Pub Date : 2017-01-01Epub Date: 2017-10-19DOI: 10.1155/2017/9807543
Eleonora Farina, Fabio Monari, Paolo Castellucci, Fabrizio Romani, Andrea Repaci, Arianna Farina, Giuseppe Zanirato Rambaldi, Giovanni Frezza, Renzo Mazzarotto, Silvia Cammelli, Luca Tagliaferri, Rosa Autorino, Francesco Deodato, Gabriella Macchia, Savino Cilla, Vincenzo Valentini, Stefano Fanti, Alessio G Morganti
Introduction: To evaluate the clinical response rate after a postoperative 18F-FDG PET/CT guided external beam radiotherapy (EBRT) in Iodine-refractory differentiated thyroid cancer.
Material and methods: Patients with thyroid cancer locally recurrent after total thyroidectomy plus metabolic radiotherapy and treated with radical EBRT were included. Inclusion criteria were detectable thyroglobulin (Tg), negative postmetabolic radiotherapy whole body scintigraphy, and no surgical indications. The pretreatment 18F-FDG PET/CT resulted positive in all cases (loggia, lymph nodes, and lung). EBRT was delivered with IMRT-SIB technique. A 18F-FDG PET/CT revaluation and Tg dosage were performed 3 months after the treatment.
Results: Sixteen consecutive patients were included in this analysis (median follow-up: 6-44 months). Post-EBRT 18F-FDG PET/CT showed CR in 43.7%, PR in 31.2%, SD in 25.0% patients, and PD due to lung metastases in 12.5%. Overall response rate was 75.0% (CI 95%: 41.4-93.3%). Tg levels decreased in 75.0% with a median Δ of 68.0%. Two-year PFS and OS rates were 80.0% and 93.0%, respectively. Acute G3 toxicity occurred in 18.7% and late G2 toxicity in 12.5%.
Conclusions: 18F-FDG PET/CT was useful in target definition for radiotherapy planning, identifying positive areas not detected with 131I scintigraphy. IMRT based EBRT was feasible and our results encourage future prospective studies. This clinical trial is registered with ID: NCT03191643.
{"title":"<sup>18</sup>F-FDG Pet-Guided External Beam Radiotherapy in Iodine-Refractory Differentiated Thyroid Cancer: A Pilot Study.","authors":"Eleonora Farina, Fabio Monari, Paolo Castellucci, Fabrizio Romani, Andrea Repaci, Arianna Farina, Giuseppe Zanirato Rambaldi, Giovanni Frezza, Renzo Mazzarotto, Silvia Cammelli, Luca Tagliaferri, Rosa Autorino, Francesco Deodato, Gabriella Macchia, Savino Cilla, Vincenzo Valentini, Stefano Fanti, Alessio G Morganti","doi":"10.1155/2017/9807543","DOIUrl":"https://doi.org/10.1155/2017/9807543","url":null,"abstract":"<p><strong>Introduction: </strong>To evaluate the clinical response rate after a postoperative <sup>18</sup>F-FDG PET/CT guided external beam radiotherapy (EBRT) in Iodine-refractory differentiated thyroid cancer.</p><p><strong>Material and methods: </strong>Patients with thyroid cancer locally recurrent after total thyroidectomy plus metabolic radiotherapy and treated with radical EBRT were included. Inclusion criteria were detectable thyroglobulin (Tg), negative postmetabolic radiotherapy whole body scintigraphy, and no surgical indications. The pretreatment <sup>18</sup>F-FDG PET/CT resulted positive in all cases (loggia, lymph nodes, and lung). EBRT was delivered with IMRT-SIB technique. A <sup>18</sup>F-FDG PET/CT revaluation and Tg dosage were performed 3 months after the treatment.</p><p><strong>Results: </strong>Sixteen consecutive patients were included in this analysis (median follow-up: 6-44 months). Post-EBRT <sup>18</sup>F-FDG PET/CT showed CR in 43.7%, PR in 31.2%, SD in 25.0% patients, and PD due to lung metastases in 12.5%. Overall response rate was 75.0% (CI 95%: 41.4-93.3%). Tg levels decreased in 75.0% with a median Δ of 68.0%. Two-year PFS and OS rates were 80.0% and 93.0%, respectively. Acute G3 toxicity occurred in 18.7% and late G2 toxicity in 12.5%.</p><p><strong>Conclusions: </strong><sup>18</sup>F-FDG PET/CT was useful in target definition for radiotherapy planning, identifying positive areas not detected with <sup>131</sup>I scintigraphy. IMRT based EBRT was feasible and our results encourage future prospective studies. This clinical trial is registered with ID: NCT03191643.</p>","PeriodicalId":17394,"journal":{"name":"Journal of Thyroid Research","volume":"2017 ","pages":"9807543"},"PeriodicalIF":2.1,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2017/9807543","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35216686","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objectives: In 2016, the American Association of Clinical Endocrinologists (AACE) and Associazione Medici Endocrinologi (AME) released updated guidelines for the diagnosis and management of thyroid nodules. The aim of this study was to evaluate the AACE/AME recommendations for FNA in clinical practice, by comparing the (US) stratification risk and indications for FNA with cytologic results.
