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Publication Open Access Factors Influencing the Relationship of the External Branch of the Superior Laryngeal Nerve with the Superior Pole Vessels of the Thyroid Gland(2020) Aygün, Nurcihan; Uludağ, Mehmet; İşgör, Adnan; Demircioğlu, Mahmut Kaan; Demircioğlu, Zeynep Gül; Akgün, İsmail Ethem; Sağlık Bilimleri Üniversitesi; Sağlık Bilimleri Üniversitesi; Bahçeşehir Üniversitesi; Sağlık Bilimleri Üniversitesi; Sağlık Bilimleri Üniversitesi; Sağlık Bilimleri ÜniversitesiObjectives: In a thyroidectomy, the external branch of the superior laryngeal nerve (EBSLN) is a potential risk during the superiorpole dissection due to its close anatomical relationship with the superior thyroid artery and its highly variable anatomy. In thisstudy, we aimed to evaluate the relationship of EBSLN with the superior pole considering Cernea classification and the factors affecting this relationship.Methods: The data of thyroidectomized 126 patients (95 female, 31 male) with 200 neck sides (mean age of 45.6±12.1 years) usingintraoperative neuromonitoring (IONM) for the EBSLN exploration were evaluated retrospectively. During the superior pole dissection, the EBSLN course was classified according to Cernea classification after being confirmed with IONM. It was defined as a largegoiter in the case of the thyroid lobe volume being >50 cc. The factors influencing the presence of type 2b, which has the highestrisk of injury, were evaluated using logistic regression analysis.Results: Of the 200 EBSLNs evaluated, 52 (26%) were type 1, 134 (68%) were type 2a, and 14 (7%) were type 2b. The mean volumesof the resected thyroid lobes were 22±25 cc (min-max: 2-136), 23±20 cc (3-163), and 39±24 cc (3-65) in type 1, 2a and 2b, respectively, which was significantly higher in type 2b (p=0.035). Presence of large goiter rates were 5.8% (n=3), 8.2% (n=11), 64.3% (n=9)in type 1, 2a, and 2b, respectively, and was significantly higher in type 2b (p=0.0001). There was no significant difference betweenEBSLN Cernea types concerning age, sex, nerve side, presence of cancer and hyperthyroidism. In logistic regression analysis, largegoiter was the only independent factor associated with Cernea type 2b. In case of a lobe volume greater than 50 cc, the probabilityof type 2b presence was approximately 25 times higher (p<0.001, odds ratio: 25.262).Conclusion: Type 2b course of EBSLN is more common in large goiters, and it is 25 times more likely to be seen in the presence ofa lobe volume over 50 cc. Thus, it should be considered that the probability of this high-risk course is significantly higher in largegoitersPublication 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 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 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.