Background: Post-thyroidectomy hypocalcemia is a common complication, yet the optimal perioperative markers for identifying high-risk patients and guiding supplementation remain debated. This study aimed to evaluate factors associated with hypocalcemia at 24 h after total thyroidectomy, identify independent predictors, and assess the reliability of early PTH measurement in determining supplementation needs. Methods: We conducted a single-center prospective cohort study including 200 patients undergoing total thyroidectomy at Genesis Hospital, Thessaloniki, between November 2022 and March 2025. PTH was measured preoperatively, 10 min post-resection, and at 24 and 72 h; calcium and phosphorus were measured preoperatively and postoperatively. Results: Independent predictors of hypocalcemia at 24 h were female sex, preoperative calcium, and PTH at 10 min. Age, pathology, incidental parathyroid excision, and extent of surgery were not significantly associated with hypocalcemia. ROC analysis showed that a preoperative calcium cutoff of 9.47 mg/dL yielded an AUC of 0.73, with 70.1% sensitivity and an NPV of 82%. PTH at 10 min with a cutoff of 24.6 pg/mL yielded an AUC of 0.66, with 70.1% sensitivity and an NPV of 79%. For supplementation needs, PTH at 10 min demonstrated excellent discrimination, with a cutoff of 16.3 pg/mL at 24 h and 14.1 pg/mL at 72 h. Conclusions: Preoperative calcium and PTH measured 10 min after thyroid removal are useful markers for predicting hypocalcemia after total thyroidectomy, with early PTH also accurately identifying supplementation needs.

Diffuse lipomatosis of the thyroid (DLT) is an uncommon condition where mature fat cells infiltrate the thyroid gland, disrupting its normal structure. Although rare, it typically manifests as neck enlargement or symptoms of compression, including breathing difficulties, trouble swallowing, and voice changes, which can complicate diagnosis. This report presents a case of a 61-year-old woman with DLT, who exhibited a multinodular goiter and progressive neck swelling, and examines 53 additional cases from the existing literature. The analysis indicates that DLT is frequently misdiagnosed because of its similarities with other thyroid disorders. The precise mechanism underlying its development remains uncertain, but theories include oxygen deprivation in tissues, developmental abnormalities, and disruptions in fat metabolism. Surgical removal is the preferred treatment, especially for patients experiencing symptoms, and has shown favorable long-term outcomes. Additional studies should aim to elucidate the exact cause of DLT and enhance diagnostic precision, particularly in distinguishing it from other fat-containing thyroid lesions such as amyloid goiter and adenolipomas. A deeper understanding of this condition will inform better treatment approaches and enhance patient outcomes for this uncommon but significant thyroid disorder.

Diffuse lipomatosis of the thyroid (DLT) is a rare condition characterized by the infiltration of thyroid parenchyma with mature adipose cells, replacing normal follicular structure. Though uncommon, it often presents as neck swelling or compression symptoms such as dyspnea, dysphagia, and hoarseness, complicating diagnosis. This case study details a 61-year-old female patient with DLT, who presented with a multinodular goiter and progressive neck swelling, and reviews 53 additional cases from the literature. The review reveals that DLT is often misdiagnosed due to its overlapping features with other thyroid pathologies. The exact pathophysiological mechanism remains unclear, but hypotheses include tissue hypoxia, embryological malformations, or lipid metabolism disturbances. Surgical excision is the most common treatment, particularly for symptomatic patients, yielding positive long-term results. Future research should focus on clarifying DLT’s exact etiology and improving diagnostic accuracy, especially in differentiating it from other fat-infiltrated thyroid lesions such as amyloid goiter and adenolipomas. Enhanced understanding will guide better management strategies and improve patient outcomes in this rare yet significant thyroid disorder.

Medullary thyroid carcinoma (MTC) is typically identified by elevated serum calcitonin levels, as the tumour’s C-cell origin generally produces this hormone. On rare occasions, however, a patient with MTC may present with a non-elevated calcitonin level, complicating early detection. We report such a case of a woman in her early 20s with a thyroid nodule and no initial biochemical markers suggestive of MTC. Despite normal laboratory findings, she was ultimately diagnosed with calcitonin-negative MTC following comprehensive evaluation, which included cytology and immunohistochemistry. We also discuss the current understanding of this rare condition’s pathogenesis, which remains under investigation, as well as the current standard of care, both pharmacological and surgical management and finally the potential and recommended follow-up procedures for patients with this rare diagnosis in accordance with existing guidelines. This case underscores the necessity for clinicians to sometimes rely on more than standard tumour markers when evaluating thyroid nodules that appear ambiguous.

Green transplant refers to the realization of the importance of understanding and improving the environmental footprint of transplantation through sustainable practices. This involves assessing the entire transplantation process including preoperative evaluation, donation, organ and patient transportation, surgery, postoperative recovery, and follow-up. This is a topic that has not been fully addressed yet, but its importance is being increasingly appreciated in surgery. The aim of this study was to investigate the carbon footprint associated with transplantation and propose sustainable mitigating solutions. A comprehensive review of the existing literature on transplantation was conducted and supplemented with findings from the broader fields of surgical and perioperative care, given the scarcity of available data. The analysis identified the most involved environmental factors and attempted to offer practical solutions based on current sustainability practices. Notably, no study has yet examined the carbon footprint associated with the entire transplantation procedure. Only five studies have attempted to assess the environmental impact of kidney or liver transplants, but they focused, almost explicitly, on specific steps of the process. By employing an extrapolative methodology from the broader surgical field, we determined that the primary contributors to the environmental impact of transplantation are energy, consumables and materials, anesthesia and pharmaceuticals, transportation, and water. This review offers practical solutions utilizing the 5R framework, emphasizing sustainability to ensure transplantation remains clinically and environmentally relevant.