Perioperative protection of parathyroid function is the focus and difficulty of thyroid surgery and also a problem that surgeons must pay attention to. It can be divided into three stages: preoperative management, intraoperative management, and postoperative management. Preoperative management mainly evaluates thyroid and parathyroid function and timely and effective treatment plan adjustment when functional abnormalities are found. Intraoperative management includes identifying and protecting the parathyroid gland, assessing and protecting parathyroid blood flow, etc. Postoperative management includes assessment of postoperative parathyroid function, effective treatment, and follow-up. Among them, intraoperative management is the key. Familiarity with the anatomical structure is the basis of parathyroid function protection, and visual recognition is an essential skill. Secondly, reasonable selection of surgical methods and application of fine membrane dissection technology can avoid the collateral damage of energy instruments to the parathyroid gland and nourishing blood vessels, and finally, timely use of autologous transplantation technology. Using assistive techniques such as imaging can help accurately locate the parathyroid gland and assess its blood flow before surgery. Preoperative localization is even more critical for hyperparathyroidism due to the non-uniqueness and uncertainty of the location of the diseased glands. The objective of treatment is to remove the diseased parathyroid glands and protect normal parathyroid tissue. To standardize the functional protection of parathyroid gland during the perioperative period, domestic guidelines and expert consensus have proposed the "1+X" basic principle and the "1+X+1" general strategy of parathyroid gland protection, guiding to help reduce the incidence of parathyroid injury during thyroid surgery.

Primary hyperparathyroidism is a disease with a large potential population. Some cases of primary hyperparathyroidism are non-primary, preventable and curable at early stage, requiring long-term follow-up after surgery. Therefore, all-round and full-cycle management are necessary for primary hyperparathyroidism, which involves an enhancing focus on etiological prevention, early detection, prompt diagnosis, timely intervention, multi-disciplinary standardized diagnosis and treatment, and postoperative scientific management. Meanwhile, implementing a "12+5+1" multidisciplinary joint diagnosis and treatment model, along with a two-way referral model, to achieve the transition from a disease-oriented diagnostic and treatment model to a patient-oriented, all-round and full-cycle interdisciplinary management model. This management can reduce the incidence and recurrence rate of primary hyperparathyroidism, and related osteoporosis or osteopenia, fractures, nephrolithiasis, metastatic vascular calcification, and systemic abnormal migratory calcium deposits, improve the overall quality of life and prognosis of patients.

Objective:To research the efficacy and safety of robotic thyroidectomy and bilateral modified radical neck dissection through bilateral axillo-breast approach (BABA) .Methods:We retrospectively analyzed the clinical data of 37 patients with thyroid cancer who received bilateral modified radical neck dissection through the BABA at the Department of Thyroid and Breast Surgery of the 960th Hospital of the People’s Liberation Army from Jan. 2014 to Jan. 2023. There were 24 females and 13 males, and the average age of the patients was (33,22±10.53) years old. The tumor diameter, number of lymph node dissection and metastasis in the central and lateral regions, average operation time, average hospital stay, complications, and aesthetic score were recorded. SPSS 25.0 software was used for statistical analysis, and the measurement data was calculated using mean ± standard deviation ( ± s), and the counting data was expressed in percentages and numbers. Results:A total of 37 thyroid cancer patients underwent robotic bilateral regional lymph node dissection. The 37 patients received total thyroidectomy, bilateral central compartment and cervical lateral regional lymph node dissection. All the pathological types were papillary carcinoma, with a maximal tumor diameter of (1.47±0.85) cm. The average number of central lymph nodes dissected was 19.46±8.84, and there were (10.24±5.95) metastases; The average number of lymph nodes removed from the bilateral cervical region was 38.92±14.21, and there were (7.92±5.84) metastases. The average operation time was (288.05±77.09) min, the average length of stay in the hospital was (10.76±3.92) days, and the average length of stay in the hospital following surgery was (8.03±2.08) days. These patients had no permanent hypoparathyroidism, permanent recurrent laryngeal nerve palsy, infection, accessory nerve injury and phrenic nerve injury after operation. Transient hypoparathyroidism occurred in 15 patients, transient recurrent laryngeal nerve palsy occurred in 1 patient, and chyle leak occurred in 2 patients. One month after surgery, the aesthetic score was 9.51±0.69.Two patients were found lymph node metastases during the (27.81±15.10) months of follow-up, and received robotic cervical lymph node dissection with BABA.Conclusion:For carefully chosen thyroid cancer patients with bilateral lateral cervical region lymph node metastases, robotic bilateral cervical lymph node regional dissection via BABA is safe and feasible, and good cosmetic results can be obtained.

