World Journal of Endocrine Surgery

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2019 | May-August | Volume 11 | Issue 2

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Original Article

Murat Ö Kiliç, Ali Sapmaz

Effect of Inadvertent Parathyroidectomy on Hypocalcemia after Thyroidectomy

[Year:2019] [Month:May-August] [Volume:11] [Number:2] [Pages:4] [Pages No:37 - 40]

Keywords: Inadvertent parathyroidectomy, Postoperative hypocalcemia, Total thyroidectomy

   DOI: 10.5005/jp-journals-10002-1256  |  Open Access |  How to cite  | 


Introduction: Inadvertent parathyroidectomy (IP) is not a rare condition following total thyroidectomy. However, the clinical relevance of IP is unclear. Aim: The aim of this study was to investigate the clinical effect of IP on postoperative hypocalcemia in patients undergoing total thyroidectomy. Materials and methods: A total of 214 patients who underwent total thyroidectomy for benign or malignant thyroid disease were included in the study. All patients were classified as patients without IP and those with IP. The two groups were then compared between each other in terms of postoperative hypocalcemia and other clinicopathological findings. Results: There were 32 (15%) males and 182 (85%) females, with a mean age of 50.2 years. IP was found in 38 (17.8%) patients. Both postoperative biochemical (p = 0.001) and symptomatic (p = 0.000) hypocalcemia were found to be more common in patients with IP compared with those without IP. Patients with IP had a significantly higher incidence of permanent hypocalcemia in comparison to those without IP (p = 0.000). Conclusion: IP is positively correlated with both transient and permanent hypocalcemia after total thyroidectomy. Careful surgical approach is of great importance to reduce the incidence of this disturbing complication.


Original Article

Kriangsak Jenwitheesuk, Kamonwan Jenwitheesuk, Suriya Punchai, Jakrapan Wittayapairoch

Treatment Outcomes of Transperitoneal Laparoscopic Adrenalectomy in Patients with Functional Adrenal Gland Tumors

[Year:2019] [Month:May-August] [Volume:11] [Number:2] [Pages:5] [Pages No:41 - 45]

Keywords: Functional adrenal gland tumor, Transperitoneal approach, Transperitoneal laparoscopic adrenalectomy, Treatment outcomes

   DOI: 10.5005/jp-journals-10002-1258  |  Open Access |  How to cite  | 


Background: Functional adrenal gland tumor is a tumor that presents with abnormal producing excess aldosterone hormone and affects the functionality of renin angiotensin aldosterone system which can be treated by laparoscopic adrenalectomy. The adrenal surgery can be approached in many techniques, such as transperitoneal and retroperitoneal approach. Materials and methods: The inclusion criterion was all patients who had diagnosed with functional adrenal gland tumor underwent laparoscopic adrenalectomy since 2011–2017 at the Srinagarind Hospital, the Faculty of Medicine, Khon Kaen University, Thailand. Patients with a lesion more than 8 cm and patients with suspected metastatic lesions were excluded. Baseline clinical features, results of clinical evaluation, pathology, operative reports, and outcome of treatment were recorded. Results: Seventy patients were treated with transperitoneal laparoscopic adrenalectomy. There were 18 men and 52 women. Mean age was 46.30 ± 11.88 years. All patients were presented with hypertension and 7 cases were presented with hypokalemia. Major histologic finding was adenoma. The mean operating time was 99.29 ± 45.66 minutes, estimated blood loss 82.36 ± 202.14 mL, and mean postoperative length of stay was 3.80 ± 2.34 days. Complications were occurred in six patients. Conclusion: Transperitoneal laparoscopic surgery had good outcomes for functional adrenal gland tumor.


