Serkan Teksoz

Aim: Hydrogen peroxide, locally produced during thyroid hormone synthesis, leads to oxidative stress in the thyroid gland. Defective repair of oxidative DNA lesions contributes to tumor development. This study aimed to understand the importance of DNA damage and repair on thyroid cancer development through the impact of the DNA repair gene OGG1 Ser326Cys polymorphism that has clinical significance in untreated patients with papillary thyroid cancer. Methods: The study was performed with 70 patients with papillary thyroid cancer and 73 volunteers as control. In lymphocytes, endogenous DNA damage, H2O2-induced DNA damage, and DNA damage after repair were determined by comet assay. The polymerase chain reaction-restriction fragment length polymorphism method was performed for OGG1 genotyping. Results: Endogenous DNA damage, H2O2-induced DNA damage, and DNA damage after repair were higher in patients with thyroid cancer than in the controls (P

Sarcoma is rarely seen in the thyroid gland and it is difficult to differentiate it from anaplastic thyroid carcinoma. Extraosseus osteosarcoma, a rare malignant nonepithelial neoplasia, can be seen in the thyroid gland, breast, soft tissue, and intraabdominal organs. A 31-year-old woman with a previous history of osteosarcoma of distal femur was presented with a constantly growing mass in her neck accompanied with progressive shortness of breath and worsening dysphagia. On physical examination, a 4 x 5 cm firm mass was palpated in the left lobe of her thyroid gland. Seven years ago, during her pregnancy, she was diagnosed with osteosarcoma of the distal femur and she received chemotherapy and radiotherapy after medical abortion. A year after her initial diagnosis, she underwent surgery for osteosarcoma. Two years later, pulmonary metastasis was detected incidentally in her control computed tomography. She was operated for pulmonary metastasis since there was no remission after chemotherapy. When she presented to the clinic with a neck mass, her thyroid function tests were within the normal range. On computed tomography scan, a 2.5 cm calcified lesion in left lobe of her thyroid gland was detected. Fine-needle aspiration of the thyroid mass displayed numerous discohesive pleomorphic tumors cells identical to osteosarcoma cells seen on her previous knee biopsy specimen. On positron emission tomography, a 3 x 3 x 4.5 cm hypermetabolic lesion with pathologic 18F-FDG uptake on the left side of her neck in thyroid cartilage level was detected. A bilateral total thyroidectomy was performed. The patient was discharged without any complications.

Objective: Hypocalcemia is a common complication following thyroidectomy. Vitamin D plays a critical role in calcium regulation. This study aimed to investigate the relation between preoperative vitamin D levels and postoperative hypocalcemia. Material and Methods: We conducted a retrospective analysis of 899 patients who underwent total thyroidectomy at our center between 2015 and 2020 due to multinodular goiter, atypia of undetermined significance, follicular lesions, and follicular neoplasia. Patients were excluded if they had a history of thyroid surgery, Graves’ disease, renal failure, incidental parathyroidectomy, or received calcium or vitamin D supplementation before surgery. The patients were divided into two groups based on their preoperative vitamin D levels: Group 1 (n= 240) with levels Results: The female-to-male ratio was 3.22, with an average vitamin D level of 18.94 ± 13.28 ng/mL. Vitamin D levels were significantly lower in women compared to men (p= 0.001). In Group 1, the rates of asymptomatic and symptomatic postoperative hypocalcemia were 17.1% and 6.7%, respectively; while in Group 2, these rates were 11.2% and 3.2% (p= 0.020). The average preoperative vitamin D level was 14.79 ± 9.4 ng/mL in patients who developed hypocalcemia and 19.12 ± 13.4 ng/mL in those who remained normocalcemic, with this difference being statistically significant (p= 0.026). Conclusion: In our study, we found that preoperative vitamin D level below 10 ng/mL is associated with increased risk of hypocalcemia following thyroidectomy.

