bluuebunny/crossref_metadata_2025_split huggingface dataset:
Management of iatrogenic parathyroid failure: beyond current BAETS guideline
Authors: Biswas Debabrata , Hardy Alistair , Shenoy Ashwini 
Published: March 2022

Abstract

Introduction
Hypocalcaemia is the most common post-operative complication of total thyroidectomy, in 23.5% of cases. The management of acute hypocalcaemia is well described, however there remains a lack of evidence for longer term management of these patients with ongoing parathyroid failure. We show how this could be predicted, prevented, and appropriately managed.

Method
We performed a systematic review of the literature regarding hypocalcaemia and parathyroid failure following total thyroidectomy.

Results
Risk factors for the development of hypocalcaemia include: female gender; lower age; Graves’ disease; level VI neck dissection; and poor surgical technique. Biochemical markers predict ongoing hypocalcaemia: calcium &lt; 1.88mmol/L 24 hours after surgery is a significant risk; PTH ≥ 1.6pmol/L is a low risk. Combining calcium levels and PTH at 4 hours post-operatively helps significantly improve the predictive values and patients can be started on treatment as required. Day 5 post-operative repeat PTH and calcium monitors the need for medication. A key moment is 1 month following surgery, when two thirds of hypocalcaemic patients have recovered. Repeated blood tests at this point can help stopping or decreasing medical therapy.

Conclusions
This research work yields a structured approach to deal with persistent hypocalcaemia into four different categories. It may help discharging patients early from hospital after thyroidectomy and also may avoid long-term supplementation. Supplements can be stopped after one month with repeat calcium and parathyroid checks to recognise those who may require long-term treatment. Close communication between surgeons, endocrinologists, and patients is key.
Levothyroxine dosing post total thyroidectomy – the ideal equation?
Authors: Oh Soo , Rathod Sneha , Ross Elizabeth 
Published: March 2022

Abstract

Aims
Levothyroxine (LT4) therapy is necessary post total thyroidectomy to suppress TSH for differentiated thyroid cancer (DTC) and euthyroidism for benign thyroid disorders. We aim to evaluate the accuracy of empirical LT4 regimens alongside existing formulas in literature and identify predictive variables for LT4 dosage.

Methods
Retrospective study between January 2018 to February 2021 for all total thyroidectomies at UHNM. Total 50 cases identified from central database for each group (DTC vs benign). Data collected and analysed including patient demographics, diagnosis, LT4 regimens and thyroid function.

Results
Most patients were started empirically on 125mcg/day LT4 (92% vs 90%, DTC vs benign). This led to 78% of DTC group and 82% of benign group being within 25mcg of the final LT4 regimen. For DTC thyroidectomies, comparing 125mcg/day versus recommended 2mcg/kg had an average error of -9.1% versus +26.1%. Correlation between Body Mass Index (BMI), Lean Body Mass (LBM) or Body Surface Area (BSA) to final LT4 was weak to moderate (r=0.4 p=0.002, r=0.6 p=&lt;0.001, r=0.6 p=&lt;0.001).
For benign thyroidectomies, comparing 125mcg/day to BNF dose 1.6mcg/kg and formulas in literature resulted in average error ranging between -1.9% to +27.1%. The best average error was +0.2% using the formula 1.5mcg/kg by Jin et al. No correlation was found between BMI, LBM or BSA with final LT4 regimens (r=0.1 p=0.443, r=0.2 p=0.216, r=0.2 p=0.211).

Conclusion
In our subset, empirical dosing at 125mcg gives reasonable estimate of final LT4 dose. BMI, LBM or BSA alone was not a consistent predictor for final LT4 dose. Further validation of predictive formulas is needed.
Safety of Daycase Thyroid and Parathyroid Surgery with Developments in Education and Training in addition to Patient Information Leaflets.
Authors: Wilson Denise , Raistrick Maria , Houghton Neil , Tomlinson Mark , Walls Gerard 
Published: March 2022

Abstract

Introduction
BAETS recently reviewed daycase thyroid surgery in the UK through a debate and webinar; and changed the society's position statement in support of daycase thyroid procedures. Post-thyroidectomy haemorrhage remains a concern. This Endocrine Surgical Unit published data (2015 & 2017) regarding our daycase thyroid/parathyroid surgery since 2005. The practice has developed in numbers, patient information given and safety protocols.

