The purpose of this study was to define and characterize the thyroid tumor-draining lymph nodes i... more The purpose of this study was to define and characterize the thyroid tumor-draining lymph nodes in genetically engineered mice harboring thyroid-specific expression of oncogenic Braf(V600E) with and without Pten insufficiency. After intratumoral injection of methylene blue, the lymphatic drainage of the thyroid gland was visualized in real time. The thyroid gland/tumor was resected en bloc with the respiratory system for histological analysis. Although mice harboring Braf(V600E) mutations were smaller in body size compared with their wild-type (WT) littermates, the size of their thyroid glands and deep cervical lymph nodes were significantly larger. Additionally, the tumor-draining lymph nodes showed increased and enlarged lymphatic sinuses that were distributed throughout the cortex and medulla. Tumor-reactive lymphadenopathy and histiocytosis, but no frank metastases, were observed in all mice harboring Braf(V600E) mutations. The tumor-draining lymph nodes undergo significant stru...
Objective To quantify how frequently intraoperative parathyroid hormone levels increase during th... more Objective To quantify how frequently intraoperative parathyroid hormone levels increase during thyroid surgery and to explore a possible relationship between secondary hyperparathyroidism due to vitamin D deficiency and elevation in intraoperative parathyroid hormone. Study Design Case series with chart review. Setting Tertiary academic center. Subjects and Methods A total of 428 consecutive patients undergoing completion and total thyroidectomy by the senior author over a 7-year period were included for analysis. All patients had baseline and postexcision intraoperative parathyroid hormone levels as well as vitamin D levels from the same laboratory. Institute of Medicine criteria were employed for vitamin D stratification (>30, normal; 20-29.9, insufficient; <20, deficient) . Other data analyzed include sex, age, neck dissection status, and parathyroid autotransplantation. Results A total of 118 patients (27.6%) had an intraoperative parathyroid hormone elevation above baseli...
Introduction: Four-dimensional CT (4D CT) can be used in the setting of hyperparathyroidism to lo... more Introduction: Four-dimensional CT (4D CT) can be used in the setting of hyperparathyroidism to localize parathyroid adenomas. In particular, 4D CT can help differentiate an adenoma from common decoys to localize ectopic lesions and identify multigland disease. The purpose of this video was to provide an introduction and general overview of this imaging modality for clinicians who treat patients with hyperparathyroidism. Materials and Methods: Imaging is performed with a 64-detector row CT scanner (Philips, Andover, MA) with the following specifications: 180 to 400 mA, 120 kV, and 180 mm field of view. To minimize the radiation dose, coverage is customized from the mandible to the aorticopulmonary window. The patient is situated in the supine position with the shoulders retracted caudally within the limits of patient comfort. The patient is passed through the scanner for the initial precontrast imaging phase. Contrast is subsequently delivered through a 20-gauge cannula in the antecubital vein. We administered 75 mg of iohexol 300 followed by a saline chaser. For patients with normal cardiac output, we used a bolus tracking technique. Additional images are obtained after 30 and 90 seconds following contrast administration. Results: There is a characteristic appearance of parathyroid glands on 4D CT imaging: low attenuation on precontrast images, peak in enhancement in the arterial phase (30 seconds), and then washout of
Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery, Jan 24, 2015
To determine differences in the mean parathyroid hormone (PTH) levels for normocalcemic and hypoc... more To determine differences in the mean parathyroid hormone (PTH) levels for normocalcemic and hypocalcemic total thyroidectomy patients who were tested for PTH during the intraoperative or early postoperative period. MEDLINE, the Cochrane Database, and other databases from 1960 to 2014 in the English language and specific to humans for relevant articles. Studies were included if PTH was obtained within 24 hours of thyroidectomy. Studies were excluded (1) if only a hemithyroidectomy was performed, (2) if means of studied PTH values were not reported in the article, or (3) if the time of the PTH draw fell outside of defined "intraoperative" or…
JAMA otolaryngology-- head & neck surgery, Jan 30, 2017
Parathyroid biopsy represents a means for normal and hyperfunctional glands to be distinguished i... more Parathyroid biopsy represents a means for normal and hyperfunctional glands to be distinguished intraoperatively. However, no data exist to guide surgeons regarding how much of a parathyroid gland must be biopsied to satisfy the 20% rule. To quantify the relative proportion of a hyperfunctional parathyroid gland that must be evaluated with the gamma probe to satisfy the 20% rule. A retrospective review of surgical data for 24 consecutive patients (16 women, 18 men; mean [SD] age, 66.6 [10] years; range, 51-83 years) who underwent surgery for primary hyperparathyroidism between May and October, 2015, in a tertieary academic medical center. Extirpated parathyroid glands were sectioned into parallel or pie-shaped biopsies and evaluated ex vivo with a gamma probe to determine what percentage of a hyperfunctional gland must be sampled to meet the Norman 20% rule. The hypothesis was formulated during data collection. In total, 253 ex vivo biopsy specimens were obtained from 33 surgically ...
