Background: Preoperative neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratio (PLR) have been associated prognostically in a few cancers. However, the role of these parameters as an adjunct with fine needle aspiration cytology (FNAC) in thyroid nodules is not determined. Objective: To evaluate if these parameters can be used as an adjunct in determining malignancy in thyroid nodules. Materials and methods: A retrospective study of 309 patients from July 2016 to July 2018 undergoing surgery for thyroid nodule was included. Their automated counts with NLR and PLR values were calculated. Receiver operator characteristic (ROC) curve was constructed for NLR and PLR to calculate cutoff, which was used to compare FNAC with histopathology in Bethesda category III and category IV between benign and malignant groups. Results: A total of 309 were included, with a mean age of 38.53 years (range: 10–80 years). Female: male was 261 (84.5%): 48 (15.5%). Benign thyroid nodules (n = 247, 79.9%), of which lymphocytic thyroiditis were 39, and malignancy (n = 62, 20.1%). Median NLR was 2.03, and median PLR was 82.74, which were taken as cutoff; there was a statistically significant difference between benign and malignant nodules (p < 0.001) for both. Similarly, at these cutoff values, Bethesda category III did not show any significant difference between benign and malignancy (p = 0.24), whereas Bethesda category II and IV had statistical significance between benign and malignancy for NLR (p < 0.001 and 0.04, respectively) but not for PLR (p = 1). Conclusion: NLR can be used as an adjunct with FNAC in suspecting malignancy in thyroid nodules.

Thyroid incidentalomas on fluorine-18-fluorodeoxyglucose positron emission tomography–computed tomography (18F-FDG-PET-CT): A tertiary care hospital experience in South India. Aim: To find the prevalence and clinical significance of unexpected focal uptake of 18F-FDG or nodules in the thyroid gland of consecutive PET-CT studies. To find the maximum standardized uptake value (SUVmax) of benign and malignant thyroid incidentalomas in FDG-avid lesions. Materials and methods: A total of 2,699 18F-FDG-PET-CT studies from January to December 2018 were reviewed. Studies with incidental focal 18F-FDG uptake with SUVmax, sonography, cytology, and histopathological results were compiled and analyzed. FDG nonavid thyroid nodules on CT were also studied. Results: In 312/2,699 patients with thyroid nodules, 18F-FDG uptake was identified in 139 (5%)—focal (76) and diffuse (63). In the cases with focal uptake, 42 were further evaluated, of which ultrasound (USG) showed thyroid imaging reporting and data system (TIRADS) 2/3 in 21 cases, TIRADS 4/5 in 20 cases, and 1 patient underwent surgery. Final histopathological examination (HPE) was suggestive of papillary thyroid carcinoma. The mean SUVmax in malignant nodules (20.20) was significantly higher (p < 0.03) than benign nodules (6.12), but there was considerable overlap (benign: 3.75–10.25; malignant: 3.34–48.32) between them. Among FDG nonavid nodules (173), only 24 were followed up with sonography [7/24 (29.16%) had TIRADS 4/5 lesions]. Only 2/173 were diagnosed with malignancy. Conclusion: Thyroid incidentalomas, though infrequent, showing 18F-FDG uptake should be evaluated with sonography followed by biopsy/fine needle aspiration (FNA) if required, to rule out malignancy. The SUVmax value was significantly lower in benign incidentalomas compared to malignant nodules; however, there was no clinically useful SUVmax cutoff value to determine malignancy due to considerable overlap between them. Clinical significance: Thyroid carcinomas detected by 18F-FDG-PET-CT are more aggressive than those detected by other imaging modalities. From our study, we found that there is a prevalence of at least 5% of thyroid incidentalomas. Therefore, understanding the importance of further steps in evaluation is needed to avoid unnecessary investigations and also to avoid missing the possibility of detecting malignancy. This study also stated that having a cutoff value for SUVmax is ambiguous in differentiating between benign and malignant nodules.