Original Article

Russel Krawitz, Anthony Glover, Ahmad Aniss, Mark Sywak, Leigh Delbridge, Stan Sidhu

Pneumothorax and Pneumomediastinum with Subcutaneous Emphysema Following Parathyroidectomy and Thyroidectomy

[Year:2019] [Month:May-August] [Volume:11] [Number:2] [Pages:3] [Pages No:46 - 48]

Keywords: Parathyroid, Parathyroidectomy, Pneumomediastinum, Pneumothorax, Subcutaneous emphysema, Thyroidectomy, Valsalva maneuver

   DOI: 10.5005/jp-journals-10002-1259  |  Open Access |  How to cite  | 


Background: Thyroidectomy and parathyroidectomy have become safe procedures with low postoperative morbidity and complication rates—hypocalcemia, RLN injury and postoperative hematoma being the most common. In our institution the risk of hematoma following sutureless technique is 1%.1 Pneumothorax following thyroidectomy and parathyroidectomy has only been reported a few times in the literature without a clear etiology. Materials and methods: Retrospective review of the complication database of the Royal North Shore Endocrine Surgical Unit from 2000 to 2018. Results: Three cases of pneumothorax or pneumomediastinum were found following thyroidectomy or parathyroidectomy with an incidence of 0.02%. A recent case of pneumomediastinum and subcutaneous emphysema following an open parathyroidectomy was attributed to the Valsalva maneuver at the end of the case. Two further cases of pneumothorax at our institution occurred post parathyroidectomy. In both cases, a laryngeal mask was used and Valsalva maneuver (VM) was not performed. All cases were managed conservatively and made a full recovery. Conclusion: The combination of pneumomediastinum with subcutaneous emphysema in the most recent case is likely from a ruptured bulla secondary to Valsalva maneuver or lung injury during mediastinal dissection. This likely caused an air leak with gas tracking up into the neck from the mediastinum. The probable etiology in the other two cases is a negative mediastinal pressure created from laryngospasm with an open neck wound and dissection in the inferior neck and superior mediastinum.


Original Article

Abilash K Prasad, Chellaiah Petchiappan Ganesh Babu, Chetan Anand, Kathirvelu Shanmugasamy

Role of Imprint Cytology in Diagnosis of Thyroid Lesions

[Year:2019] [Month:May-August] [Volume:11] [Number:2] [Pages:4] [Pages No:49 - 52]

Keywords: Cytology, Imprint cytology, Thyroid

   DOI: 10.5005/jp-journals-10002-1260  |  Open Access |  How to cite  | 


Background: Thyroid disorders are common in India. Rapid and accurate intraoperative diagnosis of thyroid lesions helps in deciding the plan of management and spares the patient the additional expenses and morbidity of a second surgery. Aim: To assess the role of imprint cytology in the diagnosis of thyroid lesions in consecutive thyroidectomy specimens. A cross-sectional study was done at the Mahatma Gandhi Medical College and Research Institute, Puducherry. The study period was between November 2015 and July 2017 during which 60 consecutive thyroidectomy specimens were subjected to touch imprint cytology by the same pathologist who was blinded of the prior fine needle aspiration cytology reports, and the results of imprint cytology and fine needle aspiration cytology were compared with the final histopathological examination report. The data obtained were entered in MS Excel sheet and analyzed. Results: A total of 60 consecutive thyroid specimens from the Departments of General Surgery and ENT were studied. Imprint cytology had a sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of 61.5%, 97.9%, 88.8%, 90.1%, and 90%, respectively, which was found to be better compared to fine needle aspiration cytology. Conclusion: Imprint cytology is a simple, cheap, and reliable intraoperative diagnostic technique for thyroid lesions. It has high specificity, positive predictive value, negative predictive value, and accuracy. The lack of uniform availability and expense remains a limiting factor for the frozen section. The diagnostic indices of imprint cytology were found to be comparable to that of frozen section in various other studies.



