The significance of Hashimoto's thyroiditis for postoperative complications of thyroid surgery: a systematic review and meta-analysis

Impact of Hashimoto's thyroiditis on radiofrequency ablation for papillary thyroid micro-carcinoma: a cohort study of 391 patients

PURPOSE

To assess the impact of Hashimoto's thyroiditis (HT) on radiofrequency ablation (RFA) outcomes for papillary thyroid microcarcinoma (PTMC).

METHODS

A retrospective study of 391 PTMC patients treated with RFA from March 2017 to August 2020, divided by HT accompanied or not. Ablation area size, volume reduction ratio (VRR), lesion disappearance, complications, and recurrences were analyzed.

RESULTS

391 patients (mean age, 41.3 ± 11.2 [SD]; 317 women, 110 with HT) were evaluated. The follow-up time was 2 years. HT+ PTMC patients (Group A) exhibited larger ablation diameters at 1st and 3rd month post-RFA. In comparison, PTMC patients (Group B) had larger diameters at 1st and 3rd months but smaller at 6th months, returning to baseline around 6th month in Group B and 9th month in Group A. VRRs in Group B were greater than Group A at 3rd, 6th, 9th, 12th and 15th month, all p < 0.05). The Kaplan-Meier curves revealed a slower lesion disappearance rate in A (12th) compared to B group (9th). Complication and recurrence rates were similar for both groups (4.4% and 0.8% overall, Group B vs Group A: 4.3% vs 4.6%, p = 0.905; 0.4% vs 1.8%, p = 0.192).

CONCLUSION

HT delays the resorption of PTMC lesions following RFA, but it does not impact the procedure's effectiveness or safety. Regardless of HT status, RFA remains a viable alternative to surgery for PTMC.

Papillary thyroid carcinoma with Hashimoto's thyroiditis: impact and correlation

Thyroid cancer is a malignant tumor of the endocrine system. Papillary thyroid carcinoma (PTC) is the most common form of thyroid cancer and has a comparatively better prognosis. An autoimmune disease called Hashimoto's thyroiditis (HT) affects the thyroid and can cause lymphocyte infiltration in the thyroid tissue as well as hypothyroidism, which is characterized by increased levels of a certain antibody. It is currently assumed that there is a connection between PTC and HT. HT may increase the incidence of PTC and improve its prognosis by regulating gene expression, participating in common signaling pathways, and creating a specific immune microenvironment. In this review, we summarized the relationship between HT and PTC as well as the effects of coexisting HT on PTC and the possible mechanisms, thereby providing new perspectives for future research.

Clinical significance and risk factors of incidental parathyroidectomy after total thyroidectomy

PURPOSE

Postoperative hypoparathyroidism is the most common complication after total thyroidectomy(TT). The clinical significance of incidental parathyroid glands(IP) detected in pathological examination of removed surgical material is still controversial. The aim of this study was to evaluate the clinical follow-up findings and risk factors of patients with IP.

METHODS

Postoperative pathology results and postoperative biochemical findings of patients who underwent TT±Central Neck Dissection(CND)/Lateral Neck Dissection(LND) between September,2020 and September,2023 in single institution were retrospectively evaluated. Patients with IP were divided into Group-1, and patients without IP were divided into Group-2. Patients of Group-1 were divided as Single IP and Double IP subgroups according to the number of IP.

RESULTS

The findings of a total of 412 patients were evaluated. IP was detected in 90(21.8%) of the patients. Postoperative hypoparathyroidism was more common in Group-1 at the 6th hour, 24th hour and 1st month postoperatively (69.7% vs. 31.7%, p < 0.0001; 61.1% vs. 27.7%, p < 0.0001, 26.2% vs. 12.2%, p = 0.002, respectively). Persistent hypoparathyroidism was observed at a rate of 5.3% in Group-2 and 11.5% in Group-1 (p = 0.041). Postoperative hypocalcemia was seen more frequently in Group-1 than in Group-2 at the 12th hour (34.4% vs. 23.2%, p = 0.031, respectively). There was no difference between Single IP vs. Double IP groups for the serum levels of Calcium and PTH. Among the risk factors evaluated for the detection of IP, in the univariance analysis, operation indications(p = 0.018), CND(p < 0.0001), surgeon experience(p = 0.016), thyroid gland volume(p = 0.02), preoperative serum TSH value(p = 0.031); in multivariance analysis, operation type ( ± CND) (OR:2.785; 95% CI: 1.175-6.605; p = 0.020) and operator experience between 10-20 years (OR: 0.117, 95% CI: 0.033-0.418, p = 0.001) and >20 years (OR: 0.254, 95%CI: 0.085-0.760, p = 0.014) were found significant compared to operators experienced <5 years.