Method
We reviewed our outcomes from the last 4 years and developed a Patient Information Leaflet that reflects the new BAETS position, outlining what to expect from surgery, what to look out for in the post-operative period, and what action to take should complications arise. This is used in conjunction with our stringent protocol for daycase thyroid/parathyroid surgery (exclusion criteria include: children; bilateral/redo surgery; sternotomy; ASA 3&4; living alone; &gt;45 minutes from hospital).

Results
Review of cases performed between June 2017 and May 2021 confirmed 25.2% (81/322) of procedures were daycase and without complication (28 (all lobectomies)/160 thyroid and 53/162 parathyroid procedures, respectively). Protocol improvements include an ‘emergency pack’ of wound-opening equipment staying with the patient throughout their stay; training for Ward and Emergency Department staff in opening neck incisions for postoperative haemorrhage (SCOOP video, posters displayed in ward areas and within the emergency pack, provision of instruments within the Emergency Department).

Conclusion
Outcomes demonstrate safety of daycase thyroid and parathyroid surgery in a UK hospital within our protocol. Refinements to our protocol, staff education, instrument availability and patient information leaflets aim to ameliorate concerns about daycase thyroid/parathyroid surgery for patients and staff.
An audit of MEN-1 screening in a large tertiary endocrine surgery centre – A single centre experience
Authors: Jaafar Mustafa , Anneback Matilda , Di Marco Aimee , Palazzo Fausto , Tolley Neil 
Published: March 2022

Abstract

Introduction
Multiple endocrine neoplasia (MEN-1) usually presents following a diagnosis of primary hyperparathyroidism (PHPT). U.K. practice guidelines advise screening patients less than age 30 to identify MEN-1 mutations. It is our departmental policy to screen all patients under the age of 40.

Methods
A retrospective review of all patients having parathyroidectomy under the age of 40. A review of their mutational analysis and yield were the audit parameters.

Results
The records of 53 patients (17 F, 36 M) were available for audit (incomplete records were excluded); 45 patients had MEN-1 mutational analysis. 8 patients were not screened and 31% (14/45) were positive for MEN-1 mutations, 1 patient was positive for CDC73.

Conclusion
An 85% rate of compliance with the departmental screening protocol was found. This compares with a 25% yield in Uppsala and 11% in Utrecht.
Attitudes of general surgical trainees towards endocrine surgery
Authors: Vance-Daniel Joseph , Jamal Karim 
Published: March 2022

Abstract

Introduction
Endocrine surgery is currently recognised by all surgical colleges in the UK as a subspecialty within general surgery. However, subjectively there appear to be very few trainees with an interest in pursuing a career in endocrine surgery. This study aims to assess the attitudes of trainees towards the subspecialty, as well as identifying possible barriers.

Methods
An online questionnaire was designed and sent to surgical trainees working in different hospitals throughout the London, to be completed anonymously.

Results
31 trainees responded - 30 who were currently in training, and 1 post CCT.
Only 1 (3.2%) wanted to pursue a career in endocrine surgery with 67.7% stating that they had not considered a career in endocrine surgery. 38.7% had no experience working in endocrine surgery. The most common deterrents to pursuing a career in endocrine surgery were:

Conclusion
Low numbers of trainees have considered or are pursuing a career in endocrine surgery. Lack of exposure, a shortfall within the curriculum and other perceived barriers play the largest role in deterring trainees. These factors could be resolved through increasing exposure and education, as well as focusing on the factors which trainees find most appealing.
Can we justify using Parathyroid Ultrasound Scan as a sole preoperative localisation study for patients undergoing surgery for Primary Hyperparathyroidism?
Authors: Acharya Ravi , Kopczynska Maja , Ghattamaneni Sunethra , Doran Helen 
Published: March 2022

Abstract

Introduction
Currently we offer unilateral neck exploration parathyroidectomy (UNE-PTX) only to patients with concordant ultrasound (USS) and nuclear medicine (NM) scans.

Objective
To compare potential cure rate from UNE-PTX to any patient with a single gland identified on USS with the current practice of dual concordant scans.

