International Association of Endocrine Surgeons - Bangkok August 2015
4DCT best for localisation - Dr Elsayad, Brown University, Providence
In a retrospective study of 915 patients undergoing parathyroidectomy, standard localisation (ultrasound and sestamibi scanning) was equivalent for pateints with higher levels of serum calcium and PTH. However in mild disease with lower PTH levels 4DCT was significantly more successful at localising abnormal parathyroid glands finding 88% of adenomas. Since 4DCT is a single test, it is also cheaper and thus more cost-effectiveness than the former strategy combining untrasound and sestamibi.
LD COMMENT: This supports our own research that 4DCT is the preferred technique to localise parathyroid adenomas
Small papillary cancers can be observed - Dr Fukuoka, Tokyo, Japan
Small papillary cancers do not necessarily progress and can be observed. in a prospective study of observed cancers since 1995, it was reported that the ultrasound characteristics could determine those most likely to grow. The presence of rime calcification with a poor blood supply correlated with a low risk of progression, whereas non calcified vascular cancers were likley to grow. Based on this type of assessment a number of Japanese centres now observe small incidental papillary thyroid cancers rather than taking them at initially.
LD COMMENT: small incidental cancers may not pose a risk, the challenge being to determine which ones are safe to observe
Laryngeal mobility improves 6 months after thyroidectomy - Dr G Gohrbrandt, Mainz, Germany
Difficulty with swallowing and tightness around the throat are common symptoms after thyroid surgery even when recurrent laryngel nerve function is documented to be normal. Mobility of the larynx was studied in 53 patients after thyroidectomy by laryngeal ultrasound and voice questionnaire. Symptoms were most common in women, and were associated with a significant restriction of laryngeal mobility which gradually recovered in all but one patient by 6 months.
LD COMMENT: most patients note changes in swallowing - this study confirms it almost always recovers by 6-12 months