فهرست مطالب behrouz kaleydari

Parathyroid dysfunction leading to symptomatic hypocalcemia is not uncommon following a total thyroidectomy and is often associated with significant patient morbidity and a prolonged hospital stay. The current study aimed at evaluating the comparative predictive role of serum calcium and intact parathyroid hormone (iPTH) for post-thyroidectomy hypocalcemia.
This prospective study was performed in 83 consecutive patients undergoing total thyroidectomy. Laboratory data such as serum calcium, vitamin D level, serum iPTH and serum phosphorus levels before surgery, postoperative calcium, and PTH levels measured after 1 and 6 hours and on the first postoperative day (1POD) were recorded.
Among the 83 patients, the mean (SD) age was 45.87 (12.57) years (range, 21–72 years); 70 (84.3%) patients were female. Final pathology was benign for 47 (56.6%) patients and malignant for 36 (43.4%) patients. In total, lymph node dissections were performed in 19 subjects (22.9%). On histological examination of the specimens, the parathyroid gland was found to have been removed inadvertently in 13 (15.7%) cases. In total, 35 (40.9%) patients developed hypocalcemia after thyroidectomy; receiver operating characteristic (ROC) analysis showed that a cut-off value of 15.39 pg/ml for iPTH, with a decline rate of 73% 1 hour after thyroidectomy is a significant predictor of hypocalcemia (area under the curve [AUC], 0.878; 95% confidence interval [CI], 0.79–0.96, P The current study showed that the decline rate in iPTH is a more reliable factor for hypocalcemia after total thyroidectomy than serum calcium. Patients with a decline rate

One of the first steps to determine the thyroid nodules nature is fine needle aspiration. Almost 15% of the nodules are reported as atypia of unknown significance/follicular lesion of unknown significance (AUS/FLUS), with no clear nature of benign or malignant cells.
This study aimed to evaluate the diagnostic value of repeated FNA in patients with AUS/FLUS undergoing thyroidectomy.
This cross-sectional study was conducted on 50 patients candidate for thyroid surgery due to both FNA report (AUS/FLUS) and clinical/ ultrasound findings from 2013 - 2014 in a referral surgery centre. First, a new FNA sample was taken from the lesion during surgery and was sent for cytopatholgy. Then, permanent pathology results (as gold standard method of diagnosis) and repeated FNA reports were analyzed and compared. The data were analyzed using SPSS Ver. 17, with P values less than 0.05 being considered significant.
The obtained results revealed that repeated FNA had sensitivity of 61.9%, specificity of 100%. It had 0% false positive and 38.1% false negative results. In our study the malignancy rate in repeated FNA was 26%. Also, according to the results, the positive and negative predictive values were 100% and 46.7% respectively, and the accuracy was reported as 71.4%.
Repeated FNA for AUS/FLUS has low sensitivity and negative predictive value despite 100% specificity and positive predictive value. Also, the prevalence of “undetermined” reports in repeated FNA for such lesions is high. It is recommended that repeating FNA for AUS/FLUS may have a limited role in decision making for managing patients with this type of thyroid nodules.