Annals of thyroid最新文献

{"title":"A look at Graves’ hyperthyroidism in pregnancy","authors":"C. Nguyen, J. Mestman","doi":"10.21037/AOT.2018.10.02","DOIUrl":"https://doi.org/10.21037/AOT.2018.10.02","url":null,"abstract":"Maternal, obstetrical, and neonatal complications are increased in women with poorly controlled thyroid disease during pregnancy. Establishing the correct diagnosis and effectively managing Graves’ hyperthyroidism (GH) remains challenging for physicians due to several reasons including, but not limited to changes in thyroid physiology during pregnancy, effect of pregnancy on laboratory testing, and teratogenicity associated with anti-thyroid drugs. This paper will review the diagnosis and management of GH in pregnancy and address: (I) preconception counseling; (II) alterations in thyroid physiology in pregnancy; (III) thyroid laboratory testing; (IV) etiologies of hyperthyroidism; (V) pregnancy-related complications; (VI) maternal management; (VII) neonatal management; (VIII) ATDs and the associated maternal and fetal complications; and (IX) post-partum management. Establishing the diagnosis of GH early, maintaining euthyroidism throughout the duration of pregnancy, and avoiding overtreatment of the fetus with antithyroid drugs (ATDs) is essential to reducing the risk of complications for the mother, fetus, and newborn. The successful care of these complex patients requires close collaboration between the endocrinologist, maternal-fetal-medicine specialist, obstetrician, neonatologist, and pediatric endocrinologist.","PeriodicalId":92168,"journal":{"name":"Annals of thyroid","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.21037/AOT.2018.10.02","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45211479","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The evolution and progress of mechanism and prevention of recurrent laryngeal nerve injury","authors":"A. Konturek, M. Barczyński","doi":"10.21037/aot.2018.11.02","DOIUrl":"https://doi.org/10.21037/aot.2018.11.02","url":null,"abstract":"Vocal fold paralysis is among the most severe complications in neck and chest surgery, being most commonly associated with thyroid and parathyroid procedures; nevertheless, it may also be an effect of cardiac or thoracic surgery. It should be remembered that the scale of the problem is much greater than it might be thought. The phenomenon most assuredly results from lack of true data to be provided by all the centers involved in surgical procedures performed in this region. The improvement of surgical techniques and the strife to limit injuries have become the symbol of progress in surgery, and quality of life after thyroid and parathyroid procedures—a sign of striving for the least number of complications. Side by side with development of new technologies there have emerged possibilities of monitoring the electrophysiological function of the nerves that help in identification of these life-important structures and allow for prognosticating their postoperative function. It should be emphasized that understanding anatomy, laws that govern neural conductivity and the ability to use new technologies have become the determinants of quality in thyroid and parathyroid surgery. The paper discusses the most important problems pertaining to injuries of the recurrent laryngeal nerves (RLNs), the mechanisms of injury infliction, intraoperative identification and prevention, as well as prognosticating the postoperative voice quality.","PeriodicalId":92168,"journal":{"name":"Annals of thyroid","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.21037/aot.2018.11.02","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49048639","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Active surveillance for very low-risk papillary thyroid carcinoma: experience and perspectives from Japan","authors":"I. Sugitani","doi":"10.21037/AOT.2018.10.04","DOIUrl":"https://doi.org/10.21037/AOT.2018.10.04","url":null,"abstract":"Low-risk papillary thyroid carcinoma (PTC) has been treated using lobectomy in Japan. This represents a very different approach to that used in Western countries, where the majority of patients have been treated with total thyroidectomy followed by radioactive iodine (RAI). Given the excellent survival and lower risk of surgical complications, Western guidelines have recently adopted a limited surgical approach for low-risk PTC. The treatment paradigm has shifted from a one-size-fits-all approach to more individualized protocols under the concept of risk-adapted management and treatment policies in the East and West have become increasingly integrated. The incidence of thyroid cancer has continued increasing around the world, mainly thanks to the increased detection of small PTCs, and debate is now emerging regarding the potential for overdiagnosis and overtreatment of subclinical thyroid cancers. Countermeasures to the phenomenon have been explored. Guidelines have been establishing new standards for cancer screening and clinical diagnosis. Pathologists have proposed changing the diagnostic criteria and terminology for indolent thyroid tumors. Since the 1990s, two Japanese institutions have initiated prospective trials of active surveillance for asymptomatic papillary microcarcinoma (PMC). These trials verified that the vast majority of tumors did not progress during active surveillance and outcomes were unaffected