Aleksandar Diklić

University of Belgrade

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Ivan Paunović

University of Belgrade

VŽ

Vladan Živaljević

University of Belgrade

Nevena Kalezić

Univerzitetski Klinički Centar Srbije

Svetislav Tatić

University of Belgrade

Ksenija Krgovic

Univerzitetski Klinički Centar Srbije

M Havelka

Croatian Institute of Transfusion Medicine

SŠ

Sandra Šipetić

University of Belgrade

Nikola Slijepčević

University of Belgrade

R Zívić

University Hospital Center Dr Dragiša Mišović

Vesna Božić

Centar za Promociju Nauke

Cooperative Institutions

University of Belgrade

110

Univerzitetski Klinički Centar Srbije

Centar za Promociju Nauke

Center for Health, Exercise and Sport Sciences

Institut za Reumatologiju

University of Belgrade – Faculty of Medicine

Institute of Public Health of Serbia

University of Nis

Institute for Cardiovascular Diseases of Vojvodina

University Hospital Center Dr Dragiša Mišović

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Hyperthyroidism in a Patient With Anaplastic Thyroid Cancer

The Endocrinologist (2009)

Vladan Živaljević Aleksandar Diklić Ksenija Krgovic R Zívić Dragan Radovanović

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Anaplastic thyroid cancer

10.1097/ten.0b013e3181b6575e

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Medullary thyroid carcinoma: Sporadic, hereditary

Acta chirurgica iugoslavica (2003)

Ivan Paunović Aleksandar Diklić Ksenija Krgovic Vladan Živaljević Svetislav Tatić

Medullary thyroid cancer (MTC) is uncommon thyroid tumor with specific characteristics which undoubtedly divide this tumor from other thyroid malignances. Patients with sporadic or hereditary form of MTC differ in clinical presentation, recurrence of the disease and outcome. The aim of study was to establish surgical characteristics of MTC as well as clinical factors that influence surgical treatment. The study group consisted of 68 patients with MTC managed at the Center for Endocrine Surgery between 1987. and 1999. Retrospective analysis included clinical form of the disease, general data, histological and other tumor characteristics. Mean age of the patients were 47.3 years (female/male ratio: 1.5:1). Mean size of tumor was 80.5 cm3, 72.1% patients had tumor greater than 4 cm. in diameter or extrathyroid spread. The majority of patients were in II and III stadium of the disease. Primary operation (at least total thyroidectomy) was performed in 57 (84%) patients. 2(3%) had postoperatively temporally nerve palsy and 7(10.29%) temporally hypoparathyroidism. The overall survival was 46.8 + 9.9% after 9 years and 63.6 + 7.2% at 5 years. Postoperative calcitonin value is significant predictor of survival /Spearman's coefficient (R=0.7048)/, worse prognosis is in correlation with high postoperative calcitonin values. The treatment of choice is at least total thyroidectomy and central lymph nodes resection if enlarged lymph nodes are found. Precise operative technique lowers the risk of postoperative complications. Complex approach to the patient with MTC includes all available methods in pre and postoperative evaluation as well as surgeon's knowledge and skill.

Medullary carcinoma

10.2298/aci0303113p

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Tuberculosis of the Thyroid Gland: A Case Report

Acta Chirurgica Belgica (2007)

Vladan Živaljević Ivan Paunović Aleksandar Diklić

Thyroid tuberculosis is a very rare condition even if the incidence of extrapulmonary forms of tuberculosis has increased. We report the case of a 56-year old female patient with tuberculosis of the thyroid gland and tubercular lymphadenitis of the neck mimicking thyroid malignancy. The diagnosis was established on histological examination after surgery in August 2002. Total thyroidectomy and central neck dissection were performed for very hard euthyroid multinodular goiter and paratracheal bilateral lymphadenopathy. There were no evidence of tubercular involvement of the other organs. The patient underwent combination treatment with antitubercular drugs for 6 months. During the three years follow-up period there was no evidence of disease recurrence.

Neck dissection

Tuberculous lymphadenitis

10.1080/00015458.2007.11680016

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[Classification, staging, prognostic factors and risk factors in thyroid carcinoma].

