Background. Performing thyroid organ-sparing surgery primarily aims to preserve the quality of life. Organ-sparing surgery should be understood as hemithyroidectomy with mandatory removal of the isthmus and pyramidal lobe of the thyroid (if present). The choice of one or another concept of prescribing hormone replacement therapy remains debatable. The purpose of the study is to determine the proportion of patients who do not need replacement therapy with levothyroxine after organ-sparing surgery on the thyroid gland, among those who were prescribed replacement therapy immediately and one month after discharge from the hospital, as well as to analyze the factors causing hypothyroidism in people with hemithyroidectomy. Materials and methods. The first group included 82 patients with hemithyroidectomy who were prescribed replacement therapy immediately after discharge from the hospital. The second group included 61 patients with hemithyroidectomy. The administration of replacement therapy was postponed for one month. A month after the operation, clinical examinations and monitoring of thyroid-stimulating hormone and free thyroxine indicators were performed. Results. After one month of observation, 72 (87.8 %) of 82 patients in the first group continued to take levothyroxine, and 8 (13.1 %) of 61 persons in the second group began to take it. In the first group, there was a moderate direct correlation between thyroid-stimulating hormone level before surgery and levothyroxine dose one month after (Spearman’s correlation coefficient 0.304, p = 0.009). It was found that the chances of continuing taking levothyroxine after one month in the first group were 47 times higher than the chances of prescribing levothyroxine after one month in the second group. The proportion of patients in the first group who continued to take levothyroxine after one month was significantly higher than the proportion of patients in the second group who started taking levothyroxine after one month (87.8 ± 3.6 % vs. 13.1 ± 3.5 %, p < 0.0001, Fisher’s exact test). Conclusions. Among patients who were prescribed hormone replacement therapy immediately after hemithyroidectomy, 12.2 % did not need to continue taking levothyroxine after one month. Among persons in whom the administration of hormone replacement therapy was postponed for one month after hemithyroidectomy, 86.9 % of patients did not require the use of levothyroxine in the future. The volume of the thyroid remnant ≤ 3.67 cm3 can be considered a predictor for hypothyroidism occurrence in the future, with a high risk of prescribing hormone replacement therapy. The study of such a factor as the ratio of the remnant thyroid volume to the body weight did not provide statistically reliable data for its use as a predictor of hypothyroidism occurrence in the postoperative period.
Objective — to determine the level of parathyroid hormone (PTH) in the early postoperative period in patients after the thyroid gland surgery, which enables to define the risk of persistent postoperative hypoparathyroidism with clinical manifestations of hypocalcemia. Materials and methods. The study involved 303 patients who were operated in the Ukrainian Scientific and Practical Center for Endocrine Surgery, Transplantation of Endocrine Organ and Tissue due to various thyroid pathologies in the period of January, 2020 through June, 2021. The scope of the operation was thyroidectomy with/without lymph node dissection. The PTH level in blood serum was determined for all patients in the morning after the surgery (16 — 22 hours later). Clinical signs of hypocalcemia due to hypoparathyroidism (PTH level < 15 pg/ml) were revealed in 147 (48.5 %) subjects. Moving forward, such patients were examined for blood serum PTH levels after 3 months (first stage of examinations) and 6 months (second stage of examinations). Results. After 3 months, normalization of PTH levels and no clinical hypocalcemia manifestations were defined in 126 patients (85.7 %); 21 patients (14.3 %) had low PTH levels (< 15 pg/ml) with clinical manifestations of hypocalcemia. The use of ROC‑analysis to predict the normalization of PTH levels after 3 months revealed the cut‑off threshold 2.8 pg/ ml. After 6 months, normalization of PTH levels and no clinical hypocalcemia manifestations were defined in 136 (92.5 %) patients, whereas 11 (7.4 %) subjects demonstrated the reduced PTH levels and clinical manifestations of hypocalcemia. Results of ROC‑analysis prediction of the normalization of PTH levels after 6 months post‑surgery, the cut‑off threshold 1.6 pg/ml. Conclusions. Postoperative PTH levels > 2.8 pg/ml after 3 months after surgery and > 1.6 pg/ml after 6 months established to be a predictor of normalization serum PTH levels. A PTH level < 1.6 pg/ml can be considered a predictor of persistent hypoparathyroidism, and allows the physician to recognize patients with possible long‑term specific treatment.
Background. Medullary thyroid cancer is a topical disease that is often accompanied by metastases. The danger of this pathology requires timely and adequate surgery. Objective to assess the prognostic value and informativeness of some clinical indicators with the selection of the most optimal and reliable potential factors in the development of the mathematical equation for calculating the personal probability of detecting metastases of medullary thyroid cancer in the absence of clinical and instrumental signs in the preoperative stage. Materials and methods. Patients with medullary thyroid carcinoma with and without locoregional metastases participated in this study. To verify metastatic deposits, a pathomorphological study was performed using the TNM classification (UICC). StatPlus Pro v.7.6, EpiTools and MedCalc statistical calculators were used for statistical processing of results. Data Mining technologies were used to assess the degree of impact of potential predictors using the data mining add-on for MS Office. To assess the diagnostic value of the test, ROC analysis was performed and the corresponding characteristic curve was constructed with the calculation of the area under it (according to the DeLong method). For the operational characteristics of the tests, 95 % confidence interval was calculated according to the Wilson method. The results were considered statistically significant at p < 0.05. Results. Basal calcitonin, patient sex, multifocality, and total tumor size have been shown to be significant in the a priori of the medullary thyroid cancer metastatic risk assessment. These indicators can be used not only as predictors of unfavourable prognosis, but also as indicators for individual determination of the surgery scope. Conclusions. The method of binary logistic regression to assess latent metastasis showed lower sensitivity (0.77 vs 0.89) and higher specificity (0.90 vs 0.64) in contrast to the monofactorial prognosis based on preoperative calcitonin levels. Further improvement of the model requires additional analysis of erroneous test results in the applied training sample. The proposed prognostic model due to calculations in MS Excel allows you to easily and quickly obtain information, so it can be used as an additional diagnostic tool when choosing a method of surgical treatment.