Objective:To explore the experience and learning curve of single-line suspension suction rod-assisted hybrid cavity-building thyroid surgery via the oral vestibular approach.Methods:Clinical data of 138 patients undergoing single-line suspension suction rod-assisted hybrid cavity-building thyroid surgery via oral vestibular approach from Sep. 2019 to Dec. 2021 in the Department of Thyroid and Breast Surgery of Affiliated Hospital of North Sichuan Medical College were retrospectively analyzed. The cumulative sum (CUSUM) method and best-fit curve analysis were used to compare the differences in each index such as operative time, intraoperative bleeding, number of lymph nodes cleared in the central region and postoperative related complications at various stages of the learning curve.Results:All 138 patients underwent single-line suspension rod-assisted hybrid cavity-building thyroid surgery via the oral vestibular approach, and one patient was converted to open surgery due to large intraoperative bleeding in the mass. There were 14 males and 124 females, mean age (36.07±8.49) years (20-55 years), thyroid tumor size (7.74±6.49) mm (2.4-50mm), 5 cases underwent Subtotal thyroidectomy, 129 cases underwent Unilateral lobectomy + lymph node dissection in the middle region, and 4 cases total thyroidectomy + central zone lymph node dissection. The number of surgical cases corresponding to the apex of the CUSUM learning curve was 45, and the learning curve was divided into two stages: the learning improvement stage (1-45 cases) and the mastery stage (46-138 cases). The operative time, intraoperative bleeding, postoperative hospital stay, and chin numbness were all lower in the proficiency period than in the learning and training period ( P<0.05), and the number of lymph nodes cleared in the central region was larger than that in the learning and improvement stage ( P<0.05), while the differences in other indexes between the two stages were not statistically significant ( P>0.05) . Conclusion:The single-line suspension suction rod-assisted hybrid cavity-building thyroid surgery via the oral vestibular approach has clinical application value and is worth promoting, and the number of surgical cases to be accumulated to master this technique is 45.

Objective:To compare the surgical outcomes between scarless endoscopic thyroidectomy-lateral neck dissection (SET-LND) and open LND for papillary thyroid cancer (PTC) with lymph node metastasis and to share the experience in the prevention and treatment of lymphatic leakage after LND.Methods:Totally 90 PTC patients (25 males) who underwent LND in the Second Affiliated Hospital of Zhejiang University School of Medicine from Jan. 2021 to Aug. 2022 were retrospectively enrolled, with an average age of (28.06±4.89) years. They were divided into the SET-LND group ( n=50) and the open LND group ( n=40). The intraoperative blood loss, operation time, drainage volume on the first and the second days, postoperative lymphatic leakage, tumor (T), and node (N) were observed. The categorical variable data were compared between groups by χ 2 test, and the continuous variable data confirming normal distribution were compared between groups by independent sample t-test. Results:The operation time of the SET-LND group was (284.00±74.65) min, significantly longer than that of the open LND group (145.38±43.26) min ( t=-10.42, P<0.001). The intraoperative blood loss ( t=-1.309, P=0.194), postoperative hospital stay ( t=-0.136, P=0.892), drainage volume on the first day ( t=-1.074, P=0.286), and drainage volume on the second day ( t=-1.595, P=0.114), postoperative lymphatic leakage ( χ2=0.001, P=0.989), T ( t=0.367, P=0.714), N ( t=-1.614, P=0.110) were not significantly different between the two groups. Conclusion:Two surgical methods of LND have similar therapeutic effects and no significant difference was observed in the incidence of postoperative lymphatic leakage between the two groups.

Objective:To determine the correlation of tumor volume and weight with biochemical parameters in patients with parathyroid adenoma (PA) .Methods:A prospective electronic database collected clinical data on 208 patients with PA treated for the first time by surgery at department of general surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College.The relationship between biochemical parameters and tumor volume and weight was analyzed with Spearman’s correlation.Results:Tumor volume and weight were positively correlated with parathyroid hormone (PTH) ( r=0.33, P<0.001; r=0.39, P<0.001), calcium ( r=0.16, P=0.018; r=0.18, P=0.007) and alkaline phosphatase levels ( r=0.24, P<0.001; r=0.27, P<0.001), respectively. Clinical correlates affecting serum PTH were age, serum calcium and tumor weight ( F=30.325, P<0.001) . Conclusions:Tumor burden in patients with PA correlates with some laboratory biochemical parameters. Age and cystic lesions of the tumor may influence the actual serum PTH levels.

