Purpose: In 2025, the American Thyroid Association (ATA) updated guidelines for papillary thyroid cancer (PTC) (1). Within is a new recommendation against prophylactic central lymph node dissection (pCLND) for clinically node-negative tumors <4cm (cT1-2), citing concern that complication rates may outweigh known reductions in locoregional recurrence. Given the acknowledged oncologic benefit of pCLND in these guidelines, we evaluated complication rates at our high-volume center to assess whether pCLND remains safe for small, clinically node-negative PTC when performed by high-volume thyroid surgeons. Methodology: We retrospectively analyzed 400 patients with PTC measuring 1-4cm (T1b-T2) with clinically negative lymph node basins who underwent thyroidectomy with pCLND between 2018-2025. Complication rates were compared between total thyroidectomy and hemithyroidectomy. Results: 69% of patients had tumors 1-2cm and 31% had tumors 2-4cm. Total thyroidectomy was performed in 65.8%, hemithyroidectomy in 34.0%, and completion hemithyroidectomy in 0.25%. Temporary recurrent laryngeal nerve (RLN) palsy occurred in 1.5% of total thyroidectomies and 5.8% of hemithyroidectomies. No permanent RLN palsy occurred. Temporary hypocalcemia occurred in 1.1% of total thyroidectomies and in 0% of hemithyroidectomies. Permanent hypoparathyroidism occurred in 0.4% of total thyroidectomies and 0% of hemithyroidectomies. Conclusions: pCLND performed by high-volume thyroid surgeons is associated with low complication rates. The low temporary hypocalcemia rate observed may reflect routine postoperative oral calcium supplementation. pCLND appears safe for T2 and smaller PTC with experienced hands, offering oncologic benefit with low perioperative risk. Locoregional recurrence analysis is ongoing in this cohort. References: (1) Ringel MD, et al. 2025 American Thyroid Association Management Guidelines for Adult Patients with Differentiated Thyroid Cancer. Thyroid. 2025 Aug;35(8):841–985.

Purpose Currently in South Australia, patients undergoing minimally invasive parathyroidectomy (MIP) are routinely admitted for overnight observation due to concerns regarding postoperative complications such as bleeding and hypocalcaemia. In recent years, there has been an increasing trend in the number of patients undergoing MIP as day surgery in other institutions, with many centres demonstrating it is safe and feasible. Additionally, with increasing hospital bed pressures, MIPs are often cancelled to facilitate more urgent cases. We aim to assess our complication rates after MIP to see if it is feasible to implement in our setting, and to use this data to create a day procedure protocol. Methodology A multicentre retrospective observational cohort study was undertaken across two metropolitan tertiary hospital networks in South Australia, between June 2023 and June 2025. All patients undergoing MIP for primary hyperparathyroidism were included. Patient demographics, imaging localisation, blood results, histopathology, operative findings and clinical outcome data were extracted from patient records and assessed for complications. Results Ninety-six patients were identified who underwent a minimally invasive parathyroidectomy for a preoperatively localised parathyroid adenoma. One patient had a postoperative bleed, one patient had hypocalcaemia requiring oral calcium replacement, one patient had hyperkalaemia, one patient had an allergic reaction to an anaesthetic agent. The remaining ninety-two patients (96%) had an unremarkable postoperative recovery and were discharged home the following day without complication. No patients were readmitted due to complications in the immediate postoperative period or subsequent 30 days. Conclusion Complication rates in our population appeared comparable to national standards and published literature. As a result, day case MIP appears to be feasible and safe for management of primary hyperparathyroidism in the Australian setting for selected patient populations with an unremarkable intraoperative course.

Purpose Radiofrequency ablation (RFA) is a novel minimally invasive treatment for symptomatic thyroid nodules. Although RFA is well established in some international centres, its application is not yet widespread in Australasia. We describe the implementation of a RFA program in a tertiary hospital endocrine surgery service and treatment related outcomes. Methodology A prospective case series of patients treated with ultrasound-guided RFA for benign symptomatic thyroid nodules between May 2024 and October 2025 was undertaken. Follow-up occurred at 3, 6 and 12 months post-RFA. The primary outcome measure was nodule volume reduction rate (VRR). Secondary outcome measures were compressive symptom and cosmetic scores. Results 10 patients were enrolled in a prospective study. All patients had compressive symptoms and/or cosmetic concerns. One patient underwent RFA of two hyperfunctioning nodules. The median energy delivered per nodule was 0.400kCal (IQR 0285-1.250kCal) Median follow-up was 6 months. The median nodule volume reduced from 8.12mL at baseline to 1.58mL at 3 months post-RFA (p<0.001). The median volume reduction rate (VRR) was 61.8%, 63.2% and 88.3% (IQR 64.7-91.0%) at 3,6 and 12 months respectively post-RFA. Therapeutic success (VRR>50%) was achieved in 7 out of 11 (63.6%) of nodules by 6 months. The median compressive symptom score reduced from 6/60 at baseline to 1/60 at 3 month follow-up (p=0.013) with no significant subsequent change. The median cosmetic score improved from 3.5/4 at baseline to 2/4 at 3-month follow-up (p=0.001). No patient experienced complications or regrowth. The patient with hyperfunctioning nodules was able to cease carbimazole and all other patients remained euthyroid. Conclusion Thyroid nodule RFA can achieve significant reduction in nodule volume and improvement in compressive symptoms. This novel treatment can be safely introduced into an established Endocrine Surgical program.

