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Cabanillas ME, Schlumberger M, Jarzab B, Martins RG, Pacini F, Robinson B, McCaffrey JC, Shah MH, Bodenner DL, Topliss D, Andresen C, O'Brien JP, Ren M, Funahashi Y, Allison R, Elisei R, Newbold K, Licitra LF, Sherman SI, Ball DW. A phase 2 trial of lenvatinib (E7080) in advanced, progressive, radioiodine-refractory, differentiated thyroid cancer: A clinical outcomes and biomarker assessment. Cancer 2015; 121:2749-56. [PMID: 25913680 PMCID: PMC4803478 DOI: 10.1002/cncr.29395] [Citation(s) in RCA: 127] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Revised: 03/03/2015] [Accepted: 03/05/2015] [Indexed: 02/05/2023]
Abstract
BACKGROUND Lenvatinib is an oral, multitargeted tyrosine kinase inhibitor of the vascular endothelial growth factor receptors 1 through 3 (VEGFR1-VEGFR3), fibroblast growth factor receptors 1 through 4 (FGFR1-FGFR4), platelet-derived growth factor receptor α (PDGFRα), ret proto-oncogene (RET), and v-kit Hardy-Zuckerman 4 feline sarcoma viral oncogene homolog (KIT) signaling networks implicated in tumor angiogenesis. Positive phase 1 results in solid tumors prompted a phase 2 trial in patients with advanced, radioiodine-refractory, differentiated thyroid cancer (RR-DTC). METHODS Fifty-eight patients with RR-DTC who had disease progression during the previous 12 months received lenvatinib 24 mg once daily in 28-day cycles until disease progression, unmanageable toxicity, withdrawal, or death. Previous VEGFR-targeted therapy was permitted. The primary endpoint was the objective response rate (ORR) based on independent imaging review. Secondary endpoints included progression-free survival (PFS) and safety. Serum levels of 51 circulating cytokines and angiogenic factors also were assessed. RESULTS After ≥14 months of follow-up, patients had an ORR of 50% (95% confidence interval [CI], 37%-63%) with only partial responses reported. The median time to response was 3.6 months, the median response duration was 12.7 months, and the median PFS was 12.6 months (95% CI, 9.9-16.1 months). The ORR for patients who had received previous VEGF therapy (n = 17) was 59% (95% CI, 33%-82%). Lower baseline levels of angiopoietin-2 were suggestive of tumor response and longer PFS. Grade 3 and 4 treatment-emergent adverse events, regardless of their relation to treatment, occurred in 72% of patients and most frequently included weight loss (12%), hypertension (10%), proteinuria (10%), and diarrhea (10%). CONCLUSIONS In patients with and without prior exposure to VEGF therapy, the encouraging response rates, median time to response, and PFS for lenvatinib have prompted further investigation in a phase 3 trial. Cancer 2015;121:2749-2756. © 2015 American Cancer Society.
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Affiliation(s)
- Maria E. Cabanillas
- Department of Endocrine Neoplasia and Hormonal DisordersDivision of Internal MedicineThe University of Texas MD Anderson Cancer CenterHoustonTexas
| | - Martin Schlumberger
- Department of Nuclear Medicine and Endocrine OncologyGustave Roussy Institute and Université Paris‐SudVillejuifFrance
| | - Barbara Jarzab
- Department of Nuclear Medicine and Endocrine OncologyMaria Sklodowska‐Curie Memorial Cancer Center and Institute of OncologyGliwice Branch, Gliwice PolandWybrzeze Armii Krajowej 15, 44‐101 GliwicePoland
| | - Renato G. Martins
- Department of Thoracic/Head and Neck Oncology, School of MedicineUniversity of WashingtonSeattleWashington
| | - Furio Pacini
- Section of EndocrinologyUniversity of SienaSienaItaly
| | - Bruce Robinson
- Faculty of Medicine, Cancer Genetics UnitKolling Institute, Royal North Shore Hospital, University of SydneyNew South WalesAustralia
| | | | - Manisha H. Shah
- Ohio State University Comprehensive Cancer CenterColumbusOhio
| | - Donald L. Bodenner
- Department of GeriatricsUniversity of Arkansas for Medical sciencesLittle RockArkansas
| | - Duncan Topliss
- Department of Endocrinology and DiabetesThe Alfred HospitalMelbourneVictoriaAustralia
| | | | | | - Min Ren
- Eisai IncWoodcliff LakeNew Jersey
| | | | - Roger Allison
- Cancer Care ServicesThe Royal Brisbane and Women's HospitalHerstonQueenslandAustralia
| | | | - Kate Newbold
- Department of OncologyRoyal Marsden HospitalLondonUnited Kingdom
| | - Lisa F. Licitra
- Foundation for Cancer Research and TreatmentNational Tumor InstituteMilanItaly
| | - Steven I. Sherman
- Department of Endocrine Neoplasia and Hormonal DisordersDivision of Internal MedicineThe University of Texas MD Anderson Cancer CenterHoustonTexas
| | - Douglas W. Ball
- The Johns Hopkins University School of MedicineBaltimoreMaryland
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Wells SA, Asa SL, Dralle H, Elisei R, Evans DB, Gagel RF, Lee N, Machens A, Moley JF, Pacini F, Raue F, Frank-Raue K, Robinson B, Rosenthal MS, Santoro M, Schlumberger M, Shah M, Waguespack SG. Revised American Thyroid Association guidelines for the management of medullary thyroid carcinoma. Thyroid 2015; 25:567-610. [PMID: 25810047 PMCID: PMC4490627 DOI: 10.1089/thy.2014.0335] [Citation(s) in RCA: 1225] [Impact Index Per Article: 136.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
