Showing papers in "Thyroid in 2010"
TL;DR: The data confirm that the newly proposed ATA recurrence staging system effectively predicts the risk of recurrence and persistent disease and can be significantly refined based on the assessment of response to initial therapy, thereby providing a dynamic risk assessment that can be used to more effectively tailor ongoing follow-up recommendations.
Abstract: Background: A risk-adapted approach to management of thyroid cancer requires risk estimates that change over time based on response to therapy and the course of the disease. The objective of this study was to validate the American Thyroid Association (ATA) risk of recurrence staging system and determine if an assessment of response to therapy during the first 2 years of follow-up can modify these initial risk estimates. Methods: This retrospective review identified 588 adult follicular cell-derived thyroid cancer patients followed for a median of 7 years (range 1–15 years) after total thyroidectomy and radioactive iodine remnant ablation. Patients were stratified according to ATA risk categories (low, intermediate, or high) as part of initial staging. Clinical data obtained during the first 2 years of follow-up (suppressed thyroglobulin [Tg], stimulated Tg, and imaging studies) were used to re-stage each patient based on response to initial therapy (excellent, acceptable, or incomplete). Clinical outcomes...
743 citations
TL;DR: In this paper, a meta-analysis was performed to assess the overall performance of real-time elastography (RTE) for the differentiation of thyroid nodules, using an inverse variance method and the Der Simonian and Laird Random effect estimator in case of established heterogeneity.
Abstract: Background: Work-up of thyroid nodules remains challenging. Fine-needle aspiration (FNA) has been shown to be the most cost-effective way to select patients for surgery with sensitivities of 54%–90% and specificities of 60%–96% for the detection of malignant lesions. Ultrasound-based real-time elastography (RTE) enables the determination of tissue elasticity and has shown promising results for the differentiation of thyroid nodules. A meta-analysis was performed to assess the overall performance of RTE for the differentiation of thyroid nodules. Methods: Literature databases were searched. The inclusion criteria for studies were the use of FNA cytology histopathology of surgical specimens as the diagnostic reference standard and assessment of sensitivity and specificity of RTE. The meta-analysis was performed using an inverse variance method and the Der Simonian and Laird Random effect estimator in case of established heterogeneity. Results: Eight studies that included a total of 639 thyroid nodules were ...
283 citations
TL;DR: It is proposed that genetic alterations in the PI3K/Akt pathway promote thyroid cell transformation to FTC and that genetic Alterations in the MAPK pathway promote cell Transformation to PTC; accumulation of multiple genetic alterations that can activate both pathways promotes thyroid cancer aggressiveness and progression to ATC.
Abstract: Background: Aberrant activation of the phosphatidylinositol-3 kinase (PI3K)/Akt pathway plays a fundamental role in thyroid tumorigenesis, particularly in follicular thyroid cancer (FTC) and aggres...
260 citations
TL;DR: The objective was to establish which patients require complete suppression of serum TSH levels, given their risk of recurrent or metastatic DTC, and how potential adverse effects on the heart and skeleton, induced by subclinical hyperthyroidism, in concert with advanced age and comorbidities, may influence the degree of TSH suppression.
Abstract: Background: Despite clinical practice guidelines for the management of differentiated thyroid cancer (DTC), there are no recommendations on the optimal serum thyrotropin (TSH) concentration to redu...
239 citations
TL;DR: After 3 years, the PLA technique achieved shrinkage of about 50% of the initial volume in a wide size range of benign cold thyroid nodules, with an improvement in local symptoms and signs, and PLA may be a new option for the management of benignCold Thyroid nodules.
Abstract: Background: Percutaneous laser ablation (PLA) is a proposed therapeutic procedure for the management of benign thyroid nodules. However, long-term results are unknown. The aim of this study was to evaluate retrospectively the safety and effects of PLA treatment in patients with benign nonfunctioning thyroid nodules in a 3-year follow-up. Methods: One hundred twenty-two patients (95 women and 27 men; age 52.2 ± 12.3 years) with benign cold thyroid solitary nodules or a dominant nodule within a normo-functioning multinodular goiter (volume range: 2.6–86.4 mL) underwent thermal Nd:YAG laser ablation of thyroid nodular tissue by 1–4 optical fibers positioned into the tissue by 21-gauge needles under ultrasound real-time assistance. The setting was an interventional suite and outpatient endocrine clinics in a community hospital in Italy. Nodule volume, ablation volume, side effects, serum thyroid-stimulating hormone (TSH), free triiodothyronine, free thyroxine (fT4), thyroglobulin (Tg), anti-Tg, anti-thyropero...
