Araştırma Çıktıları | WoS | Scopus | TR-Dizin | PubMed
Permanent URI for this communityhttps://hdl.handle.net/20.500.14719/1741
Browse
7 results
Search Results
Publication Open Access Effects of Central Neck Dissection on Complications in Differentiated Thyroid Cancer(2021) Aygün, Nurcihan; Uludağ, Mehmet; İşgör, Adnan; Gül Demircioğlu, Zeynep; Ünlü, Mehmet Taner; Sağlık Bilimleri Üniversitesi; Sağlık Bilimleri Üniversitesi; Bahçeşehir Üniversitesi; T.C. Sağlık Bakanlığı; T.C. Sağlık BakanlığıObjective: It is still controversial whether performing central neck dissection (CND) in addition to total thyroidectomy (TT) increases the risk of complications. In the present study, we aimed to evaluate the effect of CND on the development of complications in differentiated thyroid cancer (DTC) compared to TT. Material and Methods: The data of 186 patients (136 females and 50 males) with a mean age of 48.73±14.78 (range, 17–82) whom were operated for DTC were evaluated retrospectively. The patients were divided into two groups, TT (Group 1) and CND±TT/ Completion thyroidectomy±lateral neck dissection (Group 2). Results: There were 117 (91 F, 26 M) patients in Group 1 and 69 (45 F, 24 M) patients in Group 2. Parathyroid auto transplantation (PA) was significantly higher in Group 2 compared to Group 1 (42% vs. 6%) (p=0.000). Total (58% vs. 21.4%, respectively, p=0.000) and transient hypoparathyroidism (52.2% vs. 20.5%, respectively, p=0.000) were significantly higher in Group 2 than in Group 1, but permanent hypoparathyroidism rates were statistically not significant (5.8% vs. 0.9%, respectively, p=0.064). In the multinomial logistic regression analysis, CND alone was determined as an independent risk factor for increased both total and transient hypoparathyroidism. The relative risk (RR) of CND for total hypoparathyroidism was 5.2 times increased (odds ratio [OR]: 0.192) (p=0.007), while the RR for transient hypoparathyroidism was 3.5 times increased (OR: 0.285) (p=0.036). According to the number of nerves at risk, CND was performed in 119 neck side and only thyroidectomy was performed in 253 neck side. Total vocal cord paralysis (VCP) rate (9 [7.6%] vs. 6 [2.4%], respectively) (p=0.017) and transient VCP rate (7 [6%] vs. 4 [1.6%], respectively) (p=0.021) in patients who underwent CND were significantly higher compared to those who underwent only thyroidectomy. In multinomial logistic regression analysis performing only CND was an independent risk factor for total VCP, and increased the total VCP RR approximately 5.34 times (OR:0.184, p=0.007). Conclusion: Although CND can be applied without increasing the rates of permanent hypoparathyroidism and VCP compared to TT, it increases the risk of total and transient hypoparathyroidism, total, and transient VCP. Patients undergoing CND should be followed carefully in terms of transient hypoparathyroidism.Publication Open Access Parathyroidectomy Results in Primary Hyperparathyroidism:Analysis of the Results From a Single Center(2021) Yetkin, Gürkan; Aygün, Nurcihan; Uludağ, Mehmet; İşgör, Adnan; Akgün, İsmail Ethem; Ünlü, Mehmet Taner; Erol, Rümeysa Selvinaz; Sağlık Bilimleri Üniversitesi; Sağlık Bilimleri Üniversitesi; Sağlık Bilimleri Üniversitesi; Bahçeşehir Üniversitesi; Sağlık Bilimleri Üniversitesi; T.C. Sağlık Bakanlığı; Sağlık Bilimleri ÜniversitesiObjectives: The curative treatment of primary hyperparathyroidism (PHPT) is surgery. Persistent and recurrent disease may de velop after surgical treatment. In this study, we aimed to evaluate the surgical cure rate in patients who underwent surgery forPHPT in our clinic. Methods: The data of patients who underwent parathyroidectomy for PHPT by two experienced surgeons between 2000 and2015 in our clinic were retrospectively evaluated. Patients who were followed for at least 6 months after their first parathyroidec tomy were included in the study. Surgical cure and persistent and recurrent disease rates were evaluated in patients. Results: During this period, 368 interventions were performed in 357 patients (293 F and 64 M) who were operated for PHPT inour clinic, with a mean age of 54.9±13.1 years. In the first surgery, 116 patients (32.5%) had bilateral neck exploration, 251 patients(67.5%) had unilateral neck exploration (UNE) or focused parathyroid surgery (FPS). In the first operation, 343 patients (96.1%) hadcure, 14 patients (13 F and 1 M) remained persistent. Secondary surgical intervention was performed in 11 patients. UNE or FPS wasperformed to 10 patients (90.9%), partial sternotomy was performed to one patient. Ten of the patients had cure. Three of these pa tients had a solitary parathyroid adenoma that was not removed in the first surgery, and seven patients had a second adenoma. Fourpatients remained persistent (1.1%). Recurrent disease developed in four patients during follow-up (1.1%). Total cure rate was 97.8%. Conclusion: The only definitive treatment for PHPT is surgery. High surgical cure can be achieved by pre-operative evaluationand appropriate surgical planning. However, persistent PHPT may develop, especially due to double adenoma or ectopic location.Patients with persistent PHPT can be evaluated with repeat imaging methods and with appropriate surgical planning, a high curerate can be obtained in secondary surgery, which can increase the total surgical cure rate. Recurrence rate is rare.Publication Open Access Surgical Treatment of Substernal Goiter Part 1: Surgical Indications, Pre-Operative, and Peroperative Preparation(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 ÜniversitesiSurgery is one of the most appropriate treatment options for many patients with substernal goiter (SG). However, SG surgery has some technical difficulties and a higher risk of complications compared to normal cervical thyroid surgery. Due to these technical difficulties and complication risks, which we also mentioned in our study, SG surgery should be performed by experienced and high-volume endocrine surgeons in centers with a large team and technical equipment. Pre-operative clinical and radiological evaluation and definitions in SG were evaluated in detail in our previous study. Detailed pre-operative evaluation, pre-operative risk assessment, surgical anatomy, anesthesia, appropriate surgical planning and estimation of surgical width are extremely impor tant in SG surgery, where surgical technical difficulties and increased complication risks compared to cervical thyroid surgery come to the fore. In this study, we aimed to evaluate these preoperative and peroperative preparations in detail.Publication Open Access Non-Toxic Multinodular Goiter: From Etiopathogenesis to\rTreatment(2022) Ünlü, Mehmet Taner; Aygün, Nurcihan; Uludağ, Mehmet; Köstek, Mehmet; İşgör, Adnan; Sağlık Bilimleri Üniversitesi; Sağlık Bilimleri Üniversitesi; Sağlık Bilimleri Üniversitesi; Sağlık Bilimleri Üniversitesi; Bahçeşehir ÜniversitesiGoiter term is generally used for defining the enlargement of thyroid gland. Thyroid nodules are very common and some of these\rnodules may harbor malignancy. Multinodular goiter (MNG) disease without thyroid dysfunction is defined as non-toxic MNG.\rThere are many factors in etiology for development of MNG. They can be classified as iodine dependent and non-iodine dependent\rfactors basically. Beyond this basic classification, the effect of many environmental and acquired factors is also effective on the\rdevelopment of goiter.\rMany methods have described for diagnosis and treatment for non-toxic MNG. Biochemical tests, imagining methods, invasive and\rnon-invasive methods have been used for diagnosis for many years. Each method has advantages and disadvantages, separately.\rAlthough the best method for diagnosis is still debatable, distinguishing malignant nodules from benign nodules is the first and\rmost important step for MNG.\rBiochemical tests such as serum thyroid stimulating hormone (TSH) measurement, thyroid hormone measurement, and thyroid\rultrasonography are used for diagnosis of MNG, traditionally. Nowadays, there are some new techniques were developed like\rultrasound-elastography. Furthermore, thyroid scintigraphy may be used if there is abnormal TSH measurement. Fine-needle as-\rpiration biopsy and some cross-sectional imaging methods (computed tomography, magnetic resonance imaging, and positron\remission tomography) could be used, too.\rAfter a certain diagnosis is made, treatment options should be evaluated. Many treatment methods have been used for goiter\rfrom ancient times upon today. From non-invasive methods such as medical follow-up to invasive methods such as lobectomy\ror thyroidectomy are options for treatment. Patients with compression symptoms due to an enlarged thyroid gland are usually\rcandidates for surgery. In this study, it is aimed to determine the most appropriate treatment for the patient by discussing the\radvantages and disadvantages of all these methods.