World Journal of Endocrine Surgery

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2023 | May-August | Volume 15 | Issue 2

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Shaun F Purkiss

Long-term Survival Following Parathyroidectomy for Primary Hyperparathyroidism in Elderly People with Polypharmacy

[Year:2023] [Month:May-August] [Volume:15] [Number:2] [Pages:5] [Pages No:29 - 33]

Keywords: Administrative data, Australia, Parathyroidectomy, Parathyroids, Polypharmacy, Primary hyperparathyroidism

   DOI: 10.5005/jp-journals-10002-1457  |  Open Access |  How to cite  | 


Aim: Primary hyperparathyroidism (PHP) is associated with many chronic conditions. Polypharmacy may, therefore, be a feature of those people with PHP considered for parathyroidectomy. This study examines the medication profile of elderly people undergoing parathyroidectomy for PHP and the association of polypharmacy with long-term survival. Materials and methods: A publicly available Australian administrative data source describing medical services and pharmacy dispensing between 2003 and 2015 was used. Persons undergoing parathyroidectomy for PHP aged >60 years were identified from procedure codes and their dispensing profile was examined in the year prior to surgery. Polypharmacy was defined as taking more than five concomitant medications. Survival following parathyroidectomy was assessed in relation to age and polypharmacy groupings. Results: A total of 608 persons (461:147, F:M) undergoing parathyroidectomy for PHP (mean age 72.1 years) were recruited. The prevalence of polypharmacy in parathyroidectomy-treated persons was 42%. Polypharmacy prevalence and cardiovascular treatment prevalence increased with age but were lower than control groups. Overall, 5-year survival following parathyroidectomy for PHP was 91% (controls 88%, log-rank 0.01) and was influenced by the level of polypharmacy in all groups. The elderly aged >75 years with polypharmacy had better survival following parathyroidectomy than controls (5-year survival 0.90 vs 0.77, log-rank 0.002). Conclusion: The prevalence of polypharmacy and cardiovascular treatments in this elderly Australian cohort undergoing parathyroidectomy for PHP is lower than controls. The long-term survival of those aged >75 with polypharmacy is better than age-matched controls. It is likely that patients undergoing parathyroidectomy for PHP are a highly selected group. Clinical significance: Administrative data can provide a perspective of people undergoing parathyroidectomy for PHP and examine survival outcomes. Presently, Australian surgeons are rigorous in the selection of elderly patients undergoing surgery such that long-term survival outcomes appear better than those observed in control populations.



Joud O Baki, Hana N Haimour, Eman A Al-omoush, Mohammad E Salameh, Khaled S Jabaiti, Ayman A Mismar

Exploring the Presence of Risk Factors for Developing Hypocalcemia after Thyroid Surgery: A Descriptive Cross-sectional Study in Jordan

[Year:2023] [Month:May-August] [Volume:15] [Number:2] [Pages:6] [Pages No:34 - 39]

Keywords: Hypocalcemia, Risk factors, Thyroidectomy

   DOI: 10.5005/jp-journals-10002-1454  |  Open Access |  How to cite  | 


Aim: In our study, we aim to identify the presence of certain risk factors for developing hypocalcemia among patients who underwent thyroid surgery at Jordan University Hospital (JUH) to help endocrine surgeons improve the clinical outcomes of their patients. Materials and methods: We conducted a cross-sectional, descriptive study at JUH located in Amman, Jordan. Our sample included 200 patients who underwent thyroid surgery at JUH over 2 years (2017–2018). We collected data retrospectively from the medical electronic files of patients. The studied factors included age, gender, comorbidities, surgery type, thyroid pathological results, cervical lymph node dissection, incidental removal of parathyroid glands, and preoperative and postoperative calcium and phosphorus levels. Hypocalcemia was defined as serum calcium level <8 mg/dL or the presence of its signs and symptoms. It was categorized into transient hypocalcemia (early and late) and permanent hypocalcemia. We applied descriptive statistics including charts, frequencies, and percentages. Results: Hypocalcemia was detected in 19 (9.5%) patients out of 200 postoperatively, from which 16 presented with transient hypocalcemia and three presented with permanent hypocalcemia. Around 16 patients out of 19 were females and only three were males. Total thyroidectomy constituted 68.4% of their surgical operations. Papillary carcinoma was the most common thyroid pathology followed by multinodular goiter. Three out of 12 patients who had central lymph node dissection experienced hypocalcemia. Conclusion: Important risk factors were present among patients who developed hypocalcemia after thyroid surgery at JUH. Our study helps in determining the high-risk groups of patients and constitutes the basis for further studies in our region. Clinical significance: Our study draws the attention of endocrine surgeons in our region to take more precautions among patients presenting with risk factors for developing hypocalcemia to help them avoid this complication after thyroidectomy.



