Background: Thyroidectomy is a widely performed surgical procedure globally with respect to the benign and malignant disorder of thyroid gland. Total thyroidectomy, one of the most commonly performed procedures in India, carries inherent risks, predominantly hypocalcemia, voice disturbances, and other complications. Our study explores the role of steroids in potentially reducing these complications. Aim: To evaluate the effectiveness of prophylactic steroids in preventing hypocalcemia in patients undergoing total thyroidectomy. Additionally, the study examines other parameters, including pain and voice changes. Method: This randomized controlled double-blind trial included two arms: A placebo group and a steroid group, comparing outcomes between the two groups. Results and conclusion: Our study demonstrated a noticeable difference, with fewer patients in the steroid group developing hypocalcemia; however, the results were not statistically significant. Importantly, no complications due to steroid use were observed. We noted statistically significant benefits in the steroid group regarding reduced postoperative voice dysfunction and pain. A study with a larger sample size is needed to draw more definitive conclusions.

Background: Post-thyroidectomy hypocalcemia is a frequent and significant complication that can lead to considerable morbidity. Identifying reliable predictors of this condition is crucial for improving patient outcomes and managing postoperative care effectively. Aim: To determine the incidence and predictors of post-thyroidectomy hypocalcemia in patients treated at a tertiary care hospital in New Delhi. Methodology: A retrospective analysis was conducted on 117 patients who underwent total thyroidectomy between January 2021 and March 2023. Exclusion criteria included patients with prior or concomitant parathyroidectomy, known hyperparathyroidism, and preoperative hypocalcemia. Postoperative serum calcium and intact parathyroid hormone (iPTH) levels were recorded on the first postoperative day (POD1). Patients with biochemical or clinical signs of hypocalcemia were treated accordingly. Result: The incidence of transient hypocalcemia was 46.6%, with 34.16% of patients requiring intravenous calcium infusion. Low iPTH levels and postmenopausal status emerged as significant predictors of hypocalcemia. Patients with low iPTH levels were more likely to require intravenous calcium, and postmenopausal women showed a higher incidence of hypocalcemia compared to premenopausal women (62.5% vs 30%). Conclusion: Low postoperative iPTH levels and postmenopausal status are significant predictors of hypocalcemia in patients undergoing total thyroidectomy. These findings can help in developing targeted management strategies to mitigate the risk of hypocalcemia. Recommendation: Routine measurement of iPTH levels on postoperative day 1 (POD1) should be incorporated into postoperative care protocols to identify patients at risk for hypocalcemia. Special attention should be given to postmenopausal women, and early intervention strategies should be implemented to improve patient outcomes and reduce hospital stay duration. Further prospective studies with larger sample sizes are recommended to validate these findings.

Introduction: At many centers across the world, endoscopic thyroid surgery has become a well-established and safe alternative in selected patients at present. In this review, we have described the “Ten Commandments” for safe endoscopic thyroid surgery. Materials and surgical techniques: This review is based on our own experience and review of literature related to endoscopic thyroid surgery. Patients and techniques should be selected wisely while performing endoscopic thyroid surgery. Crucial steps are the creation of sufficient working space, and the identification of superior laryngeal nerve, parathyroids, and recurrent laryngeal nerve (RLN). Conclusion: As the surgical field keeps advancing, many more commandments will keep on adding to the armamentarium of surgeons and hence our 11th commandment is that thou shalt keep learning, unlearning, and re-learning. The bottom line however is to master the surgical anatomy and the correct way of doing endoscopic thyroid surgery.

In addition to the recognized types of multiple endocrine neoplasia (MEN) syndromes (MEN 1, MEN 2a, and MEN 2b), MEN 4 was described relatively recently, and there is now a proposition of a fifth variety. It has been recognized as an independent syndrome by the 5th edition of the WHO Classification of Endocrine and Neuroendocrine Tumors as well as the 5th edition of the Genetic Tumor Syndromes. Multiple endocrine neoplasia type 5 (MEN 5) is caused by a pathogenic mutation in MYC associated factor X (MAX) gene, which is a tumor suppressor gene. The endocrine manifestations include tumors of the adrenal, pituitary, parathyroid, and pancreas. The non-endocrine tumors include renal cell carcinoma, renal oncocytoma, and carcinoma of the lung. This article thoroughly reviews the available literature and tries to understand the journey of discovery of a new syndrome in endocrine surgery.

