Resistance to thyroid hormone (RTH) is an autosomal dominant hereditary disorder that is difficult to diagnose because of its rarity and variable clinical features. The magnitude of RTH is caused by mutations in the thyroid hormone receptor beta (TRbeta) gene. We recently treated a 38-yr-old woman with RTH who had incidental papillary thyroid carcinoma. She presented with goiter and displayed elevated thyroid hormone levels with an unsuppressed TSH. She was determined to harbor a missense mutation of M310T in exon 9 of the TRbeta gene, and diagnosed with generalized RTH. This mutation has not yet been reported in Korea. RTH is very rare and easily overlooked, but should be considered in patients who present with goiter and elevated thyroid hormone levels with an unsuppressed TSH. The association between thyroid cancer and RTH needs further study.
Adult ; Diagnosis, Differential ; Exons ; Female ; Humans ; Mutation, Missense ; Thyroid Gland/radionuclide imaging ; Thyroid Hormone Receptors beta/genetics ; Thyroid Hormone Resistance Syndrome/complications/*diagnosis ; Thyroid Hormones/blood ; Thyroid Neoplasms/*complications/genetics/ultrasonography

Positron emission tomography (PET) is a highly sensitive and low invasive technology for cancer biological imaging. Integrated PET/computed tomography (PET/CT) cameras combine functional and anatomical information in a synergistic manner that improves diagnostic interpretation. The role of 18F FDG PET/CT in differentiated thyroid cancer (DTC) is well established, particularly in patients presenting with elevated thyroglobulin (Tg) levels and negative radioactive iodine scan. This review presents the evidence supporting the use of 18F FDG PET/CT throughout the diagnosis and management of thyroid cancer, and provides suggestions for its clinical uses.
Fluorodeoxyglucose F18 ; Humans ; Positron-Emission Tomography ; Thyroglobulin ; blood ; Thyroid Neoplasms ; diagnosis ; Tomography, X-Ray Computed

BACKGROUND: Measurement of postoperative serum thyroglobulin (Tg) is important for detecting persistent or recurrent differentiated thyroid cancer. We evaluated the analytic performance of the DxI 800 assay (Beckman Coulter, USA) for serum Tg and anti-thyroglobulin antibodies (TgAbs) in comparison with that of the GAMMA-10 assay (Shinjin Medics Inc., Korea) for serum Tg and RIA-MAT 280 assay (Stratec, Germany) for TgAb. METHODS: We prospectively collected blood samples from 99 patients thyroidectomized for thyroid cancer. The functional sensitivity was investigated in standards and human serum. Precision and linearity were evaluated according to the guidelines of the Clinical and Laboratory Standards Institute. The correlation between the two assays was assessed in samples with different Tg ranges. RESULTS: The functional sensitivity of the DxI 800 assay for serum Tg was between 0.0313 and 0.0625 ng/mL. The total CV was 3.9-5.6% for serum Tg and 5.3-6.9% for serum TgAb. The coefficient of determination (R2) was 1.0 and 0.99 for serum Tg and TgAb, respectively. The cut-offs for serum TgAb were 4.0 IU/mL (DxI 800) and 60.0 IU/mL (RIA-MAT 280), and the overall agreement was 68.7%. The correlation between the two assays was excellent; the correlation coefficient was 0.99 and 0.88 for serum Tg and TgAb, respectively. CONCLUSIONS: The DxI 800 is a sensitive assay for serum Tg and TgAb, and the results correlated well with those from the immunoradiometric assays (IRMA). This assay has several advantages over the IRMA and could be considered an alternative test for Tg measurement.
Autoantibodies/*blood ; Humans ; Immunoradiometric Assay ; Luminescent Measurements ; Prospective Studies ; Reagent Kits, Diagnostic ; Reproducibility of Results ; Thyroglobulin/*blood ; Thyroid Neoplasms/*diagnosis/surgery

Duplex Doppler US may be useful for the detection of thyroid malignancies that show either anarchic winding or penetrating "sword like" neoangiogenic vessels. It may be helpful in selecting nodules that should undergo fine needle aspiration biopsy.
Biopsy, Fine-Needle ; Diagnosis, Differential ; Humans ; Thyroid Neoplasms/blood supply/pathology/*ultrasonography ; Thyroid Nodule/blood supply/pathology/*ultrasonography ; *Ultrasonography, Doppler, Duplex ; Ultrasonography, Interventional

OBJECTIVETo evaluate serum Nkx2-1 (NKX homeobox-1) levels in diagnosis of primary lung cancer.

METHODSThe serum NKX2-1 and CEA (carcinoma embryonic antigen) levels were measured in 61 patients with primary lung cancer admitted from May 2009 to December 2010 and 49 healthy individuals served as controls. The receiver operating characteristic curve (ROC) of NKX2-1 in diagnosis for primary lung cancer was analyzed. The value of serum NKX2-1 in diagnosing primary lung cancer was compared with that of CEA by X(2) test and Kappa test.

