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Díez JJ, Anda E, Alcazar V, Isidro ML, Familiar C, Paja M, Martín Rojas-Marcos P, Pérez-Corral B, Navarro E, Romero-Lluch AR, Oleaga A, Pamplona MJ, Fernández-García JC, Megía A, Manjón-Miguélez L, Sánchez-Ragnarsson C, Iglesias P, Sastre J. Consumption of health resources in older people with differentiated thyroid carcinoma: a multicenter analysis. Endocrine 2023; 81:521-531. [PMID: 37103683 DOI: 10.1007/s12020-023-03369-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 04/04/2023] [Indexed: 04/28/2023]
Abstract
OBJECTIVE There is hardly any information on the consumption of healthcare resources by older people with differentiated thyroid cancer (DTC). We analyzed these consumptions in older patients with DTC and compared patients 75 years and older with subjects aged 60-74 years. METHODS A multicenter, retrospective analysis was designed. We recorded three groups of health resources consumption (visits, diagnostic procedures, and therapeutic procedures) and identified a subgroup of patients with high consumption of resources. We compared patients aged between 60-74 years (group 1) with patients aged 75 and over (group 2). RESULTS We included 1654 patients (women, 74.4%), of whom 1388 (83.9%) belonged to group 1 and 266 (16.1%) to group 2. In group 2, we found a higher proportion of patients requiring emergency department visits (7.9 vs. 4.3%, P = 0.019) and imaging studies (24.1 vs. 17.3%; P = 0.012) compared to group 1. However, we did not find any significant difference between both groups in the consumption of other visits, diagnostic procedures, or therapeutic procedures. Overall, 340 patients (20.6%) were identified as high consumers of health resources, 270 (19.5%) in group 1 and 70 (26.3%) in group 2 (P = 0.013). Multivariate logistic regression analysis showed that the risk of recurrence and mortality, radioiodine treatment, tumor size, and vascular invasion were significantly related to the high global consumption of resources. However, the age was not significantly related to it. CONCLUSION In patients with DTC over 60 years of age, advanced age is not an independent determining factor in the consumption of health resources.
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Affiliation(s)
- Juan J Díez
- Department of Endocrinology, Hospital Universitario Puerta de Hierro Majadahonda, Instituto de Investigación Sanitaria Puerta de Hierro Segovia de Arana, Majadahonda, Spain.
- Department of Medicine, Universidad Autónoma de Madrid, Madrid, Spain.
| | - Emma Anda
- Department of Endocrinology, Hospital Universitario de Navarra, Pamplona, Spain
| | - Victoria Alcazar
- Department of Endocrinology, Hospital Severo Ochoa, Leganés, Spain
| | - María L Isidro
- Department of Endocrinology, Complejo Hospitalario Universitario A Coruña, Coruña, Spain
| | - Cristina Familiar
- Department of Endocrinology, Hospital Clínico San Carlos, Madrid, Spain
| | - Miguel Paja
- Department of Endocrinology, Hospital Universitario de Basurto, Bilbao, Spain
- Department of Medicine, Universidad del País Vasco, Bilbao, Spain
| | | | - Begoña Pérez-Corral
- Department of Endocrinology, Complejo Asistencial Universitario de León, León, Spain
| | - Elena Navarro
- Department of Endocrinology, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Ana R Romero-Lluch
- Department of Endocrinology, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Amelia Oleaga
- Department of Endocrinology, Hospital Universitario de Basurto, Bilbao, Spain
- Department of Medicine, Universidad del País Vasco, Bilbao, Spain
| | - María J Pamplona
- Department of Endocrinology, Hospital Royo Villanova, Zaragoza, Spain
| | - José C Fernández-García
- Department of Endocrinology, Hospital Regional Universitario de Málaga (IBIMA), Universidad de Málaga, Málaga, Spain
| | - Ana Megía
- Department of Endocrinology, Hospital Universitario de Tarragona Joan XXIII, IISPV, Universitat Rovira i Virgili, Ciberdem, Tarragona, Spain
| | - Laura Manjón-Miguélez
- Department of Endocrinology, Hospital Universitario Central de Asturias & Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
| | - Cecilia Sánchez-Ragnarsson
- Department of Endocrinology, Hospital Universitario Central de Asturias & Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
| | - Pedro Iglesias
- Department of Endocrinology, Hospital Universitario Puerta de Hierro Majadahonda, Instituto de Investigación Sanitaria Puerta de Hierro Segovia de Arana, Majadahonda, Spain
- Department of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
| | - Julia Sastre
- Department of Endocrinology, Complejo Hospitalario de Toledo, Toledo, Spain
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2
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Díez JJ, Anda E, Alcazar V, Isidro ML, Familiar C, Paja M, Rojas Marcos P, Pérez-Corral B, Navarro E, Romero-Lluch AR, Oleaga A, Pamplona MJ, Fernández-García JC, Megía A, Manjón L, Sánchez-Ragnarsson C, Iglesias P, Sastre J. Differentiated thyroid carcinoma in the elderly: influence of age on disease-free and overall survival. Endocrine 2022; 77:121-133. [PMID: 35585463 DOI: 10.1007/s12020-022-03059-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 04/12/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE We investigated whether age at diagnosis of differentiated thyroid carcinoma (DTC) may be a risk factor for structural disease and mortality after primary treatment in aging patients. METHODS A multicenter, retrospective analysis including patients older than 60 years at DCT diagnosis was designed. All subjects were treated by surgery with or without radioiodine adjuvant therapy and had a minimum follow-up of one year. We compared elderly patients (group 1, 60-74 years) with very old patients (group 2, ≥75 years). RESULTS The study involved 1668 patients (74.3% women, median age 67 years, 87.6% papillary thyroid cancer, 73.3% treated with radioiodine), including 1397 in group 1 and 271 in group 2. Patients in group 2 had larger tumor size (1.8 [0.8-3.0] vs 1.5 [0.7-2.8] cm; P = 0.005), higher proportions of tumors with vascular invasion (23.8 vs 16.4%; P = 0.006), and lower proportion of lymphocytic thyroiditis (18.6 vs 24.9%; P = 0.013) than subjects in group 1. Kaplan-Meier survival analysis showed that patients in group 2 had significantly lower structural disease-free survival (DFS) and overall survival (OS) than patients in group 1 (P = 0.035 and <0.001, respectively). In multivariate Cox regression analysis, age was a risk factor significantly associated with OS. However, age was significantly associated with DFS in unadjusted analysis and in analysis adjusted by gender and risk classification variables, but not when pathological and therapy-related variables were introduced in the model. On the other hand, patients who received radioiodine had worse DFS (P < 0.001) compared to those who did not. CONCLUSION Although age is a conditioning factor for OS, very old patients do not have a greater risk of developing structural disease throughout the follow-up than elderly patients with DTC.
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Affiliation(s)
- Juan J Díez
- Department of Endocrinology, Hospital Universitario Puerta de Hierro Majadahonda, Instituto de Investigación Sanitaria Puerta de Hierro Segovia de Arana, Majadahonda, Spain.
