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Article: Current Knowledge on the Use of Neuromonitoring in Thyroid Surgery.

Wojtczak, Beata / Sutkowska-Stępień, Karolina / Głód, Mateusz / Kaliszewski, Krzysztof / Sutkowski, Krzysztof / Barczyński, Marcin

Biomedicines

2024 Volume 12, Issue 3

Abstract: 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 ... ...

Abstract	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.
Language	English
Publishing date	2024-03-18
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2720867-9
ISSN	2227-9059
ISSN	2227-9059
DOI	10.3390/biomedicines12030675
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: The Relationship between the Burden of Acromegaly, Associated Comorbidities, Complications and Disease Status.

Elbaum, Michał / Kałużny, Marcin / Jawiarczyk-Przybyłowska, Aleksandra / Wojtczak, Beata / Zieliński, Grzegorz / Bolanowski, Marek

Journal of clinical medicine

2023 Volume 12, Issue 19

Abstract: Uncontrolled acromegaly causes increased morbidity and mortality. The analysis of acromegaly comorbidities and complications is important when establishing a standard of care for the entire population of acromegaly patients. The aim of this study was to ... ...

Abstract	Uncontrolled acromegaly causes increased morbidity and mortality. The analysis of acromegaly comorbidities and complications is important when establishing a standard of care for the entire population of acromegaly patients. The aim of this study was to determine the frequency of comorbidities and complications of acromegaly and their dependence on the activity of the disease. A retrospective analysis of medical records from 124 patients with acromegaly was carried out, including 39 who were cured, 73 treated with somatostatin analogs and 12 newly diagnosed patients. The incidence of comorbidities and complications was very high, and those most frequently observed were arterial hypertension, multinodular goiter, lipid disorders, hypopituitarism and degenerative changes. At least one complication of acromegaly was observed in 92% of patients undergoing successful neurosurgery and in all pharmacologically treated patients. By contrast, two or more complications were observed in 77% of cured patients and in pharmacologically controlled and uncontrolled patients, 82% and 91%, respectively. Conclusions: Acromegaly is associated with a high prevalence of complications. Active acromegaly is associated with a higher incidence of complications than in treated groups. Untreated patients have more complications than treated patients. Successfully cured patients have significantly fewer complications than pharmacologically controlled patients and patients with active acromegaly.
Language	English
Publishing date	2023-09-30
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2662592-1
ISSN	2077-0383
ISSN	2077-0383
DOI	10.3390/jcm12196309
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Article: Risk Factors for Calcium-Phosphate Disorders after Thyroid Surgery.

Sępek, Monika / Marciniak, Dominik / Głód, Mateusz / Kaliszewski, Krzysztof / Rudnicki, Jerzy / Wojtczak, Beata

Biomedicines

2023 Volume 11, Issue 8

Abstract: 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 ... ...

Abstract	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 ( 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.
Language	English
Publishing date	2023-08-18
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2720867-9
ISSN	2227-9059
ISSN	2227-9059
DOI	10.3390/biomedicines11082299
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Article ; Online: Cancer screening activity results in overdiagnosis and overtreatment of papillary thyroid cancer: A 10-year experience at a single institution.

Kaliszewski, Krzysztof / Diakowska, Dorota / Wojtczak, Beata / Rudnicki, Jerzy

PloS one

2020 Volume 15, Issue 7, Page(s) e0236257

Abstract: Background: 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 ... ...

Abstract	Background: 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). Aim of the study: 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). Materials and methods: 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. Results: 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). Conclusions: 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.
MeSH term(s)	Early Detection of Cancer ; Female ; Humans ; Male ; Medical Overuse ; Middle Aged ; Thyroid Cancer, Papillary/diagnosis ; Thyroid Cancer, Papillary/diagnostic imaging ; Thyroid Cancer, Papillary/pathology ; Thyroid Cancer, Papillary/therapy ; Thyroid Neoplasms/diagnosis ; Thyroid Neoplasms/diagnostic imaging ; Thyroid Neoplasms/pathology ; Thyroid Neoplasms/therapy
Language	English
Publishing date	2020-07-21
Publishing country	United States
Document type	Journal Article
ISSN	1932-6203
ISSN (online)	1932-6203
DOI	10.1371/journal.pone.0236257
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Article ; Online: Thyroid cancer surgery - in what direction are we going? A mini-review.

Kaliszewski, Krzysztof / Wojtczak, Beata / Sutkowski, Krzysztof / Rudnicki, Jerzy

The Journal of international medical research

2020 Volume 48, Issue 4, Page(s) 300060520914803

Abstract: The prevalence of thyroid cancer, especially in women, is increasing dramatically. Therefore, patients often undergo thyroidectomy upon diagnosis. However, the cosmetic outcome after surgery is of particular concern for many patients. Thus, minimally ... ...