Bodhireddy S Reddy, Shabnam Karangadan, Sarada C Devi, Anuradha Boyareddigari

A 12-year Experience with 298 Fine Needle Aspirations of Thyroid Nodules in a Single Institution: Analysis of Bethesda System of Thyroid Cytopathology Reporting and Cytohistopathological Correlation

[Year:2023] [Month:May-August] [Volume:15] [Number:2] [Pages:6] [Pages No:40 - 45]

Keywords: Bethesda system, Cytohistopathological correlation, Fine needle aspiration cytology, Thyroid cytopathology

   DOI: 10.5005/jp-journals-10002-1458  |  Open Access |  How to cite  | 


Context: Fine needle aspiration cytology (FNAC) has become a critical step in the evaluation of thyroid nodules and distinguishing neoplastic from nonneoplastic nodules. The Bethesda system for reporting thyroid cytopathology (TBSRTC) helps in a universal diagnostic terminology for the clinicians to decide on the appropriate management and reduce the risk of unnecessary surgeries. Aims: To assess the utility of the Bethesda system of thyroid cytopathology reporting and efficacy of FNAC with histopathological correlation of subsequent surgically resected specimens. Materials and methods: The present study includes 3,212 cases with thyroid nodules that underwent FNAC over a 12-year period. The cases were categorized as per the Bethesda system and correlated with clinical features, hormonal profile, and histopathological examination (HPE). Results: Out of 3,212 cases, the most common Bethesda system category was benign (88.7%) followed by follicular neoplasm (FN) or suspicious for an FN (SFN) (7.3%). Cytohistopathological correlation was done in 298 cases and discrepancy was noted in 28 cases (9.4%). Statistical analysis showed that FNAC with the Bethesda system of reporting has a sensitivity of 83.7%, specificity of 95.4%, positive predictive value (PPV) of 92.8%, negative predictive value (NPV) of 89.3%, and diagnostic accuracy of 90.6%. Conclusion: Fine needle aspiration cytology (FNAC) is a reliable diagnostic tool in the evaluation of thyroid nodules as indicated by high sensitivity, high specificity, and low rate of surgical intervention in this large comprehensive study. The inclusion of the Bethesda system has provided a more precise cytological diagnosis to effectively guide clinicians for further management.



Ahmad Younes, Souad Ghattas, Samar Semaan, Hani Maalouf, Adham Al Kadirri, Hind Rahban, Ziad El Rassi

A Rare Case of Giant Malignant Pheochromocytoma

[Year:2023] [Month:May-August] [Volume:15] [Number:2] [Pages:4] [Pages No:46 - 49]

Keywords: Case report, Giant, Malignant, Pheochromocytoma

   DOI: 10.5005/jp-journals-10002-1450  |  Open Access |  How to cite  | 


A pheochromocytoma (PCC) is a tumor that arises from an embryonic neural crest and produces catecholamines at high levels. The mean size of these tumors is approximated to be around 7.2 cm, with an average weight of 222 g. In this case, a 61-year-old female patient was referred to our medical center to investigate multiple episodes of hypertensive crisis associated with a huge 18 cm right adrenal mass identified on a computed tomography (CT) scan and magnetic resonance imaging (MRI). Twenty-four-hour urine analysis and blood level exhibited elevated total metanephrine and normetanephrine levels. Mass resection was performed via laparotomy en bloc. Histopathological analysis of the resected specimen confirmed PCC of the right adrenal gland weighing 1900 g. The Adrenal gland Scaled Score (PASS) was 13. PCC may reach sizes much larger than the average observed in the literature and size tends to be positively correlated to malignancy.



