Showing papers in "Thyroid in 2006"
Johns Hopkins University School of Medicine1, University of Michigan2, Anschutz Medical Campus3, Ohio State University4, Boston Medical Center5, University of Pennsylvania6, University of Florida7, Mayo Clinic8, University of Texas MD Anderson Cancer Center9, Memorial Sloan Kettering Cancer Center10
2,086 citations
TL;DR: It is confirmed that near-total thyroidectomy is indicated in high-risk patients and radioactive iodine therapy is beneficial for stage II, III, and IV patients, and it is shown for the first time that superior outcomes are associated with aggressive thyroid hormone suppression therapy in high risk patients, but are achieved with modest suppression in stage II patients.
Abstract: This analysis was performed to determine the effect of initial therapy on the outcomes of thyroid cancer patients. The study setting was a prospectively followed multi-institutional registry. Patients were stratified as low risk (stages I and II) or high risk (stages III and IV). Treatments employed included near-total thyroidectomy, administration of radioactive iodine, and thyroid hormone suppression therapy. Outcome measures were overall survival, disease-specific survival, and disease-free survival. Near-total thyroidectomy, radioactive iodine, and aggressive thyroid hormone suppression therapy were each independently associated with longer overall survival in high-risk patients. Near-total thyroidectomy followed by radioactive iodine therapy, and moderate thyroid hormone suppression therapy, both predicted improved overall survival in stage II patients. No treatment modality, including lack of radioactive iodine, was associated with altered survival in stage I patients. Based on our overall survival data, we confirm that near-total thyroidectomy is indicated in high-risk patients. We also conclude that radioactive iodine therapy is beneficial for stage II, III, and IV patients. Importantly, we show for the first time that superior outcomes are associated with aggressive thyroid hormone suppression therapy in high-risk patients, but are achieved with modest suppression in stage II patients. We were unable to show any impact, positive or negative, of specific therapies in stage I patients.
586 citations
TL;DR: In morbidly obese individuals, the prevalence of overt and subclinical hypothyroidism was high and the morbidly obesity subjects have higher levels of T3, FT3, T4, and TSH, probably the result of the reset of their central thyrostat at higher level.
Abstract: Morbidly obese subjects may present with abnormal thyroid function tests but the reported data are scarce. Therefore, we studied the thyroid parameters in 144 morbidly obese patients, 110 females and 34 males, to assess the prevalence of hypothyroidism. Eleven percent (11.8%) carried the diagnosis of hypothyroidism and were undergoing levothyroxine (LT4) replacement therapy, 7.7% had newly diagnosed subclinical hypothyroidism, 0.7% had subclinical hyperthyroidism and 7.7% were euthyroid with positive antibodies (anti-thyroid peroxidase antibodies [TPOAb]). From the 144 subjects, we selected a cohort of 78 euthyroid subjects with negative TPOAb, who did not receive LT4 replacement or suppression therapy (the experimental group) and compared them to 77 normal-weight euthyroid subjects, TPOA-negative, matched for age and gender who served as controls. The experimental group had higher serum levels of triiodothyronine (T3), thyroxine (T4), free triiodothyronine (FT3), and thyrotropin (TSH) compared to the con...
262 citations
TL;DR: RF ablation may be an effective and safe nonsurgical technique to treat benign cold thyroid nodules and mixed/mainly cystic tumors showed a significantly better response than mainly solid tumors.
Abstract: Context and objective: To evaluate the efficacy and safety of ultrasound (US)-guided percutaneous radiofrequency (RF) ablation for benign cold thyroid nodules as a nonsurgical therapeutic modality. Design, intervention, and patients: A total of 35 benign cold thyroid nodules in 30 euthyroid patients (M:F = 2:28; mean age 39.1 years) underwent percutaneous RF ablation with a 1-cm-internally cooled electrode. Seventy-seven percent (23/30) of patients required conscious sedation for discomfort. We evaluated the tumor size, cystic component, vascularity (by color Doppler US), and the severity of mass-related symptoms before treatment. We assessed the therapeutic efficacy and safety of RF ablation by clinical and US follow-up (median 6.4 months). Main outcome and results: The volume of the tumors before ablation had a range of 0.6–28.2 mL (mean, 6.3 mL). The residual volume was 53.5% ± 26.5% of original at 1.1–2.9 months (n = 32), 36.2% ± 27.4% at 3.0–5.9 months (n = 20), 30.7% ± 25.0% at 6.0–8.9 months (n = 1...