Purpose: Concurrence of medullary and papillary thyroid carcinoma (MTC and PTC) represents less than 1% of all thyroid malignancies. We aimed to reveal the demographic and clinical characteristics of this rare pathology and to evaluate the effect of the same or contralateral lobular localization of these two malignancies in clinical and laboratory features. Evaluation of progression-free survival (PFS) in current pathology is one of the important features of our study. Methods: All patients diagnosed with simultaneous MTC and PTC after thyroidectomy were evaluated retrospectively. Data on the following variables were recorded: age, gender, tumor localization (ipsilateral lobe located MTC and PTC-Group I, contralateral lobe located MTC and PTC-Group II), tumor size, cervical lymph node metastasis, distant metastasis, tumor stage, postoperative basal calcitonin, carcinoembryonic antigen, thyroglobulin (Tg), and anti-Tg values. In all our cases, since MTC progressed before PTC, progression was accepted as serum calcitonin values exceeded 150 pg/mL. Results: Groups were formed as follows: Group I, four cases where MTC and PTC were localized in different foci in the same lobe; Group II, nine cases where they were localized in different lobes. There was only one case in which two tumors were located in the same focus. The case with dual differentiation was included in Group I (35. 7%). When the PFS of the two groups were compared, no statistically significant difference was found (P = 0.87). Conclusions: As a result of this analysis, the location of the simultaneously detected PTC in the same or different lobes with the MTC does not make a significant difference in clinical and laboratory features.

Metastasis is the second most common type of adrenal gland mass. In patients undergoing follow-up for nonadrenal malignancy, adrenalectomy is performed when metastasis to adrenal gland is suspected on the basis of positron emission tomography–computed tomography (PET-CT) imaging. This study investigated the efficacy of PET-CT in the discrimination of metastatic lesions from nonmetastatic lesions in the adrenal glands. In this multicentric study, data was collected from enrolled centers. Forty-one patients who underwent surgery for suspected adrenal metastases were evaluated retrospectively. The following data types were collected: demographic, primary tumor, maximum standardized uptake value of adrenal mass (a-SUVx) and detectability in computed tomography and/or magnetic resonance imaging, and specimen size and histopathology. Six patients were excluded due to unavailability of PET-CT reports and 4 for being primary adrenal malignancy. The rest were divided into 2 groups (metastatic: n = 17, 55% and nonmetastatic: n = 14, 45%) according to histopathology reports. There was no statistical difference between the analyzed values, except the a-SUVx (P < .05). The a-SUVx cutoff value was defined as 5.50 by receiver operating characteristic curves and compared with literature. There was no statistical difference when each group was divided as low and high (P > .05). It was found that PET-CT was able to discriminate metastatic lesions from primary benign lesions (P = .022). PET-CT can discriminate primary benign lesions and metastatic lesions by cutoff 5.5 value for a-SUVx.

Background: The patient’s position is important for ensuring patient comfort and preventing complications after thyroidectomy. Objectives: This study was carried out to determine the effects of different degrees of head-of-bed elevation (HOBE) on the respiratory pattern and drainage following thyroidectomy and to provide suggestions for evidence-based clinical practice. Methods: The sample of this prospective, parallel arm, randomized controlled trial included 114 patients undergoing thyroidec- tomy in a university hospital in Turkey. The patients were randomly assigned (1:1:1) to supine 0° (baseline), 30° and 45° HOBE groups. Respiratory pattern including respiratory rate (RR), peripheral oxygen saturation (SpO2) and dyspnea, and drainage including amount of drainage and hematoma formation were evaluated at the 1st, 2nd, 3rd and 4th hours following thy- roidectomy. Results: The majority of the patients (83.3%) were female and 84.2% had undergone total thyroidectomy. The mean RR (18.47, 95% CI=17.85-19.09) of the patients in the supine 30° HOBE group at the 1st hour was significantly higher than that of the patients in the supine 0° group (17.32, 95% CI=16.88-17.76; p0.05). The amount of drainage was significantly higher in the supine 0° group at the 2nd hour than that of the patients in the supine 45° HOBE group (5.92±5.18; 3.34±5.56 respectively; p<0.05). None of the patients in the groups had hematoma formation. While no patient in the supine 30° HOBE group had dyspnea, dyspnea occurred in 9 patients in the supine 0° group and in 3 patients in the supine 45° HOBE group. Conclusion: This study showed that different HOBE positions resulted in clinically insignificant changes on the RR and amount of drainage during the first 4 hours following thyroidectomy but did not affect SpO2 value. Keywords: Head-of-bed elevation; thyroidectomy; controlled trial.