IMPORTANCE To improve outcomes after parathyroidectomy, several organizations advocate for select... more IMPORTANCE To improve outcomes after parathyroidectomy, several organizations advocate for selective referral of patients to high-volume academic medical centers with dedicated endocrine surgery programs. The major factors that influence whether patients travel away from their local community and support system for perceived better care remain elusive. OBJECTIVE To assess how race/ethnicity and insurance status influence domestic travel patterns and selection of high-vs low-volume hospitals in different regions of the United States for parathyroid surgery.
ObjectivesTo measure the effect of proton pump inhibitors (PPIs), with and without concurrent bis... more ObjectivesTo measure the effect of proton pump inhibitors (PPIs), with and without concurrent bisphosphonates, on parathyroid hormone (PTH), vitamin D, and calcium.To measure the effect of proton pump inhibitors (PPIs), with and without concurrent bisphosphonates, on parathyroid hormone (PTH), vitamin D, and calcium.DesignRetrospective chart review of individuals 60 years and older. Subjects with reduced renal function (creatinine >1.3 mg/dL) and low vitamin D (<30 ng/mL) were excluded.Retrospective chart review of individuals 60 years and older. Subjects with reduced renal function (creatinine >1.3 mg/dL) and low vitamin D (<30 ng/mL) were excluded.SettingAcademic geriatric outpatient center in southern midwest.Academic geriatric outpatient center in southern midwest.ParticipantsIndividuals aged 60 and older with concurrent calcium, PTH, vitamin D, and creatinine laboratory measurements (N = 80) meeting labeled criteria.Individuals aged 60 and older with concurrent calcium, PTH, vitamin D, and creatinine laboratory measurements (N = 80) meeting labeled criteria.MeasurementsSerum calcium, PTH, vitamin D, and creatinine.Serum calcium, PTH, vitamin D, and creatinine.ResultsChronic PPI exposure was associated with statistically significantly higher PTH (65.5 vs 30.3 pg/mL, P < .001; normal range 10–55 pg/mL) and lower calcium (9.1 vs 9.4 mg/dL, P = .02; normal range 8.5–10.5 mg/dL) than no PPI exposure. Chronic PPI exposure with concurrent BP therapy was associated with statistically significantly higher PTH (65.2 vs 43.4 pg/mL, P = .05) and lower calcium (9.2 vs 9.6 mg/dL, P = .04) than BP therapy only.Chronic PPI exposure was associated with statistically significantly higher PTH (65.5 vs 30.3 pg/mL, P < .001; normal range 10–55 pg/mL) and lower calcium (9.1 vs 9.4 mg/dL, P = .02; normal range 8.5–10.5 mg/dL) than no PPI exposure. Chronic PPI exposure with concurrent BP therapy was associated with statistically significantly higher PTH (65.2 vs 43.4 pg/mL, P = .05) and lower calcium (9.2 vs 9.6 mg/dL, P = .04) than BP therapy only.ConclusionBased on the present study, chronic PPI exposure in elderly adults is associated with mild hyperparathyroidism regardless of concurrent oral BP administration.Based on the present study, chronic PPI exposure in elderly adults is associated with mild hyperparathyroidism regardless of concurrent oral BP administration.