- Department of Medicine, Universidad Autónoma de Madrid, Madrid, Spain.
| | - Emma Anda
- Department of Endocrinology, Hospital Universitario de Navarra, Pamplona, Spain
| | - Victoria Alcazar
- Department of Endocrinology, Hospital Severo Ochoa, Leganés, Spain
| | - María L Isidro
- Department of Endocrinology, Complejo Hospitalario Universitario A Coruña, A Coruña, Spain
| | - Cristina Familiar
- Department of Endocrinology, Hospital Clínico San Carlos, Madrid, Spain
| | - Miguel Paja
- Department of Endocrinology, Hospital Universitario de Basurto, Bilbao, Spain
- Department of Medicine, Universidad del País Vasco, Leioa, Spain
| | | | - Begoña Pérez-Corral
- Department of Endocrinology, Complejo Asistencial Universitario de León, León, Spain
| | - Elena Navarro
- Department of Endocrinology, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Ana R Romero-Lluch
- Department of Endocrinology, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Amelia Oleaga
- Department of Endocrinology, Hospital Universitario de Basurto, Bilbao, Spain
- Department of Medicine, Universidad del País Vasco, Leioa, Spain
| | - María J Pamplona
- Department of Endocrinology, Hospital Royo Villanova, Zaragoza, Spain
| | - José C Fernández-García
- Department of Endocrinology, Hospital Regional Universitario de Málaga (IBIMA), Universidad de Málaga, Málaga, Spain
| | - Ana Megía
- Department of Endocrinology, Hospital Universitario de Tarragona Joan XXIII, IISPV, Universitat Rovira i Virgili, Ciberdem, Tarragona, Spain
| | - Laura Manjón
- Department of Endocrinology, Hospital Universitario Central de Asturias & Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
| | - Cecilia Sánchez-Ragnarsson
- Department of Endocrinology, Hospital Universitario Central de Asturias & Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
| | - Pedro Iglesias
- Department of Endocrinology, Hospital Universitario Puerta de Hierro Majadahonda, Instituto de Investigación Sanitaria Puerta de Hierro Segovia de Arana, Majadahonda, Spain
- Department of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
| | - Julia Sastre
- Department of Endocrinology, Complejo Hospitalario de Toledo, Toledo, Spain
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Liu Y, Shan Z. Expert consensus on diagnosis and treatment for elderly with thyroid diseases in China (2021). Aging Med (Milton) 2021; 4:70-92. [PMID: 34250426 PMCID: PMC8251868 DOI: 10.1002/agm2.12165] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 05/18/2021] [Indexed: 01/15/2023] Open
Abstract
In order to improve the diagnosis and treatment of senile thyroid diseases in China and to promote healthy aging, the Endocrine Metabolic Diseases Group of the Chinese Geriatrics Society, and the Thyroid Group of the Chinese Society of Endocrinology jointly drafted the "Expert consensus on diagnosis and treatment for Chinese elderly with thyroid diseases" (referred to as consensus). The Consensus consists of five parts that set 40 recommendations on main clinical issues. The consensus emphasizes clinical focus on the age-related changes of the hypothalamus-pituitary-thyroid axis in the elderly, and it recommends application of comprehensive geriatric assessment to thoroughly evaluate the impact of thyroid diseases and relevant intervention on overall health condition. Meanwhile, it recommends generalization of screening for hypothyroidism during admission to nursing institution or hospital, and routine health check-ups. Furthermore, it develops individualized stratified management on hyperthyroidism, hypothyroidism, thyroid nodules, and differentiated thyroid carcinoma in the elderly distinguished from the youngers, including treatment regimen, control ranges, and flowcharts for diagnosis and treatment. The Consensus will provide the basis for clinical decisions and health management of thyroid diseases in the elderly by geriatrician, endocrinologist, and general practitioners.
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Affiliation(s)
- Youshuo Liu
- Department of Geriatrics and Geriatric EndocrinologyThe Second Xiangya Hospitaland the Institute of Aging and GeriatricsCentral South UniversityNational Clinical Research Center for Metabolic Diseases (The Second Xiangya Hospital)ChangshaChina
| | - Zhongyan Shan
- Department of Endocrinology and MetabolismThe Institute of EndocrinologyThe First Hospital of China Medical University, NHC Key Laboratory
Diagnosis and Treatment of Thyroid DiseasesShenyangChina
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Comparative outcomes of thyroid surgery in elderly patients: A retrospective cohort study. JOURNAL OF SURGERY AND MEDICINE 2020. [DOI: 10.28982/josam.738466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Marina M, Serra MF, Aldigeri R, Ceresini G. Incidental versus clinically diagnosed differentiated thyroid cancer in both adult and elderly subjects: histological characteristics and follow-up in a retrospective analysis from a single institution. Endocrine 2020; 68:584-591. [PMID: 31970586 DOI: 10.1007/s12020-020-02200-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 01/13/2020] [Indexed: 12/31/2022]
Abstract
PURPOSE Most thyroid cancer are incidentally diagnosed. However, little is known on the different modalities of incidental diagnosis in adult versus older patients. METHODS We retrospectively analyzed data from 440 patients consecutively diagnosed with differentiated thyroid cancer (DTC) in a single institution. Modalities of diagnosis were categorized as follows: (A) clinically diagnosed, nonincidental cases; (B) incidental during carotid power-duplex (CPD); (C) incidental during neck imaging other than carotid power-duplex; (D) incidental during imaging workup of thyroid dysfunction or at histological examination after thyroidectomy for benign lesions. Demographics, histology and follow-up were compared between adult (<65 years) and older (≥65 years) patients according to the different modalities of diagnosis. RESULTS A total of 363 and 67 cases were recorded in adult and older patients, respectively with incidental proportions of 79% and 85%, respectively. A P < 0.001 significant difference in the modality of diagnosis was found between adult and older subjects, the latter presenting with a higher prevalence of Group B. In the nonincidental group, papillary histotype, larger size, and extrathyroidal invasion were more frequently observed in older subjects. Disease-free survival was comparable between adult and older subjects in the incidental cases, whereas it was reduced, though not significantly, in older subjects. CONCLUSION Incidental cases of DTC are more frequently diagnosed in the old subjects and are mainly due to CPD. Disease-free survival is comparable between adult and older subjects in both incidental and nonincidental cases, although it may be slightly reduced in nonincidentally diagnosed older patients.
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Affiliation(s)
- Michela Marina
- Unit of Internal Medicine and Oncological Endocrinology, Department of Medicine and Surgery, University Hospital of Parma, University of Parma, Parma, Italy
| | - Maria Francesca Serra
- Unit of Internal Medicine and Oncological Endocrinology, Department of Medicine and Surgery, University Hospital of Parma, University of Parma, Parma, Italy
| | - Raffaella Aldigeri
- Unit of Internal Medicine and Oncological Endocrinology, Department of Medicine and Surgery, University Hospital of Parma, University of Parma, Parma, Italy
| | - Graziano Ceresini
- Unit of Internal Medicine and Oncological Endocrinology, Department of Medicine and Surgery, University Hospital of Parma, University of Parma, Parma, Italy.
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Low-Risk Thyroid Cancer in Elderly: Total Thyroidectomy/RAI Predominates but Lacks Survival Advantage. J Surg Res 2019; 243:189-197. [PMID: 31185435 DOI: 10.1016/j.jss.2019.05.029] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 03/12/2019] [Accepted: 05/15/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND Papillary thyroid cancer (PTC) is the fastest increasing cancer in the United States; incidence increases with age. It generally has a favorable prognosis but may behave more aggressively in older patients. This study aims to describe national treatment patterns for low-risk PTC in older adults. MATERIALS AND METHODS The Surveillance, Epidemiology, and End Results-Medicare database was used to identify patients ≥66 y treated for clinical T1N0M0 PTC between 1996 and 2011. Multivariable logistic regression was used to identify factors associated with extent of surgery (total thyroidectomy versus lobectomy) and radioactive iodine (RAI) administration. Cox proportional hazards modeling was used to estimate the effect of treatment type on disease-specific survival (DSS). RESULTS Three thousand two hundred and fourteen patients met inclusion criteria; 77.6% were women, median age was 72 y, and mean tumor size was 0.7 cm. 42.7% had preoperatively diagnosed PTC (versus incidental). 65.4% underwent total thyroidectomy, 29.0% lobectomy, and 5.6% lobectomy followed by completion thyroidectomy; 33.4% received postoperative RAI. Five- and 10-year DSS were 98.9% and 98.3%, respectively. After adjustment, larger tumor size (1.1-2 cm), multifocality, and a preoperative PTC diagnosis were associated with greater odds of undergoing more extensive surgery and receiving RAI (P < 0.0001). DSS was not associated with extent of surgery or RAI administration (P > 0.05). CONCLUSIONS Most older adults with PTC underwent total thyroidectomy and a third received RAI; neither treatment improved DSS. In the growing elderly population, less extensive interventions for PTC may reduce morbidity and improve quality of life while preserving an excellent prognosis.
