No abstract available.
Diverticulum ; Thyroid Gland ; Thyroid Nodule

Papillary thyroid carcinoma and primary lung cancer have vastly different treatment approaches and prognosis. If lung mass is found in patients with papillary thyroid carcinoma, we have to be aware of the possibility of primary lung cancer especially when the lesion is not iodine-avid, or is not typical to metastatic thyroid carcinoma, or serum thyroglobulin is not elevated. Here we present two cases of non-small cell lung cancer masquerading as metastatic papillary thyroid carcinoma and think of the approach of the lung mass which is found in patients with papillary thyroid carcinoma.
Carcinoma ; Carcinoma, Non-Small-Cell Lung ; Humans ; Lung ; Lung Neoplasms ; Prognosis ; Thyroglobulin ; Thyroid Gland ; Thyroid Neoplasms

BACKGROUND AND OBJECTIVES: Off-thyroxine serum thyroglobulin (Tg) level is important to predict metastatic disease (MD) in papillary thyroid cancer (PTC); however, it is unclear whether a single off-thyroxine Tg level is sufficient for predicting MD. In this study, we determined whether serial measurement of off-thyroxine serum Tg level can predict metastasis in PTC patients after total thyroidectomy. MATERIALS AND METHODS: We enrolled 140 PTC patients in whom serum thyroid-stimulating hormone (TSH) and Tg levels were measured 7 days before radio-iodine (RAI) treatment (TSHA and TgA) and on the day of RAI treatment (TSHB and TgB) with withholding L-thyroxine for 4 weeks before RAI treatment. The values of TSHinc (TSHB-TSHA) and Tginc (TgB-TgA), Tgratio (TgB/TgA), Tginc/TSHinc and Tgratio/TSHinc were calculated. Tginc/TSHinc and Tgratio/TSHinc were tested if those parameters can predict MD in patients with TSHA>30 microIU/mL and TgA<10 ng/mL. RESULTS: Forty-four patients had MD and 96 had no evidence of MD (non-MD). MD group showed higher levels of TgA, TgB, Tginc, Tginc/TSHinc and Tgratio/TSHinc compared with non-MD group. A significant correlation was found between TSHinc and Tgratio (r=0.669) in MD group. In 43 patients with TSHA>30 microIU/mL and TgA<10 ng/mL (MD, 9; non-MD, 34), both Tginc/TSHinc (100%) and Tgratio/TSHinc (89%) had higher sensitivities for predicting MD than TgB (78%). CONCLUSION: With the increment in serum Tg corrected for the increment in serum TSH, serial measurements of off-thyroxine serum TSH and Tg levels can help predict PTC metastasis.
Factor IX ; Humans ; Neoplasm Metastasis ; Thyroglobulin ; Thyroid Gland ; Thyroid Neoplasms ; Thyroidectomy ; Thyrotropin ; Thyroxine

BACKGROUND AND OBJECTIVES: Low-iodine diet (LID) is generally recommended prior to radioactive iodine (RAI) therapy to increase RAI uptake. Recently, we suggested spot urine iodine/creatinine (I/Cr) ratio as a good alternative method replacing measurement of 24 hr urine iodine excretion for the evaluation of appropriate LID preparation. In next step, we studied to evaluate the usefulness of serum iodine concentration comparing with urine iodine concentration and urine I/Cr ratio to assess LID preparation status. MATERIALS AND METHODS: We prospectively measured serum iodine concentration, spot urine iodine concentration, and urine I/Cr ratio in 419 patients with differentiated thyroid carcinoma undergoing LID. Appropriate LID preparation was defined as urine I/Cr ratio less than 66.2 ug/gCr. RESULTS: There were significant correlations between serum iodine and the spot urine iodine concentrations or urine I/Cr ratio; the correlation coefficient was 0.51 for urine iodine concentration and 0.62 for I/Cr ratio (p<0.001). Calculated R2 after log-log transformation was 0.45 for I/Cr ratio. The cutoff value of serum iodine concentration was 20.4 ug/L (sensitivity 79.3%, specificity 81.5%) for the evaluation of appropriate LID. CONCLUSION: Measurement of serum iodine concentration may be useful as an adjunct parameter for assessing LID preparation, but its sensitivity and specificity were relatively low compared to the urine I/Cr ratio.
Diet ; Humans ; Iodine ; Prospective Studies ; Sensitivity and Specificity ; Thyroid Neoplasms