Purpose: Primary hyperparathyroidism (PHPT) commonly causes neuromuscular dysfunction such as weakness and fatigue which can substantially impair daily activity. Although many patients report subjective improvement after parathyroidectomy (PTX), objective data supporting improvements in neuromuscular performance after successful parathyroid surgery are limited. We sought to assess objective changes in muscle endurance and functional capacity after PTX for PHPT. Methodology: A prospective cohort study was conducted in patients with PHPT undergoing PTX. Muscle endurance and functional capacity were assessed using the 30-second sit-to-stand (STS) test and maximum dominant hand grip strength (HGS) measurement preoperatively and at 3 months postoperatively and compared via paired t-test. Change in STS and HGS was also compared between-groups in those with preoperative normocalcemia (<2.6mmol/L) and hypercalcemia (≥2.6mmol/L) using Mann-Whitney U tests. Results: 76 patients with PHPT underwent PTX. 75.3% were female. Mean preoperative serum corrected Ca was 2.61mmol/L and median age was 66. Focused PTX was performed in 51% of cases and the median adenoma weight was 490mg. Median STS improved from 12 repetitions preoperatively to 14 repetitions at 3 months postoperatively (p<0.001). Mean maximum dominant HGS improved from 24.1kg to 25.6kg at 3 months postoperatively (p<0.001). There was no significant difference in change in STS or HGS between patients with pre-operative normocalcemia (corrected calcium <2.6 mmol/L) and those with hypercalcemia (corrected calcium ≥2.6 mmol/L) (STS p=0.26, HGS p=0.87). Conclusions: Parathyroidectomy for PHPT is associated with significant improvement in STS and HGS. Improvement was similar regardless of preoperative calcium status. This suggests that accompanied with subjective feelings of improved strength and energy is an objective improvement in proximal muscle endurance, strength, and functional capacity following parathyroidectomy.

Background: Primary hyperparathyroidism (PHPT) is increasingly detected through routine biochemical screening. Despite this, fatigue remains a prevalent yet under-recognised symptom that may significantly impair quality of life, even in patients traditionally classified as having mild or “asymptomatic” disease. While parathyroidectomy has been shown to improve overall symptom burden, fatigue-specific outcomes remain incompletely defined. This study aimed to quantify short-term changes in fatigue following parathyroidectomy using a validated patient-reported outcome measure. Methods: A retrospective analysis of prospectively collected data was performed in adults with biochemically confirmed PHPT after exclusion of MEN1 and MEN2 syndromes, undergoing parathyroidectomy at a tertiary endocrine surgery unit between August 2024 and August 2025. Fatigue was assessed pre-operatively and at three weeks post-operatively using the Fatigue Assessment Scale (FAS). The primary outcome was change in total FAS score. Results: Of 51 eligible patients, 46 were included in the final analysis. The mean age was 60 years, and 87% of patients were female. Pre-operative fatigue (FAS ≥22) was present in 73% of patients. Mean FAS scores improved from 29.0 ± 9.7 pre-operatively to 19.0 ± 5.0 post-operatively, corresponding to a mean reduction of 10.4 ± 9.5 points (p < 0.001). Biochemical cure was achieved in all patients. Patients reporting fatigue at baseline demonstrated a significantly greater reduction in FAS scores compared with those without baseline fatigue (−13.1 ± 9.4 vs −5.8 ± 7.0; p = 0.03). No significant differences in fatigue improvement were observed according to sex, pathological diagnosis, or severity of hypercalcaemia. Conclusion: Parathyroidectomy was associated with early, statistically and clinically significant improvements in patient-reported fatigue. These findings highlight fatigue as a meaningful and modifiable symptom in PHPT and support consideration of patient-reported outcomes when evaluating surgical benefit.