Methods: From May to December 2016, we collected the cytologic results from FNAs of nodules that were classified using a three-tier US category system (low, intermediate, and high risk).
Results: We obtained 859 FNAs from 598 patients: 341 (39.7%) from low, 489 (56.9%) from intermediate, and 29 (3.4%) from high risk nodules. Of these, 88.5% and 74.9% of low and intermediate risk nodules, respectively, were cytologically benign, whereas 84.6% of high risk nodules had a moderate-to-elevated risk of malignancy or were malignant. If FNAs had been limited to intermediate risk nodules >20 mm, we would have missed 13/17 (76.5%) nodules that had moderate-to-elevated risk of malignancy or were malignant (11/13 were malignant based on histology).
Conclusions: A nonnegligible number of cytologically malignant nodules or nodules that were suspected to be malignant would be missed if intermediate US risk nodules <20 mm were not biopsied.
{"title":"Ultrasound Risk Categories for Thyroid Nodules and Cytology Results: A Single Institution's Experience after the Adoption of the 2016 Update of Medical Guidelines by the American Association of Clinical Endocrinologists and Associazione Medici Endocrinologi.","authors":"Roberto Negro, Gabriele Greco, Ermenegildo Colosimo","doi":"10.1155/2017/8135415","DOIUrl":"https://doi.org/10.1155/2017/8135415","url":null,"abstract":"<p><strong>Objectives: </strong>In 2016, the American Association of Clinical Endocrinologists (AACE) and Associazione Medici Endocrinologi (AME) released updated guidelines for the diagnosis and management of thyroid nodules. The aim of this study was to evaluate the AACE/AME recommendations for FNA in clinical practice, by comparing the (US) stratification risk and indications for FNA with cytologic results.</p><p><strong>Methods: </strong>From May to December 2016, we collected the cytologic results from FNAs of nodules that were classified using a three-tier US category system (low, intermediate, and high risk).</p><p><strong>Results: </strong>We obtained 859 FNAs from 598 patients: 341 (39.7%) from low, 489 (56.9%) from intermediate, and 29 (3.4%) from high risk nodules. Of these, 88.5% and 74.9% of low and intermediate risk nodules, respectively, were cytologically benign, whereas 84.6% of high risk nodules had a moderate-to-elevated risk of malignancy or were malignant. If FNAs had been limited to intermediate risk nodules >20 mm, we would have missed 13/17 (76.5%) nodules that had moderate-to-elevated risk of malignancy or were malignant (11/13 were malignant based on histology).</p><p><strong>Conclusions: </strong>A nonnegligible number of cytologically malignant nodules or nodules that were suspected to be malignant would be missed if intermediate US risk nodules <20 mm were not biopsied.</p>","PeriodicalId":17394,"journal":{"name":"Journal of Thyroid Research","volume":"2017 ","pages":"8135415"},"PeriodicalIF":2.1,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2017/8135415","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35200034","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-01-01Epub Date: 2017-12-12DOI: 10.1155/2017/4259183
Cheuk-Lik Wong, Ho-Kee Vicki Tam, Chun-Kit Vincent Fok, Pong-Kai Ellen Lam, Lai-Ming Fung
Background: Atrial fibrillation (AF) is one of the commonest cardiovascular manifestations of thyrotoxicosis. A significant proportion of patients have persistent AF which may have long term consequences, for example, ischemic stroke.