Background: Primary hyperparathyroidism (PHPT) is an endocrine disorder characterized by dysregulated calcium homeostasis. Currently, there is a growing trend toward diagnosis via routine biochemical screenings. Surgery remains the only curative treatment, with minimally invasive techniques like focused parathyroidectomy (FP) gaining popularity. However, postoperative hypocalcemia, including Hungry Bone Syndrome (HBS), remains a major concern. Aim: This study seeks to evaluate the surgical outcomes of FP in patients with PHPT, analyze the usefulness of intraoperative parathyroid hormone (IOPTH) assessment, and evaluate the efficacy of postoperative management with calcium and vitamin D supplements. Materials and methods: One hundred forty-two patients with sporadic PHPT who underwent parathyroidectomy at Fortis Hospital Shalimar Bagh, Delhi, between March 2018 and December 2023 were participants in a retrospective analysis. The abnormal parathyroid glands were identified by high-resolution neck ultrasonography and SestaMIBI scans used in preoperative imaging. After 15 minutes of gland removal, IOPTH was measured and compared with the preoperative PTH levels. Supplementing with calcium carbonate and calcitriol was part of the postoperative care. For a minimum of 6 months, patients were monitored to track serum calcium levels and recurrence rates. Results: One hundred eighteen of the 142 patients (83.1%) who had concordant imaging underwent successful FP. The average serum calcium level was 11.5 ± 1.2 mg/dL, and the average preoperative parathyroid hormone (PTH) level was 230.2 ± 96 pg/mL. In 17.6% of cases, patients experienced transient hypocalcemia, and 4.9% experienced HBS. There were two recurrent cases, but the overall cure rate was 98.6%. Conclusion: FP is a highly effective surgical treatment for PHPT, with a success rate similar to standard bilateral exploration. Routine IOPTH assessment is indicated to improve patient outcomes. Empirical calcium and vitamin D treatment after surgery reduced the prevalence of hypocalcemia and HBS. This study emphasizes the possibility for more widespread use of FP and IOPTH in developing nations.

Aims and background: The Bethesda system for reporting thyroid cytopathology (BSRTC) was introduced to standardize reporting and improve clinical management of thyroid nodules. In general, BSRTC has been reported to have a good diagnostic relationship with the final histopathology (HP) result. This study was aimed at evaluating the malignancy rates of BSRTC at our center, Hospital Putrajaya in Malaysia. Materials and methods: This was a retrospective study of 854 patients who had undergone fine needle aspiration cytology (FNAC) of the thyroid gland nodules at Hospital Putrajaya, which is one of the main endocrine surgery centers in Malaysia from 2008 to 2017. The FNAC results were compared with the final HP results if surgical excision was done, and malignancy rates were calculated. Results: A total of 990 patients with thyroid nodules underwent FNAC at our center during the study period; however, only 854 patients had complete records (729 female and 125 male). A total of 439 patients underwent surgical excision, therefore bearing final HP. Malignancy rates of each BSRTC category were 33.3% in the nondiagnostic/unsatisfactory (ND/US) category, 8.5% within the benign category, 23.2% within the atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) category, 66.7% in the follicular neoplasm/suspicious of follicular neoplasm (FN/SFN) category, 75% within the suspicious for malignancy (SM) category, and 100% in the malignant category. Conclusion: In our cohort, malignancy rates were higher than the ideal rate suggested by the revised BSRTC guidelines. Strong clinical judgment is required in interpreting FNAC results when using the BSRTC. More data is required to improve the utility of the BSRTC.

Aberrant right subclavian artery (ARSA) is also known as “lusorial artery” and is a developmental anomaly whereby the artery courses posterior to the esophagus as a branch of the arch of the aorta. The condition is commonly associated with a nonrecurrent laryngeal nerve (NRLN). Here, we report three cases of ARSA associated with NRLN during thyroid and parathyroid surgery, detected during routine computerized tomography of the thorax. Patients commonly present with dysphagia, which can be disabling at times. In patients with severe symptoms associated with ARSA, vascular interventions may be required with open, thoracic endovascular aortic repair (TEVAR), or hybrid procedures.