Manish K Gupta, Rathindra Sarangi

Largest Atypical Parathyroid Adenoma: A Surgeon's Conundrum

[Year:2019] [Month:May-August] [Volume:11] [Number:2] [Pages:4] [Pages No:53 - 56]

Keywords: Atypical parathyroid adenoma, Giant parathyroid adenoma, Parathyroid carcinoma

   DOI: 10.5005/jp-journals-10002-1257  |  Open Access |  How to cite  | 


Aim: To signify distinguishing features of atypical parathyroid adenoma and parathyroid carcinoma and throw light on immunohistochemistry as a new modality for diagnosis. Background: Solitary parathyroid adenomas (PAs) are the most common cause of primary hyperparathyroidism (PHPT). Generally, the PAs are small (<2 cm) and weigh approximately 70 mg to 1 g. Very rarely, some adenomas attain large sizes of >2 cm or weigh >2 g. These are termed as “Giant parathyroid adenoma (GPA).” Some of these may have few histological characteristics of parathyroid carcinoma (PC) but not sufficient to be diagnosed as cancer. These are categorized as atypical adenomas. We report a case of the largest atypical parathyroid adenoma. Case description: A 47-year-old gentleman, diagnosed with fracture shaft of the right femur, was found to have hypercalcemia (S. Cal 13.6) on routine biochemical examination along with deranged calcium metabolic profile and osteoporosis on bone scan. SestaMIBI scan and MRI reported a large PA in relation to right lobe of thyroid. Intraoperatively, a large adenoma measuring 6 × 4 × 3 cm was excised along with fracture fixation. Histopathology reported it as atypical parathyroid adenoma. Postoperatively, he developed hungry bone syndrome, which required intravenous and oral calcium and vitamin D supplementation. He became euglycemia 2 months after surgery. Conclusion: Atypical giant PA is a rare entity. Molecular phenotype of atypical adenomas are p27+, bcl+, ki67−, mdm+ but none of these is positive in carcinoma. Histopathology is a must for distinguishing these two, but this also may fail in tumors with equivocal features. Therefore, the paradigm for the diagnosis of these entities has shifted to immunohistochemistry, which holds a promising future. Clinical significance: Differentiating these two conditions is imperative in order to manage both and to keep patients of atypical parathyroid adenoma in close follow up.



Mechteld C de Jong, Michael Shawky, Virginia Rozalén García, Tom R Kurzawinski, Tarek E Abdel-Aziz

Parathyroid Carcinoma in a Center Routinely Using ioPTH: A Case Series

[Year:2019] [Month:May-August] [Volume:11] [Number:2] [Pages:3] [Pages No:57 - 59]

Keywords: Management, Outcomes, Parathyroid carcinoma, PTH

   DOI: 10.5005/jp-journals-10002-1261  |  Open Access |  How to cite  | 


Aim: Parathyroid carcinoma (PC) is a rare endocrine malignancy and therefore limited data are currently available. In this case series, we describe our institution's experience with PC and patients’ outcomes. Background: The course of PC ranges from indolent to progressive disease with an uncontrollable hypercalcemia and widespread metastases. No clear guidelines toward diagnosis as well as management currently exist owing to a lack of prospective data. Case description: Here, we present a case series of 12 patients who underwent treatment for PC at our institution. All patients were diagnosed after surgery. At time of surgery, three patients (25.0%) underwent a concomitant hemithyroidectomy owing to abnormal features. An additional four patients (33.3%) underwent a hemithyroidectomy on the side of their PC. None of our patients received any adjuvant medical therapy. One patient (8.3%) was found to have recurrent disease; this patient is currently alive with disease. Conclusion: In conclusion, although no uniform management strategy was observed during the included period, overall outcomes were good, with a recurrence rate of less than 10%. Clinical significance: PC is a very uncommon malignancy that imposes both diagnostic and management uncertainties. The current report describes the management and outcomes of a series of 12 patients with this disease. All patients were only diagnosed after surgery as having a PC. Moreover, possibly due to a lack of prospective data, all patients in our series underwent different surgical treatment strategies. Nonetheless, overall, both short- and long-term outcomes were satisfactory, with a less than 10% recurrence rate. However, this series does underline the importance of more prospective research regarding diagnostic, treatment, and prognostic variables for PC.