244 citations
TL;DR: Until additional physiologic data are available to make a better judgment, the American Thyroid Association recommends that women receive 150 microg iodine supplements daily during pregnancy and lactation and that all prenatal vitamin/mineral preparations contain 150microg of iodine.
Abstract: The fetus is totally dependent in early pregnancy on maternal thyroxine for normal brain development. Adequate maternal dietary intake of iodine during pregnancy is essential for maternal thyroxine production and later for thyroid function in the fetus. If iodine insufficiency leads to inadequate production of thyroid hormones and hypothyroidism during pregnancy, then irreversible fetal brain damage can result. In the United States, the median urinary iodine (UI) was 168 µg/L in 2001–2002, well within the range of normal established by the World Health Organization (WHO), but whereas the UI of pregnant women (173 µg/L; 95% CI 75–229 µg/L) was within the range recommended by WHO (150–249 µg/L), the lower 95% CI was less than 150 µg/L. Therefore, until additional physiologic data are available to make a better judgment, the American Thyroid Association recommends that women receive 150 µg iodine supplements daily during pregnancy and lactation and that all prenatal vitamin/mineral preparations contain 150 µ...
231 citations
TL;DR: There remains a theoretical concern that in individuals with compromised thyroid function and/or whose iodine intake is marginal soy foods may increase risk of developing clinical hypothyroidism, so it is important for soy food consumers to make sure their intake of iodine is adequate.
Abstract: Soy foods are a traditional staple of Asian diets but because of their purported health benefits they have become popular in recent years among non-Asians, especially postmenopausal women. There are many bioactive soybean components that may contribute to the hypothesized health benefits of soy but most attention has focused on the isoflavones, which have both hormonal and nonhormonal properties. However, despite the possible benefits concerns have been expressed that soy may be contraindicated for some subsets of the population. One concern is that soy may adversely affect thyroid function and interfere with the absorption of synthetic thyroid hormone. Thus, the purpose of this review is to evaluate the relevant literature and provide the clinician guidance for advising their patients about the effects of soy on thyroid function. In total, 14 trials (thyroid function was not the primary health outcome in any trial) were identified in which the effects of soy foods or isoflavones on at least one measure of thyroid function was assessed in presumably healthy subjects; eight involved women only, four involved men, and two both men and women. With only one exception, either no effects or only very modest changes were noted in these trials. Thus, collectively the findings provide little evidence that in euthyroid, iodine-replete individuals, soy foods, or isoflavones adversely affect thyroid function. In contrast, some evidence suggests that soy foods, by inhibiting absorption, may increase the dose of thyroid hormone required by hypothyroid patients. However, hypothyroid adults need not avoid soy foods. In addition, there remains a theoretical concern based on in vitro and animal data that in individuals with compromised thyroid function and/or whose iodine intake is marginal soy foods may increase risk of developing clinical hypothyroidism. Therefore, it is important for soy food consumers to make sure their intake of iodine is adequate.
171 citations
TL;DR: It is concluded that US-guided FNAB with onsite evaluation of cytology specimens substantially increases the adequacy of cytological specimens and decreases the number of required needle passes, which ultimately reduces patient discomfort and diagnostic errors, thus raising the question as to whether this should eventually become the standard of care.