Primary hyperparathyroidism (PHPT) is primarily treated with surgery, achieving a 95% cure rate when performed by skilled surgeons. However, 4–5% of patients experience persistent or recurrent PHPT post-surgery due to factors such as undetected adenomas or misdiagnoses like familial hypocalciuric hypercalcemia (FHH). Despite advancements in intraoperative parathormone monitoring and preoperative imaging, some cases remain challenging due to ectopic gland locations and other factors. This underscores the need for multidisciplinary approaches and thorough preoperative planning to enhance surgical outcomes in PHPT management.

Primary adrenal leiomyosarcoma (PAL) is an extremely rare case finding where the mesenchymal tumor is found to be originating from the mesenchymal elements surrounding the adrenal vessels. Herein we report an interesting case of a 60-year-old gentleman, presenting to us with an abdominal lump. Contrast-enhanced computed tomography of the (CECT) abdomen revealed multilobulated heterogeneously enhancing soft tissue lesion of size 99 × 93 × 33 mm in the left supra renal region. After evaluation, the patient underwent an open left adrenalectomy. Postoperatively the histopathological examination showed mesenchymal neoplasm with spindle-shaped vesicular chromatin, conspicuous nucleoli, and eosinophilic cytoplasm with occasional atypical mitosis.

Papillary thyroid cancer (PTC) often leads to cervical lymph node metastasis, occurring in 50–70% of cases. This high prevalence can sometimes cause clinicians to overlook other potential causes of cervical lymphadenopathy, especially in regions where tuberculosis (TB) is common. Distinguishing between these conditions can be challenging as they appear similar on ultrasound and cytology. However, examination of paraffin-embedded sections is the most effective way to differentiate between the two. We present a case series of three interesting patients where differentiation between the two conditions posed a diagnostic challenge. In two patients, the diagnosis was made after surgery, while in one patient, the diagnosis was made before surgery, preventing the patient from undergoing an unnecessary procedure.

Aims and background: Celiac disease (CD) is a malabsorptive disorder leading to cases of secondary hyperparathyroidism. It is uncommon for primary hyperparathyroidism (PHPT) and tertiary hyperparathyroidism (THPT) to be associated with CD, and it can be challenging to distinguish between the two conditions. Case description: Here, we report a case of CD with chronic liver disease (CLD) that had a normal renal function test and a left inferior parathyroid adenoma (LIPA) that was discovered incidentally. A successful focused parathyroidectomy was performed, and the patient is eucalcemic 2 years after the procedure. The conundrum was whether to contribute it to PHPT or THPT. Conclusion: Celiac disease can be associated with several forms of hyperparathyroidism. It is an arduous task to differentiate between PHPT and THPT associated with CD. Clinical significance: A thorough evaluation is necessary for cases of HPT associated with CD for excellent outcomes.

Retropharyngeal ectopic parathyroid adenoma (PTA) is a rare entity. We present a case report of a patient with primary hyperparathyroidism (PHPT) who underwent dissection of the retropharyngeal space for excision of the PTA. It is imperative for an endocrine surgeon to be familiar with potential ectopic locations of PTA, especially when the results of routine first-line radiographic studies are equivocal. This awareness will avoid unsuccessful neck explorations and prepare the surgeon for a minimally invasive approach to excise the PTA. This case highlights the retropharyngeal space as an important ectopic site for PTA, underscores the limitations of ultrasound, and emphasizes the importance of newer diagnostic modalities such as technetium 99m sestamibi (MIBI) and 4D-computed tomography (4DCT) scans in easy preoperative identification of the location of ectopic PTAs.