Methods: We performed a retrospective cohort study in a regional hospital from January 2004 to June 2016 to examine the clinical characteristics and outcomes of thyrotoxic patients who presented with atrial fibrillation and to investigate possible factors associated with persistent atrial fibrillation and ischemic stoke.
Results: Among 1918 patients who had a diagnosis of thyrotoxicosis, 133 (6.9%) patients presented with AF. Spontaneous sinus conversion occurred in 89 (66.9%) patients in which 85 (94%) patients developed sinus conversion before or within 6 months after having achieved euthyroidism. The remaining 44 (33.1%) had persistent AF. The rate of ischemic stroke was numerically higher among patients who had persistent AF than those with spontaneous sinus conversion (15.9% versus 10.1%; log-rank 0.442, p = 0.506). Patients who sustained an ischemic stroke were older (71 ± 11 years versus 62 ± 16 years, p = 0.023) and had a trend towards higher CHA2DS2-VASc score (2.9 ± 1.7 versus 2.3 ± 1.7, p = 0.153). History of smoking (adjusted odds ratio 4.9, 95% CI [1.8,14.0], p = 0.002), a larger left atrial diameter (adjusted odd ratio 2.6, 95% CI [1.2,5.5], p = 0.014), and a relatively lower free thyroxine level at diagnosis (adjusted odd ratio 2.1, 95% CI [1.2,3.5], p = 0.008) were associated with persistence of AF on multivariate analysis.
Conclusion: Persistence of thyrotoxic AF occurred in one-third of patients and spontaneous sinus conversion was unlikely after six months of euthyroidism. High rate of ischemic stroke was observed among patients with persistent thyrotoxic AF and older age. Patients with factors associated with persistent AF, especially older people, should be closely monitored beyond 6 months so that anticoagulation can be initiated in a timely manner to reduce risk of ischemic stroke.
背景:心房颤动(AF)是甲状腺毒症最常见的心血管表现之一。相当比例的患者有持续性房颤，这可能有长期后果，例如缺血性中风。方法:2004年1月至2016年6月在某地区医院进行回顾性队列研究，分析甲状腺毒性心房颤动患者的临床特征和预后，探讨持续性心房颤动和缺血性卒中的可能相关因素。结果:在诊断为甲状腺毒症的1918例患者中，133例(6.9%)出现房颤。89例(66.9%)患者发生自发性窦性转换，其中85例(94%)患者在实现甲状腺功能正常之前或后6个月内发生窦性转换。其余44例(33.1%)患有持续性房颤。持续性房颤患者的缺血性卒中发生率高于自发性窦性房颤患者(15.9% vs 10.1%;Log-rank 0.442, p = 0.506)。缺血性脑卒中患者年龄较大(71±11岁比62±16岁，p = 0.023)， CHA2DS2-VASc评分有较高的趋势(2.9±1.7比2.3±1.7,p = 0.153)。多因素分析显示，吸烟史(校正优势比4.9,95% CI [1.8,14.0]， p = 0.002)、左房内径较大(校正奇比2.6,95% CI [1.2,5.5]， p = 0.014)、诊断时游离甲状腺素水平相对较低(校正奇比2.1,95% CI [1.2,3.5]， p = 0.008)与房颤持续存在相关。结论:三分之一的患者持续存在甲状腺毒性房颤，在甲状腺功能亢进6个月后不太可能发生自发性窦性转换。顽固性甲状腺毒性房颤患者及老年房颤患者缺血性卒中发生率较高。伴有持续性房颤相关因素的患者，尤其是老年人，6个月以上应密切监测，及时启动抗凝治疗，降低缺血性卒中风险。
{"title":"Thyrotoxic Atrial Fibrillation: Factors Associated with Persistence and Risk of Ischemic Stroke.","authors":"Cheuk-Lik Wong, Ho-Kee Vicki Tam, Chun-Kit Vincent Fok, Pong-Kai Ellen Lam, Lai-Ming Fung","doi":"10.1155/2017/4259183","DOIUrl":"https://doi.org/10.1155/2017/4259183","url":null,"abstract":"<p><strong>Background: </strong>Atrial fibrillation (AF) is one of the commonest cardiovascular manifestations of thyrotoxicosis. A significant proportion of patients have persistent AF which may have long term consequences, for example, ischemic stroke.