Objective:To analyze the effectiveness of radioactive iodine (RAI) treatment for papillary thyroid cancer (PTC) with an intermediate and high risk of recurrence.Methods:The clinical data of 709 cases of PTC, comprising 226 men and 483 women, who underwent surgical treatment for thyroid cancer at Xiangya Hospital of Central South University from Oct. 2010 to Jan. 2020 were retrospectively analyzed. According to whether RAI treatment was performed after initial surgery or not, they were divided into a RAI group (253 cases with intermediate risk and 209 cases with high risk) and a non-RAI group (147 cases with intermediate risk and 100 cases with high risk), and the relationship between RAI treatment and clinicopathological characteristics such as sex, age, and tumor size for intermediate- and high-risk PTC was analyzed by χ2 test or Fisher’s exact test and Logistic regression analysis. The Kaplan-Meier method was used to calculate the recurrence-free survival rate. Results:The treatment rate of intermediate-risk PTC RAI was 63.25% (253/400) and that of high-risk PTC RAI was 67.64% (209/309). Univariate analysis of intermediate-risk PTC showed that age, bilateral tumors, lymph node metastasis stage, number of lymph node metastases, and intermediate-risk PTC RAI treatment were closely related (all P values <0.05). Multi-factor regression analysis of intermediate-risk PTC showed that age ≥ 55 ( OR=0.282, P=0.005), lymph node metastasis stage N1b ( OR=19.245, P<0.001), and the number of lymph node metastases ≤ 5 ( OR=0.322, P<0.001) were independent predictors of RAI treatment for intermediate-risk PTC (all P values < 0.05). The recurrence-free survival curve for intermediate-risk PTC showed a lower recurrence-free survival rate in the RAI group than in the non-RAI group, but the difference was borderline significant ( P=0.049). Univariate analysis of high-risk PTC showed that age, multifocal tumors, bilateral tumors, lymph node metastasis stage, number of lymph node metastases and high-risk PTC RAI treatment were strongly associated (all P values <0.05). Multifactorial regression analysis for high-risk PTC showed that age ≥ 55 ( OR=0.382, P=0.020), bilateral tumors ( OR=2.173, P=0.030), lymph node metastasis stage N1b ( OR=11.215, P<0.001), and the number of lymph node metastases ≤5 ( OR=0.389, P=0.004) were independent predictors of RAI treatment for high-risk PTC patients (all P values <0.05). The recurrence-free survival curve for high-risk PTC showed a lower recurrence-free survival rate in the RAI group than in the non-RAI group, however, the difference was not statistically significant ( P=0.07) . Conclusions:No significant benefit was observed with RAI treatment for intermediate- and high-risk PTC and rigorous screening of eligible patients is recommended.

Objective:To analyze the risk factors for central lymph node metastasis (CLNM) in patients with papillary thyroid cancer (PTC) aged 55 years and above, and to construct a predictive model with columnar graph.Methods:This retrospective study included 406 PTC patients aged 55 and above, treated at the First Affiliated Hospital of Zhengzhou University from Nov. 2019 to Feb. 2022. Data on demographic characteristics, disease features, and laboratory test results were collected. Univariate and multivariate logistic regression analyses were used to identify risk factors for CLNM and develop a clinical prediction model and nomogram.Results:The study involved 406 patients, divided into a modeling group (285 patients) and a validation group (121 patients). The predictive model identified independent risk factors for CLNM. In the modeling group, the model demonstrated a ROC AUC of 0.769, with 82.6% sensitivity, 63.0% specificity, and 67.7% accuracy. The validation group showed 66.7% sensitivity, 74.5% specificity, and 72.7% accuracy, with an AUC of 0.760. Hosmer-Lemeshow tests indicated good fit in both groups. Decision curve analysis confirmed the model's clinical decision-making value, showing better performance than traditional strategies and good generalizability and reliability.Conclusions:Sex, maximum tumor diameter, bilateral involvement of thyroid lobes, clinically evident cervical lymph nodes, and local invasion are independent predictive factors for CLNM in patients over 55 with papillary thyroid carcinoma (PTC). A clinical risk stratification nomogram model based on these risk factors demonstrates good predictive performance.

