Aim: To determine the incidence of postsurgical neuropathic pain following the bilateral axillo-breast approach (BABA) approach of endoscopic thyroidectomy, a minimally invasive approach for thyroid surgeries. Materials and methods: Fifteen patients undergoing BABA endoscopic thyroidectomy were followed at 15 days, 1 month, and 3 months of surgery. Incidence, character, and severity of neuropathic pain following surgery were assessed. The area of distribution of the pain was also noted. Results: The incidences of neuropathic pain following BABA endoscopic thyroidectomy were 73.3%, 40%, and 20%, respectively after 15 days, 30 days, and 3 months of surgery. The median (range) NRS pain scores were 4 (3, 5), 2 (2, 3), and 1 (0, 2) on day 15, day 30, and 3 months, respectively. The distribution of pain was mainly in the anterior aspect of the neck (66.67%) and the upper part of the chest (66.67%). The commonest neuropathic pain features were pin pricking, brush allodynia, tingling, and numbness in the involved area. Conclusion: Despite the enormous technical and surgical benefits of the BABA approach for endoscopic thyroidectomy, the high incidence of both acute and chronic neuropathic pain following surgery needs consideration. Clinical significance: To draw attention to the alarming complication of neuropathic pain after BABA endoscopic thyroidectomy, which should be addressed to decrease patient morbidity.

Introduction: Thyroidectomy is the commonest endocrine surgical procedure. Transient hypocalcemia occurs in the range of 19–38%. Though many parameters are being attributed to postthyroidectomy hypocalcemia, preoperative vitamin D and calcium supplementation seem to be debated. The objective of this study was to find out the benefits of preoperative calcium and vitamin D supplement in preventing postthyroidectomy hypocalcemia. Subjects and methods: This was a prospective randomized study conducted from 1st April 2018 to 31st July 2019. Total thyroidectomy (TT) was performed in all patients for various thyroid disorders. Group A received no preoperative supplements and group B received 6 weeks 2 gm calcium carbonate with weekly cholecalciferol 60,000 units for 6 weeks before surgery. The preoperative biochemical panel, bone mineral density, intraoperative factors, postoperative blood parameters, and clinical effects were analyzed. Results: Of 133 patients who underwent TT in the above period, 83 patients were included in the study, group A (n = 42) and group B (n = 41). Mean age was 41.6 ± 13.39 years (range: 18–74). Female:male was 11:1. Clinical hypocalcemia occurred in 37.3% (n = 31), group A (n = 19) vs group B (n = 12) (p = 0.197). Vitamin D deficiency was seen in 74.7% (n = 62), group A 76.2% (n = 32) vs group B 73.2% (n = 30) (p = 0.804). Postoperative calcium levels were significantly correlated to preoperative magnesium (r = 0.222, p = 0.043), and postoperative day (POD)-1 parathyroid hormone (PTH) levels (r = 0.219, p = 0.047). On multiple linear regression analysis, both were not statistically significant with preoperative magnesium levels (β = 0.194, p = 0.077) and POD-1 PTH (β = 0.190, p = 0.083). The number of parathyroid glands visualized was the only significant independent variable in a separate multiple linear regression analysis (β = 0.598, p = 0.019). When the number of parathyroid glands visualized was less than two, the hypocalcemia increased with an odds ratio (OR) 1.132, 95% confidence interval: 0.068–18.719. Conclusion: Preoperative calcium and vitamin D supplementation did result in lowering post-TT hypocalcemia and hospital stay.

Retroperitoneal paragangliomas (rPGL) are rare chromaffin cell tumors traditionally associated with symptoms of catecholamine excess; however, this notion is currently in question. Three cases of rPGL that were presented consecutively to our center over a period of 6 months are discussed. Each presented under completely different circumstances; the first was detected during diagnostic workup for weight loss; the second was found synchronously during workup for gynecological malignancy; and the third was diagnosed postoperatively following resection of an incidentally detected, asymptomatic retroperitoneal tumor. In all cases, typical symptoms were absent from the history. Recent advancements and ongoing gaps in understanding of this rare entity are reviewed including theories of tumor phenotype, the outdated notion of classical symptomatology, and the emerging importance of succinate dehydrogenase (SDH) gene mutations for apparent sporadic rPGL as well as disease prognostication. Pitfalls in diagnosis and management of this frequently silent but potentially catastrophic and malignant tumor are discussed. rPGL is a complex clinical entity that may not present with typical symptoms of catecholamine excess; a high index of suspicion of rPGL is necessary for all clinicians dealing with retroperitoneal tumors.

