Hereditary angioedema is a rare autosomal dominant disease characterized by the edema of subcutaneous tissues, respiratory tract and bowel. It is caused by the deficiency of C1 esterase inhibitor. Hereditary angioedema may be associated with autoimmune diseases, such as systemic lupus erythematosus, rheumatoid arthritis, autoimmune thyroiditis and glomerulonephritis. We report a 34-year-old male patient with hereditary angioedema who developed idiopathic hypoparathyroidism. Autoimmunity seems to be an important basis of this association and it might be caused by the immune dysfunction due to decreased level of complements; nevertheless, a casual association could not be excluded. To our knowledge, this is the first report of hereditary angioedema in association with idiopathic hypoparathyroidism in the medical literature.
Adult ; Angioneurotic Edema/*complications/genetics ; Case Report ; Complement 1 Inactivators/deficiency ; Human ; Hypoparathyroidism/*complications ; Male ; Pedigree

Adult ; Female ; Humans ; Hypoparathyroidism ; complications ; congenital ; drug therapy ; Recurrence ; Seizures ; etiology

To investigate the risk factors for hypoparathyroidism after thyroidectomy.
 Methods: Clinical data of 492 patients, who underwent thyroidectomy from April 2015 to December 2016 from Xiangya Hospital of Central South University, were studied retrospectively. Chi-square test and multivariable logistic regression were performed to find the risk factors for postoperative hypoparathyroidism.
 Results: The incidence of postoperative hypoparathyroidism was 43.5%, and the incidence of temporary and permanent hypoparathyroidism was 43.1% and 0.4%, respectively. Univariate analysis showed that tumor pathology, thyroidectomy types, the extent of lymph node dissection, application of carbon nanoparticles, and merged Hashimoto's thyroiditis were risk factors for postoperative hypoparathyroidism (all P<0.01). Logistic regression analysis showed that: thyroidectomy types (OR=0.149, 95% CI 0.078 to 0.28), the extent lymph node dissection (OR=0.779, 95% CI 0.617 to 0.983) and application of carbon nanoparticles (OR=1.729, 
95% CI 1.067 to 2.801) were independent risk factors for postoperative hypoparathyroidism (all P<0.05).
 Conclusion: Hypoparathyroidism is a common complication after thyroidectomy. The incidence of postoperative hypoparathyroidism is significantly increased in patients underwent total thyroidectomy and cervical lymph node dissection. Application of carbon nanoparticles intraoperatively can reduce the incidence of postoperative hypoparathyroidism.
Humans ; Hypoparathyroidism ; surgery ; Postoperative Complications ; Retrospective Studies ; Risk Factors ; Thyroid Neoplasms ; Thyroidectomy

Objective:To investigate the relationship between parathyroid hormone（PTH） level and permanent hypoparathyroidism（PHPP） on the first day after radical papillary thyroidectomy, and its predictive value. Methods:A total of 80 patients with papillary thyroid cancer who underwent total thyroid resection and central lymph node dissection were collected and analyzed from January 2021 to January 2022. According to whether PHPP occurred after surgery, the patients were divided into hypoparathyroidism group and normal parathyroid function group, and univariate and binary logistics regression were used to analyze the correlation between PTH and serum calcium levels and PHPP on the first day after surgery in two groups. The dynamic changes of PTH at different time points after operation were analyzed. The area under the receiver operating characteristic was used to evaluate the predictive power of PTH on the development of PHPP after surgery. Results:Among the 80 patients with papillary thyroid cancer, 10 cases developed PHPP, with an incidence rate of 12.5%. Binary logistics regression analysis showed that PTH on the first postoperative day（OR=14.534, 95%CI: 2.377-88.858, P=0.004） was an independent predictive risk factor for postoperative PHPP. Taking PTH=8.75 ng/L on the first postoperative day as the cut-off value, the AUC of the area under the curve was 0.874（95%CI: 0.790-0.958, P<0.001）, the sensitivity was 71.4%, the specificity was 100%, and the Yoden index was 0.714. Conclusion:PTH level on the first day after total thyroid papillary carcinoma surgery is closely related to PHPP, and is an independent predictor of PHPP.
Humans ; Calcium ; Hypoparathyroidism/surgery* ; Parathyroid Glands ; Parathyroid Hormone ; Postoperative Complications/surgery* ; Thyroid Cancer, Papillary/surgery* ; Thyroid Neoplasms/complications* ; Thyroidectomy

