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The most recent advance concerning levothyroxine (L-T4) therapy is the development of novel oral formulations: the liquid preparation, and the soft gel capsule. Areas covered: This review evaluates the most recent clinical studies about these new formulations. The liquid formulation has been shown to overcome: the food and beverages intereference with L-T4 tablets absorption, caused by food or coffee at breakfast; malabsorption induced by the increased gastric pH, resulting from atrophic gastritis, or due to proton-pump inhibitors; and malabsorption after bariatric surgery. The use of liquid L-T4 has been studied also in pregnancy, newborns and infants, suggesting a better bioequivalence than tablets. Finally, liquid L-T4 is more active than tablets in the control of thyroid-stimulating hormone (TSH) in hypothyroid patients without malabsorption, drug interference, or gastric disorders, leading to a hypothesized higher absorption of liquid L-T4 also in these patients. Few studies have evaluated soft gel L-T4 with promising results in patients with malabsorption related to coffee or gastritis. Expert opinion: Liquid L-T4 (and soft gel capsules) are more active than the tablet L-T4 in the control of TSH in hypothyroid patients with gastric disorders, malabsorption, or drug interference, but also in patients without absorption disorders.

The routine addition of total thyroidectomy to Sistrunk's procedure seems to be appropriate for comprehensive loco-regional control especially that selecting a subset of patients in which it could be omitted is a difficult task.

After a long experience and a considerable number of procedures performed in a single center, MIVAT is confirmed as a safe operation, with a complication rate comparable with open thyroidectomy. MIVAT offers a cure rate for the treatment of low-risk and intermediate-risk malignancies that is comparable with an open procedure when inclusion criteria are strictly respected.

Purpose. To highlight the changes that have come about in recent years in the etiology, diagnosis, and treatment of acquired carotid-jugular fistulas.Methods. We present a review of the literature on acquired carotid-jugular fistulas (CJFs), which includes studies from World Wars I and II up to today and a retrospective analysis of the lesion reports published in the period 2000–2012, with an update of Talwar's table. The case study of one patient suffering from an untreated, long-standing CJF recently treated by us is also presented and included in the updated table.Results. Thanks to early treatment of acute lesions by reconstructive and endovascular surgery, incidence of posttraumatic carotid-jugular fistulas is decreasing, while the number of iatrogenic ones due to medical advances is concomitantly increasing, specifically because of the ever more widespread use of central venous catheters for venous pressure monitoring, parenteral nutrition, and hemodialysis.Conclusion. Although such lesions seem destined to diminish in the future thanks to the above-mentioned diagnostic and therapeutic advances, the increasing number of internal jugular vein catheterizations performed worldwide implies that physicians will still be dealing with carotid-jugular fistulas for many years to come.