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Gambardella C, Patrone R, Di Capua F, Offi C, Mauriello C, Clarizia G, Andretta C, Polistena A, Sanguinetti A, Calò P, Docimo G, Avenia N, Conzo G. The role of prophylactic central compartment lymph node dissection in elderly patients with differentiated thyroid cancer: a multicentric study. BMC Surg 2019; 18:110. [PMID: 31074400 PMCID: PMC7402571 DOI: 10.1186/s12893-018-0433-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 10/29/2018] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Prophylactic central neck lymph-nodes dissection is still a topic of major debate in Literature. There is a lack of randomized controlled trials proving advantages in its application in terms of overall survival and local recurrence. Due to the recent rapid increase of elderly population, differentiated tumor carcinoma diagnosis increased in patients over 65 years old. The aim of this study was to compare recurrence rate, complications rate and histological features of tumors in elderly population. METHODS A retrospective study was carried out collecting data from 371 patients with differentiated thyroid cancer without clinical evidence of lymph-nodes involvement in three Italian referral centers from 2005 to 2015. All patients were aged ≥ 65 years and were divided in two groups based on the performed surgery (total thyroidectomy alone or associated with central lymph-nodes dissection). Moreover, patients were stratified according to the age between 65 and 74 years old and over 75 years old. RESULTS Total thyroidectomy alone was performed in 184 patients (group A) and total thyroidectomy with prophylactic central neck dissection was performed in 187 cases (group B). There was a statistically significant difference in complications between the groups in terms of neck hematoma (0.5% group A vs 3.7% group B), temporary hypoparathyroidism (11.4% group A vs 21.4% group B), and temporary unilateral recurrent nerve injury (1.5% group A vs 6.4% group B). Lymph nodes recurrence rate was 9.2% in group A and 8.5% in group B, with no statistically significant difference. There was a statistically significant difference in patients over 75 years old in terms of temporary hypoparathyroidism (24% group A vs 11% group B), permanent hypoparathyroidism (2,7% group A vs 0,3% group B) and recurrent nerve injury (9,5% group A vs 2% group B). CONCLUSIONS The role of prophylactic central neck dissection is still controversial, especially in elderly patients, and an aggressive surgical approach should be carefully evaluated. The Authors reported a similar low recurrence rate between total thyroidectomy and total thyroidectomy associated with prophylactic central neck dissection, with increased postoperative complications in the lymphadenectomy group and in patients over 75 years old, advocating a tailored surgical approach in elderly population.
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Affiliation(s)
- Claudio Gambardella
- Division of General and Oncologic Surgery, Department of Traslational Medical Sciences, University of Campania “Luigi Vanvitelli”, School of Medicine, Via Sergio Pansini 5, 80131 Naples, Italy
| | - Renato Patrone
- Division of General and Oncologic Surgery, Department of Traslational Medical Sciences, University of Campania “Luigi Vanvitelli”, School of Medicine, Via Sergio Pansini 5, 80131 Naples, Italy
| | - Francesco Di Capua
- Division of General and Oncologic Surgery, Department of Traslational Medical Sciences, University of Campania “Luigi Vanvitelli”, School of Medicine, Via Sergio Pansini 5, 80131 Naples, Italy
| | - Chiara Offi
- Division of General and Oncologic Surgery, Department of Traslational Medical Sciences, University of Campania “Luigi Vanvitelli”, School of Medicine, Via Sergio Pansini 5, 80131 Naples, Italy
| | - Claudio Mauriello
- Division of General and Oncologic Surgery, Department of Traslational Medical Sciences, University of Campania “Luigi Vanvitelli”, School of Medicine, Via Sergio Pansini 5, 80131 Naples, Italy
| | - Guglielmo Clarizia
- Division of General and Oncologic Surgery, Department of Traslational Medical Sciences, University of Campania “Luigi Vanvitelli”, School of Medicine, Via Sergio Pansini 5, 80131 Naples, Italy
| | - Claudia Andretta
- Division of General and Oncologic Surgery, Department of Traslational Medical Sciences, University of Campania “Luigi Vanvitelli”, School of Medicine, Via Sergio Pansini 5, 80131 Naples, Italy
| | - Andrea Polistena
- Endocrine Surgery Unit, University of Perugia, Piazza dell’Università, 06123 Perugia, Italy
| | - Alessandro Sanguinetti
- Endocrine Surgery Unit, University of Perugia, Piazza dell’Università, 06123 Perugia, Italy
| | - Pietrogiorgio Calò
- Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
| | - Giovanni Docimo
- Division of General and Oncologic Surgery, Department of Traslational Medical Sciences, University of Campania “Luigi Vanvitelli”, School of Medicine, Via Sergio Pansini 5, 80131 Naples, Italy
| | - Nicola Avenia
- Endocrine Surgery Unit, University of Perugia, Piazza dell’Università, 06123 Perugia, Italy
| | - Giovanni Conzo
- Division of General and Oncologic Surgery, Department of Traslational Medical Sciences, University of Campania “Luigi Vanvitelli”, School of Medicine, Via Sergio Pansini 5, 80131 Naples, Italy
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8
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Wong EH, Smith M, Fish B, Jani P, Palme CE, Smith MC, Riffat F. Thyroidectomy in octogenarians is not associated with poorer postoperative outcomes. Head Neck 2019; 41:2500-2506. [DOI: 10.1002/hed.25712] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2018] [Revised: 12/20/2018] [Accepted: 02/05/2019] [Indexed: 11/10/2022] Open
Affiliation(s)
- Eugene H. Wong
- Department of Otolaryngology; Westmead Hospital; Westmead New South Wales Australia
- Sydney Medical School; University of Sydney; Camperdown New South Wales Australia
| | - Murray Smith
- Department of Otolaryngology; Westmead Hospital; Westmead New South Wales Australia
| | - Brian Fish
- Department of Otolaryngology; Addenbrooke's Hospital; Cambridge United Kingdom
| | - Piyush Jani
- Department of Otolaryngology; Addenbrooke's Hospital; Cambridge United Kingdom
| | - Carsten E. Palme
- Department of Otolaryngology; Westmead Hospital; Westmead New South Wales Australia
- Sydney Medical School; University of Sydney; Camperdown New South Wales Australia
| | - Mark C. Smith
- Department of Otolaryngology; Westmead Hospital; Westmead New South Wales Australia
- Sydney Medical School; University of Sydney; Camperdown New South Wales Australia
| | - Faruque Riffat
- Department of Otolaryngology; Westmead Hospital; Westmead New South Wales Australia
- Sydney Medical School; University of Sydney; Camperdown New South Wales Australia
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Sasi Mouli V, Shreyamsa M, Gaurav K, Singh KR, Ramakant P, Mishra AK. Advanced age does not increase morbidity after total thyroidectomy. Result of a prospective study. Am J Surg 2018; 218:663. [PMID: 30554662 DOI: 10.1016/j.amjsurg.2018.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 11/17/2018] [Indexed: 11/26/2022]
Affiliation(s)
- V Sasi Mouli
- Department of Endocrine Surgery, King Georges' Medical University, Lucknow, UP, India.
