Differentiated thyroid cancers are rarely associated with distant metastases and have 10-year survival rates higher than 80%; however, the prognosis deteriorates significantly if metastasis occurs. Bone is the second most common site of metastasis after the lungs in cases of thyroid cancer. Here we describe a case in which a 57-year-old female patient had extremely severe pain on the posterior neck. After magnetic resonance imaging, 18F-FDG PET CT and ultrasonography guided biopsy, right papillary thyroid carcinoma with cervical spine metastasis was suspected; therefore, she underwent surgery for removal of thyroid carcinoma and seventh cervical spine metastasis. Pathologic diagnosis was confirmed as left thyroid follicular carcinoma with seventh cervical spine metastasis and synchronous right thyroid papillary carcinoma. The patient then underwent an additional spinal tumor removal operation, I131 treatment and external radiation therapy. Complete removal of the cervical spine tumor could not be achieved due to intra-operative bleeding and the need to prevent damage to the spinal cord. Following treatment, the patient reported great relief from severe neck pain. This is a rare presentation of follicular thyroid carcinoma with cervical spine metastasis in Korea.
Adenocarcinoma, Follicular* ; Biopsy ; Carcinoma, Papillary ; Diagnosis ; Female ; Fluorodeoxyglucose F18 ; Hemorrhage ; Humans ; Korea ; Lung ; Magnetic Resonance Imaging ; Middle Aged ; Neck ; Neck Pain ; Neoplasm Metastasis ; Prognosis ; Spinal Cord ; Spine* ; Survival Rate ; Thyroid Gland ; Thyroid Neoplasms ; Ultrasonography

PURPOSE: Gasless transaxillary approach to endoscopic thyroidectomy is a widely performed procedure for benign or malignant thyroid neoplasms. However, it requires wide dissection for approaching the target area. The intravenous patient-controlled analgesia (IV PCA) is an effective method for postoperative pain control and patients can use it according to their requirement. However, patients suffer from nausea, vomiting, sleep disturbance, etc. due to opioids. Pain pump ON-Q® PainBuster® (pain buster) has been used widely in various surgeries for control of postoperative localizing and wide area pain without side effects of opioid analgesia because it consists of Ropivacaine. METHODS: From Aug. 2008 to Jan. 2013, Gasless transaxillary endoscopic thyroidectomy was performed in 90 patients in a single institution, who were divided into three groups, including the IV PCA, pain buster, and null groups. We compared postoperative outcomes, pain severity between groups. We recorded scores immediately, 6, 12, 24, and 48 hours after surgery following visual analog pain score (VAS), and investigated hospital stay and occurrence of events of nausea, vomiting, and complications. RESULTS: In the IV PCA group, it was discontinued due to nausea in 36.7% of patients. No significant difference in pain severity following VAS score was observed among the three groups. However, smaller numbers of analgesia injections were required in the Pain buster group than in the other groups, and fewer patients suffered from constipation, compared with the PCA group. CONCLUSION: Pain buster showed even effects compared to IV PCA, with few side effects and less discomfort of patients, compared with the other groups. Therefore, pain buster was thought to be the proper method for pain control after dissection of the anterior chest wall, cervical area in order to secure an operative view for transaxillary endoscopic thyroidectomy.
Analgesia ; Analgesia, Patient-Controlled* ; Analgesics, Opioid ; Constipation ; Humans ; Length of Stay ; Methods ; Nausea ; Pain, Postoperative ; Passive Cutaneous Anaphylaxis ; Thoracic Wall ; Thyroid Neoplasms ; Thyroidectomy* ; Vomiting

PURPOSE: This study was conducted to investigate whether the use of HA-CMC solution in thyroid surgery influences drainage amount and hospital stay. METHODS: Between November 2012 and December 12, 147 patients with thyroid cancer who underwent total thyroidectomy with central compartment neck dissection were analyzed retrospectively. The patients were divided into four groups; those with or without HA-CMC solution application and high or low output drainage. RESULTS: There were no differences in hospital stay and mean total drainage between the with and without HA-CMC solution application groups (P=0.230, P=0.732). The mean hospital stay was 2.2±0.4 days for the low output of drainage group and 3.1±0.6 days for the high output drainage group (P<0.001). There was no significant difference in the use of HA-CMC solution (41.1% vs. 56.8%, P=0.070). CONCLUSION: The use of HA-CMC solution in thyroid cancer surgery might not increase drainage amount and make hospital stay longer.
Drainage* ; Humans ; Length of Stay ; Neck Dissection ; Retrospective Studies ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyroidectomy

PURPOSE: Adrenalectomy is a very rare operation and its associated learning curve has not yet been studied. The objective of this study was to determine whether the operation time decreases with experience and to evaluate the safety and feasibility of laparoscopic adrenalectomy performed by a surgeon who is new to laparoscopic and open-surgical adrenalectomy. METHODS: This study is a retrospective analysis of laparoscopic adrenalectomies performed between April 2007 and September 2012. All surgeries were performed by a single young surgeon who had no experience in performance of open or laparoscopic adrenalectomy. All surgeries were performed using the transperitoneal approach. RESULTS: In total, 42 cases were included. The average tumor size was 4.7 cm. The mean operating time was 125 min. Mean duration of hospital stay was 8.7 days. None of the cases showed conversion to open surgery or perioperative mortality. The operator achieved mastery after performance of left laparoscopic adrenalectomy in 12 cases and right laparoscopic adrenalectomy in 11 cases. CONCLUSIONS: A new surgeon can perform laparoscopic transperitoneal adrenalectomy successfully, independently, and safely after having performed the surgery in 12 cases.
Adrenalectomy* ; Conversion to Open Surgery ; Learning Curve* ; Learning* ; Length of Stay ; Mortality ; Retrospective Studies

PURPOSE: Laparoscopic adrenalectomy has become the standard of care for a variety of benign adrenal pathologies. A total of 111 consecutive adrenalectomies were performed using a lateral transperitoneal or posterior retroperitoneal approach, each with its own inherent benefits and shortcomings. The authors compared the effectiveness and safety of posterior retroperitoneal adrenalectomy (PRA) with that of lateral transperitoneal adrenalectomy (LTA). METHODS: Medical records of 111 patients diagnosed with adrenal tumor who underwent laparoscopic adrenalectomy from January 2000 through April 2012 at Chungnam National Hospital were reviewed retrospectively. Study variables included operative time, length of hospital stay, number of days of pain control, diet beginning and advance, and complications. RESULTS: PRA was shorter in most variables, including operative time, hospital stay, first diet beginning, and full diet advance time compared with that of LTA. In pheochromocytoma less than or equal to 7 cm in size, operation time for LTA was longer than that of PRA. One PRA-specific complication was pseudo-hernia of the ipsilateral abdominal wall, which was resolved spontaneously within 1~2 months. CONCLUSION: Laparoscopic adrenalectomy is a safe and effective approach to benign adrenal pathology, and PRA should be considered in patients with tumors less than or equal to 7 cm.
Abdominal Wall ; Adrenalectomy* ; Chungcheongnam-do ; Diet ; Humans ; Length of Stay ; Medical Records ; Operative Time ; Pathology ; Pheochromocytoma ; Retrospective Studies ; Standard of Care

PURPOSE: Because the main drawback of bilateral adrenalectomy is permanent adrenal insufficiency and the subsequent risks of life-long steroid use, adrenal preserving partial adrenalectomy is being accepted as its alternative. The aim of this study is to investigate the indications for bilateral adrenalectomy and to assess the postoperative outcomes and steroid replacement according to operative methods. METHODS: From May 1996 through July 2013, a total of 25 patients who underwent bilateral adrenalectomy in our institution were reviewed retrospectively. Surgical outcomes were compared between total and partial adrenalectomy, and postoperative steroid hormone replacement were examined according to the volume of remnant adrenal gland. RESULTS: The median follow-up duration of 25 patients was 55.8 months. The most common indication for bilateral adrenalectomy was bilateral pheochromocytoma (n=16), which was associated with genetic mutation of RET or VHL gene in 11 cases. Cushing's syndrome (n=8) and hyperaldosteronism (n=1) were another indications of bilateral adrenalectomy. Total adrenalectomy was performed in 8 patients and adrenal preserving partial adrenalectomy in 17 patients. Among the 17 patients, only 5 patients needed adrenal hormone replacement and 2 patients had a recurrence at remnant adrenal tissue. CONCLUSION: Adrenal preserving partial adrenalectomy might be a better option for bilateral adrenal tumor than total adrenalectomy because it can reduce complications associated with adrenal insufficiency and recurrence of the disease is not common.
Adrenal Glands ; Adrenal Insufficiency ; Adrenalectomy* ; Cushing Syndrome ; Follow-Up Studies ; Humans ; Hyperaldosteronism ; Pheochromocytoma ; Recurrence ; Retrospective Studies

