Objective:To evaluate the feasibility, safety, and short-term efficacy of robot-assisted unilateral axillary approach for partial or total thyroidectomy without inflation. Methods:A retrospective analysis was performed on the clinical data of 98 patients who underwent gasless unilateral axillary approach robot-assisted resection of bilateral thyroid lesions at Sun Yat-sen University Cancer Center between October 2022 and October 2024. Perioperative indicators were recorded and compared among patients undergoing different surgical approaches（total thyroidectomy vs. bilateral partial thyroidectomy） and with different body mass index（BMI） values, including operative time, intraoperative blood loss, number of lymph nodes dissected, incidence of postoperative hoarseness, incidence of postoperative hypocalcemia, and other postoperative complications. Results:A total of 98 patients were included, of whom 78.57% were female, with a median age of 39 years（interquartile range[IQR]: 35-49） and a median BMI of 24.08 kg/m²（IQR: 21.43-25.98）. The median intraoperative blood loss was 32.14 mL（IQR: 20.00-50.00）, the median operative time was 130.0 minutes（IQR: 104.80-150.30）, and the median hospital stay was 2.01 days（IQR: 1.00-2.00）. The most common postoperative complication was transient hypocalcemia, with an incidence of 16.32%. There were no cases of permanent recurrent laryngeal nerve palsy or conversion to open surgery. Compared with the non-total thyroidectomy group, the total thyroidectomy group had a significantly longer operative time（135.10±33.28 min vs 120.30±30.53 min, P=0.033）. Subgroup analysis based on BMI showed no statistically significant differences in operative time, hospital stay, drainage volume, or incidence of hypocalcemia between patients with BMI≥25 kg/m² and those with BMI<25 kg/m². Conclusion:The gasless unilateral axillary approach for robot-assisted partial or total thyroidectomy demonstrates favorable safety, cosmetic outcomes, and feasibility. Appropriate selection of surgical techniques and meticulous protection of critical structures during the procedure can further reduce the risk of complications and optimize therapeutic outcomes.
Humans ; Thyroidectomy/methods* ; Retrospective Studies ; Female ; Robotic Surgical Procedures/methods* ; Male ; Adult ; Middle Aged ; Axilla/surgery* ; Operative Time ; Postoperative Complications ; Thyroid Neoplasms/surgery* ; Thyroid Gland/surgery* ; Lymph Node Excision

Objective: To investigate the application efficacy of the "classification of external branch of superior laryngeal nerve (EBSLN)" combined with intraoperative neuromonitoring (IONM) in the dissection of EBSLN for protecting the nerve from injuery, compared with ligation of branches of the superior thyroid vessels without attempts to visually identify the nerve. Methods: A prospective randomized controled study was performed in our center. Patients subjected to thyroidectomy from January 2017 to June 2019 were randomly divided into 2 groups, patients in experimental group underwent thyroidectomy and "classification of EBSLN" with IONM to dissect EBSLN, and patients in control group received synchronous surgery without attempts to visually identify the nerve. The anatomical subtypes of EBSLN in experimental group were recorded. The voice handicap index 10 (VHI-10) score was evaluated and the movement of bilateral vocal cords was examined by laryngoscope before surgery, 1 month, 3 months, and 6 months after surgery, respectively. SPSS 26.0 statistical software was used for statistical analysis. Results: Among the 1 377 EBSLN from 827 patients (317 males and 510 females, aged 24-58 years old), 691 EBSLNs in experimental group and 686 EBSLNs in control group. Totally 98.3% of EBSLNs in experimental group were identified by IONM including 16.4% (113/691) for type Ⅰ, 21.3% (147/691) for type Ⅱa, 31.4% (217/691) for type Ⅱb, 10.4% (72/691) for type Ⅲa, 3.9% (27/691) for type Ⅲb, 16.6% (115/691) for type Ⅲc. There was no statistical significance difference in baseline data between 2 groups (all P>0.05). All patients were followed up for more than 6 months. The postoperative nerve injury rate of experimental group was significantly lower than that of control group (1.2% vs. 7.5%, χ²=12.659, P<0.001), and the VHI-10 scores and laryngoscope results of experimental group were better than those of control group in three follow-up visits (P<0.001). With postoperative laryngoscope examination, 3 patients in the experimental group and 23 patients in the control group showed vocal cord relaxation, bilateral oblique asymmetry and other phenomena, which were considered as the results of permanent injury. Other patients with symptoms were relieved to varying degrees during the follow-up, and their symptoms were considered as the results of temporary injury. Conclusion: IONM combined with "classification of EBSLN" can reduce significantly the risk of EBSLN injury in thyroidectomy, which is better than direct ligation of branches without attempts to visually identify the nerve.
Adult ; Female ; Humans ; Laryngeal Nerve Injuries ; Laryngeal Nerves ; Male ; Middle Aged ; Monitoring, Intraoperative ; Prospective Studies ; Thyroid Gland ; Thyroidectomy ; Young Adult