</p><p><strong>Methods: </strong>We performed a retrospective cohort study in a regional hospital from January 2004 to June 2016 to examine the clinical characteristics and outcomes of thyrotoxic patients who presented with atrial fibrillation and to investigate possible factors associated with persistent atrial fibrillation and ischemic stoke.</p><p><strong>Results: </strong>Among 1918 patients who had a diagnosis of thyrotoxicosis, 133 (6.9%) patients presented with AF. Spontaneous sinus conversion occurred in 89 (66.9%) patients in which 85 (94%) patients developed sinus conversion before or within 6 months after having achieved euthyroidism. The remaining 44 (33.1%) had persistent AF. The rate of ischemic stroke was numerically higher among patients who had persistent AF than those with spontaneous sinus conversion (15.9% versus 10.1%; log-rank 0.442, <i>p</i> = 0.506). Patients who sustained an ischemic stroke were older (71 ± 11 years versus 62 ± 16 years, <i>p</i> = 0.023) and had a trend towards higher CHA<sub>2</sub>DS<sub>2</sub>-VASc score (2.9 ± 1.7 versus 2.3 ± 1.7, <i>p</i> = 0.153). History of smoking (adjusted odds ratio 4.9, 95% CI [1.8,14.0], <i>p</i> = 0.002), a larger left atrial diameter (adjusted odd ratio 2.6, 95% CI [1.2,5.5], <i>p</i> = 0.014), and a relatively lower free thyroxine level at diagnosis (adjusted odd ratio 2.1, 95% CI [1.2,3.5], <i>p</i> = 0.008) were associated with persistence of AF on multivariate analysis.</p><p><strong>Conclusion: </strong>Persistence of thyrotoxic AF occurred in one-third of patients and spontaneous sinus conversion was unlikely after six months of euthyroidism. High rate of ischemic stroke was observed among patients with persistent thyrotoxic AF and older age. Patients with factors associated with persistent AF, especially older people, should be closely monitored beyond 6 months so that anticoagulation can be initiated in a timely manner to reduce risk of ischemic stroke.</p>","PeriodicalId":17394,"journal":{"name":"Journal of Thyroid Research","volume":"2017 ","pages":"4259183"},"PeriodicalIF":2.1,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2017/4259183","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35774880","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-01-01Epub Date: 2017-10-25DOI: 10.1155/2017/4324130
Ulla Feldt-Rasmussen, Sofie Bliddal, Åse Krogh Rasmussen, Malene Boas, Linda Hilsted, Katharina Main
[This corrects the article DOI: 10.4061/2011/598712.].
[这更正了文章DOI: 10.4061/2011/598712.]
{"title":"Corrigendum to \"Challenges in Interpretation of Thyroid Function Tests in Pregnant Women with Autoimmune Thyroid Disease\".","authors":"Ulla Feldt-Rasmussen, Sofie Bliddal, Åse Krogh Rasmussen, Malene Boas, Linda Hilsted, Katharina Main","doi":"10.1155/2017/4324130","DOIUrl":"https://doi.org/10.1155/2017/4324130","url":null,"abstract":"<p><p>[This corrects the article DOI: 10.4061/2011/598712.].</p>","PeriodicalId":17394,"journal":{"name":"Journal of Thyroid Research","volume":"2017 ","pages":"4324130"},"PeriodicalIF":2.1,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2017/4324130","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35315022","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-01-01Epub Date: 2017-08-20DOI: 10.1155/2017/6917841
Stephen Paul Fitzgerald, Nigel Geoffrey Bean
[This corrects the article DOI: 10.1155/2016/6351473.].