Abstract: Fine-needle aspiration biopsy (FNAB) of thyroid nodules is a safe, cost-effective procedure but the rates of inadequate cytology specimens range from approximately 1% to 15%. This study tests the hypothesis that ultrasonographically (US) guided FNAB and onsite assessment of cytology improves the adequacy rate of FNAB. A retrospective analysis was performed on 693 thyroid FNAB specimens obtained with and without ultrasound guidance and with or without onsite cytology assessment. Overall, 29 specimens (4%) were inadequate for diagnosis. Among 163 cystic nodules and 530 solid nodules, inadequacy rates were 15% (n = 24) and 1% (n = 5) respectively (p = 0.0001). An onsite assessment of cytology for adequacy was done in 550 cases (83%), which was more accurately performed by a cytopathologist (97%) than a cytotechnologist (93%, p = 0.015). With US-guided FNAB, 3% of the cytology specimens were inadequate, compared to a 7% rate when US was not done (p = 0.003). The mean number of needle punctures necessary for an adequate specimen was 3.8 +/- 0.06 (median, 3.0; range, 1-11), which was different among various types of doctors, ranging from 3.2 +/- 0.07 to 5.4 +/- 0.12 (p = 0.001 analysis of variance [ANOVA]). The fewest number of needle passes to achieve an adequate specimen were required by university endocrinologists and pathologists working together (average, 3.2 +/- 0.07; median, 3.0; range, 1-11). Sample inadequacy rate varied significantly among physician groups, ranging from 3% to 18% (p = 0.0001 ANOVA). Stepwise regression analysis showed that onsite assessment of cytology, US-guided FNAB (p = 0.16), and cystic nature of the nodule (p < 0.0001 for all) correlated with adequacy of the specimen. We conclude that US-guided FNAB with onsite evaluation of cytology specimens substantially increases the adequacy of cytology specimens and decreases the number of required needle passes, which ultimately reduces patient discomfort and diagnostic errors, thus raising the question as to whether this should eventually become the standard of care. We believe this is a goal that training programs should strive to achieve.
162 citations
TL;DR: A high frequency of PTEN promoter hypermethylation is shown, especially in follicular tumors, suggesting its possible role in thyroid tumorigenesis.
Abstract: The tumor-suppressor gene PTEN/MMAC1, on chromosome 10q23.3, has been implicated in an important number of human tumors, such as thyroid carcinomas. PTEN somatic mutations occur in sporadic tumors of the endometrium, brain, prostate, or melanomas, while germline mutations predispose to development of the multiple hamartoma syndromes (i.e., Cowden's disease and Bannayan-Zonana syndrome). Activation of the two alleles of PTEN is required for its tumor-suppression role. Because the frequency of PTEN suppression in thyroid tumors exceeds that of PTEN mutations or deletions, it is very likely that epigenetic mechanisms, such as promoter hypermethylation, may account for its inactivation in a subset of tumors. The main aim of this study was to assess the frequency of promoter hypermethylation of PTEN in thyroid tumors. We studied frozen tissue samples from 46 papillary carcinomas, 7 follicular carcinomas, 6 follicular adenomas as well as 39 normal thyroid tissue samples. Methylation-specific polymerase-chain reaction (PCR) with three different sets of primers was used. Two of the primer sets were designed to avoid any interference with PTEN pseudogene promoter. PTEN promoter hypermethylation was detected in 21 of 46 (45.7%) papillary carcinomas, 6 of 7 follicular carcinomas, and 5 of 6 follicular adenomas. It was negative in all normal tissues. Negative immunohistochemical staining for PTEN was significantly associated with the presence of promoter hypermethylation (p < 0.001). These results show a high frequency of PTEN promoter hypermethylation, especially in follicular tumors, suggesting its possible role in thyroid tumorigenesis.
153 citations
TL;DR: Increasing PTC incidence is largely attributable to greater diagnosis of small PTC, many of which are likely to have been asymptomatic, identified by neck ultrasonography and subsequent FNAB, suggesting the occurrence of clinically relevant tumors may also have increased.
