Kaniksha Desai

All Publications

• Hyperthyroidism Due to Graves Disease After Radiofrequency Ablation. JCEM case reports McAninch, E. A., Desai, K., McCowen, K. C., Orloff, L. A. 2023; 1 (3): luad056

  Abstract

  Management options for benign, autonomously functioning, and malignant thyroid nodules were limited to surgery or targeting by radioactive iodine before the availability of radiofrequency ablation (RFA). Despite being a relatively new technique, RFA may be favored for patients of high surgical risk, and for those who wish to avoid hypothyroidism. Although insurance coverage for the procedure can be a significant barrier, several groups of investigators have shown improved quality of life for RFA compared to surgery, due to the less invasive nature and favorable risk profile. Hyperthyroidism due to transient thyroiditis is a known risk of RFA, secondary to direct trauma and subsequent thyroid hormone release. Here we present a case of an adult with large, symptomatic, multinodular goiter, with no prior history of thyroid autoimmunity, who underwent RFA with successful volume reduction of two nodules, but who developed acute hyperthyroidism due to Graves disease eight weeks after RFA. Larger studies evaluating the risks of RFA should evaluate for incident hyperthyroidism, specifically for Graves disease/thyroid autoimmunity, as this could represent an additional risk of the procedure.

  View details for DOI 10.1210/jcemcr/luad056

  View details for PubMedID 37908568

  View details for PubMedCentralID PMC10580446

• Surgical resection of mediastinal ectopic thyroid tissue: a case series JOURNAL OF THORACIC DISEASE Motlaghzadeh, Y., Nesbit, S., Guo, H., Yang, E., Desai, K., Lui, N. S. 2023

  View details for DOI 10.21037/jtd-22-479

  View details for Web of Science ID 000942495700001

• A Parathyroid Hormone-guided Calcium and Calcitriol Supplementation Protocol Reduces Hypocalcemia-related Readmissions Following Total Thyroidectomy. Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists Chindris, A., Desai, K., Ozgursoy, S. K., Heckman, M. G., Casler, J. D. 2023

  Abstract

  OBJECTIVE: To determine the effect of a 4 hour postoperative serum parathyroid hormone (PTH) guided calcium and calcitriol supplementation protocol on the incidence of hypocalcemia and hospital readmissions in patients undergoing total thyroidectomy.METHODS: This was a single institution, retrospective chart review of patients who underwent total thyroidectomy, 148 had been operated on prior to the protocol implementation and 389 after. Hypocalcemia risk was stratified as low (PTH >30 pg/ml), medium (15-30 pg/ml), and high (<15 pg/ml), using serum PTH values obtained 4 hours postoperatively. Hypocalcemia was defined as a total serum calcium level <8 mg/dl. Baseline demographic and operative characteristics, and postoperative outcome were recorded for both groups. Fisher's exact test or Wilcoxon rank sum test were used to compare the characteristics of the two groups. A multivariable logistic regression model was applied to account for potentially confounding variables.RESULTS: Postoperative hypocalcemia occurred significantly less frequently in the protocol group compared to the preprotocol group (10.3% vs. 20.9%, P=.002). The reduction in hypocalcemia in the protocol group was observed both in patients with (16.3% vs. 25.6%) and without (8.4% vs. 19.3%) cervical lymph node dissection. There was a significantly lower incidence of hospital readmission events in the protocol group compared to the preprotocol group (1.0% vs. 4.7%, P=.013).CONCLUSIONS: Compared to a historical cohort, a PTH-guided protocol for calcium and calcitriol supplementation significantly reduces postoperative hypocalcemia and hospital readmission rates, in patients undergoing total thyroidectomy.