Methods
Case ascertainment; patients undergoing successful parathyroidectomy 2008 to 2018 by a single surgeon. Electronic patient records reviewed for imaging, operative records and pathology.

Results
331 patients underwent surgery, 325 (98.2%) were cured. 288 (88.6%) had a single adenoma (PA), 37 (11.4%) had multi-gland disease (MGD)
All patient had either USS or NM. 320 underwent US & 315 NM scans. 309 patients had dual imaging.
Sensitivity and specificity respectively were 72.3% & 60.5% for US and 65.8% & 62.2% for NM scans.
USS accuracy was not influenced by the radiologist having prior access to NM report (kappa 0.4 vs 0.44).
Concordant imaging; 141 patients. Of these 135 had a confirmed PA. 127 underwent UNE-PTX, 14 required bilateral neck exploration (BNE).
US localised single gland; 217 patients. Of these 51(20.6%) had no uptake on NM scans.
Based on US localisation alone if all 217 were offered UNE-PTX, 205/217 (94.5%) of patients with adenoma would be cured; 12 /217 (4.5%) with MGD recognisable at operation would have to be converted to BNE.

Conclusion
In our patients with a single adenoma using USS alone would have avoided 20.6% unnecessary BNE This has financial benefits to the health service as it avoids another investigation and hospital visit.
Malignancy rates and initial management of Thy3 thyroid nodules in a district general hospital: The ‘Reading’ experience
Authors: Maweni Robert , Nair Dilip , Kandiah Shivanthi , Rourke Thomas , Corbridge Rogan , Nagala Sidhartha 
Published: March 2022

Abstract

Introduction
Ultrasound-guided fine-needle aspiration cytology is the gold standard for investigating thyroid nodules. Stratifying the Thy3 thyroid nodule risk of malignancy is essential for clinical decision-making. According to the Royal College of Pathologists Guidance (2016), the rate of malignancy for Thy3a is 5–15% and for Thy3f 15–30%. Our aim was to investigate the malignancy rate and the initial management of Thy3 nodules in our institution.

Methods
A retrospective review was undertaken of 115 patients with Thy3 cytology results from thyroid fine-needle aspirations performed between January 2015 and June 2020 at a single centre. A total of 90 out of 115 patients underwent surgery.

Results
Of the 90 patients, we had a 40% malignant rate (36/90). Specifically, 14 of 34 (41.1%) Thy3a and 22 of 56 (39.2%) Thy3f nodules were malignant. Of the malignant lesions, 52.7% (19/36) were follicular thyroid carcinoma. 58.8% (10/17) of male patients and 35.6% (26/73) of female patients had a malignant histology. Eighteen patients eventually needed a completion thyroidectomy.

Conclusion
Compared with national data, we showed a higher risk of malignancy in Thy3 nodules in our centre. Our study should encourage other centres to audit their own data. We propose setting up a national Thy3 registry as a basis to promote research in improving preoperative diagnosis of indeterminate thyroid nodules.
Clinical Efficacy And Cure Rate Of Fixed Dose Radioactive Iodine For The Treatment Of Hyperthyroidism: A Single Centre Study
Authors: Maweni Robert , Nair Dilip , Constatinou Christoforos , Kandiah Shivanti , Aung Theingi , Nagala Sidhartha 
Published: March 2022

Abstract

Introduction
Iodine-131 is an effective treatment for thyrotoxicosis. In 2019, the National Institute for Clinical Excellence (NICE) guidelines suggested offering radioactive iodine as first-line definitive treatment for adults with Graves’ disease, toxic nodular and multinodular goitre unless it is unsuitable or anti-thyroid drugs are likely to achieve remission. The aim of this study was to evaluate the clinical outcome one year after using fixed dose Iodine-131 for hyperthyroidism and to identify any associated factors.

Methods
Electronic patient records were studied retrospectively for all patients who were treated with radioiodine therapy for hyperthyroidism between July 2017 and March 2020 at a district general hospital in the UK. Response to radioiodine therapy was assessed at 6 and 12 months by a dedicated thyroid nurse-led virtual follow-up.

