European Journal of Molecular & Clinical Medicine

Background: Thyroid swelling is a condition commonly encountered by General Surgeons. Some patients need only Medical Management, whereas others need Surgical management in the form of Hemi or Total Thyroidectomy. Compared to RLN the EBSLN is less studied in terms of course and relation to thyroid gland intraoperatively. In our study we observed the course and relation of EBSLN with respect to the thyroid gland during surgery.
Materials and Methods: A prospective analysis of 60 patients who underwent thyroidectomy in General Surgery department in Rajah Muthiah Medical College was done. Intraoperatively, the EBSLN was visually identified and preserved before proceeding to ligate the superior thyroid vessels. The nerve was classified according to the Cernea classification.
Results: In 60 patients, 95 nerves were planned to be identified. The nerve was type 1 in 28/95 (29.5%), Type 2a in 46/95 (48.5%), and Type 2b in 11/95 (11.5%) patients. The nerve could not be identified in 10/95 (10.5%) patients.
Conclusion: The course and relation of EBSLN with respect to thyroid gland varies in different thyroid pathologies.

Background: Unrecognized transection of the recurrent laryngeal nerve (RLN) or its motor branch could result in an unexpected permanent palsy. So, for a safe thyroid operation, intraoperative assurance of anatomical and functional RLN integrity is a necessity. Aim of work: To evaluate the recognition and protection of RLN by staining the RLN intraoperatively with methylene blue (MB) in one side and comparing it with the identification alone in the other side visually during total thyroidectomy. Subjects and methods: A case control study (retrospective study) carried out in the department of surgical oncology Zagazig university hospitals and Ismailia teaching oncology hospital during the period from November 2018 to August 2019. The study included 112 patients with bilateral thyroid disease who will do total thyroidectomy. The patients were subdivided into two groups depending on the MB use. Complete history taking was taken from all subjects. General examination of all body systems and local examination of the neck were done. We also did full lab investigations, neck U/S then the operations were performed. Results: We detected transient vocal cord palsy 10 sides (8.6%) of visual  identification alone, while in MB sides no case was detected with the same lesion. Conclusion: Recognition of RLN intraoperatively by MB staining is cheap and widely available technique and can decrease the stress during thyroidectomy, especially when Intra Operative Nerve Monitoring (IONM) is absent.

Background: Thyroid nodules are extremely common and are usually benign. 4%-6.5% from thyroid nodulesaremalignant. Among Thyroid cancer investigations manydiagnostic molecular biomarkers were found to have applications in thyroid nodules managment and avoid unnecessary thyroidectomy.(1)
This study aims:To detect value of micro-RNA 221 expression in sera of Patients with thyroid nodules and its relation to outcome after surgery.
Patients and Methods: Forty-five adult subjects aged between 18 to 70-years old who were diagnosed with suspicious thyroid nodules that required total thyroidectomy were offered participation in the study. In addition, five healthy Subjects, were included as a control group, based on the patient’s history, physical examination, US and FNAB findings. Patients who had thyroid nodules with U/S pattern suggestive of malignant potential (TIRADS score ≥ 3),also with indeterminate FNAB results (Bethesda III, IV)were selected. Samples of human plasma were collected from selected patients visiting outpatient clinics. Results was correlated with postoperative pathology results.
Results: In our study there was no significant difference regarding outcome in patients (benign or malignant) with respect to serum microRna 221. There was a significant difference between benign and malignant outcomes regarding size of dominant nodules by ultrasound with a mean value equals 4.6 cm in largest dimension in patients with malignant thyroid nodules and p value equals 0.027 indicating increased size of nodule may be associated with increased risk of malignancy.