\rThe present review discusses definition of goiter term, etiology, epidemiology, pathogenesis, diagnostic methods, and treatment\rmethods for nontoxic MNG.\rPublication Open Access Influence of Recurrent Laryngeal Nerve Variations \ron Vocal Cord Paralysis(2022) Aygün, Nurcihan; Uludağ, Mehmet; İşgör, Adnan; Demircioğlu, Mahmut Kaan; Demircioğlu, Zeynep Gül; Akgün, İsmail Ethem; Ünlü, Mehmet Taner; Sağlık Bilimleri Üniversitesi; Sağlık Bilimleri Üniversitesi; Bahçeşehir Üniversitesi; T.C. Sağlık Bakanlığı; T.C. Sağlık Bakanlığı; Sağlık Bilimleri Üniversitesi; T.C. Sağlık BakanlığıObjective: Vocal cord paralysis (VCP) due to recurrent laryngeal nerve (RLN) injury is a significant potential complication of \rthyroid and parathyroid surgery. The aim of this study was to investigate the influence on VCP of the anatomical relationship \rof the RLN to the inferior thyroid artery (ITA) and extralaryngeal branching of the RLN.\rMaterials and Methods: The data of 123 patients (95 female, 28 male, mean age: 46+13.6 years), a total of 204 neck \rsides, who underwent a thyroidectomy and/or a parathyroidectomy performed with intraoperative nerve monitoring between March and December 2015 were evaluated retrospectively. Preoperative and postoperative vocal cord examinations \rwere performed in all cases. RLN branching at a distance of >5 mm with both branches entering the larynx was considered \rextralaryngeal branching of the nerve. Age, gender, nerve side, RLN branching, and the relationship between the RLN and \rthe ITA were evaluated to assess the possible effect on VCP.\rResults: Of the 204 neck sides, 11 (5.4%) RLNs developed VCP. Ten cases were temporary (4.9%) and 1 (0.5%) was \rpermanent. There was no significant difference in age, gender, nerve side, or RLN-ITA relationship in the VCP cases. Extralaryngeal branching was detected in 42 (22.7%) of 185 nerves, and the rate of total and transient VCP was significantly \rhigher in branching nerves than in nonbranching nerves (11.9% vs 3.5%, p=0.034, 11.9% vs 2.8%, p=0.030, respectively).\rConclusion: RLN branching is a potential risk factor for total and transient VCP, awareness of this anatomical variation and \rcomplete exposure during thyroid surgery are crucial to the prevention of RLN injury.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.Publication Open Access The relationship of pre-operative vitamin D and TSH levels with papillary thyroid cancer(2023) Aygün, Nurcihan; Uludağ, Mehmet; İşgör, Adnan; Ünlü, Mehmet Taner; Çalışkan, Ozan; Sağlık Bilimleri Üniversitesi; Sağlık Bilimleri Üniversitesi; Bahçeşehir Üniversitesi; Sağlık Bilimleri Üniversitesi; Sağlık Bilimleri ÜniversitesiOBJECTIVE: Our goal in this study is to analyze the correlation between papillary thyroid cancer (PTC) with elevated thy- roid-stimulating hormone (TSH) levels and deficiency of vitamin D. METHODS: Patients who underwent thyroidectomy, also with available vitamin D test results preoperatively, were included in the study. The patients were separated into two different categories as having papillary thyroid carcinoma (Group 1), benign diseases (Group 2). According to the TSH (mUI/mL) level and vitamin D values, patients were categorized into four quarters. RESULTS: Preoperatively, TSH level (mean±SD mUI/mL) was higher in Group 1 (2.04±1.55) compared to Group 2 (1.82±1.94) significantly (p=0.029). Preoperatively, vitamin D levels (mean±SD) were higher in Group 1 (15.88±10.88) than in Group 2 (12.94±10.26) significantly (p=0.011). There was no significant difference between Group 1 and Group 2 accord- ing to the vitamin D deficiency (65.5%, 72.8%, respectively (p=0.472)). When categorized with reference to pre-operative vitamin D levels, the proportion of patients in Group 2 and Category 1 was higher significantly (p=0.031). CONCLUSION: Although the pre-operative TSH level was significantly higher in papillary thyroid carcinoma than benign thyroid diseases, the categorical distributions of the patients according to the TSH value were similar and the TSH values overlapped. Pre-operative mean vitamin D levels were similar in both PTC and benign thyroid disease groups so PTC was not associated with vitamin D deficiency.