In Situ Preservation Fraction of Parathyroid Gland in Thyroidectomy: A Cohort Retrospective Study

Background and Objectives. Parathyroid failure is the most common symptom after thyroidectomy. To prevent it, a gland was preserved in situ or an ischemic one was autotransplanted. This study explored the relationship between in situ preservation of the parathyroid gland and gland failure. Methods. Consecutive patients who underwent initial total thyroidectomy were enrolled retrospectively in a prospectively maintained database. Patients were divided into groups by parathyroid gland remaining in situ fraction (PGRIF) (PGRIF = number of in situ glands/(total number of identified glands − number of glands in specimen). Patients were graded by tertiles and followed at least one year after surgery. Results. 559 patients were included. PGRIF is significantly inversely associated with transient hypoparathyroidism, protracted hypoparathyroidism, and postoperative hypocalcemia. PGRIF was identified as an independent risk factor for transient hypoparathyroidism, protracted hypoparathyroidism, and postoperative hypocalcemia (OR=0.177, 0.190, and 0.330, resp.). Autotransplantation of parathyroid gland would not affect the calcium level in the long term. Conclusion. In situ preservation of parathyroid gland is crucial for parathyroid function. Less preserved is the independent risk factor for postoperative hypoparathyroidism and hypocalcemia, resulting in a worse function of parathyroid gland in the long term

Pretracheal Lymph Node Subdivision in Predicting Contralateral Central Lymph Node Metastasis for Unilateral Papillary Thyroid Carcinoma: Preliminary Results

BackgroundThe aims of this study were to assess the clinical value of pretracheal lymph node subdivision in identifying patients with contralateral central lymph node metastasis (CLNM) and risk factors for occult contralateral CLNM in unilateral PTC.MethodsA total of 139 unilateral PTC patients with a clinically node-negative neck (cN0) who underwent bilateral central neck dissection (CND) were prospectively enrolled. Intraoperatively, the pretracheal region was further divided into ipsilateral and contralateral subregions. Ipsilateral and contralateral pretracheal lymph nodes (LNs) as well as other CLNs (prelaryngeal, ipsilateral paratracheal and contralateral paratracheal) were labeled separately and sent for pathological examination. Demographic and clinicopathologic variables were analyzed to identify factors predictive of contralateral CLNM.ResultsOf 139 patients, bilateral CLNM was present in 37 (26.6%) patients. Contralateral pretracheal LNM was significantly associated with contralateral CLNM. In multivariate analysis, prelaryngeal LNM (P = 0.004, odds ratio = 3.457) and contralateral pretracheal LNM (P = 0.006, odds ratio = 3.362) were identified as risk factors for contralateral CLNM. Neither neck recurrence nor distant metastasis was observed within the mean follow-up duration of 9.1 ± 1.8 months.ConclusionsIn most unilateral cN0 PTCs, performing ipsilateral CND is appropriate, while patients presenting with evident nodal disease intraoperatively or preoperatively in the contralateral central neck should undergo bilateral CND. Intraoperative re-evaluation of prelaryngeal and contralateral pretracheal LNs may be helpful in determining the extent of CND

Propensity score-matched analysis of the ‘2+2’ parathyroid strategy in total thyroidectomy with central neck dissection

ObjectiveTo evaluate the clinical efficacy of the “2+2” strategy (preserving 2 superior glands in situ and autotransplanting 2 inferior glands) in patients with papillary thyroid carcinoma (PTC) undergoing total thyroidectomy (TT) with bilateral central lymph node dissection (BCLND), using propensity score matching (PSM) to control confounding.Materials and methodsA retrospective cohort of 1,099 PTC patients treated with TT+BCLND at West China Hospital (2017–2023) was analyzed. After 1:1 PSM, 592 patients (296 per group) were included. Outcomes included temporary hypoparathyroidism (THP), permanent hypoparathyroidism (PHP), and postoperative PTH, calcium (Ca), and vitamin D (VitD) levels. Logistic regression identified predictors of THP and PHP.ResultsAfter matching, baseline characteristics were comparable. The “2+2” group had longer operative time (150 vs. 123 min, p<0.01), higher THP incidence (72.97% vs. 48.31%, p<0.01), and lower PHP incidence (0.68% vs. 3.72%, p = 0.03). PTH and Ca levels dropped more on postoperative day 1 in the “2+2” group but recovered more rapidly between day 1 and month 1. By month 12, levels converged in both groups. Parathyroid autotransplantation was an independent risk factor for THP (OR = 2.476, p<0.01) but protective against PHP (OR = 0.139, p = 0.02). Tumor size was also associated with THP risk (OR = 1.424, p = 0.04).ConclusionThe “2+2” strategy increases short-term THP risk but significantly reduces long-term PHP. Rapid biochemical recovery supports the functional viability of autotransplanted glands. This approach may offer a safe and effective strategy for parathyroid management in high-risk thyroid surgeries