CONCLUSION

Patients with detected IP after total thyroidectomy have lower postoperative Calcium and PTH. Significant risk factors for the IP were low level of surgeon experience and undergoing CND.

Prevalence and Predictors of Postoperative Hypoparathyroidism: A Multicenter Observational Study

Background/Objectives: Hypoparathyroidism (HPT) is a common complication following thyroid surgery with an incidence reaching up to 29%, potentially resulting in significant long-term morbidity. To improve its early identification and patient outcomes, we investigated the prevalence and predictors of postoperative HPT. Methods: This retrospective, multicenter observational study included patients who underwent thyroid surgery from 2016 to 2022 in four centers located in Saudi Arabia's Eastern Province. We analyzed demographic data, underlying thyroid or parathyroid conditions, surgical indications, types of procedures, pathology results, and preoperative corrected calcium and vitamin D levels, along with postoperative corrected calcium and parathyroid hormone (PTH) levels. For data analysis, IBM Statistical Package for the Social Sciences (SPSS) Statistics 22 was used, with categorical variables presented as frequencies/percentages and non-normal continuous variables as the median/first quartile (Q1) and third quartile (Q3). Associations were tested with chi-square/Fisher exact tests, medians with Mann-Whitney U-tests, and odds ratios (ORs) with 95% confidence intervals (CIs) via multivariate analysis with statistical significance set at p < 0.05. Results: A total of 679 cases were included. The median age of patients was 43 years (with 48.9% of them aged 41-60 years), and 82% were female. HPT occurred in 228 cases (35.3%), with 115 (81.0%) experiencing transient HPT and 27 (19.0%) permanent HPT. Multivariate analysis identified total thyroidectomy (OR 2.7, p = 0.005), completion thyroidectomy (OR 8.4, p = 0.004), and low immediate postoperative PTH level (OR 3.1, p < 0.001) as independent predictors of HPT. Central lymph node dissection (CLND; OR 4.03, p = 0.004) and low postoperative PTH level (OR 2.56, p = 0.049) were significant predictors of permanent HPT. Conclusions: Key predictors of HPT include surgical extent and low postoperative PTH level, while CLND and low postoperative PTH level are the strongest predictors of permanent HPT. Careful assessment of these risks when determining the extent of surgery and avoiding unnecessary aggressive procedures can help to minimize the occurrence of HPT. Measuring the PTH level immediately after surgery may aid in identifying high-risk patients for early intervention and appropriate follow-up.

Impact of chronic lymphocytic thyroiditis on the diagnostic and intraoperative management of papillary thyroid cancer

BACKGROUND

Chronic lymphocytic thyroiditis is an autoimmune thyroid disorder and the most common cause of hypothyroidism in women. Many studies suggest that chronic lymphocytic thyroiditis contributes to a diagnostic challenge in thyroid nodules and may increase the risk of developing papillary thyroid cancer. This study examines preoperative clinical factors and tumor characteristics associated with papillary thyroid cancer among patients with chronic lymphocytic thyroiditis.

METHODS

A retrospective review of prospectively collected data of patients who underwent total thyroidectomy between 2009 and 2020 at a tertiary institution was performed. Sociodemographic factors, comorbidities, surgeon-performed ultrasound, fine needle aspiration, tumor characteristics, and final histopathology were studied. Patients were subdivided into 2 groups based on final histopathology: chronic lymphocytic thyroiditis alone and chronic lymphocytic thyroiditis with papillary thyroid cancer. χ2 tests were used for independence among categorical variables, and comparisons were based on t tests.