INTRODUCTION The American Thyroid Association appointed a Task Force of experts to revise the original Medullary Thyroid Carcinoma: Management Guidelines of the American Thyroid Association. METHODS The Task Force identified relevant articles using a systematic PubMed search, supplemented with additional published materials, and then created evidence-based recommendations, which were set in categories using criteria adapted from the United States Preventive Services Task Force Agency for Healthcare Research and Quality. The original guidelines provided abundant source material and an excellent organizational structure that served as the basis for the current revised document. RESULTS The revised guidelines are focused primarily on the diagnosis and treatment of patients with sporadic medullary thyroid carcinoma (MTC) and hereditary MTC. CONCLUSIONS The Task Force developed 67 evidence-based recommendations to assist clinicians in the care of patients with MTC. The Task Force considers the recommendations to represent current, rational, and optimal medical practice.
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Affiliation(s)
- Samuel A. Wells
- Genetics Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Sylvia L. Asa
- Department of Pathology, University Health Network, and Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Henning Dralle
- Department of General, Visceral, and Vascular Surgery, University Hospital, University of Halle-Wittenberg, Halle/Saale, Germany
| | - Rossella Elisei
- Department of Endocrinology, University of Pisa, Pisa, Italy
| | - Douglas B. Evans
- Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Robert F. Gagel
- Department of Endocrine Neoplasia and Hormonal Disorders, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Nancy Lee
- Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Andreas Machens
- Department of General, Visceral, and Vascular Surgery, University Hospital, University of Halle-Wittenberg, Halle/Saale, Germany
| | - Jeffrey F. Moley
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Furio Pacini
- Section of Endocrinology and Metabolism, Department of Internal Medicine, Endocrinology and Metabolism and Biochemistry, University of Siena, Policlinico Santa Maria alle Scotte, Siena, Italy
| | - Friedhelm Raue
- Endocrine Practice, Moleculargenetic Laboratory, Medical Faculty, University of Heidelberg, Heidelberg, Germany
| | - Karin Frank-Raue
- Endocrine Practice, Moleculargenetic Laboratory, Medical Faculty, University of Heidelberg, Heidelberg, Germany
| | - Bruce Robinson
- University of Sydney School of Medicine, Sydney, New South Wales, Australia
| | - M. Sara Rosenthal
- Departments of Internal Medicine, Pediatrics and Behavioral Science, University of Kentucky, Lexington, Kentucky
| | - Massimo Santoro
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Universita' di Napoli “Federico II,” Napoli, Italy
| | - Martin Schlumberger
- Institut Gustave Roussy, Service de Medecine Nucleaire, Université of Paris-Sud, Villejuif, France
| | - Manisha Shah
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University, Columbus, Ohio
| | - Steven G. Waguespack
- Department of Endocrine Neoplasia and Hormonal Disorders, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Colato C, Vicentini C, Cantara S, Pedron S, Brazzarola P, Marchetti I, Di Coscio G, Chilosi M, Brunelli M, Pacini F, Ferdeghini M. Break-apart interphase fluorescence in situ hybridization assay in papillary thyroid carcinoma: on the road to optimizing the cut-off level for RET/PTC rearrangements. Eur J Endocrinol 2015; 172:571-82. [PMID: 25698220 DOI: 10.1530/eje-14-0930] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Chromosomal rearrangements of the RET proto-oncogene is one of the most common molecular events in papillary thyroid carcinoma (PTC). However, their pathogenic role and clinical significance are still debated. This study aimed to investigate the prevalence of RET/PTC rearrangement in a cohort of BRAF WT PTCs by fluorescence in situ hybridization (FISH) and to search a reliable cut-off level in order to distinguish clonal or non-clonal RET changes. DESIGN Forty BRAF WT PTCs were analyzed by FISH for RET rearrangements. As controls, six BRAFV600E mutated PTCs, 13 follicular adenomas (FA), and ten normal thyroid parenchyma were also analyzed. METHODS We performed FISH analysis on formalin-fixed, paraffin-embedded tissue using a commercially available RET break-apart probe. A cut-off level equivalent to 10.2% of aberrant cells was accepted as significant. To validate FISH results, we analyzed the study cohort by qRT-PCR. RESULTS Split RET signals above the cut-off level were observed in 25% (10/40) of PTCs, harboring a percentage of positive cells ranging from 12 to 50%, and in one spontaneous FA (1/13, 7.7%). Overall, the data obtained by FISH matched well with qRT-PCR results. Challenging findings were observed in five cases showing a frequency of rearrangement very close to the cut-off. CONCLUSIONS FISH approach represents a powerful tool to estimate the ratio between broken and non-broken RET tumor cells. Establishing a precise FISH cut-off may be useful in the interpretation of the presence of RET rearrangement, primarily when this strategy is used for cytological evaluation or for targeted therapy.