| | - M Shreyamsa
- Department of Endocrine Surgery, King Georges' Medical University, Lucknow, UP, India
| | - Kushagra Gaurav
- Department of Endocrine Surgery, King Georges' Medical University, Lucknow, UP, India
| | - Kul Ranjan Singh
- Department of Endocrine Surgery, King Georges' Medical University, Lucknow, UP, India
| | - Pooja Ramakant
- Department of Endocrine Surgery, King Georges' Medical University, Lucknow, UP, India
| | - Anand K Mishra
- Department of Endocrine Surgery, King Georges' Medical University, Lucknow, UP, India
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10
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Thyroidectomy in the Eldery. Eur J Surg Oncol 2018; 45:299-300. [PMID: 30150155 DOI: 10.1016/j.ejso.2018.07.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 07/23/2018] [Indexed: 11/21/2022] Open
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McIntire JB, McCammon S, Mong ER. Endocrine Surgery in the Geriatric Population. Otolaryngol Clin North Am 2018; 51:753-758. [PMID: 29699709 DOI: 10.1016/j.otc.2018.03.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Age must be a factor when considering endocrine surgery. Age itself is a risk factor for complications after thyroidectomy, specifically pulmonary, infectious, and cardiac complications. For this reason, in patients with nodular thyroid disease or thyroid microcarcinoma, length of observation must be measured against age and surgical risk. Outcomes of thyroid surgery in geriatric patients can be improved with several measures, including careful preoperative risk stratification based on comorbidities and frailty. In this population subset, it is imperative to have an earnest discussion with patients, their families, and any surrogate decision maker regarding potential outcomes of treatment versus observation.
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Affiliation(s)
- John Benjamin McIntire
- Department of Otolaryngology, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX 77555-0521, USA.
| | - Susan McCammon
- Department of Otolaryngology, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX 77555-0521, USA
| | - Eric R Mong
- University of Texas Medical Branch, 301 University Boulevard, Galveston, TX 77555-0521, USA
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Wang Z, Vyas CM, Van Benschoten O, Nehs MA, Moore FD, Marqusee E, Krane JF, Kim MI, Heller HT, Gawande AA, Frates MC, Doubilet PM, Doherty GM, Cho NL, Cibas ES, Benson CB, Barletta JA, Zavacki AM, Larsen PR, Alexander EK, Angell TE. Quantitative Analysis of the Benefits and Risk of Thyroid Nodule Evaluation in Patients ≥70 Years Old. Thyroid 2018; 28:465-471. [PMID: 29608439 DOI: 10.1089/thy.2017.0655] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND In older patients, thyroid nodules are frequently detected and referred for evaluation, though usually prove to be benign disease or low-risk cancer. Therefore, management should be guided not solely by malignancy risk, but also by the relative risks of any intervention. Unfortunately, few such data are available for patients ≥70 years old. METHODS All consecutive patients ≥70 years old assessed by ultrasound (US) and fine-needle aspiration (FNA) between 1995 and 2015 were analyzed. Clinical, US, and histologic data, including patient comorbidities and outcomes, were obtained. Imaging and cytology results from initial evaluation were reviewed to detect significant-risk thyroid cancer (SRTC), which was defined as anaplastic, medullary, or poorly differentiated carcinoma, or the presence of distant metastases. Overall survival analyses were then performed to assist with risk-to-benefit assessment. RESULTS A total of 1129 patients ≥70 years old with 2527 nodules ≥1 cm were evaluated. FNA was safe in all, and cytology proved benign in 67.3% of patients. However, FNA led to surgery in 208 patients, of whom 93 (44.7%) had benign histopathology. Among all patients who underwent FNA, only 17 (1.5%) SRTC were identified, all of which were preoperatively identifiable by imaging and/or cytology. These SRTC were responsible for all (n = 10; 0.9%) thyroid cancer deaths. Among all other patients (n = 1112), 160 deaths (14.4%) were confirmed during a median follow-up of four years. None of these were thyroid cancer related. Survival analysis for these 1112 patients demonstrated that a separate non-thyroidal malignancy or coronary artery disease at the time of nodule evaluation was associated with increased mortality compared to those without these diagnoses (hazard ratio = 2.32 [confidence interval 1.66-3.26]; p < 0.01), confirming these are important variables to identify prior to thyroid nodule evaluation. CONCLUSIONS For patients ≥70 years old, US and FNA are safe and prove helpful in identifying SRTC and benign cytology. However, the surgical management of patients ≥70 years old presenting without high-risk findings should be tempered, especially when comorbid illness is identified.
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Affiliation(s)
- Zhihong Wang
- 1 Department of Thyroid Surgery, the First Hospital of China Medical University , Shenyang, China
- 2 The Thyroid Section, Division of Endocrinology, Diabetes, and Hypertension, The Brigham and Women's Hospital and Harvard Medical School , Boston, Massachusetts
| | - Chirag M Vyas
- 2 The Thyroid Section, Division of Endocrinology, Diabetes, and Hypertension, The Brigham and Women's Hospital and Harvard Medical School , Boston, Massachusetts
| | - Olivia Van Benschoten
- 2 The Thyroid Section, Division of Endocrinology, Diabetes, and Hypertension, The Brigham and Women's Hospital and Harvard Medical School , Boston, Massachusetts
| | - Matt A Nehs
- 3 Department of Surgery, The Brigham and Women's Hospital and Harvard Medical School , Boston, Massachusetts
| | - Francis D Moore
- 3 Department of Surgery, The Brigham and Women's Hospital and Harvard Medical School , Boston, Massachusetts
| | - Ellen Marqusee
- 2 The Thyroid Section, Division of Endocrinology, Diabetes, and Hypertension, The Brigham and Women's Hospital and Harvard Medical School , Boston, Massachusetts
| | - Jeffrey F Krane
- 4 Department of Pathology, The Brigham and Women's Hospital and Harvard Medical School , Boston, Massachusetts
| | - Matthew I Kim
- 2 The Thyroid Section, Division of Endocrinology, Diabetes, and Hypertension, The Brigham and Women's Hospital and Harvard Medical School , Boston, Massachusetts
| | - Howard T Heller
- 5 Department of Radiology, The Brigham and Women's Hospital and Harvard Medical School , Boston, Massachusetts
| | - Atul A Gawande
- 3 Department of Surgery, The Brigham and Women's Hospital and Harvard Medical School , Boston, Massachusetts
| | - Mary C Frates
- 5 Department of Radiology, The Brigham and Women's Hospital and Harvard Medical School , Boston, Massachusetts
| | - Peter M Doubilet
- 5 Department of Radiology, The Brigham and Women's Hospital and Harvard Medical School , Boston, Massachusetts
| | - Gerard M Doherty
- 3 Department of Surgery, The Brigham and Women's Hospital and Harvard Medical School , Boston, Massachusetts
| | - Nancy L Cho
- 3 Department of Surgery, The Brigham and Women's Hospital and Harvard Medical School , Boston, Massachusetts
| | - Edmund S Cibas
- 4 Department of Pathology, The Brigham and Women's Hospital and Harvard Medical School , Boston, Massachusetts
| | - Carol B Benson
- 5 Department of Radiology, The Brigham and Women's Hospital and Harvard Medical School , Boston, Massachusetts
| | - Justine A Barletta
- 4 Department of Pathology, The Brigham and Women's Hospital and Harvard Medical School , Boston, Massachusetts
| | - Ann Marie Zavacki
- 2 The Thyroid Section, Division of Endocrinology, Diabetes, and Hypertension, The Brigham and Women's Hospital and Harvard Medical School , Boston, Massachusetts
| | - P Reed Larsen