OBJECTIVES: To measure the effect of proton pump inhibitors (PPIs), with and without concurrent b... more OBJECTIVES: To measure the effect of proton pump inhibitors (PPIs), with and without concurrent bisphospho-nates, on parathyroid hormone (PTH), vitamin D, and calcium. DESIGN: Retrospective chart review of individuals 60 years and older. Subjects with reduced renal function (creatinine >1.3 mg/dL) and low vitamin D (<30 ng/mL) were excluded. SETTING: Academic geriatric outpatient center in southern midwest. PARTICIPANTS: Individuals aged 60 and older with concurrent calcium, PTH, vitamin D, and creatinine laboratory measurements (N = 80) meeting labeled criteria. MEASUREMENTS: Serum calcium, PTH, vitamin D, and creatinine. RESULTS: Chronic PPI exposure was associated with statistically significantly higher PTH (65.5 vs 30.3 pg/mL, P < .001; normal range 10–55 pg/mL) and lower calcium (9.1 vs 9.4 mg/dL, P = .02; normal range 8.5–10.5 mg/dL) than no PPI exposure. Chronic PPI exposure with concurrent BP therapy was associated with statistically significantly higher PTH (65.2 vs 43.4 pg/mL, P = .05) and lower calcium (9.2 vs 9.6 mg/dL, P = .04) than BP therapy only. CONCLUSION: Based on the present study, chronic PPI exposure in elderly adults is associated with mild hyper-parathyroidism regardless of concurrent oral BP administration. J Am Geriatr Soc 2015.
Objective. To determine differences in the mean parathyroid hormone (PTH) levels for normocalcemi... more Objective. To determine differences in the mean parathyroid hormone (PTH) levels for normocalcemic and hypocalcemic total thyroidectomy patients who were tested for PTH during the intraoperative or early postoperative period. Data Sources. MEDLINE, the Cochrane Database, and other databases from 1960 to 2014 in the English language and specific to humans for relevant articles. Review Methods. Studies were included if PTH was obtained within 24 hours of thyroidectomy. Studies were excluded (1) if only a hemithyroidectomy was performed, (2) if means of studied PTH values were not reported in the article, or (3) if the time of the PTH draw fell outside of defined ‘‘intraoperative’’ or ‘‘early postoperative’’ windows. PTH values were divided into 3 groups: preoperative (control group), intraoperative (ie, discharge decisions were based on PTH values drawn in the operating room), and early postoperative (ie, PTH values at 1 to 4 hours after surgery were used as a guide). Results. The reported means of perioperative PTH levels and percentage of patients who developed hypocalcemia were collected from 14 studies. PTH evaluated at both the intraoperative and early postoperative periods was signifi- cantly lower in patients who became hypocalcemic versus patients who remained normocalcemic. There was no signif- icant difference when PTH was measured intraoperatively or early postoperatively. Conclusion. Intraoperative PTH has no significant disadvan- tage versus early postoperative PTH when used as a clinical guide for discharge after thyroidectomy.
Objective. To evaluate 4-dimensional (4D) computed tomography (CT) for the localization of parath... more Objective. To evaluate 4-dimensional (4D) computed tomography (CT) for the localization of parathyroid adenomas previously considered nonlocalizing on ultrasound and single-photon emission
The purpose of this study was to define and characterize the thyroid tumor-draining lymph nodes i... more The purpose of this study was to define and characterize the thyroid tumor-draining lymph nodes in genetically engineered mice harboring thyroid-specific expression of oncogenic Braf(V600E) with and without Pten insufficiency. After intratumoral injection of methylene blue, the lymphatic drainage of the thyroid gland was visualized in real time. The thyroid gland/tumor was resected en bloc with the respiratory system for histological analysis. Although mice harboring Braf(V600E) mutations were smaller in body size compared with their wild-type (WT) littermates, the size of their thyroid glands and deep cervical lymph nodes were significantly larger. Additionally, the tumor-draining lymph nodes showed increased and enlarged lymphatic sinuses that were distributed throughout the cortex and medulla. Tumor-reactive lymphadenopathy and histiocytosis, but no frank metastases, were observed in all mice harboring Braf(V600E) mutations. The tumor-draining lymph nodes undergo significant stru...