We report a case of a 47-year-old female known with metastatic papillary thyroid cancer. Her treatment history included total thyroidectomy and 3 previous radio ablations with a cumulative dose of 950 mCi of ¹³¹I. On follow-up, her thyroglobulin levels had demonstrated a rising trend (from 3789.0 to 4240.0 ug/L) despite a ¹²³I whole-body scan demonstrating a reduction in tracer avid lesions. She was suspected of having radio-resistant disease. The patient underwent both ¹⁸F-FDG and ⁶⁸Ga-PSMA PET/CT imaging with both scans demonstrating congruent lesions however with far greater intensity on the ⁶⁸Ga-PSMA study.
Female ; Follow-Up Studies ; Humans ; Iodine ; Middle Aged ; Positron-Emission Tomography and Computed Tomography ; Thyroglobulin ; Thyroid Gland ; Thyroid Neoplasms ; Thyroidectomy

Primary thyroid lymphoma (PTL) is a relatively rare disease, accounting for less than 0.5~5% of all thyroid malignancies. We encountered two cases of a primary thyroid lymphoma with Hashimoto's thyroiditis; one in a 63-year-old man and the other in a 79-year-old woman. The first case was a mucosa-associated lymphoid tissue lymphoma, and the other was a diffuse large B-cell lymphoma. Both patients underwent surgery and radiotherapy after being diagnosed using fine-needle aspiration cytology (FNAC). Both patients recovered well with no recurrence throughout the study period. The role of the surgeon in the treatment and diagnosis of thyroid lymphoma has been reduced due to the development of FNAC and combination therapy with chemotherapy and radiotherapy. On the other hand, surgery can be an effective treatment option for PTL confined to the thyroid, for achieving a definitive diagnosis, and in the treatment of patients with an airway obstruction.
Aged ; Airway Obstruction ; Biopsy, Fine-Needle ; Diagnosis ; Drug Therapy* ; Female ; Hand ; Humans ; Lymphoma* ; Lymphoma, B-Cell ; Lymphoma, B-Cell, Marginal Zone ; Middle Aged ; Radiotherapy ; Rare Diseases ; Recurrence ; Thyroid Gland* ; Thyroidectomy ; Thyroiditis

Thyroid hemiagenesis is a rare congenital anomaly that is caused by a developmental defect of a thyroid. Previous reports indicate that thyroid cancer associated with hemiagenesis is extremely rare. A 47-year-old woman presented with single nodule in the right thyroid gland that was incidentally detected during a routine medical checkup. Ultrasonography showed a 1.5×1.2 cm sized ill-defined irregular hypoehoic nodule in the right thyroid and the isthmus was present. However, the left thyroid was not seen and thyroid was disconnected at left paraisthmic area. Fine-needle aspiration cytology confirmed that the right thyroid nodule was papillary thyroid carcinoma. Total thyroidectomy with bilateral central compartment node dissection was performed. Permanent pathologic finding was 1.3×1 cm sized classical type papillary thyroid carcinoma with nodular hyperplasia. There was extensive lymphatic invasion and 3 metastatic lymph nodes out of 4 in central compartment. In conclusion, although thyroid hemiagenesis associated with thyroid carcinoma is extremely rare, treatment strategy is not different with patients with normal anatomy. And the possibility of developing a thyroid carcinoma should be considered in patients with hemiagenesis. Furthermore, it requires awareness of anatomical difference around the thyroid gland during operation.
Biopsy, Fine-Needle ; Female ; Humans ; Hyperplasia ; Lymph Nodes ; Middle Aged ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyroid Nodule ; Thyroidectomy ; Ultrasonography

