PubMed Health⌕ Search

Biomedical subjects

Geoffrey B Thompson

Publications and source records attributed to Geoffrey B Thompson.

35 records · Page 2Linked to original sources
PubMed2003

Adrenal incidentaloma.

Adrenal incidentalomas are incidentally discovered adrenal masses greater than 1 cm in diameter that appear to be clinically nonfunctioning. They are detected during imaging procedures of the abdomen and chest (CT, MRI, and ultrasonography) for an unrelated condition or symptom complex. With the widespread escalation in the use of these imaging modalities and marked improvements in image resolution, the probability of finding an incidentaloma on cross-section imaging is rapidly approaching the 6% prevalence of previously reported autopsy studies. All incidentalomas greater than 1 cm should be evaluated for hormonal activity, including a 1-mg overnight dexamethasone suppression test, total 24-hour urinary metanephrines and fractionated catecholamines, and, in the hypertensive patient, a serum potassium level and plasma aldosterone concentration to plasma renin activity ratio. All hormonally active tumors should be removed. Hormonally inactive tumors are resected based on size, imaging phenotype, and interval growth. Percutaneous biopsies are generally unwarranted and are potentially dangerous. Laparoscopic adrenalectomy has become the surgical procedure of choice for most benign functioning and nonfunctioning tumors of the adrenal gland. Subclinical metabolic abnormalities associated with adrenal incidentalomas remain an area of intense clinical research.

Adrenal Gland Neoplasms↗
PubMed2003

Androgen receptor expression in C-cells and in medullary thyroid carcinoma.

Recent studies have shown a higher incidence of C-cell hyperplasia (CCH) in men compared with women in postmortem thyroid tissues. We postulated that the expression of androgen receptor (AR) protein may, in part, explain the differences. To test this hypothesis, we examined thyroid tissue from 27 consecutive autopsy cases for the presence of CCH (defined as >50 C-cells/x100 magnification in three fields) and for AR expression in autopsy cases and in 43 medullary thyroid carcinomas (MTCs) from patients with sporadic and familial disease as well as two multiple endocrine neoplasia type 2A patients with only CCH. CCH was present in 8 of 20 males (40%) and in 1 of 7 females (14%) at autopsy. AR protein was detected in most surgically resected thyroids with MTC and CCH (80%), but in only 25% of autopsy thyroids, probably reflecting postmortem degradation of the receptor protein. Reverse transcriptase polymerase chain reaction confirmed the presence of AR mRNA in MTC and in papillary thyroid carcinomas. These results support the observation that CCH is more common in postmortem thyroids of males and suggest that the presence of AR with higher circulating levels of androgens may contribute to the higher incidence of CCH in men.

Aged↗
PubMed2003

Laparoscopic adrenalectomy for pheochromocytoma.

OBJECTIVE: To determine the safety and results of laparoscopic resection of benign pheochromocytomas. PATIENTS AND METHODS: We retrospectively reviewed the medical charts of all patients who underwent laparoscopic adrenalectomy for benign pheochromocytomas at all 3 Mayo Clinic sites between January 1, 1992, and December 31, 2001. Demographics, comorbidities, clinical presentation, imaging studies, biochemical findings, operative intervention, and outcome were examined. Long-term follow-up was obtained via chart review and/or by direct telephone contact with the patient or a relative. RESULTS: Twenty-four women and 23 men with a mean age of 53.1 years (range, 16-81 years) underwent attempted laparoscopic resection of pheochromocytomas. In 5 patients, the procedure was converted to open laparotomy because of bleeding (2), inadequate exposure (2), and adhesions (1). The mean tumor size was 4.3 cm. The mean operative time (181.8 vs 1405 minutes; P = .03), mean hospital stay (6.00 vs 2.64 days; P < .001), and mean blood loss (340 mL vs 80 mL; P < .001) were greater in patients who underwent open laparotomy vs those who underwent laparoscopic resection. All specimens were classified as benign. The mean follow-up was 41 months (range, 10-89 months). No patients experienced a recurrence or developed metastatic disease. CONCLUSIONS: In light of surgical and anesthesia expertise, laparoscopic resection of benign pheochromocytomas is safe and effective with resultant short hospital stays. A low threshold to convert to an open procedure reduces operative times and decreases potentially serious complications. Although there have been no recurrences to date, long-term follow-up is required for all patients, especially those with hereditary forms of pheochromocytomas.