Results
We identified 67 patients with a mean age of 55.9 years (range 18–84); 48 (72%) females, 19 (28%) males. Of these, 57 (85%) patients were cured at 12 months (93.7% in non-Graves’, 82.3% in Graves’ group). Gender, diagnosis, and pre-treatment disease interval were not significantly associated with treatment success. Non-Graves’ patients had a significantly shorter time to discharge than Graves’ patients receiving Iodine-131 (8 vs 10.3 months, p=0.0174).

Conclusions
The results of the present study demonstrate that a single fixed dose of Iodine-131 therapy is highly effective and comparable to outcomes from calculated dose therapy in literature. We propose the routine use of scoring system to calculate risk of relapse for all newly diagnosed hyperthyroid patients to tailor treatment modality.
New, simple, fast, whole blood Intraoperative PTH assay – Laboratory and Clinical validation
Authors: Kurzawinski Tom , Soromani Christina , Aziz Tarek Abdel , Lam Francis , Garcia Virginia Rozalen , Matias Michele , Morley sujiwa , Barth Julian 
Published: March 2022

Abstract

Introduction
IOPTH monitoring is a reliable method of predicting cure during the surgery for Primary Hyperparathyroidism (PHPT) but current methods are slow and require presence of laboratory staff. NBCL Connect is the first Analyser which can be used by theatre staff and measures whole blood PTH in 5 minutes.

Aim
Laboratory and Clinical validation of new IOPTH assay in patients undergoing surgery for PHPT.

Methods
Intra and inter assay variability using BioRad Liquichek Specialty Immunoassay, internal quality controls and serum and whole blood PTH concentrations in patients cured by parathyroidectomy for PHPT measured on NBCL and “gold standard” Future Diagnostics (FD) and Roche platforms. Pearson coefficient was used for linear correlation between measurements.

Results
Preliminary precision data confirms good analytical performance of NBCL Analyser which is similar to that of FD platform. Further precision, accuracy, linearity and sensitivity studies are ongoing.
Plasma PTH concentration from 4 patients (5 samples each, total 20) measured on NBCL and FD platforms showed good correlation (R 0.90, slope 0.644, IC – 0.68)
Whole blood PTH concentration in 2 patients (5 samples each, total 10) measured on NBCL, FD and Roche platforms showed good correlation. 50% reduction in circulating PTH, main (Miami) criteria confirming biochemical cure, were similar for all 3 platforms

Conclusions
NBCL Connect Analyser assay showed good laboratory and clinical performance able to predict biochemical cure in patients undergoing surgery for PHPT. Our preliminary data suggests that this straightforward to operate and fast system is a promising technology which can be used widely during parathyroid surgery.
Morbidity after thyroid surgery in children: patient perspective
Authors: Patel Neil , Johnson Paul , Mihai Radu 
Published: March 2022

Abstract

Aim
To explore the children’s/parents’ perception of morbidity after thyroid surgery.

Methods
Retrospective analysis of consecutive unselected patients who had undergone a thyroid operation under joint care of Paediatric and Endocrine surgeons. Electronic patients records were used to obtain relevant information and a standardised questionnaire was mailed to all children.

Results
Between Jan2009- Dec2020 62 children age 2–18 (median 15.2) had thyroid lobectomy (n=27) or total thyroidectomy (n=35). In-hospital stay ranged 1–3 days (mode1).
Replies were received from 20 children at a median 37 months (range 5–60 months) after lobectomy (n= 8) or total thyroidectomy (n=12). Subjective voice assessment using a visual analogue scale remained normal in all children. Voice handicap index scores were normal in 13 (65%) children and increased in 7 (35%) to a median of 4 (range 1–10). Voice-related quality of life was excellent in 18 (90%) children and very good in two children. Swallowing was normal in 14 children, moderately affected in four children and severely affected in 2 children. Appearance of the scar assessed using the Manchester score ranged from 5–16, median 9, with only one child with an ideal score of 5. Three children have had or are waiting for scar revision. There was no persistent hypoparathyroidism.

