Calcium plays a critical role in neuromuscular excitement and other cellular functions. Therefore, extracellular calcium concentration is maintained within a very narrow range through interaction of calcium regulating hormones such as parathyroid hormone, calcitonin, and vitamin D. Thus, symptomatic severe hypercalcemia has rarely occurred in a clinical situation, particularly in patients with hypoparathyroidism. In general, a large amount of calcium and vitamin D should be supplied in order to avoid hypocalcemia in hypoparathyroid patients. A 63-year old female patient was admitted suffering from nausea, vomiting, and weakness for two weeks. She had a history of total thyroidectomy and subsequent permanent hypoparathyroidism and long-term calcium and vitamin D supplementation. For over 10 years she had not changed her daily amount of calcium and vitamin D intake. Her initial serum calcium was 17.5 mg/dL, creatinine was 2.57 mg/dL, and total CO2 was 33.1 meq/L. After thorough examination, we concluded that milk-alkali syndrome was the cause of severe hypercalcemia. Therefore, special pay attention should be paid to aged patients on calcium supplementation in situations of increased risk of dehydration and renal insufficiency, even though the usual amount of calcium intake was unchanged for several years.
Calcitonin ; Calcium* ; Creatinine ; Dehydration ; Female ; Humans ; Hypercalcemia* ; Hypocalcemia ; Hypoparathyroidism* ; Nausea ; Parathyroid Hormone ; Renal Insufficiency ; Thyroidectomy ; Vitamin D ; Vomiting

PURPOSE: Thyroid papillary carcinoma is the most common endocrine tumor. There are many known factors affecting the pathophysiology of papillary carcinomas. In this study, we attempted to determine the clinical characteristics of papillary carcinomas with other benign pathologies. METHODS: From May 2007 to December 2012, a total of 994 patients underwent thyroidectomy and were diagnosed as papillary carcinomas. Retrospective study was performed using medical records. We categorized them according to five groups depending on associated benign disease, Papillary carcinoma with Graves disease (Group 1), Multinodular goiter (Group 2), Hashimoto thyroiditis (Group 3), Multinodular goiter and Hashimoto thyroiditis (Group 4), and Papillary carcinoma only (Group 5), and we performed a comparison analysis. RESULTS: T and N stage of group 2 were lower than those of group 5 and T stage of group 3 was lower than that of group 4. T and N stage of group 4 were lower than those of group 5 and extrathyroidal extension rate of group 4 was lower than that of group 5. CONCLUSION: Papillary carcinomas have variable clinical characteristics according to underlying benign thyroid disease. Conduct of advanced research regarding the mechanisms of the effect of benign thyroid disease on papillary carcinomas is needed.
Carcinoma, Papillary* ; Goiter ; Graves Disease ; Hashimoto Disease ; Humans ; Medical Records ; Pathology* ; Retrospective Studies ; Thyroid Diseases ; Thyroid Gland ; Thyroidectomy

PURPOSE: The goal of this study was to evaluate the diagnostic accuracy of preoperative fine needle aspiration biopsy cytology (FNAB-C) in predicting lateral lymph node metastasis in papillary thyroid cancer patients. METHODS: A total of 592 patients who underwent thyroid cancer surgery and intra-operative lateral cervical LN frozen section or RND, from January 2002 to December 2011, were evaluated retrospectively. Among them, 228 cases had suspicious findings in FNAB-C of lateral nodes. We reviewed their radiological and pathological reports. RESULTS: Intra-operative frozen section examination was performed in 540 cases and RND was performed in 314 cases. This study included 534 women (83.4%) and 106 men (16.6%). Patients' ranged in age from 9 to 83 years (mean, 45.65 years). FNAB-C was performed in 228 cases. The sensitivity and specificity of FNAB-C was 71.5% and 78.6%, respectively; 35.9% of cases had a false negative result. The combination of FNAB-C and intra-operative frozen section test sensitivity and specificity was 87.2% and 93.6%, respectively. CONCLUSION: The results for sensitivity in FNAB-C actually appear low, and false negative results were very high. In papillary thyroid cancer in patients with FNAB-C, even if the result is negative, if lymph node metastasis is suspected based on radiologic evidence, frozen section examination should be performed for determination of metastasis.
Biopsy ; Biopsy, Fine-Needle ; Female ; Frozen Sections ; Humans ; Lymph Nodes ; Male ; Neoplasm Metastasis* ; Retrospective Studies ; Sensitivity and Specificity ; Thyroid Neoplasms*