- 2 The Thyroid Section, Division of Endocrinology, Diabetes, and Hypertension, The Brigham and Women's Hospital and Harvard Medical School , Boston, Massachusetts
| | - Erik K Alexander
- 2 The Thyroid Section, Division of Endocrinology, Diabetes, and Hypertension, The Brigham and Women's Hospital and Harvard Medical School , Boston, Massachusetts
| | - Trevor E Angell
- 2 The Thyroid Section, Division of Endocrinology, Diabetes, and Hypertension, The Brigham and Women's Hospital and Harvard Medical School , Boston, Massachusetts
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Rossi ED, Bizzarro T, Martini M, Straccia P, Lombardi CP, Pontecorvi A, Larocca LM, Fadda G. The role of fine-needle aspiration in the thyroid nodules of elderly patients. Oncotarget 2017; 7:11850-9. [PMID: 26919251 PMCID: PMC4914252 DOI: 10.18632/oncotarget.7643] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 01/30/2016] [Indexed: 12/18/2022] Open
Abstract
We assess the role of thyroid fine needle aspiration cytology(FNAC) in our series of elderly patients. The growing subset of people aged older than 70 years has shown an increased incidence of thyroid diseases which need to be studied in order to reduce the percentage of surgical treatments in patients with higher likelihood of co-morbidities and associated life risk. We compared Follicular/Indeterminate Neoplasms(FN) and suspicious of malignancy(SM) with pediatric and adult cohorts. We discussed the role of immunocytochemistry-ICC to refine diagnoses. Four hundred and eighty out of 3539FNACs(13.5%) in elderly patients, were surgical followed-up. They included: 35Inadequate, 188benign(BL), 164FN/AUS, 49SM and 44positive for malignancy (PM). All PM and 95.7%BL were histological confirmed. The malignant rate was 24.3% mostly diagnosed as papillary thyroid carcinomas. An ICC panel (HBME-1 and Galectin-3) was carried out on liquid based cytology (LBC) and performed on FN/AUS, SM and PM. We found concordant positive ICC in 69.3%malignancies and concordant negative ICC in 97.6%benign follicular adenomas. Among FNs, 42.9%malignant histologic cases had concordant positivity whilst 97.4%benign histology had negative panel. Thyroid FNAC shows high feasibility in elderly patients. ICC helps in reducing the number of useless thyroidectomies and providing a more adequate clinical and/or surgical selection in elderly patients.
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Affiliation(s)
- Esther Diana Rossi
- Division of Anatomic Pathology and Histology, Università Cattolica del Sacro Cuore, "Agostino Gemelli" School of Medicine, Rome, Italy
| | - Tommaso Bizzarro
- Division of Anatomic Pathology and Histology, Università Cattolica del Sacro Cuore, "Agostino Gemelli" School of Medicine, Rome, Italy
| | - Maurizio Martini
- Division of Anatomic Pathology and Histology, Università Cattolica del Sacro Cuore, "Agostino Gemelli" School of Medicine, Rome, Italy
| | - Patrizia Straccia
- Division of Anatomic Pathology and Histology, Università Cattolica del Sacro Cuore, "Agostino Gemelli" School of Medicine, Rome, Italy
| | - Celestino Pio Lombardi
- Division of Endocrine Surgery, Università Cattolica del Sacro Cuore, "Agostino Gemelli" School of Medicine, Rome, Italy
| | - Alfredo Pontecorvi
- Division of Endocrinology, Università Cattolica del Sacro Cuore, "Agostino Gemelli" School of Medicine, Rome, Italy
| | - Luigi Maria Larocca
- Division of Anatomic Pathology and Histology, Università Cattolica del Sacro Cuore, "Agostino Gemelli" School of Medicine, Rome, Italy
| | - Guido Fadda
- Division of Anatomic Pathology and Histology, Università Cattolica del Sacro Cuore, "Agostino Gemelli" School of Medicine, Rome, Italy
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Kai H, Xixia L, Miaoyun L, Qinchang C, Xinzhi P, Dingyuan L, Honghao L. Intraoperative nerve monitoring reduces recurrent laryngeal nerve injury in geriatric patients undergoing thyroid surgery. Acta Otolaryngol 2017; 137:1275-1280. [PMID: 28741396 DOI: 10.1080/00016489.2017.1354397] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE This research was aimed to investigate whether the intraoperative nerve monitoring (IONM) can reduce the incidence of recurrent laryngeal nerve (RLN) injury in geriatric patients undergoing thyroid surgery. METHODS This retrospective cohort study included 522 geriatric patients undergoing thyroid surgery between January 2013 and June 2016 in the Sun Yat-sen Memorial Hospital. Patients with IONM during the surgery (n = 340) were compared with patients without IONM (n = 212). RLN injury was verified by direct or indirect laryngoscope and relative factors for injury would be retrospectively analyzed. RESULTS The use of IONM group showed significant reduction in both total and transient RLN injury incidence, when compared with that in control group (1.76 versus 4.72%, p = .01 and 1.32 versus 3.67%, p = .03, respectively). However, the permanent RLN injury incidence did not show difference between the two groups (p = .3). CONCLUSIONS Our finding showed the use of IONM resulted in significantly reduction in RLN injury incidence. The technology of IONM is safe and convenient to detect, track and monitor the complete function of RLN and to provide the guidance for the surgeons during the thyroid surgery in geriatric patients, who are at high risk of RLN injury.
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Affiliation(s)
- Huang Kai
- Division of Vascular and Thyroid Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, PR China
| | - Lin Xixia
- Division of Vascular and Thyroid Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, PR China
| | - Long Miaoyun
- Division of Vascular and Thyroid Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, PR China
| | - Chen Qinchang
- Division of Vascular and Thyroid Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, PR China
| | - Peng Xinzhi
- Division of Vascular and Thyroid Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, PR China
| | - Luo Dingyuan
- Division of Vascular and Thyroid Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, PR China
| | - Li Honghao
- Division of Vascular and Thyroid Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, PR China
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Diagnostics of Thyroid Malignancy and Indications for Surgery in the Elderly and Younger Counterparts: Comparison of 3,749 Patients. BIOMED RESEARCH INTERNATIONAL 2017; 2017:1012451. [PMID: 29124061 PMCID: PMC5662825 DOI: 10.1155/2017/1012451] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Accepted: 09/11/2017] [Indexed: 01/14/2023]
Abstract
Background It seems valuable for clinicians to know if diagnostics of thyroid malignancy (TM) and indications for surgery in the elderly patients differ from these in younger counterparts. Materials and Methods Retrospective analysis of the medical records of 3,749 patients surgically treated for thyroid tumor. Data of patients with histopathology confirmed TM (n = 309) were studied. Results The rate of cytological prediction to malignancy was more than three times higher in elderly women. Compression was a main reason for surgery in the elderly (p < 0.0001). The final diagnosis of malignancy was significantly higher in older women (p = 0.002). Clinical suspicion of malignancy was positively correlated with histopathological diagnosis in total group of women (r = 0.543, p < 0.001) and total group of men (r = 0.560, p < 0.001). The subgroup of the eldest TM patients included a significantly higher number of subjects with advanced cancer and primary tumor progression (p < 0.0001). Distant metastases were significantly more presented among the elderly patients (p = 0.032). Conclusions The rate of cytological prediction to malignancy in elderly women is high. Tracheal compression is a common surgical indication in the elderly patients. The final diagnoses of malignancy predominate in elderly women. The oldest TM patients present a higher number of advanced thyroid tumors and distant metastases.
