Risk factors for postoperative cervical haematoma in patients undergoing thyroidectomy: a retrospective, multicenter, international analysis (REDHOT study)

Background Postoperative cervical haematoma represents an infrequent but potentially life-threatening complication of thyroidectomy. Since this complication is uncommon, the assessment of risk factors associated with its development is challenging. The main aim of this study was to identify the risk factors for its occurrence.Methods Patients undergoing thyroidectomy in seven high-volume thyroid surgery centers in Europe, between January 2020 and December 2022, were retrospectively analysed. Based on the onset of cervical haematoma, two groups were identified: Cervical Haematoma (CH) Group and No Cervical Haematoma (NoCH) Group. Univariate analysis was performed to compare these two groups. Moreover, employing multivariate analysis, all potential independent risk factors for the development of this complication were assessed.Results Eight thousand eight hundred and thirty-nine patients were enrolled: 8,561 were included in NoCH Group and 278 in CH Group. Surgical revision of haemostasis was performed in 70 (25.18%) patients. The overall incidence of postoperative cervical haematoma was 3.15% (0.79% for cervical haematomas requiring surgical revision of haemostasis, and 2.35% for those managed conservatively). The timing of onset of cervical haematomas requiring surgical revision of haemostasis was within six hours after the end of the operation in 52 (74.28%) patients. Readmission was necessary in 3 (1.08%) cases. At multivariate analysis, male sex (P < 0.001), older age (P < 0.001), higher BMI (P = 0.021), unilateral lateral neck dissection (P < 0.001), drain placement (P = 0.007), and shorter operative times (P < 0.001) were found to be independent risk factors for cervical haematoma.Conclusions Based on our findings, we believe that patients with the identified risk factors should be closely monitored in the postoperative period, particularly during the first six hours after the operation, and excluded from outpatient surgery

L'impact de la chirurgie transphénoïdale sur la fonction anté-hypophysaire des patients opérés pour un macroadénome non-fonctionnel

L’impact de la chirurgie des macroadénomes hypophysaires non-fonctionnels sur les différents axes hormonaux est controversé et mal défini. La seule indication absolue à la prise en charge chirurgicale dans cette pathologie est l’atteinte des voies optiques par la tumeur. Ce travail a comme objectif d’évaluer les résultats de la chirurgie transphénoïdale sur les fonctions anté-hypophysaires chez les patients opérés pour un macroadénome non-fonctionnel, sur la base de l’analyse rétrospective d’une cohorte de 137 patients, opérés aux Hôpitaux Universitaires de Genève entre 2004 et 2018. Le risque d’apparition d’au moins un nouveau déficit postopératoire a été calculé à 9.6% et le taux de récupération d’au moins un déficit anté-hypophysaire avec la chirurgie, à 45.5%. Les patients qui ne profitent pas beaucoup de la chirurgie sur le plan volumétrique tumoral sont les plus à risque de présenter des nouveaux déficits postopératoires et les hommes ont plus de chances de récupérer un déficit hormonal préexistant avec l’opération. La présence d’un hypopituitarisme peut alors être considérée comme une indication valable, bien que discutable, pour une prise en charge chirurgicale d’un macroadénome non-fonctionnel sans atteinte visuelle. </p

Prise en charge des personnes avec incongruence de genre : le point de vue de l'endocrinologue

Les soins médicaux offerts aux personnes avec incongruence de genre méritent d’être optimisés. La nouvelle Classification internationale des maladies, 11e version, de l’OMS, présentée cette année, classe l’incongruence de genre parmi les « conditions liées à la santé sexuelle », et non plus dans les « troubles mentaux et du comportement ». Sur le plan endocrinien, les traitements hormonaux d’affirmation de genre permettent d’induire des changements physiques correspondant à l’identité du genre, mais des études d’efficacité et sécurité de meilleure qualité et au long cours sont nécessaires. La prise en charge de cette population par une équipe spécialisée et multidisciplinaire et l’amélioration de la formation du corps médical sont des mesures indispensables pour le futur.Health care of gender-incongruent persons deserves optimization. The new World Health Organization ICD-11, introduced this year, classifies gender-incongruence to « conditions related to sexual health », and not anymore to « mental and behavioral disorders ». From an endocrine perspective, gender-affirming hormonal treatment induces physical changes consistent with gender identity, but good-quality, long follow-up studies concerning efficacy and safety are needed. Improvements in training of medical professionals as well as a specialized multidisciplinary approach are important measures to be taken

Hypothyroidism-Associated Dyslipidemia: Potential Molecular Mechanisms Leading to NAFLD

Thyroid hormones control lipid metabolism by exhibiting specific effects on the liver and adipose tissue in a coordinated manner. Different diseases of the thyroid gland can result in hypothyroidism. Hypothyroidism is frequently associated with dyslipidemia. Hypothyroidism-associated dyslipidemia subsequently results in intrahepatic accumulation of fat, leading to nonalcoholic fatty liver disease (NAFLD), which leads to the development of hepatic insulin resistance. The prevalence of NAFLD in the western world is increasing, and evidence of its association with hypothyroidism is accumulating. Since hypothyroidism has been identified as a modifiable risk factor of NAFLD and recent data provides evidence that selective thyroid hormone receptor &beta; (THR-&beta;) agonists are effective in the treatment of dyslipidemia and NAFLD, interest in potential therapeutic options for NAFLD targeting these receptors is growing. In this review, we summarize current knowledge regarding clinical and molecular data exploring the association of hypothyroidism, dyslipidemia and NAFLD

