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It is estimated that one of the potential cause of the increasing prevalence of thyroid cancer (TC) is the easier and widespread access to diagnostic tools. If an individual evaluates the thyroid gland due to a mentioned mechanism without considering TC risk factors or symptoms, we can describe this phenomenon as cancer screening activity (CSA). We 1) estimated what types of TC were diagnosed due to CSA, 2) analyzed what clinicopathological features were characteristic of TCs diagnosed by CSA, 3) determined if these features were characteristic of indolent cases, and finally we 4) assessed whether CSA could have resulted in the increasing incidence of potentially indolent papillary thyroid cancer (PTC). A retrospective review of 4,701 medical records of patients admitted and surgically treated at one surgical center between 2008 and 2017 was performed. Among the enrolled patients, 569 (12.1%) had thyroid malignancy, and 514 (10.9%) were diagnosed with PTC. We divided these patients into two groups: 1) patients in whom TC diagnostics were performed without considering any TC risk factors or symptoms (CSA-yes) and 2) those in whom TC was diagnosed due to TC risk factors or symptoms (CSA-no). We then compared the clinicopathological features of these two groups. The most common type of TC diagnosed in the CSA-group was PTC (p = 0.024). CSA-yes patients showed a significantly lower degree of Tumor-Node-Metastasis (TNM) staging and demonstrated a significantly lower rate of multifocality, but not of bilaterality (p<0.0001 and p = 0.198, respectively). In the CSA-yes group, the number of TC foci was significantly lower than that in the CSA-no group (p<0.0001). All clinicopathological features characteristic of aggressive cases of TC were absent in CSA-yes patients (p<0.0001), while all features observed in CSA-yes patients were characteristic of indolent cases (p<0.0001). The use of CSA results in the diagnosis of indolent cases of PTC and may be one of the potential causes of overdiagnosis and overtreatment of this malignancy.

In the last 25 years, there have been significant advances in the diagnosis and treatment of thyroid disorders. The aim of this study was to analyze 25 years of experience in thyroid surgery in high volume endocrine center in terms of demographic changes, indications for surgical treatment, the type of thyroid surgery and complications. Clinical material (3748 patients) from the years 1996–2020 was analyzed by compering two Periods: I (1996–2003) vs. II (2011–2015/2018–2020). The percentage of patients operated on for thyroid cancer increased ( p  < 0.00001) and the extent of thyroid surgery changing from partial to total excision was statistically significant ( p  < 0.00001). The increase in the extent of thyroidectomy did not affect the overall recurrent laryngeal nerve palsy ( p  = 0.1785), but resulted in an increase of postoperative clinical hypoparathyroidism ( p  < 0.00001). The introduction of new technologies, such as intraoperative nerve monitoring of the recurrent laryngeal nerves had a significant impact on the changes in thyroid surgery over 25 years.

Background Papillary thyroid cancer (PTC) is unique among cancers in that patient age is a consideration in staging. One of the most important modifications in the 8th Edition of the American Joint Committee on Cancer (AJCC) classification is to increase the age cut off for risk stratification in PTC from 45 to 55 years. However, whether this cut off is useful in clinical practice remains controversial. In the present study, we assessed how well this new age threshold stratifies patients with aggressive PTC. Methods We retrospectively analyzed the clinicopathological features and overall survival rate of patients with PTC admitted to and surgically treated at a single surgical center. The study protocol was divided into two series. In each series all patients ( n  = 523) were divided in 2 groups according to age cut off. In the first series (cut off 45) patients < 45 ( n  = 193) vs. ≥45 ( n  = 330) were compared, and in the second series (cut off 55) patients < 55 ( n  = 306) vs. ≥55 ( n  = 217) were compared. Results The rate of the prevalence of locally advanced disease (pT3 and pT4) was significantly higher in the patients above 55 years old than in those below 55 years old ( p  = 0.013). No significant differences were found for this parameter in series with cut off point 45 years old. A significantly higher risk of locally advanced disease T3 + T4 (OR = 4.87) and presence of LNM (N1) (OR = 3.78) was observed in ≥45 years old group ( p  = 0.021 and p  < 0.0001, respectively). More expressive results were found for the patients ≥55 years old group, where the risk of locally advanced disease (T3 + T4) was higher (OR = 5.21) and LNM presence was OR = 4.76 ( p  < 0.001 and p  < 0.0001, respectively). None of the patients below 55 years old showed distant metastasis, but 19 patients above 55 years old showed M1 (p < 0.0001). In older patients group (≥55 years old) we observed deaths related thyroid cancer in 11 individuals. Conclusions The age cut off of 55 years old for risk stratification proposed by the 8th Edition of AJCC effectively stratifies PTC patients with a poor prognosis, indicating it is likely to be useful in clinical practice.