Background: Various techniques are used to detect intraoperative bleeding points in thyroid surgery. We aimed to assess the effect of increasing peak airway pressure to 30, 40 and 50 cm H₂O manually in detecting intraoperative bleeding points. Methods: One hundred and 34 patients scheduled for total thyroidectomy were included to this prospective randomised controlled clinical study. We randomly assigned patients to increase peak airway pressure to 30, 40 and 50 cm H₂O manually intraoperatively just before surgical closure during hemostasis control. The primary endpoint was the rate of bleeding points detected by the surgeon during peak airway pressure increase. Results: The rate of detection of the bleeding points was higher in 50 cm H₂O Group than the other two groups (15.9 vs 25.5 vs 40%, P = 0.030), after pressure administration, the HR, SpO₂, and P peak were similar between groups (P = 0.125, 0.196, 0.187, respectively). The median duration of the bleeding point detection after the pressure application was 21.82 s in 30 cm H₂O, 25 s in 40 cm H₂O, and 22.50 s in 50 cm H₂O groups. Postoperative subcutaneous hematomas or hemorrhages requiring surgery were not seen in any patient. Conclusions: Manually increasing peak airway pressure to 50 cm H₂O during at least 22.50 s may be used as an alternative way to detect intraoperative bleeding points in thyroid surgery. Clinical trial registration: NCT03547648. Registered 6 June2018

Uslu-Beşli L, et al. Korean J Radiol. 2020 Jan;21:e3. https://doi.org/10.3348/kjr.2019.0268

Background Laparoscopic adrenalectomy (LA) is currently recognized as the gold standard for the treatment of most adrenal lesions, with a high safety and feasibility profile. This study aimed to present the extensive experience of a specialized endocrine surgeon in LA in a relatively large series of patients. Methods A total of 116 LAs performed from June 2009 to 2018 were evaluated in terms of adrenal pathologies, perioperative management, complications, conversions, tumor size, operative time, and learning curve. The learning curve was assessed using the cumulative sum (CUSUMOT) technique. Results Of 116 LAs, 107 (92.2%) were completed successfully, 77 (72%) of which were for Cushing’s syndrome (n = 43, 55.8%), pheochromocytoma (n = 26, 33.8%), and Conn’s syndrome (n = 8, 10.4%). Conversion was required in 9 cases (7.8%), the most common cause being limited space complicating dissection (n = 3). The mean operative time for successful LAs (unilateral 85, bilateral 22) was 74.7 min (range 40–210 min) and the mean hospital stay was 1.7 days (range 1–5 days). Gender, tumor size and body mass index were found to have no significant relationship with the operative time (p > 0.05). Postoperative normalization in hormone profiles was obtained in all patients but one. Aside from grade-I port-site infections in four patients (3.7%), no postoperative major complications and 30-day mortality were observed. On the CUSUMOT graph, the learning period covered the first 34 operations. Conclusions Laparoscopic adrenalectomy is safe and advantageous, but requires a dedicated team involving experienced endocrine surgeons who have achieved competency after completion of the learning curve.

Of all ingested foreign bodies, 2.4% comprise of sewing needles. Through perforation of gastrointestinal tract, which occurs in 1% of cases, they can migrate into the liver and pancreas. Foreign bodies in pancreas should be considered in the differential diagnosis of chronic abdominal pain. Computed tomography scans provide valuable information for the localization of the lesion, which guide the surgeon during the operation. Secondary to foreign bodies that migrate to the pancreas, complications with high mortality such as pancreatitis, pseudoaneurysm, and pancreas abscess can be seen. Thus, for this patient group, diagnostic laparoscopy is recommended, considering its advantages of decreased postoperative pain, decreased wound infection, and faster recovery time. Here we present a case of a 23-year-old female patient, from whom an ingested needle that migrated from the back wall of the stomach to the pancreas was extracted by laparoscopic surgery.