A 61-year-old woman who underwent total thyroidectomy for papillary thyroid carcinoma (PTC) five years previously referred for a cervical retrotracheal mass. The mass had intense fluorodeoxyglucose (FDG) uptake on positron emission tomography-computed tomography (PET-CT), and was thus thought to be malignant. Transcutaneous ultrasonography with fine needle aspiration (FNA) was not feasible, so we tried endobronchial ultrasonography (EBUS) with transbronchial needle aspiration (TBNA) to obtain a cytology specimen. After surgery, the mass was confirmed to be a metastatic lymph node from the previous PTC, confirming the TBNA results. Although the utility of EBUS-TBNA for evaluating mediastinal metastasis has been reported in a number of studies, few reports have addressed its utility in the cervical region. Here we report this unusual case of metastatic lymph node of PTC that recurred in the cervical retrotracheal area. It was found to exhibit esophageal muscular invasion, and was accurately diagnosed on EBUS-TBNA.
Biopsy, Fine-Needle ; Electrons ; Female ; Humans ; Lymph Nodes ; Middle Aged ; Needles* ; Neoplasm Metastasis ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyroidectomy ; Ultrasonography*

Amyloidosis is an abnormal extracellular deposit of amyloid in various organs of the body. Amyloid goiter, defined by a clinically detectable thyroid enlargement due to amyloid deposition, is a rare cause of hyperthyroidism. We report the case of amyloid goiter mimicking Graves' disease in a 62-year-old woman. Graves' disease was diagnosed by diffuse goiter, hyperthyroidism, and positive TSH receptor antibody. Total thyroidectomy was planned due to progression of Graves' disease and respiratory distress. At surgery thyroid gland was very friable and fragmented like cobblestones when grasped with forceps. A diagnosis of amyloid goiter was established by the presence of diffuse amyloid deposits in the parafollicular areas. After systemic evaluation for amyloidosis, coexisting both multiple myeloma and systemic amyloidosis involving kidney and heart were detected. She underwent palliative chemotherapy but disease progressed. Amyloid goiter might be suspected in patient with thyroid enlargement and concomitant systemic disease such as renal or heart failure.
Amyloid* ; Amyloidosis ; Diagnosis ; Drug Therapy ; Female ; Goiter* ; Graves Disease* ; Hand Strength ; Heart ; Heart Failure ; Humans ; Hyperthyroidism ; Kidney ; Middle Aged ; Multiple Myeloma ; Plaque, Amyloid ; Receptors, Thyrotropin ; Surgical Instruments ; Thyroid Gland ; Thyroidectomy

We report a rare case of co-occurrence of papillary thyroid carcinoma (PTC), follicular thyroid carcinoma (FTC) and primary thyroid lymphoma. A 55-year-old woman presented with a large mass in left lobe of thyroid, biopsy confirmed diffuse large B-cell lymphoma. After 4 cycles of rituximab, cyclophosphamide, doxorubicin hydrochloride, vincristine sulfate, and prednisolone chemotherapy, positron emission tomography scan revealed markedly decreased in size, but still present. Repeated ultrasonography-guided gun biopsies of 2 lesions indicated Hurthle cell neoplasm. After total thyroidectomy and bilateral central lymph node dissection, residual hypermetabolic lesion of left lobe was determined to be FTC and right lower lesion to be nodular hyperplasia. Besides, a PTC was incidentally detected in left lobe. If there are multiple nodular lesions at diagnosis or there is insufficient response after 1st line chemotherapy for primary thyroid lymphoma, each lesion should be biopsied to confirm its pathological type.
Adenocarcinoma, Follicular ; Biopsy ; Carcinoma, Papillary* ; Cyclophosphamide ; Diagnosis ; Doxorubicin ; Drug Therapy ; Female ; Humans ; Hyperplasia ; Lymph Node Excision ; Lymphoma* ; Lymphoma, B-Cell ; Middle Aged ; Positron-Emission Tomography ; Prednisolone ; Rituximab ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyroidectomy ; Vincristine