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Abstract
OBJECTIVE Review physiologic thyroid function changes with aging and emphasize careful interpretation of tests in the aging population. METHODS Literature review. RESULTS Using age-specific thyroid-stimulating hormone (TSH) reference ranges should minimize or avoid the unnecessary diagnosis of thyroid disease in elderly patients. Subclinical thyroid dysfunction and abnormal TSH with normal thyroid levels may improve with time, so careful monitoring of thyroid function is recommended. Overt thyroid disease should always be treated. CONCLUSION Clinical judgement is always warranted to decide how and when to treat subclinical thyroid disease in the elderly. ABBREVIATIONS FT4 = free thyroxine; rT3 = reverse triiodothyronine; T3 = triiodothyronine; T4 = thyroxine; TFT = thyroid function test; TSH = thyroid-stimulating hormone.
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Grubey JS, Raji Y, Duke WS, Terris DJ. Outpatient thyroidectomy is safe in the elderly and super-elderly. Laryngoscope 2017; 128:290-294. [PMID: 28573781 DOI: 10.1002/lary.26707] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Revised: 04/04/2017] [Accepted: 05/01/2017] [Indexed: 11/06/2022]
Abstract
OBJECTIVES 1) Determine the safety of outpatient thyroidectomy in the geriatric patient population. 2) Analyze the risk of postoperative complications from thyroid surgery in patients aged over 65 years (elderly) and aged over 80 years (super-elderly) undergoing ambulatory thyroidectomy compared to patients aged 21 through 40 years. STUDY DESIGN A retrospective analysis of consecutive patients undergoing thyroidectomy between January 2008 and July 2015 at a tertiary academic institution. METHOD Patients were stratified by age, and three subsets within this population were considered and analyzed further: youthful/control (aged 21-40 years), elderly (aged 65-79 years), and super-elderly (≥ 80 years). Patient demographics, surgical and pathological data, admission status, complication, and readmission rates were recorded. RESULTS A total of 1,429 thyroidectomies were accomplished; of these, 1,207 (84.5%) were outpatient operations. Among the outpatients, 85.2% were female, 14.1% were male, and the mean age was 50.3 ± 15.2 years. The control (youthful) group was comprised of 328 patients with a mean age of 33.3 years; the elderly group of 201 patients had a mean age of 70.3 years; and 16 patients in the super-elderly group had a mean age 82.7 years. The complication rates (5.2%, 5.0%, and 6.3%, respectively; P = 0.98) and re-admission rates (1.5%, 1.5%, and 0.0%, respectively; P = 0.89) were not different among these groups. CONCLUSION Outpatient thyroid surgery is as safe in appropriately selected elderly and super-elderly patients as it is in a control group of youthful patients. Therefore, age should not be a contraindication to conducting thyroidectomy on an ambulatory basis. LEVEL OF EVIDENCE 4. Laryngoscope, 128:290-294, 2018.
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Affiliation(s)
- Jamie Segel Grubey
- Department of Otolaryngology-Head and Neck Surgery, Augusta University, Augusta, Georgia, U.S.A
| | - Yazdan Raji
- Department of Otolaryngology-Head and Neck Surgery, Augusta University, Augusta, Georgia, U.S.A
| | - William S Duke
- Department of Otolaryngology-Head and Neck Surgery, Augusta University, Augusta, Georgia, U.S.A
| | - David J Terris
- Department of Otolaryngology-Head and Neck Surgery, Augusta University, Augusta, Georgia, U.S.A
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Bann DV, Kim Y, Zacharia T, Goldenberg D. The effect of aging on the anatomic position of the thyroid gland. Clin Anat 2016; 30:205-212. [DOI: 10.1002/ca.22804] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 10/25/2016] [Accepted: 10/26/2016] [Indexed: 11/10/2022]
Affiliation(s)
- Darrin V. Bann
- Division of Otolaryngology-Head and Neck Surgery; Department of Surgery; College of Medicine, The Pennsylvania State University; Hershey Pennsylvania
| | - Yesul Kim
- Division of Otolaryngology-Head and Neck Surgery; Department of Surgery; College of Medicine, The Pennsylvania State University; Hershey Pennsylvania
| | - Thomas Zacharia
- Department of Radiology; College of Medicine, The Pennsylvania State University; Hershey Pennsylvania
| | - David Goldenberg
- Division of Otolaryngology-Head and Neck Surgery; Department of Surgery; College of Medicine, The Pennsylvania State University; Hershey Pennsylvania
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Kshirsagar RS, Chandy Z, Mahboubi H, Verma SP. Does resident involvement in thyroid surgery lead to increased postoperative complications? Laryngoscope 2016; 127:1242-1246. [PMID: 27753090 DOI: 10.1002/lary.26176] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 04/23/2016] [Accepted: 06/09/2016] [Indexed: 11/09/2022]
Abstract
OBJECTIVES/HYPOTHESIS To evaluate the impact of resident involvement during thyroid surgery on 30-day postoperative complications. STUDY DESIGN Retrospective cohort study. METHODS All patients who underwent thyroid surgery in 2011 were identified from the American College of Surgeons National Surgical Quality Improvement Program database. Patient demographics, perioperative details, resident involvement in surgery, and 30-day postoperative complications were extracted. Propensity score analysis was used to match resident and nonresident cases. Univariate and multivariate analysis were performed to determine the relationship between resident involvement in thyroid surgery and postoperative outcomes. RESULTS One thousand seven hundred forty-seven patients with and 1,747 patients without resident involvement were case-matched for patient demographics, perioperative variables, and surgical case type. There was no significant difference (P = .19) in 30-day postoperative complication rates of surgeries with and without resident involvement, which were 1.4% and 2%, respectively. Operative time was longer in surgeries with residents than those without residents (119 ± 67 minutes vs. 102 ± 55 minutes, P < .001). Cases with resident involvement had an unplanned reoperation rate of 0.9%, which was significantly lower than the 2.3% rate of surgeries without residents (P = .001). Multivariate analysis revealed no significant association between resident involvement and overall complications (odds ratio = 0.70; P = .18). CONCLUSIONS Resident participation in thyroid surgery was not associated with an increased 30-day postoperative complication rate. These findings demonstrate that patient safety is not adversely affected by resident participation in thyroid surgery. LEVEL OF EVIDENCE 2C Laryngoscope, 127:1242-1246, 2017.
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Affiliation(s)
- Rijul S Kshirsagar
- Department of Head and Neck Surgery, Kaiser Permanente Oakland Medical Center, Oakland, California
| | - Zachariah Chandy
- Department of Head and Neck Surgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California
| | - Hossein Mahboubi
- University Voice and Swallowing Center, Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Irvine, California, U.S.A
| | - Sunil P Verma
- University Voice and Swallowing Center, Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Irvine, California, U.S.A
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Al-Qahtani KH, Tunio MA, Asiri MA, Bayoumi Y, Balbaid A, Aljohani NJ, Fatani H. Comparative clinicopathological and outcome analysis of differentiated thyroid cancer in Saudi patients aged below 60 years and above 60 years. Clin Interv Aging 2016; 11:1169-74. [PMID: 27621604 PMCID: PMC5010076 DOI: 10.2147/cia.s107881] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION The aim of this study was to evaluate the treatment outcomes of differentiated thyroid cancer in Saudi patients aged above 60 years. MATERIALS AND METHODS Comparative analysis was performed in 252 patients aged 46-60 years (Group A) and 118 patients aged above 60 years (Group B), who had thyroidectomy, radioactive iodine-131, and thyroid-stimulating hormone suppression therapy between July 2000 and December 2012. Different clinicopathological features, treatment, complications, disease-free survival, and overall survival rates were compared. RESULTS Mean age of patients in Group A was 51.9 years (range: 46-60), and mean age of those in Group B was 68.6 years (range: 62-97). Group B patients had higher positive lymph nodes (43.2%), P=0.011. The frequency of extrathyroidal extension, multifocality, and lymphovascular space invasion was seen more in Group B than in Group A. Postsurgical complications (permanent hypoparathyroidism, bleeding, and wound infections) were also seen more in Group B (P=0.043, P=0.011, and P=0.021, respectively). Group B patients experienced more locoregional recurrences (11.0%, P=0.025); similarly, more distant metastases were observed in Group B (15.3%, P=0.003). The 10-year disease-free survival rates were 87.6% in Group A and 70.8% in Group B (P<0.0001). CONCLUSION Differentiated thyroid cancer in patients aged above 60 years are more aggressive biologically and associated with a worse prognosis, and the morbidity is significantly high as compared to patients aged below 60 years.