Adolescent↗
PubMed2002

Papillary thyroid carcinoma managed at the Mayo Clinic during six decades (1940-1999): temporal trends in initial therapy and long-term outcome in 2444 consecutively treated patients.

It is uncertain whether more extensive primary surgery and increasing use of radioiodine remnant ablation (RRA) for papillary thyroid carcinoma (PTC) have resulted in improved rates of cause-specific mortality (CSM) and tumor recurrence (TR). Details of the initial presentation, therapy, and outcome of 2444 PTC patients consecutively treated during 1940-1999 were recorded in a computerized database. Patients were followed for more than 43,000 patient-years. The 25-year rates for CSM and TR were 5% and 14%, respectively. Temporal trends were analyzed for six decades. During the six decades, the proportion with initial MACIS (distant Metastasis, patient Age, Completeness of resection, local Invasion, and tumor Size) scores <6 were 77%, 82%, 84%, 86%, 85%, and 82%, respectively (p = 0.06). Lobectomy accounted for 70% of initial procedures during 1940-1949 and 22% during 1950-1959; during 1960-1999 bilateral lobar resection (BLR) accounted for 91% of surgeries (p <0.001). RRA after BLR was performed during 1950-1969 in 3% but increased to 18%, 57%, and 46% in successive decades (p <0.001). The 40-year rates for CSM and TR during 1940-1949 were significantly higher (p = 0.002) than during 1950-1999. During the last 50 years the 10-year CSM and TR rates for the 2286 cases did not significantly change with successive decades. Moreover, the 10-year rates for CSM and TR were not significantly improved during the last five decades of the study, either for the 1917 MACIS <6 patients or the 369 MACIS < 6 patients. Increasing use of RRA has not apparently improved the already excellent outcome, achieved before 1970, in low risk (MACIS <6) PTC patients managed by near-total thyroidectomy and conservative nodal excision.

Adolescent↗
PubMed2002

Will directed parathyroidectomy utilizing the gamma probe or intraoperative parathyroid hormone assay replace bilateral cervical exploration as the preferred operation for primary hyperparathyroidism?

The trend toward limited exploration for primary hyperparathyroidism (1 degrees HPT) has stemmed from advances in sestamibi scanning, gamma probe technology, and intraoperative parathyroid hormone monitoring (iPTH). Prior to widespread application, directed parathyroidectomy must be shown to meet the high standards of conventional cervical exploration. In this prospective, nonrandomized trial, results of parathyroidectomy utilizing the gamma probe, iPTH, or neither technique were evaluated. Altogether, 150 patients underwent parathyroidectomy utilizing the gamma probe (n = 50), iPTH (n = 50), or neither technique (n = 50). Each group was evaluated for operating time, length of hospitalization, cure rate, morbidity, mortality, and cost. A telephone survey was conducted with 25 patients in each group (n = 75) to address patient satisfaction. The gamma probe localized the abnormal gland in 66% of patients and confirmed cure intraoperatively in 84%. In the iPTH group, a more than 50% decrease from baseline occurred in 98%. The mean operating times were 76, 84, and 90 minutes, respectively (p = 0.16); and the mean length of hospitalization was 1 day. The biochemical cure rates were 98%, 100%, and 96%, respectively (p = 0.17). Total costs were $4476, $3918, and $3905, respectively. A total of 96% of patients in all three groups were "very satisfied" with their surgical procedure. Directed parathyroidectomy utilizing the gamma probe or iPTH assay does not significantly alter the operating time, length of hospitalization, cure rate, morbidity, mortality, or patient satisfaction when compared to conventional exploration in our practice. The probe is more expensive and was not a consistently reliable tool for localizing parathyroid pathology. PTH monitoring reliably predicts cure intraoperatively.

Female↗
PubMed2002

Pancreas-sparing duodenectomy for duodenal polyposis.