Socioeconomic status and delayed surgery: impact on non-metastatic papillary thyroid carcinoma outcomes

IntroductionThe growing popularity of active surveillance for papillary thyroid cancer and the COVID-19 pandemic have increased surgery delay, further necessitating a reassessment of the link between surgery delay and survival outcomes for papillary thyroid cancer. In this study, we aim to investigate the interplay among various oncological factors, socioeconomic status, and surgical timing with respect to survival outcomes of papillary thyroid cancer.MethodsA total of 58,378 non-metastatic papillary thyroid cancer patients from 2000 to 2018 were screened from the Surveillance, Epidemiology, and End Results database. Kaplan–Meier survival curve, Cox proportional hazard regression, competing risk hazard regression, and multinomial logistic regression were applied.ResultsReceiving neck dissection or radioactive iodine therapy, being married at diagnosis, living in an urban area, being richer, and being of other minority ethnicity were estimated to be independent predictors for better overall survival. Single, older Black patients living in rural areas that experienced long surgery delays were more associated with a higher non- papillary thyroid cancer mortality rate. High income level was the only independent socioeconomic status predictor for lower papillary thyroid cancer -specific mortality. Unmarried, older patients of minority ethnicity tended to undergo longer surgery delays.ConclusionSurgery for non-metastatic papillary thyroid cancer patients can be safely delayed. The elevated non-papillary thyroid cancer mortality has reflected low socioeconomic status population’s survival status

Branching fraction and CP asymmetries of B-0 ->(KSKSKS0)-K-0-K-0

We present measurements of the branching fraction and time-dependent CP-violating asymmetries in B-0-> (KSKSKS0)-K-0-K-0 decays based on 227x10(6) Upsilon(4S)-> B (B) over bar decays collected with the BABAR detector at the PEP-II asymmetric-energy B factory at SLAC. We obtain a branching fraction of (6.9(-0.8)(+0.9)+/- 0.6)x10(-6), and CP asymmetries C=-0.34(-0.25)(+0.28)+/- 0.05 and S=-0.71(-0.32)(+0.38)+/- 0.04, where the first uncertainties are statistical and the second systematic

Effect of different surgical approaches for papillary thyroid carcinoma of isthmus on postoperative tumor recurrence rate and complications, a systematic review and meta-analysis

Review question / Objective: The effectiveness and safety of different surgical approaches for papillary thyroid carcinoma of isthmus(PTCI) were evaluated by assessing tumor recurrence, postoperative complications, and prognostic outcomes in patients with PTCI after total thyroidectomy and less-than-total thyroidectomy. Condition being studied: In 2015, the ATA stated in the treatment guidelines for PTC that total or near-total thyroidectomy is recommended for tumors &gt;4 cm in diameter, cN1, cM1, or the apparent presence of extra thyroidal extension (ETE). For tumor diameter of 1-4 cm, no ETE and no lymph node metastasis, total or near-total thyroidectomy is feasible. However, the scope of surgery and lymph node dissection for PTCI is not clearly defined. Therefore, in clinical practice, there are many controversies among domestic and foreign scholars regarding the scope of surgery for patients with PTCI, and it is difficult to draw credible conclusions due to the low incidence of PTCI and the relatively small number of cases selected from various clinical studies. And there is no relevant meta-analysis, so it is clinically significant to conduct this study.</jats:p