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  1. Selective Laryngeal Examination: Sensitivity of Endocrine Surgeons in Screening Voice Abnormality
    Al-Yahya SN, Muhammad R, Suhaimi SNA, Azman M, Mohamed AS, Baki MM
    J Voice, 2020 Sep;34(5):811.e13-811.e20.
    PMID: 30612893 DOI: 10.1016/j.jvoice.2018.12.003
    OBJECTIVES: Selective laryngeal examination for patients undergoing thyroidectomy is recommended for patients with voice alterations, history of prior cervical or chest surgery, and patients with proven or suspected thyroid malignancy. The study objective is to measure the sensitivity of surgeons in detecting voice abnormalities in patients undergoing thyroidectomy, parathyroidectomy complicated with laryngeal nerve paralysis, or patients with known vocal cords palsy (VCP) due to other neck surgeries.

    DESIGN AND SETTING: Descriptive cross-sectional study in a tertiary center.

    PARTICIPANTS AND METHODS: The subjects are 274 audio files of voices of patients undergoing thyroid, parathyroid surgeries, and known VCP due to other neck surgeries. Voice assessments were done by three endocrine surgeons (A, B, and C) with 20, 12, and 4 years of surgical experience.

    MAIN OUTCOME MEASURES: Sensitivity and specificity of surgeon documented voice assessment in patients with underlying VCP. Subjects' acoustic analysis and Voice Handicap Index (VHI-10) were analyzed.

    RESULTS: Raters A, B, and C have sensitivity of 63.6%, 78.8%, and 66.7%, respectively. Inter-rater reliability shows substantial agreement (ƙ = 0.67). VHI-10 has sensitivity of 75.8% and strong correlation of 0.707 (p value <0.001) to VCP. Subjects with VCP have notably higher jitter, shimmer, and noise-to-harmonic ratio compared to normal subjects with sensitivity of 74.2%, 71.2%, and 72.7%, respectively.

    CONCLUSIONS: The results for surgeons documented voice assessment did not reach the desired sensitivity for a screening tool for patients with underlying VCP. Other tools such as VHI-10 and acoustic analysis may not be used as standalone tools in screening patients with underlying VCP. Routine preoperative laryngeal examination may be recommended for all patients undergoing thyroid, parathyroid, or other surgeries that places the laryngeal nerves at risk.

  2. Fulltext The 'CASTLE' tumour: An extremely rare presentation of a thyroid malignancy. A case report
    Dualim DM, Loo GH, Suhaimi SNA, Md Latar NH, Muhammad R, Abd Shukor N
    Ann Med Surg (Lond), 2019 Aug;44:57-61.
    PMID: 31312445 DOI: 10.1016/j.amsu.2019.06.013
    Thyroid carcinoma showing thymic-like differentiation (CASTLE) is a rare malignancy of the thyroid gland, and it accounts for 0.1-0.15% of all thyroid cancers. As the name suggests, it has a histological and immunophenotypic resemblance to thymic carcinoma. Preoperative diagnosis of CASTLE can be difficult as its clinical manifestations, and histological characteristic resembles other aggressive and advanced thyroid carcinomas. It is essential to distinguish CASTLE from other aggressive neoplasms as the former has a more favourable prognosis. Immunohistochemical staining with CD5 can help to differentiate thyroid CASTLE from other aggressive thyroid neoplasms. Due to the rarity of this disease, there is no clear definitive treatment strategy. Surgical resection of CASTLE is usually attempted initially. Nodal involvement and extrathyroidal extension are shown to be the main prognostic factors that influenced the survival of patients. Therefore, complete resection of the tumour is vital to reduce local recurrence rates and to improve the chance of long-term survival. Radiotherapy (RT) for CASTLE is an effective treatment. Curative surgery followed by adjuvant RT should be considered in cases with extrathyroidal extension and nodal metastases. With RT, shrinkage of the tumour and reduction of local recurrence rate is possible. With that in mind, we present a case of CASTLE who presented with airway compression symptoms three years after thyroid surgery. He subsequently underwent tumour debulking surgery and a tracheostomy. The patient refused adjuvant chemoradiotherapy, and during our serial follow-up, he is well and symptom-free.
  3. Fulltext Deep Small RNA Sequencing of BRAF V600E Mutated Papillary Thyroid Carcinoma With Lymph Node Metastasis
    Yusof AM, Jamal R, Saidin S, Muhammad R, Suhaimi SNA, Rose IM, et al.
    Front Genet, 2019;10:941.
    PMID: 31649724 DOI: 10.3389/fgene.2019.00941
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