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Affiliation(s)
- Chiara Colato
- Department of Pathology and DiagnosticsARC-NET Research CentreUniversity of Verona, Policlinico GB Rossi, Piazzale LA Scuro, 10, Piastra Odontoiatrica (II floor), 37134 Verona, ItalyDepartment of Internal MedicineEndocrinology, and Metabolism and Biochemistry, University of Siena, Siena, ItalyDepartment of Surgery and OncologyUniversity of Verona, Verona, ItalyDivision of SurgicalMolecular and Ultrastructural, Section of Cytopathology, University Hospital of Pisa, Pisa, ItalyNuclear Medicine UnitUniversity Hospital of Verona, Verona, Italy
| | - Caterina Vicentini
- Department of Pathology and DiagnosticsARC-NET Research CentreUniversity of Verona, Policlinico GB Rossi, Piazzale LA Scuro, 10, Piastra Odontoiatrica (II floor), 37134 Verona, ItalyDepartment of Internal MedicineEndocrinology, and Metabolism and Biochemistry, University of Siena, Siena, ItalyDepartment of Surgery and OncologyUniversity of Verona, Verona, ItalyDivision of SurgicalMolecular and Ultrastructural, Section of Cytopathology, University Hospital of Pisa, Pisa, ItalyNuclear Medicine UnitUniversity Hospital of Verona, Verona, Italy
| | - Silvia Cantara
- Department of Pathology and DiagnosticsARC-NET Research CentreUniversity of Verona, Policlinico GB Rossi, Piazzale LA Scuro, 10, Piastra Odontoiatrica (II floor), 37134 Verona, ItalyDepartment of Internal MedicineEndocrinology, and Metabolism and Biochemistry, University of Siena, Siena, ItalyDepartment of Surgery and OncologyUniversity of Verona, Verona, ItalyDivision of SurgicalMolecular and Ultrastructural, Section of Cytopathology, University Hospital of Pisa, Pisa, ItalyNuclear Medicine UnitUniversity Hospital of Verona, Verona, Italy
| | - Serena Pedron
- Department of Pathology and DiagnosticsARC-NET Research CentreUniversity of Verona, Policlinico GB Rossi, Piazzale LA Scuro, 10, Piastra Odontoiatrica (II floor), 37134 Verona, ItalyDepartment of Internal MedicineEndocrinology, and Metabolism and Biochemistry, University of Siena, Siena, ItalyDepartment of Surgery and OncologyUniversity of Verona, Verona, ItalyDivision of SurgicalMolecular and Ultrastructural, Section of Cytopathology, University Hospital of Pisa, Pisa, ItalyNuclear Medicine UnitUniversity Hospital of Verona, Verona, Italy
| | - Paolo Brazzarola
- Department of Pathology and DiagnosticsARC-NET Research CentreUniversity of Verona, Policlinico GB Rossi, Piazzale LA Scuro, 10, Piastra Odontoiatrica (II floor), 37134 Verona, ItalyDepartment of Internal MedicineEndocrinology, and Metabolism and Biochemistry, University of Siena, Siena, ItalyDepartment of Surgery and OncologyUniversity of Verona, Verona, ItalyDivision of SurgicalMolecular and Ultrastructural, Section of Cytopathology, University Hospital of Pisa, Pisa, ItalyNuclear Medicine UnitUniversity Hospital of Verona, Verona, Italy
| | - Ivo Marchetti
- Department of Pathology and DiagnosticsARC-NET Research CentreUniversity of Verona, Policlinico GB Rossi, Piazzale LA Scuro, 10, Piastra Odontoiatrica (II floor), 37134 Verona, ItalyDepartment of Internal MedicineEndocrinology, and Metabolism and Biochemistry, University of Siena, Siena, ItalyDepartment of Surgery and OncologyUniversity of Verona, Verona, ItalyDivision of SurgicalMolecular and Ultrastructural, Section of Cytopathology, University Hospital of Pisa, Pisa, ItalyNuclear Medicine UnitUniversity Hospital of Verona, Verona, Italy
| | - Giancarlo Di Coscio
- Department of Pathology and DiagnosticsARC-NET Research CentreUniversity of Verona, Policlinico GB Rossi, Piazzale LA Scuro, 10, Piastra Odontoiatrica (II floor), 37134 Verona, ItalyDepartment of Internal MedicineEndocrinology, and Metabolism and Biochemistry, University of Siena, Siena, ItalyDepartment of Surgery and OncologyUniversity of Verona, Verona, ItalyDivision of SurgicalMolecular and Ultrastructural, Section of Cytopathology, University Hospital of Pisa, Pisa, ItalyNuclear Medicine UnitUniversity Hospital of Verona, Verona, Italy
