Thyroidectomy is a commonly performed surgery for thyroid cancer, Graves’ disease, and thyroid nodules. With the increasing incidence of thyroid cancer, understanding the anatomy and surgical techniques is crucial to ensure successful outcomes and minimize complications. This review discusses the anatomical considerations of the thyroid and neck, including lymphatic drainage and the structures at risk during thyroidectomy. Emphasis is placed on the significance of cautious dissection to preserve critical structures, such as the parathyroid glands and recurrent laryngeal nerve. Neck dissection is also explored, particularly in cases of lymph node metastasis, in which its proper execution is essential for better survival rates. Additionally, this review evaluates various thyroidectomy techniques, including minimally invasive approaches, highlighting their potential benefits and limitations. Continuous surgical knowledge and expertise updates are necessary to ensure the best results for patients undergoing thyroidectomy.

Background: Thyroidectomy constitutes an important portion of endocrine surgery procedures and is associated with various complications such as bleeding, recurrent laryngeal nerve injury, and postoperative hypoparathyroidsm. Effective parathyroid preservation during thyroid surgery is crucial for patient well-being, with current strategies heavily reliant on surgeon experience. Among various methods, Indocyanine Green Angiography (ICGA) offers a promising method for intraoperative assessment of parathyroid gland perfusion. Methods: In a retrospective study, patients undergoing bilateral thyroidectomy from January 2021 to January 2023 were analyzed, excluding those with previous thyroidectomy, parathyroid disease, or chronic kidney disease. The study compared a control group (n = 175) with an ICGA group (n = 120), using propensity score matching for statistical analysis. Matched cohorts included 120 patients in each group. The primary outcome of this study was identified as temporary postoperative hypoparathyroidism, with secondary outcomes including the rate of parathyroid reimplantation and the incidence of permanent postoperative hypoparathyroidism. Results: The ICGA group showed significantly more parathyroid autotransplantations (p < 0.01). While not statistically significant, the control group had a higher incidence of temporary postoperative hypoparathyroidism (p < 0.09). Rates of hypocalcemia on postoperative day 1 and permanent hypocalcemia were similar. Subgroup analysis indicated more postoperative day 1 hypoparathyroidism in the control group during central neck dissections (p < 0.049). Conclusions: Intraoperative ICGA use correlated with higher parathyroid autotransplantation and suggested reduced postoperative hypoparathyroidism. Changes in fluorescence intensity following a second ICG injection may provide an objective method to assess parathyroid perfusion. Further large-scale studies are needed to fully understand ICGA’s impact on parathyroid preservation.

Background/Objectives: Clinical scores are recommended for excluding acute appendicitis without imaging, but their rule-out thresholds were derived in patients selected on suspicion of appendicitis. This study tested whether these thresholds retain their reported sensitivity in patients selected by CT performance, estimated the incremental diagnostic value of successive layers of clinical information, and, as an exploratory aim, compared machine learning models with the scores. Methods: This single centre retrospective cohort comprised 761 emergency department patients undergoing abdominal CT for acute abdominal pain. The Alvarado score, the Appendicitis Inflammatory Response (AIR) score and the Adult Appendicitis Score (AAS) were reconstructed from data documented before CT. The reference standard was histopathology in operated patients and the index CT report with the clinical course otherwise. Models were fitted to five cumulative information layers by cross-validation, with nested algorithm selection and a temporal split. Results: Appendicitis was confirmed in 178 patients (23.4%). Sensitivity at the recommended thresholds was 0.680 (95% CI 0.609 to 0.751), 0.848 (0.791 to 0.899) and 0.697 (0.628 to 0.764), against published values of 0.99, 0.95 and 0.959, leaving 57, 27 and 54 confirmed cases in the low probability strata, and the shortfall was present in both temporal periods. Discrimination was preserved, with areas under the curve of 0.848, 0.868 and 0.881. Model discrimination rose from 0.874 with symptoms to 0.918 with laboratory values, with each increment conditional on the preceding layers and the pattern similar with a single algorithm held fixed. With nested selection, the model was not distinguishable from the AAS, and in the later temporal period its deferral threshold attained a sensitivity of 0.925. Conclusions: In a population defined by imaging rather than by clinical suspicion, the recommended rule-out thresholds did not translate. Thresholds should be re-derived and verified in the population in which imaging is to be deferred. The model analysis was exploratory and was not externally validated.