Hypothyroidism, a prevalent endocrine disorder characterized by insidious onset and prolonged progression, leads to metabolic slowdown and multiorgan dysfunction, significantly compromising patients' quality of life. While hormone replacement therapy improves most patients' serum thyroid function, it faces limitations, including individual response variations, lifelong medication requirements, and potential risks, with no reversal of existing tissue damage. In recent years, the mesenchymal stem cells (MSCs) and their derivatives have gained prominence in immunomodulation and regenerative medicine because of their abundant sources, low immunogenicity, potent paracrine effects, and multidirectional differentiation capabilities for tissue repair. Their unique advantages in modulating the immune microenvironment, promoting angiogenesis, reducing fibrosis, and stimulating endogenous cell regeneration offer novel strategies to overcome treatment bottlenecks in hypothyroidism and its complications, effectively repairing thyroid and multiorgan damage in animal models. This review synthesizes literature from the PubMed and Web of Science databases, incorporating relevant basic research and clinical trials. This study examined the systemic impacts of hypothyroidism, evaluated the experimental and clinical roles of the MSCs in thyroid tissue reconstruction and organ protection, and analyzed molecular mechanisms, including immune regulation, the antioxidant stress response, anti-apoptosis, and cellular function restoration. Clinical application potential is assessed alongside critical challenges such as standardized preparation, long-term safety, in vivo homing efficiency, and large-scale production.

Postoperative recurrence for secondary hyperparathyroidism (SHPT) remains a clinical challenge. Ectopic parathyroid glands are a major cause of recurrence, and those located in the submandibular region are rare. This report retrospectively analyzes three patients on maintenance dialysis who developed recurrent elevation of parathyroid hormone (PTH) levels 3 to 37 months after parathyroidectomy (PTX) for SHPT. Neck ultrasound revealed no definite lesions; however, 99mTc-methoxyisobutylisonitrile (99mTc-MIBI) single-photon emission computed tomography/computed tomography (SPECT/CT) fusion imaging showed abnormal radioactive tracer uptake in the submandibular region, suggestive of ectopic parathyroid glands. All three patients underwent a second or multiple surgeries, with complete excision of the submandibular masses. Postoperative pathology confirmed parathyroid tissue. After surgery, PTH levels returned to the normal range, and clinical symptoms improved markedly. Combined with a literature review, this article discusses the causes of recurrence after SHPT surgery, the anatomical basis of ectopic lesions in the submandibular region, and the localization diagnosis and treatment strategies for ectopic parathyroid glands, aiming to improve clinical awareness of such rare cases.

This study aimed to evaluate the diagnostic utility of next-generation sequencing (NGS) for identifying genetic alterations in fine-needle aspiration (FNA) samples from thyroid nodules, with a specific focus on its clinical implications for surgical management. In total, 631 patients underwent FNA cytology, yielding 683 cytological samples. Of these, 264 patients with indeterminate or suspicious cytological results underwent surgical intervention, and their samples were subjected to molecular analysis targeting single-nucleotide variants (SNVs) and insertion/deletion (InDel) mutations in a 20-gene panel associated with thyroid carcinoma. Genetic alterations were identified in 160 (57.55

Background: The incidence of thyroid cancer has increased globally. In recent years, robotic surgical systems have been applied in thyroid surgery, and the rapid development of fifth-generation (5G) communication technology has laid a solid foundation for the smooth implementation of remote surgery. Objective: The aim was to explore the feasibility and safety of telerobotic radical thyroidectomy using 5G communication technology to treat thyroid cancer. Methods: From August 2024 to October 2024, telerobotic radical thyroidectomy was performed on seven female patients using a 5G wireless network and a dedicated line network (or ordinary wired broadband) spanning 22-2200 km. The patients' clinical and information transmission data were analyzed. Results: All patients (papillary thyroid carcinoma, female, with an average age of 44.0 ± 4.6 years) underwent uneventful surgical procedures without any transfer to open surgery or complications. The average surgical duration was 91.3 ± 11.8 min, the average blood loss was 11.4 ± 4.8 mL, and the average postoperative hospital stay was 3.6 ± 0.8 days. All subjects were successfully discharged within 5 days after surgery. The average total latency time of the intraoperative network was 137.5 (range, 121-159) ms, and there were no adverse events, such as network disconnection, frame loss, or network attacks. The operator worked smoothly without any obvious delay or lag, and the recorded audio and video are clear. Conclusions: Telerobotic radical thyroidectomy for thyroid cancer over a 5G network demonstrates promising feasibility and safety. With stable network transmission and a clear surgical field, the precise operations required in thyroid surgery can be performed reliably. These findings suggest that this technology can facilitate high-quality surgical care in remote areas, contributing to a more balanced distribution of medical resources.