| | - Marco Chilosi
- Department of Pathology and DiagnosticsARC-NET Research CentreUniversity of Verona, Policlinico GB Rossi, Piazzale LA Scuro, 10, Piastra Odontoiatrica (II floor), 37134 Verona, ItalyDepartment of Internal MedicineEndocrinology, and Metabolism and Biochemistry, University of Siena, Siena, ItalyDepartment of Surgery and OncologyUniversity of Verona, Verona, ItalyDivision of SurgicalMolecular and Ultrastructural, Section of Cytopathology, University Hospital of Pisa, Pisa, ItalyNuclear Medicine UnitUniversity Hospital of Verona, Verona, Italy
| | - Matteo Brunelli
- Department of Pathology and DiagnosticsARC-NET Research CentreUniversity of Verona, Policlinico GB Rossi, Piazzale LA Scuro, 10, Piastra Odontoiatrica (II floor), 37134 Verona, ItalyDepartment of Internal MedicineEndocrinology, and Metabolism and Biochemistry, University of Siena, Siena, ItalyDepartment of Surgery and OncologyUniversity of Verona, Verona, ItalyDivision of SurgicalMolecular and Ultrastructural, Section of Cytopathology, University Hospital of Pisa, Pisa, ItalyNuclear Medicine UnitUniversity Hospital of Verona, Verona, Italy
| | - Furio Pacini
- Department of Pathology and DiagnosticsARC-NET Research CentreUniversity of Verona, Policlinico GB Rossi, Piazzale LA Scuro, 10, Piastra Odontoiatrica (II floor), 37134 Verona, ItalyDepartment of Internal MedicineEndocrinology, and Metabolism and Biochemistry, University of Siena, Siena, ItalyDepartment of Surgery and OncologyUniversity of Verona, Verona, ItalyDivision of SurgicalMolecular and Ultrastructural, Section of Cytopathology, University Hospital of Pisa, Pisa, ItalyNuclear Medicine UnitUniversity Hospital of Verona, Verona, Italy
| | - Marco Ferdeghini
- Department of Pathology and DiagnosticsARC-NET Research CentreUniversity of Verona, Policlinico GB Rossi, Piazzale LA Scuro, 10, Piastra Odontoiatrica (II floor), 37134 Verona, ItalyDepartment of Internal MedicineEndocrinology, and Metabolism and Biochemistry, University of Siena, Siena, ItalyDepartment of Surgery and OncologyUniversity of Verona, Verona, ItalyDivision of SurgicalMolecular and Ultrastructural, Section of Cytopathology, University Hospital of Pisa, Pisa, ItalyNuclear Medicine UnitUniversity Hospital of Verona, Verona, Italy Department of Pathology and DiagnosticsARC-NET Research CentreUniversity of Verona, Policlinico GB Rossi, Piazzale LA Scuro, 10, Piastra Odontoiatrica (II floor), 37134 Verona, ItalyDepartment of Internal MedicineEndocrinology, and Metabolism and Biochemistry, University of Siena, Siena, ItalyDepartment of Surgery and OncologyUniversity of Verona, Verona, ItalyDivision of SurgicalMolecular and Ultrastructural, Section of Cytopathology, University Hospital of Pisa, Pisa, ItalyNuclear Medicine UnitUniversity Hospital of Verona, Verona, Italy
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Castagna MG, Fugazzola L, Maino F, Covelli D, Memmo S, Sestini F, Fioravanti C, Ferraris Fusarini C, Scapellato C, Macchini F, Cevenini G, Pacini F. Reference range of serum calcitonin in pediatric population. J Clin Endocrinol Metab 2015; 100:1780-4. [PMID: 25955324 DOI: 10.1210/jc.2014-4508] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Children belonging to the multiple endocrine neoplasia type 2 (MEN 2) pedigree and carrying germline RET mutations are candidates for prophylactic thyroidectomy, the timing of which is based on the mutation-associated risk and the calcitonin (CT) levels. DESIGN The aim of this study was to establish the reference range for serum CT in a pediatric population. The study included 2740 subjects (1339 females and 1401 males) ranging in age from 1 day to 16 years and undergoing blood testing