BACKGROUND AND OBJECTIVES: The harmonic scalpel using the ultrasonic energy is able to grasp and divide tissue while sealing small vessels in narrow operating fields. The aim of the present study was to evaluate the usefulness of the harmonic scalpel in thyroid surgery. MATERIALS AND METHODS: This study was performed for 247 patients who underwent thyroidectomy. According to the use of harmonic Scalpel, the patients could be divided into two groups: the conventional technique (CT) group of knot tying and the harmonic scalpel (HS) group. RESULTS: For hemithyroidectomy, operation time and hospital stay were shorter in the HS group compared with the CT group (p<0.05). For total thyroidectomy with central neck dissection (CND), operation time, total drainage volume, drain removal date, and hospital stay were significantly reduced in the HS group (p<0.05). Among the patients who underwent total thyroidectomy with CND with the HS, one patient (2.9%) showed transient recurrent laryngeal nerve palsy. Transient hypoparathyroidism showed significantly lower incidence in the HS group (p<0.05). CONCLUSION: HS might be cost-effective by reducing operation time and hospital stay without increased postoperative complications.
Drainage ; Hand Strength ; Humans ; Hypoparathyroidism ; Incidence ; Length of Stay ; Neck Dissection ; Postoperative Complications ; Thyroid Gland ; Thyroidectomy ; Ultrasonics ; Vocal Cord Paralysis

Anaplastic thyroid carcinoma (ATC) is a rare type of malignancy of thyroid follicular cell origin. It is one of the most aggressive human cancers, and typically associated with a fatal prognosis. Most patients are presenting as locally advanced and systemically disseminated disease. A single mode of therapy, whether it is surgery, chemotherapy, or radiotherapy, fails to afford significantly favorable outcomes. While multimodality approaches may enhance the treatment response to a small degree, such implementations of these modalities are often impractical as many patients are of old age and are unable to tolerate the intensity of treatments. As in many other types of carcinomas, radical resection may be the mainstay of therapy for ATC, but surgery itself is seldom possible for this condition. Even with aggressive surgical therapy for those invasive ATCs, there is no evidence of decreased recurrence rates, while only the post-surgical morbidity rates increase. One chemotherapeutic agent that seems to demonstrate some effect against ATC is adriamycin, which is more effective when administered in combination, and is also known to act synergistically with radiotherapy. A commonly employed treatment modality is the combination therapy of adriamycin and cisplatin administration with hyperfractionated radiation therapy. Other chemotherapeutic agents proven to be effective are taxanes such as paclitaxel and docetaxel. Despite of disappointing result of conventional radiotherapy, however, hyperfractionated radiation therapy and combined chemotherapy has been suggested to improve survival rates by some institutions, while others disagree. The dismal results of conventional treatments for ATCs have stimulated the investigation for new therapeutic methods with improved outcome. There have been a number of trials of new materials or therapeutic methods. In recent studies, some trials were partially successful or promising in vitro or in vivo. The examples of these trials are; redifferentiation therapies, molecular targeted therapies, and some other miscellaneous methods. Although the observations may suggest that some of the methods may have a therapeutic effect on ATCs, or may act as an adjunct to other primary treatment modality, the efficacy and safety have not been ascertained yet in human trials, and further confirmation through in-depth studies are required.
Cisplatin ; Doxorubicin ; Humans ; Molecular Targeted Therapy ; Paclitaxel ; Prognosis ; Recurrence ; Survival Rate ; Taxoids ; Thyroid Gland ; Thyroid Neoplasms

Multiple endocrine neoplasia (MEN) is defined as a disorder with neoplasms in two or more different hormonal tissues in several members of a family. MEN1, or Wermer's syndrome, is inherited as an autosomal dominant trait. This syndrome is characterized by neoplasia of the parathyroid glands, enteropancreatic tumors, anterior pituitary adenomas, and other neuroendocrine tumors with variable penetrance. Inherited medullary thyroid carcinoma (MTC) consists of MEN2A, MEN2B, and familial medullary thyroid cancer (FMTC). The identification of hereditary MTC has been facilitated in recent years by direct analysis of germline RET proto-oncogene mutation.
Carcinoma, Medullary ; Humans ; Multiple Endocrine Neoplasia ; Multiple Endocrine Neoplasia Type 1 ; Multiple Endocrine Neoplasia Type 2a ; Multiple Endocrine Neoplasia Type 2b ; Neuroendocrine Tumors ; Parathyroid Glands ; Penetrance ; Pituitary Neoplasms ; Proto-Oncogenes ; Thyroid Gland ; Thyroid Neoplasms

