Outpatient thyroidectomy in the pediatric population

Preoperative optimization and patient education have allowed for the transition of thyroid surgery to the outpatient setting over the last few decades. Performing these operations in the outpatient setting has proven to be cost-effective and safe in the adult population. The purpose of this study is to evaluate the safety and efficacy of outpatient thyroid surgery in the pediatric population. A retrospective review from December 2015 to February 2019 of patients under the age of 18 years of age undergoing thyroidectomy performed by two endocrine surgeons at a large academic was performed. There were 55 consecutive operations performed in 51 patients for thyroid pathology, two were excluded as they were inpatient procedures. Cases were reviewed for complications, unplanned same-day admission, 30-day admission, unplanned reoperation, and death. Mean age was 15 ± 0.3 years (range 9–18 years), 79% of the patients were female. Operations were performed for Graves’ disease (n = 29), thyroid cancer (n = 9), thyroid nodule (n = 6), multinodular goiter (n = 4), Hashimoto’s disease (n = 3), and toxic adenoma (n = 2). Operations performed included: total thyroidectomy (n = 36), thyroid lobectomy (n = 13), total thyroidectomy with lymph node dissection (n = 2), and lateral neck dissection (n = 2). All patients were discharged home within 6 h after completion of the operation. Five (9.4%) patients had transient hypoparathyroidism, with parathyroid hormone levels <10 pg/mL immediately postoperatively. One patient (1.9%) developed a postoperative hematoma on postoperative day six and required reoperation and readmission. Two patients (3.8%) had permanent hypoparathyroidism and one had transient hoarseness (1.9%). There were otherwise no readmissions or ED visits. In conclusion, outpatient thyroid surgery is safe and effective for pediatric patients.     

Quality of life after thyroid surgery in women with benign euthyroid goiter: influencing factors including Hashimoto's thyroiditis

Background

Hashimoto's thyroiditis is associated with decreased quality of life (QoL). Thyroid surgery could hypothetically lead to an increase in QoL.

Methods

In a follow-up analysis of a prospective cohort study that included euthyroid women undergoing thyroid surgery for benign thyroid disease, 248 patients were willing to answer the SF-36 QoL questionnaire.

Results

At follow-up after a median of 26 months, only the SF-36 module of “bodily pain” had increased (P = .046). Preoperative anti–thyroid peroxidase antibody levels were positively correlated with increasing QoL in the SF-36 modules “bodily pain” (P < .001) and “role emotional” (P < .001). For the presence of histologically confirmed Hashimoto's thyroiditis, a significant positive correlation (P < .001) was found for all modules apart from “physical functioning.”

Conclusions

In women with benign euthyroid goiter, thyroid surgery does not lead to an overall improvement in health-related QoL. It should not be recommended for patients with elevated anti–thyroid peroxidase antibody levels. Patients with histologically confirmed Hashimoto's thyroiditis might benefit in terms of QoL.     

小金胶囊联合左甲状腺素钠片治疗桥本氏甲状腺炎的临床研究

目的:探讨小金胶囊联合左甲状腺素钠片治疗桥本氏甲状腺炎的临床研究。方法:选取2017年8月—2019年1月收治的桥本氏甲状腺炎患者106例,按照数字表法将其随机分为两组,对照组应用左甲状腺素钠片治疗,研究组应用小金胶囊联合左甲状腺素钠片治疗,对两组患者临床疗效、甲状腺功能及炎症反应等指标进行分析。结果:研究组的临床治愈比例高于对照组(50.9%vs 18.7%);研究组的T3(2.2±0.5) nmol/L、T4(124.2±17.8) nmol/L、FT3(4.3±0.7) pmol/L及FT4(14.4±2.9) pmol/L与对照组无明显差异(P 0.05),研究组的TSH(1.8±0.2)μIU/L低于对照组(P 0.05);研究组甲状腺抗体水平TG-Ab(253.4±12.8) IU/mL、TPO-Ab(241.3±12.8) IU/mL均低于对照组(P 0.05);研究组IL-8(0.4±0.2) ng/mL、IL-17(7.4±2.1) pg/mL及APN(5.9±1.1)μg/mL低于对照组(P 0.05),研究组的IL-10(91.8±12.6) pg/mL高于对照组(P 0.05);研究组不良反应(22.64%)与对照组(24.53%)无明显差异(P 0.05)。结论:采用小金胶囊联合左甲状腺素钠片治疗桥本氏甲状腺炎患者,能有效改善患者甲状腺抗体水平,调节自身炎症因子平衡,具有较高的安全性,可以在临床中进行进一步推广。     