for any medical condition not affecting serum CT. RESULTS Overall, serum CT was undetectable in 61.5% of the samples and detectable in 38.5%. Detectable samples were more frequent in the first 2 years of life. Thereafter, undetectable samples became more frequent, particularly in females. Mean serum CT concentrations were higher in the first year of life (9.81 ± 8.8 pg/mL; range, 2.0-48.9 pg/mL) and the second year of life (4.56 ± 2.64 pg/mL; range, 2.0-14.7 pg/mL). A significant decrease of serum CT levels was observed thereafter (P < .001), and starting from the third year of life serum CT levels were similar to those found in adults. No gender difference was found in any age group. Based on these results, age-specific CT reference ranges are needed in the pediatric population, and especially in the first 2 years of life. CONCLUSIONS This is the first study defining the reference range for serum CT in the pediatric population and large enough to be statistically meaningful. Our proposal may facilitate the process of decision making when dealing with gene carriers of MEN 2.
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Affiliation(s)
- Maria G Castagna
- Department of Medical, Surgical, and Neurological Sciences (M.G.C., F.M., S.M., F.S., C.F., F.P.), University of Siena, 53100 Siena, Italy; Endocrine Unit (L.F., D.C.), Fondazione Instituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca'Granda, and Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy; Clinical Pathology Laboratory (C.F.F.), Fondazione IRCCS Ca'Granda, 20122 Milan, Italy; Laboratory of Clinical Pathology (C.S.), Azienda Ospedaliera Universitaria Senese, 53100 Siena, Italy; Pediatric Surgery Unit (F.M.), Fondazione IRCCS Ca'Granda, 20122 Milan, Italy; and Department of Surgery and Bioengineering (G.C.), University of Siena, 53100 Siena, Italy
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Rosato L, Pacini F, Panier Suffat L, Mondini G, Ginardi A, Maggio M, Bosco MC, Della Pepa C. Post-thyroidectomy chronic asthenia: self-deception or disease? Endocrine 2015; 48:615-20. [PMID: 25033997 DOI: 10.1007/s12020-014-0353-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Accepted: 06/28/2014] [Indexed: 02/05/2023]
Abstract
There is clinical evidence that post-total thyroidectomy (TT) patients can present persistent asthenia. The aim of this study was to evaluate the prevalence of asthenia symptoms in such patients, assess whether a chronic asthenia syndrome could be caused by TT or become evident after it. An observational study was carried out comparing two groups of 100 patients each, all with homogeneous characteristics. Group A was treated with total lobectomy (TL), Group B with TT. All patients presented normal thyroid hormone levels. The patients were interviewed in order to identify the ones affected by post-operative asthenia persisting for at least six months, with reduced ability to perform physical and mental work, not showing improvement with rest. The severity of the symptoms has been measured by means of the brief fatigue inventory (BFI). Statistical analysis was performed to evaluate statistically significative differences between groups and prognostic factors in TT group. The incidence of post-operative asthenia was 0 % after TL and 25 % after TT, with the operation being the only significant variable. Asthenia is well known as symptom of post-thyroidectomy, but it has not been adequately investigated as consequence of surgery. We demonstrated that the complete removal of the thyroid gland could determine chronic post-thyroidectomy asthenia, although with intensity limited to low/moderate. Post-thyroidectomy asthenia is a relevant sequela interfering with quality of life of at least 25 % of patients operated, suggesting the need to identify its real causes and limit the indication to TT only when strictly required.