[这更正了文章DOI: 10.1155/2016/6351473]。
{"title":"Corrigendum to \"The Relationship between Population T4/TSH Set Point Data and T4/TSH Physiology\".","authors":"Stephen Paul Fitzgerald, Nigel Geoffrey Bean","doi":"10.1155/2017/6917841","DOIUrl":"https://doi.org/10.1155/2017/6917841","url":null,"abstract":"[This corrects the article DOI: 10.1155/2016/6351473.].","PeriodicalId":17394,"journal":{"name":"Journal of Thyroid Research","volume":"2017 ","pages":"6917841"},"PeriodicalIF":2.1,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2017/6917841","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35514352","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
I. Rachinsky, M. Rajaraman, W. Leslie, A. Zahedi, C. Jefford, A. McGibbon, J. Young, K. Pathak, M. Badreddine, S. De Brabandere, H. Fong, S. V. Van Uum
Background. Use of radioactive iodine (RAI) ablation has been reported to vary significantly between studies. We explored variation in RAI ablation care patterns between seven thyroid cancer treatment centers in Canada. Methods. The Canadian Collaborative Network for Cancer of the Thyroid (CANNECT) is a collaborative registry to describe and analyze patterns of care for thyroid cancer. We analyzed data from seven participating centers on RAI ablation in patients diagnosed with well-differentiated (papillary and follicular) thyroid cancer between 2000 and 2010. We compared RAI ablation protocols including indications (based on TNM staging), preparation protocols, and administered dose. We excluded patients with known distant metastases at time of RAI ablation. Results. We included 3072 patients. There were no significant differences in TNM stage over time. RAI use increased in earlier years and then declined. The fraction of patients receiving RAI varied significantly between centers, ranging between 20–85% for T1, 44–100% for T2, 58–100% for T3, and 59–100% for T4. There were significant differences in the RAI doses between centers. Finally, there was major variation in the use of thyroid hormone withdrawal or rhTSH for preparation of RAI ablation. Conclusion. Our study identified significant variation in use of RAI for ablation in patients with well-differentiated thyroid cancer both between Canadian centers and over time.
{"title":"Regional Variation across Canadian Centers in Radioiodine Administration for Thyroid Remnant Ablation in Well-Differentiated Thyroid Cancer Diagnosed in 2000–2010","authors":"I. Rachinsky, M. Rajaraman, W. Leslie, A. Zahedi, C. Jefford, A. McGibbon, J. Young, K. Pathak, M. Badreddine, S. De Brabandere, H. Fong, S. V. Van Uum","doi":"10.1155/2016/2867916","DOIUrl":"https://doi.org/10.1155/2016/2867916","url":null,"abstract":"Background. Use of radioactive iodine (RAI) ablation has been reported to vary significantly between studies. We explored variation in RAI ablation care patterns between seven thyroid cancer treatment centers in Canada. Methods. The Canadian Collaborative Network for Cancer of the Thyroid (CANNECT) is a collaborative registry to describe and analyze patterns of care for thyroid cancer. We analyzed data from seven participating centers on RAI ablation in patients diagnosed with well-differentiated (papillary and follicular) thyroid cancer between 2000 and 2010. We compared RAI ablation protocols including indications (based on TNM staging), preparation protocols, and administered dose. We excluded patients with known distant metastases at time of RAI ablation. Results. We included 3072 patients. There were no significant differences in TNM stage over time. RAI use increased in earlier years and then declined. The fraction of patients receiving RAI varied significantly between centers, ranging between 20–85% for T1, 44–100% for T2, 58–100% for T3, and 59–100% for T4. There were significant differences in the RAI doses between centers. Finally, there was major variation in the use of thyroid hormone withdrawal or rhTSH for preparation of RAI ablation. Conclusion. Our study identified significant variation in use of RAI for ablation in patients with well-differentiated thyroid cancer both between Canadian centers and over time.","PeriodicalId":17394,"journal":{"name":"Journal of Thyroid Research","volume":"56 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2016-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88423949","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background. Pretibial myxedema (PTM) is a rare dermopathy. The morphologic features and mechanism of its evolving process are not reported in large case series. Methods. 