Partial Thyroidectomy With Incidental Metastatic Lymph Nodes

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including frailty, general balance, and mobility, as well as the capacity and willingness to adhere to the recommended PT regimen during and after therapy sessions at home as important covariates. 2 At the same time, we acknowledge constraints in assessing these variables in our analyses due to their unavailability in the administrative dataset we used. We agree with the authors on the necessity for further research to elucidate how these variables may affect PT use and the effects of PT for patients experiencing dizziness.Wu and colleagues reference a 2022 commentary 3 highlighting limitations of using the Charlson Comorbidity Index (CCI), a weighted index, rather than specific individual diagnoses to measure comorbidity, particularly for assessing risk of death or survival time in patients with cancer. We acknowledge the imperfections of grouping predefined comorbidities and the limitations of indices including CCI to capture the full spectrum of patient-specific comorbidities. Despite these imperfections, the CCI remains the most widely used comorbidity index, boasting more than 10 000 citations. Its appeal, especially in administrative studies like ours, 1 lies in its utility and generalizability for large cohorts and its adaptability for use with administrative data. 4,5 We concur with Wu and colleagues that additional work is warranted. The association we observed in the cohort between PT and falls among individuals with dizziness was robust at all time points, and yet inclusion of the variables proposed by our colleagues would add important and practical clinical nuance. Specifically, we propose that future research, ideally using a clinical trial design, is necessary to explore the independent effect of PT on the risk of subsequent falls for adults experiencing dizziness. A prospective trial would best facilitate the measurement of patient-specific covariates of interest that are not captured in claims data. We also contend that further investigation is required to delineate the specific components of PT, such as particular exercises, education, timing and frequency of sessions, duration of therapy, and adherence that are most beneficial.

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confidence: 99%

Monitoring Thyroglobulin Following Total Thyroidectomy After Lobectomy—Reply

Alameer,

Eagan,

Ganly

2024

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“…In the article titled “Partial Thyroidectomy With Incidental Metastatic Lymph Nodes” published on November 16, 2023, in JAMA Otolaryngology–Head & Neck Surgery , there was an error in the Discussion section that indicated microscopic extrathyroidal extension occurred in 122 of 74 patients (30%). It now correctly reads 22 of 74 patients.…”

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confidence: 99%

Error in Discussion Section

2024

by lobectomy or isthmectomy, recurrence-free survival, disease-specific survival, and overall survival were 97.4%, 100%, and 96.2%, respectively.First, Chow notes that thyroglobulin (Tg) was used as a tumor marker for surveillance and that, although monitoring with Tg following total thyroidectomy is widely practised, its usage or benefit is dubious for lobectomy. We agree that the use of Tg for monitoring for recurrence after thyroid lobectomy is widely practiced but with limited evidence of any benefit. A recent study by Jang et al 2 evaluating postoperative Tg levels in 463 patients with 1 to 4 cm papillary thyroid cancer who underwent lobectomy between January 2005 and December 2012 showed serum Tg levels did not differ significantly between the recurrence and nonrecurrence groups, and there was no tendency for the recurrence group to increase Tg levels.Second, Chow asks if prophylactic ipsilateral central dissection was performed on the patients. Prophylactic ipsilateral central neck dissection was not carried out on any patient.Finally, Chow asks if thyroxine was prescribed in this series to suppress the thyrotropin. Following surgery, thyroid function tests were carried out 6 weeks later. Thyroxine was given if there was evidence of hypothyroidism. We did not routinely carry out thyroid hormone suppression suppression. We try to keep thyroid hormone suppression lower than 2.5 to 3.0. We have previously reported 3 that thyroid hormone suppression significantly increases the risk of postoperative osteoporosis without changing tumor recurrence in patients with low-and intermediate-risk differentiated thyroid cancer.

“…To the Editor The article “Partial Thyroidectomy With Incidental Metastatic Lymph Nodes” authored by Alameer et al has attracted my attention. Of 74 patients (most are classified as intermediate risk per the American Thyroid Association) with localized thyroid cancer with low-volume incidental N1a metastases treated by lobectomy or isthmectomy, recurrence-free survival, disease-specific survival, and overall survival were 97.4%, 100%, and 96.2%, respectively.…”

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confidence: 99%

Monitoring Thyroglobulin Following Total Thyroidectomy After Lobectomy

Chow

2024