214 citations
TL;DR: The results show the potential importance of miR-221, mi-222, and mi-146b in determining the aggressive properties of PTCs and highlight the need to identify the gene targets of these miRNAs.
Abstract: Background: Papillary thyroid carcinoma (PTC) are clinicopathogenetically heterogeneous. Micro-RNAs (miRNAs) are involved in the pathogenesis of diverse human cancers, including PTC. Information regarding associations between clinicopathological features of PTC with the expression of specific miRNAs, however, is sparse. In this study, we compared expression of deregulated miRNAs in PTCs to assess this was associated with selected clinicopathogenetic features. Methods: We analyzed the expression levels of three reported deregulated miRNAs (miR-221, miR-222, and miR-146b) using quantitative real-time polymerase chain reaction in 100 cases of PTCs with distinct clinicopathogenetic characteristics and 16 paired normal controls. The tumor samples were categorized into low- and high-risk groups on the basis of the tumor-node-metastasis staging system. Results: The expression levels of miR-221, miR-222, and miR-146b were significantly associated with extrathyroidal invasion (p = 0.013, 0.05, and 0.003, respectiv...
205 citations
TL;DR: Significant progress has been made in the understanding of the immunogenetic mechanisms leading to thyroid autoimmunity and it is hoped that these new data will be translated into novel therapies and prevention strategies in AITD, such as costimulatory blockade.
Abstract: Background
Autoimmune thyroid diseases (AITD), including Graves' disease and Hashimoto's thyroiditis, arise due to complex interactions between environmental and genetic factors. There are sound data coming from epidemiological, family, and twin studies demonstrating a strong genetic influence on the development of AITD. In this review we summarize the new findings on the genetic susceptibility to AITD focusing on emerging mechanisms of susceptibility.
201 citations
TL;DR: Experienced radiologists showed more than a moderate degree of agreement in US assessment of thyroid nodules, and their final assessments were highly accurate.
Abstract: Background: Thyroid ultrasound (US) is used as the first diagnostic tool to assess the management of the disease. In spite of its importance, US is a very subjective method and highly dependent on ...
196 citations
TL;DR: Graves' ophthalmopathy appears to have a complex genetic basis with multiple susceptibility alleles that act in combination with nongenetic factors to contribute to disease expression.
Abstract: Background: Graves' ophthalmopathy (GO) significantly impairs the quality of life of affected individuals and the most severe cases can be sight threatening. Given the limited therapeutic options, a strong emphasis should be placed on disease prevention to diminish the significant morbidity associated with this disease. Summary: GO is most prevalent in women and most severe in men. Although some genetic differences between GO patients and Graves' disease patients without ophthalmopathy have been identified, none of the polymorphisms identified to date impart a high enough risk of GO to justify genetic testing to guide therapy or preventive strategies. Poorly defined mechanical factors that appear also to play a role in GO susceptibility will likely be better elucidated with advances in imaging techniques. Tobacco smoking has been consistently linked to development or deterioration of GO. Smokers who receive radioactive iodine have the highest incidence of unfavorable GO outcome, which is proportional to t...
177 citations
TL;DR: Considering the low incidence of regional lymph node recurrence and the levels with frequent regional recurrence in patients without lymph node metastasis, elective neck dissection in all cases of total thyroidectomy may be immoderate and a systematic compartment-oriented lymphadenectomy should be considered.
Abstract: Background: Recurrence of regional cervical lymph nodes in patients with papillary thyroid carcinoma (PTC) is not uncommon, and is an important factor affecting the quality of life. The aims of this study are to investigate the risk factors that are associated with regional lymph node recurrence by comparing a group of patients with regional lymph node recurrence with a group without lymph node recurrence, and to analyze the clinical characteristics of recurrent regional lymph nodes in PTC. Methods: A retrospective analysis was performed on 189 patients who underwent surgery for PTC. By comparing a group with recurrent cervical lymph nodes (n = 33) with a group without recurrent cervical lymph nodes (n = 156), the risk factors for cervical lymph node recurrence were investigated and the clinical characteristics of recurrent cervical lymph nodes were analyzed. Results: Tumor size >2 cm, presence of extrathyroid tumor spread, high T stage, and presence of lymph node metastasis were associated with regional ...