Thyroid follicular adenoma and hyperplastic adenomatoid nodule may show overlapping cytologic pattern with thyroid follicular carcinoma and follicular variant of thyroid papillary carcinoma. Fine-needle aspiration cytology (FNAC) has limited role in differential diagnosis of those lesions showing high cellularity and absence of colloid. Those lesions are conventionally termed 'follicular neoplasm'. As diagnostic hallmarks of follicular carcinoma (vascular- and capsular invasion) cannot be detected by cytology, verification by histology after surgery is mandatory. However, only 20% of patients with thyroid nodules diagnosed cytologically as 'follicular neoplasm' are finally diagnosed as carcinoma after surgery. Therefore, there have been many trials to differentiate follicular adenoma (FA) from follicular carcinoma (FTC) in preoperative setting. Among those trials are 1) cell morphometry analysis by computer graphics, analysis of telomerase expression level, quantitation of specific protein markers, or intensive cytological analysis using FNAC specimens, 2) ultrasonographic evaluation, dynamic MRI, or MR spectroscopy for thyroid nodules and 3) gene expression profile analysis for thyroid nodules by microarray technique, all showing limited success or limitations hampering clinical application. Similarly, intra-operative frozen section analysis of thyroid nodule had been known to be of no diagnostic utility in a prospective, randomized trial. Current management strategy for 'follicular neoplasm' is initial surgery for diagnostic purpose to get pathologic diagnosis. If the nodule is diagnosed finally as FTC, completion thyroidectomy with or without radioactive iodine therapy is recommended in most cases. Minimally invasive FTC (without vascular invasion) is known to have excellent prognosis in most cases, so traditionally those patients had undergone unilateral operation without completion thyroidectomy. But, there had been reported cases showing distant metastasis and/or recurrence in patients with 'minimally invasive FTC'. One of problems in diagnosis of 'minimally invasive FTC' is lack of international standardization for pathologic diagnosis. Optimal surgical extent for cases with FTC is not known yet. It might have been due to lack of risk stratification of patients which is unique to FTC (not well differentiated thyroid cancer as a whole), lack of biomarker predicting prognosis of FTC, and lack of controlled trial for management of patients with FTC. In near future, application of molecular diagnostic markers is expected to improve our management strategy for thyroid nodules diagnosed as 'follicular neoplasm', if molecular pathogenesis of FA and of FTC are comprehensively understood.
Adenocarcinoma, Follicular ; Adenoma ; Biopsy, Fine-Needle ; Carcinoma, Papillary ; Colloids ; Computer Graphics ; Diagnosis, Differential ; Frozen Sections ; Humans ; Iodine ; Magnetic Resonance Spectroscopy ; Neoplasm Metastasis ; Pathology, Molecular ; Prognosis ; Recurrence ; Telomerase ; Thyroid Gland ; Thyroid Neoplasms ; Thyroid Nodule ; Thyroidectomy ; Transcriptome

The current TNM staging including N staging has been suggested as a gold standard for the appropriate therapy in the well differentiated thyroid cancer patients. N staging was established based on histopathologic findings, however, the newly suggested prognostic factors for the revision of N staging include some clinicopathologic factors, such as clinical metastasis (macrometastasis), large node metastasis (> or =3 cm), extranodal extension and the number of metastatic node. Recently, American Thyroid Association reported the possibility that the low-risk group patients would be overestimated as high-risk group patients that leads to the overtreatment, the following unnecessary complication and the economic cost. The preexisting N1a/N1b classification by anatomical location of metastatic node still remains as a strong prognostic factor; however, many evidences indicated that the clinicopathologic factors described above should be considered in the risk stratification in the near future. Thus, it needs to be stressed that the four factors of micrometastasis, large node metastasis (> or =3 cm), gross or microscopic extranodal extension and multiple metastatic node (>5 cm) have been established as negative or positive prognostic factors and should be noted in clinical practice.
Humans ; Neoplasm Metastasis ; Neoplasm Micrometastasis ; Neoplasm Staging ; Thyroid Gland ; Thyroid Neoplasms

Fine needle aspiration cytology (FNAC) of thyroid nodules is the best screening test for the selection of patients that may require surgical management. However, the diagnosis of follicular neoplasm on FNAC remains a gray area and the main differential diagnosis of follicular neoplasm includes benign (nodular hyperplasia and follicular adenoma) and malignant (follicular carcinoma and follicular variant of papillary carcinoma) lesions. The cytologic diagnosis of follicular neoplasm is based on the high cellularity, microfollicular or trabecular pattern, overlapping follicular cells, and scanty or absent colloid. Histologically, the diagnosis of follicular carcinoma requires the presence of tumor capsular invasion or vascular invasion. In the follicular variant of papillary carcinoma, nuclear features of papillary carcinoma may be subtle and seen in only a small number of cells, and thus may not be readily appreciated. Analyses of BRAF and RAS point mutations and RET/PTC and PAX8/PPARgamma rearrangements have been reported to be a useful ancillary tool for diagnosing thyroid cancer in cytology specimens. The presence of BRAF or RET/PTC mutation is a strong indicator of papillary carcinoma. PAX8/PPARgamma rearrangement is exclusively found in follicular carcinoma. RAS mutations are found in follicular adenoma/carcinoma and follicular variant of papillary carcinoma. Therefore, molecular testing of FNAC samples can improve the accuracy of cytologic diagnosis.
Biopsy, Fine-Needle ; Carcinoma, Papillary ; Colloids ; Diagnosis, Differential ; Humans ; Hyperplasia ; Mass Screening ; Molecular Diagnostic Techniques ; Point Mutation ; Thyroid Gland ; Thyroid Neoplasms ; Thyroid Nodule