Abstract	The prevalence of thyroid cancer, especially in women, is increasing dramatically. Therefore, patients often undergo thyroidectomy upon diagnosis. However, the cosmetic outcome after surgery is of particular concern for many patients. Thus, minimally invasive procedures for treating thyroid disease have been established in recent decades. Total endoscopic and robotic procedures have been slowly and successively introduced while meeting all oncological criteria. Our analysis of the advantages and disadvantages of scarless surgical procedures suggests that the cosmetic aspects of these surgeries will continue to become more important. This review assesses the recent findings regarding the roles of endoscopic and robotic procedures in thyroid cancer surgery.
MeSH term(s)	Clinical Decision-Making ; Combined Modality Therapy/adverse effects ; Combined Modality Therapy/methods ; Disease Management ; Female ; Humans ; Neoplasm Metastasis ; Neoplasm Staging ; Thyroid Neoplasms/diagnosis ; Thyroid Neoplasms/mortality ; Thyroid Neoplasms/surgery ; Thyroidectomy/adverse effects ; Thyroidectomy/methods ; Treatment Outcome
Language	English
Publishing date	2020-04-06
Publishing country	England
Document type	Journal Article ; Meta-Analysis ; Review
ZDB-ID	184023-x
ISSN	1473-2300 ; 0300-0605 ; 0142-2596
ISSN (online)	1473-2300
ISSN	0300-0605 ; 0142-2596
DOI	10.1177/0300060520914803
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Article: The Correlation of Age with Prognosis of Atypia of Undetermined Significance and Follicular Lesion of Undetermined Significance in Thyroid Nodules.

Kaliszewski, Krzysztof / Diakowska, Dorota / Rzeszutko, Marta / Wojtczak, Beata / Rudnicki, Jerzy

Cancer management and research

2021 Volume 13, Page(s) 3101–3111

Abstract: Purpose: Although some prognostic variables and risk factors for thyroid cancer (TC) are age-related, the association between age and the risk of TC in patients with thyroid nodules (TNs) assigned to atypia of undetermined significance (AUS) and ... ...

Abstract	Purpose: Although some prognostic variables and risk factors for thyroid cancer (TC) are age-related, the association between age and the risk of TC in patients with thyroid nodules (TNs) assigned to atypia of undetermined significance (AUS) and follicular lesion of undetermined significance (FLUS) is poorly estimated. The aim of this study was to assess the histopathology of AUS/FLUS and the risk of TC according to the age of the patients at the time of AUS/FLUS diagnosis. Patients and methods: Among 5021 individuals treated for TNs at one institution from 2008 to 2018, 161 (3.2%) patients with 161 TNs assigned to the AUS/FLUS category (1 nodule per patient) were selected and stratified by age at initial diagnosis: <55 years, 55-75 years and >75 years. Logistic regression analysis was used to estimate the association of age with the risk of TC diagnosis. Results: Ninety-one (56.52%) patients <55 years old, 58 (36.02%) patients 55-75 years old, and 12 (7.45%) individuals >75 years old were identified. There were 130 (80.7%) females and 31 (19.3%) males with a mean age of 50.6 ± 16.12 years. Among the evaluated TNs, 142 (88.2%) were ultimately diagnosed as benign, and 19 (11.8%) were diagnosed as malignant. Younger age in patients was significantly related to malignancy outcome (p=0.024 for age <55 years). Patients aged 55-75 years had a significantly lower risk of TC than the other age categories (p=0.040). The risks of high vascularity and fast tumor growth were significantly higher in the youngest category than in the other categories (age <55 years old: p=0.045 and p=0.002, respectively). Conclusion: Although patients with TNs classified as AUS/FLUS by ultrasound-guided fine needle aspiration biopsy (UG-FNAB) are not typically qualified for surgery, it is worth noting that younger patients with an AUS/FLUS diagnosis might be at a higher risk of TC.
Language	English
Publishing date	2021-04-08
Publishing country	New Zealand
Document type	Journal Article
ZDB-ID	2508013-1
ISSN	1179-1322
ISSN	1179-1322
DOI	10.2147/CMAR.S304686
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Article: Analysis of Risk Factors for Phonation Disorders after Thyroid Surgery.

Głód, Mateusz / Marciniak, Dominik / Kaliszewski, Krzysztof / Sutkowski, Krzysztof / Rudnicki, Jerzy / Bolanowski, Marek / Wojtczak, Beata

Biomedicines

2022 Volume 10, Issue 9

Abstract: Phonation disorders after thyroidectomy are among the most common complications and occur as a result of recurrent laryngeal nerve (RLN) injury. The multivariate analysis of risk factors for phonation disorders after thyroidectomy was assessed. A group ... ...