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Affiliation(s)
- Khalid Hussain Al-Qahtani
- Department of Otolaryngology- Head & Neck Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Mutahir A Tunio
- Department of Radiation Oncology, Comprehensive Cancer Center, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Mushabbab Al Asiri
- Department of Radiation Oncology, Comprehensive Cancer Center, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Yasser Bayoumi
- Department of Radiation Oncology, NCI, Cairo University, Cairo, Egypt
| | - Ali Balbaid
- Department of Radiation Oncology, Comprehensive Cancer Center, King Fahad Medical City, Riyadh, Saudi Arabia
| | | | - Hanadi Fatani
- Histopathology, Comprehensive Cancer Center, King Fahad Medical City, Riyadh, Saudi Arabia
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Differentiated thyroid cancer in patients ≥75 years: Histopathological features and results of surgical treatment. Int J Surg 2016; 33 Suppl 1:S159-63. [PMID: 27393960 DOI: 10.1016/j.ijsu.2016.07.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
INTRODUCTION The aim of this retrospective study was to investigate clinical and pathologic characteristics of differentiated thyroid cancer (DTC) in patients ≥75 years and to analyze results of surgical treatment in this age group. METHODS The clinical records of patients submitted to total thyroidectomy between 2009 and 2014 with histopathological diagnosis of DTC were analyzed. Patients were divided into 3 groups: patients ≤64 years were included in group A, those between 65 and 74 in B and those ≥75 years in C. RESULTS Classic papillary thyroid cancer was more frequent in group A, whereas follicular variant of papillary carcinoma, tall cell and follicular carcinoma were more frequent in C. Multicentric and locally invasive tumors were more frequent in group C; younger patients (group A) showed higher incidence of node metastases (12.54% in group A, 6.33% in B and 7.89% in C). Postoperative stay was significantly longer in group C (3.13 ± 1.28 days vs 2.55 ± 1.27 vs 2.89 ± 1.27; p < 0.001). Transient hypoparathyroidism was more frequent in groups A and B compared with C (29.26% vs 19.71% vs 18.42%; p 0.033) whereas transient recurrent laryngeal nerve palsy was more frequent in group C compared with A and B (2.63% vs 0.16% vs 2.11% p 0.009). CONCLUSIONS In aging patients DTC show a worse prognosis compared with younger patients due to higher incidence of more aggressive histotypes but also to a significant diagnostic delay. Total thyroidectomy is safe when surgical operation is performed by skilled surgeons. Age alone does not exclude surgical option.
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Abstract
INTRODUCTION The number of elderly people in Italy is growing, so it is important to study the presentation of diseases in these subjects. MATERIALS AND METHODS We selected 1362 patients who underwent thyroidectomy for different thyroid diseases from January 2008 to December 2014. The patients weredivided into two groups, according to the age. The patients aged 65 years and over were included in the group A, and the patients under the age of 65 years were included in the group B. DISCUSSION Thyroid diseases in the elderly often present with atypical symptoms which are very similar to symptoms of the aging process. In elderly hypothyroidism occurs frequently sub-clinically and hyperthyroidism is often presented with cardiovascular symptoms. In our study we evaluated the differences in incidence of thyroid diseases in the elderly and in the younger groups of patients. CONCLUSION The data analyzed in this study showed that in the elderly we have a reduced secretion and metabolization of thyroid hormones. The symptomatology in the elderly is nonspecific and can create a delay in the correct diagnosis.
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McLeod DSA, Carruthers K, Kevat DAS. Optimal Differentiated Thyroid Cancer Management in the Elderly. Drugs Aging 2015; 32:283-94. [DOI: 10.1007/s40266-015-0256-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Santangelo G, Del Giudice S, Gallucci F, Parmeggiani U, De Falco M. Cancer of the thyroid gland in geriatric age: A single center retrospective study with a 10-year post-operative follow-up. Int J Surg 2014; 12 Suppl 2:S103-S107. [DOI: 10.1016/j.ijsu.2014.08.368] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Accepted: 06/15/2014] [Indexed: 11/28/2022]
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Nawrot I, Pragacz A, Pragacz K, Grzesiuk W, Barczyński M. Total thyroidectomy is associated with increased prevalence of permanent hypoparathyroidism. Med Sci Monit 2014; 20:1675-81. [PMID: 25234952 PMCID: PMC4179543 DOI: 10.12659/msm.890988] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background Thyroid disorders are very common in adults. Despite advances in conservative management, surgery remains a treatment modality of choice in many cases. The mortality and morbidity of thyroidectomy are low, but long-term postoperative hypoparathyroidism (HPT) remains a prominent complication of the procedure. The aim of this study was to assess the incidence of permanent HPT and identify the risk factors for this complication in a cohort of post-thyroidectomy patients followed at a District Endocrine Clinic. Material/Methods This was a retrospective analysis of 401 patients followed up at a Regional/District Endocrine Clinic, who had undergone thyroid surgery in the years 1993–2011. The percentage of patients with permanent (>12 months) HPT was the primary endpoint of the study. The statistically analyzed data of patients with permanent HPT versus the remaining patients free from postoperative complications included their demographic data, indications for surgical treatment of their thyroid disorder, and extent of the thyroid resection. The risk factors for postoperative hypoparathyroidism were assessed using logistic regression analysis. Results Permanent HPT following surgery on the thyroid gland occurred in 8.5% of the patients. It was more frequent following total thyroidectomy (20.2%) than near-total thyroidectomy (6.7%) or subtotal thyroidectomy (4.2%); p<0.0001. A multivariate statistical regression analysis demonstrated that primary total thyroidectomy was a significant risk factor for permanent HPT (OR 6.5; 95% CI: 2.9–14.4; p<0.0001). Conclusions Total thyroidectomy was associated with increased prevalence of permanent hypoparathyroidism when compared to less extensive thyroid resection modes in patients with benign thyroid diseases.