RESULTSThe serum Nkx2-1 levels in lung cancer were significantly higher than those in controls [(1.4206 ±0.1257)ng/ml compared with (0.7646 ±0.0734)ng/ml,P<0.01]. ROC analysis showed the area under the curve of serum NKX2-1 was 0.859. The Kappa value of NKX2-1 was higher than that of CEA (0.586 compared with 0.396,P<0.05). Combination of serum NKX2-1 with CEA improved the Kappa value to 0.704, and also had high sensitivity (83.6%) and specificity (87.0%) for diagnosis of primary lung cancer.

CONCLUSIONSerum NKX2-1 protein can be used as a marker for diagnosis of lung cancer, the combination of NKX2-1 with CEA may further improve the diagnostic value.

Biomarkers, Tumor ; blood ; Carcinoembryonic Antigen ; blood ; Case-Control Studies ; Humans ; Lung Neoplasms ; blood ; diagnosis ; Nuclear Proteins ; blood ; Sensitivity and Specificity ; Thyroid Nuclear Factor 1 ; Transcription Factors ; blood

Adult ; Asymptomatic Diseases ; Carcinoembryonic Antigen ; blood ; Carcinoma, Neuroendocrine ; blood ; diagnosis ; Early Detection of Cancer ; methods ; Female ; Humans ; Male ; Middle Aged ; Thyroid Neoplasms ; blood ; diagnosis

Smooth muscle antibodies (SMAs) are diagnostic markers for the serological diagnosis of type 1 autoimmune hepatitis. SMA that is restricted to staining of the stomach muscle and blood vessel walls was referred to as "SMA-V". In addition, SMAs are classified into the peritubular (SMA-T) and glomerular (SMA-G) patterns. SMAs are occasionally present in patients with malignancies, but have not yet been reported in thyroid cancer. We came across the first case of SMA positivity in a patient with papillary thyroid carcinoma (PTC). A 31-yr-old male was admitted to our hospital for evaluation of incidentally detected thyroid cancer. He had been diagnosed with PTC based on pathological results following fine-needle aspiration biopsy. The patient underwent total thyroidectomy followed by radio-iodine treatment. The serum levels of AST and ALT were increased before radiotherapy. Tests were conducted for the evaluation of liver disease. SMA was positive at a titer of 1:320, showing positive results for the vessel walls but negative results for the glomerulus and tubules in the kidney (SMA-V pattern). The association of SMA with malignancies and the classification of SMA immunofluorescent subtypes have been previously reported. However, these studies have not clearly established the ability of SMA subtype to predict a specific disease. Therefore, evaluation of an association of SMA pattern with specific diseases in SMA-positive patients may provide additional and useful information for the rapid diagnosis and accurate treatment of patients with autoimmune diseases or malignancies. This case report could serve as a great resource for further studies on SMA.
Antibodies ; Autoimmune Diseases ; Biopsy, Fine-Needle ; Blood Vessels ; Classification ; Diagnosis ; Hepatitis, Autoimmune ; Humans ; Kidney ; Liver Diseases ; Male ; Muscle, Smooth* ; Radiotherapy ; Stomach ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyroidectomy

OBJECTIVE: To retrospectively evaluate the risk of thyroid cancer in patients with hyperfunctioning thyroid nodules through ultrasonographic-pathologic analysis. MATERIALS AND METHODS: Institutional review board approval was obtained and informed consent was waived. From 2003 to 2007, 107 patients consecutively presented with hot spots on thyroid scans and low serum thyroid-stimulating hormone levels. Among them, 32 patients who had undergone thyroid ultrasonography were analyzed in this study. Thyroid nodules depicted on ultrasonography were classified based on size and categorized as benign, indeterminate, or suspicious malignant nodules according to ultrasonographic findings. The thyroid nodules were determined as either hyperfunctioning or coexisting nodules and were then correlated with pathologic results. RESULTS: In 32 patients, 42 hyperfunctioning nodules (mean number per patient, 1.31; range, 1-6) were observed on thyroid scans and 68 coexisting nodules (mean, 2.13; range, 0-7) were observed on ultrasonography. Twenty-five patients (78.1%) had at least one hyperfunctioning (n = 17, 53.1%) or coexisting (n = 16, 50.0%) nodule that showed a suspicious malignant feature larger than 5 mm (n = 8, 25.0%), or an indeterminate feature 1 cm or greater (n = 20, 62.5%) in diameter, which could have been indicated by using fine needle aspiration (FNA). Seven patients were proven to have 11 thyroid cancers in 3 hyperfunctioning and 8 coexisting nodules. All of these had at least one thyroid cancer, which could have been indicated by using FNA. The estimated minimal risk of thyroid cancer was 6.5% (7/107). CONCLUSION: Patients with hyperfunctioning nodules may not be safe from thyroid cancer because hyperfunctioning nodules can coexist with thyroid cancer nodules. To screen out these cancers, ultrasonography should be performed.
Adult ; Biopsy, Fine-Needle ; Disease Progression ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Positron-Emission Tomography ; Retrospective Studies ; Risk Factors ; Thyroid Neoplasms/blood/*diagnosis ; Thyroid Nodule/blood/*diagnosis ; Thyrotropin/*blood

OBJECTIVETo investigate the variation of serum thyroid transcription factor-1 (TTF-1) in different patients and explore its significance in the diagnosis of lung carcinoma.

