Introduction: With the widespread use of high-quality cross-sectional imaging, the prevalence of incidentally discovered adrenal lesions has been increasing. Accurate preoperative size estimation of adrenal nodules is vital for diagnosis and decision-making, particularly for smaller nonfunctioning nodules, as these lend themselves to the need for decision-making and follow-up. There is controversy regarding the concordance between radiological and pathological sizes of adrenal lesions, with studies suggesting that computerized tomography (CT) scans underestimate the actual size across all size subgroups and the need to apply correction formulae to determine true size. The older published literature that evaluated size discrepancies between radiological assessment and final pathologies focused mostly on larger adrenal masses at first presentation because of the low incidence of cancer in smaller nodules. Additionally, these reports are over 2 decades old now, and therefore, the accuracy of assessment of the size of adrenal masses needs to be reviewed in light of more accurate current-day modern CT scanners. We wanted to determine if modern CT scans accurately predict the size of adrenal masses. Methods: Records of all patients who underwent adrenalectomy (n = 55) from 2014 to 2024 were examined. The largest nodule diameters reported on CT scans were compared with the final pathological size. A paired two-tailed t-test was used to compare sizes. Student's t-test and single-measure intraclass correlation were used to compare individual differences. A pretest two-tailed significance level of 0.05 and 95% confidence intervals (CI) were established. A p-value of <0.05 was regarded as statistically significant. Results: Computerized tomography scans showed adrenal nodule sizes of 47 (M:F of 27:20) patients between 7 and 94 mm (largest dimension). The histopathological sizes varied from 7 to 100 mm, with our analysis showing a size discrepancy of 0–17 mm (mean: CT size: 29.5 mm vs pathological size: 29.9 mm; p = 0.68). Subgroup analysis of nodules smaller than 3 cm showed that CT underestimated mean diameter (18.4 mm) as compared to pathological assessment (19.4 mm; p = 0.33), whilst for nodules larger than 3 cm, CT scan overestimated the size of adrenal masses at 49.9 mm as compared to 49.2 mm on pathological assessment (p = 0.67). A total of 16 of the 47 patients in our series showed a 0–1 mm discrepancy between CT scan and histopathological sizes. No statistically significant size differences were seen based on laterality and different diagnosis subgroups. Radiological sizes and final pathology measurements of cases showing a difference of 4 mm and above were evaluated using a single measure intraclass correlation for absolute agreement to compare dimensions between two measurement methods, which also showed a lack of any statistical significance for 17 (underestimated: 11, overestimated: six) such cases. Conclusion: No statistically significant difference between the sizes of adrenal nodules was detected between modern CT scanners and final pathology across all subgroups. This avoids the need to apply any correction formula, as mentioned in older studies.

Background: Recurrent laryngeal nerve palsy (RLNP) after total thyroidectomy (TT) is a potentially life-threatening complication with medicolegal implications and remains underestimated. Temporary bilateral RLNP can cause acute airway obstruction, while permanent palsy persisting beyond 6 months post-TT causes long-term morbidity. This cohort study determined the incidence and clinicopathological risk factors of unilateral and bilateral RLNP in patients undergoing TT. Patients and methods: Surgical candidates (n = 812, male: female = 110:702) were assessed for vocal cord (VC) status with videolaryngoscopy preoperatively, at 72 hours, and 6 months post-TT. Serum corrected calcium and parathormone were also assessed. Demographics, surgical time, intraoperative RLN identification, and histopathology were noted. Results: Unilateral and bilateral RLNP were observed in 8 (1%) and 4 (0.5%) patients preoperatively, 56 (6.9%) and 15 (1.8%) patients postoperatively, and 11 (1.4%) and 6 (0.7%) patients after 6 months. On multivariate analysis, major determinants of unilateral temporary palsy were Hashimoto's/lymphocytic thyroiditis [odds ratio (OR) = 7.4], malignancy (OR = 4.6), and Graves’ disease (OR = 3.9), while RLN nonvisualization (OR = 8.9) predicted bilateral palsy, each p < 0.05. Intraoperative RLN injury (OR = 38.1) independently predicted permanent palsy. In receiver operative characteristic analysis, surgical time and 48-hour calcium predicted RLNP at cut-points of 127 minutes and 1.94 mmol/L, respectively, with area under the curve ≥0.8, each p < 0.01. Conclusion: Routine pre- and postoperative videolaryngoscopy identified the true incidence of RLNP, which was relatively high. Intraoperative RLN identification improved long-term outcomes at an increased risk of temporary palsy. RLN nonvisualization, prolonged surgery, transient hypocalcemia, malignancy, Graves’ disease, and thyroiditis were determinants of temporary palsy, while RLN injury or transection independently predicted permanent RLNP post-TT. Clinical significance: Routine intraoperative RLN visualization during thyroidectomy and postoperative videolaryngoscopy should be implemented in clinical practice. It provides accurate information for clinical audit of performance, particularly in teaching hospitals. Malignancy, Graves’ disease, and thyroiditis, which carry an increased risk for RLNP, should be managed by high-volume surgeons.

Introduction: The 8th edition of the tumor node metastasis (TNM) system presents changes compared to the 7th edition. This study aimed to evaluate the behavior of recurrence and remission between stages of TNM 7th and 8th editions in a descriptive study of thyroid cancer. Materials and methods: Medical records of a level 4 clinic, thyroid cancer patients, over 18 years were reviewed. We restaged patients according to the TNM 8th edition; recurrence, remission, and excellent response (%) between TNM 7th and 8th editions were evaluated for concordance based on serum levels of thyroglobulin (Tg). Results: A total of 116 patients were evaluated. Of these, 84.5% (98/116) were women, with a mean age of 50.6 ± 16.5 at diagnosis. 92.2% (106/116) had papillary thyroid carcinoma. The mean radioactive iodine (RAI) activity was 63.4 ± 35.0 mCi. Using the TNM 8th edition, 82 patients (70.6%) were classified as stage I, 32 (27.5%) as stage II, 1 (0.9%) as stage III, and 1 (0.9%) as stage IV. After a median follow-up of 13.2 ± 2.8 months, 80.1% (93/116) maintained remission, 19.8% (23/116) had recurrence, and 43.9% (51/116) had an excellent response based on levels of Tg. The rates of remission, recurrence, and excellent response between TNM 7th and 8th editions were not statistically significant. Conclusions: About 72.4% of thyroid cancer patients were downstaged applying TNM 8th vs 7th edition. 100% of TNM 8th stage III–IV patients had a recurrence, and 100% of TNM 8th edition stage I and II patients had an excellent response.

Pheochromocytomas are rare neuroendocrine tumors. The catecholamine-secreting tumors make patients prone to life-threatening cardiovascular complications like uncontrolled hypertension, dysrhythmias, cardiac ischemia, and myocardial dysfunction. The goal of preoperative medication is to normalize blood pressure and heart rate, optimize glucose and electrolytes, and assess other end organ functions (cardiomyopathy) for better perioperative outcomes in patients. About one-fifth to one-third of patients lead to cardiovascular complications, which is associated with high morbidity and mortality. Rarely, these patients present with myocarditis/cardiogenic shock in a preoperative period, which needs urgent medical treatment and management. We present a case of a 47-year-old female scheduled to undergo adrenalectomy for pheochromocytoma, who presented with myocarditis preoperatively and was well managed with magnesium sulfate.