OBJECTIVETo investigated the clinicopathologic features of familial papillary thyroid carcinoma (PTC) compared to sporadic PTC.

METHODSBetween January 2008 and August 2014, 20 patients who underwent surgery at Liaoning Cancer Hospital and Institute were diagnosed with familial PTC. We compared the clinicopathologic characteristics between familial PTC and sporadic PTC.

RESULTSThe prevalence of familial PTC was 1.3% (20/1 587). The median age of patients at diagnosis was 37 years and there were 12 females and 8 males. Thirty percent of the familial PTC cases exhibited a parent-offspring relationship, and 70% exhibited a sibling relationship. There were significant differences between familial PTC and sporadic PTC in terms of concomitant chronic thyroiditis (P < 0.01), nodular goiter (P = 0.04), tumor multicentricity (P < 0.01), bilaterality (P < 0.01), histological subtype (P < 0.01), and central lymph node metastasis (P = 0.02). When familial PTC patients were classified based on parent-child and sibling relationship, there were significant differences in preoperative TSH level (P = 0.02) and concomitant chronic thyroiditis (P = 0.01) between the two categories.

CONCLUSIONSThere are significant differences in clinicopathologic features between familial PTC and sporadic PTC and between familial PTC with parent-child and those with sibling relationship. Familial PTC appears more aggressive than sporadic carcinoma. Optimal treatment for familial PTC is not yet established, but improved awareness and screening will permit earlier detection, more timely intervention, and improved outcomes for patients and their families.

Adult ; Carcinoma ; diagnosis ; pathology ; Carcinoma, Papillary ; diagnosis ; pathology ; Family Health ; Female ; Goiter, Nodular ; complications ; Humans ; Lymphatic Metastasis ; Male ; Thyroid Neoplasms ; diagnosis ; pathology ; Thyroiditis ; complications

We have reviewed 1066 thyroid lesions and compared the relative incidence of the so called 'palpation thyroiditis' between autoimmune thyroiditis and normal thyroid parenchyme surrounding the nodular thyroid lesion and also discussed the pathogenesis of palpation thyroiditis. The typical histopathologic features of 'palpation thyroiditis' were seen in 275 cases among 467 adenomatous goiters and in none of the autoimmune thyroiditis. We here in this paper suggest that the so called 'palpation thyroiditis' is not merely a secondary phenomenon to mechanical follicular damage by vigorous palpation, but this lesion more likely develops in conditions where certain types of physiologic alteration has occurred in follicular basement membrane, just like a pathogenesis of subacute granulomatous thyroiditis.
Adenocarcinoma/complications/pathology ; Adenoma/complications/pathology ; Carcinoma, Papillary/complications/pathology ; Diagnosis, Differential ; Goiter, Nodular/complications/pathology ; Humans ; *Iatrogenic Disease ; Palpation/*adverse effects ; Thyroid Gland/*injuries/pathology ; Thyroid Neoplasms/complications/*pathology ; Thyroiditis/diagnosis/etiology/*pathology ; Thyroiditis, Autoimmune/*pathology

Total thyroidectomy has been used to treat benign or malignant thyroid diseases. However, concern about the postoperative complications after the extensive and aggressive operation makes surgeons reluctant to do total thyroidectomy. Instead, in many cases, less invasive and less complicating subtotal thyroidectomy has replaced it. But total thyroidectomy is required to eradicate bilateral and multiple nodules, diffuse toxic goiter, and thyroid cancer that cannot be cured by subtotal thyroidectomy. To evaluate the effectiveness and complications of total thyroidectomy, we reviewed retrospectively 81 patients who received total thyroidectomy from June 1987 to August 1993 according to the age, sex, clinical symptoms, duration of symptom, diagnoses, operative modalities, pathologies, postoperative complications and thyroid function. The results are as follows: 1) Male to female ratio was 1 to 4.8 (male:14, female:67). The sixth decade included 27 % of patients, and showed the peak incidence. 2) The most common symptom was the palpable mass on the precervical area or in the thyroid (96%). Palpitation (15%) and voice change (12%) were present in descending order. 3) On the duration of symptom, patients' visiting hospital after one to two years occupied the largest portion (26%). Three to four years occupied 19 cases (23%), and cases of more than five years were 17 cases (21%). Masses of 2 to 3 cm in diameter were the most common size (27%) and of 2 to 5 cm occupied more than half(59%). Most of the patients visited the hospital after full-blown of mass or symptoms. 4) Sixty five cases were cancers, and 16 cases were benign diseases. Modified radical neck dissection was done in 7 cases, suspicious of local lymph node invasion during the operation. Radical neck dissection was done in 6 cases with palpable cervial nodes. 5) The order of accuracy of preoperative diagnostic modality was thyroid scan (86%), frozen section (83%), and fine needle aspiration biopsy(80%). These result seemed different compared with the recent diagnostic value of fine needle aspiration biopsy, but might be due to the technique. 6) Pathological classification is composed of differentiated cancer (80%), toxic goiter (16%), nodular goiter (6%), adenomatous goiter (2%), and Hashimoto's thyroiditis (1%). Papillary cancer occupied 92 percent of cancer. Lymph node metastasis showed diffuse distribution according to the mass size. 7) No deaths were reported. The most common complication was hypocalcemia (38%), most of which was transient and 61 per cent of which was symptomatic. It usually persisted less than 7 days, and only 3 cases continued more than 7 days (3.7%). The other complications were hoarseness (19%), bleeding (7%), and the recurrent laryngeal nerve injury(1%). 8) Follow up on the postoperative thyroid function was available on 66 patients (81%). Of those, forty six patients (70%) were euthyroid, 2 (18%) were hypothyroid, and 8 (12%) were hyperthyroid. The cause of the hyperthyroid status after total thyroidectomy might be due to the medication for the thyroid supplementation or to the time of serum measurement shortly after the medication. We think that total thyroidectomy could be done without additional risk compared with subtotal thyroidectomy, if it were done meticulously. We suggest that total thyroidectomy should be considered for the treatment of diffuse thyroid diseases and carcinomas.
Biopsy ; Biopsy, Fine-Needle ; Classification ; Diagnosis ; Female ; Follow-Up Studies ; Frozen Sections ; Goiter ; Goiter, Nodular ; Hemorrhage ; Hoarseness ; Humans ; Hypocalcemia ; Incidence ; Lymph Nodes ; Male ; Neck Dissection ; Neoplasm Metastasis ; Pathology ; Postoperative Complications ; Recurrent Laryngeal Nerve ; Retrospective Studies ; Thyroid Diseases ; Thyroid Gland ; Thyroid Neoplasms ; Thyroidectomy* ; Thyroiditis ; Voice