Currently, less aggressive treatment or even active surveillance of papillary thyroid microcarcinoma (PTMC) is widely accepted and recommended as a therapeutic management option. However, there are some concerns about these approaches. We investigated whether there are any demographic, clinical and ultrasound characteristics of PTMC patients that are easy to obtain and clinically available before surgery to help clinicians make proper therapeutic decisions. We performed a retrospective chart review of 5,021 patients with thyroid tumors surgically treated in one center in 2008-2018. Finally, 182 (3.62%) PTMC patients were selected (158 (86.8%) females and 24 (13.2%) males, mean age 48.8±15.4 years). We analyzed the disease-free survival (DFS) time of the PTMC patients according to demographic and histopathological parameters. Univariate and multivariate logistic regression analyses were used to assess the relationships of demographic, clinical and ultrasound characteristics with aggressive histopathological features. Age ≥55 years, hypoechogenicity, microcalcifications, irregular tumor shape, smooth margins and high vascularity significantly increased the risk for minimal extrathyroidal extension (minETE), lymph node metastasis (LNM), and capsular and vascular invasion (p<0.0001). Multivariate logistic regression analysis demonstrated a statistically significant risk of LNM (OR = 5.98, 95% CI: 2.32-15.38, p = 0.0002) and trends toward significantly higher rates of minETE and capsular and vascular invasion (OR = 2.24, 95% CI: 0.97-5.19, p = 0.056) in patients ≥55 years than in their younger counterparts. The DFS time was significantly shorter in patients ≥55 years (p = 0.015), patients with minETE and capsular and vascular invasion (p = 0.001 for all), patients with tumor size >5 mm (p = 0.021), and patients with LNM (p = 0.002). The absence of microcalcifications, irregular tumor shape, blunt margins, hypoechogenicity and high vascularity in PTMC patients below 55 years and with tumor diameters below 5 mm may allow clinicians to select individuals with a low risk of local recurrence so that they can receive less aggressive management.

Thyroid surgery rates have tripled over the past three decades, making it one of the most frequently performed procedures within general surgery. Thyroid surgery is associated with the possibility of serious postoperative complications which have a significant impact on the patient’s quality of life. Recurrent laryngeal nerve (RLN) palsy and external branch of the superior laryngeal nerve (EBSLN) palsy are, next to hypoparathyroidism and postoperative bleeding, some of the most common complications. The introduction of neuromonitoring into thyroid surgery, which enabled both the confirmation of anatomical integrity and the assessment of laryngeal nerve function, was a milestone that began a new era in thyroid surgery. The International Neural Monitoring Study Group has produced a standardization of the technique of RLN and EBSLN monitoring during thyroid and parathyroid surgery, which in turn increased the prevalence of neural monitoring during thyroidectomy. The current status of IONM and the benefits of its use have been presented in this publication.

Background: Suspicious ultrasound patterns are essential for the accurate preoperative assessment of thyroid cancer (TC). The number of tumor foci may serve as an additional parameter, particularly when considered in association with ultrasound patterns and the reoperation rate. Methods: We conducted a retrospective analysis of 665 well-differentiated TC (WDTC) patients treated between 2008 and 2024. The analysis included preoperative data, ultrasound patterns (hypoechogenicity, microcalcifications, high vascularity, and irregular tumor shape or margins), and histopathological findings regarding the number of tumor foci and reoperation rates, additionally stratified by TNM stage and sex. Results: A statistically significant association was observed between the number of tumor foci and the mean number of ultrasound patterns (p < 0.05). The highest mean number of patterns was found with ≥4 foci (SD: 2.50 ± 1.20). However, this relationship was not linear, as in each focus category (1, 2, 3, and ≥4), the greatest number of ultrasound patterns consistently predominated. No significant association was found between a higher number of foci and a complete set of ultrasound patterns (p = 0.273) or the reoperation rate (p = 0.469). Analyses stratified by TNM stage and sex also did not reveal any significant differences (p > 0.05). Conclusions: Although the number of tumor foci demonstrates an association with ultrasound patterns, the lack of a consistent linear correlation and the absence of an impact on reoperation rates suggest that this parameter may provide limited additional clinical value beyond the general concept of multifocality.

Background: Ultrasonography is frequently used preoperatively to assess thyroid nodules. Hypoechogenicity, microcalcifications, high vascularity, or irregular tumor shape suggest malignancy. Methods: This is a retrospective analysis of 724 patients from 2008 to 2024 who underwent surgery for TC. Preoperative data, ultrasonographic findings, and histopathological results were collected. Ultrasonographic features indicative of possible malignancy included hypoechogenicity, microcalcifications, high vascularity, and irregular tumor shape. These were correlated with histopathologically seen extrathyroidal extension, capsular and vascular invasion, and lymph node metastasis. Results: A statistically significant association was seen for each of the evaluated ultrasonographic features (p < 0.05). More advanced TC had a greater number of suspicious ultrasonographic features averaging 3.05 to 3.12. Microcalcifications, high vascularity, and irregular tumor shape showed a strong correlation (r > 0.7) with all histopathological features. Hypoechogenicity had a strong correlation with lymph node metastasis and a moderate correlation (r = 0.5–0.7) with other features. Conclusions: Ultrasonographic features predict the likelihood of histopathological extrathyroidal extension, capsular and vascular invasion, and lymph node metastasis.