This study aimed to evaluate whether mitoxantrone hydrochloride injection (MHI) provides lymph node tracing and parathyroid preservation outcomes comparable to those of carbon nanoparticle suspension injection (CNP) during robotic thyroidectomy for papillary thyroid carcinoma (PTC). We conducted a retrospective review of 507 patients with PTC who underwent robotic thyroidectomy from September 2024 to September 2025. Patients were categorized into CNP and MHI groups based on the tracer utilized. After 1:1 propensity score matching, 62 matched pairs were selected for the final analysis. The primary outcomes encompassed the counts of dissected, metastatic, and stained lymph nodes, along with outcomes related to parathyroid preservation. Secondary outcomes included perioperative parameters and postoperative complications. After matching, the baseline characteristics of the two groups were well balanced. There were no notable differences in the counts of total lymph nodes, metastatic lymph nodes, stained level VI lymph nodes, parathyroid autotransplantation, incidental parathyroid resection, or intraoperative parathyroid identification. Preoperative, postoperative day 1, and 6-month postoperative serum calcium and parathyroid hormone (PTH) levels were comparable between the groups. Surgical recovery indicators and postoperative complication rates were also similar between the groups. In this single-center, propensity score-matched retrospective study, MHI showed efficacy and safety similar to those of CNP in lymph node tracing and parathyroid preservation. These findings suggest that MHI may be a practical alternative tracer in robotic thyroid cancer surgery.

AIMS/BACKGROUND:Severe hypocalcemia (SH) is a common and serious complication after parathyroidectomy (PTX) in patients with secondary hyperparathyroidism (SHPT). However, accurately predicting high-risk patients remains challenging. This study aimed to develop and validate a linear predictive model to identify these patients preoperatively. METHODS:From January 2013 to May 2025, 755 total parathyroidectomy (TPTX) or TPTX with autotransplantation (TPTX-AT) were performed by a single surgical team at the 960th Hospital of the PLA Joint Logistics Support Force. After applying inclusion and exclusion criteria, 685 patients were enrolled and randomly divided (7:3) into training and validation cohorts. Variables associated with serum calcium levels on the first postoperative day (POD1 Ca) were identified through linear regression analysis in the training cohort. Model validity was assessed using ten-fold and leave-one-out cross-validation. Bland-Altman plots and paired t-tests evaluated agreement within groups. Model performance in the validation cohort was measured using bias, precision, and accuracy metrics. RESULTS:Significant predictors of POD1 Ca included TPTX-AT (β [95% confidence interval (CI)]: -0.055 [-0.119, -0.001]), parathyroid hormone (PTH) (-0.078 [-0.115, -0.041], ng/mL), C-terminal cross-linked telopeptide of type I collagen (CTX) (-0.147 [-0.198, -0.096], μg/L), preoperative serum calcium (0.626 [0.516, 0.736], mmol/L), and alkaline phosphatase (ALP) (-0.018 [-0.024, -0.012], μkat/L). Bland-Altman analysis showed good agreement in the validation cohort (bias <0.001, 95% limits of agreement [LoA]: -0.507, 0.566). CONCLUSION:The nomogram provides an accurate, individualized prediction of postoperative hypocalcemia risk after parathyroidectomy, supporting tailored clinical management of SHPT patients.

BackgroundThe purpose of this study was to investigate the surgical model of hypothyroidism in rats and the feasibility and stability of the model.MethodsForty-eight adult male Wistar rats were randomly divided into 12 sham-operated rats (control group) and 36 operated rats (18 rats in the group with total thyroidectomy and 18 rats in the group with subtotal thyroidectomy). Thyroid-stimulating hormone (TSH), free thyroxine (FT4), and free triiodothyronine (FT3) serum concentrations were measured prior to surgery and on postoperative days 14, 28 and 90; blood calcium (Ca), blood phosphorus (P), and parathyroid hormone (PTH) concentrations were measured on postoperative day 10; and thyroglobulin (Tg) concentrations were measured on postoperative day 60. The postoperative behavioral status of the rats was comprehensively evaluated on the basis of behavioral indicators.ResultsThere was no significant difference in preoperative TSH, FT4, or FT3 between the control and surgical groups (p > 0.05). On postoperative day 10, there were no significant differences in Ca, P, or PTH levels among the groups (p > 0.05). On postoperative days 14, 28 and 90, the TSH level was greater, whereas the FT4 and FT3 levels were lower in the surgical group (p < 0.05). On the 60th postoperative day, the Tg was significantly lower in the surgical group (p < 0.05).ConclusionSurgical removal of the thyroid gland can be used to successfully establish a hypothyroid rat model that is stable and reliable and can provide a model basis for hypothyroidism-related research.

Background:The prevalence of thyroid carcinoma is on the rise, with cervical lymph node metastasis being a frequent occurrence necessitating surgical intervention. Chyle fistula, a significant postoperative complication, can have a substantial impact on recovery. Objective:To reduce the incidence of chyle fistula, enhance the effectiveness of postoperative treatment, and assist thyroid surgeons in performing cervical lymph node dissection, the consensus was compiled in a standardized and secure manner. Methods:Drawing from the expertise of Chinese specialists in managing chyle fistula and the latest international advancements in this field following cervical lymph node dissection, the thyroid tumor experts group of Chinese Thyroid Association, Chinese College of Surgeons, Chinese Medical Doctor Association and Thyroid Disease Professional Committee of Chinese Research Association have developed innovative approaches to address this issue. An evidence-based approach was employed, integrating the knowledge and practical experience of the panelists. Results:We developed twelve expert consensus recommendations, addressing the prevention, diagnosis, and treatment of postoperative chyle fistula. These recommendations included the dietary management and nutritional support, continuous negative pressure suction, local adhesive treatment, application of local compression methods, the use of somatostatin and its analogs, and surgery treatment. Conclusion:This evidence-based consensus would be valuable to assist front-line surgeons and medical specialists in the management of chyle fistula.

Our study aimed to evaluate and compare the surgical and oncological outcomes of robotic bilateral lateral neck dissection (LND) via the bilateral axillo-breast approach (BABA) with the conventional open procedures (COP) in patients with papillary thyroid carcinoma (PTC) and bilateral lateral neck metastasis (LNM). The clinical data of 181 patients with PTC and bilateral LNM who underwent robotic bilateral LND or COP (61:120) between April 2018 and February 2024 at our institution were retrospectively analyzed. 36 matched pairs were generated using a 1:1 propensity score matching (PSM) method. All robotic BABA bilateral LND procedures were successfully completed without conversion to open surgery. PSM analysis revealed that the postoperative stay, drainage volume, and the numbers of retrieved or metastatic lymph nodes were comparable between the matched groups. However, the operating time was significantly longer in the robotic group compared to the open group (p < 0.001). Furthermore, there were no significant differences between the two groups in terms of hypoparathyroidism (p = 0.637), vocal cord palsy (p = 1), and chyle leakage (p = 1). Additionally, there was no recurrence in either group. Notably, the aesthetic score was significantly higher in the robotic group compared to the open group (median, [IQR] 9 [IQR: 8–10] versus. 5 [IQR: 3–5], p < 0.001). Robotic BABA bilateral LND resulted in comparable surgical outcomes and superior cosmetic in a cohort of patients with papillary thyroid carcinoma and bilateral lateral neck metastasis.

