Browsing by Subject "Thyroidectomy"

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    Association of Insurance Expansion With Surgical Management of Thyroid Cancer
    (American Medical Association, 2017-08-01) Loehrer, Andrew P.; Murthy, Shilpa S.; Song, Zirui; Lubitz, Carrie C.; James, Benjamin C.; Surgery, School of Medicine
    Importance: To our knowledge, thyroid cancer incidence is increasing faster than any other cancer type and is currently the fifth most common cancer among women. While this rise is likely multifactorial, there has been scarce consideration of the effect of insurance statuses on the treatment of thyroid cancer. Objective: We evaluate the association of insurance expansion with thyroid cancer treatment using the 2006 Massachusetts health reform, which serves as a unique natural experiment. Design, Setting, and Participants: We used the Agency for Healthcare Research and Quality State Inpatient Databases to identify patients with government-subsidized or self-pay insurance or private insurance who were admitted to a hospital with thyroid cancer and underwent a thyroidectomy between 2001 and 2011 in Massachusetts (n = 8534) and 3 control states (n = 48 047). Difference-in-differences models were used to evaluate an association between the 2006 Massachusetts health care reform and thyroid cancer treatment, and participants were controlled for age, sex, comorbidities, and secular trends. Main Outcomes and Measures: Change in the thyroidectomy rate for thyroid cancer treatment was the primary outcome evaluated. Results: The Massachusetts cohort consisted of 6443 women (75.5%) and 2091 men (24.5%), of whom 6388 (79.6%) were white, 391 (4.9%) were black, 527 (6.6%) were Hispanic, 424 (5.3%) were Asian/Pacific Islander, 63 (0.8%) were Native American, and 228 (2.8%) were other. The participants from control states included 36 818 women (76.6%) and 11 229 men (23.4%), of whom 30 432 (65.5%) were white, 3818 (8.2%) were black, 6462 (13.9%) were Hispanic, 2591 (5.6%) were Asian/Pacific Islander, 211 (0.5%) were Native American, and 2947 (6.3%) were other. Before the 2006 Massachusetts insurance expansion, patients with government-subsidized or self-pay insurance had lower thyroidectomy rates for thyroid cancer in Massachusetts and the control states compared with patients with private insurance. The Massachusetts insurance expansion was associated with a 26% increased rate of undergoing a thyroidectomy (incident rate ratio, 1.26; 95% CI, 1.04-1.52; P = .02) and a 22% increased rate of neck dissection (incident rate ratio, 1.22; 95% CI, 1.07-1.37; P = .002) for treating cancer compared with control states. Conclusions and Relevance: The 2006 Massachusetts health reform, which is a model for the Affordable Care Act, was associated with a 26% increased rate of thyroidectomy for treating thyroid cancer. Our study suggests that insurance expansion may be associated with increased access to the surgical management of thyroid cancer. Further studies need to be conducted to evaluate the effect of healthcare expansion at a national level.
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    Correction to: Is the new ASNM intraoperative neuromonitoring supervision "guideline" a trustworthy guideline? A commentary
    (Springer Nature, 2019-04) Skinner, Stanley A.; Aydinlar, Elif Ilgaz; Borges, Lawrence F.; Carter, Bob S.; Currier, Bradford L.; Deletis, Vedran; Dong, Charles; Dormans, John Paul; Drost, Gea; Fernandez-Conejero, Isabel; Hoffman, E. Matthew; Holdefer, Robert N.; Kimaid, Paulo Andre Teixeira; Koht, Antoun; Kothbauer, Karl F.; MacDonald, David B.; McAuliffe, John J.; Morledge, David E.; Morris, Susan H.; Norton, Jonathan; Novak, Klaus; Park, Kyung Seok; Perra, Joseph H.; Prell, Julian; Rippe, David M.; Sala, Francesco; Schwartz, Daniel M.; Segura, Martín J.; Seidel, Kathleen; Seubert, Christoph; Simon, Mirela V.; Soto, Francisco; Strommen, Jeffrey A.; Szelenyi, Andrea; Tello, Armando; Ulkatan, Sedat; Urriza, Javier; Wilkinson, Marshall; Pediatrics, School of Medicine
    The article Is the new ASNM intraoperative neuromonitoring supervision "guideline" a trustworthy guideline? A commentary, written by Stanley A. Skinner, Elif Ilgaz Aydinlar, Lawrence F. Borges, Bob S. Carter, Bradford L. Currier, Vedran Deletis, Charles Dong, John Paul Dormans, Gea Drost, Isabel Fernandez‑Conejero, E. Matthew Hoffman, Robert N. Holdefer, Paulo Andre Teixeira Kimaid, Antoun Koht, Karl F. Kothbauer, David B. MacDonald, John J. McAuliffe III, David E. Morledge, Susan H. Morris, Jonathan Norton, Klaus Novak, Kyung Seok Park, Joseph H. Perra, Julian Prell, David M. Rippe, Francesco Sala, Daniel M. Schwartz, Martín J. Segura, Kathleen Seidel, Christoph Seubert, Mirela V. Simon, Francisco Soto, Jeffrey A. Strommen, Andrea Szelenyi, Armando Tello, Sedat Ulkatan, Javier Urriza and Marshall Wilkinson, was originally published electronically on the publisher's internet portal (currently SpringerLink) on 05 January 2019 without open access. With the author(s)' decision to opt for Open Choice the copyright of the article changed on 30 January 2019 to © The Author(s) 2019 and the article is forthwith distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits use, duplication, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license and indicate if changes were made. The original article has been corrected.