  View details for DOI 10.1016/j.eprac.2023.01.009

  View details for PubMedID 36682414

• Radiotherapy for brain metastases from thyroid cancer: an institutional and national retrospective cohort study. Thyroid : official journal of the American Thyroid Association Blomain, E. S., Berta, S., Hug, N. F., Giao, D. M., Meola, A., Binkley, M. S., Hui, C., Churilla, T., Shahsavari, N., Desai, K., Chang, S. D., Soltys, S., Pollom, E. L. 2022

  Abstract

  BACKGROUND: Stereotactic radiosurgery (SRS) is the standard of care for patients with a limited number of brain metastases. Despite the fact that the seminal studies regarding SRS for brain metastases were largely tissue agnostic, several current national guidelines do not uniformly recommend SRS in thyroid cancer. We therefore investigated oncologic outcomes in a cohort of patients with brain metastases from thyroid cancer who received radiotherapy at our institution as well as those in a nationally representative cancer cohort, the national cancer database (NCDB).METHODS: We identified patients with thyroid cancer and brain metastases treated with radiotherapy at our institution from 2002 through 2020. For the NCDB cohort, the national database of patients with thyroid cancer was screened on the basis of brain-directed radiotherapy or brain metastases. For the institutional cohort, the cumulative risk of local failure, distant intracranial failure and radiation necrosis were calculated, adjusted for the competing risk of death. Overall survival (OS) in both cohorts was analyzed using Kaplan-Meier method. Univariate analysis was accomplished via clustered competing risks regression.RESULTS: For the institutional cohort, we identified 33 patients with 212 treated brain metastases. Overall survival was 6.6 months. The 1-year cumulative incidences of local failure and distant intracranial failures were 7.0% and 38%, respectively. The 1-year risk of radiation necrosis was 3.3%. In the NCDB cohort, there were 289 patients and median survival was 10.2 months. NCDB national practice patterns analysis showed an increasing use of SRS over time in both the entire cohort and the subset of anaplastic patients. Univariate analysis was performed for overall survival, risk of local failure, risk of regional intracranial failure and risk of radiation necrosis.CONCLUSIONS: SRS is a safe, effective and increasingly-utilized treatment for thyroid cancer brain metastases of any histology and should be the standard of care treatment.

  View details for DOI 10.1089/thy.2021.0628

  View details for PubMedID 35229625

• Benign Ectopic Thyroid in the Lateral (Level II) Neck Compartment CUREUS JOURNAL OF MEDICAL SCIENCE Liu, G. S., Berry, G. J., Desai, K., Megwalu, U. C. 2022; 14 (2)

  View details for DOI 10.7759/cureus.22140

  View details for Web of Science ID 000755197000018

• Benign Ectopic Thyroid in the Lateral (Level II) Neck Compartment. Cureus Liu, G. S., Berry, G. J., Desai, K., Megwalu, U. C. 2022; 14 (2): e22140

  Abstract

  Ectopic thyroid most commonly presents in the midline and is typically associated with the absence of an orthotopic thyroid. Less commonly, ectopic thyroid can present in the lateral neck, typically with a coexisting orthotopic thyroid and abnormal pathology in either the ectopic or orthotopic thyroid tissue. This paper describes a rare case of a benign, ectopic thyroid in the lateral neck (level II) associated with a normal, benign orthotopic thyroid. This report illustrates clinical pearls for the management of this unusual entity.

  View details for DOI 10.7759/cureus.22140

  View details for PubMedID 35308702

  View details for PubMedCentralID PMC8920790

• RADIOTHERAPY FOR BRAIN METASTASES FROM THYROID CANCER: A RETROSPECTIVE COHORT STUDY Blomain, E., Berta, S., Hug, N., Giao, D., Meola, A., Binkley, M., Shahsavari, N., Desai, K., Chang, S., Soltys, S., Pollom, E. OXFORD UNIV PRESS INC. 2021: 42

  View details for Web of Science ID 000757356200166

• Metastatic Paraganglioma of the Spine With SDHB Mutation: Case Report and Review of the Literature INTERNATIONAL JOURNAL OF SPINE SURGERY Jabarkheel, R., Pendharkar, A., Lavezo, J. L., Annes, J., Desai, K., Vogel, H., Desai, A. M. 2021; 14: S37–S45