The history of adrenal hormones provides a fascinating insight into how the discovery of adrenal hormones transformed our understanding of homeostasis. Owing to the small size of the gland and its anatomical location, there was quite a disparity in its existence for a large part of the time. However, at the dawn of the 19th century, the discovery of microscopes paved the way to identify the glands. In a nutshell, the discovery of various hormones from the adrenal cortex and medulla has been revolutionary both in the understanding of normal physiological processes and their therapeutic uses. A review of existing literature from PubMed eventually carved this article in which evolution in the discovery of these hormones and major clinical aspects related to adrenal hormones is discussed. As always, each discovery found birth in someone's question and was eventually fully realized by cooperative teamwork and leadership. The mechanism of hormones’ action was identified through animal and human experimentation, while scientists demonstrated the structure of hormones using the conventional biochemical analysis. Mostly, diseases were identified as syndromes earlier than hormones.

Introduction: Pheochromocytomas are rare neuroendocrine tumors that arise from the chromaffin cells of sympathetic or parasympathetic tissue. Composite pheochromocytomas have additional histological components and account for only 3% of pheochromocytomas. We present a case of composite pheochromocytoma with chronic diarrhea, profound hypokalemia, and global weakness on presentation. Case description: The patient reported an 18-month history of severe vomiting and watery diarrhea, with no associated headaches or sweating. She had an initial serum potassium of 1.1mmol/L (3.5–5.3), requiring a continuous intravenous potassium infusion, intubation, and ventilation for profound weakness. She remained normotensive throughout. A computed tomography (CT) scan revealed a left adrenal mass. She had markedly elevated urine metanephrine and normetanephrine levels [19,823 nmol/24 hr (152–913) and 17,933 nmol/24 hr (262–2129), respectively]. The patient underwent a left adrenalectomy and had complete resolution of her symptoms postoperatively. Histology revealed a composite tumor comprising both pheochromocytoma and ganglioneuroma. Conclusion: This case highlights a rare presentation of pheochromocytoma, being an unusual cause of hypokalemia as well as interesting histopathology.

Anaplastic thyroid cancer (ATC) is the most aggressive with the worst prognosis of thyroid malignancies. The malignant transformation from preexisting differentiated thyroid cancer (DTC) remains ambiguous. Another rare cutaneous tumor known as dermatofibrosarcoma protuberans (DFSP) has a low metastatic rate yet a high risk of recurrence. DFSP requires diagnosis by pathological examination, and the main treatment is surgical resection with a good negative margin. We describe a young patient with malignant transformation of ATC from differentiated papillary thyroid cancer with the collision of DFSP variants. A 42-year-old lady presented with left neck swelling, which developed 6 months after total thyroidectomy and bilateral lymph node dissection for papillary thyroid carcinoma (PTC). Despite radioiodine ablation after surgery, the swelling progressively increased in size. It involved the overlying surrounding skin and previous thyroidectomy scar. Serum thyroglobulin was high, with low antithyroglobulin suggestive of local recurrence. A tissue biopsy of the lesion confirmed the anaplastic transformation of PTC. She has unilateral left vocal cord palsy due to disease progression. Further fluorodeoxyglucose-positron emission tomography (FDG-PET) scan revealed a positive uptake only in the left thyroid bed. She underwent debulking surgery, tracheostomy, and percutaneous endoscopic gastrostomy, given her young age and good performance status. The final histopathology results showed a collision tumor of DFSP with anaplastic thyroid carcinoma. The disease progressed, and she succumbed to the disease 6 months after surgery. DFSP variants and ATC are two rare kinds of tumors. There are a few reports in the literature on metastatic DFSP variants to the thyroid gland. The diagnosis of ATC or even DFSP is important as the management will be different in the intent of therapy. We report a case of these collision tumors for their rarity and difficulty in their management.

This article presents a picture of a nonrecurrent laryngeal nerve found during surgery for a benign parathyroid tumor along with a thyroid nodule. The patient had recurrent renal stones, worked up, and was found to have hypercalcemia due to primary hyperparathyroidism along with a nodule in the right lobe of the thyroid. A preoperative computed tomography (CT) scan identified a right aberrant subclavian artery. During surgery, we found a nonrecurrent laryngeal nerve originating from the vagus nerve higher up in the neck and entering directly into the larynx by taking a curved course as shown in the picture. The nerve was saved at full length and postoperatively, and there was no vocal dysfunction.