PURPOSE: The treatment of choice for well-differentiated thyroid cancer is surgical excision. However, the operation method is still controversial. Also, the operation method has been changing gradually. Thus, we reviewed the records of patients with well-differentiated thyroid cancer who had received operations in our hospital to assess the trend in surgical procedure, and to determine the proper procedure, method, considering both recurrence and complications. METHODS: We retrospectively analyzed the cases of 452 patients with differentiated thyroid cancer who had received operations from January 1989 to December 1998. We divided the 10 years into two periods; period I was from 1989 to 1993 (254 patients) and period II was from 1994 to 1998 (198 patients). We analyzed recurrences and complications according to the operation method, including neck lymph-node dissection. The incidences and locations of lymph- node metastasis were taken into account, too. The statistical analysis was done by using the Fisher's exact test. RESULTS: In period I, 147 patients (58%) received a total thyroidectomy, and in period II, all patients received total thyroidectomy. In period I, 24 patients (9.4%) had a recurrence, and in period II, 13 patients (6.6%) had a recurrence. In period I, 55 patients (21.7%) had postoperative hypoparathyr oidism, and in period II, 38 patients (19.2%) had postoperative hypoparathyroidism. In period I, 15 patients (5.9%) had postoperative hoarseness, and in period II, 7 patients (3.5%) had postoperative hoarseness. Two hundred eighty-one patients (62.2%) had lymph-node metastasis, and the anterior neck region was the most common site of metastasis (60.2%). CONCLUSION: In the operation method for differentiated thyroid cancer, the trend is toward a total thyroidectomy away from a lobectomy. Also, a skillful and experienced surgeon can reduce the incidence of postoperative complications. Thus the best operation method for differentiated thyroid cancer is a total thyroidectomy, including a preventive anterior-neck lymph-node dissection, which is done by a skillful and experienced surgeon.
Hoarseness ; Humans ; Hypoparathyroidism ; Incidence ; Neck ; Neoplasm Metastasis ; Postoperative Complications ; Recurrence ; Retrospective Studies ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyroidectomy

BACKGROUND: The optimal extent of thyroid resection in Graves' disease has not been clearly determined. A significant proportion of patients experience recurrence of the disease after subtotal thyroidectomy. Total thyroidectomy can eliminate the source of the disease. However, many surgeons are reluctant to conduct a total thyroidectomy because it has been known to be associated with increased postoperative morbidity. METHODS: Thirty-six patients underwent subtotal thyroidectomy (ST, n=19) or total/near total thyroidectomy (T/NT, n=17) for Graves' disease after treatment with antithyroid drugs. Relapse of the hyperthyroidism, surgical complications, and serum calcium levels were evaluated. RESULTS: Operation time was not prolonged by the extent of thyroidectomy (ST: 106+/-32.1 min., T/NT: 118+/-34.3 min.). Transient hypocalcemia was observed in 5 patients (29.4%) after a total or a near total thyroidectomy, whereas 3 patients (15.7%) experienced transient hypocalcemia after a subtotal thyroidectomy. All patients showed normal serum calcium level 1 month after the operation and had become free of hypocalcemic symptoms. No patient had injury to the recurrent laryngeal nerve, regardless of the extent of the surgery. Recurrence of the hyperthyroidism was observed in 3 patients who had undergone a subtotal thyroidectomy. CONCLUSIONS: Total thyroidectomy can be conducted safely in patients with Graves' disease without any increase in postoperative complications, such as hypoparathyroidism or injury to the recurrent laryngeal nerve. Therefore, total thyroidectomy appears to be an effective alternative treatment modality for Graves' disease.
Antithyroid Agents ; Calcium ; Graves Disease* ; Humans ; Hyperthyroidism ; Hypocalcemia ; Hypoparathyroidism ; Postoperative Complications ; Recurrence ; Recurrent Laryngeal Nerve ; Thyroid Gland ; Thyroidectomy*

BACKGROUND AND OBJECTIVES: The harmonic scalpel using the ultrasonic energy is able to grasp and divide tissue while sealing small vessels in narrow operating fields. The aim of the present study was to evaluate the usefulness of the harmonic scalpel in thyroid surgery. MATERIALS AND METHODS: This study was performed for 247 patients who underwent thyroidectomy. According to the use of harmonic Scalpel, the patients could be divided into two groups: the conventional technique (CT) group of knot tying and the harmonic scalpel (HS) group. RESULTS: For hemithyroidectomy, operation time and hospital stay were shorter in the HS group compared with the CT group (p<0.05). For total thyroidectomy with central neck dissection (CND), operation time, total drainage volume, drain removal date, and hospital stay were significantly reduced in the HS group (p<0.05). Among the patients who underwent total thyroidectomy with CND with the HS, one patient (2.9%) showed transient recurrent laryngeal nerve palsy. Transient hypoparathyroidism showed significantly lower incidence in the HS group (p<0.05). CONCLUSION: HS might be cost-effective by reducing operation time and hospital stay without increased postoperative complications.
Drainage ; Hand Strength ; Humans ; Hypoparathyroidism ; Incidence ; Length of Stay ; Neck Dissection ; Postoperative Complications ; Thyroid Gland ; Thyroidectomy ; Ultrasonics ; Vocal Cord Paralysis