  View details for DOI 10.14444/7163

  View details for Web of Science ID 000618077900008

• Metastatic Paraganglioma of the Spine With SDHB Mutation: Case Report and Review of the Literature. International journal of spine surgery Jabarkheel, R., Pendharkar, A. V., Lavezo, J. L., Annes, J., Desai, K., Vogel, H., Desai, A. M. 2021; 14 (s4): S37-S45

  Abstract

  Paragangliomas (PGLs) are rare neuroendocrine tumors that can arise from any autonomic ganglion of the body. Most PGLs do not metastasize. Here, we present a rare case of metastatic PGL of the spine in a patient with a germline pathogenic succinate dehydrogenase subunit B (SDHB) mutation.In addition to a case report we provide a literature review of metastatic spinal PGL to highlight the importance of genetic testing and long-term surveillance of these patients.A 45-year-old woman with history of spinal nerve root PGL, 17 years prior, presented with back pain of several months' duration. Imaging revealed multilevel lytic lesions throughout the cervical, thoracic, and lumbar spine as well as involvement of the right mandibular condyle and clavicle. Percutaneous biopsy of the L1 spinal lesion confirmed metastatic PGL and the patient underwent posterior tumor resection and instrumented fusion of T7-T11. Postoperatively the patient was found to have a pathogenic SDHB deletion.Patients with SDHx mutation, particularly SDHB, have increased risk of developing metastatic PGLs. Consequently, these individuals require long-term surveillance given the risk for developing new tumors or disease recurrence, even years to decades after primary tumor resection. Surgical management of spinal metastatic PGL involves correcting spinal instability, minimizing tumor burden, and alleviating epidural cord compression. In patients with metastatic PGL of the spine, genetic testing should be considered.

  View details for DOI 10.14444/7163

  View details for PubMedID 33900943

• Doege-Potter syndrome presenting as 'end-stage renal disease-associated hypoglycaemia': a primary presentation of retroperitoneal sarcoma. BMJ case reports Shekhar, S., Chen, J., Desai, K. 2020; 13 (8)

  Abstract

  A middle-aged woman with end-stage renal disease (ESRD) due to obstructive nephropathy presented to the hospital for an episode of unresponsiveness and hypoglycaemia. Initially, she was diagnosed with hypoglycaemia associated with ESRD and was discharged. However, she returned to the hospital after experiencing tonic-clonic seizures and recurrent hypoglycaemia. Her hypoglycaemia workup revealed an elevated insulin-like growth factor 2 (IGF2) to IGF1 ratio consistent with paraneoplastic IGF2 secretion. Subsequently, a CT abdomen revealed a retroperitoneal mass, found to be a retroperitoneal sarcoma. Her hypoglycaemia was treated with glucocorticoids and growth hormone. Surgical debulking of her tumour was attempted, but she expired due to postoperative haemorrhagic shock. Doege-Potter syndrome is a rare cause of hypoglycaemia which should be suspected in any new-onset, worsening, inexplicable or refractory hypoglycaemia, particularly in non-diabetic ESRD. Here we present a report of retroperitoneal sarcoma presenting with hypoglycaemia in a patient with ESRD without diabetes.

  View details for DOI 10.1136/bcr-2020-235549

  View details for PubMedID 32843457

• Visual Vignette ENDOCRINE PRACTICE Vukkadala, N., Desai, K., Megwalu, U. 2019; 25 (12): 1366

  View details for DOI 10.4158/EP-2019-0054

  View details for Web of Science ID 000505055300017

• Socioeconomic Predictors of Pituitary Surgery. Cureus Deb, S., Vyas, D. B., Pendharkar, A. V., Rezaii, P. G., Schoen, M. K., Desai, K., Gephart, M. H., Desai, A. 2019; 11 (1): e3957