PubMed (2003)

Zivaljević Ivan Paunović Aleksandar Diklić Ksenija Krgovic R Zívić

Thyroid carcinomas arise from follicular cells (papillary, follicular, Hurthle, anaplastic), parafollicular cells (medullary) and stroma (lymphoma, sarcoma). Gradation and prognostic factors are different for every one of histological type. Most patients with papillary and follicular thyroid cancer have an excellent prognosis. At the other extreme is anaplastic thyroid cancer whose usual mean survival can be measured in months. Exposure to external radiation and living in endemic goiter area increase the frequency of thyroid cancer. Medullary thyroid carcinoma is often familial and may occur in associations with the multiple endocrine neoplasia syndromes.

Medullary carcinoma

Anaplastic carcinoma

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Papillary thyroid carcinoma

Acta chirurgica iugoslavica (2003)

Ksenija Krgovic Ivan Paunović Aleksandar Diklić Vladan Živaljević Svetislav Tatić

Papillary thyroid cancer is after ovarian cancer the most frequent malignant disease of the endocrine system and because of this fact, early detection and appropriate surgical treatment is essential. Radical surgical treatment lower the risk of the disease relapse and postoperative adjuvant therapy with radio iodine is possible as well as postoperative follow up with tireoglobulin measurement. If the total thyroidectomy is performed in highly specialized institution the risk of postoperative complications is acceptable and therefore is the treatment of choice for papillary thyroid cancer. Only the patients with occult papillary thyroid cancer can be treated with hemythyroidectomy. In our series of 410 patients the majority of the patients (85,12%) were in the early phase of the disease and the degree of successfully performed radical surgery for papillary thyroid cancer was very high (tumor reduction was performed in only 1,46% of cases).

Occult

Papillary adenocarcinoma

10.2298/aci0303078k

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[Characteristics of primary hyperparathyroidism in our country].

PubMed (1995)

Radovan Janković Aleksandar Diklić

Primary hyperparathyroidism (HPT) is rarely diagnosed in our country and when found, it is in the very late phase. Skeletal and renal forms of the disease are predominating, as it was in the developed couuntries thirty or forty years ago. Among 100 patients operated for HPT from 1980 to 1993, skeletal changes dominated in 30 patients, and 50% of them had pathological fractures before operation. We found classical renal form in 47 patients. Nineteen patients were operated for urological complications before HPT was diagnosed. Hypercalcaemic form dominated in 16 patients, of whom one third had hypercalcaemic crisis. In 7 patients with oligosymptomatic form, we fond adenoma of the parathyroid gland during the thyroid operation.

Hypercalcaemia

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Preoperative preparation of patients with hyperparathyroidism as comorbidity

Acta chirurgica iugoslavica (2011)

Vladan Živaljević Nevena Kalezić Dijana Jovanović Vera Sabljak Aleksandar Diklić

Preoperative preparation of patients with hyperparathyroidism planned to be operated and/or already operated because of some other disease have specific characteristics in function of the type of hyperparathyroidism, primary or secondary. In primary hyperparathyroidism, repercussions of pronounced hypercalcemia on organs and systems are of essential importance. The most important aspect of preoperative preparation of these patients is therefore the treatment of hypercalcemia. In patients with secondary hyperparathyroidism as comorbidity, calcium level is of lesser importance since it stays mostly within reference values. Essential for perioperative preparation of these patients is the fact that they have chronic renal insufficiency and usually are on extrarenal depuration, so that uremic toxic disorders important for the perioperative course should be taken into account. Disorders caused by primary or secondary hyperparathyroidism (and terminal chronic renal insufficiency) must be brough to so-called "stable state" in elective surgical interventions. Preoperative preparation in urgent surgical interventions is focused only on vitally endangering consequences of hyperparathyroidism such as hypercalcemic crisis or extreme hyperkalemia.

10.2298/aci1102109z

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Acute Suppurative Klebsiella Thyroiditis: A Case Report

Acta Chirurgica Belgica (2009)

Blaženka Kljaić Bukvić Aleksandar Diklić Vladan Živaljević

Acute suppurative thyroiditis and thyroid abscess are extremely rare disorders. The most common pathogens causing acute suppurative thyroiditis are Gram-positive bacteria, including staphylococcal and streptococcal species. Thyroid abscess is mostly located in the left thyroid lobe. We report the case of a 75-year-old female patient with acute suppurative thyroiditis and right lobe thyroid abscess caused by Klebsiella spp. The patient had a firm, livid, hardly mobile cervical swelling. Axial computed tomography image showed soft-tissue swelling, an abscess in the right thyroid lobe and swelling of the thyroid gland. The diagnosis was established on a smear culture result. The patient was diabetic and had been operated on for goitre fifty years before. On indirect laryngoscopic examination, the patient was found to have right vocal cord paralysis. Infection and abscess resolved following surgical drainage and treatment with intravenous antibiotics, while the vocal cord paralysis persisted. Diabetes mellitus and previous thyroid surgery, in which sutures were used with unresorptive material, might have been the precipitating factors for the patient to acquire this unusual infection.

