Tertiary hyperparathyroidism (tHPT) most commonly refers to a persistent secondary hyperparathyroidism even after successful renal transplantation. Parathyroidectomy (PTX) is an efficient method for treatment of tHPT. In this study, we examined our 31-year experience with patients who underwent PTX for tHPT after KTX and assessed the effects of PTX on graft function according to the type of surgery. Among 2,981 recipients who underwent renal allograft between April 1979 and Dec. 2010, 15 patients (0.5%) were identified as having tHPT and underwent PTX. Levels of intact parathyroid hormone (iPTH) and serum calcium were measured before and after PTX for evaluation of the therapeutic effect, and glomerular filtration rate (GFR) using the Modification of Diet in Renal Disease (MDRD) equation for investigation of any effect on graft function. One patient showed persistent hyperparathyroidism and hypercalcemia after limited PTX. We experienced 14 successful PTXs, including 3 total PTX with autotransplantations, 8 subtotal PTXs, and 3 limited PTXs. Level of iPTH and serum calcium were at normal range after PTX. Estimated GFR decreased after PTX. Total PTX with autotransplantation showed a tendency of more decrease in the values of iPTH, and GFR after PTX than Subtotal PTX. PTX can cure tHPT-specific symptoms and signs by recovery of hypercalcemia, but may carry the risk of deterioration of kidney graft function. We suspect that subtotal PTX, rather than total PTX with AT, prevent any risk of kidney graft deterioration in surgical treatment of tHPT, and, in selective tHPT patients, limited PTX might be recommended.
Purpose: This study investigated the clinicopathological characteristics and prognostic factors in young patients with differentiated thyroid carcinoma. Methods: Among the 3,837 patients with DTC who were treated in the Department of Surgery at Yonsei University College of Medicine from March 1986 to March 2005, 71 patients were less than 20 years of age when diagnosed. The mean age was 14.9 years (range, 420 years). There were 59 females and 12 males with a mean follow-up period of 91.8 months (range, 14205 months). Results: The cause specific and the progression-free survivals at 10 years were 100% and 80.3%, respectively. Eleven patients (15%) experienced a recurrence and 1 patient showed a progression of a pulmonary metastasis at diagnosis. Compared with 39 patients older than 15, 32 patients younger than 15 years of age tended to have a higher incidence of a N1b and M1 stage, and a lower progression-free survival rate. Univariate analysis revealed that an age 15 years, multicentricity, N1b stage, M1 stage, and bilateral radical neck dissection had a negative impact on the progression-free survival. However, multivariate analysis showed that the age at diagnosis and the M1 stage were independent prognostic factors for progression- free survival. Conclusion: Being younger 15 years and the M1 stage are the most significant prognostic factors negatively influencing the progression-free survival. The high incidence of lateral neck and lung metastasis justifies a total thyroidectomy and modified radical neck dissection, followed by postoperative 131I therapy even in patients younger than 15 years of age.
Introduction:Surgical indication of thyroid surgery in small benign nodules is cosmesis.To improve the cosmesis, transoral endoscopic thyroid surgery (TOETVA) is considered one of the best modalities as it gives no visible scar.However, swallowing related quality of life (SWAL QoL) after TOETVA has not been compared with open thyroid surgery (OTS).The aim of this study is to compare the two modes of surgical therapy on swallowing related quality of life.Methods: This case control study was conducted prospectively between Sept 2020 and May 2022.Patient operated for benign euthyroid nodules undergoing either OTS or TOETVA were included in the study.Swallowing related quality of life was evaluated before and after the surgery and compared for the two groups.Results: Thirty-four patients underwent TOETVA and 76 had OTS.Out of 90 OTS patients, 40 age and sex matched cohort was selected as control.Pre-surgery scores were comparable between the two groups.Postoperatively, short term (1 month) SWAL-QoL was significantly better in TOETVA group as compared to OTS.However, long-term (3 months) SWOL-QoL was comparable in both groups.Conclusion: TOETVA results in significant improvement in shortterm swallowing related QoL.However, long term SWAL-QoL is same as open thyroid surgery.
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