RESULTS

Of 2,200 total thyroidectomy patients, the majority of 250 patients with chronic lymphocytic thyroiditis were women (90.4%) and had a mean age of 50 (±13) years. All patients with chronic lymphocytic thyroiditis underwent preoperative ultrasound, 89.2% (n = 223) underwent fine needle aspiration preoperatively, and 25.2% (n = 63) presented with obstructive symptoms, whereas 53.6% (n = 134) had papillary thyroid cancer on final histopathology and 74.8% (n = 187) underwent central neck lymph node removal. When comparing patients with chronic lymphocytic thyroiditis alone with those with chronic lymphocytic thyroiditis and papillary thyroid cancer, no differences for sex, race, nodule density, nodule size, echogenicity, irregular borders, and number of nodules were identified, but there was a statistically significant difference for obstructive symptoms (37.1% vs 14.9%), multinodular goiter (55.8% vs 32.3%), microcalcifications (18.4% vs 36.6%), Bethesda III fine needle aspiration results (41.4% vs 27.4%), and central neck lymph node removal (58.6% vs 88.8%), respectively (P < .05). Preoperative fine needle aspiration in patients with chronic lymphocytic thyroiditis for papillary thyroid cancer had a positive predictive value of 92.9%, negative predictive value of 83.3%, false positive rate of 13.8%, and false negative rate of 8.8%.

CONCLUSION

Although thyroid ultrasound features may have limited utility for malignancy, fine needle aspiration of index thyroid nodules still demonstrates a high positive predictive value in stratifying patients with chronic lymphocytic thyroiditis with papillary thyroid cancer. A higher level of suspicion preoperatively may be needed to avoid unnecessary lymph node removal for patients with chronic lymphocytic thyroiditis.

Outcomes of thyroidectomy in symptomatic, euthyroid Hashimoto's patients: a case control study

BACKGROUND

Hashimoto's thyroiditis (HT) is managed with thyroid hormone replacement to maintain a euthyroid state. A subset of patients have refractory symptoms, which improve with thyroidectomy (TT). There remains a reluctance to proceed with surgery due to perceptions of complications, and limited data availability regarding improvements in quality of life (QoL). This retrospective case control study aims to analyse the outcomes and QoL scores for symptomatic euthyroid HT patients who underwent TT.

METHODS

Thirty euthyroid patients who underwent TT for the management of HT between 2017 and 2022 were identified. An age-matched control group of patients who underwent TT for symptomatic multinodular goitre (MNG) were randomly selected. Demographics, biochemistry, histology, outcomes, and pre- and post-operative SF-36 and ThyPRO-39 scores were compared between groups.

RESULTS

There were no surgical complications in the HT group, whilst two MNG patients had complications. There was a similar rate of parathyroid auto-transplantation in both groups, more glands were transplanted in the HT group. There was a significant difference in pre- and post-operative QoL scores for both groups. Comparison revealed a significant improvement in hyperthyroid symptoms, social life and daily life scores in the HT group. There was a significant difference in pre- and post-operative anti-TPO, anti-TG and TSH levels in the HT group.

CONCLUSION

Patients with symptomatic Hashimoto's thyroiditis, despite being euthyroid, may benefit from total thyroidectomy however this remains under-utilized. This study demonstrated that thyroidectomy was associated with an improvement in validated post-operative quality of life scores and was not associated with increased complication rates for appropriately selected patients.

Enhancing surgical precision: unveiling the impact of preoperative colonoscopy in anal fistula patients

BACKGROUND

Anal fistula is a common benign anorectal disease that often requires surgical intervention for effective treatment. In recent years, preoperative colonoscopy as a diagnostic tool in patients with anal fistula has garnered increasing attention due to its potential clinical application value. By investigating underlying inflammatory bowel disease (IBD), polyps, and other abnormalities, preoperative colonoscopy can offer insights to refine surgical strategies and improve patient outcomes.

METHODS

This retrospective study focused on 1796 patients with various benign anorectal diseases who underwent preoperative intestinal endoscopy and met surgical criteria within the preceding three years at the First Affiliated Hospital of Guizhou University of Traditional Chinese Medicine. Among these patients, 949 diagnosed with anal fistula comprised group A, while 847 patients without anal fistula were assigned to group B for comparison. The investigation encompassed an analysis of general patient information, endoscopic findings, polyp histopathology, distribution of bowel inflammation sites, and results of inflammatory bowel disease assessments between the two patient cohorts. A subgroup analysis was also conducted on 2275 anal fistula patients with no surgical contraindications. This subgroup was categorized into Group A (949 patients who underwent preoperative intestinal endoscopy) and Group C (1326 patients who did not undergo preoperative colonoscopy). The study compared the rates of detecting endoscopic lesions and IBD-related findings between the two subgroups.

