Abdominal paraganglioma is a rare endocrine tumor associated with genetic mutations, however, the ability to predict long-term risk of metastasis has not been clarified. The aim of this study was to examine the clinicopathological features and outcomes in patients undergoing surgery for an abdominal paraganglioma. A retrospective analysis was performed for all patients undergoing surgery for abdominal paragangliomas from one surgical department between 1998 and 2010. Clinical presentation, hormone secretion and clinical outcomes were examined. A total of 23 patients underwent surgery for abdominal paraganglioma with the most common presentation being hypertension. Median time to metastasis was 32 months with all patients developing disease progression having a rise in urine catecholamines. Patients with capsular invasion or predisposing genetic conditions are at a higher risk of having more aggressive disease. All patients with a diagnosis of paraganglioma should be screened for predisposing genetic abnormalities and postoperative follow-up must include routine urinary catecholamine assessment.

Thyroglossal duct carcinoma (TGDC) is a rare disease with few reported series. No clear consensus exists regarding further management after adequate excision of the cyst, especially the role of total thyroidectomy and postoperative radioiodine therapy. We review our experience of nine cases and the literature to clarify the management of this rare condition. A retrospective study over a period of 10 years was performed using the clinical records from Christian Medical College, Vellore to identify patients with TGDC and to assess the frequency of cases with concomitant papillary carcinoma of the thyroid. The clinical presentation, fine needle aspiration cytology (FNAC), imaging, treatment and follow-up were analyzed. There were a total of nine cases of TGDC with five males. Imaging available in six patients detected a suspicious lesion in four cysts and three thyroid glands. Preoperative FNAC detected atypical cells in two of five cases. Thyroid carcinoma was seen in four (44.4%) after histopathological evaluation. Ultrasound of the neck and image-guided FNAC of the cyst may be adequate initial investigation for thyroglossal cysts. FNAC by itself is not a good investigation to diagnose TGDC as rate of false-negatives and inadequate specimens were high. Solid components and calcification on imaging were predictive of carcinoma within a thyroglossal cyst in 100% cases. All patients with TGDC may be offered total thyroidectomy as a simultaneous or staged procedure to address the high incidence of concomitant thyroid foci of cancer. The role of adjuvant therapy is still debatable.

Patients with goiter who have associated RLN palsy and/or hoarseness of voice are usually thought to have a malignant goiter, which has directly or indirectly involved the RLN. However, cases of vocal cord palsy in the setting of benign thyroid disease, though rare has been reported in literature. We present five cases of vocal cord palsy associated with benign thyroid disease and discuss the mechanisms of the vocal cord paralysis and also highlight the impact of early surgery on voice recovery.

Management of toxic multinodular goiter (TMNG) is still debated. We report our current experience with thyroidectomy for toxic multinodular goiter at a tertiary center. A retrospective database of 141 patients who underwent surgery for TMNG disease from January 1985 to December 2008. During that period, six patients underwent subtotal thyroidectomy and 135 patients underwent near total thyroidectomy. Around 53 patients (38%) underwent surgery for recurrent disease after medical therapy; 88 patients (62%) had surgery as a primary treatment, the indications were large goiter size in 58 (66%), associated cold nodule in 16 (18%), patient preference in 14 (16%). The incidence of cancer was 6.4%. Permanent hypoparathyroidism was observed in two patients. Unilateral transitory vocal cord palsy was observed in 11 patients (8%), no bilateral transitory vocal cord palsy was observed. One unilateral definitive vocal cord palsy was observed and was provoked by a mediastinal compression. Two patients (1.5%) experienced postoperative hemorrhagia requiring surgical revision. Near total thyroidectomy for TMNG provide an immediate and definitive treatment with a low complication rate. Near total thyroidectomy offers an appropriate treatment for coexisting malignancy. Only NTT can alleviate compressive symptoms. This procedure can be safely recommended even as a primary treatment.