216 cases with PTM were retrospectively reviewed to analyze demographics, history, lesional morphology and its evolving process, histopathology and immunohistochemistry, serum TRAb levels, treatment, and outcome. Results. First appearing lesions evolved into 6 variants that were correlated with serum TRAb levels. Subvariants were caused by different kinds and frequencies of local trauma. The evolving process could be classified into 4 stages that were correlated with serum TRAb levels and perivascular infiltration of CD8+ and CD4+ lymphocytes. Serum TRAb levels at remission and in nonrecurred cases became lower than those before therapy and in recurred cases, respectively, but increased when PTM relapsed. TRAb level in nodule variant went down invariably with the extension of course and its autoimmune activity had a trend to stop but in other 5 variants TRAb levels fluctuated. Their autoimmune activities had no trends to stop and clinically worsen through intermittent repeats of active and stable stages. Conclusions. In the chronic course of PTM, nodule variant is self-limited and other 5 variants are not self-limited. PTM needed early treatment to avoid severe variants.
{"title":"Morphological Diversity of Pretibial Myxedema and Its Mechanism of Evolving Process and Outcome: A Retrospective Study of 216 Cases","authors":"C. Lan, Yi Wang, Xia Zeng, J. Zhao, Xiaoxi Zou","doi":"10.1155/2016/2652174","DOIUrl":"https://doi.org/10.1155/2016/2652174","url":null,"abstract":"Background. Pretibial myxedema (PTM) is a rare dermopathy. The morphologic features and mechanism of its evolving process are not reported in large case series. Methods. 216 cases with PTM were retrospectively reviewed to analyze demographics, history, lesional morphology and its evolving process, histopathology and immunohistochemistry, serum TRAb levels, treatment, and outcome. Results. First appearing lesions evolved into 6 variants that were correlated with serum TRAb levels. Subvariants were caused by different kinds and frequencies of local trauma. The evolving process could be classified into 4 stages that were correlated with serum TRAb levels and perivascular infiltration of CD8+ and CD4+ lymphocytes. Serum TRAb levels at remission and in nonrecurred cases became lower than those before therapy and in recurred cases, respectively, but increased when PTM relapsed. TRAb level in nodule variant went down invariably with the extension of course and its autoimmune activity had a trend to stop but in other 5 variants TRAb levels fluctuated. Their autoimmune activities had no trends to stop and clinically worsen through intermittent repeats of active and stable stages. Conclusions. In the chronic course of PTM, nodule variant is self-limited and other 5 variants are not self-limited. PTM needed early treatment to avoid severe variants.","PeriodicalId":17394,"journal":{"name":"Journal of Thyroid Research","volume":"51 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2016-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78018076","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
T. Kobawala, T. Trivedi, K. Gajjar, Darshita H. Patel, G. Patel, N. Ghosh
This study sought to reveal the significance of IL-6 in papillary thyroid carcinoma by determining its circulating levels, tumoral protein, and mRNA expressions. As compared to the healthy individuals, serum IL-6 was significantly higher in patients with benign thyroid diseases and PTC. Further, its level was significantly higher in PTC patients as compared to patients with benign thyroid diseases. ROC curves also confirmed a good discriminatory efficacy of serum IL-6 between healthy individuals and patients with benign thyroid diseases and PTC. The circulating IL-6 was significantly associated with poor overall survival in PTC patients. IL-6 immunoreactivity was significantly high in PTC patients as compared to the benign thyroid disease patients. Significantly higher IL-6 mRNA expression was also observed in the primary tumour tissues of PTC patients than the adjacent normal tissues. The protein expression of IL-6 at both the circulating and tissue level correlated with disease aggressiveness in PTC patients. Moreover, a significant positive correlation was observed between the IL-6 protein and mRNA expression in the primary tumours of PTC patients. Finally in conclusion, IL-6 has an important role in thyroid cancer progression. Thus targeting IL-6 signalling can help in clinical management of thyroid carcinoma patients.