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Affiliation(s)
- Lodovico Rosato
- Department of Surgery - Endocrine Surgical Unit, Ivrea Hospital, School of Medicine, ASL TO4, University of Turin, Turin, Italy
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Marcucci G, Cianferotti L, Beck-Peccoz P, Capezzone M, Cetani F, Colao A, Davì MV, degli Uberti E, Del Prato S, Elisei R, Faggiano A, Ferone D, Foresta C, Fugazzola L, Ghigo E, Giacchetti G, Giorgino F, Lenzi A, Malandrino P, Mannelli M, Marcocci C, Masi L, Pacini F, Opocher G, Radicioni A, Tonacchera M, Vigneri R, Zatelli MC, Brandi ML. Rare diseases in clinical endocrinology: a taxonomic classification system. J Endocrinol Invest 2015; 38:193-259. [PMID: 25376364 DOI: 10.1007/s40618-014-0202-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Accepted: 10/17/2014] [Indexed: 02/05/2023]
Abstract
PURPOSE Rare endocrine-metabolic diseases (REMD) represent an important area in the field of medicine and pharmacology. The rare diseases of interest to endocrinologists involve all fields of endocrinology, including rare diseases of the pituitary, thyroid and adrenal glands, paraganglia, ovary and testis, disorders of bone and mineral metabolism, energy and lipid metabolism, water metabolism, and syndromes with possible involvement of multiple endocrine glands, and neuroendocrine tumors. Taking advantage of the constitution of a study group on REMD within the Italian Society of Endocrinology, consisting of basic and clinical scientists, a document on the taxonomy of REMD has been produced. METHODS AND RESULTS This document has been designed to include mainly REMD manifesting or persisting into adulthood. The taxonomy of REMD of the adult comprises a total of 166 main disorders, 338 including all variants and subtypes, described into 11 tables. CONCLUSIONS This report provides a complete taxonomy to classify REMD of the adult. In the future, the creation of registries of rare endocrine diseases to collect data on cohorts of patients and the development of common and standardized diagnostic and therapeutic pathways for each rare endocrine disease is advisable. This will help planning and performing intervention studies in larger groups of patients to prove the efficacy, effectiveness, and safety of a specific treatment.
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Affiliation(s)
- G Marcucci
- Head, Bone Metablic Diseases Unit, Department of Surgery and Translational Medicine, University of Florence, Viale Pieraccini 6, 50139, Florence, Italy.
| | - L Cianferotti
- Head, Bone Metablic Diseases Unit, Department of Surgery and Translational Medicine, University of Florence, Viale Pieraccini 6, 50139, Florence, Italy
| | - P Beck-Peccoz
- Department of Clinical Sciences and Community Health, University of Milan and Endocrine Unit, Fondazione IRCCS Ca' Granda, Milan, Italy
| | - M Capezzone
- Section of Endocrinology and Metabolism, Department of Internal Medicine, Endocrinology and Metabolism and Biochemistry, University of Siena, Policlinico Santa Maria alle Scotte, Siena, Italy
| | - F Cetani
- Unit of Endocrinology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - A Colao
- Dipartimento di Medicina Clinica e Chirurgia, Università Federico II di Napoli, Naples, Italy
| | - M V Davì
- Section D, Department of Medicine, Clinic of Internal Medicine, University of Verona, Verona, Italy
| | - E degli Uberti
- Section of Endocrinology, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - S Del Prato
- Section of Metabolic Diseases and Diabetes, Department of Endocrinology and Metabolism, University of Pisa, Pisa, Italy
| | - R Elisei
- Unit of Endocrinology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - A Faggiano
- Dipartimento di Medicina Clinica e Chirurgia, Università Federico II di Napoli, Naples, Italy
| | - D Ferone
- Endocrinology, Department of Internal Medicine and Medical Specialties and Center of Excellence for Biomedical Research, IRCCS AOU San Martino-IST, University of Genoa, Genoa, Italy
| | - C Foresta
- Department of Medicine and Centre for Human Reproduction Pathology, University of Padova, Padua, Italy
| | - L Fugazzola
- Department of Clinical Sciences and Community Health, University of Milan and Endocrine Unit, Fondazione IRCCS Ca' Granda, Milan, Italy
| | - E Ghigo
- Division of Endocrinology, Diabetology and Metabolism Department of Medical Sciences, University Hospital Città Salute e Scienza, Turin, Italy
| | - G Giacchetti
- Division of Endocrinology, Azienda Ospedaliero-Universitaria, Ospedali Riuniti Umberto I-GM Lancisi-G Salesi, Università Politecnica delle Marche, Ancona, Italy
| | - F Giorgino
- Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari, Italy
| | - A Lenzi
- Chair of Endocrinology, Section Medical Pathophysiology, Food Science and Endocrinology, Department Exp. Medicine, Sapienza University of Rome, Policlinico Umberto I, Rome, Italy
| | - P Malandrino
- Endocrinology, Department of Clinical and Molecular Biomedicine, Garibaldi-Nesima Medical Center, University of Catania, Catania, Italy
| | - M Mannelli
- Endocrinology Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - C Marcocci
- Department of Endocrinology and Metabolism, University of Pisa, Pisa, Italy