Injury to the recurrent laryngeal nerve is the most common and serious complication after thyroid surgery. Many different techniques have been described in the literature and interest in intraoperative neuromonitoring (IONM) has increased in an effort to prevent adverse events. IONM implicated for identification of the nerve and evaluation of its function during the operation. Continuous IONM was recently introduced and looks promising for early recognition and safe operation in the end. This paper describes the role of IONM, and its current and future issues.
Recurrent Laryngeal Nerve ; Thyroid Gland* ; Thyroidectomy

PURPOSE: PET-CT is often used to differentiate benign or malignant thyroid incidentalomas. In this retrospective study, we evaluated whether the ¹⁸F-FDG uptake pattern and PET-CT findings improved accuracy over the standardized uptake value (SUV). METHODS: ¹⁸F-FDG PET-CT was performed on 2,178 subjects from August, 2004, to October, 2007, in Sung-ae Hospital. PET-CT was performed on 806 patients (37%) with suspected or known nonthyroidal cancer and 1,372 healthy subjects (63%) without a previous history of cancer. We investigated the clinical characteristics of patients, history, standardized uptake value (SUV), ultrasonography, and hormone levels in blood. Thyroidal cancer was confirmed by ultrasonography-guided fine needle aspiration and pathology after thyroid operation. RESULTS: The prevalence of focal thyroid lesions on PET-CT was 8.8% (191/2178). Thyroid cancer confirmation was 7.9% (15/191). The maximum SUV of malignant thyroid lesions were significantly higher than that of benign lesions (7.00±3.08 vs. 4.49±1.84, P<0.001). CONCLUSION: PET-CT image interpretation that includes 18F-FDG uptake and SUV is better than PET-CT alone for differentiating benign and malignant lesions. Thyroid cancer risk increases as SUVmax levels increase.
Biopsy, Fine-Needle ; Fluorodeoxyglucose F18 ; Healthy Volunteers ; Humans ; Pathology ; Prevalence ; Retrospective Studies ; Thyroid Gland* ; Thyroid Neoplasms ; Ultrasonography

PURPOSE: Conventional surgery for thyroid disease requires long skin incisions and can lead to prominent scars of the neck, adhesions, hypoesthesia, and paresthesia. To overcome these problems we performed an endoscopic thyroidectomy via an axillo-bilateral breast approach. METHODS: Seventy patients with benign thyroid nodules by fine needle aspiration were selected. Patients underwent endoscopic thyroidectomy via axillo-bilateral breast approach from May, 2003, through November, 2007. RESULTS: Operations included 67 lobectomies, 1 isthmectomy, and 2 total thyroidectomies. Two cases were converted to an open thyroidectomy because of bleeding. The mean operating time was 90.6 min (range, 60~170). The mean length of hospital stay was 6.39 days (range, 4~12), and the mean duration of drainage was 3.87 days (range, 2~9). Postoperative hematoma for 3 patients was observed, but absorbed spontaneously. Two patients complained of hoarseness and 1 patient had vocal cord palsy, but these disappeared during follow-up. CONCLUSION: This approach resulted in satisfactory cosmetic results and no significant complications. We believe that endoscopic thyroidectomy via an axillo-bilateral breast approach is feasible and safe.
Biopsy, Fine-Needle ; Breast* ; Cicatrix ; Drainage ; Follow-Up Studies ; Hematoma ; Hemorrhage ; Hoarseness ; Humans ; Hypesthesia ; Length of Stay ; Neck ; Paresthesia ; Skin ; Thyroid Diseases ; Thyroid Nodule ; Thyroidectomy* ; Vocal Cord Paralysis

PURPOSE: Although the diagnostic accuracy of thyroid cancer by fine needle aspiration cytology (FNAC) is increasing, there are some nodules for which ultrasonography and FNAC show indeterminant. The purpose of this study was to determine the usefulness of thyroid ultrasonography by the surgeon prior to operation METHODS: Forty-nine patients who underwent thyroid operations between June 2006 and January 2007 were selected for this study. Thyroid ultrasonography was performed on each patient.And we recorded and analyzed the shape and the margin of the nodule, internal echogeneiety, heterogeneiety, the presence of microcalcification, height versus width, and the presence of level VI lymph node larger than 3 mm, assigning each a score of 1, 2 or 3. RESULTS: The average score was 17.1. Assuming an average score over 14 is considered to be malignant, the sensitivity, specificity, positive predictive value, and negative predictive value were 95.6%, 88.9%, 91.7%, 94.1% respectively. Statistically significant characteristics of malignancy were the shape and the margin of the nodule, internal echogeneiety, microcalcification, taller than wide shape and the presence of enlarged VI lymph nodes. The heterogeneiety had no significant P value. CONCLUSION: When malignancy cannot be confirmed even after repeated FNAC, preoperative ultrasonograpy performed by surgeons can be a reliable test and helpful for operations.
Biopsy, Fine-Needle ; Humans ; Lymph Nodes ; Sensitivity and Specificity ; Surgeons* ; Thyroid Gland* ; Thyroid Neoplasms ; Ultrasonography*

