Ozan Caliskan

Background: Graves' disease (GD) is associated with substantial impairment in health‐related quality of life (HRQoL) owing to a broad spectrum of systemic and neuropsychiatric symptoms. Although total thyroidectomy (TT) is an effective definitive treatment, the temporal pattern of postoperative symptom resolution and recovery of HRQoL has not been well characterized. This study aimed to evaluate the time course of symptom resolution and longitudinal changes in HRQoL following TT for GD. Methods: In this prospective observational study, 48 consecutive patients who underwent TT for GD between February 2025 and January 2026 were enrolled. All patients completed at least 6 months of postoperative follow‐up. Graves' disease–related symptoms were prospectively assessed before surgery and at scheduled postoperative visits using a standardized symptom assessment form. Time to symptom resolution was analyzed using Kaplan–Meier survival analysis. HRQoL was evaluated preoperatively and at 1 and 6 months postoperatively using the 36‐Item Short Form Health Survey (SF‐36). Results: The most common preoperative symptoms were irritability (72.9%), palpitations (70.8%), and heat/cold intolerance (70.8%). Kaplan–Meier analysis demonstrated that palpitations, tremor, heat/cold intolerance, diarrhea, and memory impairment resolved most rapidly, with a median time to resolution of 1 week. Anxiety, depression, ocular symptoms, pain, and irritability resolved more gradually, with a median time to resolution of 4 weeks. By the end of the 24‐week follow‐up, complete resolution was observed in all affected patients with palpitations, tremor, heat/cold intolerance, diarrhea, and pain. Significant improvements were observed across all SF‐36 domains over time (all p < 0.005). Improvements in physical functioning, bodily pain, vitality, role limitations due to physical health, and general health were evident early after surgery and continued through 6 months, whereas social functioning improved significantly only at the sixth postoperative month. Conclusions: TT was associated with rapid resolution of the classic manifestations of hyperthyroidism and significant, sustained improvements in both physical and psychosocial aspects of HRQoL. Defining the temporal pattern of postoperative recovery may improve patient counseling, optimize expectation management, and support shared decision‐making for patients with GD.

Objectives: The incidence of thyroid carcinoma in patients with Graves' disease (GD) has increased, with reported rates ranging from 1% to 21%. While thyroid nodules are a well‐established risk factor, the role of body mass index (BMI) in predicting malignancy in GD remains unclear. This study aimed to evaluate the prevalence of thyroid cancer in GD and identify independent predictors to improve preoperative risk stratification. Methods: We retrospectively analyzed 206 consecutive patients who underwent thyroidectomy for GD between 2016 and 2024. Demographic characteristics, preoperative biochemical parameters, and postoperative histopathological findings were reviewed. Patients were classified as malignant ( n = 42) or benign ( n = 164). All malignancies were papillary thyroid carcinoma. Results: The mean age was 42.3 ± 13.2 years, and 74.8% were female. Age was not associated with malignancy. Female sex was more prevalent in the malignant group (88.1% vs. 71.3%; p = 0.026). Patients with malignancy had significantly higher BMI (28.1 ± 4.2 vs. 25.5 ± 4.3 kg/m ² ; p = 0.001) and a higher rate of thyroid nodules (66.7% vs. 31.1%; p < 0.001). Biochemical parameters were not predictive. Multivariable analysis identified female sex (OR = 2.90, p = 0.045), thyroid nodules (OR = 3.27, p = 0.002), and BMI (OR = 1.13 per kg/m ² , p = 0.005) as independent predictors. BMI alone showed moderate discrimination (AUC = 0.67). Conclusion: Higher BMI is independently associated with thyroid malignancy in GD and may serve as a clinically relevant adjunctive risk marker. When combined with thyroid nodules and sex, BMI may enhance preoperative risk stratification and support more individualized surgical decision‐making in patients with GD. Level of Evidence: 3.