{"title":"Significance of Interleukin-6 in Papillary Thyroid Carcinoma","authors":"T. Kobawala, T. Trivedi, K. Gajjar, Darshita H. Patel, G. Patel, N. Ghosh","doi":"10.1155/2016/6178921","DOIUrl":"https://doi.org/10.1155/2016/6178921","url":null,"abstract":"This study sought to reveal the significance of IL-6 in papillary thyroid carcinoma by determining its circulating levels, tumoral protein, and mRNA expressions. As compared to the healthy individuals, serum IL-6 was significantly higher in patients with benign thyroid diseases and PTC. Further, its level was significantly higher in PTC patients as compared to patients with benign thyroid diseases. ROC curves also confirmed a good discriminatory efficacy of serum IL-6 between healthy individuals and patients with benign thyroid diseases and PTC. The circulating IL-6 was significantly associated with poor overall survival in PTC patients. IL-6 immunoreactivity was significantly high in PTC patients as compared to the benign thyroid disease patients. Significantly higher IL-6 mRNA expression was also observed in the primary tumour tissues of PTC patients than the adjacent normal tissues. The protein expression of IL-6 at both the circulating and tissue level correlated with disease aggressiveness in PTC patients. Moreover, a significant positive correlation was observed between the IL-6 protein and mRNA expression in the primary tumours of PTC patients. Finally in conclusion, IL-6 has an important role in thyroid cancer progression. Thus targeting IL-6 signalling can help in clinical management of thyroid carcinoma patients.","PeriodicalId":17394,"journal":{"name":"Journal of Thyroid Research","volume":"39 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2016-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74814752","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sunil Malla Bujar Barua, A. Mishra, K. Kishore, S. Mishra, G. Chand, G. Agarwal, A. Agarwal, A. Verma
The aim of the current study was to investigate the efficacy of greater occipital nerve (GON) block and bilateral superficial cervical plexuses (BSCP) blocks in alleviating postoperative occipital headache and posterior neck pain after thyroidectomy. This randomized prospective study consisted of 75 women undergoing total thyroidectomy. Patients were randomized into three groups: Group I (n = 25): patients receiving GON, Group II (n = 25): patients receiving bilateral (BSCP) blocks, and Group III (n = 25): patients receiving no block. Assessment of occipital headache, posterior neck, and incision site pains was made at 12 hours and 24 hours after extubation by Visual Analogue Scale (VAS). In comparison to Group III significantly fewer patients in Groups I and II experienced occipital headache at 12 (p = 0.006) and 24 hours (p = 0.005) and also posterior neck pain at 24 hours (p = 0.003). Mean VAS scores at 12 and 24 hours for occipital headache (p = 0.003 and p = 0.041) and posterior neck pain (p = 0.015 and p = 0.008) were significantly lower in Group I. The differences between Groups II and III were not significant except for the occipital headache at 12 hours. The efficacy of GON block is superior to BSCP blocks in alleviating postthyroidectomy occipital headache and posterior cervical pain.