Coexistence of secondary chondrosarcoma and lung carcinoma metastasis in the humerus of a patient with Ollier's disease: A case report

Tumor-to-tumor metastasis in the same bone is an extremely rare condition. Limited number of case reports exists for coincidence of benign and malign neoplasms but none for malignant to malignant metastasis. Occurrence of several individual malignancies in the same patient may eventually cause such coexistences. We report an Ollier's disease patient with malignant transformation to chondrosarcoma complicated by a pathologic fracture and eventually whose pathological examination revealed that the lesion was not only the chondrosarcoma but an accompanying metastasis from existing lung adenocarcinoma. This report includes clinical, radiological, histological diagnostic challenges in an unexpected lesion and a review of literature.     

Randomized phase II study to determine the optimal dose of 3-week cycle nab-paclitaxel in patients with metastatic breast cancer

BackgroundChemotherapy-induced peripheral neuropathy is commonly observed in patients treated with nanoparticle albumin–bound paclitaxel (nab-PTX). We conducted a multicenter randomized controlled study to evaluate the optimal dose of nab-PTX.MethodsWe compared three different doses of q3w nab-PTX (Standard: 260 mg/m² [SD260] vs Medium: 220 mg/m² [MD220] vs Low: 180 mg/m² [LD180]) in patients with HER2-negative metastatic breast cancer (MBC). Primary endpoint was progression-free survival (PFS). Grade 3/4 neuropathy rates in the three doses were estimated using the logistic regression model. The optimal dose was selected in two steps. Initially, if the hazard ratio (HR) for PFS was <0.75 or >1.33, the inferior dose was excluded, and we proceeded with the non-inferior dose. Then, if the estimated incidence rate of grade 3/4 neurotoxicity exceeded 10%, that dose was also excluded.ResultsOne hundred forty-one patients were randomly assigned to SD260 (n = 47), MD220 (n = 46), and LD180 (n = 48) groups, and their median PFS was 6.66, 7.34, and 6.82 months, respectively. The HRs were 0.73 (95% confidence interval [CI]: 0.42–1.28) in MD220 vs SD260, 0.77 (95% CI 0.47–1.28) in LD180 vs SD260, and 0.96 (95% CI 0.56–1.66) in LD180 vs MD220. SD260 was inferior to MD220 and was excluded. The estimated incidence rate of grade 3/4 neurotoxicity was 29.5% in SD260, 14.0% in MD220, and 5.9% in LD180. The final selected dose was LD180.ConclusionsIntravenous administration of low-dose nab-PTX at 180 mg/m² q3w may be the optimal therapy with meaningful efficacy and favorable toxicity in patients with MBC.     

Safety and efficacy of ribociclib plus letrozole in patients with HR+, HER2– advanced breast cancer: Results from the Spanish sub-population of the phase 3b CompLEEment-1 trial

BackgroundBreast cancer is the most common malignancy and the second leading cause of cancer-related mortality in Spanish women. Ribociclib in combination with endocrine therapy (ET) has shown superiority in prolonging survival in patients with hormone receptor-positive (HR+), human epidermal growth factor receptor 2-negative (HER2−) advanced breast cancer (ABC) vs. ET alone.MethodsCompLEEment-1 is a single-arm, open-label phase 3b trial evaluating ribociclib plus letrozole in a broad population of patients with HR+, HER2– ABC. The primary endpoints were safety and tolerability. Here we report data for Spanish patients enrolled in CompLEEment-1.ResultsA total of 526 patients were evaluated (median follow-up: 26.97 months). Baseline characteristics showed a diverse population with a median age of 54 years. At study entry, 56.5% of patients had visceral metastases and 8.7% had received prior chemotherapy for advanced disease. Rates of all-grade and Grade ≥3 adverse events (AEs) were 99.0% and 76.2%, respectively; 21.3% of patients experienced a serious AE, and 15.8% of AEs led to treatment discontinuation. AEs of special interest of neutropenia, increased alanine aminotransferase, increased aspartate aminotransferase and QTcF prolongation occurred in 77.8%, 14.8%, 11.4% and 4.0% of patients, respectively. Patients aged >70 years experienced increased rates of all-grade and Grade ≥3 neutropenia and anemia. Efficacy results were consistent with the global study.ConclusionsResults from Spanish patients enrolled in CompLEEment-1 are consistent with global data showing efficacy and a manageable safety profile for ribociclib plus letrozole treatment in patients with HR+, HER2− ABC, including populations of interest (NCT02941926).Trial registrationClinicalTrials.gov NCT02941926