| | - L Masi
- Department of Orthopedic, Metabolic Bone Diseases Unit AOUC-Careggi Hospital, Largo Palagi, 1, Florence, Italy
| | - F Pacini
- Section of Endocrinology and Metabolism, University of Siena, Siena, Italy
| | - G Opocher
- Familial Cancer Clinic and Oncoendocrinology, Veneto Institute of Oncology, IRCCS, Padua, Italy
- Department of Medicine DIMED, University of Padova, Padova, Italy
| | - A Radicioni
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - M Tonacchera
- Unit of Endocrinology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - R Vigneri
- Department of Clinical and Molecular Biomedicine, University of Catania, and Humanitas Catania Center of Oncology, Catania, Italy
| | - M C Zatelli
- Section of Endocrinology, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - M L Brandi
- Head, Bone Metablic Diseases Unit, Department of Surgery and Translational Medicine, University of Florence, Viale Pieraccini 6, 50139, Florence, Italy.
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57
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Affiliation(s)
- F Pacini
- Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy.
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Formichi C, Cantara S, Ciuoli C, Neri O, Chiofalo F, Selmi F, Tirone A, Colasanto G, Di Cosmo L, Vuolo G, Pacini F. Weight loss associated with bariatric surgery does not restore short telomere length of severe obese patients after 1 year. Obes Surg 2014; 24:2089-93. [PMID: 24913239 DOI: 10.1007/s11695-014-1300-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Telomere shortening is physiologically associated with ageing but it may be influenced by oxidative stress and chronic inflammation, linked to obesity. Thus, obesity might represent an additional cause of telomere attrition. We aim to study relative telomere length (RTL) in obese subjects with and without metabolic syndrome and to assess the effect of weight loss induced by bariatric surgery. METHODS We evaluated RTL in 107 obese subjects (62 with metabolic syndrome and 45 without metabolic syndrome), compared to 130 age-matched non-obese subjects. We also measured RTL in a subgroup of 93 obese patients prior to and 3, 6, 9 and 12 months after surgery. RESULTS RTL of obese subjects was significantly shorter (p<0.0001) than non-obese subjects but without differences between patients with and without metabolic syndrome (p=0.19). RTL was significantly shorter than baseline at 3, 6, 9 and 12 months after bariatric surgery. CONCLUSIONS These results confirm that obese subjects have shorter telomeres compared to non-obese subjects, but RTL is not influenced by the presence of metabolic syndrome. RTL shows an additional attrition during the immediate post-operative period, probably due to a catabolic state.
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Affiliation(s)
- Caterina Formichi
- Department of Medical, Surgical and Neurological Sciences, University of Siena, Viale Mario Bracci 16, 53100, Siena, Italy,
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Cantara S, Pilli T, Sebastiani G, Cevenini G, Busonero G, Cardinale S, Dotta F, Pacini F. Circulating miRNA95 and miRNA190 are sensitive markers for the differential diagnosis of thyroid nodules in a Caucasian population. J Clin Endocrinol Metab 2014; 99:4190-8. [PMID: 25057879 DOI: 10.1210/jc.2014-1923] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
CONTEXT MicroRNA (miRNAs) are nonprotein-encoding RNAs that regulate gene expression and enable the distinction of benign from malignant tissues in human cancers. OBJECTIVE We investigated the role of miRNA circulating in the blood for the differential diagnosis of thyroid nodules. SETTING AND DESIGN miRNA profiling was assessed by TaqMan Array Human MicroRNA A Cards v2.0 in pooled sera from 12 healthy subjects (HS), 12 nodular goiters (NG), and 12 patients with papillary thyroid cancer (PTC) (cohort 1). From this analysis, we selected eight miRNAs that were validated in individual samples (same of cohort 1) by qRT-PCR. Four miRNAs were confirmed differentially expressed in PTC and were analyzed in a larger second cohort. RESULTS The profiling analysis revealed eight miRNAs (miRNA579, -95, -29b, 5-01-3p, -548d-5p down-regulated, and miR190, -362-3p, -518a-5p up-regulated) which differ in PTC compared with NG and HS. After the validation in individual samples, we confirmed as differentially expressed miRNA579, -95, -29b, and miRNA190. These miRNAs were further validated in a second cohort of sera from 79 PTC, 80 NG, and 41 HS. MiRNA95 had a sensitivity of 94.9%, which reached 100% in a multivariate risk model combined with miRNA190. We developed a mathematical formula that calculates the probability of malignancy with a cut-off value of 0.5 above which the patient was at high risk of malignancy. CONCLUSIONS We have identified for the first time two miRNAs differently expressed in serum of PTC patients who in combination allow the differential diagnosis of thyroid nodules with great accuracy in our study population. Additional studies are required; however, to define whether these results will also be generalized across other patient populations."
