Kuma Hospital

Endocrine surgery encompasses various organ systems, but thyroid surgery represents the major component. The Japanese Association of Thyroid Surgeons published nationwide data on thyroid cancer surgery until 2005, since when no further reports have been published. Thus, we analyzed thyroid surgery trends using data from the National Clinical Database (NCD) from 2014 to 2023. We analyzed cases of thyroid surgery, for malignant and benign conditions, recorded in the NCD. A detailed analysis of papillary thyroid carcinoma (PTC) cases was conducted in 2014, 2019, and 2023 to assess TNM classification, surgical procedures, complications, and outcomes. The number of thyroid surgery facilities and the number of thyroid surgeries being performed have both declined since 2020. A trend toward more hemithyroidectomies and fewer total thyroidectomies for PTC is evident. The number of surgeries for cancers < 1cm and lateral node dissection for PTC have also decreased. Endoscopically assisted surgery has increased continuously, accounting for > 4% of thyroid operations in 2020. The incidence of permanent hypoparathyroidism has decreased and perioperative mortality is rare. The changes in surgical trends are aligned with guideline updates and shifts in surgical practice. Future efforts will refine data collection and utilize the NCD to improve thyroid surgical quality and research.

Molecular testing is recommended for risk stratification of atypia of undetermined significance (AUS) nodules in the USA; however, it is not routinely performed in some countries owing to limited availability and affordability. Here, we propose a risk stratification algorithm for AUS nodules when molecular testing is unavailable. We examined 304 (4.3%) AUS nodules among 7073 thyroid fine-needle aspiration cytology specimens examined at Kuma Hospital from January 2020 to December 2020. Clinical data were obtained from the medical records of Kuma Hospital. AUS with nuclear atypia and AUS-other each accounted for half of the total AUS nodules. The repeat aspiration rate was 19.7%; 61.7% of the nodules were reclassified as benign or malignant upon repeat aspiration. Resection rate and overall risk of malignancy (ROM) were 32.6% and 12.8%, respectively. Architectural atypia showed the lowest (1.1%) overall ROM in the AUS nodules. For AUS with nuclear atypia, nodules ≤ 10 mm in size showed significantly lower overall ROM than those of > 10 mm, and nodules with ultrasonographically low suspicion showed significantly lower overall ROM than those with intermediate to high suspicion. AUS nodules with atypical lymphoid cells, possible medullary thyroid carcinoma, or possible parathyroid lesion were confirmed using flow cytometry, biochemical testing using needle washout fluid or immunocytochemistry, respectively. Our proposed clinical management algorithm for each subdivision according to cytological findings, based on repeat aspiration rates, ROM, ultrasound findings and results of ancillary tests except for molecular testing, should be useful for the clinical management of AUS nodules.

The latest “General Rules for the Description of Thyroid Cancer,” published in 2023, introduced depth-based subcategories of tumor invasion, dividing sEx2 into sEx2a, sEx2b, and sEx3. However, the “Clinical Guidelines on the Management of Thyroid Tumors,” published in 2024, continue to classify these categories uniformly as high-risk for papillary thyroid carcinoma (PTC). We evaluated the appropriateness of reclassifying sEx2a-high-risk patients as intermediate-risk. A total of 9,247 patients [median age: 52 years (7–93)] who underwent locally curative surgery were enrolled, with a median follow-up of 7.8 years. Cause-specific survival (CSS), distant recurrence-free survival (DR-FS), and local recurrence-free survival (LR-FS) worsened progressively from low-risk to high-risk patients. We compared the prognoses among the patients classified as sEx2a-high-risk, sEx2b, and intermediate-risk. The CSS, DR-FS, and LR-FS outcomes of sEx2b patients were significantly poorer than those of sEx2a-high-risk and intermediate-risk patients. By reclassifying sEx2a-high-risk patients as intermediate-risk, we established a new high-risk and intermediate-risk classification. The number of high-risk patients decreased from 2,274 to 1,132, whereas the number of intermediate-risk patients increased from 2,875 to 4,017. Prognoses in these new groups showed minimal differences compared to the original high- and intermediate-risk classifications. We established novel prognostic groups: favorable (N = 6,398, low-risk and intermediate-risk <55 years), intermediate (N = 2,324, intermediate-risk ≥55 years and high-risk <55 years), and poor (N = 525, high-risk ≥55 years). Prognoses significantly worsened across these groups from favorable to poor (p < 0.001). The reclassification of PTC based on tumor extension and the proposed novel prognostic groups provide a more accurate evaluation of PTC outcomes.