Background Papillary thyroid microcarcinoma (PTMC) generally is a cancer with excellent prognosis, but the term “cancer” sounds severe and harsh, which can elicit emotional and physical responses from patients. To eliminate the word “cancer,” the term noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) was introduced. However, not all PTMCs can be classified as NIFTP. Sometimes, very aggressive PTMC cases might be observed. Some authors suggest that one of the risk factors for poor prognosis is lymph node metastasis. The aim of the study was to evaluate some clinicopathological features of PTMC as the risk factors for lymph node metastasis. Material and methods We performed a retrospective chart review and selected 177 patients with PTMC. To analyze the cases with potentially aggressive behavior, we enrolled PTMC patients with lymph node metastases (pN1, central, and/or lateral) and evaluated some of their clinicopathological features. Results The logistic regression analysis results demonstrated significantly higher rates of multifocal or bilateral tumor occurrence in the PTMC patients with pN1 than in the patients with pN0 ( P  < 0.0001 for both). In addition, the occurrence of thyroid tumors with sizes above 0.5 cm was a significant risk factor for lymph node metastasis ( P  < 0.0001). The results of the ROC analyses showed that the presence of multifocal or bilateral tumors and tumor sizes above 0.5 cm were significant predictors of lymph node metastasis ( P  < 0.0001 for all). Conclusions Multifocal and bilateral PTMC tumors with diameters above 0.5 cm should be treated aggressively as “true cancer” and might benefit from lymph node dissection. Unifocal PTMC tumors with diameters equal to or below 0.5 cm may be treated less aggressively.

Introduction: Iatrogenic hypoparathyroidism following thyroidectomy is one of the most common complications significantly reducing patients’ quality of life. Objectives: This study aimed to analyze the risk factors for calcium-phosphate disorders following thyroidectomy. Patients and methods: The study group consisted of 211 patients who underwent thyroidectomy for different conditions in 2018–2020. Demographic, clinical and surgical risk factors were analyzed against hypoparathyroidism and hypocalcemia. Results: Hypoparathyroidism occurred in 15.63% of patients, and hypocalcemia occurred in 45% of those operated on. There was statistical significance between hypoparathyroidism and the extent of thyroid surgery: thyroidectomy vs. lobectomy (p = 0.02, OR = 4.5) and surgeon experience (p = 0.016, OR = 6.9). Low preoperative PTH levels were associated with a higher incidence of hypoparathyroidism (p = 0.055, OR = 0.9). There was a statistically significant correlation between the occurrence of hypocalcemia and preoperative vitamin D deficiency (p = 0.04, OR = 3.5). Low calcium levels before surgery were associated with a higher incidence of hypocalcemia (p = 0.051, OR = 0.5). Meta-analyses of selected risk factors confirmed that the most significant factor in the incidence of hypocalcemia was a decrease in PTH levels (p < 0.001). Conclusions: The extent of thyroid surgery and the experience of the surgeon are the most significant risk factors for hypoparathyroidism. Hypocalcemia is much more common than hypoparathyroidism. Among the risk factors for hypocalcemia, in addition to the decrease in parathormone levels due to iatrogenic parathyroid damage, we should mention vitamin D deficiency in the preoperative period.

Thyroid nodules (TNs) assigned to the Bethesda System categories III and IV include numerous clinical characteristics, which increase or decrease the risk of malignancy. However, there are very few data regarding the influence of TSH non-suppressive thyroid hormone therapy (NSTHT) on the risk of malignancy in patients in the aforementioned categories. We assessed the number of patients with thyroid nodules assigned to categories III and IV who take TSH NSTHT and if thyroid hormone therapy is associated with a rate of malignancy. We retrospectively analyzed the medical records of 4,716 individuals and selected 532 (11.28%) patients with Bethesda System category III and IV thyroid nodules. All participants underwent surgery, and histopathological verification was obtained in all cases. In all, 33.1% of individuals with category III and IV thyroid nodules took TSH NSTHT. In patients with category III nodules, application of NSTHT was associated with a lower rate of thyroid cancer (TC), though this observation was not significant (OR = 0.55, p = 0.381). In patients with category IV nodules, we demonstrated a significantly lower rate of TC when NSTHT was applied (OR = 0.44, p = 0.005). In conclusion, the prevalence of patients with Bethesda System category III and IV thyroid nodules who take NSTHT is high. TSH NSTHT significantly decreases a rate of malignancy in category IV, but not category III patients.