by delaying surgery. The Japanese guidelines adopted active surveillance management for asymptomatic PMC in 2010. The 2015 American Thyroid Association (ATA) guidelines have accepted the policy as an alternative to immediate surgery in patients with very low-risk tumors. Further studies have revealed that PMC was less progressive in older patients than in younger patients. Strong calcification and poor vascularity were indicators of stable disease. Several clinical issues remain unsolved in terms of active surveillance options for very low-risk PTC. Studies on patient-reported outcomes are still lacking and more specific predictors for the progression of low-risk PTC at the time of diagnosis are in demand.","PeriodicalId":92168,"journal":{"name":"Annals of thyroid","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.21037/AOT.2018.10.04","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45723965","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Central neck dissection via the transoral approach.","authors":"Christopher R Razavi,&nbsp;Akeweh Fondong,&nbsp;Ralph P Tufano,&nbsp;Jonathon O Russell","doi":"10.21037/aot.2017.10.02","DOIUrl":"https://doi.org/10.21037/aot.2017.10.02","url":null,"abstract":"<p><p>There has been a strong impetus for the development of remote access approaches to the central neck. The primary motivation for this has been to alleviate the negative impact that some patients may perceive from a central neck scar. Numerous approaches have been described; however the only approach that provides midline access and equivalent visualization of the bilateral thyroid lobes and paratracheal basins is transoral neck surgery (TONS). TONS has been shown to be safe and effective in performing thyroidectomy, parathyroidectomy, and central neck dissection (CND) via both the endoscopic and robotic techniques. In contrast with other remote access techniques, it provides the surgeon with familiar views of the bilateral recurrent laryngeal nerves (RLN) at their insertion site in concert with equivalent access to both paratracheal basins, thus uniquely facilitating safe and comprehensive CND. Though feasible and safe, CND via TONS is not appropriate in all cases. CND via TONS should only be performed with concomitant transoral total thyroidectomy, either prophylactically if the surgeon routinely performs prophylactic CND, or therapeutically if there is newly found evidence of nodal metastasis in the central compartment at the time of surgery. We base these recommendations on both the recent American Head and Neck Society (AHNS) consensus statement for indications for transcervical CND and the baseline indications for TONS.</p>","PeriodicalId":92168,"journal":{"name":"Annals of thyroid","volume":"2 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.21037/aot.2017.10.02","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35783102","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Indications and contraindications to transoral thyroidectomy.","authors":"Christopher R Razavi,&nbsp;Jonathon O Russell","doi":"10.21037/aot.2017.10.01","DOIUrl":"https://doi.org/10.21037/aot.2017.10.01","url":null,"abstract":"<p><p>Patient motivation to avoid neck scarring has been a strong impetus in the development of remote access approaches to the thyroid, including transoral robotic or endoscopic thyroidectomy vestibular approach (TOR/ETVA). TOR/ETVA continues to become more prevalent given its early success in North America and the demonstration of its safety and efficacy in Asia. As more surgeons perform this procedure, it is important that specific and uniform indications and contraindications exist to prevent surgical complications due to poor patient selection. In this article, we review the existing English literature regarding TOR/ETVA and compile the inclusion and exclusion criteria of individual authors for both robotic and endoscopic techniques to date. We then resolve differences in the existing literature to provide recommended indications and contraindications to TOR/ETVA based on both our review and our own experience with TOR/ETVA to date. The following are our resultant recommended indications for TOR/ETVA: patient history of hypertrophic scarring or motivation to avoid a cervical neck incision with a maximal thyroid diameter ≤ 10 cm and dominant nodule ≤6 cm, with one of the following pathologic criteria; benign lesion, multinodular goiter, indeterminate nodule, or suspicious lesions/well-differentiated thyroid carcinomas ≤ 2 cm. Recommended contraindications to TOR/ETVA are as follows: history of head & neck surgery, history of head, neck, or upper mediastinal irradiation, inability to tolerate general anesthesia, evidence of clinical hyperthyroidism, preoperative recurrent laryngeal nerve palsy, lymph node metastasis, extrathyroidal extension including tracheal or esophageal invasion, oral abscesses, substernal thyroidal extension, or failure to meet inclusion criteria as above. Relative contraindications include smoking and other oral pathology, and surgeons should be aware that morbid obesity may make it difficult to raise skin flaps.</p>","PeriodicalId":92168,"journal":{"name":"Annals of thyroid","volume":"2 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.21037/aot.2017.10.01","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35783622","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}