166 citations
TL;DR: A management guideline is proposed based on a patient's risk-very low, low, moderate, and high-for clinicians to use when delineating those patients who should undergo RAI treatment for initial postoperative management of DTC.
Abstract: Background: Radioactive iodine (RAI) remnant ablation has been used to eliminate normal thyroid tissue and may also facilitate monitoring for persistent or recurrent thyroid carcinoma. The use of RAI for low-risk patients who we define as those under age 45 with stage I disease or over age 45 with stage I or II disease based on American Joint Committee on Cancer (AJCC) 6th edition, or low risk under the metastases, age, completeness of resection, invasion, size (MACIS) staging system (value <6) is controversial. In this extensive literature review, we sought to analyze the evidence for use of RAI treatment to improve mortality and survival and to reduce recurrence in patients of various stages and disease risk, particularly for those patients who are at low risk for recurrence and death from thyroid cancer. Methods: A MEDLINE search was conducted for studies published between January 1966 and April 2008 that compared the effectiveness of administering versus not administering RAI for treatment of differen...
TL;DR: Se supplementation is associated with a significant decrease in TPOab titers at 3 months and with improvement in mood and/or general well-being and this, if confirmed, could be used to identify which patients would benefit most from treatment.
Abstract: Background: Evidence suggests that selenium (Se) supplementation could be useful as an adjunctive therapy to levothyroxine (LT4) in the treatment of Hashimoto's thyroiditis (HT). To summarize evidence regarding its effect on thyroid autoantibodies' titers, demands in LT4 replacement therapy, ultrasonographic thyroid morphology, and mood in patients with HT under LT4 treatment, a systematic review and meta-analysis of relevant literature were performed. Methods: Systematic review of prospective studies involving patients with HT under LT4 treatment and meta-analysis of studies on randomized, placebo-controlled, blinded trials were performed. Results: Patients with HT assigned to Se supplementation for 3 months demonstrated significantly lower thyroid peroxidase autoantibodies (TPOab) titers (four studies, random effects weighted mean difference: −271.09, 95% confidence interval: −421.98 to −120.19, p < 10−4) and a significantly higher chance of reporting an improvement in well-being and/or mood (three stud...
TL;DR: A broad spectrum of clinical expertise and the published literature are combined to suggest a clinical algorithm as a guide to management, addressing both diagnosis and acute and long-term management ofute suppurative thyroiditis.
Abstract: Background: Acute suppurative thyroiditis (AST) resulting from a bacterial infection is an infrequent but potentially life-threatening endocrine emergency. Traditional management of this disease has been surgery in conjunction with targeted antibiotic therapy. Recent nonrandomized reports of small series have demonstrated good outcomes using less invasive approaches. No randomized clinical trials have been performed. Here, we provide a review of the literature and an approach to this problem based on expert opinion. Methods: The literature was reviewed utilizing PubMed, and a representative case of AST was presented to a panel of experts. Endocrinology, surgery, and infectious disease experts responded to a series of questions regarding diagnosis, management, prognosis, and harm. Results: Combining a broad spectrum of clinical expertise and the published literature, the authors suggest a clinical algorithm as a guide to management, addressing both diagnosis and acute and long-term management. Conclusions:...
TL;DR: It is reported for the first time that a positive serum TgAb test was an independent predictor for thyroid malignancy in thyroid nodules along with serum TSH levels regardless of the presence of AIT.