PURPOSE: To assess the value of preoperative ultrasonography (US) - guided skin marking for the investigation of cervical lymph node (LNs) metastasis in papillary cancer patients who had not undergone evaluation of cervical LNs at the initial diagnosis. METHODS: We evaluated cervical lymph nodes in 40 patients with papillary thyroid cancer. Ultrasonography wasperformed just prior to surgery. The shape, echogenicity, size, and location of lymph nodes were noted and the location of lymph nodes was marked on the skin surface with a pen under ultrasound guidance. The retrieved lymph nodes underwent intraoperative frozen section analysis to plan the extent of surgery. RESULTS: One hundred thirty two LNs were detected on preoperative US, 1087 LNs were surgically removed. Of 40 patients, 28 patients had lymph node metastasis. The cystic appearance, the presence of calcifications, hyperechogenicity and the absence of an echogenic hilum were significantly greater in malignant LNs than in benign LNs (P< 0.001). Among these, the cystic appearance and the presence of calcifications showed a very high specificity and seemed to be the most reliable in indicating malignant LNs. CONCLUSION: In papillary thyroid cancer patients, preoperatively ultrasound-guided localization of cervical LNs with skin marking shows good potential to determine surgical extent. Ultrasound features of LNs help in the selection of the node to remove with intraoperative frozen section analysis.
Diagnosis ; Frozen Sections ; Humans ; Lymph Nodes* ; Neoplasm Metastasis ; Sensitivity and Specificity ; Skin* ; Thyroid Gland* ; Thyroid Neoplasms* ; Ultrasonography

PURPOSE: Various techniques of minimally invasive thyroid surgery have been introduced during the past decade, including the endoscopic technique. We have developed a novel method of gasless endoscopic thyroidectomy via an axillary approach. The present report describes the technique of this method and the analysis of the surgical outcomes. METHODS: Between Dec. 2001 and Feb. 2008 (the actual operation period was 55 months), 634 patients with thyroid tumors underwent gasless endoscopic thyroidectomy via an axillary approach. The clinical and pathologic characteristics of the patients, the type of operation, the operative time, the post operative hospital stay and the post operative complications were retrospectively analyzed. RESULTS: Among the 634 patients, 176 patients had benign tumor and 458 patients had malignant tumor. The type of operationwas classified according to the extent of surgery. Lymphadenectomy (CCND, SND, MRND) was respectively performed for treating the patients with malignant tumor, depending on the indications. The mean operating time and the mean length of the post-operative hospital stay were 129.4±51.3 minutes, 3.3±1.7 days for benign tumor and 135.5±47 minutes, 3.4±0.9 days for malignancy, respectively. The mean tumor size was 2.7±1.2 (0.4~6.0) cm for benign tumor and 0.78±0.5 (0.1~4.0) cm for malignancy. Central compartment lymph node metastasis was found in 117 (25.6%) patients and lateral neck lymph node metastasis was found in 14 (3.0%) patients. There was no conversion to open thyroidectomy. As for the post-operative complications, transient hypocalcemia occurred in 19 patients, transient hoarseness was noted in 13 patients and permanent vocal cord palsy occurred in 2 patients. For the TNM stage, 406 (88.6%) patients were stage I, 51 (11.2%) patients were stage III and 1 (0.2%) patient was stage IVA. CONCLUSION: According to our experience, gasless endoscopic thyroidectomy using a trans-axillary approach is a feasible and safe method. Endoscopic thyroid surgery has become a new treatment modality for selected patients with benign tumors and it can be an effective treatment for selected patients who suffer with thyroid cancer.
Hoarseness ; Humans ; Hypocalcemia ; Length of Stay ; Lymph Node Excision ; Lymph Nodes ; Methods ; Neck ; Neoplasm Metastasis ; Operative Time ; Retrospective Studies ; Thyroid Gland ; Thyroid Neoplasms ; Thyroidectomy* ; Vocal Cord Paralysis

No abstract available.