Insulinomas, a rare clinical entity, are usually small, single, benign and intrapancreatic in location. Several modalities are available for preoperative localization of insulinomas. Intraoperative ultrasound is an important tool used for localization as well as to find anatomical relation of tumor to surrounding tissue. We are reporting three cases of insulinomas with brief discussion on modalities used for localization. After biochemical confirmation of hyperinsulinemia, preoperative localization was done initially by computed tomography followed by intraoperative ultrasonography. Preoperative localization by computed tomography was successful in all the cases but missed an additional lesion in one of the patients which was picked up by intraoperative ultrasonography (IOUS) that changed surgical management. Preoperative localization may not be successful in all the cases. Intraoperative direct inspection, palpation and ultrasound can be used to identify lesions in the cases where preoperative localization was unsuccessful.

Subtotal thyroidectomy has been advocated as the standard treatment for Graves' disease (GD) because of the assumed lower risk of complications compared with total thyroidectomy, and also it provides the chance to avoid thyroxin therapy. The present study aims to examine our institutional experience with total thyroidectomy for GD. Patients were divided into two surgical treatment groups: Total thyroidectomy (TT) (n = 97) and total thyroidectomy with intraoperative thyroid autotransplantation (TTITA) (n = 74). TTITA performed in 74 patients. 0.5 to 2 gm of thyroid tissue was cut into small pieces and autotransplanted into the forearm muscle of the patient. Postoperative complications included eight cases of RLN palsy, two patients had nerve paralysis, two patients underwent tracheostomy, transient hypoparathyroidism in 25 patients, permanent hypoparathyroidism in two cases, wound hemorrhage in two patients. TPOAb levels were increased in 9% of patients with TT whereas in patients with TTITA TPOAb concentrations were elevated in 65% of patients at 3 months follow-up. TRAb in patients with TT were not detected while 20% patients undergone TTITA had high TRAb levels and 13.3% had terminal concentrations at 3 months follow-up. Serum TPOAb and TRAb were detected in none of the patients who underwent TT and TTITA at 1, 3 and 5 years follow-up. Removal of all thyroid tissue offers the best chance of preventing recurrent hyperthyroidism and we saw no increase in postoperative complications in the TT group. We feel that TT is safe and superior for achieving the goal of treatment of Graves' disease.

During the past five years, transaxillary approaches to thyroid surgery have been introduced into surgical literature. These techniques were initially performed using traditional endoscopy, and most recently with a surgical robot. This manuscript describes our approach to robotassisted transaxillary surgery (RATS) for thyroidectomy using a single axillary incision. Because of the steep learning curve, this procedure is best implemented with a team approach. The ideal team consists of a console surgeon who operates the robot, a bedside surgeon who assists with retraction and troubleshoots robotic arm collisions and a circulating assistant who helps optimize the efficiency of the operation.

Great vessels in the neck and upper mediastinum are involved either by invasion or encasement in malignant thyroid disease. Rarely benign conditions, like Riedel's thyroiditis, may involve them due to extensive extracapsular fibrosis. We report a rare case of carotid artery engulfment due to benign goiters, which is a largely unknown entity.

This paper presents a case on symptomatic hypocalcemia due to sodium phosphate use for bowel preparation following parathyroidectomy. Serum calcium and parathyroid hormone were in normal levels postoperatively. Two months following the operation, phosphosoda was administered for bowel preparation. Following bowel preparation severe carpopedal spasm developed. It can be speculated that sodium phosphate administration for bowel preparation may precipitate hypocalcemic tetany in the patients undergoing parathyroidectomy for primary hyperparathyroidism.

Metastases to the thyroid gland are rare. We report the case of a 50-year-old man with an isolated thyroid metastasis from renal cell carcinoma (RCC), 3 years after radical nephrectomy for the primary disease. Although uncommon, if a patient with a previous history of malignancy has a new thyroid mass, it should be considered metastatic tumor of recurrent malignancy until proved otherwise.

We report a case of a 37-year-old man who presented with a neck swelling associated with recent onset respiratory distress. The patient was receiving hemodialysis due to chronic renal failure three times a week for 8 years. Local examination showed a diffuse thyroid enlargement. The thyroid function test results of the patient were within normal limits. At the ultrasonography examination, there was a 17 × 11 mm nodule at the isthmus with a hypoechoic halo containing calcified foci. The fine needle aspiration biopsy (FNAB) of the nodule at the isthmus that contained calcification revealed adenomatous nodule rich in cells, which showed degeneration and follicular neoplasia. Total thyroidectomy was planned due to the patient's ongoing symptoms and dyspnea. The pathological examination revealed diffuse lipomatosis and amyloidosis.