Primary hyperparathyroidism (PHPT) has become an asymptomatic disease in the Western world with the introduction of routine calcium screening. However, the same phenomenon is not observed in India. We have now systematically reviewed the status of PHPT in India. While there is a paucity of literature on PHPT from India when compared to Western countries, some information can be gleaned upon. Most patients present with symptomatic disease whereas very few are screen-detected cases (bone disease 77%, renal disease 36%, and 5.6% asymptomatic). Mean calcium, parathyroid hormone (PTH), and alkaline phosphate levels are high while Vitamin D levels are low. The average parathyroid gland weight is large and the majority being parathyroid adenomas (89.1%). Hungry bone syndrome (HBS) is common in the postoperative period. The disease-related mortality rate is 7.4%, recurrence 4.16%, and persistent disease 2.17%. We suggest that dedicated efforts are needed to pick up asymptomatic disease in India by methods like incorporating calcium estimation in the routine health check-up programs.

Morbidity after thyroidectomy is related to injuries to the parathyroids, recurrent laryngeal (RLN) and external branch of superior laryngeal nerves (EBSLN). Mostly these are due to variations in the surgical anatomy. In this study we analyse the surgical anatomy of the laryngeal nerves in Indian patients undergoing thyroidectomy. Materials and Methods. Retrospective study (February 2008 to February 2010). Patients undergoing surgery for benign goitres, T1, T2 thyroid cancers without lymph node involvement were included. Data on EBSLN types, RLN course and its relation to the TZ & LOB were recorded. Results. 404 thyroid surgeries (180 total & 224 hemithyroidectomy) were performed. Data related to 584 EBSLN and RLN were included (324 right sided & 260 left sided). EBSLN patterns were Type 1 in 71.4%, Type IIA in 12.3%, and Type IIB in 7.36%. The nerve was not seen in 4.3% cases. RLN had one branch in 69.34%, two branches in 29.11% and three branches in 1.36%. 25% of the RLN was superficial to the inferior thyroid artery, 65% deep to it and 8.2% between the branches. TZ was Grade 1 in 65.2%, Grade II in 25.1% and Grade III in 9.5%. 31.16% of the RLN passes through the LOB. Conclusions. A thorough knowledge of the laryngeal nerves and anatomical variations is necessary for safe thyroid surgery.

CSH after TT is multi-factorial, and a combination of factors (Hypocalcemia prediction score > 3) can be used to predict it so as to discharge patients within 24 hours after surgery.

Harlequin syndrome (HS) is known to be associated with conditions like brain stem infarcts and superior mediastinal neurinoma. However, it has not been reported in association with autoimmune hyperthyroidism. We report a case of exacerbation of unilateral sweating in a patient with HS following the onset of toxic goitre. Previous reports have suggested that a tortuous inferior thyroid artery can produce neurovascular compression of the sympathetic chain which was not observed in our patient. Autoimmune aetiology for HS needs to be explored. Increased sweating in hyperthyroid patients needs to be assessed properly so as to prognosticate appropriately.

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BACKGROUND AND OBJECTIVESThe clinical presentation of thyroglossal cyst and its variation from adult thyroglossal cyst has not been well studied. This study is to determine if the clinical presentation of thyroglossal duct cysts (TGDC) varies between children and adults and whether this affects the optimal management of individual cases.DESIGN AND SETTINGRetrospective study of all cases operated on for TGDC from February 2008 to November 2011 in a tertiary care teaching hospital.SUBJECTS AND METHODSThe gender, age, clinical presentation, radiologic imaging, surgical management, postoperative complications, and recurrence rates between the children (≤18 years) and adults (>18 years) were compared.RESULTSOf the 46 patients, 30 were adults and 16 pediatric; 46.5% of the adults and 74% of the children were females (P=.11). The mean (SD) age in adults was 40.5 (16.0) years, while in children the mean (SD) age was 9.0 (1.4) years, suggesting a bimodal presentation. Hypothyroidism was present in 6.7% of the adults and 56.3% of pediatric cases (P=.0004). Twenty percent of the adults had either an infected TGDC or fistulae, but none of the children had either infection (P=.0001). In both adults and children the duration of disease was significantly shorter in females. In the pediatric group, males had a larger compared to females (P=.006). The most common location of TGDC was the infrahyoid region. The Sistrunk procedure resulted in cure with no recurrences and complications in all.CONCLUSIONTGDC is commoner in adults with no sex predilection. Children have a shorter duration of disease. Male children present with larger cysts. Hypothyroidism is more common in pediatric TGDC. Infected TGDC and fistulae are uncommon in children. The Sistrunk procedure is adequate for both groups.

Figure 1. The characteristic soap bubble calcification.

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