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    Factors Associated with Physicians’ Recommendations for Managing Low-Risk Papillary Thyroid Cancer
    (Elsevier, 2021) McDow, Alexandria D.; Roman, Benjamin R.; Saucke, Megan C.; Jensen, Catherine B.; Zaborek, Nick; Jennings, Jamia Linn; Davies, Louise; Brito, Juan P.; Pitt, Susan C.; Surgery, School of Medicine
    Background: The 2015 American Thyroid Association endorsed less aggressive management for low-risk papillary thyroid cancer (LR-PTC). We aimed to identify factors influencing physicians' recommendations for LR-PTC. Methods: We surveyed members of three professional societies and assessed respondents' recommendations for managing LR-PTC using patient scenarios. Multivariable logistic regression models identified clinical and non-clinical factors associated with recommending total thyroidectomy (TT) and active surveillance (AS). Results: The 345 respondents included 246 surgeons and 99 endocrinologists. Physicians' preference for their own management if diagnosed with LR-PTC had the strongest association with their recommendation for TT and AS (TT: OR 12.3; AS: OR 7.5, p < 0.001). Physician specialty and stated patient preference were also significantly associated with their recommendations for both management options. Respondents who received information about AS had increased odds of recommending AS. Conclusions: Physicians' recommendations for LR-PTC are strongly influenced by non-clinical factors, such as personal treatment preference and specialty.
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    Hürthle cell neoplasms of the thyroid: Pathologic outcomes and ultrasonographic analysis
    (Wiley, 2020-12) Shin, Timothy J.; Rabbani, Cyrus C.; Murthy, Henna D.; Traylor, Katie; Sim, Michael W.; Otolaryngology -- Head and Neck Surgery, School of Medicine
    Background: Fine-needle aspiration (FNA) of thyroid nodules suspicious for Hürthle cell neoplasms (HCN) have uncertain rate of malignancy. We aim to characterize rate and predictors of malignancy at our institution and compare these findings with established literature to help guide management. Methods: Single tertiary-referral center, retrospective study of 166 adults who underwent hemithyroidectomy or total thyroidectomy following FNA suspicious for HCN from 1998-2018. Demographic information and surgical histopathologic results were collected. Preoperative ultrasonography was independently scored on the American College of Radiology Thyroid Imaging Reporting and Data System (TI-RADS) by a board-certified head and neck radiologist. Results: There were 39 males and 127 females. Overall, 25 (15.1%) patients had carcinoma, with 15 (9%) being Hürthle cell carcinoma (HCC). Men had higher incidence of carcinoma (25.6% v. 11.8%, P = .035), and especially older males. Contralateral carcinoma was seen in 3 of 13 (23.1%) patients that underwent completion thyroidectomy. Patients with carcinoma had larger nodules (average diameter 3.3 cm versus 2.5 cm, respectively, P = .01), but no association with TI-RADS. Conclusion: Adults with nodules suspicious for HCN have significant risk of malignancy consistent with prior studies. Older males and larger nodule diameter are associated with malignancy in this cohort, but TI-RADS grade is not. These findings provide a framework for management and counseling for lesions suspicious for HCN.
