Carbonic anhydrase II (CA II) has an important role in thyroid hormone synthesis via regulating iodide (I-) transport across thyroidal cell membranes and the existence of autoantibodies against CA I and/or CA II have been shown in sera from patient with various autoimmune diseases such as Sjögren's Syndrome, Systemic Lupus Erythmatosus, type 1 diabetes, primary biliary cirrhosis and ulcerative colitis. The aim of this study was to investigate the presence of anti-CA I and CA II antibodies in autoimmune thyroid disease and the relationships between the autoantibodies and other clinical parameters. We studied 40 autoimmune thyroid patients (20 Hashimoto's thyroiditis, HT and 20 Graves' disease, GD ) and 21 healthy control subjects. Serum anti-CA I and CA II antibodies were screened by ELISA. Positive rate of anti-CA II (25%) antibody was significantly higher in GD patients as compared to HT patients and control subjects (p<0.05). There were no significant changes in positive rate of anti-CA I antibody. In addition, a significant correlation between serum anti-CA antibodies titers and other studied clinical parameters was not found. The results suggest that anti-CA II antibodies may be involved in the pathogenesis of GD.
Background The aim of this study was to evaluate a new surgical technique by the European Transoral Endoscopic Thyroidectomy Vestibular Approach (TOETVA) Study Group. Methods This study included 391 patients (47 [(12%]) male and 344 [(88%)] female) who had undergone endoscopic thyroid or parathyroid surgery via the vestibular approach between February 2016 and May 2022 at nine centers. The data were analyzed with regard to complications, surgery time and specimen retrieval. Results Overall, 376 (96.2%) TOETVA and 15 (3.8%) transoral endoscopic parathyroidectomy vestibular approach interventions were performed with an average surgery time of 145 (± 61.2) minutes and 509 nerves at risk. The specimens were retrieved via a transoral vestibular and retroauricular approach in 66 (16.9%) patients and via a transaxillary approach in 8 (2%). Benign histology including Grave’s disease was identified in 272 (69.6%) patients, 1 (0.3%) presented noninvasive follicular thyroid neoplasms with papillary-like nuclear features, and 103 (26.3%) showed differentiated thyroid carcinoma. Solitary parathyroid adenoma were removed in 15 (3.8%) patients. Conversion to open surgery was necessary in 13 (3.3%) and revision had to be performed in 2 (0.5%) patients. Transient recurrent laryngeal nerve palsy (RLNP) was present in 18 (4.6%) and permanent RLNP in 2 (0.5%) patients. Fifteen (3.8%) patients experienced transient hypoparathyroidism after thyroidectomy. No case of permanent hypoparathyroidism was observed. Postoperative surgical site infection occurred in 1 (0.3%) patient. Despite a higher rate of sensory and motor disorders and skin discoloration at discharge, permanent disorders were present in only 3 (0.8%) and 16 (4.1%) patients, respectively. Conclusion Our results show that transoral endoscopic surgery, performed by experienced endocrine surgeons, is a safe alternative to conventional thyroid surgery.
Purpose Curative treatment for primary hyperparathyroidism (PHPT) is parathyroidectomy (PTX) with removal of the hyperfunctioning gland(s). In an endemic goitre region, 35–78% of PHPT patients show concomitant thyroid disease. This study aimed to evaluate if 99mTc-sestamibi (MIBI)-positive thyroid nodules decrease sensitivity in regard to localising the hyperfunctioning parathyroid gland(s) in PHPT patients. Methods Within 5 years, 497 consecutive patients with biochemically proven PHPT were included in this study. The data was analysed retrospectively. Results In total, 198 patients underwent PTX with thyroid surgery and 299 patients underwent sole PTX. Sensitivity of MIBI scan for PTX with and without thyroid surgery was 72.1% and 73.6%, respectively. A statistically significant difference in sensitivity of ultrasound for PTX with and without thyroid surgery (57.0% and 70.9%, respectively) was observed (p = 0.029). Thyroid nodule histology did not have a significant effect on the MIBI scan. Unilateral neck exploration (UNE) was performed in 110 patients and bilateral neck exploration (BNE) in 177 patients. The probability of surgical conversion from UNE to BNE due to incorrect localisation was 1.733 times higher in patients with thyroid nodules. Conclusions Concomitant benign thyroid nodules did not influence MIBI sensitivity. No correlation between thyroid carcinoma and MIBI uptake was determined. However, MIBI detection of thyroid malignancy is important in patients initially being considered for minimal invasive parathyroidectomy. Sensitivity and positive predictive value of ultrasound were significantly lower in patients with thyroid nodules. The probability of conversion from UNE to BNE due to incorrect localisation was 1.733 times higher in patients with thyroid nodules.
ZusammenfassungEine Unterfunktion der Nebenschilddrüsen (postoperativer Hypoparathyreoidismus) ist die häufigste Komplikation in der Schilddrüsenchirurgie. Obwohl sie zumeist nur vorübergehend besteht, kann sie zu einer starken Einschränkung der Lebensqualität führen. Um die Rate an temporärem und permanentem Hypoparathyreoidismus zu vermindern, kann zur intraoperativen Erkennung der Nebenschilddrüsen die Nahinfrarot-Autofluoreszenz(NIRAF)-Bildgebung verwendet werden. Die Overlay-Ansicht stellt hierbei eine Weiterentwicklung der bisherigen NIRAF-Bildgebung dar, die durch die Überlappung von Nahinfrarot und Weißlicht entsteht und sich somit von der klassischen Schwarz-weiß-Ansicht unterscheidet.
ZusammenfassungDer konventionelle Kocher-Kragenschnitt in der Schilddrüsenchirurgie konnte in den letzten 15 Jahren so weit modifiziert werden, dass von einer minimal-invasiven offenen Chirurgie mit einer Operationsnarbe von 3–5 cm gesprochen werden kann. Dennoch besteht großes Interesse an einer Operationstechnik, bei welcher es zu keinen Narben im sichtbaren Bereich kommt. Die transoral-endoskopische Schilddrüsenchirurgie über den vestibulären Zugang (TOETVA) stellt ein solches Operationsverfahren dar, welches nach jahrelanger Erforschung alternativer Zugänge zur Entfernung der Schilddrüse und der Nebenschilddrüsen letztendlich 2015 im asiatischen Raum, in Thailand, etabliert werden konnte und vielversprechende Ergebnisse lieferte. Somit wird auch im europäischen Raum immer häufiger zu dieser Operationsmethode gegriffen. Zur Bergung größerer Präparate im Rahmen der endoskopischen Schilddrüsenchirurgie kann der transorale mit einem retroaurikulären Zugang kombiniert werden und umfasst somit ein größeres Indikationsspektrum. Nach Anlegen des transoralen Zugangs gestalten sich die restlichen Schritte der transoral-endoskopischen Thyreoidektomie ähnlich denen des offenen Eingriffs. Abgesehen von den auch in der offenen Schilddrüsenchirurgie bekannten Komplikationen, der Recurrensparese und dem Hypoparathyreoidismus, stellen die häufigsten postoperativen Komplikationen periorale, mandibuläre oder zervikale Dys- und Hypästhesien, Hämatome und Störungen des Nervus mentalis dar.
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