IntroductionSurgical treatment of thyroid gland diseases is associated with the possibility of severe complications. The most dangerous of them is bleeding. Current studies focus on its risk factors, rather than reoperation-related consequences.Material and methodsWe analyzed 7805 thyroid operations performed from 1996 to 2014 in the Clinic of General, Gastroenterological and Endocrine Surgery of Wroclaw Medical University. Typical risk factors, symptoms and consequences of bleeding were analyzed.ResultsAmong operated patients 88.2% were female and 11.8% male. Bleeding occurred in 84 (1.08%) patients. Sex (p = 0.006), preoperative thyroid pathology (p = 0.03), and type of operation (p < 0.001) are significant risk factors for bleeding, while retrosternal goiter and surgeon’s experience are not. Risk of bleeding is highest in the case of male sex, toxic goiter and total resection of the thyroid gland. Most reoperations took place within 6 h. In 88.8% of cases of this kind of complication the surgeon indicated the exact source of bleeding; most commonly it was the neck muscles, skin and subcutaneous tissue, or the thyroid stump. Three patients required a second reoperation, 24 suffered further complications, and 8 required transfer to the Intensive Care Unit (ICU). Cardiac arrest occurred in 3 patients and 2 suffered bilateral vocal cord palsy.ConclusionsBleeding after thyroid operations is a direct life threat that requires immediate intervention. As a result death may occur, half of patients suffer other complications and some require intensive care. The risk is highest in the case of male sex, toxic goiter and total resection of the thyroid gland. Each patient after thyroid surgery needs to be closely observed. An operating theatre and ICU should be available at all times.

Background/Aim: Morphological features, combined with Ki-67 proliferative index, remain the standard for discriminating benign and malignant adrenocortical tumors. The aim of this study was to evaluate the role of minichromosome maintenance proteins MCM-3, MCM-5, MCM-7, and Ki-67 as proliferative markers in adrenocortical tumors. Materials and Methods: Specimens of 81 adrenocortical adenomas and 3 adrenocortical carcinomas were stained with antibodies against MCM-3, 5, 7 and Ki-67. Results: Malignant tumors were characterized by a greater size (p=0.017), volume (p=0.017), and higher levels of Ki-67 (p=0.005), MCM-3 (p=0.005), MCM-7 (p=0.008), but not MCM-5 (p=0.069). The markers' levels were independent from the tumors' size and volume, the patient's age and hormonal status. ROC curves showed Ki-67 (AUC 0.984), MCM-3 (AUC 0.984), and MCM-7 (AUC 0.950), but not MCM-5 (AUC 0.820) to be reliable markers. Conclusion: Ki-67, MCM-3, and MCM-7, but not MCM-5 are reliable proliferative and diagnostic markers in discerning benign and malignant adrenocortical tumors. Adrenal gland tumors (AGTs) are relatively common and constitute 5-9% of all human tumors. The greater accessibility to diagnostic imaging in recent years, especially ultrasound (US) and computed tomography (CT), has revealed that the rate of AGTs is significantly higher than previously reported. The prevalence of incidentally detected adrenal mass (socalled incidentaloma) is greater with age and ranges from 0.2% (20-29 years old) to 3% (over 50 years of age) and even up to 7% (over 70 years of age) (1, 2). The mean value for the general population is about 2-4% (3, 4). An incidentaloma is typically detected in the right adrenal gland, between the 5th and 7th decade of life (mean age 55 years). AGTs are found on average in 1-8.9% (mean 2.3%) of autopsies, and even in as high as 15% according to some authors (2, 4). Apart from an incidentaloma, adrenal tumors may present symptoms, either of hormonal excess or a mass effect (5). Following the finding of an AGT, steps are taken to determine its origin (cortical/medullar) and character (benign/malignant) (1, 3, 6). Most AGTs are of cortical origin and benign, adrenocortical adenoma (ACA) is the most frequent diagnosis (70-94%) (2, 5). The majority of ACAs do not display hormonal activity. The most common functioning ACA is aldosterone-producing adenoma (APA), followed by cortisol-producing adenoma (CPA) (7). A malignant AGT can be either a primary adrenal lesion or a metastasis (3). Primary malignancies consist of cortical (adrenocortical carcinoma-ACC) and medullar lesions (malignant pheochromocytomaabout 10% (2.5-26%) of all pheochromocytomas) (6). Metastatic AGTs vary in origin, including lung, renal, breast, gastrointestinal (gastric, colorectal), hepatocellular carcinoma and melanoma (1, 3, 5, 8). The presence of an extra-adrenal primary malignancy increases significantly the odds of an 1151 This article is freely accessible online.