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    Is the new ASNM intraoperative neuromonitoring supervision "guideline" a trustworthy guideline? A commentary
    (Springer Nature, 2019-04) Skinner, Stanley A.; Aydinlar, Elif Ilgaz; Borges, Lawrence F.; Carter, Bob S.; Currier, Bradford L.; Deletis, Vedran; Dong, Charles; Dormans, John Paul; Drost, Gea; Fernandez-Conejero, Isabel; Hoffman, E. Matthew; Holdefer, Robert N.; Kimaid, Paulo Andre Teixeira; Koht, Antoun; Kothbauer, Karl F.; MacDonald, David B.; McAuliffe, John J.; Morledge, David E.; Morris, Susan H.; Norton, Jonathan; Novak, Klaus; Park, Kyung Seok; Perra, Joseph H.; Prell, Julian; Rippe, David M.; Sala, Francesco; Schwartz, Daniel M.; Segura, Martín J.; Seidel, Kathleen; Seubert, Christoph; Simon, Mirela V.; Soto, Francisco; Strommen, Jeffrey A.; Szelenyi, Andrea; Tello, Armando; Ulkatan, Sedat; Urriza, Javier; Wilkinson, Marshall; Pediatrics, School of Medicine
    Erratum in Correction to: Is the new ASNM intraoperative neuromonitoring supervision "guideline" a trustworthy guideline? A commentary. [J Clin Monit Comput. 2019] Comment in Response to: Is the new ASNM intraoperative neuromonitoring supervision "guideline" a trustworthy guideline? A commentary. [J Clin Monit Comput. 2019] Comment on Practice guidelines for the supervising professional: intraoperative neurophysiological monitoring. [J Clin Monit Comput. 2019]
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    Post-thyroidectomy Hypocalcemia in Patients With History of Bariatric Operations: Current Evidence and Management Options
    (The International Institute of Anticancer Research, 2019) Spartalis, Eleftherios; Thanassa, Antonia; Athanasiadis, Dimitrios I.; Schizas, Dimitrios; Athanasiou, Antonios; Zografos, Georgios N.; Tsourouflis, Gerasimos; Dimitroulis, Dimitrios; Nikiteas, Nikolaos; Surgery, School of Medicine
    BACKGROUND/AIM: Both bariatric and thyroid surgeries promote calcium and vitamin D deficiency. The correlation, however, of hypocalcemia after thyroidectomy in patients with previous bariatric surgery has been poorly described. This review aimed to investigate the relationship between history of bariatric operations and post-thyroidectomy hypocalcemia, as well as suggested management options. MATERIALS AND METHODS: MEDLINE and Cochrane databases were searched for relevant publications regarding post-thyroidectomy hypocalcemia in patients with previous bariatric surgery. RESULTS: A total of 17 publications reporting on 126 patients met the inclusion criteria. These included 13 publications about Roux-en-Y gastric bypass (RYGB), 2 regarding biliopancreatic diversion (BPD), 1 about sleeve gastrectomy (SG) and 1 compared three bariatric procedures: SG, RYGB, laparoscopic adjustable gastric band (LAGB). Post-thyroidectomy hypocalcemia was found to be more prevalent in patients with previous RYGB and BPD, but not in previous LAGB and SG. CONCLUSION: Patients with previous bariatric surgery are at high risk of post-thyroidectomy hypocalcemia that sometimes leads to higher length of hospital stay and demands more invasive solutions. There is a need, however, for additional studies and further investigation in order to reach more conclusive results.
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    Thyroid cancer surgery during the coronavirus disease 2019 pandemic: perioperative management and oncological and anatomical considerations
    (Future Medicine, 2021-11) Spartalis, Eleftherios; Plakopitis, Nikolaos; Theodori, Maria Anna; Karagiannis, Sotirios P.; Athanasiadis, Dimitrios I.; Spartalis, Michael; Boutzios, Georgios; Paschou, Stavroula A.; Nikiteas, Nikolaos; Troupis, Theodore; Surgery, School of Medicine
    The coronavirus disease 2019 (COVID-19) pandemic has changed many aspects of our everyday lives and medical practice, including oncology treatment; thyroid cancer surgery is not an exception. The reported number of fine-needle aspirations performed during the first semester of 2020 was significantly reduced. Poorly differentiated, medullary and anaplastic thyroid tumors are considered important indications for immediate surgical intervention. By contrast, most well-differentiated carcinomas present slow growth, and thus surgery can be deferred for a short period of time during which patients are under active surveillance. Thyroid surgeries have decreased during the COVID-19 pandemic. Furthermore, prior to any intervention, negative COVID-19 status – with the use of a nasopharyngeal swab and reverse transcription PCR assay as the gold standard and chest CT scan as a complementary modality in some cases – must be confirmed to achieve a COVID-free pathway. Thorough preoperative assessment regarding both oncological and anatomical aspects should be performed to identify optimal timing for safe management.