Lobectomy versus total thyroidectomy in differentiated thyroid carcinoma: A review

BackgroundThyroid cancer is on the rise globally, there is increasing adoption of lobectomy for low-risk differentiated thyroid cancer.AimsThe current review aimed to assess lobectomy versus total thyroidectomy in low-risk differentiated thyroid carcinoma.Methods A systematic electronic search was conducted in the Pub Med and Google Scholar with no limitation of the period, 85 articles published in English were retrieved, two researchers screened the abstract for removal of duplications. Twenty-one articles fulfilled the inclusion and exclusion criteria.Results Among the twenty-one articles included (more than two-thirds were retrospective), eleven were from the USA, two from Europe, six from Asia, one from Canada and one from Australia. The results were mixed, some preferred lobectomy, others were on the side of total thyroidectomy, while some advised to weigh the risks and benefits.ConclusionThe results were mixed regarding the mode of surgery in low-risk differentiated thyroid cancer. Further, well-designed studies are needed to solve the current controversy

Pattern and temporal profile of thyroid carcinoma in the Kingdom of Saudi Arabia: A review and meta-analysis

BackgroundThere is an increasing rate of thyroid carcinoma in the developed world attributed mainly to over-diagnosis due to healthcare improvement. Saudi Arabia has made health a top priority, an increasing rate of over diagnosis is expected.AimsThe current review assessed the trends, spatial distribution, and epidemiology of thyroid carcinoma in the Kingdom of Saudi Arabia.Methods A systematic electronic search was conducted in PubMed and Google Scholar for relevant articles. All human studies published during the period 2009-December 2019 including Epub and ahead of print were eligible. The keywords thyroid carcinoma, thyroid lesion, Saudi Arabia, prevalence, and incidence were used in different combinations, among the three hundred fifty-four articles identified, twenty-three full text were assessed and only seventeen studies were included. Then the author's names, year and region of publication, the study type, period of study, and the result were recorded. The Statistical Package for Social Sciences (SPSS, IBM, version 20, New York was used for data analysis.Results Seventeen articles were included (9754 patient, age 44.53±5.42 years), women outmoded men and showed younger age (36.59 years), papillary carcinoma was the commonest sub-variant of carcinoma (75.62±17.53, age 52.3 years) followed by follicular (6.52±2.92).  An increasing trend was observed all over the Kingdom, but not consistent in all-region.ConclusionAn increasing rate of thyroid carcinoma was evident in the Kingdom of Saudi Arabia, the commonest being papillary carcinoma. Females were more commonly affected at a younger age group. Further National studies assessing whether the increased rate is due to over-diagnosis or other risk factors are highly recommended

The current state of knowledge regarding thyroid-stimulating hormone lowering/suppressive therapy and its cardiovascular risks in differentiated thyroid carcinoma

BackgroundThyroid-stimulating hormone acts as a growth factor for thyroid follicular cells, so some patients with differentiated thyroid carcinoma (DTC) are placed on thyroid hormone suppressive therapy. However, (TSH) suppression is not without risks.AimsWe thought to assess the potential benefits and cardiovascular risks among patients on TSH suppressive therapy following thyroid surgery for DTC.Methods A systematic electronic search was conducted in PubMed, MEDLINE, and Google Scholar for relevant articles. All human and cell lines studies published during the period 2009-October 2019 were eligible. The keywords TSH suppression, differentiated thyroid carcinoma, TSH level, cardiovascular risk, cardiovascular morbidity, cardiovascular mortality, atrial fibrillation, and left ventricular volume were used One hundred and eighty-five articles were retrieved and only eighteen met the inclusion and exclusion criteria.Results Out of 185 articles, eighteen studies were included, more than half (55.6 per cent)were published in Europe, 22.2 per cent were from Asia,11.1 per cent from Latin America and one study was from the USA, the majority (72.2 per cent were observational studies),. Patients on TSH suppression were at a high risk of cardiovascular morbidity and mortality that increases at lower TSH levels. Levels < .1mU/L are beneficial in patients with micro or macroscopic disease. However it may induce tumour growth among patients with aggressive recurrent disease, no benefit was observed in low-intermediate DTC.ConclusionPhysicians may need to suppress TSH in patients with micro or macroscopic DTC. However, caution is needed in aggressive recurrent disease. The available level of evidence showed no benefit of TSH lowering therapy in low-intermediate disease

Burnout among surgeons before and during the SARS-CoV-2 pandemic: an international survey