Abstract: Background: The association between autoimmune thyroiditis (AIT) and thyroid cancer is still not clear despite many previous reports. This study investigated whether serologic thyroid antibodies are predictive of thyroid cancer in patients with thyroid nodules. Method: We retrospectively reviewed records of patients with thyroid nodules evaluated by ultrasonography-guided fine-needle aspiration cytology at our institution between January 2006 and December 2008. Thyroid autoimmunity was assessed by measuring thyroglobulin antibody (TgAb) and thyroid peroxidase antibody (TPOAb). The final outcome deciding a benign or malignant status involved a combination of cytology and histology. Results: Of the 1638 patients, malignant nodules had a higher rate of positive TgAb (30.8% vs. 19.6%; p < 0.001) and elevated thyrotropin (TSH) levels (2.5 ± 2.8 mIU/L vs. 2.1 ± 2.0 mIU/L; p = 0.021) than benign nodules. The rate of positive TPOAb was not higher in malignant nodules, although both TPOAb and TgAb were well correl...
TL;DR: In this article, the enhancement patterns of thyroid nodules on gray-scale contrast-enhanced ultrasound (US) were characterized and evaluated in the differential diagnosis of malignant thyroid nodule.
Abstract: Background: No conventional imaging method reliably distinguishes between benign and malignant thyroid nodules. Our objectives were to characterize the enhancement patterns of thyroid nodules on gray-scale contrast-enhanced ultrasound (US) and to evaluate whether these patterns were useful in the differential diagnosis of thyroid nodules. Methods: Ninety-five patients, scheduled for surgery for thyroid nodules detected by gray-scale sonography, were enrolled in this prospective study. In all, there were 104 nodules (47 papillary carcinomas, 3 medullary carcinomas, 1 metastatic carcinoma, 44 hyperplasia nodule, 7 follicular adenomas, 1 suture granulomas, and 1 Hashimoto's disease). After intraveneous (i.v.) injection of a 1.2 mL bolus of SonoVue, lesions were scanned with real-time gray-scale pulse inversion harmonic imaging US for at least 3 minutes at low mechanical index (MI) (0.05 to 0.08). The enhancement patterns were classified into one of four patterns by two experienced readers. Results: After adm...
TL;DR: Evidence is provided that the higher incidence of thyroid cancer in women is potentially attributed to the presence of a functional ER that participates in cellular processes contributing to enhanced mitogenic, migratory, and invasive properties of thyroid cells.
Abstract: Background: Over 200 million people worldwide are affected by thyroid proliferative diseases, including cancer, adenoma, and goiter, annually. The incidences of thyroid malignancies are three to four times higher in women, suggesting the possible involvement of estrogen. Based on this observed sex bias, we hypothesize that estrogen modulates the growth and metastatic propensity of thyroid cancer cells. Methods: In this study, two thyroid cell lines (Nthy-ori 3-1 and BCPAP) were evaluated for the presence of estrogen receptor (ER) by Western blot analysis and estrogen responsiveness by using a cell proliferation assay. In addition, the effect of estradiol (E2) on modulation of metastatic phenotype was determined by using in vitro adhesion, migration, and invasion assays. Results: Thyroid cells expressed a functionally active ER-α and ER-β as evidenced by 50–150% enhancement of proliferation in the presence of E2. E2 also enhanced adhesion, migration, and invasion of thyroid cells in an in vitro experimenta...
TL;DR: Differences in diagnostic scrutiny may explain the differences in the REG-related trend, but this cannot easily explain the relatively small degree of increase in the trend in the Asian and the Indians/Alaska Natives groups nor can it explain the increaseIn the trend of large tumors that are likely to be discovered by self-palpation by patients.
Abstract: Background: Thyroid cancer incidence has continuously increased for decades and the causes of this increase are still controversial. The objective of this study was to examine if the increased trend is different among the different National Cancer Institute (NCI) Race/Ethnicity Groups (REGs) within the NCI surveillance epidemiology and end results database for the United States. Methods: Using recent 13-year surveillance epidemiology and end results data, we described the specific incidence trend of thyroid cancer for the REGs by tumor size, tested the statistical significance of the trend of incidence, and estimated the annual percentage change (APC) and 95% confidence interval. In addition, we compared the difference of 5-year survival rate among the REGs. Results: Papillary thyroid cancer incidence significantly increased over 13 years from 1992 to 2004 among the five major REGs. The estimated APC was 5.6% (95% confidence interval = 5.1%–6.1%, p < 0.01) for the non-Hispanic whites group, 4.3% (3.0–5.5,...
TL;DR: Understanding the association of environmental agents with thyroid dysfunction can be utilized to reduce the risk to populations and knowledge of the specific factors that trigger autoimmune thyroid disease and their mode of action may also inform risk reduction in the individual patient.