PURPOSE: Decision to perform concurrent ipsilateral thyroidectomy on patients with hypopharyngeal cancer is important, and unnecessary thyroidectomy should be avoided if oncologically feasible. We hypothesized that concurrent ipsilateral thyroidectomy is not routinely required to prevent occult metastasis. This study aimed to determine the prevalence of histological thyroid invasion in patients with hypopharyngeal cancer, and to refine the indications for prophylactic ipsilateral thyroidectomy in patients with hypopharyngeal cancer. MATERIALS AND METHODS: A retrospective review of the medical records from the Department of Otolaryngology at Yonsei University College of Medicine was conducted from January 1994 to December 2009. A total of 49 patients underwent laryngopharyngectomy with thyroidectomy as a primary treatment of hypopharyngeal cancer. RESULTS: The incidence of thyroid gland involvement was 10.2%. The most common route of invasion was direct extension through the thyroid cartilage. Thyroid cartilage invasion (p=0.034) was the most significant factor associated with thyroid invasion. Disease-specific survival at 5 years was lower in patients with than without thyroid gland invasion (26.7% vs. 55.2%, respectively; p=0.032). Disease-free survival at 5 years was also lower in patients with than without thyroid gland invasion (20.0% vs. 52.1%, respectively; p=0.024). CONCLUSION: Ipsilateral thyroidectomy in combination with total laryngopharyngectomy is indicated when invasion of the thyroid cartilage is suspected in patients with hypopharyngeal cancer.
Adult ; Aged ; Aged, 80 and over ; Carcinoma, Squamous Cell/epidemiology/pathology/*surgery ; Disease-Free Survival ; Female ; Humans ; Hypopharyngeal Neoplasms/epidemiology/pathology/*surgery ; Incidence ; *Laryngectomy ; Male ; Middle Aged ; Neoplasm Invasiveness ; Neoplasms, Second Primary/epidemiology/pathology/surgery ; *Pharyngectomy ; Predictive Value of Tests ; Prevalence ; Republic of Korea/epidemiology ; Retrospective Studies ; Thyroid Gland/*pathology/surgery ; Thyroid Neoplasms/epidemiology/*secondary ; Thyroidectomy/*methods

Distant metastasis from papillary thyroid carcinoma (PTC), particularly from papillary thyroid microcarcinoma, is rare. We present a case of perigastric lymph node metastasis from PTC in a patient with early gastric cancer and breast cancer. During post-surgical follow-up for breast cancer, a 56-year-old woman was diagnosed incidentally with early gastric cancer and synchronous left thyroid cancer. Therefore, laparoscopic distal gastrectomy with lymph node dissection and left thyroidectomy were performed. On the basis of the pathologic findings of the surgical specimens, the patient was diagnosed to have papillary thyroid microcarcinoma with perigastric lymph node metastasis and early gastric cancer with mucosal invasion. Finally, on the basis of immunohistochemical staining with galectin-3, the diagnosis of perigastric lymph node metastasis from PTC was made. When a patient has multiple primary malignancies with lymph node metastasis, careful pathologic examination of the surgical specimen is necessary; immunohistochemical staining may be helpful in determining the primary origin of lymph node metastasis.
Breast Neoplasms ; Diagnosis ; Female ; Follow-Up Studies ; Galectin 3 ; Gastrectomy ; Humans ; Lymph Node Excision ; Lymph Nodes* ; Middle Aged ; Neoplasm Metastasis* ; Stomach Neoplasms* ; Thyroid Gland ; Thyroid Neoplasms* ; Thyroidectomy