Abstract: Context: Papillary thyroid carcinoma (PTC) is the most prevalent endocrine malignancy. The reported incidence of PTC has more than doubled in many countries during the past half century. In Tasmania, an island state of the Commonwealth of Australia the incidence has increased by 24.7% per annum during the last two decades. Objective: Using the Tasmanian population as a model, this study sought to determine the relationship between changes in PTC incidence and trends for utilization of thyroid surgery and thyroid fine-needle aspiration biopsy (FNAB) cytology. Design: Hospital and pathology services in Tasmania provided data relating to all thyroid surgical, cytologic, and histopathology procedures undertaken between 1988 and 1998. The accuracy of PTC case ascertainment by the Tasmanian Cancer Registry was validated and the relationship between thyroid procedures and PTC incidence assessed. Results: A total of 3452 individuals underwent a thyroid procedure, comprising 1968 surgical and 1756 FNAB cytologic p...
150 citations
TL;DR: The high prevalence of postpartum thyroid dysfunction among general and high-risk women and in women with antithyroid peroxidase antibodies may warrant routine screening TPOAbs, but the benefits, cost, and risks related to subsequent therapy must be weighed.
Abstract: Estimates of the prevalence of postpartum thyroid dysfunction (PPTD) vary widely because of variations in study design, populations, and duration of screening. Our objective was to estimate the prevalence of PPTD among general and high-risk women, across geographical regions and in women with antithyroid peroxidase antibodies (TPOAbs). We conducted a systematic review and pooled analysis of the published literature (1975-2004), simultaneously accounting for sample size, study quality, percentage follow-up, and duration of screening. Data sources were MEDLINE and the bibliography of candidate studies. Two reviewers independently extracted data. Of 587 studies identified, 21 articles (8081 subjects) met the study criteria. The pooled prevalence of PPTD, defined as an abnormal thyroid-stimulating hormone (TSH) level, for the general population was 8.1% (95% confidence interval [CI] 6.6%-10.0%). The risk ratios for the development of PPTD among women with TPOAbs compared to women without TPOAbs ranged between 4 and 97 with a pooled risk ratio of 5.7 (95% CI: 5.3-6.1). Global prevalence varied from 4.4% in Asia to 5.7% in the United States. Prevalence among women with type 1 diabetes mellitus was 19.6% (95% CI 19.5%-19.7%). PPTD occurs in 1 of 12 women in the general population worldwide, 1 of 17 women in the United States and is 5.7 times more likely to occur in women with TPOAbs. The high prevalence may warrant routine screening TPOAbs, but the benefits, cost, and risks related to subsequent therapy must be weighed.
147 citations
TL;DR: Transgenic mice with thyrocyte-specific expression of FLIP have normal thyroid development with no significant changes in thyroid cell death or proliferation.
Abstract: FLIP is an antiapoptotic protein that has been demonstrated to play an important role in inflammation, cancer, and autoimmune diseases. However, it is not known whether increased expression of FLIP...
TL;DR: Using data for differentiated thyroid cancer (DTC) provided by the Surveillance Epidemiology and End Results (SEER) branch of the National Cancer Institute, and fine-needle aspiration data from Mayo Clinic, it is found that the likelihood of 2 cases of sporadic DTC (RR) in a 9-member first-degree family was 1.25% of all DTC families.
Abstract: Clinical and genetic studies of familial nonmedullary thyroid cancer (FNMTC) have yielded conflicting results concerning the aggressiveness of the tumors, and uncertainty of their genetic makeup. In most reports of multiply affected families, the composition of the kindreds has favored families of 2 affected members. Using data for differentiated thyroid cancer (DTC) provided by the Surveillance Epidemiology and End Results (SEER) branch of the National Cancer Institute, and fine-needle aspiration data from Mayo Clinic, I found that the likelihood of 2 cases of sporadic DTC (RR) in a 9-member first-degree family was 1.25% of all DTC families, amounting to 39.4% of 306 multi-hit families reported in the literature. To study the remaining affected families I used the Bernouilli trials model of exact probability. The 60.6% of non-RR, multiply affected families are mostly concentrated in kindreds of 2 to 5 affected members. In 2-hit families, 62%-69% of affected members are sporadic (RR) cases. In families having 3 or more affected members, fewer than 6% have 1 or more sporadic (R) cases, and fewer than 0.15% have 2 or more. In families of 3 to 5 affected members, more than 96% of affected members have the familial (F) trait. Approximately 1 of 338 DTC cases carries the F-trait. Since approximately 40% of multiply affected member first-degree kindreds of DTC, and a significant majority of 2-hit families, are composed of clinically evident, sporadic cases only clinical and genetic investigations of FNMTC should center on families of 3 or more affected members.