HYPOTHESIS: Pancreas-sparing duodenectomy (PSD) is a safe and effective operative procedure for patients with nonmalignant duodenal polyps. DESIGN: Retrospective analysis of outcomes in patients undergoing PSD. SETTING: A tertiary referral center. PATIENTS: All patients undergoing PSD at the Mayo Clinic, Rochester, Minn. Indications were the presence of numerous duodenal polyps or large, solitary, adenomatous polyps not amenable to endoscopic resection. Dysplasia without frank malignancy was demonstrated in all patients by endoscopic biopsy specimens. Follow-up was complete in all patients. MAIN OUTCOME MEASURES: Operative feasibility, short- and long-term complications, quality of life, and survival. RESULTS: Five patients had diffuse polyposis (familial adenomatous polyposis) and 3 had very large periampullary villous adenomas. The mean age of the patients was 54 years (female-male ratio, 3:1). Colectomy preceded PSD in 5 patients (familial adenomatous polyposis); 3 had previous transduodenal excision of adenomas, and 2 had previous resections of desmoid tumors. The mean operating room time was 370 minutes; blood loss, 340 mL; and the length of the hospital stay, 18 days. All specimens showed dysplasia (5 low grade, 3 high grade). There were 5 major complications--3 ampullary leaks that closed spontaneously with drainage, 1 intra-abdominal hemorrhage requiring a second exploratory surgical procedure, and 1 deep wound infection. The mean follow-up was 23 months. All patients experienced weight gain and good performance status. A second endoscopy (performed in 5 patients) demonstrated small polyps in the neoduodenum in 2 patients and tiny anastomotic ulcers in 2 patients. For 1 patient, there were no abnormalities seen on the endoscopy. Two patients have since developed transient bouts of pancreatitis. CONCLUSIONS: Pancreas-sparing duodenectomy, although technically demanding, eliminates the need for pancreatic resection. Pancreas-sparing duodenectomy is associated with good absorptive capacity, weight gain, and quality of life. Furthermore, it may reduce the risk of subsequent malignancy. Long-term surveillance, however, is still required. Pancreas-sparing duodenectomy is contraindicated in the setting of malignancy.

Adenoma, Villous↗
PubMed2002

Pheochromocytomas and paragangliomas in von Hippel-Lindau disease: a role for laparoscopic and cortical-sparing surgery.

HYPOTHESIS: Von Hippel-Lindau disease (VHL) is an autosomal-dominant disorder characterized by benign and malignant tumors involving the central nervous system, kidneys, pancreas, adrenal glands, and paraganglia. Appropriate management of pheochromocytomas and paragangliomas in VHL is evolving as we better understand the genetics and natural course of the disease and master advanced surgical techniques for adrenalectomy. DESIGN: Retrospective chart review. SETTING: Tertiary referral center. PATIENTS: A total of 109 patients identified at the Mayo Clinic, Rochester, Minn, with VHL (60 males and 49 females) between January 1, 1975, and June 30, 2000. Seventeen patients (16%) had an identifiable adrenal mass and 3 patients had paragangliomas. Follow-up was complete in all but 2 patients. MAIN OUTCOME MEASURES: Clinical presentation, preoperative evaluation, surgical management, and outcome. RESULTS: Three patients with paragangliomas and 13 of 17 patients with adrenal masses underwent surgical resection. Median age at time of diagnosis was 30 years (range, 16-47 years); 8 (40%) were asymptomatic. Fractionated urinary catecholamine and metanephrine concentrations were normal in one third of patients. Computed tomographic scanning identified 20 (83%) of 24 tumors. Adrenalectomies were performed as unilateral or bilateral, open or laparoscopic, and, finally, total or cortical-sparing. Seven (50%) of the patients underwent other concurrent abdominal procedures. There were no deaths, with an overall operative morbidity of 2 patients (14%). Only the 2 patients in whom bilateral total adrenalectomies were performed became corticosteroid dependent. No recurrences have been noted to date. CONCLUSIONS: A multidisciplinary approach is imperative for proper examination and monitoring of patients with VHL. Evaluation should begin early in life and always before elective surgery and childbirth. All adrenal masses in patients with VHL should be thoroughly evaluated and most should be resected. Early intervention and advanced surgical techniques better allow for cortical-sparing and laparoscopic procedures. With low recurrence rates, corticosteroid independence can be maintained for prolonged periods.

Adolescent↗
PubMed2002

The predictive value of laboratory findings in patients with primary hyperparathyroidism.