Conclusion
In this cohort of children undergoing thyroid surgery, there were no significant voice changes and swallowing morbidity was infrequent. Concerns related to scar appearance were far more common than in the adult population and this should be highlighted in the consent process.
Quality outcomes comparison of total thyroidectomy between UKRETS and HES databases
Authors: Rajan Sendhil , Aspinall Sebastian , Gray William , Day Jamie , Lansdown Mark , Tolley Neil 
Published: March 2022

Abstract

Aims
Hospital Episodes Statistics for England (HES) and UK Registry of Endocrine and Thyroid Surgery (UKRETS) are the largest databases on thyroidectomy within the UK. A validation of UKRETS data accuracy has never occurred. The purpose of this study was to compare quality outcomes in total thyroidectomy (TT) between the UKRETS and HES datasets.

Methods
A retrospective comparison study between UKRETS and HES for TT from April 2012–March 2018. Vocal cord palsy, hypocalcaemia, mortality & length of stay were the quality outcomes studied.

Results
The HES and UKRETS databases contained 23,025 and 11,242 patients respectively with UKRETS capturing 48.8% of HES data for TT. 18.8%(42/223) of surgeons performed ≥20 procedures/year in 54.3%(6110/11,242) of UKRETS procedures compared to only 9.7%(72/740) of surgeons from HES performing 44.6%(10,279/23,035) of all TTs. Median length of stay was significantly higher within in HES(2 days, IQR 1-3) versus UKRETS(1 day, IQR 1-2). 30.7%(7,071) of HES patients stayed for &gt;2 days compared to 18.7%(1,837) within the UKRETS registry. Both databases reported a mortality of 0.1%. Post-operative hypocalcaemia was reported higher in UKRETS (21.7%) compared to HES (6.8%), p&lt;0.0001. Rates of voice change were significantly higher in UKRETS (9.4%) compared to those in HES (1.3%), p&lt;0.0001.

Conclusions
Surgeons contributing to UKRETS had a higher volume practice and shorter stay than those within HES. UKRETS appears to underreport the number of procedures conducted, with less low volume surgery captured. However, recording of hypocalcaemia and voice changes is mandatory in UKRETS, and HES appear to substantially under-report such complications.
The Rise of Twiplomacy and the Making of Customary International Law on Social Media
Authors: Green James A 
Published: February 2022

Abstract
Social media usage by States has increased exponentially in recent years. This phenomenon, known as “twiplomacy”, has become ubiquitous. Given that almost every State in the world now issues statements via social media, this article examines the potential for Twitter posts to form part of the “raw material” for the formation of customary international law. In other words, it considers whether customary international law can be “made”, or evidence of it identified, on social media. Public statements can, in the right contexts, act as State practice or as evidence of opinio juris, and a Twitter post from a State account ultimately is a public statement like any other. Based on an original scoping study, it is argued that there is evidence of statements being posted on Twitter that, were they issued in a more traditional context, would be seen as having the potential to constitute State practice or evidence of opinio juris. The study also suggests that such examples are not yet common, but it is predicted that they will become so. Therefore, this article goes on to examine a number of possible implications of twiplomacy for the identification of customary international law that must be considered, should social media indeed emerge as a notable breeding ground for new rules of custom. These implications include the blurring between the “personal” and the “official”; the brevity and (lack of) clarity and rigour of tweets; the significant increase in the amount of relevant data but also its comparative “centralisation” (with potentially positive as well as negative consequences); and concerns regarding authenticity. It ultimately is concluded that twiplomacy will not change the requirements for the formation of customary international law, but it is likely to have significant implications for how lawyers and researchers go about the practical process of identifying it.
When Do Established Powers Support Rising Powers’ Multilateral Institutions? The Case of the Asian Development Bank
Authors: Kaya Ayse , Salah Matthew 
Published: February 2022

Abstract
What are the institutional features that incentivize established powers to join rising powers’ new institutions? Going beyond alliance versus rivalry, this paper develops a novel theory in answering this question. We argue that the established power must address two primary design issues: 1. how to navigate the control and burden-sharing trade-off and 2. how to limit the potential diffusion of power by rendering the new institution “complementary” to the existing order. To the extent that these issues are resolved in line with the established power’s (EP’s) preferences, the EP is more likely to join the rising powers’ institutions. We support our theory with an in-depth case analysis of the Japanese-led Asian Development Bank, utilizing primarily archival materials. The relatively under-theorized core question has both historical and contemporary relevance. The paper also advances the history of US multilateral economic policy.