METHODSDot-enzyme linked immunosorbent assay (dot-ELISA) and Leica Q500 MC image analysis system were used to quantitatively detect TTF-1 protein in the serum samples from normal healthy adults and from patients with benign lung disease, lung cancer, thyroid carcinoma and non-thyroid carcinoma.

RESULTSThe sensitivity, specificity, standardized positive predicative value, standardized negative predicative value, standardized accuracy and standardized wrong diagnostic rate of the method were 90.91%, 82.22%, 83.64%, 90.04%, 86.57% and 13.43%, respectively. The cutoff value of serum TTF-1 in healthy normal adults was 36.39, with a ROC value of 0.95. Serum TTF-1 PU was significantly higher in patients with lung adenocarcinoma, squamous cell lung carcinoma and thyroid carcinoma than in healthy adults and patients with benign lung diseases and non-thyroid carcinoma (P=0.000). Serum TTF-1 PU was similar in lung adenocarcinoma, squamous cell lung carcinoma, small cell lung carcinoma, large cell lung carcinoma and thyroid carcinoma (P=0.744, 0.677, and 0.333, respectively). Serum TTF-1 PU was greater than the PU in the corresponding homogenate of lung adenocarcinoma, squamous cell lung carcinoma, small cell lung carcinoma, large cell lung carcinoma and thyroid carcinoma (P=0.000). Serum and homogenate TTF-1 PU was correlated to TNM stage of lung cancer patients (P=0.000) but not to gender, tumor types, differentiation or lymph node metastasis.

CONCLUSIONSLung adenocarcinoma, squamous cell lung carcinoma and thyroid carcinoma are suspected when serum TTF-1 PU is higher than 36.39. Serum TTF-1 is not helpful in differentiating the types of lung carcinomas and thyroid carcinoma. After exclusion of thyroid carcinoma, detection of serum TTF-1 can be helpful in the diagnosis of lung cancer. In different lung carcinomas and thyroid carcinomas, the serum TTF-1 is higher than the corresponding homogenate TTF-1 level. Serum TTF-1 increases with the progression of TNM stage of lung carcinoma.

Case-Control Studies ; Humans ; Lung Neoplasms ; blood ; classification ; diagnosis ; Nuclear Proteins ; blood ; Predictive Value of Tests ; Sensitivity and Specificity ; Thyroid Nuclear Factor 1 ; Transcription Factors ; blood

OBJECTIVETo investigate serum vascular endothelial growth factor-C (VEGF-C), VEGF-D and VEGFR-3 levels in patients with papillary thyroid carcinoma (PTC) and analyze their relation with the clinicopathological and thyroid function of the patients.

METHODSSerum samples and the data of thyroid function were collected from 55 patients with PTC and 24 with benign thyroid tumor (BT). ELISA was used to detect VEGF-C/D and VEGFR-3 concentration in the serum samples and their relation with the thyroid function was analyzed.

RESULTSThe VEGF-C and VEGFR-3 levels were significantly higher in PTC group than in BT group (P<0.05), but VEGF-D level was comparable between them (P>0.05). In PTC patients, the elevation of serum VEGF-C and VEGFR-3 levels was associated with an advanced clinical stage (III-IV), elevated thyroid-stimulating hormone (TSH) level, an age over 45 years, and a tumor diameter exceeding 2 cm (P<0.05 or P<0.01). Patients with lymph node metastasis had significantly higher VEGF-C level but lower VEGF-3 level than those without metastasis regardless of gender. Serum VEGF-D level was higher in PTC patients with lymph node metastasis (P<0.05) and elevated TSH level (P<0.01) without association with the clinical stage, tumor diameter, age, or gender. The area under ROC curve (AUC) of serum VEGF-C, VEGFR-3 and TSH was 0.803, 0.734 and 0.707 respectively (P<0.01), and that of VEGF-D was 0.556 (P>0.05); when combined, serum VEGF-C, VEGFR-3 and TSH showed an AUC of 0.862 (P<0.01).

CONCLUSIONDetecting serum VEGF-C and VEGFR-3 levels combined with TSH may enhance the early diagnosis rate of papillary thyroid carcinoma.

Carcinoma ; blood ; diagnosis ; Carcinoma, Papillary ; Early Detection of Cancer ; Enzyme-Linked Immunosorbent Assay ; Humans ; Lymphatic Metastasis ; Thyroid Neoplasms ; blood ; diagnosis ; Thyrotropin ; blood ; Vascular Endothelial Growth Factor C ; blood ; Vascular Endothelial Growth Factor D ; blood ; Vascular Endothelial Growth Factor Receptor-3 ; blood