Aim and objectives: Thymic carcinoids are rare, incidentally detected in anterior mediastinal tumor, accounting for 2–4% of mediastinal tumor with an incidence of 0.18 per 1,000,000. Notably, 25% of thymic carcinoids are associated with MEN-1 syndrome. They are often detected incidentally, though some patients present with hormone-related symptoms, namely carcinoid syndrome, Cushing's syndrome, and very rarely acromegaly. We hereby present a case of thymic carcinoid, which was incidentally detected in a male patient who was evaluated for multiple head and neck AV-malformations. Case description: A 37-year-old male came with preauricular swelling. He had similar complaints of left preauricular swelling which was operated as parotid swelling, intraoperatively found to have AV malformation, and final histopathology reported as AV malformation. A few months later, he developed recurrent swelling was at the same site. On evaluation with MRI head and neck, along with multiple AV malformations, an anterior mediastinal mass was detected. On further evaluation, it was diagnosed as a thymic carcinoid with lymph node metastasis without distant metastasis. Functional and MEN1 syndromic evaluation were done, which were negative. The case was discussed in the tumor board meeting, and a decision was taken for surgical excision of the thymic tumor and observation for AV malformations. Sternotomy and Excision of the mass with lymph nodes are done in a cardiothoracic vascular operation theatre with the help of a cardiothoracic surgeon. Postoperatively, a patient recovered well. Histopathology revealed typical carcinoid (TC) with lymph node metastasis. The case was re-discussed in the tumor board meeting and planned for follow-up. Conclusion: Thymic carcinoids are rare mediastinal tumors that are incidentally detected, which mandates comprehensive functional, syndromic evaluation, and adequate surgical resection. Clinical significance: In our case, thymic carcinoid was indolent, typical, and found in association with multiple head and neck AV malformations. The association between these two is unknown. After a thorough search of the literature, this is probably the first case of the association of thymic carcinoid with multiple AV malformations.

Background: Primary thyroid lymphoma (PTL) is an uncommon condition, accounting for under 5% of thyroid cancers and no more than 2.5% of all lymphoma cases. Case presentation: We present the case of a 50-year-old gentleman who presented with a rapidly progressive right solitary thyroid nodule and a palpable cervical lymph node. Ultrasound imaging revealed a heterogeneous right TIRADS-4 lesion, and positron emission tomography-computed tomography (PET-CT) showed a fluorodeoxyglucose (FDG) avid thyroid lesion and supradiaphragmatic lymph nodes. Fine-needle aspiration cytology (FNAC) of the thyroid was suggestive of lymphoma, and a cervical lymph node biopsy confirmed diffuse large B-cell lymphoma (DLBCL). The patient was treated with chemotherapy (R-CHOP regimen: Rituximab, Cyclophosphamide, Doxorubicin, Vincristine, Prednisolone) and achieved a complete response. Discussion: Primary thyroid lymphoma is characterized by the presence of lymphoma solely within the thyroid gland or in the thyroid and nearby lymph nodes, without any contiguous spread or metastasis at the time of diagnosis. The most prevalent form of PTL is DLBCL. Diagnosis typically relies on biopsy, as FNAC is not adequate. Staging involves the use of FDG PET-CT and follows the Ann Arbor classification system. The main treatment approach combines chemotherapy (R-CHOP) with radiotherapy, while surgical intervention is considered only for cases that do not respond to chemotherapy or have remaining thyroid disease. The 5-year survival rate stands at 90% for patients with disease confined to the thyroid, but this drops to 35% for those with disease extending beyond the thyroid. Conclusion: Primary thyroid lymphoma is a rare malignancy of the thyroid gland with a challenging preoperative diagnosis. A biopsy is essential for diagnosis, and staging is performed using PET-CT. Treatment primarily involves chemotherapy (R-CHOP) and radiotherapy, with surgery reserved for resistant or residual disease. Take-home message: Primary thyroid lymphoma is a rare thyroid cancer, primarily non-Hodgkin's lymphoma, most commonly DLBCL. Diagnosis is confirmed by biopsy rather than FNAC, and staging is done using PET-CT. The primary treatment involves chemotherapy (R-CHOP) and radiotherapy, not surgery.