BACKGROUND: Despite extensive preoperative imaging and intraoperative "gadgetry" to facilitate localization of abnormal parathyroid glands, the onus of identification and resection remains with the surgeon in the operating room. We pondered the relative usefulness of routine laboratory studies to the surgeon as predictive guides to the intraoperative findings in patients with primary hyperparathyroidism (HPT). STUDY DESIGN: Pre- and postoperative laboratory data were analyzed in 166 consecutive patients (1998 to 1999) undergoing successful cervical exploration for sporadic primary HPT and were correlated with the pathologic findings. Patients with secondary HPT, multiple endocrine neoplasia, familial HPT, and parathyroid carcinoma were not included in this study. RESULTS: One hundred eighteen women and 48 men (mean age = 63 years) with parathyroid adenoma (n = 155) and sporadic hyperplasia (n = 11) were evaluated. Mean parathormone (PTH) levels varied little with the pathology: adenoma = 9.6 pmol/L and hyperplasia = 10.2 pmol/L (p > 0.05). In patients with parathyroid adenoma, analysis of preoperative measures showed a positive correlation (r = 0.48, p < 0.0001) with PTH and gland weight. The correlation appeared to be the strongest in the tails of the distribution; in 22 of 23 (96%) cases with PTH levels lower than 6 pmol/L, the offending lesion or lesions were less than 400 mg; in all six cases with PTH levels higher than 18.0 pmol/L, the abnormal gland or glands weighed more than 800 mg. PTH levels between 6 and 18 pmol/L revealed mean adenoma weight of 757 mg (median = 420 mg; range = 50 to 5,500 mg). CONCLUSIONS: Extreme values of PTH in patients with single-gland parathyroid disease alert the surgeon to the likelihood of small or large parathyroid adenomas. Laboratory studies do not differentiate adenoma from hyperplasia, nor do they pinpoint the size of abnormal glands with moderate-range PTH values.

Adenoma↗
PubMed2002

Aldosterone-secreting adrenocortical carcinomas are associated with unique operative risks and outcomes.

BACKGROUND: Adrenocortical carcinoma (ACC) that produces aldosterone is an extremely rare, uncharacterized endocrine malignancy. Our aim was to characterize this neoplasm in terms of its clinical behavior and patient outcomes. METHODS: A retrospective review was made of all patients who had operative management of aldosterone-secreting ACC from 1957 to 2000 at the Mayo Clinic. Comparisons were made to patients with non-aldosterone-secreting ACC treated during the same period. RESULTS: Of 141 patients with ACC, we identified 15 patients with aldosterone-secreting ACC. Isolated aldosterone hypersecretion was present in 10 patients, and mixed hormonal secretion was detected in 5. Mean tumor size and weight were 10.8 cm and 453 g, respectively. Surgical management included curative resection in 10 patients (67%). Perioperative mortality was 20%. Disease recurred in 7 patients (70%) with a median interval of 17 months. Five-year survival was 52%. Patients with aldosterone-secreting ACC had an increased risk of perioperative mortality (20% vs 5%), yet they had an overall survival of 63 months compared to 19 months for patients with non-aldosterone-secreting ACC. CONCLUSIONS: Aldosterone hypersecretion occurs in 11% of all ACCs and is associated with unique operative risk and outcome. Although patients harboring aldosterone-secreting ACC appear to have an increased risk of perioperative death, survivors may have an improved overall survival rate compared with patients with non-aldosterone-secreting ACC.

Adolescent↗
PubMed2002

Concurrent resections of pancreatic islet cell cancers with synchronous hepatic metastases: outcomes of an aggressive approach.

BACKGROUND: Pancreatic islet cell cancers are often characterized by the presence of endocrinopathies, an indolent clinical course, and a propensity for hepatic metastases. Hepatic metastases are associated with a negative impact on survival. The role of concurrent resections of pancreatic islet cell cancers and the hepatic metastases has not been defined. METHODS: The records of all consecutive patients undergoing concurrent resections of pancreatic islet cell cancers and their hepatic metastases between 1980 and 1998 were reviewed. Outcomes regarding overall progression-free and symptom-free survival and perioperative morbidity and mortality were assessed. RESULTS: All 23 patients underwent distal pancreatectomy and splenectomy. Six major (> or = 3 segments) and 17 minor (c3 segments) partial hepatectomies were performed. Complete gross resection of cancer (R0/R1) were performed in 9 patients and debulking resections (R2) (<10% residual tumor volume) in 14 patients. There were no perioperative deaths. Major complications occurred in 4 patients (18%). Overall, progression-free, and symptom-free survival was 71% (median: 76 months), 5% (median: 21 months), and 24% (median: 26 months), respectively, at 5 years. Conclusions. These data support aggressive concurrent resection of the pancreatic islet cell cancers and synchronic hepatic metastases when technically feasible. Because disease progression is frequent and the major cause of death, investigations of adjuvant and adjunctive therapies are warranted.

Adult↗
PubMed2002

Current treatment of nodular goiter with hyperthyroidism (Plummer's disease): surgery versus radioiodine.