Background Currently, less aggressive treatment or even active surveillance of papillary thyroid microcarcinoma (PTMC) is widely accepted and recommended as a therapeutic management option. However, there are some concerns about these approaches. We investigated whether there are any demographic, clinical and ultrasound characteristics of PTMC patients that are easy to obtain and clinically available before surgery to help clinicians make proper therapeutic decisions. Methods We performed a retrospective chart review of 5,021 patients with thyroid tumors surgically treated in one center in 2008–2018. Finally, 182 (3.62%) PTMC patients were selected (158 (86.8%) females and 24 (13.2%) males, mean age 48.8±15.4 years). We analyzed the disease-free survival (DFS) time of the PTMC patients according to demographic and histopathological parameters. Univariate and multivariate logistic regression analyses were used to assess the relationships of demographic, clinical and ultrasound characteristics with aggressive histopathological features. Results Age ≥55 years, hypoechogenicity, microcalcifications, irregular tumor shape, smooth margins and high vascularity significantly increased the risk for minimal extrathyroidal extension (minETE), lymph node metastasis (LNM), and capsular and vascular invasion (p<0.0001). Multivariate logistic regression analysis demonstrated a statistically significant risk of LNM (OR = 5.98, 95% CI: 2.32–15.38, p = 0.0002) and trends toward significantly higher rates of minETE and capsular and vascular invasion (OR = 2.24, 95% CI: 0.97–5.19, p = 0.056) in patients ≥55 years than in their younger counterparts. The DFS time was significantly shorter in patients ≥55 years (p = 0.015), patients with minETE and capsular and vascular invasion (p = 0.001 for all), patients with tumor size >5 mm (p = 0.021), and patients with LNM (p = 0.002). Conclusions The absence of microcalcifications, irregular tumor shape, blunt margins, hypoechogenicity and high vascularity in PTMC patients below 55 years and with tumor diameters below 5 mm may allow clinicians to select individuals with a low risk of local recurrence so that they can receive less aggressive management.

PurposeVoice problems are common after thyroidectomy. The aim of this study was to assess the voice related quality of life after thyroidectomy with neuromonitoring. The sociodemographic and treatment factors influencing the quality of voice after the operation were investigated.MethodsA total of 40 patients after thyroidectomy with neuromonitoring were enrolled into the study. The voice outcome was analyzed pre and postoperatively by two validated self-assessment questionnaires: Voice Handicap Index and Voice-Related Quality of Life survey.ResultsAll external branches of the superior laryngeal nerve were identified during the operation. There were no recurrent laryngeal nerve palsies. The mean total VHIs before and after thyroid operation were 1.2 [SD 2.564] and 2.8 [SD 6.944], respectively (p = 0.5). Preoperatively, the mean overall score for the V-RQOL was 99.6; postoperatively 98.7 (p = 0.05). A strong correlation between the V-score of the V-RQOL and O-score of the VHI before and after thyroidectomy was observed (both p < 0.001).There was no correlation between V-RQOL or VHI and sex, the kind of thyroid operations, diagnosis, thyroid function, the mean volume of the goitre, the presence of retrosternal position and the extent of thyroid operations (p > 0.05). A small correlation between the mean age of the patients and postoperative O-Score of the VHI (p = 0.007650) and between the mean age and postoperative V-Score for the V-RQOL (p = 0.00648) was observed.ConclusionsThe use of neuromonitoring in thyroid surgery is beneficial for patients to improve voice quality. The identification and preservation of EBSLNs is crucial to eliminate altered voice after thyroidectomy.

A thyroid nodule discovered during imaging study performed due to unrelated thyroid disease is known as a thyroid incidentaloma, while positron emission tomography (PET) associated incidental neoplasm of thyroid is known as a “PAIN” phenomenon.To evaluate which patients with “PAIN” phenomenon should undergo surgery in regards to cytology results.Retrospective review of 4716 patients consecutively admitted and surgically treated in tertiary surgical center. 49 (1.04%) patients with “PAIN” phenomenon were identified. All of them had ultrasound-guided fine needle aspiration biopsy (UG-FNAB) performed and cytological results were evaluated according to The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC). Patients were divided into 2 subgroups according to histopathological diagnosis: group 1 (n = 25) with benign tumor and group 2 (n = 24) with thyroid cancer.Cytology results were the significant predictors of cancer occurrence in patients with “PAIN” phenomenon (P < .0001). Logistic regression analysis confirmed that category III or higher of TBSRTC in patients with “PAIN” phenomenon significantly increased the risk of cancer (OR = 168.7, P < .0001).Patients with “PAIN” phenomenon and cytology assigned to category III or higher of the Bethesda system should undergo surgery due to significant risk of thyroid malignancy.