There is a higher incidence of toxicity and malignancy in MNG in an endemic goiter zone. The limited diagnostic and therapeutic facilities in the region under study warrant a high degree of clinical suspicion and judgment, sound knowledge of thyroid physiology, thorough interpretation of hormone test results, and meticulous surgical techniques. The treatment must be individualized with consideration of humanitarian and socioeconomic factors, without compromising the quality of care and its long-term consequences. Aggressive management of malignancy and toxicity with total thyroidectomy is needed as primary therapy in many instances. However, subtotal excision is more useful in carefully selected cases with a small remnant. Specialized training in thyroid surgery appears to be valuable in reducing complications.

Unilateral or bilateral hypoplasia or agenesis of one or both thyroid lobes, with or without isthmic agenesis, is a rare developmental anomaly. Hemiagenesis of the left lobe is far commoner than of the right. Clinically, these patients may be euthyroid, hyperthyroid, or hypothyroid. Ultrasonography is usually able to diagnose this condition easily, as we demonstrate in this case report of a 37-year-old lady with an incidentally detected thyroid nodule who was found to have hemiagenesis of the right lobe and isthmus.

No abstract

Introduction: Frailty is an important predictor of clinical outcomes, but its contribution to resource utilization remains understudied. This study investigates the impact of frailty on high resource utilization (HRU) in patients undergoing Coronary Artery Bypass Graft Surgery (CABG). Methods: We reviewed data on patients who underwent CABG at a single center between 04/2018 and 12/2019. A Frailty score (FS) was calculated using the Essential Frailty Toolset (EFT). Patients were divided into two groups: Frail (FS ≥ 3/5) & Non-Frail (FS <3/5). Baseline clinical characteristics and outcomes were compared in both groups. The primary outcome was HRU (post-operative length of stay > 7 days or readmission within 30-days). Secondary outcomes included operative time, prolonged ventilation, & direct procedure costs. Multivariable logistic regression was used to assess the effect of frailty on HRU. Results: The study included 740 patients of whom 18% (n=132) were frail. Compared to Non-Frail patients, Frail patients were older (66 vs. 70 yrs. P<0.001) and more likely to be high risk for operative mortality (1.3% vs. 14%, p<0.001). The incidence of HRU was 28% vs. 53%, p<0.001, in Non-Frail vs. Frail patients. Frail patients had longer operative times (272 vs. 247 mins; p<0.001), and a higher incidence of prolonged ventilation (9.9% vs. 4%; p<0.001). Median direct costs were also higher in Frail subjects ($33,434 vs. $22, 207; p<0.001). On multivariable logistic regression analysis, independent predictors of HRU were (OR: 95% C.I.) Frailty: 2.19(1.44, 3.33; p=0.003), Sex (Female): 1.66 (1.14, 2.40; p=0.008), and history of COPD: 2.32(1.53, 3.54; p<0.001). Conclusions: About one out of every five patients undergoing CABG was classified as frail by the EFT. Frailty was associated with higher direct costs and found to be an independent predictor of high resource utilization. Further attention is required to optimize outcomes and resource use in this vulnerable population.