ObjectiveTo develop and validate a machine learning (ML)-based prediction model of Bethesda III nodules and create a nomogram based on the best model.MethodsWe collected data on patients with Bethesda III nodules who were admitted between January 2020 and June 2024, including 276 Bethesda III nodules from 7371 patients who underwent ultrasound-guided fine needle aspiration (US-FNA). Clinical, ultrasonographic, cytological, laboratory, and molecular data were collected and randomly split into training and validation cohorts at a ratio of 7: 3. Six feature selection methods and ML algorithms—Logistic Regression (LR), Decision Tree (DT), Random Forest (RF), Extreme Gradient Boosting (XGB), Support Vector Machine (SVM), and K-Nearest Neighbors (KNN)—were evaluated. A nomogram was then created based on the best-performing model.ResultsThe study cohort included 276 Bethesda III nodules with a final malignancy rate of 65.2% (180/276). LR exhibited the highest area under the receiver operating characteristic (ROC) curve (AUC: 0.823) in cross-validation of the validation set. Additionally, the calibration curves and Decision Curve Analysis (DCA) results were also favorable. The model included BRAF, composition, shape, orientation, and the thyroid imaging reporting and data system (TI-RADS). The nomogram exhibited robust discrimination (AUC: 0.846 in the validation set), calibration, and clinical applicability across the two datasets after 500 bootstraps.ConclusionAmong the six ML algorithms, the LR algorithm demonstrated the best performance. A nomogram was developed to predict the malignancy risk in Bethesda III nodules. This nomogram may serve as a valuable tool to reduce diagnostic uncertainty and provide personalized risk stratification for patients.

BACKGROUND:Peripherally inserted central catheters (PICCs) are widely used for administering chemotherapy to breast cancer patients due to their long-term indwelling capability, versatility in drug administration, and flexibility. PICCs infection are a relatively common occurrence, yet there were no reported instances that it can metastasise to the lumbar spine. CASE SUMMARY:This case report describes a breast cancer patient who developed a methicillin-resistant Staphylococcus aureus lumbar vertebral infection secondary to a PICC-related infection during chemotherapy. Following PICC removal, bacterial culture confirmed the presence of highly virulent methicillin-resistant Staphylococcus aureus. The patient presented with fever and severe lumbar pain. Lumbar magnetic resonance imaging revealed paraspinal muscle edema from L1 to L3 with abnormal signal intensity in the affected regions, suggestive of vertebral osteomyelitis. Prompt initiation of appropriate antibiotic therapy based on the culture results led to significant improvement in the patient's lumbar pain. CONCLUSION:This case highlights the importance of vigilant infection prevention and control measures to minimize the risk of PICC-related complications, such as bloodstream infections and subsequent metastatic infections.

Many patients with medullary thyroid cancer (MTC) experience recurrent or persistent disease after surgery due to its aggressive nature. However, the prognostic factors for progression-free survival (PFS) have been poorly investigated. This study aimed to explore prognostic factors associated with PFS in patients with MTC. Patients with MTC were enrolled from 15 medical centers in Shandong Province, China, between January 2010 and December 2021. Univariate and multivariate Cox regression analyses were used to explore the prognostic factors for PFS in patients with MTC. Receiver operating characteristic curve analysis was performed to determine the optimal cutoff value of the metastatic lymph node ratio (LNR) in predicting PFS. Patients with MTC from the Surveillance, Epidemiology, and End Results (SEER) database were used to test the predictive value of the LNR cutoff for overall survival (OS) and disease-specific survival (DSS). In the Shandong cohort, extrathyroidal extension (HR, 1.622; 95

Secondary hyperparathyroidism (SHPT) is characterized by parathyroid hyperplasia, persistently elevated parathyroid hormone levels, and disturbances in mineral metabolism. Currently, a considerable amount of literature has consistently shown that thermal ablation is effective in maintaining parathyroid hormone levels within an appropriate range, normalizing calcium and phosphorus levels, improving clinical symptoms, and reducing the volume of parathyroid glands. However, there are currently no established guidelines regarding its utilization. The Asian consensus statement of experts on thermal ablation for SHPT in chronic kidney disease was jointly initiated by experts from China and Korea in the fields of nephrology, interventional ultrasound or radiology, thyroid surgery, ultrasound medicine, nuclear medicine, and diagnostic radiology-to formulate recommendations aimed at establishing standardized protocols for thermal ablation targeting the parathyroid glands. Based on the systematic review of literatures related to ultrasound-guided thermal ablation of parathyroid glands and the professional opinions of experts, the consensus statement covers the relevant content regarding thermal ablation treatment for SHPT, including indications, contraindications, pre-ablation evaluation, operational procedures, post-ablation follow-up, therapeutic effect evaluation, complications prevention and treatment. According to the Grading of Recommendations Assessment, Development and Evaluation, a total of 18 recommendations were given. This consensus statement will positively promote the standardization of ultrasound-guided thermal ablation of parathyroid glands.

