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Publication Open Access Can Active Surveillance be an Alternative to Surgery in Papillary Thyroid Microcarcinoma?: The Current Situation Worldwide(2018) Aygün, Nurcihan; İşgör, Adnan; Uludağ, Mehmet Emin; Sağlık Bilimleri Üniversitesi; Bahçeşehir Üniversitesi; Sağlık Bilimleri ÜniversitesiPapillary thyroid carcinoma is the most common endocrine malignancy. Papillary thyroid microcarcinomas (PTMCs) are tumorswith a size of ≤1 cm. The biological behavior of these tumors differs due to the presence of their aggressive features. The prognosisof PTMCs with high-risk features, such as clinical node metastasis, distant metastasis, and significant extrathyroidal extension tothe tracheal or recurrent laryngeal nerve invasion, is poor, even if a sufficient immediate surgery is performed at diagnosis. However,PTMCs without these aggressive features are low-risk tumors because of their indolent and slow growth behaviors. The increasein thyroid cancer incidence is mostly a result of overdiagnosis of small low-risk PTMCs with indolent clinical course. Despitethe sudden increase in thyroid cancer incidence worldwide, cancer mortality did not increase. Although the traditional treatmentstrategy for PTMC is immediate surgery at diagnosis, because of the rather low disease-specific mortality rate, low recurrence rate,and potential risk for postoperative complications, active surveillance has been proposed recently as an alternative option forPTMCs without invasion, metastasis, or cytological or molecular characteristics. The recent data support that active surveillanceof low-risk PTMC should be the initial treatment modality, because only a small percentage of low-risk PTMCs show signs of progression,and delayed surgery has not caused significant recurrence. However, recent management guidelines are shifting towardmore conservative treatments, such as active surveillance. Although there is an increase in the number of studies related to activesurveillance, prospective studies have been mostly from academic referral centers in Japan. The world still needs class 1 evidenceextended prospective studies originating from different geographic regions. Active surveillance may be a good alternative to immediatesurgery for appropriately selected patients with PTMC.Publication Open Access Endocrine Surgery during the COVID-19 Pandemic: Recommendations from the Turkish Association of Endocrine Surgery(2020) Teksöz, Serkan; Sormaz, İsmail Cem; İçöz, Recep Gökhan; Makay, Özer; Dural, Ahmet Cem; Hacıyanlı, Mehmet; Şahbaz, Nuri Alper; İşcan, Yalın; Soylu, Selen; Aygün, Nurcihan; İşgör, Adnan; Özdemir, Murat; Aydın, Oğuz Uğur ; Tunca, Fatih; Şenyürek, Yasemin; Uludağ, Mehmet Emin; Emre, Ali Uğur; İstanbul Üniversitesi - Cerrahpaşa; İstanbul Üniversitesi; Ege Üniversitesi; Ege Üniversitesi; Sağlık Bilimleri Üniversitesi; İzmir Katip Çelebi Üniversitesi; Sağlık Bilimleri Üniversitesi; İstanbul Üniversitesi; T.C. Sağlık Bakanlığı; Sağlık Bilimleri Üniversitesi; Bahçeşehir Üniversitesi; Ege Üniversitesi; T.C. Sağlık Bakanlığı; İstanbul Üniversitesi; İstanbul Üniversitesi; Sağlık Bilimleri Üniversitesi; T.C. Sağlık BakanlığıThe 2019 novel coronavirus disease (COVID-19) was initially seen in Wuhan, China, in December 2019. World Health Organizationclassified COVID-19 as a pandemic after its rapid spread worldwide in a few months. With the pandemic, all elective surgeries andnon-emergency procedures have been postponed in our country, as in others. Most of the endocrine operations can be postponedfor a certain period. However, it must be kept in mind that these patients also need surgical treatment, and the delay time shouldnot cause a negative effect on the surgical outcome or disease process. It has recently been suggested that elective surgical interventionscan be described as medically necessary, time-sensitive (MeNTS) procedures.Some guidelines have been published on proper and safe surgery for both the healthcare providers and the patients after theimmediate onset of the COVID-19 pandemic. We should know that these guidelines and recommendations are not meant toconstitute a position statement, the standard of care, or evidence-based/best practice. However, these are mostly the opinionsof a selected group of surgeons. Generally, only life-threatening emergency operations should be performed in the stage wherethe epidemic exceeds the capacity of the hospitals (first stage), cancer and transplantation surgery should be initiated when theoutbreak begins to be controlled (second stage), and surgery for elective cases should be performed in a controlled manner withsuppression of the outbreak (third stage).In this rapidly developing pandemic period, the plans and recommendations to be made on this subject are based on expert opinionsby considering factors, such as the course and biology of the disease, rather than being evidence-based. In the recent reportsof many endocrine surgery associations and in various reviews, it has been stated that most of the cases can be postponed to thethird stage of the epidemic.We aimed to evaluate the risk reduction strategies and recommendations that can help plan the surgery, prepare for surgery, protectboth patients and healthcare workers during the operation and care for the patients in the postoperative period in endocrine surgery.Publication Open Access Substernal Goiter: From Definitions to Treatment(2022) Aygün, Nurcihan; Uludağ, Mehmet; İşgör, Adnan; Köstek, Mehmet; Ünlü, Mehmet Taner; Sağlık Bilimleri Üniversitesi; Sağlık Bilimleri Üniversitesi; Bahçeşehir Üniversitesi; Sağlık Bilimleri Üniversitesi; Sağlık Bilimleri ÜniversitesiThe enlargement of multinodular goiter into the mediastinum through the thoracic inlet or ectopic thyroid tissues directly in the \rmediastinum is defined as Substernal Goiter (SG). However, there is no clear consensus in the literature on this definition. There \rare many definitions for SG in the literature. Most definitions are similar or overlapping. Since the thyroid is located in the neck \rabove the thoracic inlet in its normal anatomical position, the simplest clinical definition should be preferred among the definitions regarding its descent below the thoracic inlet and adjacent to the mediastinal organs. In the American Thyroid Association \rguideline, SG is defined as clinical or radiological protrusion of the thyroid gland over the sternal notch or clavicle in a patient with \ra slightly extended neck in the supine position. SGs can be classified as primary or secondary according to their origins. In addition, there are combined SGs resulting from the enlargement of the primary SG, which is the growth of the cervical thyroid gland \rtoward the mediastinum, and the secondary SG, which is defined as an ectopic mediastinal mass, together. We find it appropriate \rto define such SGs as mixed SGs. In this disease, which has the same etiology and etiopathogenesis as cervical goiter, the descent \rof the thyroid gland into the mediastinum due to some anatomical factors explains the physiopathology. Compression symptoms \rof mediastinal major vascular structures, trachea, and esophagus cause the symptoms and findings of SGs due to its localization. \rIn addition, the relationship of SGs with possible malignancy risk and hyperthyroidism affecting the indications and methods of \rtreatment has been discussed for a long time. In this study, we aimed to evaluate the definitions, classification, physiopathology, \rlaboratory and imaging methods used for diagnosis, the relationship of SG with hyperthyroidism and malignancy, and briefly the \rtreatment methods, according to the current studies from literature.