Aneesh Sugunan, Zahir Hussain Samhoon, Kumaran M Palaniappan, Ramesh Kalyanapu, Aadarsh Raghavan, Boddukara Sahithi Priya

A Rare Case of Thyroid Hemiagenesis with Graves Disease

[Year:2023] [Month:May-August] [Volume:15] [Number:2] [Pages:3] [Pages No:50 - 52]

Keywords: Autoimmune disease, Case report, Graves disease, Hyperthyroidism, Thyroid hemiagenesis

   DOI: 10.5005/jp-journals-10002-1455  |  Open Access |  How to cite  | 


Background: Hemiagenesis of the thyroid is a rare congenital condition that is characterized by an absence of a thyroid lobe. The prevalence rate of hemiagenesis is about 0.02% and is usually detected incidentally. Hemiagenesis of the thyroid gland is a rare congenital anomaly with about 800 cases reported in the literature untill 2020. Case description: A 36-year-old female presented with complaints of weight loss, palpitation, and tremors for the past 3 months. She also gives a history of right-sided neck swelling of a duration of 1 month. A thyroid function test was done and revealed a hyperthyroid state (free T4:3.2 ng/dL, free T3:12.7 pg/mL, TSH: <0.005 mIU/mL). Ultrasound revealed a diffusely enlarged (4.5 × 3.5 × 3 cm) heterogenous hypoechoic right lobe with increased vascularity on Doppler and isthmus of thickness 7.9 mm and an absent left lobe. Thyroid scintigraphy revealed an increased uptake of 8% in the right lobe and isthmus with absent uptake of tracer in the left lobe. A thyroid antibody panel was done and it revealed elevated levels of anti-thyroid stimulating hormone (TSH) receptor antibodies and anti-thyroid peroxidase (TPO) antithyroid microsomal antibody (AMA) antibodies. She attained a clinical and biochemical euthyroid state after 3 months of medical treatment and was admitted and planned for total thyroidectomy. The final histopathology report was suggestive of hyperplastic goiter with an absent left thyroid lobe. Conclusion: Thyroid hemiagenesis is a rare congenital anomaly of the thyroid gland and when suspected the diagnosis should be confirmed by an ultrasound neck and a thyroid scintigraphy scan. Clinical significance: Patients with hemiagenesis of the thyroid have a higher risk of developing thyroid disorders and should be kept under close follow-up to diagnose them early for a better outcome.



Pa Sandhya

When Ewing Sarcoma Feigns to be a Brown Tumor: A Report on Rare Case Scenario

[Year:2023] [Month:May-August] [Volume:15] [Number:2] [Pages:3] [Pages No:53 - 55]

Keywords: Bone sarcoma, Brown tumor, Case report, Ewing's sarcoma, Hyperparathyroidism, Parathyroid adenoma

   DOI: 10.5005/jp-journals-10002-1456  |  Open Access |  How to cite  | 


Introduction: It is not uncommon for a patient with a brown tumor to be misdiagnosed as a primary bone tumor, while the contrary is not true. The association of bone sarcomas with hyperparathyroidism is quite rare, and here, we report one such case where Ewing's sarcoma was misdiagnosed as a brown tumor. Care description: A 17-year-old lady was treated elsewhere for a pathological fracture of the left femur with open reduction and internal fixation (ORIF) with intramedullary (IM) nailing. On evaluation, the patient was found to have hyperparathyroidism secondary to parathyroid adenoma. Following 1 month of parathyroid gland excision (histologically proven to be adenoma), patient developed increased swelling at the ORIF site which on further evaluation was found to be Ewing's sarcoma. Despite the aggressive local and systemic therapy, patient progressed to develop distant metastasis. Conclusion: Ewing's sarcoma can mimic brown tumors, and a high degree of suspicion is required to make a proper diagnosis. These patients are better treated at high-volume centers to avoid misdiagnosis and mismanagement.


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Ajay Suraj, Kasturi Rangan, Varun K Agarwal, Mantasha Khan, Shweta Yadav

“Polar Vessel Sign”: Radiological Pointer of Parathyroid Adenoma

[Year:2023] [Month:May-August] [Volume:15] [Number:2] [Pages:2] [Pages No:56 - 57]

Keywords: Parathyroid adenoma, Polar vessel sign, Primary hyperparathyroidism

   DOI: 10.5005/jp-journals-10002-1459  |  Open Access |  How to cite  | 


A 49-year-old lady presented with recurrent renal stones and bone pains for 5 years. On evaluation, she was found to have raised serum calcium—11.2 mg/dL, intact parathyroid hormone (PTH), and low serum phosphorus with adequate 25-OH vitamin D. So, a biochemical diagnosis of primary hyperparathyroidism (PHPT) was established. Ultrasound of the neck showed a well-defined, oval-shaped, hypoechoic heterogeneous lesion (9.8 × 12.4 × 28.3 mm) noted at the posteroinferior side of the left thyroid lobe. The lesion shows peripheral vascularity and a feeding artery (polar vessel sign) suggestive of parathyroid adenoma (PA). “Polar vessel sign” is a characteristic ultrasound feature of PA and may help to identify the same in equivocal cases.


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