{"title":"Effect of Preoperative Nerve Block on Postthyroidectomy Headache and Cervical Pain: A Randomized Prospective Study","authors":"Sunil Malla Bujar Barua, A. Mishra, K. Kishore, S. Mishra, G. Chand, G. Agarwal, A. Agarwal, A. Verma","doi":"10.1155/2016/9785849","DOIUrl":"https://doi.org/10.1155/2016/9785849","url":null,"abstract":"The aim of the current study was to investigate the efficacy of greater occipital nerve (GON) block and bilateral superficial cervical plexuses (BSCP) blocks in alleviating postoperative occipital headache and posterior neck pain after thyroidectomy. This randomized prospective study consisted of 75 women undergoing total thyroidectomy. Patients were randomized into three groups: Group I (n = 25): patients receiving GON, Group II (n = 25): patients receiving bilateral (BSCP) blocks, and Group III (n = 25): patients receiving no block. Assessment of occipital headache, posterior neck, and incision site pains was made at 12 hours and 24 hours after extubation by Visual Analogue Scale (VAS). In comparison to Group III significantly fewer patients in Groups I and II experienced occipital headache at 12 (p = 0.006) and 24 hours (p = 0.005) and also posterior neck pain at 24 hours (p = 0.003). Mean VAS scores at 12 and 24 hours for occipital headache (p = 0.003 and p = 0.041) and posterior neck pain (p = 0.015 and p = 0.008) were significantly lower in Group I. The differences between Groups II and III were not significant except for the occipital headache at 12 hours. The efficacy of GON block is superior to BSCP blocks in alleviating postthyroidectomy occipital headache and posterior cervical pain.","PeriodicalId":17394,"journal":{"name":"Journal of Thyroid Research","volume":"4 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2016-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90475579","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ashwini Aithal Padur, Naveen Kumar, A. Guru, Satheesha Nayak Badagabettu, Swamy Ravindra Shanthakumar, M. Virupakshamurthy, J. Patil
Diseases associated with the thyroid gland are one of the most frequently seen endocrine disorders across the globe. Total thyroidectomy is currently the preferred treatment for many thyroid diseases. Controversies exist among surgeons regarding safety of total thyroidectomy due to the risk associated with it like postoperative hypoparathyroidism or recurrent laryngeal nerve damage. Since, in the recent years, the incidence of thyroidectomy is in increasing trend in south Indian population, this review aims to study the available data regarding the appropriateness and safety of total thyroidectomy and compares it with subtotal thyroidectomy and other thyroid surgeries. This is a retrospective comprehensive review of various articles and publications regarding total and partial thyroidectomy performed across the world. Many retrospective studies and few prospective studies suggest that the incidence of transient hypocalcemia is higher after total thyroidectomy than after subtotal thyroidectomy, but the incidence of other complications including recurrent laryngeal nerve palsy and postoperative hematoma is not significantly different between the two procedures. Hence in our review we found that total thyroidectomy is safe and cost effective with low complication rates and provides little significant advantage of being safer procedure compared to subtotal thyroidectomy.
{"title":"Safety and Effectiveness of Total Thyroidectomy and Its Comparison with Subtotal Thyroidectomy and Other Thyroid Surgeries: A Systematic Review","authors":"Ashwini Aithal Padur, Naveen Kumar, A. Guru, Satheesha Nayak Badagabettu, Swamy Ravindra Shanthakumar, M. Virupakshamurthy, J. Patil","doi":"10.1155/2016/7594615","DOIUrl":"https://doi.org/10.1155/2016/7594615","url":null,"abstract":"Diseases associated with the thyroid gland are one of the most frequently seen endocrine disorders across the globe. Total thyroidectomy is currently the preferred treatment for many thyroid diseases. Controversies exist among surgeons regarding safety of total thyroidectomy due to the risk associated with it like postoperative hypoparathyroidism or recurrent laryngeal nerve damage. Since, in the recent years, the incidence of thyroidectomy is in increasing trend in south Indian population, this review aims to study the available data regarding the appropriateness and safety of total thyroidectomy and compares it with subtotal thyroidectomy and other thyroid surgeries. This is a retrospective comprehensive review of various articles and publications regarding total and partial thyroidectomy performed across the world. Many retrospective studies and few prospective studies suggest that the incidence of transient hypocalcemia is higher after total thyroidectomy than after subtotal thyroidectomy, but the incidence of other complications including recurrent laryngeal nerve palsy and postoperative hematoma is not significantly different between the two procedures. Hence in our review we found that total thyroidectomy is safe and cost effective with low complication rates and provides little significant advantage of being safer procedure compared to subtotal thyroidectomy.","PeriodicalId":17394,"journal":{"name":"Journal of Thyroid Research","volume":"360 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2016-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76432393","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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