Obesity’s role in thyroid cancer development is still debated, as well as its association with aggressive histopathological subtypes (AHSs). To clarify the link between Body Mass Index (BMI) and AHS of differentiated thyroid carcinoma (DTC), we evaluated patients who underwent thyroidectomy for DTC from 2020 to 2022 at four European referral centres for endocrine surgery. Based on BMI, patients were classified as normal-underweight, overweight, or obese. AHSs were defined according to 2022 WHO guidelines. Among 3868 patients included, 34.5% were overweight and 19.6% obese. Histological diagnoses were: 93.6% papillary (PTC), 4.8% follicular (FTC), and 1.6% Hürthle cell (HCC) thyroid carcinoma. Obese and overweight patients with PTC had a higher rate of AHSs (p = 0.03), bilateral, multifocal tumours (p = 0.014, 0.049), and larger nodal metastases (p = 0.017). In a multivariate analysis, BMI was an independent predictor of AHS of PTC, irrespective of gender (p = 0.028). In younger patients ( 1 cm, BMI predicted a higher ATA risk class (p = 0.036). Overweight and obese patients with FTC had larger tumours (p = 0.036). No difference was found in terms of AHS of FTC and HCC based on BMI category. Overweight and obese patients with PTC appear to be at an increased risk for AHS and aggressive clinico-pathological characteristics.

Background: Postoperative neck hematoma is an infrequent but potentially fatal complication following thyroidectomy. The main aim of this study was to evaluate the impact of direct oral anticoagulants (DOACs) on the occurrence of this complication. Methods: Patients who underwent thyroidectomy between January 2020 and December 2022 in nine high-volume thyroid surgery centers in Europe were retrospectively evaluated. Based on taking direct oral anticoagulants, patients were divided into two groups: the DOAC Group and the Control Group. Propensity score matching 1:1 was performed between the two groups, which were then compared through a univariate analysis. Results: The total number of patients enrolled based on the inclusion/exclusion criteria was 8985. Following propensity score matching, the study population consisted of 316 patients: 158 in the DOAC Group and 158 in the Control Group. In the DOAC Group, the overall incidence of neck hematoma was 5.70% (4.43% for neck hematomas managed conservatively, and 1.27% for those that required surgical revision of hemostasis). No statistically significant difference was found between the two groups in terms of the incidence of this complication. Hospital readmission due to neck hematoma was not observed in any patient. No statistically significant difference was found between the two groups in terms of the timing of the onset of neck hematomas that required surgical revision of hemostasis. Conclusions: This study showed that direct oral anticoagulants, in the field of thyroid surgery, have no impact on the occurrence of postoperative neck hematoma. Therefore, based on our findings, it can be concluded that thyroidectomy can be safely performed in patients taking this class of drugs.

Objective: Radiofrequency ablation (RFA) has gained recognition as a minimally invasive alternative to surgery for managing symptomatic benign thyroid nodules. However, predicting RFA efficacy remains challenging, especially in identifying patients who may require multiple treatment sessions. The aim of the present study is to identify predictors of suboptimal volume reduction (SVR), defined as failure to achieve a volume reduction greater than 5% between 6 and 12 months after procedure and persistence of symptoms. Methods: A retrospective single-center analysis of consecutive patients who underwent a single RFA procedure for benign thyroid at Verona University Hospital between 2020 and 2023 was conducted. Clinical data, including nodule volume and compressive symptoms, were collected preoperatively and at 1, 6, and 12 months post-RFA. Regression analysis was performed to identify predictors of SVR and persistence of symptoms. Results: A total of 50 patients were included. Baseline nodule volume, higher ACR-TIRADS score, and higher body mass index (BMI) were identified as independent predictors of SVR (p < 0.05). At 12 months, 18.4% of patients reported persistent compressive symptoms; however, no significant predictors of symptom persistence were identified. Conclusions: RFA is effective in reducing benign thyroid nodule volume, with a minority of patients experiencing persistent symptoms. Baseline nodule volume, ultrasonographic characteristics, and BMI significantly influence RFA outcomes, suggesting the need for additional procedures. Further studies are required to identify predictors of treatment response, enhancing patient selection and optimizing therapeutic efficacy.

Background: Postoperative neck hematoma is an uncommon but potentially fatal complication following thyroid surgery. The main aim of this study was to evaluate the impact of direct oral anticoagulants on the occurrence of this complication. Methods: Patients who underwent thyroidectomy, between January 2020 and December 2022, in nine high-volume thyroid surgery centers in Europe, were retrospectively evaluated. Based on taking direct oral anticoagulants, patients were divided in two groups: DOAC Group and Control Group. Propensity score matching 1:1 was performed between the two groups, which were then compared through univariate analysis. Results: Patients enrolled based on inclusion/exclusion criteria were 8985. Following propensity score matching, the study population consisted of 316 patients: 158 in DOAC Group and 158 in Control Group. In DOAC Group, the overall incidence of neck hematoma was 5.70% (4.43% for neck hematomas managed conservatively, and 1.27% for those that required surgical revision of hemostasis). No statistically significant difference was found between the two groups in terms of incidence of this complication. Readmission for neck hematoma was not observed in any patient. No statistically significant difference was found between the two groups in terms of timing of onset of neck hematomas that required surgical revision of hemostasis. Conclusions: This study showed that, in the field of thyroid surgery, direct oral anticoagulants have no impact on the occurrence of postoperative neck hematoma. Therefore, based on our findings, it can be concluded that thyroidectomy can be safely performed in patients taking this class of drugs.

Background: The ERAS (Enhanced Recovery After Surgery) protocol is a multidisciplinary perioperative care pathway aimed at improving postoperative recovery. Few studies have investigated their effectiveness in thyroid surgery. The aim of this study was to evaluate the potential clinical benefits of a structured ERAS protocol applied to thyroid surgery in a tertiary referral center. Methods: We conducted a single-center retrospective study on consecutive series of patients undergoing thyroid surgery for benign or malignant disease before (January 2018–December 2022) and after (May 2024–July 2024) the introduction of the ERAS protocol. A propensity score matching (PSM) analysis was used, matching the groups for age, gender, BMI and type of surgery. Results: After PSM, 64 matched patient pairs were analyzed. ERAS patients showed a significant reduction in length of hospital stay (p < 0.001), postoperative nausea and vomiting (3.1% vs. 12.5%, p = 0.04), and pain with an NRS > 5 12 h after surgery (9.4% vs. 26.6%, p = 0.01). Patients in the ERAS group showed significantly higher calcium levels at 6 h (9.09 vs. 8.7 mg/dL, p < 0.001) and 24 h (8.8 vs. 8.6 mg/dL, p = 0.008) postoperatively, with a reduction in the need for intravenous calcium therapy (0% vs. 12.5%, p = 0.003). Conclusions: This study showed significant clinical benefits and reduced length of stay were achieved in thyroid surgery patients after the implementation of a structured ERAS protocol with potential implications for healthcare cost reduction.