Objective To quantify how frequently intraoperative parathyroid hormone levels increase during th... more Objective To quantify how frequently intraoperative parathyroid hormone levels increase during thyroid surgery and to explore a possible relationship between secondary hyperparathyroidism due to vitamin D deficiency and elevation in intraoperative parathyroid hormone. Study Design Case series with chart review. Setting Tertiary academic center. Subjects and Methods A total of 428 consecutive patients undergoing completion and total thyroidectomy by the senior author over a 7-year period were included for analysis. All patients had baseline and postexcision intraoperative parathyroid hormone levels as well as vitamin D levels from the same laboratory. Institute of Medicine criteria were employed for vitamin D stratification (>30, normal; 20-29.9, insufficient; <20, deficient) . Other data analyzed include sex, age, neck dissection status, and parathyroid autotransplantation. Results A total of 118 patients (27.6%) had an intraoperative parathyroid hormone elevation above baseli...
Introduction: Four-dimensional CT (4D CT) can be used in the setting of hyperparathyroidism to lo... more Introduction: Four-dimensional CT (4D CT) can be used in the setting of hyperparathyroidism to localize parathyroid adenomas. In particular, 4D CT can help differentiate an adenoma from common decoys to localize ectopic lesions and identify multigland disease. The purpose of this video was to provide an introduction and general overview of this imaging modality for clinicians who treat patients with hyperparathyroidism. Materials and Methods: Imaging is performed with a 64-detector row CT scanner (Philips, Andover, MA) with the following specifications: 180 to 400 mA, 120 kV, and 180 mm field of view. To minimize the radiation dose, coverage is customized from the mandible to the aorticopulmonary window. The patient is situated in the supine position with the shoulders retracted caudally within the limits of patient comfort. The patient is passed through the scanner for the initial precontrast imaging phase. Contrast is subsequently delivered through a 20-gauge cannula in the antecubital vein. We administered 75 mg of iohexol 300 followed by a saline chaser. For patients with normal cardiac output, we used a bolus tracking technique. Additional images are obtained after 30 and 90 seconds following contrast administration. Results: There is a characteristic appearance of parathyroid glands on 4D CT imaging: low attenuation on precontrast images, peak in enhancement in the arterial phase (30 seconds), and then washout of
Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery, Jan 24, 2015
To determine differences in the mean parathyroid hormone (PTH) levels for normocalcemic and hypoc... more To determine differences in the mean parathyroid hormone (PTH) levels for normocalcemic and hypocalcemic total thyroidectomy patients who were tested for PTH during the intraoperative or early postoperative period. MEDLINE, the Cochrane Database, and other databases from 1960 to 2014 in the English language and specific to humans for relevant articles. Studies were included if PTH was obtained within 24 hours of thyroidectomy. Studies were excluded (1) if only a hemithyroidectomy was performed, (2) if means of studied PTH values were not reported in the article, or (3) if the time of the PTH draw fell outside of defined "intraoperative" or…
JAMA otolaryngology-- head & neck surgery, Jan 30, 2017
Parathyroid biopsy represents a means for normal and hyperfunctional glands to be distinguished i... more Parathyroid biopsy represents a means for normal and hyperfunctional glands to be distinguished intraoperatively. However, no data exist to guide surgeons regarding how much of a parathyroid gland must be biopsied to satisfy the 20% rule. To quantify the relative proportion of a hyperfunctional parathyroid gland that must be evaluated with the gamma probe to satisfy the 20% rule. A retrospective review of surgical data for 24 consecutive patients (16 women, 18 men; mean [SD] age, 66.6 [10] years; range, 51-83 years) who underwent surgery for primary hyperparathyroidism between May and October, 2015, in a tertieary academic medical center. Extirpated parathyroid glands were sectioned into parallel or pie-shaped biopsies and evaluated ex vivo with a gamma probe to determine what percentage of a hyperfunctional gland must be sampled to meet the Norman 20% rule. The hypothesis was formulated during data collection. In total, 253 ex vivo biopsy specimens were obtained from 33 surgically ...
IMPORTANCE To improve outcomes after parathyroidectomy, several organizations advocate for select... more IMPORTANCE To improve outcomes after parathyroidectomy, several organizations advocate for selective referral of patients to high-volume academic medical centers with dedicated endocrine surgery programs. The major factors that influence whether patients travel away from their local community and support system for perceived better care remain elusive. OBJECTIVE To assess how race/ethnicity and insurance status influence domestic travel patterns and selection of high-vs low-volume hospitals in different regions of the United States for parathyroid surgery.