  Abstract

  There exists a lack of data on the effect of socioeconomic status (SES) on outcomes for pituitary tumors, which have been associated with significant morbidity. The goal of this population-level study is to investigate the role of SES on receiving treatment and survival in patients with pituitary tumors.The Surveillance, Epidemiology, and End Results (SEER) program database from the National Cancer Institute was used to identify patients diagnosed with pituitary tumors between 2003 and 2012. SES was determined using a validated composite index. Race was categorized as Caucasian and non-Caucasian. Treatment received included surgery, radiation, and radiation with surgery. Odds of receiving surgery and survival probability were analyzed using multivariate logistic regression and Cox proportional hazards model, respectively.A total of 25,802 patients with pituitary tumors were identified for analysis. High SES tertile (odds ratio (OR) = 1.095; 95% confidence interval (CI) [1.059, 1.132]) and quintile (OR = 1.052; 95% CI [1.031, 1.072]) were associated with higher odds of receiving surgery (p<0.0001). Caucasian patients had higher odds of receiving surgery when compared to non-Caucasian patients (OR = 1.064; 95% CI [1.000, 1.133]; p<0.05). Neither SES nor race were significant predictors of survival probability.Socioeconomic status and race were found to be associated with higher odds of receiving surgery for pituitary tumors, and thus serve as independent predictors of surgical management. Further studies are required to investigate possible causes for these findings.

  View details for DOI 10.7759/cureus.3957

  View details for PubMedID 30956910

  View details for PubMedCentralID PMC6436671

• Socioeconomic Predictors of Pituitary Surgery CUREUS Deb, S., Vyas, D. B., Pendharkar, A., Rezaii, P. G., Schoen, M. K., Desai, K., Gephart, M. H., Desai, A. 2019; 11 (1)

  View details for DOI 10.7759/cureus.3957

  View details for Web of Science ID 000461525500004

• Clinical efficacy of frameless stereotactic radiosurgery in the management of spinal metastases from thyroid carcinoma. Spine Hariri, O. n., Takayanagi, A. n., Lischalk, J. n., Desai, K. n., Florence, T. J., Yazdian, P. n., Chang, S. D., Vrionis, F. n., Adler, J. R., Quadri, S. A., Desai, A. n. 2019

  Abstract

  MINI: Study evaluates the efficacy of CyberKnife® (CK) SRS for thyroid spinal metastases (SM). Patients with SMs from thyroid carcinoma that were treated with CK SRS between 2003 and 2013were identified. CK can be safely used to treat SMs from thyroid cancer with a high rate of local control.A retrospective data review.To evaluate the efficacy of CyberKnife® SRS for thyroid SMs.Thyroid carcinoma is an infrequent cause of spinal metastasis (SM). The absolute efficacy of stereotactic radiosurgery (SRS) generally and CyberKnife® (CK) in particular remains poorly characterized for thyroid SM. The current study is the first to specifically evaluate the efficacy of CyberKnife® SRS for thyroid SMs.A retrospective review of patients at our institution between 2003 and 2013 was done. Details about tumor location, radiographic findings before and after CK SRS, tumor recurrence, prescription isodose level, total and maximum dose, number of fractions, and gross tumor volume coverage were similarly collected. For comparison with other studies, the biologically effective dose (BED) and the equivalent total dose in 2Gy fractions (EQD2) were calculated. Each patient was assessed for survival and local disease control from the time of the first CK session and survival analysis was carried out using the Kaplan-Meier method. Risk factors for local failure were assessed using multivariate logistic regression.A total of 12 patients with 32 spinal metastases from thyroid carcinoma that were treated with CK SRS were identified. Survival for 1, 2, and 3 years was 55%, 44%, and 33%, and local control was 67%, 56%, and 34% respectively. The study found that the single strongest factor associated with local control was prior radiotherapy (β-coefficient -27.72, p = 0.01). No complications occurred in the immediate or late follow-up period.This was the first study to specifically investigate the efficacy of CK for treatment of thyroid SMs. Our findings suggest that CK can be safely used to treat spinal SMs from thyroid cancer and is associated with a high rate of local control.4.

  View details for DOI 10.1097/BRS.0000000000003087

  View details for PubMedID 31261273

• DUAL ECTOPIC THYROID GLANDS. Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists Vukkadala, N. n., Desai, K. n., Megwalu, U. n. 2019

  View details for PubMedID 31013156