Background. The sensitivity of the ultrasound method to determine lymph node metastases of papillary thyroid cancer (PTC) to the central lymphatic collector of the neck at the preoperative stage is low, 49 % only, therefore assessment of the factors leading to the prolongation of the process is of great importance in the development of surgical treatment tactics.Aim — to evaluate factors that increase the risk of locoregional metastases of papillary thyroid cancer and substantiate the advisability of systematic central neck dissection (SCND).Materials and methods. A retro-prospective single center study of the risk of PTC prolongation in the form of locoregional metastases (LRM) was carried out. The data of 514 patients operated for papillary thyroid disease were processed. The main group included 240 patients in whom LRM was found according to the results of histopathological examination (HPE), control group consisted of 274 patients without LRMsigns. The following signs were taken into account: multifocal lesions of the thyroid gland, the patients’age, gender, presence of thyroiditis, the size of the dominant tumor, invasion of adipose tissue. In order to substantiate the expediency of the SCND, retrospective processing of the data of 514 patients, operated from 2018 to 2020, was carried out for PTC, in which the presence of metastases was not cytologically confirmed at the preoperative stage (cN0).Results. The mean age of patients of the main group was lower than in the control group (p < 0.001). The median size of the primary tumor in patients of the main group was significantly higher than in the control group (p < 0.001). The men portion in the main group was significantly higher than in the control group, and the part of women vice versa (p < 0.05). Invasion of the tumor into the adipose tissue in the main group occurred almost twice as often (p < 0.01). The number of patients with multifocal lesions in both groups was practically the same and did not differ statistically (p > 0.05). Ipsilateral and contralateral localization of tumors in both groups did not differ significantly (p > 0.05). The presence of thyroiditis in the control group was higher than in the main group (p < 0.05). The diagnostic efficiency (DE) of accounting for the factor of invasion into adipose tissue was 64.8 %, tumor size over 1.3 cm — 66.7 %, age up to 47 years — 60.0 %. The frequency of detecting metastases with cN0 at the preoperative stage, according to HPE results, was 25.8 %.Conclusions. The reliability of preoperative imaging and diagnostic methods does not allow to ignore the likelihood of LRM and not perform SCND. According to the obtained data, in 25.8 % of casesmetastases were verified based on HPE owing to thesystematic central neck dissection. Male gender (p < 0.01), age of patients (p < 0.001), size of primary tumor (p < 0.001), invasion of adipose tissue (p < 0.01) can serve as predictors of the increased LRMPTC risk. The presence of invasion of adipose tissue (diagnostic efficacy 64.8 %), tumor size more than 1.3 cm (66.7 % DE) and age < 47 (60.0 % DE) increased the risk of LRMPTC. The presence of thyroiditis (the frequency of thyroiditis exposure in control group was higher than in the main group (p < 0.05)), contralateral lesions of the thyroid gland (p > 0.05), multifocal lesions (p > 0.05) cannot serve as reliable prognostic factors for the increased LRMrisk.
Background. The urgency of the study is due to the need to find effective methods for the diagnosis and treatment of medullary thyroid cancer. Basal calcitonin is a biomarker that determines both the presence of this disease and the level of metastasis. However, above-threshold calcitonin levels have a low prognostic value of the positive result. The study was aimed to analyze the importance of additional factors (besides calcitonin) in predicting the medullary thyroid cancer metastasis: age, sex, tumor focus, tumor volume (total volume). Materials and methods. A retrospective monocenter analysis was performed using the records of 194 patients treated for medullary thyroid cancer. The study involved 143 patients with primary forms of the disease. The required characteristics of the tumor were assessed in the postoperative period based on the pathomorphological examination. Results. The association between age and metastasis was not found, but a moderate relationship between sex and metastasis has been shown. The ratio of the chances of metastases detected in male patients is estimated at 3 : 1. It is proved that in the presence of tumor multifocality, the likelihood of metastasis detection increases. With an odds ratio of 2.368, the multifocal factor shows a weak but statistically significant strong association with the presence of metastases. Total tumor size is associated with metastasis. More than half (54.5 %) of cases are in the range of tumor sizes smaller than the selected cut-off threshold, with 16.7% metastasizing. On the other hand, the share of cases of exceeding the cut-off threshold (Cut-off = 1.9 cm; AUC = 0.703, Se = 0.745, Sp = 0.680) is 45.5 %, and metastasis is observed in 53.8 % of patients in this range. Conclusions. No association was found between age and metastasis. Male gender is a risk factor for metastasis. Multifocality is a risk factor for metastasis with a weak connection. The total size of the tumor is associated with metastasis with medium strength.
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