TL;DR: A significant increase of the prevalence has been observed both for thyroid autoimmune disorders as well as for hypothyroidism, and the abovementioned evidences seem sufficient to suggest careful thyroid monitoring during the follow-up of patients with HCV infection.
Abstract: The prevalence of thyroid disorders has been evaluated in patients with hepatitis C virus (HCV) infection by many studies. From a review of the published controlled studies, it is possible to observe that: (1) most investigated patients with chronic HCV hepatitis, while a minority evaluated hepatitis C virus antibody (HCVAb)- seropositive patients (the two conditions are not comparable with regards to thyroidal repercussions, in fact, HCVAb-seropositive patients do not necessarily display changes of the immune system present in chronically infected HCV patients); and (2) some authors selected as internal control hepatitis B virus (HBV)-infected patients, while others selected apparently healthy controls or HCVAb-negative subjects. Pooling all data about HCV-positive patients (with chronic hepatitis or HCVAb positivity) and using as control the sum of healthy controls, HBV-infected patients and sera negative for HCVAb, a significant increase of the prevalence has been observed both for thyroid autoimmune d...
TL;DR: Gen expression in fresh frozen papillary thyroid carcinoma specimens is interpreted to be consistent with altered cell motility, extracellular matrix remodeling and increased cell proliferation, as important processes in PTC tumor progression.
Abstract: We used cDNA microarrays to study gene expression in fresh frozen papillary thyroid carcinoma (PTC) specimens. Seven clinically aggressive carcinomas were included, comprising poorly differentiated PTC and tumors with extensive local invasion or synchronous distant metastases. Ten differentiated (classic) papillary thyroid carcinomas (PTC) and non-neoplastic thyroid tissues were also investigated. TaqMan quantitative reverse transcriptase-polymerase chain reaction (RT-PCR), in situ hybridization, and immunohistochemistry verified the differential gene expression. The B-Raf gene was mutated with a T-->A transversion at nucleotide 1799 (V600E) in 8 of 10 differentiated PTC, and in 4 of 7 aggressive carcinomas. Among genes markedly and equally over-expressed in carcinomas of both the aggressive and classic PtC groups, compared to normal thyroid tissue, were CBP/p300 transactivator (CItED1), fibronectin, growth/differentiation factor 15, potassium inwardly rectifying channel KCNJ2, glutaminyl peptide cyclotransferase, WNT7A, and dipeptidyl peptidase IV. A marked upregulation in carcinomas of P-cadherin mRNA and protein concomitant with E-cadherin downregulation, indicates a possible P-E cadherin "switch" in PTC. The growth factor homologue Nel-like 2, dual specificity phosphatase 5, the serine protease kallikrein 10, and also the tight junction genes claudin 1 and claudin 16, were upregulated in classic PTC but not in aggressive tumors, which may be consistent with altered cell polarity in the dedifferentiated PtC. The aggressive, poorly differentiated PtC group was specifically characterized by marked upregulation of several genes related to cell proliferation such as cell division cycle 2 (CDC2), CDC7, kinesin-like 5, ubiquitin conjugating enzyme E2C, and topoisomerase IIalpha, and by upregulation of genes encoding extracellular matrix proteins such as seprase, extracellular matrix protein 1, and several collagens. These aggressive tumors were also characterized by overexpression of the integrin ligand periostin, and in some biopsies also of osteopontin and of the upstream Rac-regulator dedicator of cytokinesis 10 (DOCK10). These data are interpreted to be consistent with altered cell motility, extracellular matrix remodeling and increased cell proliferation, as important processes in PTC tumor progression.