Abstract: Background: Environmental exposures, ranging from perchlorate in rocket fuel to polychlorinated biphenols, have been shown to influence thyroid function. Although most of these agents are associate...
TL;DR: The VEGF-A, V EGFR-1, and VEGFR-2 immunoreactive proteins are overexpressed in MTC lesions and might be implicated in tumor progression.
Abstract: Background: Vascular endothelial growth factor (VEGF-A) expression is upregulated in the majority of human tumors, where it stimulates proliferation, migration, and survival of endothelial cells. Studies have suggested that VEGF inhibitors can be used as an alternative therapy in medullary thyroid carcinoma (MTC), but data about expression of VEGF-A and its receptor in this tumor are scarce. The aims of this study were to evaluate VEGF-A, VEGF receptor (VEGFR)-1, VEGFR-2, and microvessel density (MVD) expression in MTC samples and correlate it with clinical parameters. Methods: Paraffin-embedded samples from 38 MTC patients were evaluated for VEGF-A, VEGFR-1, VEGFR-2, and MVD expression by immunohistochemistry. Clinical data were retrospectively reviewed in medical records. Results: Thirty-eight patients aged 31.8 ± 17.1 years were enrolled. Twenty-seven patients had hereditary disease (71.1%). Twenty-five of them were found to have multiple endocrine neoplasia (MEN) 2A and two were found to have MEN 2B. ...
TL;DR: This study indicates that use of rhTSH preserves QoL in patients undergoing RI ablation and affords an ablation success rate comparable to that seen after thyroid hormone withdrawal.
Abstract: Background: Few reports have examined the use of recombinant human thyroid-stimulating hormone (rhTSH) for ablation of postsurgical thyroid remnants after low-dose radioactive iodine (RI) therapy, compared with conventional thyroid hormone withdrawal. We investigated whether patient preparation using rhTSH was comparable to conventional thyroid hormone withdrawal with respect to efficacy of postsurgical remnant ablation in low-risk patients receiving a 30 mCi RI. In addition, we also evaluated the impact of rhTSH (rhTSH vs. conventional thyroid hormone withdrawal) on quality of life (QoL) of thyroid cancer patients undergoing RI ablation. Methods: This study included three groups of patients, enrolled consecutively. From February 2006 to March 2007, 291 patients were enrolled and randomized, after total thyroidectomy: (1) withdrawal of levothyroxine (LT4) for 4 weeks (T4-WD Group, n = 89), (2) withdrawal of LT4 for 4 weeks plus 2 weeks on and then 2 weeks off liothyronine (LT3) (T3-WD Group, n = 133), and...
TL;DR: Clinical relevant thyroidal side effects of drugs used for nonthyroidal conditions are summarized, important for the clinician to be familiar with thyroid-drug interactions, as enhanced surveillance may be necessary in patients undergoing therapies known to affect thyroid function.
Abstract: Introduction: Over the years, several drugs used in the treatment of nonthyroidal conditions have been shown to affect thyroid function. As novel drugs are introduced, novel interactions are described. The aim of this review is to summarize clinically relevant thyroidal side effects of drugs used for nonthyroidal conditions. Special focus is given to recent developments and to drugs with the largest clinical relevance. Summary: Thyrosine kinase inhibitors are novel drugs used in the treatment of several neoplasias, including thyroid cancer. Thyroidal side effects are being increasingly detected with these drugs. Some drugs in this category affect thyroid hormone metabolism and therefore only affect patients on thyroid replacement. Others affect the thyroid directly profoundly, causing primary hypothyroidism. Immune modulators used in infectious, inflammatory, and neoplastic conditions also cause hyper- and hypothyroidism, through poorly understood immune or nonimmune mechanisms. The effects of amiodarone ...
TL;DR: Induction chemotherapy by weekly paclitaxel is a promising therapeutic strategy for stage IVB ATC patients and can be expected to achieve long-term survival, although there were some cases that responded well.