The aim of this study was to investigate the complications following surgical treatment of thyroid cancer and the association between the extent of surgery and complication rates. A total of 2,636 patients who underwent surgery due to thyroid cancer were retrospectively reviewed to identify surgical complications. Complication rates were assessed according to the extent of surgery, which was classified as follows; less-than-total thyroidectomy with central compartment node dissection (CCND) (Group I, n=636), total thyroidectomy with CCND (Group II, n=1,390), total thyroidectomy plus ipsilateral neck dissection (Group III, n=513), and total thyroidectomy plus bilateral neck dissection (Group IV, n=97). The most common surgical complication was symptomatic hypoparathyroidism, of which 28.4% of cases were transient and 0.3% permanent. The other surgical complications included vocal cord palsy (0.7% transient, and 0.2% permanent), hematoma (0.5%), seroma (4.7%), chyle fistula (1.8%), and Horner's syndrome (0.2%). The complication rates increased significantly with increasing the extent of surgery from Group I to Group IV. The more extensive surgery makes more complications, such as hypoparathyroidism, seroma, and others.
Adult ; Female ; Humans ; Hypoparathyroidism/etiology ; Male ; Middle Aged ; Paralysis/etiology ; Parathyroid Glands/surgery ; *Postoperative Complications ; Retrospective Studies ; Seroma/etiology ; Thyroid Neoplasms/*complications/pathology/*surgery

PURPOSE: To assess the effectiveness of low-dose (30 mCi) I-131 ablation therapy for remnant thyroid tissue following total thyroidectomy for differentiated thyroid cancer. METHODS: Between March 1995 and December 1997, 48 patients were given ablative doses (30 mCi) of I-131 following total thyroidectomy for differentiated thyroid cancer in the presence of I-131 uptake in remnant thyroid tissue. The effective ablation of remnant thyroid tissue was determined using a subsequent I-131 whole body scan. If any remnant thyroid tissue remained, we repeated the same management protocol at 6-month intervals. RESULTS: Thirty-eight (79.1%) patients displayed papillary, 8 (16.7%) follicular, 1 (2.1%) medullary and 1 (2.1%) Hurthle cell type cancer. Forty-eight patients underwent total thyroidectomy, 35 cases of which underwent central neck dissection, and 14 cases modified radical neck dissection. Postoperative complication developed in 8 cases, including 4 cases of transient hypoparathyroidism, 1 case of permanent hypoparathyroidism, 2 cases of transient recurrent laryngeal nerve palsy, and 1 case of wound hematoma. There was significant remnant thyroid tissue detected in 46 cases (95.8%) following total thyroidectomy, which were able to be ablated by low dose (30 mCi) I-131. There was no statistical difference between the operative procedures or the numbers of treatment of I-131. CONCLUSION: This data suggests that low-dose (30 mCi) I 131 therapy is effective for the ablation of remnant thyroid tissue following total thyroidectomy for differentiated thyroid cancer.
Hematoma ; Humans ; Hypoparathyroidism ; Neck Dissection ; Postoperative Complications ; Surgical Procedures, Operative ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyroidectomy* ; Vocal Cord Paralysis ; Whole Body Imaging ; Wounds and Injuries

PURPOSE: Papillary thyroid carcinoma is the most common endocrine malignancy. Despite the recent advances in diagnosis, controversy still remains concerning the surgical management. In order to select the appropriate surgical treatment, the outcome of different types of surgical procedures were reviewed. METHODS: 435 patients with papillary thyroid carcinoma who underwent surgery from January 1988 to December 1999 were retrospectively reviewed. The 12 years were divided into two periods; period 1 was from 1988 to 1993 (234 patients) and period 2 was from 1994 to 1999 (201 patients). The recurrence and complication rates according to the operation method, including a neck lymph node dissection, were analyzed. RESULTS: Twenty-six (10.7%) and 13 patients (6.5%) had a recurrence in period 1 and 2, respectively. Eighty-one (34.6%) and 51 patients (25.4%) had a postoperative complication including hypoparathyroidism and hoarseness in period 1 and 2, respectively. 271 patients (62.3%) had a lymph node metastasis, and the anterior neck was the most common site of metastasis (60.2%). CONCLUSION: A total thyroidectomy with a routine central node dissection reduces both the incidence and number of postoperative complications.
Diagnosis ; Hoarseness ; Humans ; Hypoparathyroidism ; Incidence ; Lymph Node Excision ; Lymph Nodes ; Neck ; Neoplasm Metastasis ; Postoperative Complications ; Recurrence* ; Retrospective Studies ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyroidectomy