STUDY QUESTION: What are the consequences of radioactive iodine (RAI) therapy for testicular function? SUMMARY ANSWER: A single activity of 3.7 GBq RAI for differentiated thyroid carcinoma (DTC) treatment in young men transiently altered Sertoli cell function and induced sperm chromosomal abnormalities. WHAT IS KNOWN ALREADY: Few studies, mainly retrospective, have reported the potential impacts of RAI on endocrine and exocrine testicular function. STUDY DESIGN, SIZE, DURATION: A longitudinal prospective multi-center study on testicular function performed in DTC patients before a single I-131 ablative activity of 3.7 GBq (V0) and at 3 months (v3) and 13 months (V13) after treatment. PARTICIPANTS/MATERIALS, SETTING, METHODS: Forty male patients, aged 18-55 years, with DTC participated. Hormonal analysis included FSH, LH, testosterone and inhibin B serum levels at V0, V3 and V13. Furthermore, sperm parameters, DNA fragmentation and sperm chromosomal abnormalities were evaluated at each time points. The differences in all parameters, between V0-V3, V0-V13 and V3-V13, were analyzed, using a Wilcoxon test. MAIN RESULTS AND THE ROLE OF CHANCE: Prior to RAI administration, all patients had normal gonadal function. At V3, a statistically significant increase in FSH levels and a decrease in inhibin B levels were observed and sperm concentration, as well as the percentage of morphologically normal spermatozoa, were significantly decreased (P < 0.0001). These modifications were transient as both sperm concentration and normal morphology rate returned to baseline values at V13. However, at this later time point, FSH and inhibin B levels were still impacted by RAI administration but remained in the normal range. Although no DNA fragmentation was observed at V3 nor V13, our study revealed a statistically significant increase in the number of sperm chromosomal abnormalities both at V3 (P < 0.001) and V13 (P 0.01). LIMITATIONS, REASONS FOR CAUTION: Among the 40 patients included in the study, only 24 had all the parameters available at all visits. WIDER IMPLICATIONS OF THE FINDINGS: Prospective studies with longer term follow up would be helpful to determine whether the chromosome abnormalities persist. These studies would be required before sperm banking should be suggested for all patients. However, sperm preservation for DTC patients who require cumulative radioiodine activities higher than 3.7 GBq should be proposed.

L’irathérapie (131I) est un traitement de référence dans la maladie de Basedow (MB) mais ses modalités restent débattues. Nous avons comparé 2 protocoles d’activités fixes avec pour objectif de diminuer l’activité administrée sans perdre en efficacité. Une étude rétrospective a inclus les patients adressés pour une MB ayant reçu une irathérapie entre 2010 et 2016 (groupe 1). Après évaluation échographique (masse thyroïdienne : MT) et scintigraphique (fixation de 123I à 2 h : F2 h) de leur thyroïde, les doses prescrites étaient 370, 555 ou 740MBq. Puis prospectivement, pendant 1 an, 555MBq étaient prescrits si MT > 20 g et F2h < 30 %. Dans les autres cas l’activité était 370MBq (groupe 2). Le succès correspond à la guérison de l’hyperthyroïdie dans les 6 mois post-traitement. Dans le groupe 1, 121 patients ont été inclus : 48 % ont reçu 370MBq, 34 % 555MBq et 18 % 740MBq. Dans le groupe 2, l’activité moyenne a diminué de 93MBq (522MBq vs 429MBq, p < 0,001, Student) : sur les 29 patients inclus, 72 % ont reçu 370MBq. Dans les 2 groupes qui étaient globalement comparables, il y a eu 83 % de succès (p = 1, Chi2). Les échecs du groupe 1 concernent 24 % des patients traités par 370MBq, 12 % par 555MBq et 9 % par 740MBq. Dans le groupe 2, les 17 % de patients en échec ont reçu 370MBq. Une analyse multivariée a identifié la MT comme seul facteur indépendant pronostique de réussite. Malgré une diminution des activités, les résultats sont identiques dans les 2 études. Pour optimiser le nombre de succès, la MT est un facteur important à retenir.

L’irathérapie (131I) est un traitement de référence du(des) nodule(s) toxique(s) (NTs) mais ses modalités restent débattues. Nous avons comparé 2 protocoles d’activités fixes avec pour objectif de diminuer l’activité sans perdre en efficacité. Une étude rétrospective a inclus les patients adressés pour NTs ayant reçu une irathérapie entre 2010 et 2016 (Groupe 1). Après évaluation échographique (diamètre du nodule : Nod ou masse thyroïdienne : MT) et scintigraphique (fixation de 123I à 2 h : F2 h) de leur thyroïde, les activités prescrites étaient de 555 ou 740MBq. Puis prospectivement sur 1 an (Groupe 2), 740MBq étaient prescrits si Nod > 30 mm ou MT > 20 g et si F2 h < 7 %. Dans les autres cas l’activité était de 555MBq. Le succès correspond à la guérison de l’hyperthyroïdie dans les 6 mois post-traitement. Dans le Groupe 1 103 patients ont été inclus : 88 % ont reçu 740MBq. Dans le Groupe 2, l’activité moyenne a diminué de 181MBq (p < 0,001, Student) : sur 40 patients inclus, 95 % ont reçu 555MBq. Les 2 groupes étaient comparables. Il y a eu 1 échec dans le Groupe 1 : le patient ayant reçu 740MBq, avec un goitre important (87 g) et fixant à 3,1 %. Dans le Groupe 2 il y a eu 2 échecs avec 555MBq : 1 nodule de 12 mm fixant à 21 % et un goitre volumineux (104 g) fixant fortement à 81 %. Les hypothyroïdies post-traitement ont diminué au profit d’euthyroïdies (54 % vs 29 %, p < 0,05, Chi2). La diminution des activités a permis d’éviter des traitements hormonaux substitutifs sans perte d’efficacité (échecs 2 % versus 5 %, p = 0,078, Fischer).

Le traitement du carcinome différencié de la thyroïde est chirurgical. Il est souvent complété par l’administration d’iode radioactif. À ce jour, les conséquences de ce traitement sur la fonction testiculaire sont mal connues.

Les médicaments radiopharmaceutiques sont couramment utilisés en pédiatrie en médecine nucléaire. Du fait des modifications physiologiques des enfants en cours de croissance et de leur radiosensibilité, des précautions sont à prendre afin de sécuriser leur prise en charge. L'objectif de ce travail est de proposer des recommandations sous l'égide de la Société française de radiopharmacie (SoFRa) pour la population pédiatrique à toutes les étapes du circuit du médicament radiopharmaceutique. Le plan suit ces étapes. Des recommandations concernant l'étape de la prescription médicale sont proposées pour les médicaments radiopharmaceutiques à visée thérapeutique et pour ceux à visée diagnostique ; elles sont basées sur l'analyse de deux enquêtes menées sur les posologies appliquées dans différents services de médecine nucléaire en France. Les spécificités de la préparation pour les patients en pédiatrie sont abordées en utilisant l'exemple des médicaments radiopharmaceutiques utilisés pour la réalisation de scintigraphie pulmonaire. De même, la préparation de doses à administrer et l'administration sont décrites. Ainsi, l'expertise des radiopharmaciens concernant le circuit du MRP apporte une sécurisation indispensable. Un travail pluridisciplinaire est nécessaire afin d'optimiser la prise en charge des patients pédiatriques.Radiopharmaceuticals are commonly used in children in nuclear medicine. Because of physiological differences in growing children and their radiosensitivity, precautions must be taken throughout the medication use process. The aim of this work is to propose recommendations, under the aegis of the Société française de radiopharmacie (SoFRa), for each subsystem of the process, in order to ensure the safety of pediatric patients. Furthermore, an analysis of two surveys on diagnostic radiopharmaceuticals dosage used in different nuclear medicine departments in France is detailed. Recommendations for therapeutic radiopharmaceuticals are also provided. Specificities of the preparation for pediatric patients are discussed through the example of the radiopharmaceuticals for lung perfusion scintigraphy. The preparation of individual dose and administration are also described. In nuclear medicine, radiopharmacist's expertise is essential for patient safety. A multidisciplinary approach is necessary to secure pediatric radiopharmaceutical use process.

Les exemples et les cas cliniques présentés dans cette partie n'ont pas vocation à être considérés comme des modèles absolus en termes de qualité image ou de paramétrage des appareils. Les exemples doivent contribuer à initier une réflexion individuelle concernant le paramétrage du scanner en fonction de la situation clinique, du niveau de scanner que l'on souhaite réaliser et de l'appareillage dont on dispose. Ils permettent de présenter de manière concrète, à partir d'images de sélection, des exemples des différents niveaux de scanner envisageables dans une situation donnée.The examples and clinical cases presented in this section are not intended to be considered as absolute models in terms of image quality or device parameter settings. They must initiate an individual analysis according to CT parameters and image quality. Nevertheless, they present practically different CT levels, which can be used according to the clinical context and the type of device.

L’objectif principal de l’étude était de décrire les résultats oncologiques de tous les patients suivis en Île-de-France pour un cancer thyroïdien traité par voie axillaire au robot et IRAthérapie. Étude rétrospective des caractéristiques cliniques, biologiques et morphologiques des tous les patients suivis pour un cancer thyroïdien traité par thyroïdectomie totale, avec ou sans évidement ganglionnaire, par voie axillaire au robot, entre 2011 et 2015, et IRAthérapie. Le statut oncologique était évalué a posteriori selon les critères de l’ATA2015. 28 patients dont 22 femmes ont été inclus, d’âge moyen 47 ans, avec un suivi médian de 12 mois (1–38). Les cancers thyroïdiens étaient tous bien différenciés (86 % carcinomes papillaires, 15 % carcinomes vésiculaire), de taille médiane 22 mm (7–70) ; 46 % seraient classés bas risques et 54 % risque intermédiaire de récidive (dont 5N1a et 6N1b). IRAthérapie : 21 % des patients ont reçu 1,1GBq et 79 % 3.7GBq d’iode131. Les scintigraphies post-thérapeutiques étaient normales sauf une montrant une adénopathie persistante et une des micronodules pulmonaires fixants, aucune image inhabituelle n’a été retrouvée. L’évaluation à 6–12 mois après IRAthérapie retrouve 20 réponses complètes, 2 réponses indéterminées, 3 maladies résiduelles morphologiques dont 2 bénéficieront d’une reprise chirurgicale, et 3 perdus de vue. Le statut oncologique aux dernières nouvelles est inchangé. Nous décrivons une petite cohorte de patients atteints de cancer thyroïdien traité par une technique chirurgicale récente [1]. L’IRAthérapie a des résultats équivalents à ceux de la chirurgie classique. La réponse oncologique est bonne.

Ces dernières années ont été marquées par l’émergence de nouvelles molécules pour le traitement des formes métastatiques du mélanome cutané avec un bénéfice significatif sur la survie des patients apportant ainsi de nouvelles perspectives thérapeutiques. Par ailleurs, de nombreuses techniques se développent actuellement pour le traitement locorégional des sites métastatiques. La prise en charge du mélanome métastatique est donc en pleine mutation, marquée par des approches thérapeutiques innovantes. Néanmoins, la mise à disposition de ces nouveaux traitements soulève auprès des professionnels de santé des interrogations quant à leur utilisation et place dans la stratégie thérapeutique.L’Institut national du cancer (INCa), dont l’une des missions est de définir et de favoriser la diffusion de recommandations nationales de bonnes pratiques cliniques depuis 2008, a souhaité diffuser un état des lieux des connaissances sur ces modalités de traitement et formuler des recommandations afin de permettre une diffusion au niveau national de l’innovation tout en favorisant son bon usage.Le processus d’élaboration est basé sur une revue systématique de la littérature et sur le jugement argumenté d’experts cliniciens au sein d’un groupe de travail multidisciplinaire. Avant publication, les recommandations sont revues par des experts cliniciens indépendants du groupe de travail.Cet article présente les recommandations nationales relatives au traitement systémique de 1re et de 2e ligne et aux traitements locorégionaux des sites métastatiques des patients atteints d’un mélanome cutané métastatique.Recent years have seen the emergence of new molecules for the treatment of patients with metastatic cutaneous melanoma, with significant benefits in terms of survival and the opening of new therapeutic perspectives. In addition, many techniques are currently being developed for locoregional treatment of metastatic sites. Management of metastatic melanoma is thus fast-changing and is marked by innovative therapeutic approaches. However, the availability of these new treatments has prompted debate among healthcare professionals concerning their use and their place in therapeutic strategy.Since 2008, the French National Cancer Institute (INCa) has been leading a project to define and diffuse national clinical practice guidelines. It has performed a review of these treatment methods, which it aims to circulate, and it is seeking to develop recommendations in order to allow nationwide implementation of innovative approaches while promoting good use thereof.The clinical practice guidelines development process is based on systematic literature review and critical appraisal by experts within a multidisciplinary working group, with feedback from specialists in cancer care delivery. The recommendations are thus based on the best available evidence and expert agreement. Prior to publication, the guidelines are reviewed by independent practitioners in cancer care delivery.This article presents the national recommendations for first- and second-line systemic treatment and for locoregional treatment of metastatic sites in patients presenting metastatic cutaneous melanoma.

European Annals of Otorhinolaryngology, Head and Neck Diseases - Vol. 129 - N° 4 - p. 197-206

Rehospitalization early post–kidney transplant is common and has a negative impact in morbidity, graft survival, and health costs. Infection is one the most common causes, and identifying the risk factors for early readmission due to infectious complications may guide a preventive program and improve outcome. The aim of this study was to evaluate the incidence, characterize the population, and identify the risk factors associated with early readmission for infectious complications post–kidney transplantation.We performed a retrospective cohort study of all the kidney transplants performed during 2015. The primary outcome was readmission in the first 3 months post-transplant due to infectious causes defined by clinical and laboratory parameters.We evaluated 141 kidney transplants; 71% of subjects were men, with an overall mean age of 50.8 ± 15.4 years. Prior to transplant, 98% of the patients were dialysis dependent and 2% underwent pre-emptive living donor kidney transplant. The global readmission rate was 49%, of which 65% were for infectious complications. The most frequent infection was urinary tract infection (n = 28, 62%) and the most common agent detected by blood and urine cultures was Klebsiella pneumonia (n = 18, 40%). The risk factors significantly associated with readmission were higher body mass index (P = .03), diabetes mellitus (P = .02), older donor (P = .007), and longer cold ischemia time (P = .04). There were 3 graft losses, but none due to infectious complications.There was a high incidence of early rehospitalization due to infectious complications, especially urinary tract infections to nosocomial agents. The risk factors identified were similar to other series.

Nitrides have been proposed to be a suitable material for fast neutronic systems from beginning of the development of nuclear fuel. Starting with the production of uranium nitride and sesquinitrides up to mixed plutonium uranium nitrides, today's developments are inert nitride matrix materials to burn plutonium or to transmute long-lived actinides in accelerator-driven sub-critical systems (ADS) or fast reactors (FR). Several authors proposed zirconium nitride as possible inert matrix material for this reason. Mixed zirconium nitrides can be fabricated by carbothermal nitridation of the oxides in a narrow temperature window. Obtaining high quality material with low carbon and oxygen content is still the major challenge. Producing mixed nitride fuels by special shaping methods, as for example direct coagulation casting or freeze drying, in comparison to conventional powder compaction enables to use this material in special shapes to optimize burn up.The history of nitride fuels at PSI will be shown up to today's CONFIRM project, dealing with plutonium zirconium nitride fuels.

Purpose: This prospective study evaluated the recurrence rate in 715 patients with differentiated thyroid cancer who had no evidence of persistent disease after total thyroidectomy and lymph node dissection in 94% of them followed up by radioiodine ablation (30-100 mCi) and assessed the predictive value of the initial thyroglobulin (Tg) levels for detecting recurrence, both during levo-thyroxine (LT4) treatment and after TSH stimulation.Patients and Methods: Patients had Tg determinations performed at 3 months on LT4 treatment (Tg1) and at 9-12 months after stimulation by either thyroid hormone withdrawal or recombinant human TSH (Tg2); the Access kit was used (functional sensitivity of 0.11 ng/ml); they had undetectable anti-Tg antibodies. Patients were followed up annually. Predictive values were calculated by comparing Tg levels (Tg1 and Tg2) and the outcome in terms of recurrence.Results: During the median follow-up of 6.2 yr, 32 patients had a recurrence. Assuming a cutoff level for Tg1 at 0.27 ng/ml, Tg1 sensitivity and specificity reached 72 and 86%, respectively, whereas predictive positive and negative values were 20 and 99%, respectively. With a cutoff level for Tg2 at 1.4 ng/ml, sensitivity and specificity reached 78 and 90%, respectively, whereas positive and negative predictive values were 26 and 99%, respectively.Conclusion: This large prospective cohort of patients presented a low rate of recurrence. Initial Tg measurements allow to predict long-term recurrence with an excellent specificity. Stimulated Tg determination presented a slightly higher sensitivity than Tg determination on LT4. TSH stimulation may be avoided when Tg measured 3 months after ablation is less than 0.27 ng/ml during LT4 treatment. (J Clin Endocrinol Metab 96: 1352-1359, 2011)

Abstract Background: Prospective evaluation of the role of 18FDG-PET/CT in patients with large primary operable breast cancer. Material and Methods: During 56 months, consecutive patients with large (>2cm) breast cancer and clinical stage IIA/IIB/IIIA (based on clinical examination, mammography, breast MRI and ultrasonography) underwent 18FDG-PET/CT. The nuclear physician was blind to the results of any other procedure (bone scan, chest X-ray, liver ultrasound, or thoraco-abdominal CT scan). Results: Out of the 131 examined patients, 36 had clinical stage IIA (34 T2 N0, 2 T1 N1), 48 stage IIB (20 T3 N0, 28 T2 N1), and 47 stage IIIA (29 T3 N1, 9 T2 N2, 9 T3 N2). 18FDG-PET/CT modified staging for 5.6% of stage IIA patients, for 14.6% of stage IIB patients, and for 27.6% of stage IIIA patients. However, within stage IIIA, the yield was specifically high among the 18 patients with N2 disease (56% stage modification). When considering stage IIB and primary operable IIIA (T3 N1) together, the yield of 18FDG-PET/CT was 13% (10/77); extra-axillary regional lymph nodes were detected in 5 and distant metastases in 7 patients. In this series, 18FDG-PET/CT outperformed bone scan with only 1 misclassification versus 8 for bone scan (p=0.036). Discussion: 18FDG-PET/CT provided useful information in 13% of patients with T3 N0 / T2 N1 / T3 N1 disease. The yield was more modest in patients with T2 N0 disease. The very high yield in the case of lymph nodes classified N2 demonstrates that stage IIIA comprises two quite distinct groups of patients. Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P2-09-11.

As compared to conventional axillary dissection, the sentinel node technique is accompanied by reduced morbidity and shorter hospital stay. Based on available data, the use of this technique does not seem to yield higher rates of axillary recurrence. A combination of both radioisotope detection and blue dye increases the identification rate, while also reducing false-negative rate. Surgical results are optimized when preoperative lymphoscintigraphy mapping is obtained in addition to peroperative probe detection. Considering the site of injection, the subareolar injection can be easy to apply even in case of non-palpable tumours, and gives higher count rates. However, the intraparenchymal, peritumoral, injection is necessary to evidence cases of extra-axillary drainage (internal mammary, infra- or supraclavicular) that is present in about 20% of patients. With the advent of hybrid cameras (SPECT-CT), the topography of these extra-axillary nodes can be given with high precision. Use of the sentinel node technique has been accompanied by an increase in the percent of patients with node involvement, due to an increased detection of micrometastases inferior or equal to 2 mm. Following an overview of basic principles, and of the main results with the sentinel node technique we focus the discussion on several points that are still open to debate, such as: 1) which group of patients can benefit from the sentinel node technique? 2) What is the optimal methodology? 3) What is the prognostic significance of micrometastases and of isolated tumour cells? 4) What attention should be given to extra-axillary drainage?

The present paper addresses the advantages and limits of PET-CT in the work-up of cervical cancer. PET-CT is not to be overlooked in initial staging. It is useful to assess involvement of pelvic and lumbar lymph nodes. It can improve staging accuracy and help guide initial treatment such as optimisation of radiation therapy fields. Given its limited spatial resolution however, PET does not seem so adequate to document tumours less than 5 mm in diameter. It is not warranted for staging carcinoma in situ (FIGO stage 0) or preclinical carcinoma (FIGO stage 1A1 and 1A2). Furthermore MRI performances are best as far as local extension and tumour volume measurement are concerned. PET brings prognostic information. High initial uptake in tumour tissue or persistent increased uptake at completion of treatment indicates rather poor prognosis. PET is useful to evaluate therapy, but its exact role in this issue remains to be further refined. Finally, PET-CT can document early recurrence of disease.

As compared to conventional axillary dissection, the sentinel node technique is accompanied by reduced morbidity and shorter hospital stay. Based on available data, the use of this technique does not seem to yield higher rates of axillary recurrence. A combination of both radioisotope detection and blue dye increases the identification rate, while also reducing false-negative rate. Surgical results are optimized when preoperative lymphoscintigraphy mapping is obtained in addition to peroperative probe detection. Considering the site of injection, the subareolar injection can be easy to apply even in case of non-palpable tumours, and gives higher count rates. However, the intraparenchymal, peritumoral, injection is necessary to evidence cases of extra-axillary drainage (internal mammary, infra- or supraclavicular) that is present in about 20% of patients. With the advent of hybrid cameras (SPECT-CT), the topography of these extra-axillary nodes can be given with high precision. Use of the sentinel node technique has been accompanied by an increase in the percent of patients with node involvement, due to an increased detection of micrometastases inferior or equal to 2 mm. Following an overview of basic principles, and of the main results with the sentinel node technique we focus the discussion on several points that are still open to debate, such as: 1) which group of patients can benefit from the sentinel node technique? 2) What is the optimal methodology? 3) What is the prognostic significance of micrometastases and of isolated tumour cells? 4) What attention should be given to extra-axillary drainage?

We report on the case of a man with a previous history Of testicular seminoma and a pathological paravertebral mass definitely taking-up FDG on PET/CT. This mass was finally a benign schwannoma. (C) 2008 Elsevier Masson SAS. All rights reserved.

Multinodular goiter is a common disorder, found in 5% of the general population. If only one thyroid lobe is affected, hemithyroidectomy may be preferred to total thyroidectomy, to limit the risk of complications and avoid hormone replacement therapy, but incurs a risk of subsequent completion thyroidectomy. The aim of the present study is to determine whether the arguments in favor of hemithyroidectomy are justified and whether it still provides real benefit.A retrospective observational study based on prospective data included all patients who underwent surgery for goiter or nodule in our center between September 2010 and September 2014. Rates of hormone replacement 6 months after hemithyroidectomy, postoperative complications and completion thyroidectomy during the postoperative year due to the discovery of carcinoma were analyzed.Four hundred and ninety-three patients were studied: 335 with total thyroidectomy and158 with hemithyroidey. The rate of hormone replacement 6 months after hemithyroidectomy was 84.4%. The rate of definitive hypocalcemia was 6.3% in total thyroidectomy and zero in hemithyroidectomy (P < 0.05). There was no significant difference between groups in terms of recurrent laryngeal nerve palsy (1.8% versus 1.9%; P = 1) or hematoma (1.2% versus 3.5%; P = 0.15). A total of 11.3% of hemithyroidectomies required completion due to discovery of carcinoma (mean interval between surgeries 3.58 ± 2.5 months).This study suggests that hemithyroidectomy does not in fact avoid the risk of hormone replacement and places the patient at risk of completion thyroidectomy. However, it does avoid a 6% rate of hypocalcemia. We would recommend hemithyroidectomy only in case of single toxic or euthyroid nodule with healthy contralateral lobe and/or refusal of hormone replacement by the patient.Le goitre multinodulaire est une pathologie fréquente, de l’ordre de 5 % de la population générale. Si un seul lobe thyroïdien est atteint, l’isthmolobectomie peut être préférée à une thyroïdectomie totale pour diminuer les risques de complications et éviter la supplémentation hormonale, mais expose le patient à un risque de totalisation. Le but de cette étude est de savoir si ces arguments sont justifiés et s’il reste vraiment un intérêt à l’isthmolobectomie.Nous avons réalisé une étude observationnelle rétrospective basée sur des données recueillies de façon prospective. Nous avons étudié tous les patients opérés d’un goitre ou nodule thyroïdien dans notre centre entre septembre 2010 et septembre 2014. Nous avons analysé le taux de supplémentation hormonale à 6 mois après isthmolobectomie, les complications postopératoires et le taux de totalisation dans l’année du fait de la découverte d’un carcinome thyroïdien.Nous avons étudié 493 patients (335 thyroïdectomies totales et 158 isthmolobectomies). Le taux de supplémentation hormonale était de 84,4 % à 6 mois de l’isthmolobectomie. Nous avons trouvé un taux d’hypocalcémie définitive de 6,3 % parmi les cas de thyroïdectomies totales et aucun parmi les isthmolobectomies (p < 0,05). Il n’y avait pas de différence significative en terme de paralysie récurrentielle (1,8 % versus 1,9 %; p = 1) ou d’hématome (1,2 % contre 3,5 %; p = 0,15). Au total, 11,3 % des isthmolobectomies ont été totalisées en raison de la découverte d’un carcinome, avec un intervalle moyen de 3,58 ± 2,5 mois après la première opération.Cette étude suggère que l’isthmolobectomie ne réduit pas le risque de supplémentation hormonale et expose le patient au risque d’une totalisation secondaire. Néanmoins, l'isthmolobectomie prévient le risque de 6 % d’hypocalcémie associée à la thyroïdectomie totale. Nous recommandons une isthmolobectomie en cas de nodule unique (toxique ou euthyroïdien) avec un lobe controlatéral sain et/ou en cas de refus de supplémentation hormonale du patient après chirurgie.