Purpose: Thyroid surgery is commonly performed for nodules deemed low-suspicion on ultrasound (US) for compressive symptoms, thyrotoxicosis or interval growth. Published false-negative (FN) rates for benign cytology vary widely (5% to >20%). A 2025 meta-analysis demonstrated FN rates of 5.3-6.9% across over 5000 nodules.2 We aimed to identify the number of clinically significant malignancies on final histology among presumed benign nodules in a West Australian cohort. Methodology: Adults (≥18 years) who underwent thyroid surgery for benign appearing lesions (Jan 2020–Nov 2025) were identified from a database. Baseline data including sex, age, history of neck irradiation and indication for surgery was collected. Patients with benign cytology and available final histology were included. US features including size, echotexture, vascularity and presence of microcalcifications were extracted from radiology reports. Histology was recorded postoperatively. Statistical analysis was performed using R. Results: 711 patients underwent surgery for benign indications. Radiology reports were available for 396 patients. Twenty patients received a post-operative histological diagnosis of clinically significant carcinoma (>1cm). The false negative rate for combined US and FNA was 5.1% (20/396). The presence of microcalcifications on US was the strongest predictor of malignancy in the group (OR 6.55, 95% CI 2.11-20.03, p=0.01). Conclusion: In this Western Australian cohort, benign preoperative assessment with US and FNA was associated with a 5.1% false negative rate, with microcalcification on US as the strongest predictor of malignancy. This data is in keeping with level I evidence. References: 1) Cotter A, Jinih M. Discov Oncol. 2025;16:1188

Purpose Following hemithyroidectomy, the remnant thyroid lobe typically compensates avoiding the need for lifelong thyroxine, as required in total thyroidectomy. However, previous literature has identified the incidence of hypothyroidism following hemithyroidectomy at 20-30% and risk factors of Hashimoto’s disease, side of resection, and demographic variables. This retrospective study investigates the incidence, risk factors and natural history of hypothyroidism following hemithyroidectomy in a sizeable single surgeon cohort. We aim to better characterise this complication to improve preoperative risk stratification and patient outcomes. Methodology The study cohort consists of 279 patients who underwent hemithyroidectomy between 2013-2023 under a single surgeon. Incidence was calculated at 1, 3, 6 months, and overall, after hemithyroidectomy. Univariate and multivariate logistic regression identified risk factors of hypothyroidism. Results Hypothyroidism incidence at 1-month post-operatively was 20%. Risk factors included preoperatively diagnosed Hashimoto’s disease, histological lymphocytic thyroiditis, and right lobe resection. This study is first to report smoking as a protective factor against postoperative hypothyroidism. Of those hypothyroid at 1-month post-hemithyroidectomy, 45% were observed for natural recovery while 55% were treated with thyroxine. 8% of patients developed delayed hypothyroidism after 1-month. Conclusion This study utilised a single surgeon cohort to investigate incidence, risk factors and natural history of hypothyroidism following hemithyroidectomy, minimising variability in surgical technique and follow-up practices. Findings support known risk factors like Hashimoto’s disease but identify smoking as a novel protective factor in hypothyroidism development. These insights may assist clinical decision making in order to improve outcomes after hemithyroidectomy.

Purpose: 18F-fluorocholine PET (FCH-PET) is a new and emerging method for localising parathyroid adenomas, which allows for a minimally invasive parathyroidectomy, improving surgical recovery and reducing complication rates. FCH-PET is currently used in our institution as a second- or third-line investigation in complex pre-surgical localization for persistent or recurrent hyperparathyroidism cases. This study aims to examine the localisation rates of FCH-PET in our institution. Methodology: A search for all patients who had FCH-PET scans done in Fiona Stanley Hospital from its first use until the start of the audit was performed, and patients who did not have surgery and thus no histological or surgical confirmation of the localisation were excluded. The results of the FCH-PET scan were compared with intraoperative findings and the histopathology report. The accuracy of the localisation was also compared to 4DCT and sestamibi scans if the patient had those as well. Results: 52 patients had an FCH-PET from 15 Aug 2016 to 5 Aug 2025. A total of 17 patients from this population proceeded to surgery. FCH-PET localised the adenoma correctly 58.8% of the time, which was comparable with those that had 4DCT (60%). Both were superior to sestamibi which had a localisation rate of 33.3%. Conclusion: The localisation rates in our cohort for FCH-PET, 4DCT and sestambi are lower than globally reported rates, and this is due to the inherently complicated nature of the cases used in this study. FCH-PET is used as a second- or third-line modality in our institution, hence patients in this study were of a complex case history – usually due to prior parathyroid surgeries, and discordant or non-convincing first line imaging. Nonetheless, FCH-PET seems to be a promising modality for localising missed or ectopic parathyroid adenomas comparable with 4DCT, and warrants a deeper look into its efficacy and its potential role in enabling successful focused re-operative parathyroidectomy.

