovered, treatment should be similar to that of non‐transplant patients. J. Surg. Oncol. 2017;115:105–108 . © 2017 Wiley Periodicals, Inc.
    Type of Medium: Online Resource
    ISSN: 0022-4790 , 1096-9098
    URL: Issue
    URL: Article
    DOI: 10.1002/jso.v115.2
    DOI: 10.1002/jso.24495
    Language: English
    Publisher: Wiley
    Publication Date: 2017
    detail.hit.zdb_id: 1475314-5
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  • 5
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    Online Resource
    Incidental positive lymph nodes in patients with papillary thyroid cancer is independently associated with recurrent disease
    Wiley ; 2017
    In:  Journal of Surgical Oncology Vol. 116, No. 3 ( 2017-09), p. 275-280
    Details
    In: Journal of Surgical Oncology, Wiley, Vol. 116, No. 3 ( 2017-09), p. 275-280
    Abstract: Pathological examination occasionally reveals incidental central lymph nodes metastasis (iLNM) after thyroidectomy for patients with papillary thyroid cancer (PTC) who did not undergo compartment‐orientated lymphadenectomy. We aimed to investigate the risk of recurrence for patients with iLNM. Methods We conducted a retrospective review of all patients undergoing total thyroidectomy for PTC (January 2000 to January 2010). Patients with distant metastases, central‐ or lateral neck dissection and pre‐operative suspicious lymph nodes (by ultrasound or clinical examination) were excluded. The association between iLNM and recurrent disease was investigated using Kaplan‐Meier survival estimates and Cox proportional hazards analysis. Results 225/1000 patients had incidental nodes after total thyroidectomy for PTC. 183 were node‐negative and 42 had iLNM. Mean age was 46 years and 201 (89%) were women. Mean number of resected nodes was 2.3. Disease recurred in 8/183 (4.4%) of patients with N0 versus 7/42 (17%) with iLNM. After adjusting for other factors, iLNM was independently associated with recurrent disease (hazard ratio = 4.01 [95% CI 1.21–13.3] ). Conclusions Positive incidental lymph nodes are independently associated with recurrent disease in patients with PTC. These patients should therefore be monitored more carefully.
    Type of Medium: Online Resource
    ISSN: 0022-4790 , 1096-9098
    URL: Issue
    URL: Article
    DOI: 10.1002/jso.v116.3
    DOI: 10.1002/jso.24680
    Language: English
    Publisher: Wiley
    Publication Date: 2017
    detail.hit.zdb_id: 1475314-5
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  • 6
    Online Resource
    Online Resource
    Ultrasonography and Fine‐Needle Aspiration in Indeterminate Thyroid Nodules: A Systematic Review of Diagnostic Test Accuracy
    Wiley ; 2022
    In:  The Laryngoscope Vol. 132, No. 1 ( 2022-01), p. 242-251
    Details
    In: The Laryngoscope, Wiley, Vol. 132, No. 1 ( 2022-01), p. 242-251
    Abstract: Sonographic risk criteria may assist in further prognostication of indeterminate thyroid nodules (ITNs). Our aim was to determine whether sonographic criteria could further delineate the post‐test probability of malignancy in ITNs. Study Design Meta‐analysis of diagnostic test accuracy. Methods A systematic review of Web of Science, MEDLINE, EMBASE, and CINAHL was performed from inception to April 15, 2021. Eligible studies included those which reported ultrasonographic evaluations with the American Thyroid Association (ATA) or the Thyroid Imaging Reporting and Data System (TIRADS) in adult patients with ITNs. ATA or TIRADS were scored as low (negative) or high (positive) malignancy risk using a previously validated binary classification. Primary outcomes included pooled sensitivity, specificity, likelihood ratios, and diagnostic odds ratio for all sonographic criteria. Studies were appraised using Quality Assessment of Diagnostic Accuracy Studies and the data were pooled using bivariate random‐effects models. Results Seventeen studies were included in the analysis. For Bethesda III, ATA had a specificity (0.90, 95% confidence interval (CI): 0.74–0.94), but a sensitivity of 0.52 (95% CI: 0.25–0.77). Conversely, K‐TIRADS had the highest sensitivity (0.78, 95% CI: 0.62–0.89) with a specificity of 0.53 (95% CI: 0.31–0.74). Furthermore, American College of Radiology and EU TIRADS had specificities of 0.60 (95% CI: 0.36–0.80) and 0.81 (95% CI: 0.73–0.87) with sensitivities of 0.70 (95% CI: 0.37–0.90) and 0.38 (95% CI: 0.20–0.60), respectively. There were few studies with Bethesda IV nodules. Conclusions Though dependent on malignancy rates, Bethesda III nodules with low‐suspicion TIRADS features may benefit from clinical observation, whereas nodules with high‐suspicion ATA features may require molecular testing and/or surgery. Level of Evidence NA Laryngoscope , 132:242–251, 2022
    Type of Medium: Online Resource
    ISSN: 0023-852X , 1531-4995
    URL: Issue
    URL: Article
    DOI: 10.1002/lary.v132.1
    DOI: 10.1002/lary.29778
    Language: English
    Publisher: Wiley
    Publication Date: 2022
    detail.hit.zdb_id: 2026089-1
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  • 7
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    Surgeon Thyroidectomy Case Volume Impacts Disease‐free Survival in the Management of Thyroid Cancer
    Wiley ; 2023
    In:  The Laryngoscope Vol. 133, No. S4 ( 2023-05)
    Details
    In: The Laryngoscope, Wiley, Vol. 133, No. S4 ( 2023-05)
    Abstract: To assess the association between surgeons thyroidectomy case volume and disease‐free survival (DFS) for patients with well‐differentiated thyroid cancer (WDTC). A secondary objective was to assess a surgeon volume cutoff to optimize outcomes in those with WDTC. We hypothesized that surgeon volume will be an important predictor of DFS in patients with WDTC after adjusting for hospital volume and sociodemographic and clinical factors. Methods In this retrospective population‐based cohort study, we identified WDTC patients in Ontario, Canada, who underwent thyroidectomy confirmed by both hospital‐level and surgeon‐level administrative data between 1993 and 2017 ( N  = 37,233). Surgeon and hospital volumes were calculated based on number of cases performed in the year prior by the physician and at an institution performing each case, respectively and divided into quartiles. A multilevel hierarchical Cox regression model was used to estimate the effect of volume on DFS. Results A crude model without patient or treatment characteristics demonstrated that both higher surgeon volume quartiles ( p   〈  0.001) and higher hospital volume quartiles ( p   〈  0.001) were associated with DFS. After controlling for clustering and patient/treatment covariates and hospital volume, moderately low (18–39/year) and low (0–17/year) volume surgeons (hazard ratios [HR]: 1.23, 95% confidence interval [CI] : 1.09–1.39 and HR: 1.34, 95% CI: 1.17–1.53 respectively) remained an independent statistically significant negative predictor of DFS. Conclusion Both high‐volume surgeons and hospitals are predictors of better DFS in patients with WDTC. DFS is higher among surgeons performing more than 40 thyroidectomies a year. Level of Evidence 3 Laryngoscope , 133:S1–S15, 2023
    Type of Medium: Online Resource
    ISSN: 0023-852X , 1531-4995
    URL: Issue
    URL: Article
    DOI: 10.1002/lary.v133.S4
    DOI: 10.1002/lary.30276
    Language: English
    Publisher: Wiley
    Publication Date: 2023
    detail.hit.zdb_id: 2026089-1
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