Background: SARS-CoV-2 pandemic has had many significant impacts within the surgical realm, and surgeons have been obligated to reconsider almost every aspect of daily clinical practice. Methods: This is a cross-sectional study reported in compliance with the CHERRIES guidelines and conducted through an online platform from June 14th to July 15th, 2020. The primary outcome was the burden of burnout during the pandemic indicated by the validated Shirom-Melamed Burnout Measure. Results: Nine hundred fifty-four surgeons completed the survey. The median length of practice was 10&nbsp;years; 78.2% included were male with a median age of 37&nbsp;years old, 39.5% were consultants, 68.9% were general surgeons, and 55.7% were affiliated with an academic institution. Overall, there was a significant increase in the mean burnout score during the pandemic; longer years of practice and older age were significantly associated with less burnout. There were significant reductions in the median number of outpatient visits, operated cases, on-call hours, emergency visits, and research work, so, 48.2% of respondents felt that the training resources were insufficient. The majority (81.3%) of respondents reported that their hospitals were included in the management of COVID-19, 66.5% felt their roles had been minimized; 41% were asked to assist in non-surgical medical practices, and 37.6% of respondents were included in COVID-19 management. Conclusions: There was a significant burnout among trainees. Almost all aspects of clinical and research activities were affected with a significant reduction in the volume of research, outpatient clinic visits, surgical procedures, on-call hours, and emergency cases hindering the training. Trial registration: The study was registered on clicaltrials.gov "NCT04433286" on 16/06/2020

The quality of life after trans oral video-assisted thyroidectomy and cervical thyroidectomy: a systematic review and meta-analysis

Trans oral video-assisted thyroidectomy (TOVAT) is increasingly performed for cosmetic reasons. The quality of life after thyroidectomy is important for decision-making. This is the first meta-analysis to compare the quality of life among conventional transcervical thyroidectomies. This meta-analysis aimed to assess the same in the current literature. The authors systematically searched PubMed, Google Scholar, and EBSCO for relevant articles from the first published to December 4, 2022. The keywords endoscopic transoral via vestibular thyroidectomy, transcervical thyroidectomy, conventional thyroidectomy, scarless thyroidectomy, and quality of life were used. Out of the 482 studies retrieved, 27 full texts were reviewed, and only six fulfilled the inclusion and exclusion criteria. Patients with transoral thyroidectomy showed better quality of life that their counterparts who underwent transcervical thyroidectomy at 4–6 weeks following surgery, odd ratio, 2.26, 95% CI, 2.02–2.5, P-value &lt;0.001. Substantial heterogeneity was observed, I2 for heterogeneity, 100%. The quality of life was better among patients who underwent the trans oral video-assisted thyroidectomy (TOVAT) compared to their counterparts with the conventional cervical approach (surgical questionnaire). All the components of the SF-36 quality of life questionnaire were better among TOVAT compared to the conventional approach except for social and general health components, which were equal between the two arms. Further multi-center studies with larger samples and controlling for pain and the surgical curve are needed

In Silico Investigation of AKT2 Gene and Protein Abnormalities Reveals Potential Association with Insulin Resistance and Type 2 Diabetes

Type 2 diabetes (T2D) develops from insulin resistance (IR) and the dysfunction of pancreatic beta cells. The AKT2 protein is very important for the protein signaling pathway, and the non-synonymous SNP (nsSNPs) in AKT2 gene may be associated with T2D. nsSNPs can result in alterations in protein stability, enzymatic activity, or binding specificity. The objective of this study was to investigate the effect of nsSNPs on the AKT2 protein structure and function that may result in the induction of IR and T2D. The study identified 20 variants that were considered to be the most deleterious based on a range of analytical tools included (SIFT, PolyPhen2, Mut-pred, SNAP2, PANTHER, PhD-SNP, SNP&Go, MUpro, Cosurf, and I-Mut). Two mutations, p.A179T and p.L183Q, were selected for further investigation based on their location within the protein as determined by PyMol. The results indicated that mutations, p.A179T and p.L183Q alter the protein stability and functional characteristics, which could potentially affect its function. In order to conduct a more in-depth analysis of these effects, a molecular dynamics simulation was performed for wildtype AKT2 and the two mutants (p.A179T and p.L183Q). The simulation evaluated various parameters, including temperature, pressure, density, RMSD, RMSF, SASA, and Region, over a period of 100 ps. According to the simulation results, the wildtype AKT2 protein demonstrated higher stability in comparison to the mutant variants. The mutations p.A179T and p.L183Q were found to cause a reduction in both protein stability and functionality. These findings underscore the significance of the effects of nsSNPs (mutations p.A179T and p.L183Q) on the structure and function of AKT2 that may lead to IR and T2D. Nevertheless, they require further verifications in future protein functional, protein–protein interaction, and large-scale case–control studies. When verified, these results will help in the identification and stratification of individuals who are at risk of IR and T2D for the purpose of prevention and treatment