RESULTS

The study initially confirmed the comparability of general patient information between groups A and B. Notably, the abnormal detection rate in group A was significantly higher than in group B (P < 0.01). In terms of endoscopic findings, the anal fistula group (group A) exhibited higher rates of detecting bowel inflammation, inflammatory bowel disease, and polyps compared to the non-anal fistula group (group B) (P < 0.05). The distribution of inflammation locations indicated higher detection rates in the terminal ileum, ileocecal region, and ascending colon for group A compared to group B (P < 0.05). Although the incidence of IBD in group A was higher than in group B, this difference did not reach statistical significance (P > 0.05). Subsequently, the analysis of the subgroup (groups A and C) revealed a significant disparity in intestinal endoscopic detection rates (P < 0.01) and statistically significant differences in detecting IBD (P < 0.05) and Crohn's disease (P < 0.05) between the two anal fistula subgroups.

CONCLUSIONS

The findings of this study underscore the substantial clinical value of preoperative colonoscopy in the comprehensive evaluation of patients with anal fistula. Preoperative colonoscopy aids in ruling out localized perianal lesions caused by underlying inflammatory bowel disease, thereby mitigating the likelihood of missed diagnoses and enhancing treatment outcomes. This research highlights the importance of incorporating preoperative colonoscopy as a valuable diagnostic tool in managing anal fistula patients.

Surgical Decision-Making in Thyroiditis: A Review Article

Thyroiditis is a common thyroid disorder worldwide. Its commonest variant is Hashimoto's thyroiditis (HT). The usual presenting symptom is hypothyroidism at the time of diagnosis. Most patients are asymptomatic. A few cases may experience more obvious symptoms. The standard treatment is medical, and surgery is rarely indicated. This review aims to shed light on the most relevant articles discussing surgery in thyroiditis and compare them. The author included 16 relevant articles focused on the surgical management of thyroiditis. Of the studies, 10 were designed as retrospective reviews, four as prospective studies, and two as systematic reviews. The included studies aimed to focus on certain objectives. Three of them discussed indications of surgical intervention in cases of thyroiditis. Five covered postoperative complications. Six looked at the thyroid cancer association with thyroiditis. Two explored the impact of thyroiditis on surgery. Five discussed the postoperative improvement of symptoms and the effect on the quality of life. All the studies listed in this review engaged cases of HT except two. This review concentrates on conceptualizing and organizing the parameters in the minds of surgeons who manage cases of thyroiditis to enable them to decide whether to operate or not. These factors are indications of surgery, improvement of local compressor symptoms post thyroidectomy like dysphasia and shortness of breath, risk of thyroid cancer, intraoperative difficulty, and postoperative complications. Different variants of thyroiditis cases are treated medically, and surgery is rarely indicated. The surgeons should consider the mentioned factors affecting their decision to operate on this special entity. Thus, each case should be individualized in deciding whether to operate or not by assessing the benefit-risk ratio.

Network Pharmacology to Explore the Molecular Mechanisms of Prunella vulgaris for Treating Hashimoto's Thyroiditis

Purpose:Prunella vulgaris (PV), a traditional Chinese medicine, has been used to treat patients with thyroid disease for centuries in China. The purpose of the present study was to investigate its bioactive ingredients and mechanisms against Hashimoto’s thyroiditis (HT) using network pharmacology and molecular docking technology to provide some basis for experimental research.

Methods: Ingredients of the PV formula were retrieved from the Traditional Chinese Medicine Systems Pharmacology (TCMSP) database. Additionally, HT-related genes were retrieved from the UniProt and GeneCards databases. Cytoscape constructed networks for visualization. A protein–protein interaction (PPI) network analysis was constructed, and a PPI network was built using the Search Tool for the Retrieval of Interacting Genes (STRING) database. These key targets of PV were enriched and analyzed by molecular docking verification, Gene Ontology (GO), and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment.

Results: The compound–target network included 11 compounds and 66 target genes. Key targets contained Jun proto-oncogene (JUN), hsp90aa1.1 (AKI), mitogen-activated protein kinase 1 (MAPK1), and tumor protein p53 (TP53). The main pathways included the AGE-RAGE signaling pathway, the TNF signaling pathway, the PI3K–Akt signaling pathway, and the mitogen-activated protein kinase signaling pathway. The molecular docking results revealed that the main compound identified in the Prunella vulgaris was luteolin, followed by kaempferol, which had a strong affinity for HT.

Conclusion: Molecular docking studies indicated that luteolin and kaempferol were bioactive compounds of PV and might play an essential role in treating HT by regulating multiple signaling pathways.