(编者按:随着现代科学技术的飞速发展临床诊疗技术和方法不断发展和完善.本专栏的开辟旨在创建一个学术交流平台针对本学科临床工作中的热点和难点邀请在相关领域做出大量工作并颇有建树的专家和教授介绍他们的见解和经验以飨读者.圆桌论坛为个人意见不具共识性.)

With the increasingly widespread use of endoscopic and robotic surgery as intelligent and precise forms of minimally invasive surgery in parathyroid surgery, and in response to the lack of uniform guidelines for their clinical practice, this expert consensus has been formulated with the aim of promoting the standardized implementation and promotion of endoscopic and robotic parathyroid surgery. Based on the latest literature and multicenter clinical experience, the expert group on thyroid surgery of the College of Surgeons of the Chinese Medical Association, the Thyroid Disease Specialty Committee of the Chinese Association of Research Hospitals and the Parathyroid and Bone Metabolism Disease Specialty Committee of the Chinese Association of Research Hospitals, the recommendations were formulated by a thorough discussion and multiple rounds of voting, and were ultimately developed This consensus (2025 edition). This consensus systematically describes the indications and contraindications for endoscopic and robotic parathyroid surgery (especially primary hyperparathyroidism PHPT, secondary SHPT, and tertiary THPT), preoperative evaluation and preparation (whole-body assessment, stereotactic approach, and equipment selection), surgical equipment and instruments, operator qualification and training, choice of surgical access (robotic: BABA, non-inflatable The key contents include axillary approach, transoral vestibular approach; endoscopic: neck, chest and breast, transoral, etc.), key points of surgical operation and perioperative management, and prevention and treatment of complications. The Chinese Expert Consensus on Endoscopic and Robotic Parathyroid Surgery (2025 Edition) provides comprehensive guidance and reference for clinicians to standardize, safely and effectively perform endoscopic and robotic parathyroid surgery.

The safety and feasibility of transoral endoscopic thyroidectomy vestibular approach in pediatric patients has been clinically proven, and its cosmetic results have been recognized by children and their families. However, there are no reports on using transoral robotic in pediatric thyroid surgery. In this study, we report the experience of 5 cases of transoral vestibular robotic thyroidectomy in treating of thyroid disease in children. Retrospective analysis of clinical data of five children who underwent robotic thyroid surgery via the TOVRT in our hospital from February 2021 to April 2023, including operation time, tumor diameter, postoperative hospitalization time, and surgical complications. All five patients were operated on by the same team, and the postoperative pathological results were all follicular adenoma of thyroid. The children had a strong desire for cosmetic surgery, and their families voluntarily chose the robotic surgical system for their surgery. All five patients underwent unilateral thyroid lobectomy without conversion to open surgery. All patients were female, with a mean BMI of (19.63 ± 1.79) kg/m2 and the mean age was (14.40 ± 2.33) years. The average operation time was (52.00 ± 5.10) mins, the average tumor diameter was (41.60 ± 8.41) mm, and the average postoperative hospital stay was (3.60 ± 0.49) days. There were no complications such as hypoparathyroidism, recurrent laryngeal nerve injury, genioglossal nerve injury, or skin necrosis. The transoral vestibular robotic thyroidectomy is safe and feasible, providing a new treatment option for pediatric thyroid diseases that require surgical treatment.

The transoral robotic thyroidectomy (TORT) has been increasingly adopted for minimally invasive thyroid surgery and it has proved to have better cosmetic results and comparable surgical outcomes with open operations. Most reports on TORT are case series, or single center, small-sample controlled, retrospective studies, and clinical guidelines have not been established so far. To better promote the standardized implementation and widespread adoption of TORT in China, the expert panel have organized thyroid minimally invasive surgery experts and some robotic thyroidectomy experts in China jointly formulate the Chinese expert consensus on transoral vestibular approach robotic thyroidectomy and parathyroidectomy (2024 edition) based on the latest relevant literature and clinical experiences from multiple centers. This consensus aims to provide guidance and reference for colleagues.