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Affiliation(s)
- Ireneusz Nawrot
- Department Of General, Vascular and Transplantation Surgery, Medical University of Warsaw, Warsaw, Poland
| | - Aneta Pragacz
- District Endocrine Clinic, Independent Public Healthcare Institution, Staszów, Poland
| | - Krzysztof Pragacz
- Department of General Surgery, Independent Public Healthcare Institution, Staszów, Poland
| | - Wiesław Grzesiuk
- Endocrine Clinic - Medical Center, Medical University of Warsaw, Warsaw, Poland
| | - Marcin Barczyński
- Department of Endocrine Surgery, Third Chair of General Surgery, Jagiellonian University Medical College, Cracow, Poland
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Calò PG, Medas F, Loi G, Erdas E, Pisano G, Nicolosi A. Differentiated thyroid cancer in the elderly: our experience. Int J Surg 2014; 12 Suppl 2:S140-S143. [PMID: 25183640 DOI: 10.1016/j.ijsu.2014.08.362] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Revised: 08/23/2014] [Accepted: 06/15/2014] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The objective of this retrospective study was to investigate clinical and pathologic characteristics of differentiated thyroid cancer in elderly patients and to evaluate the results of surgical treatment in this age group. METHODS The clinical records of patients who underwent total thyroidectomy between 2002 and 2012 with histopathological diagnosis of differentiated thyroid cancer were analyzed. Patients were divided into two groups: those 65 years old or older were included in group A (101), those younger in group B (354). RESULTS The mean surgical time was 100.9 ± 30.5 min in group A and 100.7 ± 27.6 in B. Postoperative stay was significantly longer in group A (2.8 ± 1.5 days vs 2.4 ± 0.7; p < 0.01). Classic papillary carcinoma was more frequent in group B, whereas follicular variant of papillary carcinoma and tall cell carcinoma in A. In group B node metastases were nearly twice. In Group A transient hypoparathyroidism occurred in 25 patients (24.8%), permanent hypoparathyroidism in 4 (4%), hematoma in 6 (5.9%), recurrent nerve palsy in 2 (2%), and wound infection in 2 (2%). In group B transient and permanent hypoparathyroidism occurred in 48 and 7 patients respectively (13.6% and 2%), hematoma in 4 (1.1%), recurrent nerve palsy in 5 (1.4%), and wound infection in 1 (0.3%). CONCLUSIONS Differentiated thyroid carcinoma is more aggressive in elderly patients for biological causes connected to age and to histotype but also for the diagnostic delay. Thyroid surgery in elderly patients is safe when the procedure is carried out by experienced staff. Total thyroidectomy is the surgical operation of choice.
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Affiliation(s)
| | - Fabio Medas
- Department of Surgical Sciences, University of Cagliari, Cagliari, Italy.
| | - Giulia Loi
- Department of Surgical Sciences, University of Cagliari, Cagliari, Italy.
| | - Enrico Erdas
- Department of Surgical Sciences, University of Cagliari, Cagliari, Italy.
| | - Giuseppe Pisano
- Department of Surgical Sciences, University of Cagliari, Cagliari, Italy.
| | - Angelo Nicolosi
- Department of Surgical Sciences, University of Cagliari, Cagliari, Italy.
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Gervasi R, Orlando G, Lerose MA, Amato B, Docimo G, Zeppa P, Puzziello A. Thyroid surgery in geriatric patients: a literature review. BMC Surg 2012; 12 Suppl 1:S16. [PMID: 23173919 PMCID: PMC3499269 DOI: 10.1186/1471-2482-12-s1-s16] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Thyroid disease is common in the elderly population. The incidence of hypothyroidism and multinodular goitre gradually increases with age. In view of a growth of aging population, we performed a literature review about the feasibility of thyroid surgery in the elderly. METHODS We conducted a literature search in the PubMed database in September 2012 and all English-language publications on thyroidectomy in geriatric patients since 2002 were retrieved. The potential original articles mainly focusing on thyroidectomy in elderly patients were all identified and full texts were obtained and reviewed for further hand data retrieving. RESULTS We retrieved five papers based on different primary end-point. Four were retrospective non randomized studies and one was prospective non randomized study. At last 65, 70, 75 and 80 years were used as an age cut-off. All studies evaluate the indications of thyroidectomy in geriatric patients, postoperative morbility and mortality. Only one study specifically assesses the rate of the rehospitalization after thyroidectomy among the elderly. CONCLUSIONS Thyroid nodules are particularly important in elderly patients, as the incidence of malignancy increases and they are usually more aggressive tumors. An age of at least 70 years is an independent risk factor for complications after general surgery procedures. Thyroid surgery in patients aged 70 years or older is safe and the relatively high rate of thyroid carcinoma and toxic goiter may justify an aggressive approach. A programmed operation with a careful pre-operative evaluation and a risk stratification should make the surgical procedures less hazardous, specially in 80 years old patients with an high ASA score.
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Affiliation(s)
- Rita Gervasi
- Endocrinosurgery Unit, Dept of Medical and Surgical Sciences, University Magna Graecia, Catanzaro, Italy
| | - Giulio Orlando
- Endocrinosurgery Unit, Dept of Medical and Surgical Sciences, University Magna Graecia, Catanzaro, Italy
| | - Maria Antonietta Lerose
- Endocrinosurgery Unit, Dept of Medical and Surgical Sciences, University Magna Graecia, Catanzaro, Italy
| | - Bruno Amato
- General Surgery Unit, Dept of General Surgery, Geriatric and Endoscopy, University Federico II, Naples, Italy
| | - Giovanni Docimo
- VII General Surgery Unit, Dept of General Surgery, Second University of Naples, Italy
| | - Pio Zeppa
- VII General Surgery Unit, Dept of General Surgery, Second University of Naples, Italy
| | - Alessandro Puzziello
- Endocrinosurgery Unit, Dept of Medical and Surgical Sciences, University Magna Graecia, Catanzaro, Italy
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Clinical and economic outcomes of thyroid surgery in elderly patients: a systematic review. J Thyroid Res 2012; 2012:615846. [PMID: 22779035 PMCID: PMC3388385 DOI: 10.1155/2012/615846] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2012] [Accepted: 04/21/2012] [Indexed: 01/29/2023] Open
Abstract
The U.S. population is undergoing a dramatic shift in demographics, with a rise in the proportion of elderly Americans. Given an increased prevalence of thyroid disease and malignancy with age, understanding the safety of thyroid surgery in this age group is increasingly pertinent. There remains disagreement regarding the clinical outcomes of elderly patients after thyroidectomy and the applicability of single-institution cohorts to the population at large. This paper reviews the epidemiology of thyroid disease in the elderly, current surgical indications and practice patterns, and the clinical and economic outcomes of elderly patients with thyroid disease after surgical intervention.
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Mitrou P, Raptis SA, Dimitriadis G. Thyroid disease in older people. Maturitas 2011; 70:5-9. [PMID: 21719219 DOI: 10.1016/j.maturitas.2011.05.016] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2011] [Accepted: 05/27/2011] [Indexed: 01/07/2023]
Abstract
Several changes in thyroid hormone secretion, metabolism, and action occur with the increase in age. Aging is often associated with a decrease in serum thyroid stimulating hormone and T3 levels, whereas serum free T4 levels usually remain unchanged. The prevalence of thyroid dysfunction is higher in the elderly as compared to the younger population. In elderly individuals the non-specific clinical manifestations of thyroid hormone excess or deprivation can cause confusion in the clinical setup; while some of the symptoms of thyroid disease are similar to those in younger patients, it is not uncommon for both hyperthyroidism and hypothyroidism to be manifested in subtle ways in older patients, often mimicking symptoms of aging or masquerading as diseases of the cardiovascular, gastrointestinal, or nervous system. In addition, diagnosis of thyroid disorders is commonly complicated, due to chronic, non-thyroidal illness or medication therapy. Early diagnosis and treatment of overt thyroid disorders is crucial, since these disorders are associated with increased morbidity and mortality in the elderly, usually due to common coexistent diseases such as diminished cardiovascular reserve. Treatment of subclinical thyroid disease should also be considered, based on a combination of age, symptoms and risk factors in the individual patients. In addition, both prevalence and aggressiveness of thyroid cancer increase with age. This review summarizes the changes of thyroid function, as well as the clinical manifestations and treatment of thyroid disorders with advancing age.
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Affiliation(s)
- Panayota Mitrou
- Hellenic National Center for Research, Prevention and Treatment of Diabetes Mellitus and its Complications (HNDC), Athens, Greece
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Puzziello A, Lucisano AM, Gervasi R, Siani C, Lerose MA, Orlando G, Innaro N, Vescioe G, Sacco R. Indications to total thyroidectomy for multinodular goiter in old patients. BMC Geriatr 2011. [PMCID: PMC3194377 DOI: 10.1186/1471-2318-11-s1-a49] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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