MY Razaleigh, A Nor Safariny, B Anita

Risk of Malignancy in a Multinodular Goiter: Report of Two Cases with a Literature Review

[Year:2019] [Month:May-August] [Volume:11] [Number:2] [Pages:4] [Pages No:60 - 63]

Keywords: Intrathoracic goiter, Micropapillary carcinoma, Multinodular goiter

   DOI: 10.5005/jp-journals-10002-1262  |  Open Access |  How to cite  | 


Goiter is a common disease in Malaysia. It can be classified as retrosternal, substernal, and intrathoracic goiter. According to this classification, the approach to surgery differs. We have two cases presented with a multinodular goiter with evidence from imaging and histopathology. Both cases were treated as intrathoracic goiters and underwent thyroidectomy with the postoperative pathology report indicating them as micropapillary carcinomas. We will discuss regarding management options for both patients according to the pathology. In conclusion, management will differ based on classification and postoperative pathology reports.



Rajiv V Dave, John Ciciulla, Philip Antippa, Julie Ann Miller

Massive Spontaneous Cervicomediastinal Hemorrhage from a Parathyroid Adenoma

[Year:2019] [Month:May-August] [Volume:11] [Number:2] [Pages:6] [Pages No:64 - 69]

Keywords: Endocrine surgery, Neck hematoma, Parathyroid adenoma, Spontaneous hemorrhage

   DOI: 10.5005/jp-journals-10002-1263  |  Open Access |  How to cite  | 


Aim: We aimed to describe an unusual case of a patient presenting with subacute neck and chest tightness, and eventual ecchymosis, leading to the diagnosis of a bleeding parathyroid adenoma. We summarize the current literature and discuss important learning points. Background: Significant neck hematoma is a rare condition, and related most frequently to trauma. Rarer causes can include bleeding from the thyroid or parathyroid gland. Case description: A 62-year-old woman presented with subacute neck and chest tightness, and eventual progressive neck swelling and skin discoloration. Initial radiological investigations could not identify the source of bleeding, and subsequent outpatient investigations included a gastrograffin swallow, endoscopic ultrasound, and positron emission tomography. A follow-up contrast CT scan, a sestamibi scan, and USS characterized a right-sided neck nodule to be a likely parathyroid adenoma, confirmed by a raised parathyroid-hormone level and serum calcium. Minimally invasive parathyroidectomy, four months following initial diagnosis, revealed fused tissue planes, with residual petechial hemorrhage. A 813 mg atypical parathyroid adenoma was resected, with hemosiderin being evident within the gland. Conclusion: Review of the literature reveals some similarities to the case described herein, with patients of a similar demographic presenting with symptoms of hoarseness, dysphagia, cervical swelling, and ecchymosis. The physiopathological mechanisms behind such nontraumatic bleeding from the parathyroid gland remains unknown. Clinical significance: A clinical triad of acute neck swelling, hypercalcemia, and neck and/or chest ecchymosis should evoke the potential diagnosis of ruptured parathyroid adenoma. Once the diagnosis is confirmed, minimally invasive parathyroid is a safe approach in experienced hands.



Veladi Sasi Mouli, Manjunath Shreyamsa

Intrathoracic Mass Masquerading as a Retrosternal Goiter!

[Year:2019] [Month:May-August] [Volume:11] [Number:2] [Pages:2] [Pages No:70 - 71]

Keywords: Chylothorax, Goiter, Mediastinal, Non-Hodgkin's Lymphoma

   DOI: 10.5005/jp-journals-10002-1255  |  Open Access |  How to cite  | 


Thyroid swellings with retrosternal extension are usually diagnosed by the history, clinical examination, and imaging. An intrathoracic mass extending into the neck can easily be mistaken for a thyroid swelling with retrosternal extension. A high degree of suspicion is necessary to identify such swellings that are confusing in their presentation. Here we report a case of mediastinal mass masquerading as a goitre with retrosternal extension along with spontaneous chylothorax, and was diagnosed to have non-Hodgkin's lymphoma (NHL). She was administered chemotherapy after the diagnosis.


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