ObjectivesTo measure the effect of proton pump inhibitors (PPIs), with and without concurrent bis... more ObjectivesTo measure the effect of proton pump inhibitors (PPIs), with and without concurrent bisphosphonates, on parathyroid hormone (PTH), vitamin D, and calcium.To measure the effect of proton pump inhibitors (PPIs), with and without concurrent bisphosphonates, on parathyroid hormone (PTH), vitamin D, and calcium.DesignRetrospective chart review of individuals 60 years and older. Subjects with reduced renal function (creatinine >1.3 mg/dL) and low vitamin D (<30 ng/mL) were excluded.Retrospective chart review of individuals 60 years and older. Subjects with reduced renal function (creatinine >1.3 mg/dL) and low vitamin D (<30 ng/mL) were excluded.SettingAcademic geriatric outpatient center in southern midwest.Academic geriatric outpatient center in southern midwest.ParticipantsIndividuals aged 60 and older with concurrent calcium, PTH, vitamin D, and creatinine laboratory measurements (N = 80) meeting labeled criteria.Individuals aged 60 and older with concurrent calcium, PTH, vitamin D, and creatinine laboratory measurements (N = 80) meeting labeled criteria.MeasurementsSerum calcium, PTH, vitamin D, and creatinine.Serum calcium, PTH, vitamin D, and creatinine.ResultsChronic PPI exposure was associated with statistically significantly higher PTH (65.5 vs 30.3 pg/mL, P < .001; normal range 10–55 pg/mL) and lower calcium (9.1 vs 9.4 mg/dL, P = .02; normal range 8.5–10.5 mg/dL) than no PPI exposure. Chronic PPI exposure with concurrent BP therapy was associated with statistically significantly higher PTH (65.2 vs 43.4 pg/mL, P = .05) and lower calcium (9.2 vs 9.6 mg/dL, P = .04) than BP therapy only.Chronic PPI exposure was associated with statistically significantly higher PTH (65.5 vs 30.3 pg/mL, P < .001; normal range 10–55 pg/mL) and lower calcium (9.1 vs 9.4 mg/dL, P = .02; normal range 8.5–10.5 mg/dL) than no PPI exposure. Chronic PPI exposure with concurrent BP therapy was associated with statistically significantly higher PTH (65.2 vs 43.4 pg/mL, P = .05) and lower calcium (9.2 vs 9.6 mg/dL, P = .04) than BP therapy only.ConclusionBased on the present study, chronic PPI exposure in elderly adults is associated with mild hyperparathyroidism regardless of concurrent oral BP administration.Based on the present study, chronic PPI exposure in elderly adults is associated with mild hyperparathyroidism regardless of concurrent oral BP administration.
OBJECTIVES: To measure the effect of proton pump inhibitors (PPIs), with and without concurrent b... more OBJECTIVES: To measure the effect of proton pump inhibitors (PPIs), with and without concurrent bisphospho-nates, on parathyroid hormone (PTH), vitamin D, and calcium. DESIGN: Retrospective chart review of individuals 60 years and older. Subjects with reduced renal function (creatinine >1.3 mg/dL) and low vitamin D (<30 ng/mL) were excluded. SETTING: Academic geriatric outpatient center in southern midwest. PARTICIPANTS: Individuals aged 60 and older with concurrent calcium, PTH, vitamin D, and creatinine laboratory measurements (N = 80) meeting labeled criteria. MEASUREMENTS: Serum calcium, PTH, vitamin D, and creatinine. RESULTS: Chronic PPI exposure was associated with statistically significantly higher PTH (65.5 vs 30.3 pg/mL, P < .001; normal range 10–55 pg/mL) and lower calcium (9.1 vs 9.4 mg/dL, P = .02; normal range 8.5–10.5 mg/dL) than no PPI exposure. Chronic PPI exposure with concurrent BP therapy was associated with statistically significantly higher PTH (65.2 vs 43.4 pg/mL, P = .05) and lower calcium (9.2 vs 9.6 mg/dL, P = .04) than BP therapy only. CONCLUSION: Based on the present study, chronic PPI exposure in elderly adults is associated with mild hyper-parathyroidism regardless of concurrent oral BP administration. J Am Geriatr Soc 2015.