Abstract: Background: Anaplastic thyroid carcinoma (ATC) has a very dire prognosis and no effective therapeutic strategies have been established for ATC patients, especially those with stage IVB or IVC. Our objective was to investigate the effectiveness of weekly paclitaxel administered as induction chemotherapy and to establish novel therapeutic strategies for ATC. Methods: We performed induction chemotherapy by weekly paclitaxel administration for patients with stage IVB (nine patients) and IVC (four patients) disease. Clinical and histological responses were assessed. Overall survival was compared with that of ATC patients with stage IVB (n = 50) and IVC (n = 13) treated without paclitaxel. Results: One patient demonstrated complete response (CR) and two demonstrated partial response (PR) in the stage IVB group (response rate: 33%), and one patient showed PR in stage IVC (response rate: 25%). Curative surgery and adjuvant therapy were performed for four patients with stage IVB, and 32 months after treatment, all...
TL;DR: On the basis of cytopathological criteria, thyroid nodules in patients with HT are no more likely to be malignant than in those without HT.
Abstract: Background: The risk of thyroid carcinoma in patients with thyroid nodules associated with Hashimoto's thyroiditis (HT) is a debatable issue. The studies defining the true risk of thyroid malignancy are scanty and mainly depend on retrospective series. To eliminate inherent bias of retrospective studies, this prospective study was carried out to evaluate the true malignancy rate of unselected thyroid nodules in patients with HT who underwent fine-needle aspiration cytology (FNAC). Methods: These prospective data were gathered on all patients newly diagnosed with thyroid nodules who were sent for FNAC between May 2006 and August 2009. All patients were evaluated for the presence of HT diagnosis by measuring thyroid autoantibodies. If a patient had at least one positive thyroid autoantibody, then the patient was defined as HT with thyroid nodules. There were 164 patients (147 women and 17 men) with thyroid nodules associated with HT (HT group). There were 551 patients (432 women and 119 men) with thyroid no...
TL;DR: Recombinant human thyrotropin (rhTSH) stimulation is frequently used to assess the disease status of patients treated for differentiated thyroid cancer (DTC) when basal (unstimulated) thyroglobulin (b-Tg) is below the assay sensitivity limit, and correlations between four different assays showed that the use of a fixed Tg cut-off was influenced by assay selection.
Abstract: Background: Recombinant human thyrotropin (rhTSH) stimulation is frequently used to assess the disease status of patients treated for differentiated thyroid cancer (DTC) when basal (unstimulated) t...
TL;DR: TCV exhibits poorer survival than classical PTC, and tall-cell histology alone remains a significant prognostic factor for disease-specific death when the major prognostic factors for thyroid cancer are controlled for.
Abstract: Background: The tall-cell variant (TCV) of papillary thyroid carcinoma (PTC) is considered a more aggressive variant of PTC, with a poor prognosis. This is largely due to the tendency for TCV to present at an older age and with extrathyroidal extension (ETE). When these two variables are controlled for, it is unclear whether tall-cell histology alone portends a poor prognosis. Because previous studies have been underpowered to adequately answer this question, we hypothesized that TCV may have poorer prognosis than PTC. Our objective was to utilize a large cancer registry to obtain sufficient power to differentiate between outcomes in cases of TCV and PTC. Methods: Using the National Cancer Institute's Surveillance, Epidemiology, and End Results database, we identified 278 TCV patients and 2522 classical PTC patients with sufficient information for a detailed matched-pair analysis. Each TCV patient was matched with a PTC patient for age, sex, extent of ETE, regional and distant metastases, surgical and adj...
TL;DR: Imatinib appears to have activity in advanced ATC and is well tolerated, and due to difficulty of accruing patients with a rare malignancy at a single institution, further investigation of imatinib in ATC may be warranted in a multi-institutional setting.
Abstract: Background: Currently, there is no standard treatment for metastatic anaplastic thyroid cancer (ATC). DNA microarray analysis has shown platelet-dervived growth factor receptor (PDGFR) overexpression in ATC relative to well-differentiated thyroid cancer. In p53-mutated/deficient ATC cell lines, cABL is overexpressed, and selective inhibition of cABL results in a cytostatic effect. Imatinib inhibits tyrosine kinase activity of Bcr-ABL and PDGF. We hypothesize that patients with ATC that over-expresses PDGF receptors or cABL will respond to imatinib. Methods: Patients with histologically confirmed ATC who had measurable disease and whose disease expressed PDGF receptors by immunohistochemistry were eligible for study. Imatinib was administered at 400 mg orally twice daily without drug holiday. Response to treatment was assessed every 8 weeks. Patients with complete response, partial responses, or stable disease were treated until disease progression. The study was terminated early due to poor accrual. Resul...