Microvascular decompression (MVD) of the trigeminal nerve is an effective procedure for treating patients with trigeminal neuralgia (TGN). However, vertebrobasilar decompression involves technical difficulties and demonstrates a higher risk of minor trigeminal hypesthesia/hypalgesia, transient diplopia, and hearing loss. Stereotactic radiosurgery (SRS) has been an effective alternative treatment for TGN. Few studies reported the treatment results of SRS for TGN caused by vertebrobasilar compression. This report presents the treatment results of SRS using gamma knife (GK) in four TGN cases. GK-SRS was performed for TGN due to vertebrobasilar compression in four patients, including two males and two females, aged 67-90 years. The maximum dose of 80 Gy was delivered at the retrogasserian portion (RGP) of the ipsilateral trigeminal nerve root. All four cases with TGN achieved relief in four to 10 months after GK-SRS. However, TGN recurred 41 months after GK-SRS in one of the four cases. A second GK-SRS at the root entry zone (REZ) at a maximum dose of 70 Gy relieved pain again 10 days later. TGN in another case among the four partially recurred in three years but did not deteriorate until the patient died from old age 62 months after GK-SRS. The other three cases, including the one with repeat GK-SRS, were alive with complete TGN remission at the end of follow-up of 20-52 months. GK-SRS-related adverse effects were not observed in any case. GK-SRS was a safe and effective treatment in all four TGN cases due to vertebral artery (VA)-basilar artery (BA)compression, although a second treatment session was added again for pain recurrence in one of the four cases.

Subclinical hyperthyroidism (SHyper) is defined as normal levels of free thyroxine (fT4) and free triiodothyronine (fT3) with suppressed levels of TSH. Previous studies have reported the individual pathophysiology of endogenous SHyper patients and athyreotic patients receiving TSH suppression therapy with levothyroxine; however, apparently no studies have compared the two conditions. Five-hundred-forty untreated endogenous SHyper patients and 1,024 patients receiving TSH suppression therapy who underwent total thyroidectomy for papillary thyroid carcinoma were sampled. Thyroid hormone profiles and peripheral indices related to thyrotoxicosis were investigated in endogenous SHyper patients, athyreotic patients receiving TSH suppression therapy, and healthy participants. Endogenous SHyper patients showed significantly higher thyroid hormone levels (fT4 [p < 0.001] and fT3 [p < 0.001]), and peripheral indices showed a significant tendency towards thyrotoxicosis (strong TSH suppression: alkaline phosphatase [ALP, p < 0.001], creatinine [Cre, p < 0.001], pulse rate [p < 0.05]; and mild TSH suppression: Cre [p < 0.05]) than healthy participants. In contrast, athyreotic patients receiving TSH suppression therapy showed a significant tendency towards thyrotoxicosis than healthy participants only when TSH was strongly suppressed (fT3 [p < 0.001] and Cre [p < 0.001]). Endogenous SHyper patients showed significantly higher fT3 levels (p < 0.001) than athyreotic patients receiving TSH suppression therapy; however, there was a significant tendency towards thyrotoxicosis only when TSH was strongly suppressed (ALP [p < 0.05] and pulse rate [p < 0.05]). The effects of endogenous SHyper and TSH suppression therapy on target organ function are different. Although the serum thyroid hormone profile is similar to that of the thyrotoxic state, athyreotic patients receiving TSH suppression therapy with mildly suppressed serum TSH levels are not thyrotoxic.

Local residents and tourists of Kume Island suffer from the biting of Leptoconops taiwanensis (Lien, Lin &amp; Weng 1998) (Ceratopogonidae), a species known as asa-mushi (sea lettuce bug). Because L. taiwanensis bites tend to occur while harvesting sea lettuce, some locals mistakenly believe that L. taiwanensis inhabits the sea lettuce. The objectives of the current study are to (i) identify the chironomid species inhabiting the sea lettuce, (ii) determine the distribution of the larvae, and (iii) perform a faunistic investigation of Chironomidae at Shinri Beach. Only one male chironomid species, Ainuyusurika tuberculatum (Tokunaga, 1940), emerged from the samples taken from the beach. The density of chironomid larvae was the highest in the presence of sea lettuce. A total of 53 males were collected using light traps, of which we identified males of seven genera and seven species belonging to three subfamilies. No L. taiwanensis were collected in this study.