PURPOSE: During the past decade, various endoscopic thyroid surgeries have been conducted, each with its own benefits. The incorporation of robotic systems to endoscopic thyroid surgery has improved the visualization and precision of endoscopic techniques. We previously reported our initial experience with robotic modified radical neck dissection (MRND) of papillary thyroid carcinoma (PTC) with lateral neck node metastasis (LNM). The aim of this study was to compare surgical outcomes of robotic vs. conventional open MRND of PTC with LNM using propensity score matching. METHODS: From January 2008 to February 2011, 515 patients with PTC with LNM were enrolled. One hundred patients underwent robotic MRND, and 415 patients underwent conventional open MRND. These two groups were retrospectively compared with respect to their clinicopathological characteristics, surgical outcomes, and surgical completeness. Furthermore, to avoid selection bias, propensity score matching analysis was used to compare surgical outcomes of each group without any compounding factors. RESULTS: The operative time for the robotic MRND was longer than for the open MRND (297.9±60.2 min vs. 212.1±55.6 min, P=0.089). However, the mean numbers of retrieved lymph nodes and mean hospital stay after surgery were similar in the two groups (36.0±12.9 vs. 40.8±13.3, P=0.235), (6.1±1.6 days vs. 6.1±2.1 days, P=0.577). The complication rates were similar between the two groups, and there was no statistical difference in postoperative thyroglobulin levels between groups (0.51±0.83 ng/ml vs. 0.89±2.46 ng/ml, P=0.593). CONCLUSION: According to our study, robotic MRND shows similar surgical outcomes to conventional open MRND after case-matched analyses. We suggest that robotic MRND is an acceptable alternative as an operative method for PTC with LNM, resulting in excellent cosmesis and patient satisfaction.
Humans ; Length of Stay ; Lymph Nodes ; Methods ; Neck Dissection ; Neck* ; Neoplasm Metastasis* ; Operative Time ; Patient Satisfaction ; Propensity Score* ; Retrospective Studies ; Selection Bias ; Thyroglobulin ; Thyroid Gland* ; Thyroid Neoplasms*

PURPOSE: The causal association between Hashimoto's thyroiditis (HT) and papillary thyroid cancer (PTC) remains controversial. This research attempted to analyze clinicopathological relationships between HT and PTC, and to determine what influence the former has on the latter. METHODS: We retrospectively reviewed 773 patients who underwent thyroid surgery with PTC. These patients were divided into two groups, coexistent HT group and PTC alone group, and the clinicopathologic data were analyzed. RESULTS: Out of 773 patients, the coexistent HT group included 269/773 (34.8%) patients and the control group included 504/773 (65.2%) patients. In comparison of these two groups, there were no significant differences in age, extent of surgery, serum T3, Free T4, number of tumors, multifocality, tumor size, extrathyroidal extension, and lymph node metastasis. In sex, women were at the higher rate in coexistent HT group than in the control group (P=0.008). Serum TSH level was higher in the coexistent HT group (P<0.001). In addition, using the AMES scoring system, the coexistent HT group showed a significantly higher rate of low risk than the control group (P=0.048). Multivariate analysis showed no significant association between HT and lymph node metastasis (P=0.081, odds ratio=1.335; 95% CI, 0.965~1.847). CONCLUSION: The rate of women and serum TSH level were higher in the coexistent HT group. In addition, the low-risk group showed the higher rate in the case of accompanying HT, and though the HT does not affect the lymph node metastasis but much more researches would be needed on that.
Female ; Humans ; Lymph Nodes ; Multivariate Analysis ; Neoplasm Metastasis ; Retrospective Studies ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyroiditis*

PURPOSE: Extrathyroidal extension (ETE) is one of the risk factors to be considered when deciding on operation extent and radioiodine ablation in differentiated thyroid carcinoma. Ultrasonography (USG) is the most widely used imaging modality in preoperative evaluation of thyroid carcinoma; however, few studies regarding accuracy of USG in preoperative evaluation of ETE have been reported. In this study, we investigated the accuracy of preoperative USG in detection of ETE and evaluated other risk factors associated with permanent ETE. METHODS: We reviewed the medical records of 349 consecutive patients who underwent curative thyroidectomy for differentiated thyroid carcinoma. Preoperative USG findings according to percent of contact and disruption of thyroid capsule were evaluated and compared with the permanent pathology. Clinicopathologic characteristics were investigated for assessment of the risk factors associated with ETE. RESULTS: ETE was identified in permanent pathology of 68 (19.5%) patients. When we defined the ETE on preoperative USG as more than 25% contact with the adjacent capsule, the positive predictive value (PPV) and negative predictive value (NPV) were 43.03% and 90.73%, respectively. Size of the nodule and preoperative USG findings with the percent of contact with adjacent capsule and capsule disruption showed an association with ETE on permanent pathology. However, in multivariate analysis, only size of the nodule and capsule disruption on USG were identified as risk factors for prediction of ETE on permanent pathology. CONCLUSION: Capsule disruption on preoperative USG can provide useful predictive information about permanent ETE. Another risk factor associated with ETE was size of nodule in differentiated thyroid carcinoma.
Humans ; Medical Records ; Multivariate Analysis ; Pathology ; Risk Factors* ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyroidectomy ; Ultrasonography

Minimally invasive follicular thyroid carcinoma (MIFTC) is a subtype of follicular thyroid carcinoma. The definition of MIFTC is somewhat confusing; as a result, diagnosis of MIFTC is difficult. MIFTC is known to have an excellent prognosis. Thus, no further treatment is usually required after diagnostic lobectomy. However, some patients with MIFTC experience distant metastasis after initial lobectomy. In this review, we will discuss the definition of MIFTC and risk factors of distant metastasis after initial lobectomy.
Adenocarcinoma, Follicular* ; Diagnosis ; Humans ; Neoplasm Metastasis ; Prognosis ; Risk Factors ; Thyroid Neoplasms