Purpose: With increasing adoption of Trans Oral Endoscopic thyroidectomy (TOETVA), prevention of complications such as parathyroid injury and postoperative hypoparathyroidism has become increasingly important. The combination of enhanced endoscopic visualization and indocyanine green (ICG) angiography offers a potential method for accurate identification of parathyroid glands and assessment of their vascularity and viability. Objective: To evaluate the effectiveness of ICG angiography in identifying parathyroid glands, assessing their vascularity and viability during TOETVA. Methodology & Results: This prospective observational study included 115 patients undergoing TOETVA. Parathyroid glands were identified intraoperatively using standard endoscopic visualization and confirmed with ICG angiography. ICG was used to delineate vascular anatomy and assess perfusion of the parathyroid glands. Based on fluorescence intensity and perfusion patterns, glands were graded from 0 to 2 as per viability. ICG angiography was repeated at the end to reassess gland perfusion and guide the need for autotransplantation. Combined use of high-definition endoscope and ICG angiography enabled accurate identification and confirmation of parathyroid glands, significantly reducing inadvertent injury. The incidence of transient and permanent hypoparathyroidism was low, less than 3% and 1% of patients respectively, which was statistically significant compared with historical controls. Conclusion: The use of ICG angiography in conjunction with enhanced endoscopic visualization during TOETVA provides a reliable method for identifying parathyroid glands and assessing their viability. This technique significantly reduces the incidence of parathyroid injury and postoperative hypoparathyroidism and may be considered a valuable adjunct in endoscopic thyroid surgery.

Purpose: Papillary thyroid microcarcinoma (PTMC) is an increasingly common diagnosis and associated with an overall excellent prognosis. As a result, there have been calls for de-escalation of PTMC postoperative surveillance. It is also recognised, however, that some patients with PTMC develop locoregional and metastatic disease or recurrence following surgical intervention, suggesting PTMC may represent a more diverse cohort of patients requiring different follow up strategies. This study aimed to assess recurrence rates in a Western Australian cohort of patients with incidental PTMC and identify potential risk factors for recurrence to help guide local practice. Methodology: A retrospective analysis was conducted of all patients with an incidental histopathological diagnosis of PTMC after undergoing thyroid surgery for a benign indication at public hospitals in Western Australia over a 10-year period (2013-2023). Data collected included potential risk factors for recurrence (age, sex, indication for operation, lymphovascular invasion, lymph node metastasis, tumour size, multifocality, thyroiditis, tumour location, extrathyroidal extension, tall cell variant, BRAF mutation) as well as outcome variables (locoregional recurrence, distant recurrence, survival). Results: Data were collected from 182 patients. Only 1 patient had locoregional recurrence of PTMC 14 months after the index operation. Potential risk factors for recurrence present in this patient included male sex, >5mm tumour, multifocality, positive BRAF mutation and lymph node metastasis identified at the index operation. However, all other patients with these potential risk factors did not develop recurrence. Conclusion: Findings from this study confirm that incidental PTMC has an excellent prognosis in the Western Australian population with very low rates of recurrence despite the presence of potential risk factors. This suggests that incidental PTMC does not require routine postoperative surveillance.

Background: Post-operative hypocalcaemia remains a significant complication of thyroid and parathyroid surgery. While high-volume centres have access to intra-operative techniques such as parathyroid hormone sampling and frozen section to aid parathyroid identification, regional centres frequently lack immediate access to these resources. The PTeye device (Medtronic) utilizes parathyroid autofluorescence to provide intra-operative tissue differentiation. While validated in specialized centres, its utility in lower-volume settings is less defined. Methods: We have performed a case series of four patients undergoing thyroid or parathyroid surgery our regional institution. The PTeye device was utilised as an adjunct to classical identification techniques. In this paper, we report the pre-operative investigations, operation findings and post-operative histological and pathological results. We evaluated the device's ease of implementation, intra-operative utility, and limitations in a setting without ad hoc access to frozen section or rapid parathyroid hormone analysis. Results: The PTeye was easily integrated into the surgical workflow with negligible setup time, comparable to standard nerve monitoring systems. Surgeons reported that the device served as a useful confirmative tool, increasing confidence in parathyroid preservation. However, the device demonstrated limitations in detecting intrathyroidal parathyroid glands, where probe contact could not be achieved. Conclusion: The PTeye is a promising adjunct for thyroid and parathyroid surgery in regional settings where resource-heavy investigations are limited. While it augments surgical decision-making and confidence, it does not replace the necessity for classical anatomical knowledge and surgical technique.