Endocrinologie

La prise en charge de l’orbitopathie de Basedow, manifestation extraoculaire de la maladie et principal contributeur de morbidité, fait l’objet de nouvelles recommandations, publiées en 2021. Le traitement du cancer thyroïdien bien différencié et à faible risque de récidive connaît une désescalade thérapeutique avec moins de chirurgies et de curiethérapies et à plus faible dose. La prise en charge de l’acromégalie s’oriente vers une approche personnalisée; des facteurs pronostiques sont proposés et l’accent est mis sur le traitement des complications de la maladie et du traitement subi.The management of Graves' orbitopathy, an extraocular manifestation of the disease and the main contributor to morbidity, is the subject of new recommendations, published in 2021. The treatment of low risk differentiated thyroid cancer is simplified, with less surgery and less radioiodine treatment and at lower dose. The management of acromegaly is oriented towards a personalized approach; prognostic factors are more widely used, and the treatment of complications is emphasized

Syndrome des ovaires polykystiques : quoi de neuf ?

Polycystic ovary syndrome is a very common endocrine disorder in women of reproductive age, with important clinical implications (fertility issues, hirsutism, metabolic abnormalities). The Endocrine society has published in 2013 a series of diagnostic and treatment recommendations, followed by the European society of endocrinology in 2014. Recently, advances have been made in the measure of androgen biomarker and the evaluation of ovarian morphology with 3D ultrasound techniques. New treatments have emerged for fertility problems associated with the syndrome (ex. letrozole)

Hypothyroidism-Associated Dyslipidemia: Potential Molecular Mechanisms Leading to NAFLD

Thyroid hormones control lipid metabolism by exhibiting specific effects on the liver and adipose tissue in a coordinated manner. Different diseases of the thyroid gland can result in hypothyroidism. Hypothyroidism is frequently associated with dyslipidemia. Hypothyroidism-associated dyslipidemia subsequently results in intrahepatic accumulation of fat, leading to nonalcoholic fatty liver disease (NAFLD), which leads to the development of hepatic insulin resistance. The prevalence of NAFLD in the western world is increasing, and evidence of its association with hypothyroidism is accumulating. Since hypothyroidism has been identified as a modifiable risk factor of NAFLD and recent data provides evidence that selective thyroid hormone receptor β (THR-β) agonists are effective in the treatment of dyslipidemia and NAFLD, interest in potential therapeutic options for NAFLD targeting these receptors is growing. In this review, we summarize current knowledge regarding clinical and molecular data exploring the association of hypothyroidism, dyslipidemia and NAFLD.</p

H₂O₂ Metabolism in Normal Thyroid Cells and in Thyroid Tumorigenesis: Focus on NADPH Oxidases

Thyroid hormone synthesis requires adequate hydrogen peroxide (H2O2) production that is utilized as an oxidative agent during the synthesis of thyroxin (T4) and triiodothyronine (T3). Thyroid H2O2 is generated by a member of the family of NADPH oxidase enzymes (NOX-es), termed dual oxidase 2 (DUOX2). NOX/DUOX enzymes produce reactive oxygen species (ROS) as their unique enzymatic activity in a timely and spatially regulated manner and therefore, are important regulators of diverse physiological processes. By contrast, dysfunctional NOX/DUOX-derived ROS production is associated with pathological conditions. Inappropriate DUOX2-generated H2O2 production results in thyroid hypofunction in rodent models. Recent studies also indicate that ROS improperly released by NOX4, another member of the NOX family, are involved in thyroid carcinogenesis. This review focuses on the current knowledge concerning the redox regulation of thyroid hormonogenesis and cancer development with a specific emphasis on the NOX and DUOX enzymes in these processes

Pulmonary Vein Thrombosis Associated with Metastatic Follicular Thyroid Carcinoma: A Case Report and Review

Pulmonary vein thrombosis (PVT) mainly occurs following lung transplantation but cases associated with thoracic malignancy have also been described. We describe here the first case of PVT in an asymptomatic patient with metastatic follicular thyroid carcinoma

Prise de poids pendant la ménopause : physiologie et implications pratiques

Fluctuations in sex hormones at different stages of reproductive life, such as the menopausal transition, have been suggested as players in weight regulation. Indeed, the transition from a predominantly estrogenic state to an androgenic state characteristic of the menopausal transition contributes to changes in body composition with accumulation of fat and simultaneous loss of lean mass. However, whether these changes contribute to the weight gain remains debatable. Other physiological and psychosocial factors come into play. It is therefore important to offer individualized support with the objective to minimize the risk of weight gain and associated complications.La fluctuation des hormones sexuelles à différentes étapes de la vie reproductive, telles que la transition ménopausique, a été proposée comme une des composantes de la régulation de poids. Effectivement, le passage d’un état principalement œstrogénique à un état androgénique, caractéristique de la transition ménopausique, contribue à des modifications de la composition corporelle avec une accumulation de graisse et une perte simultanée de masse maigre. Cependant, la question de savoir si ces changements contribuent à une prise de poids reste discutable. L’obésité est une maladie multifactorielle et d’autres facteurs d’ordre physiologique et psychosociaux rentrent en jeu. Il est donc important d’offrir un accompagnement individualisé aux femmes concernées pour les aider à minimiser le risque de prise pondérale et des complications associées