Objective. To determine differences in the mean parathyroid hormone (PTH) levels for normocalcemi... more Objective. To determine differences in the mean parathyroid hormone (PTH) levels for normocalcemic and hypocalcemic total thyroidectomy patients who were tested for PTH during the intraoperative or early postoperative period. Data Sources. MEDLINE, the Cochrane Database, and other databases from 1960 to 2014 in the English language and specific to humans for relevant articles. Review Methods. Studies were included if PTH was obtained within 24 hours of thyroidectomy. Studies were excluded (1) if only a hemithyroidectomy was performed, (2) if means of studied PTH values were not reported in the article, or (3) if the time of the PTH draw fell outside of defined ‘‘intraoperative’’ or ‘‘early postoperative’’ windows. PTH values were divided into 3 groups: preoperative (control group), intraoperative (ie, discharge decisions were based on PTH values drawn in the operating room), and early postoperative (ie, PTH values at 1 to 4 hours after surgery were used as a guide). Results. The reported means of perioperative PTH levels and percentage of patients who developed hypocalcemia were collected from 14 studies. PTH evaluated at both the intraoperative and early postoperative periods was signifi- cantly lower in patients who became hypocalcemic versus patients who remained normocalcemic. There was no signif- icant difference when PTH was measured intraoperatively or early postoperatively. Conclusion. Intraoperative PTH has no significant disadvan- tage versus early postoperative PTH when used as a clinical guide for discharge after thyroidectomy.
Objective. To evaluate 4-dimensional (4D) computed tomography (CT) for the localization of parath... more Objective. To evaluate 4-dimensional (4D) computed tomography (CT) for the localization of parathyroid adenomas previously considered nonlocalizing on ultrasound and single-photon emission
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Papers by Andrew M Hinson
Data Sources. MEDLINE, the Cochrane Database, and other databases from 1960 to 2014 in the English language and specific to humans for relevant articles.
Review Methods. Studies were included if PTH was obtained within 24 hours of thyroidectomy. Studies were excluded (1) if only a hemithyroidectomy was performed, (2) if means of studied PTH values were not reported in the article, or (3) if the time of the PTH draw fell outside of defined ‘‘intraoperative’’ or ‘‘early postoperative’’ windows. PTH values were divided into 3 groups: preoperative (control group), intraoperative (ie, discharge decisions were based on PTH values drawn in the operating room), and early postoperative (ie, PTH values at 1 to 4 hours after surgery were used as a guide).
Results. The reported means of perioperative PTH levels and percentage of patients who developed hypocalcemia were collected from 14 studies. PTH evaluated at both the intraoperative and early postoperative periods was signifi- cantly lower in patients who became hypocalcemic versus patients who remained normocalcemic. There was no signif- icant difference when PTH was measured intraoperatively or early postoperatively.
Conclusion. Intraoperative PTH has no significant disadvan- tage versus early postoperative PTH when used as a clinical guide for discharge after thyroidectomy.
Data Sources. MEDLINE, the Cochrane Database, and other databases from 1960 to 2014 in the English language and specific to humans for relevant articles.
Review Methods. Studies were included if PTH was obtained within 24 hours of thyroidectomy. Studies were excluded (1) if only a hemithyroidectomy was performed, (2) if means of studied PTH values were not reported in the article, or (3) if the time of the PTH draw fell outside of defined ‘‘intraoperative’’ or ‘‘early postoperative’’ windows. PTH values were divided into 3 groups: preoperative (control group), intraoperative (ie, discharge decisions were based on PTH values drawn in the operating room), and early postoperative (ie, PTH values at 1 to 4 hours after surgery were used as a guide).
Results. The reported means of perioperative PTH levels and percentage of patients who developed hypocalcemia were collected from 14 studies. PTH evaluated at both the intraoperative and early postoperative periods was signifi- cantly lower in patients who became hypocalcemic versus patients who remained normocalcemic. There was no signif- icant difference when PTH was measured intraoperatively or early postoperatively.
Conclusion. Intraoperative PTH has no significant disadvan- tage versus early postoperative PTH when used as a clinical guide for discharge after thyroidectomy.