TL;DR: This document suggests initial minimum steps that surgeons should consider during initial implementation of robotic thyroidectomy, the introduction of new technology to any surgery mandates a rational framework for initial assessment and safe implementation.
Abstract: Robotic thyroidectomy is a new approach to thyroid surgery that offers the benefit of eliminating the anterior neck incision utilized in traditional approaches. Although no level I evidence exists to strongly support a robotic approach to thyroid surgery, initial non-randomized reports of robotic surgical approaches, in a variety of surgical specialty areas such as cardiothoracic, urologic, gynecologic and head and neck surgery suggest possible advantages of robot assisted techniques. These include platform and instrument stability, tremor reduction, articulating end effectors, three-dimensional, magnified imaging, and improved surgeon ergonomics. Potential negatives associated with robotic surgery include its expense, the lack of haptic feedback, instrument limitations, and the implicit learning curve. Robotic thyroidectomy introduces new potential risks, not typically associated with thyroid surgery. These risks are related to a new approach to the surrounding anatomy and are also associated with the learning curve. The introduction of new technology to any surgery mandates a rational framework for initial assessment and safe implementation. A New Technology Task Force was convened to draft guiding principles which may serve as a framework for the safe implementation of emerging technologies in thyroid surgery. This document suggests initial minimum steps that surgeons should consider during initial implementation of robotic thyroidectomy.
TL;DR: There is a need for prospective, collaborative multicenter studies of TC and evidence of increasing numbers of cases of TC diagnosed yearly during the study period, or difference in tumor aggressiveness, or between outcomes in children aged less than or greater than 10 years.
Abstract: Background: Thyroid cancer (TC) is an uncommon childhood malignancy, but the incidence may be increasing. Recent American Thyroid Association guidelines focus primarily on adult data. Natural histo...
TL;DR: There is an association between HT and TC, and HT may predispose to the development of TC, which indicates the need for close observation of neoplastic changes in patients with HT.
Abstract: Background: Some but not all reports, particularly those of a retrospective nature, have noted an increased risk of carcinoma in thyroid nodules in patients with Hashimoto's thyroiditis (HT). Thyroid cancer (TC) in patients with HT, however, have been reported to have a better prognosis. In the presence of HT, the ultrasonography (US) appearance of the thyroid gland might vary greatly, making it more difficult to differentiate between benign and malignant nodules. The aim of this study was to determine if there is an association between TC and HT and to determine if the US and histopathologic characteristics of malignant nodules in patients with and without HT are similar. Methods: Six hundred thirteen patients who underwent total thyroidectomy between 2005 and 2008 for nodular goiter were included in this study. The preoperative US characteristics and postoperative histopathologic features in patients with and without HT were compared. The diagnosis of HT was based on histopathologic features. Results: N...
TL;DR: Impaired thyroid function in the first trimester is altered in pregnancies ending in miscarriage or fetal death, and in the prediction of fetal loss there were significant contributions from FT4 MoM, maternal black ethnic origin, history of chronic hypertension, and use of ovulation drugs.
Abstract: Background: Studies have shown that overt hypothyroidism is associated with a substantial risk of miscarriage. There is controversy as to whether subclinical hypothyroidism has the same effect and whether such effect is mediated by the presence of antithyroid antibodies. Our hypothesis is that maternal thyroid function in the first trimester is altered in pregnancies ending in miscarriage or fetal death. Methods: Thyroid-stimulating hormone (TSH), free thyroxine (FT4), free triiodothyronine, anti-thyroperoxidase antibody, and anti-thyroglobulin antibody at 11–13 weeks of gestation were measured in 202 singleton pregnancies that subsequently resulted in miscarriage or fetal death, and the values were compared with the results of 4318 normal pregnancies. Results: In the fetal loss group, compared to the unaffected group, there was an increase in median TSH multiple of the normal median (1.133 vs. 1.007 MoM), decrease in median FT4 MoM (0.958 vs. 0.992 MoM), and increase in the incidence of TSH above the 97....