TL;DR: UGFNAB is considered to be superior to PGFNAB for obtaining adequate material especially for small-sized nodules, as well as providing more accurate cytologic evaluation.
Abstract: Objective: Although fine-needle aspiration biopsy (FNAB) of thyroid nodules is a reliable and simple method, the diagnostic value may be limited by inadequate and false-negative results. In this pr...
TL;DR: The finding that muscle strength and cross-sectional area are reduced in SCH and improved after treatment lends support for the clinical decision to treat rather than observe this condition.
Abstract: Objective: Patients with overt hyperthyroidism (OH) commonly have proximal limb muscle weakness that improves after correction of hyperthyroidism. It is unclear, however, if patients with milder de...
TL;DR: It is believed that measurement of bone mineral density is recommended in postmenopausal women with DTC starting TSH suppressive therapy and should be subsequently regularly measured to enable timely intervention with bone protective agents.
Abstract: Patients with differentiated thyroid carcinoma (DTC) are commonly treated long-term with thyrotropin (TSH)- suppressive thyroxine replacement therapy resolving in a state of subclinical hyperthyroidism. The relationship between subclinical hyperthyroidism and osteoporosis is not clear. In this review, we systematically selected and analyzed 21 studies addressing this issue. Although multiple methodological differences between studies prevented a structured meta-analysis, our data suggest that postmenopausal women with subclinical hyperthyroidism are most at risk, whereas no increased risk was observed in men and premenopausal women. Based on these findings we believe that measurement of bone mineral density is recommended in postmenopausal women with DTC starting TSH suppressive therapy. This should be subsequently regularly measured to enable timely intervention with bone protective agents.
TL;DR: The rPTH assay is a highly accurate and effective tool for predicting symptomatic hypocalcemia immediately after thyroidectomy, and routine utilization of this assay is recommended, because it will allow safe and timely discharge of normocalcemic patients and the early identification of patients requiring treatment of postthyroidectomy hypocalCEmia.
Abstract: Purpose: To evaluate the rapid parathyroid hormone assay (rPTH) as a perioperative tool in predicting postoperative symptomatic hypocalcemia following thyroidectomy. Methods: We conducted a prospec...
TL;DR: The results show that hypermethylation of several tumor-related gene promoters is a frequent event in UTC and the hyper methylation status may be reversed by DNA demethylating agents.
Abstract: Objective: To understand the role of epigenetic inactivation of tumor-related genes in the pathogenesis of thyroid cancer, we investigated the methylation profile of distinct thyroid neoplasms. Des...
TL;DR: The results support the need for a more standardized terminology for FNAB reporting and education of the clinicians on that terminology.
Abstract: Introduction: Guidelines on thyroid fine-needle aspiration biopsy (FNABs) reporting calls for unambiguous diagnostic terminology in order to maximize treatment. This study evaluates how pathologist...
TL;DR: These data provide evidence for the presence of adult stem and precursor cells of endodermal origin in the human thyroid gland.
Abstract: Objective: Adult stem cells have been detected in several human tissues. The object of this study was to investigate whether they also occur in the human thyroid gland. Design: The expression of the stem cell marker Oct- 4 and the early endodermal markers GATA-4 and HNF4α was analyzed in histologic slides and cultured cells derived from goiters, in the FRTL5 cell line, and the HTh74, HTC, C643, and XTC133 thyroid carcinoma cell lines. Main outcome: Stem cell markers were detectable in all primary cultures whereas in the differentiated FRTL5 cell line no expression was observed. Expression of stem cell marker mRNA was not affected by thyrotropin (TSH) stimulation and did not decrease when cells underwent several passages. Immunostaining of cultured cells and of histologic slides of goitrous tissues showed only single cells that were immunoreactive for Oct-4, GATA-4, and HNF4a. Expression of Oct-4 but not of endodermal marker GATA-4 was also detectable in some thyroid carcinoma cell lines. Fluorescence-acti...