Abstract	Phonation disorders after thyroidectomy are among the most common complications and occur as a result of recurrent laryngeal nerve (RLN) injury. The multivariate analysis of risk factors for phonation disorders after thyroidectomy was assessed. A group of 830 patients with 1500 RLNs at risk of injury during thyroidectomy were analyzed retrospectively. The impact of the method of RLN identification, age, sex, BMI, kind of thyroid surgery, pathology, surgeon's experience and thyroid volume on vocal cord paralysis was analyzed. We found that the retrosternal goiter and the volume above 100 mL were the most important risk factors for both transient and permanent paralysis. Thyroid cancer had a statistically significant impact on the increase in permanent paralysis, while this indication had practically no impact on transient paralysis. Among patients over 65 years with obesity, the probability of transient complications approximately doubled, with no effect on the permanent paralysis. Men were approximately 1.7 times more likely to develop any type of phonation disorder. Secondary operations more than doubled the risk of transient and permanent vocal cord paralysis. Thyroidectomy with only visual RLN identification was associated with a risk of both transient and permanent vocal cord paralysis almost two times higher, compared to neuromonitoring.
Language	English
Publishing date	2022-09-14
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2720867-9
ISSN	2227-9059
ISSN	2227-9059
DOI	10.3390/biomedicines10092280
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Article: Proving the Superiority of Intraoperative Recurrent Laryngeal Nerve Monitoring over Visualization Alone during Thyroidectomy.

Wojtczak, Beata / Marciniak, Dominik / Kaliszewski, Krzysztof / Sutkowski, Krzysztof / Głód, Mateusz / Rudnicki, Jerzy / Bolanowski, Marek / Barczyński, Marcin

Biomedicines

2023 Volume 11, Issue 3

Abstract: Vocal fold paralysis after thyroid surgery is still a dangerous complication that significantly reduces patients' quality of life. Since the intraoperative neuromonitoring (IONM) technique has been introduced and standardized, the most frequently asked ... ...

Abstract	Vocal fold paralysis after thyroid surgery is still a dangerous complication that significantly reduces patients' quality of life. Since the intraoperative neuromonitoring (IONM) technique has been introduced and standardized, the most frequently asked question is whether its use has significantly reduced the rate of RLN injury during thyroid surgery compared to visual identification alone (VA). The aim of this study was to attempt to prove the superiority of IONM over VA of the RLN during thyroid surgery in the prevention of vocal fold paralysis, taking into account risk factors for complications. The medical records of 711 patients (1265 recurrent laryngeal nerves at risk of injury) were analyzed retrospectively: in 257 patients/469 RLNs at risk, thyroid surgery was performed with IONM; in 454 patients/796 RLNs at risk, surgery was performed with VA. The statistical analysis showed that in the group of patients with IONM only one risk factor-the surgeon's experience-proved statistically significant (OR = 3.27;
Language	English
Publishing date	2023-03-13
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2720867-9
ISSN	2227-9059
ISSN	2227-9059
DOI	10.3390/biomedicines11030880
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Article ; Online: The age threshold of the 8th edition AJCC classification is useful for indicating patients with aggressive papillary thyroid cancer in clinical practice.

Kaliszewski, Krzysztof / Diakowska, Dorota / Nowak, Łukasz / Wojtczak, Beata / Rudnicki, Jerzy

BMC cancer

2020 Volume 20, Issue 1, Page(s) 1166

Abstract: 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 ... ...

Abstract	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.
MeSH term(s)	Age Factors ; Female ; Humans ; Male ; Middle Aged ; Periodicals as Topic/classification ; Retrospective Studies ; Thyroid Cancer, Papillary/epidemiology
Language	English
Publishing date	2020-11-30
Publishing country	England
Document type	Journal Article
ISSN	1471-2407
ISSN (online)	1471-2407
DOI	10.1186/s12885-020-07636-0
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Article: Evaluation of selected ultrasound features of thyroid nodules with atypia of undetermined significance/follicular lesion of undetermined significance for the Bethesda reporting system for thyroid cytology.

Kaliszewski, Krzysztof / Diakowska, Dorota / Wojtczak, Beata / Forkasiewicz, Zdzisław

Cancer management and research

2018 Volume 10, Page(s) 2223–2229

Abstract: Background and objective: The risk of malignancy from "atypia of undetermined significance/follicular lesion of undetermined significance" (AUS/FLUS) is estimated to lie between 5% and 15%; however, some authors suggest that the risk of malignancy in ... ...

Abstract	Background and objective: The risk of malignancy from "atypia of undetermined significance/follicular lesion of undetermined significance" (AUS/FLUS) is estimated to lie between 5% and 15%; however, some authors suggest that the risk of malignancy in AUS/FLUS depends upon specific clinical situations. This was a retrospective study which aimed to determine the incidence and risk of thyroid cancer (TC) based upon selected ultrasound features from patients with thyroid nodules (TN) classified as AUS/FLUS. Methods: Univariate and multivariate logistic regression analyses were used to identify significant associations between ultrasound features and the risk of TC. Results: Of 127 patients with TN classified as AUS/FLUS who underwent thyroidectomy, 114 (89.8%) had benign disease while 13 (10.2%) had TC. Univariate analysis identified several significant predictors for TC (all Conclusion: Microcalcifications and fast growth of the TN could therefore be used as predictive factors for the development of TC in patients with AUS/FLUS.
Language	English
Publishing date	2018-07-23
Publishing country	New Zealand
Document type	Journal Article
ZDB-ID	2508013-1
ISSN	1179-1322
ISSN	1179-1322
DOI	10.2147/CMAR.S168409
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