BACKGROUND: First described 9 decades ago by H. S. Plummer, thyroidectomy and radioiodine remain the 2 therapeutic modalities for toxic nodular goiter. The aim of this study was to determine its optimal treatment. METHODS: The presentation, operative treatment, pathology, and clinical course of 362 consecutive patients treated at our institution for Plummer's disease from 1990 to 1999 were retrospectively reviewed. RESULTS: Three hundred forty-six patients (63 men and 283 women) were treated surgically (181, 53%), with radioiodine (RAI, 157, 45%), or a combination of both (8, 2%). Mean age was 62 years (surgical, 55 years; RAI, 69 years). Nearly half were symptomatic, 51 (15%) with airway or swallowing compromise and 110 (32%) with cardiac complications. The estimated goiter size was larger (60 g or greater) in surgical (72 patients, 38%) than medically treated (45 patients, 29%) patients. RAI treatment dose averaged 28 mCi; 10 patients (6%) required a second treatment, and 8 patients failed treatment and required subsequent thyroidectomy. Types of thyroidectomy included total (29 patients, 16%), near-total (47 patients, 26%), bilateral subtotal (46 patients, 25%), and unilateral (58 patients, 32%). One month after treatment, hyperthyroidism had resolved in 96% of the surgical patients but only 6% of the RAI patients (mean time to resolution, 5.4 months). Only 55 (38%) of the RAI patients' goiters reduced in size. Recurrent laryngeal nerve paralysis and hypoparathyroidism each occurred in 3 (2%) patients. CONCLUSIONS: Surgical treatment results in rapid, reliable resolution of hyperthyroidism and removal of the nodular goiter with low morbidity and no mortality. RAI is also safe and effective, usually requiring a single dose, but the results are delayed and it usually fails to resolve a goiter.

Adolescent↗
PubMed2002

Insulinoma in chronic renal failure: a case report.

The diagnosis of insulinoma depends on the fulfillment of well-established criteria during the 72-h fast. However, these criteria rely on normal renal function. Spontaneous hypoglycemia that is not attributable to insulinoma may occur in persons with renal failure. We describe herein a patient with renal impairment who had undergone renal transplant and had a 20-yr history of hypoglycemic symptoms and successful resection of insulinoma. Although the results of a 72-h fast were consistent with endogenous hyperinsulinemia, their interpretation was complicated in the presence of renal impairment. Fortunately, the identification of the tumor, by endoscopic ultrasonograph, led to a correct diagnosis. This case seems to be the second report of a patient with insulinoma with concomitant renal failure.

Humans↗
PubMed2002

Medical and surgical management of hyperparathyroidism.

Hypercalcemia is frequently encountered in healthy outpatients. Reliable measurements of the mediators of hypercalcemia have improved diagnostic certainty about the etiology in most patients. Hyperparathyroidism is overwhelmingly the most common cause. Medical evaluation of the patient with hyperparathyroidism requires an understanding of the complications of the disorder and the associated syndromes. At present decreased bone mineral density and nephrolithiasis are the major sequelae of hyperparathyroidism. Most cases of primary hyperparathyroidism are sporadic; however, hereditary forms can occur in patients with the multiple endocrine neoplasia syndromes. Surgery is the only curative therapy. Results are excellent when an experienced endocrine surgeon performs parathyroid surgery.

Diagnosis, Differential↗
PubMed2002

Intraoperative monitoring of parathyroid hormone with a rapid automated assay that is commercially available.

The Mayo Clinic was one of the first institutions to develop an in-house rapid parathyroid hormone (PTH) assay that used homegrown antibodies to monitor plasma PTH levels during parathyroidectomy. This PTH assay is economical, but it requires highly trained technologists and an experienced laboratory director and it is difficult to perform in the operating suite. We sought a fully automated multipurpose autoanalyzer with bar code reader to identify different patients' names and capacity to manage specimens from several patients who are having simultaneous operations. In addition, after complete tumor removal, the plasma PTH level should decrease to < 25% of the baseline level; otherwise, it may indicate that the antibodies used in the assay have cross-reacted with long half-life fragments other than intact PTH, which has a half-life of only approximately 2 min. An automated multipurpose analyzer, the Immulite 1000 with a Turbo PTH kit (DPC), fits these criteria and has replaced our in-house rapid assay. Of 47 patients who had parathyroidectomy for primary hyperparathyroidism and were tested with the new equipment, 45 (96%) had their plasma PTH levels decrease to < 25% of the baseline levels. In 41 of 47 patients (87%), the PTH value decreased to < 5 pmol/L (provisional reference range) within 20 min after tumor excision. The usefulness of the PTH assay extends from the traditional diagnosis of parathyroid disease to intraoperative monitoring, helping to ensure a higher cure rate.