TL;DR: The temporal trend in tumor size, age at diagnosis, and histology in a retrospective analysis of 500 thyroid cancers diagnosed over 20 years confirmed the importance of evaluating thyroid nodules smaller than 10mm and corroborate recent findings suggesting that age be reconsidered as an independent prognostic factor for differentiated thyroid cancers.
Abstract: Recently, the Italian Network of Cancer Registries analyzed 5101 cases of thyroid carcinoma showing a reduction of mortality rate of 4%/year. This prompts us to evaluate the temporal trend in tumor...
TL;DR: It is suggested that TRAb maintain stimulating activity after a full course of MMI treatment in the large majority of patients with Graves' disease, however, it is likely that the potency of these antibodies and/or the thyroid response to them change during treatment, as suggested by the different values measured in euthyroid control subjects and in euthYroid patients after M MI treatment.
Abstract: Aim and methods: We performed a quantitative retrospective analysis of serum thyrotropin receptor antibody (TRAb) concentrations measured by a second-generation radioreceptor assay in 58 patients w...
TL;DR: The recent discovery that defects in the SECIS-binding protein 2 (SBP2) result in thyroid dysfunction, reveal not only the indispensability of Se and the selenoproteins as essential factors in thyroid metabolism and pathogenesis, but open up new prospects for enhanced treatment.
Abstract: The essential micronutrient selenium (Se) occurs in the form of the amino acid selenocysteine in selenoproteins which exert various effects, while maintaining the cell reduction-oxidation balance. The discovery that all three deiodinases that convert thyroxine (T4) into triiodothyronine (T3) contain selenocysteine illustrates how the production of the active thyroid hormone is dependent on Se status. The selenoenzyme families of glutathione peroxidases (GPx) and thioredoxin reductases (TRx) possess powerful antioxidant properties and form a complex defense system that protects thyrocytes from oxidative damage. Se supplementation in patients with autoimmune thyroiditis seems to modify the immune response, probably by enhancing plasma GPx activity and decreasing excess levels of hydrogen peroxide. However, the enhancement of immunocompetence may also be the result of the synergistic action of various selenoproteins and not exclusively of GPx. There is evidence supporting considerable oxidative stress in Graves' disease where Se supplementation, because of its free radical scavenging properties, may increase the enzymatic antioxidant activity. TRx has been found significantly elevated in GD revealing its involvement in the pathogenesis of this condition and representing a potential future target for therapeutical intervention. Low Se serum levels have also been associated with increased risk of thyroid cancer and may play a role in carcinogenesis. It is noteworthy, that the Food and Drug Administration has recently determined that there is sufficient evidence to warrant a qualified health claim for Se and cancer. Furthermore, the recent discovery that defects in the SECIS-binding protein 2 (SBP2), which is an indispensable protein for the incorporation of Se into the selenoproteins, result in thyroid dysfunction, together with the recognition of the many roles of selenoprotein P in Se distribution and storage in the human body, reveal not only the indispensability of Se and the selenoproteins as essential factors in thyroid metabolism and pathogenesis, but open up new prospects for enhanced treatment.
TL;DR: The majority of patients may be able to receive much higher dosages of (131)I relative to empiric dosages thereby delivering potentially higher radiation absorbed doses to the metastases without exceeding 200 rads (cGy) to the blood (potential undertreating).
Abstract: The dosage of 131I for the treatment of metastatic well-differentiated thyroid cancer is typically selected empirically Benua and Leeper implemented a method to estimate the maximum dosages of 131I that could be administered to a patient so as not to exceed a maximum tolerated radiation absorbed dose (MTD), which was defined as 200 rads (cGy) to the blood The objective of this study was to determine the frequency of 131I treatments in which the patient (1) would have exceeded the MTD (ie, overtreatment) or (2) would have been able to receive higher dosages of 131I thereby delivering a potentially higher radiation absorbed dose to their metastases (ie, undertreatment) had the patient been administered various assumed empiric dosages of 131I The dosimetrically- determined maximum tolerated radioactivities (MTA) to deliver 200 rads to the blood (MTD) were tabulated at our facility Data were then grouped to determine the percentage of patients who would have received less than or more than the MTD for
TL;DR: As a nonsurgical therapeutic option, ILP-1 approximately halves thyroid nodule volume with concomitant symptom relief and there is little incremental effect of additional ILP treatment, which should be limited to patients with large nodules or limited nodule reduction after the first treatment.