Purpose: Postoperative hypoparathyroidism is the most common complication after total thyroidectomy(TT). The clinical significance of incidental parathyroid glands(IP) detected in pathological examination of removed surgical material is still controversial. The aim of this study was to evaluate the clinical follow-up findings and risk factors of patients with IP. Methods: Postoperative pathology results and postoperative biochemical findings of patients who underwent TT±Central Neck Dissection(CND)/Lateral Neck Dissection(LND) between September,2020 and September,2023 in single institution were retrospectively evaluated. Patients with IP were divided into Group-1, and patients without IP were divided into Group-2. Patients of Group-1 were divided as Single IP and Double IP subgroups according to the number of IP. Results: The findings of a total of 412 patients were evaluated. IP was detected in 90(21.8%) of the patients. Postoperative hypoparathyroidism was more common in Group-1 at the 6th hour, 24th hour and 1st month postoperatively (69.7% vs. 31.7%, p < 0.0001; 61.1% vs. 27.7%, p < 0.0001, 26.2% vs. 12.2%, p = 0.002, respectively). Persistent hypoparathyroidism was observed at a rate of 5.3% in Group-2 and 11.5% in Group-1 (p = 0.041). Postoperative hypocalcemia was seen more frequently in Group-1 than in Group-2 at the 12th hour (34.4% vs. 23.2%, p = 0.031, respectively). There was no difference between Single IP vs. Double IP groups for the serum levels of Calcium and PTH. Among the risk factors evaluated for the detection of IP, in the univariance analysis, operation indications(p = 0.018), CND(p < 0.0001), surgeon experience(p = 0.016), thyroid gland volume(p = 0.02), preoperative serum TSH value(p = 0.031); in multivariance analysis, operation type ( ± CND) (OR:2.785; 95% CI: 1.175–6.605; p = 0.020) and operator experience between 10–20 years (OR: 0.117, 95% CI: 0.033–0.418, p = 0.001) and >20 years (OR: 0.254, 95%CI: 0.085–0.760, p = 0.014) were found significant compared to operators experienced <5 years. Conclusion: Patients with detected IP after total thyroidectomy have lower postoperative Calcium and PTH. Significant risk factors for the IP were low level of surgeon experience and undergoing CND.

Purpose: The anatomical variations of the recurrent laryngeal nerve (RLN) are common during thyroidectomy. We aimed to evaluate the risk of RLN paralysis in case of its anatomical variations, retrospectively. Methods: The patients with primary thyroidectomy between January 2016 and December 2019 were enrolled. The effect of age, gender, surgical intervention, neuromonitorisation type, central neck dissection, postoperative diagnosis, neck side, extralaryngeal branching, non-RLN, relation of RLN to inferior thyroid artery (ITA), grade of Zuckerkandl tubercle on vocal cord paralysis (VCP) were investigated. Results: This study enrolled 1070 neck sides. The extralaryngeal branching rate was 35.5%. 45.9% of RLNs were anterior and 44.5% were posterior to the ITA, and 9.6% were crossing between the branches of the ITA. The rate of total VCP was 4.8% (transient:4.5%, permanent: 0.3%). The rates of total and transient VCP were significantly higher in extralaryngeal branching nerves compared to nonbranching nerves (6.8% vs. 3.6%, p = 0.018; 6.8% vs. 3.2%, p = 0.006, respectively). Total VCP rates were 7.2%, 2.5%, and 2.9% in case of the RLN crossing anterior, posterior and between the branches of ITA, respectively (p = 0.003). The difference was also significant regarding the transient VCP rates (p = 0.004). Anterior crossing pattern increased the total and transient VCP rates 2.8 and 2.9 times, respectively. Conclusion: RLN crossing ITA anteriorly and RLN branching are frequent anatomical variations increasing the risk of VCP in thyroidectomy that cannot be predicted preoperatively. This study is the first one reporting that the relationship between RLN and ITA increased the risk of VCP.