Automation↗
PubMedDate not supplied

Spectrum of malignant somatostatin-producing neuroendocrine tumors.

OBJECTIVE: To evaluate the clinical manifestations and outcome of patients with somatostatinomas--rare neuroendocrine tumors of pancreaticoduodenal origin. METHODS: We searched the medical archives and tumor registry of our institution for somatostatinomas or somatostatin-staining tumors for the 12-year period from January 1990 to February 2002. In addition, we reviewed laboratory databases for patients who had an elevated serum somatostatin level. Patients with a neuroendocrine tumor and an elevated serum somatostatin level or somatostatin-positive tumor immunostaining were included in this study. RESULTS: Eleven patients qualified (9 men and 2 women; median age at diagnosis, 45 years; age range, 22 to 73). The diagnosis of a somatostatinoma was made by immunostaining of the tumor in 9 patients and by finding elevated serum somatostatin levels in 2. Five primary tumors were of duodenal and 6 of pancreatic origin. Psammoma body formation and association with neurofibromatosis were seen only in the duodenal tumors. The known primary tumor sizes varied from 2 to 6 cm. Liver metastatic lesions were present in 6 patients, abdominal lymph node involvement was found in 10 patients, and lung, spleen, and ovarian metastatic involvement was noted in 1 patient each. Diabetes was present in 4 patients (36%) and cholelithiasis in 7 (64%). The presence of a mass led to the diagnosis in most patients with primary duodenal tumors, whereas patients with pancreatic tumors were more likely to have endocrine manifestations. A Whipple procedure was performed in 6 patients, distal pancreatectomy in 3, hepatic artery embolization or ligation in 3, and partial hepatectomy in 1. Cancer-related death occurred in 4 patients, 1 to 8 years after diagnosis (median, 4.5 years). At last follow-up, 2 patients were alive without evidence of disease (8 and 10 years after diagnosis), and 3 were alive with liver metastatic lesions. The status of 2 patients was unclear. CONCLUSION: Somatostatinomas occurred with approximately equal frequency in the duodenum and the pancreas. The duodenal tumors were more likely to be pure somatostatinomas and have psammoma bodies. Pancreatic tumors were more likely to be multihormonal. Cholelithiasis and diabetes were seen in 64% and 36%, respectively, of the patients. Mass effect of the tumor was the usual manifestation leading to diagnosis. These tumors are slow growing, and long-term survival is possible.

Adult↗
PubMedDate not supplied

de Quervain's thyroiditis: surgical experience.

OBJECTIVE: To review a 35-year experience with management of de Quervain's thyroiditis (dQT), an uncommon inflammatory process of the thyroid gland that is usually treated medically and seldom necessitates surgical intervention. METHODS: A retrospective review was performed of medical records of patients with dQT treated surgically at a single institution between 1966 and 2000. The study group consisted of 11 women and 6 men (mean age, 50 years; range, 23 to 66). All pathology specimens were reviewed. RESULTS: Of the 17 study patients, 14 had surgical treatment before 1980. Typical symptoms of dQT, including pain and tenderness of the thyroid gland, occurred in eight patients, and two had dysphagia from an enlarged thyroid gland. Seven patients were asymptomatic. The indications for operation were a clinically indeterminate thyroid nodule (N = 14), dysphagia (N = 2), and hyperthyroidism with nodular goiter (N = 1). Fine-needle aspiration biopsy (FNAB) was performed in only two patients; biopsy findings were suspicious for a malignant lesion in one patient, and nondiagnostic in the other patient. Thyroid function tests (N = 14) revealed that 12 patients were euthyroid and 2 had hyperthyroidism. Surgical treatment consisted of unilateral lobectomy in 4 patients, near-total thyroidectomy in 12, and total thyroidectomy in 1. Temporary vocal cord palsy and temporary hypocalcemia occurred in one patient each. Fourteen patients (mean follow-up, 204 months) required long-term thyroid replacement therapy. No patient required further thyroid surgical intervention or had further thyroid disease. CONCLUSION: Although surgical intervention is not the primary treatment for dQT, when resection is performed it can be done safely and with low associated morbidity. In the modern era, with routine use of FNAB, fewer patients with this rare entity will require surgical exploration. Patients with atypical features and ones with euthyroidism are more likely candidates than others for surgical intervention.

Adult↗