Background: For patients with recurrent thyroid cancer, traditional open re-operative surgeries often leave conspicuous cervical scars, significantly impacting patients' long-term quality of life. The potential for robotic surgery to enhance the aesthetic outcomes of re-operative surgery and improve the quality of life for these patients has rarely been studied. This study aimed to assess the feasibility and effectiveness of robotic reoperation for recurrent thyroid cancer following initial surgery, offering a viable surgical alternative tailored to patients with heightened aesthetic concerns. Methods: We conducted a retrospective analysis of patients with recurrent thyroid cancer who underwent robotic reoperation via the bilateral axillo-breast approach (BABA) at the 960th Hospital of People's Liberation Army between September 2018 and March 2024. The study design involved a comprehensive review of clinical data, including patient demographics, surgical outcomes, and postoperative complications. Results: A cohort of 24 patients (18 females, 6 males) with a mean age of 34.13 +/- 10.06 years successfully underwent robotic BABA reoperation without conversion to open surgery. Two patients underwent completion total thyroidectomy (CTT) with central neck node dissection (CND), four underwent CTT with lateral neck dissection (LND), and the remaining 18 patients received LND alone. Histopathological examination revealed papillary thyroid carcinoma (PTC) in 23 patients and medullary thyroid carcinoma (MTC) in one patient. The mean number of lymph nodes retrieved from LND was 14.21 +/- 12.30, with 2.74 +/- 2.64 nodes harboring metastases. Postoperative complications were transient, including hypoparathyroidism in four patients and temporary vocal cord palsy in one patient, with no permanent complications reported. During an average follow-up period of 29.71 +/- 19.29 months, no recurrences were detected. Cosmetic satisfaction was assessed and yielded a median satisfaction score of 9.2. Conclusions: Robotic BABA reoperation emerges as a feasible and safe surgical modality for managing recurrent thyroid cancer, offering effective treatment while catering to patients' high aesthetic demands.

Robotic thyroidectomy is one of the most advanced surgical procedures used to manage benign and malignant thyroid nodules. However, complication risks such as tracheal injury still exists. Tracheal injury in robotic thyroidectomy is difficult to detect and is one of the life-threatening complications. This study reviews the current literature on the tracheal injury following robotic thyroidectomy and also discusses our findings on 2060 cases of robotic thyroidectomy via Da Vinci Surgical System performed in our department and finally presents 3 cases treated in our center. PubMed and Web of Science database were searched using Medical Subject Headings (Mesh) related to "tracheal injury" and "robotic thyroidectomy". The search was conducted without publication date limits. We reviewed the literature and summarized common causes, diagnosis and therapeutic options of tracheal injury in robotic thyroidectomy, which has been described in comparison studies or retrospective studies. Tracheal injury is often diagnosed when patients suffer from dyspnea and usually leads to severe postoperative consequences. Tracheal injury can be suspected in all patients having subcutaneous emphysema, pneumomediastinum, pneumothorax or dyspnea after robotic thyroidectomy. Tracheoscopy is necessary to determine the location and size of tracheal injury. In patients whose condition is stable and the injury is contained, conservative treatment is feasible. Certainly, primary closure or tracheotomy is necessary for patients with serious respiratory difficulty or pneumothorax.

To screen the risk factors for lateral lymph node metastasis (LLNM) in unifocal papillary thyroid carcinoma (PTC) with central lymph node metastasis (CLNM) and create a corresponding model. A retrospective analysis of 362 patients from our hospital was performed. All patients were randomized into training and validation groups in a ratio of 7:3. Risk factors were screened using the least absolute shrinkage and selection operator (LASSO) and logistic regression analysis. The analysis indicated that upper location, number of CLNM ≥ 3, rate of CLNM ≥ 0.172, prelaryngeal LNM, pretracheal LNM, and tall cell variant of papillary thyroid carcinoma (TCV-PTC) are independent risk factors. Visualizing the model with a nomogram, receiver operating characteristic (ROC) curves revealed an area under the curve (AUC) of 0.773 for the training group and 0.779 for the validation group. This confirms the stability and outstanding accuracy of the model. Also, the calibration curves and clinical descision curves reflect strong calibration,offering potential clinical benefits. The risk factors for LLNM include metastasis to the prelaryngeal lymph nodes, metastasis to the pretracheal lymph nodes, location in the upper level, number of metastases ≥3 in CLNM, TCV-PTC and metastasis rate ≥0.172. A nomogram incorporating these factors exhibits excellent predictive value and stability.