Background: Laparoscopic surgery is usually associated with increased levels of intracranial pressure (ICP). The impact of positional changes on ICP measurements via optic nerve sheath diameter (ONSD) in bariatric surgery has yet to be studied. We aimed at evaluating the impact of positional changes on ONSD values during the laparoscopic sleeve gastrectomy. Methods: One hundred and four obese patients who underwent laparoscopic sleeve gastrectomy were recruited. Patients were allocated into two groups based on initiating pneumoperitoneum in supine (Group SP, n = 51) and reverse Trendelenburg (Group RTP, n = 53) positions. Intraoperative ONSD measurements were performed at different time points: T0 (baseline, before anesthesia induction), T1 (after endotracheal intubation), T2 (after pneumoperitoneum in Group SP and after positioning in Group RTP), T3 (after positioning in Group SP and after pneumoperitoneum in Group RTP), T4 (intraoperative), and T5 (after desufflation). ONSD measurements at different time points and postoperative nausea-vomiting are the primary outcomes. Results: ONSD values at T2 in Group RTP were significantly lower than in Group SP (p < 0.001). For T4 and T5 time points, there were significantly lower ONSD values in Group RTP (p = 0.004 and p = 0.040). Conclusions: Initiation of pneumoperitoneum in reverse Trendelenburg position resulted in significantly lower values of ONSD during laparoscopic bariatric surgery.

Intestinal neomucosa formation is a technique defined for the treatment of short bowel syndrome. This study evaluates the effect of glutamine and omega-3 fatty acids on the growth of intestinal neomucosa on the colonic serosal surface has been evaluated.Materials and methods: Thirty-two adult male Sprague-Dawley rats were randomly divided into 4 groups: sham, control, glutamine, and omega-3. Laparotomy was performed on all groups. For rats other than the sham group, a 1-cm full-thickness incision was made 4 cm proximal to the ileocecal valve, and colonic serosal surface was sutured as a serosal patch over these openings. By using the oral gavage technique, the glutamine group was ingested with 200 mg/kg/day of glutamine, and the omega-3 group was ingested with 100 mg/kg/day of omega-3 fatty acids. At the end of 14 days, the rats were euthanized, blood specimens were collected, and intestinal segments, including serosal patches, were excised.Results: Transforming growth factor-beta was significantly lower in the glutamine group compared to the control group. Similarly, fibroblast growth factor-2 was significantly lower in the glutamine group compared to the sham group. Intestinal neomucosa formation was observed in 100% of rats in the glutamine group. In the control and omega-3 groups, intestinal neomucosa formation was observed in 57.1% and 60% of rats, respectively. The inflammatory response, granulation tissue formation, and fibroblastic activity were more severe in the rats of the glutamine and omega-3 groups.Conclusion: The intestinal neomucosa formation is an experimental technique, and both glutamine and omega-3 fatty acids have the potential to positively affect inflammatory response, granulation tissue formation, and fibroblastic activity. Specifically, glutamine has a favorable effect on intestinal neomucosa formation.

Postoperative nausea and vomiting (PONV) is a frequent adverse effect following laparoscopic sleeve gastrectomy. Palonosetron with a standard dosing (75 μg) schedule has been questioned due to its low efficiency in obese patients. This study aimed to investigate the effectiveness and safety of the body weight-based dosing of palonosetron in managing PONV following laparoscopic sleeve gastrectomy. A single-center, prospective, double-blinded randomized study was conducted between August 2021 and December 2021. Patients who underwent laparoscopic sleeve gastrectomy were prospectively recruited in the study. One hundred patients were randomly divided into palonosetron (Group P) and ondansetron (Group O). The demographic and clinical variables were recorded. The primary outcome of the study was the incidence of PONV between the two groups during the hospitalization. The secondary outcomes were the number of rescue anti-emetic and analgesic medications and the Functional Living Index-Emesis scores. There were 50 patients in each group (Group P and Group O). There were significant differences in the scores of POVN, nausea, and vomiting favoring Group P. In Group P, the rate of patients using rescue anti-emetics was significantly lower. The incidence of complete response and proportion of patients with higher Functional Living Index-Emesis scores were significantly higher in patients using palonosetron. The use of palonosetron significantly reduced the incidence of PONV following laparoscopic sleeve gastrectomy. There was a significant improvement in the scores of Functional Living Index-Emesis in patients using palonosetron.