Background/Objectives: Hypoparathyroidism (HPT) is a common complication following thyroid surgery with an incidence reaching up to 29%, potentially resulting in significant long-term morbidity. To improve its early identification and patient outcomes, we investigated the prevalence and predictors of postoperative HPT. Methods: This retrospective, multicenter observational study included patients who underwent thyroid surgery from 2016 to 2022 in four centers located in Saudi Arabia’s Eastern Province. We analyzed demographic data, underlying thyroid or parathyroid conditions, surgical indications, types of procedures, pathology results, and preoperative corrected calcium and vitamin D levels, along with postoperative corrected calcium and parathyroid hormone (PTH) levels. For data analysis, IBM Statistical Package for the Social Sciences (SPSS) Statistics 22 was used, with categorical variables presented as frequencies/percentages and non-normal continuous variables as the median/first quartile (Q1) and third quartile (Q3). Associations were tested with chi-square/Fisher exact tests, medians with Mann–Whitney U-tests, and odds ratios (ORs) with 95% confidence intervals (CIs) via multivariate analysis with statistical significance set at p < 0.05. Results: A total of 679 cases were included. The median age of patients was 43 years (with 48.9% of them aged 41–60 years), and 82% were female. HPT occurred in 228 cases (35.3%), with 115 (81.0%) experiencing transient HPT and 27 (19.0%) permanent HPT. Multivariate analysis identified total thyroidectomy (OR 2.7, p = 0.005), completion thyroidectomy (OR 8.4, p = 0.004), and low immediate postoperative PTH level (OR 3.1, p < 0.001) as independent predictors of HPT. Central lymph node dissection (CLND; OR 4.03, p = 0.004) and low postoperative PTH level (OR 2.56, p = 0.049) were significant predictors of permanent HPT. Conclusions: Key predictors of HPT include surgical extent and low postoperative PTH level, while CLND and low postoperative PTH level are the strongest predictors of permanent HPT. Careful assessment of these risks when determining the extent of surgery and avoiding unnecessary aggressive procedures can help to minimize the occurrence of HPT. Measuring the PTH level immediately after surgery may aid in identifying high-risk patients for early intervention and appropriate follow-up.

Background and Objectives: Indeterminate thyroid nodules (Bethesda III and IV) are a common clinical entity that present a diagnostic challenge due to their intermediate risk of malignancy. This study aimed to evaluate the role of ultrasound in risk stratification and malignancy prediction to support clinical decision-making and reduce unnecessary surgical interventions. Materials and Methods: This retrospective multicenter cohort study included patients aged ≥18 years who underwent thyroid surgery between 2016 and 2022 at four centers in the Eastern Province of Saudi Arabia. Only nodules with indeterminate cytology (Bethesda III or IV) were included. Data collected included demographic characteristics, thyroid function, ultrasound features, cytology results, and histopathological findings. Results: A total of 679 patients with 733 nodules were reviewed. Of these, 206 patients with 223 indeterminate nodules were included (median age: 42 years; 88.3% female). The overall malignancy rate was 46.6%. Independent predictors of malignancy included solid hypoechoic composition (OR = 2.26, p = 0.012), microcalcifications (OR = 3.07, p = 0.002), lymph node involvement (OR = 2.43, p = 0.021), American Thyroid Association (ATA) intermediate to high suspicion category (OR = 1.9, p = 0.018), and Thyroid Imaging Reporting and Data Systems (TI-RADS) categories 4–5 (OR = 2.3, p = 0.003). Solid hypoechoic nodules showed 82.3% specificity and 63.0% positive predictive value (PPV); microcalcifications demonstrated 84.1% specificity and 68.4% PPV; lymph node involvement had 87.6% specificity and 68.9% PPV. The ATA and TI-RADS classifications showed higher sensitivity (63.5% and 68.0%, respectively), but lower specificity (53.1% and 52.8%, respectively). Conclusions: Ultrasound features, particularly solid hypoechoic composition, microcalcifications, and lymph node involvement, as well as ATA and TI-RADS classifications, were independent predictors of malignancy in indeterminate thyroid nodules. Although ATA and TI-RADS offered higher sensitivity, individual features demonstrated greater specificity and PPV. These findings support the use of ultrasound risk stratification to guide surgical decisions in high-risk cases and suggest that additional diagnostic evaluation may be appropriate for low-risk nodules.

Involvement of adrenal glands in lymphoma is rare; the patient may have variable presentations. We report a case of a 62-year-old Saudi female who presented to our center with a few-week history of fatigue, weight loss, subjective fever, and a recent change in skin color. On examination, she looked dehydrated and had a drop in blood pressure with postural change and hyperpigmentation of the skin of the face and hands. Morning cortisol levels were low, and adrenocorticotropic hormone levels were high, which indicated primary adrenal insufficiency (PAI). An adrenal computed tomography (CT) scan revealed bilateral adrenal enlargement. After excluding pheochromocytoma, a CT scan-guided trucut biopsy of the adrenals confirmed non-Hodgkin lymphoma. The patient was started on steroid replacement therapy, and after stabilization, a plan was made to initiate chemotherapy for the treatment of lymphoma; unfortunately, the patient died shortly after diagnosis because of rapid progression of the disease. Adrenal lymphoma can present with PAI and should be considered in the presence of bilateral adrenal enlargement; it is an aggressive tumor and carries poor prognosis if the treatment is delayed.