Abstract: Objective: Interstitial laser photocoagulation (ILP) is a safe and effective procedure when inducing thyroid nodule necrosis. In this prospective randomized study, we evaluated a possible dose-resp...
TL;DR: US screening for goiters contributes markedly to diagnosis of lymphoma at an early phase, facilitating early initiation of therapy.
Abstract: Background: Recent developments in ultrasonography (US) and the prevalence of ultrasound-guided fine needle aspiration biopsy (US-FNAB) has enabled physicians to detect and diagnosis thyroid diseases, including thyroid malignant lymphoma, much more easily. Methods: We describe our diagnostic strategy for malignant lymphoma on US screening. We screened possible malignant lymphoma patients by US characteristics such as enhanced posterior echoes. Results: Among 170 patients suspected of malignant lymphoma between 2000 and 2004, 74 (43.5%) were also diagnosed as having or suspected of lymphoma by US-FNAB. Five patients dropped out, and 67 of 69 patients who underwent surgical examination were pathologically diagnosed as having lymphoma. Finally, 79 (47.9%) of 165 US-suspected patients were confirmed as having lymphoma. Only 21.5% of lymphoma patients complained of rapidly growing goiter. Conclusion: US screening for goiters contributes markedly to diagnosis of lymphoma at an early phase, facilitating early in...
TL;DR: Thyroglobulin and TTF can show focal positivity in PSCCT distinguishing it from SSCCT, an aggressive cancer with death occurring within the first year in most patients.
Abstract: Objectives: To define the clinical and pathologic characteristics of primary squamous cell carcinoma of the thyroid (PSCCT), a rare tumor, and compare it to the more common secondary squamous cell ...
TL;DR: There is little evidence to support elective anatomical imaging with CT or MRI in those patients with suspected or proven malignancy at the primary site as indicated by fine needle aspiration cytology but who have no clinical evidence of nodal disease.
Abstract: There is considerable controversy regarding the treatment of patients with cervical metastases from differentiated thyroid cancer. Most have papillary carcinoma and the main areas of contention relate to methods of assessment and staging, surgical management and mode of follow up. there is little evidence to support elective anatomical imaging with CT or MRI in those patients with suspected or proven malignancy at the primary site as indicated by fine needle aspiration cytology (FNAC) but who have no clinical evidence of nodal disease. The role of routine ultrasound (US) in the pre-operative assessment of suspected or known malignancy is developing but is largely unproven. When it is performed, high risk areas for metastatic neck disease (levels II-V) should be assessed. Suspicious nodes on US should be further evaluated by FNAC. Suspected or proven neck disease may be further assessed pre-operatively with CT or MRI and then treated surgically. Disease in the central compartment requires a total thyroidectomy and level VI central compartment neck dissection. Suspected or proven lateral compartment cancer should be treated by selective neck dissection (at least levels III, IV, and V) below the accessory nerve. There is no role for 'Berry picking' and clinically node negative high risk patients should have an elective central compartment level VI neck dissection. Sentinel node biopsy lays no role and neither does elective lateral compartment surgery in patients with no clinical or radiological evidence of disease. For follow up, US represents the most sensitive means of detecting neck recurrences and in the presence of an elevated serum thyroglobulin, imaging may also include whole body iodine-131 scanning and anatomical imaging with CT or MRI. The role of PET remains controversial but is likely to develop further as the technique becomes more widely available. In the future, the concentration of patients with this disease in large center can only improve the way we treat differentiated thyroid cancer.