Objective:To explore the clinical efficacy of areola approach endoscopic thyroidectomy (AET) and gasless axillary approach endoscopic thyroidectomy (GAET) in the treatment of papillary thyroid carcinoma (PTC) patients.Methods:A total of 96 PTC patients from the Thyroid Surgery Department of Linyi People’s Hospital from May. 2019 to May. 2022 were selected and randomly divided into 48 patients using a random number table method. The areola group received AET, while the armpit group received GAET. The surgical situation, postoperative recovery, relevant biochemical indicators [white blood cell count (WBC), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), parathyroid hormone (PTH), blood calcium] before and after surgery, postoperative pain level, discomfort level, neck function, and complications were compared between the two groups.Results:The surgical time and extubation time of the armpit group were (125.71±15.73) minutes and (3.12±0.53) days, respectively, which were shorter than those of the areola group (137.94±20.02) minutes and (3.48±0.46) days. The intraoperative bleeding volume was (14.19±4.16) mL, which was less than that of the areola group (22.65±7.39) mL, and the number of lymph nodes cleaned was 5.06±1.02, which was more than that of the areola group (4.23±1.14) ( P<0.05) ; there was no significant difference in postoperative drainage volume and hospital stay between the two groups ( P>0.05) ; Peripheral blood WBC in the armpit group on the 1st and 3rd day after surgery [ (5.69±0.15) ×10 9/L, (5.52±0.14) ] ×10 9/L, ESR [ (8.21±0.55) mm/h, (7.64±0.60) mm/h], CRP [ (10.06±1.78) ng/L, (8.93±1.33) ng/L] were lower than those in the areola group [ (5.83±0.21) ×10 9/L, (5.70±0.23) ×10 9/L, (8.87±0.74) mm/h, (8.19±0.68) mm/h, (12.45±1.90) ng/L, (10.45±1.50) ng/L] ( P<0.05). There was no significant difference in the levels of the above biochemical indicators 5 days after surgery ( P>0.05). There was no significant difference in peripheral blood PTH and calcium levels between the two groups on the 1st, 3rd, and 5th postoperative days ( P>0.05). The pain level [ (3.25±0.32) scores, (2.53±0.27) scores, (1.82±0.22) scores] and discomfort level [ (6.85±0.71) scores, (5.24±0.66) scores, (3.51±0.57) scores] in the axillary group were lower than those in the areola group [ (3.78±0.40) scores, (2.89±0.34) scores, (2.06±0.26) scores, (7.46±0.84) scores, (6.09±0.73) scores, (4.16±0.60) scores] on the 1st, 3rd, and 5th postoperative days ( P<0.05). The neck flexion, lateral flexion, and extension range of motion in the axillary group on the 3rd day after surgery were (33.16±3.09) °, (27.63±2.57) °, and (30.44 2.73) °, respectively, which were greater than those in the areola group[ (30.08±2.76) °, (25.14±2.30) °, and (27.98±2.54) °], and the swallowing disorder index was (30.16±4.97) points lower than the (34.83±4.13) points in the areola group ( P<0.05). The incidence of complications in the axillary group was 4.17% (2/48), lower than the 16.67% (8/48) in the areola group. Conclusion:GAET treatment for PTC patients can improve the effect of lymph node dissection, reduce the degree of surgical trauma, postoperative pain and discomfort, accelerate early postoperative recovery of neck function, and reduce complications.

Objective:To investigate the efficacy and prognosis of different surgical approaches in sporadic medullary thyroid carcinoma.Methods:A retrospective analysis was conducted on 101 patients with sporadic medullary thyroid carcinoma (MTC) who underwent surgical treatment at the Department of Thyroid Surgery, China-Japan Union Hospital of Jilin University, from Feb. 2009 to Nov. 2023. The patients included 36 males and 75 females, with a male-to-female ratio of 1:2.1. The median age of the patients was 47 years old, with an age range of 21 to 72 years old. The study divided participants into two groups based on their surgical methods: an observation group (78 cases) and a control group (23 cases). The observation group received surgical methods in accordance with expert consensus, while the control group did not. The study compared the efficacy and prognosis of the two groups.Results:Statistical differences were found between the two groups in terms of stage II and III in TNM staging, intraoperative frozen pathological findings, number of lymph node resections in the central group, number of lymph node metastases in the central group, number of lymph node resections in the lateral cervical region, postoperative follow-up time, and five-year postoperative serum procalcitonin (Ctn) levels ( P<0.05) .Both groups of patients obtained a significant decrease in Ctn after surgical treatment. In the observation group, Ctn was at the remission level in 57 cases (73.1%), at the stable level in 13 cases (16.7%), and at the progression level in 8 cases (10.2%), while in the control group, Ctn was at the remission level in 20 cases (86.9%), at the progression level in 3 cases (13.1%), and there were no patients at the stable level after the operation.One patient (1.3 per cent) in the observation group had a recurrence after surgery; Two patients (8.7 per cent) in the control group had a recurrence. Conclusions:Standardised and thorough surgery can maximise the clearance of metastatic lymph nodes, effectively reduce the recurrence rate, achieve better efficacy, and improve the long-term prognosis of patients without increasing the risk of surgery and postoperative complications.