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    An Evaluation of the Factors Affecting Failure of the Procedure in reoperated Thyroidectomies: A Retrospective Analysis
    (Sage Publications Inc, 2022) Comcali, Bulent; Ozdemir, Buket A.; Atas, Hakan; Ozdemir, Egemen; Tikici, Deniz; Saylam, Baris
    Background The aim of this study was to determine the factors affecting procedure failure in revision thyroidectomy surgery. Methods A total of 148 patients applied with revision surgery were separated into 2 groups according to the surgical success status. Comparisons were made of the 2 groups of patients where residual tissue was totally excised (Group 1, n:132) and patients where residual tissue could not be completely excised (Group 2, n:16). The patients were examined in respect of factors affecting the success of the procedure. Results The patients comprised 133 (89.9%) females and 15 (10.1%) males with a mean age of 49.68 +/- 12.02 years. Surgical failure was observed in 7 patients as the lesion could not be determined despite the use of intraoperative USG, and in 9 patients because of weak signal or signal loss. The determination of residual tissue <= 25mm on preoperative USG examination was seen to have a significant negative effect on surgical success (r=-0.329, p0.001). The patient having undergone >= 3 previous operations was determined to have a negative effect on surgical success (r=-0.229, p=0.005), and nerve damage on the opposite side to the lesion in a previous surgical procedure was determined to be the most important factor with a negative effect on surgical success (r=-0.571, p<0.001). In multinomial logistic regression analysis of the factors affecting success, the preoperative presence of nerve damage in the contralateral lobe to the lesion (OR: 33.11, 95% CI: 4.22-192.28, p<0.001) and lesion size <= 25 mm (OR: 10.10, 95% CI: 3.54-75.01, p=0.001) were determined to contribute significantly to surgical failure. Conclusion The results of this study clearly showed that as residual tissue size <= 25mm and contralateral nerve damage in the preoperative ultrasonographic evaluation are associated with surgical failure, alternative treatment methods such as radioactive iodine ablation may be preferred in these patients.
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    How should normocalcemic primary hyperparathyroidism be managed? Comparison with classical hypercalcemic form
    (2021) Comcali, Bulent; Atas, Hakan; Altun Ozdemir, Buket
    Aim: Normocalcemic primary hyperparathyroidism (N-PHPT) is a different variant of primary hyperparathyroidism characterized by normal serum calcium (Ca) concentrations and elevated parathormone (PTH) levels in the absence of secondary causes of hyperparathyroidism. However, the clinical course and therapeutic approaches of this entity have been not fully demonstrated. We aimed to determine the clinicopathological characteristics and surgical outcomes of patients with N-PHPT, comparing with patients who had hypercalcemic PHPT (H-PHPT). Materials and Methods: A total of 185 patients who underwent parathyroidectomy for PHPT were included in the study. The patients were classified as N-PHPT and H-PHPT. The two groups were then compared between each other in terms of all demographic, clinical, and surgical features. Results: One hundred and fifty-one (81.6%) patients had a diagnosis of H-PHPT while 34 (18.4%) patients were normocalcemic. Both groups were similar in age, preoperative vitamin D level, preoperative PTH level, and type of surgery (p > 0.05). Preoperative Ca level was significantly different between the groups (p < 0.01). Prevalence of urolithiasis and decreased bone density was similar between the groups (p > 0.05). Conclusion: N-PHPT patients had similar demographic and clinical features in comparison to those with H-PHPT, indicating that the surgical decision in patients with N-PHPT should be similar with H-PHPT cases.