Vocal Cord Paralysis

Subacute thyroiditis

10.1080/00015458.2009.11680419

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Citations (7)

Total thyroidectomy as a method of choice in the treatment of Graves’ disease - analysis of 1432 patients

BMC Surgery (2015)

Toplica Bojić Ivan Paunović Aleksandar Diklić Vladan Živaljević Goran Zorić

Graves' disease represents an autoimmune disease of the thyroid gland where surgery has an important role in its treatment. The aim of our paper was to analyze the results of surgical treatment, the frequency of microcarcinoma and carcinoma, as well as to compare surgical complications in relation to the various types of operations performed for Graves' disease.We analysed 1432 patients (221 male and 1211 female) who underwent surgery for Graves' disease at the Centre for Endocrine Surgery in Belgrade during 15 years (1996-2010). Average age was 34.8 years. Frequency of surgical complications within the groups was analyzed with nonparametric Fisher's test.Total thyroidectomy (TT) was performed in 974 (68%) patients, and Dunhill operation (D) in 221 (15.4). Carcinoma of thyroid gland was found in 146 patients (10.2%), of which 129 (9%) were a microcarcinoma. Complication rates were higher in the TT group, where there were 31 (3.2%) patients with permanent hypoparathyroidism, 9 (0.9%) patients with unilateral recurrent nerve paralysis and 10 (1.0%) patients with postoperative bleeding. Combined complications, such as permanent hypoparathyroidism with bleeding were more common in the D group where there were 2 patients (0,9%), while unilateral recurrent nerve paralysis with bleeding was more common in the TT group where there were 3 cases (0,3%).Frequency of complications were not significantly statistically different in relation to the type of surgical procedure. Total thyroidectomy represents a safe and efficient method for treating patients with Graves' disease, and it is not followed by a greater frequency of complications in relation to less extensive procedures.

Hypoparathyroidism

10.1186/s12893-015-0023-3

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Incidence of difficult intubation in thyroid gland surgery

Archive of oncology (2003)

Nevena Kalezić Milena Kazic Ivan Paunović Aleksandar Diklić Vladimir Zivaljevic

Background: Difficult intubation (DI) occurs in 1% to 3% in general population, and unsuccessful intubation in 0.04%. DI may cause a lot of undesirable effects during prolonged intubation period, including lethal outcome. The aim of the study was to establish the incidence of DI in thyroid gland surgery and to compare the incidence of DI to predicted DI due to different DI screening testes. Methods: Prospective study included 2000 patients, which underwent thyroid gland surgery in Center for endocrine gland surgery, Clinical Center of Serbia, Belgrade, during 1999-2001. 436 of them were thyroid carcinomas 525 were nodal goiter, 671 polynodal goiter and 368 hyperthyreosis; 1705 female, 295 men, average age 48.1 year. According to ASA classification (American Society of Anesthesiologist's classification for correlation between co-existing diseases and perioperative complications) there were 886 ASA I, 901 ASA II and 213 ASA III. We used Mallampathi classes, Wilson criteria and Cormack-Lehane (CL) criteria to predict DI, and CL criteria to define DI. The complications during DI were analyzed and the ratio of DI to predicted DI was established. Results: There were 110 DI- 84 women, 26 men. Considering diagnosis there were T 24, PS 42 H 22. ASA III were 9.38%, ASAII 5.77, ASAI 4.28%. There were 3 unsuccessful intubations. Complications during DI were noted in 32 patients. Ratio between expected DI and DI, and unexpected DI and DI were: 12.77% failed positive and 0.45% failed negative results. Conclusion: Incidence of DI in thyroid gland surgery is twice more in men than in women. Screening tests for prediction DI showed higher specify than sensitivity.

10.2298/aoo0303187k

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Citations (1)