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Affiliation(s)
- Silvia Cantara
- Department of Medicine, Surgery and Neuroscience (S.Can., T.P., G.S., G.B., S.Car., F.D., F.P.), University of Siena, Siena, Italy; Fondazione Umberto Di Mario ONLUS (G.S., F.D.), Toscana Life Sciences, Siena, Italy; and Department of Medical Biotechnologies (G.C.), University of Siena, Siena, Italy
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Castellone MD, Langella A, Cantara S, Laurila JP, Laatikainen LE, Bellelli R, Pacini F, Salvatore M, Laukkanen MO. Extracellular superoxide dismutase induces mouse embryonic fibroblast proliferative burst, growth arrest, immortalization, and consequent in vivo tumorigenesis. Antioxid Redox Signal 2014; 21:1460-74. [PMID: 24328532 DOI: 10.1089/ars.2013.5475] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
AIMS Rat sarcoma virus (RAS)-induced tumorigenesis has been suggested to follow a three-stage model consisting of an initial RAS activation, senescence induction, and evasion of p53-dependent senescence checkpoints. While reactive oxygen species act as second messengers in RAS-induced senescence, they are also involved in oncogenic transformation by inducing proliferation and promoting mutations. In the current work, we investigated the role of extracellular superoxide dismutase (SOD3) in RAS-induced senescence and immortalization in vitro and in vivo. We used a mouse embryonic fibroblast (MEF) primary cell model along with immortalized and transformed human cell lines derived from papillary and anaplastic thyroid cancer. RESULTS Based on our data, sod3 RNA interference in H-RasV12-transduced cells markedly inhibited cell growth, while sod3 over-expression in MEFs initially caused a proliferative burst followed by the activation of DNA damage checkpoints, induction of p53-p21 signal transduction, and senescence. Subsequently, sod3-transduced MEF cells developed co-operative p21-p16 down-regulation and acquired transformed cell characteristics such as increased telomerase activity, loss of contact inhibition, growth in low-nutrient conditions, and in vivo tumorigenesis. Interestingly, as previously reported with RAS, we showed a dose-dependent response to SOD3 in vitro and in vivo involving transcriptional and non-transcriptional regulatory mechanisms. INNOVATION SOD3 may mediate H-RasV12-induced initiation of primary cell immortalization. CONCLUSIONS Our results indicate that SOD3 influences growth signaling in primary and cancer cells downstream of the ras oncogene and could serve as a therapy target at an early tumorigenesis phase.
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Affiliation(s)
- Maria Domenica Castellone
- 1 Department of Molecular Medicine and Medical Biotechnologies, Institute of Experimental Endocrinology and Oncology (CNR), University of Naples Federico II , Naples, Italy
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Ciuoli C, Neri O, Brusco L, Formichi C, Chiofalo F, Selmi F, Tirone A, Colasanto G, Vuolo G, Pacini F. Severe hypovitaminosis D and secondary hyperparathyroidism in obese subjects submitted to Roux-en-Y gastric bypass and biliopancreatic diversion. NTM 2014; 32:136-9. [DOI: 10.5301/ntm.2014.12617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Castagna MG, Belardini V, Memmo S, Maino F, Di Santo A, Toti P, Carli AF, Caruso G, Pacini F. Nodules in autoimmune thyroiditis are associated with increased risk of thyroid cancer in surgical series but not in cytological series: evidence for selection bias. J Clin Endocrinol Metab 2014; 99:3193-8. [PMID: 24892990 DOI: 10.1210/jc.2014-1302] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND The association of thyroid cancer and autoimmune thyroiditis (AIT) has been widely addressed, with conflicting results in surgical and cytological series, likely affected by selection bias. OBJECTIVE The objective of the study was to evaluate the association between the cytological features suggestive or indicative of malignancy and AIT in 2504 consecutive patients (2029 females and 475 males, mean age 58.3 ± 14.1 y) undergoing fine-needle aspiration cytology for thyroid nodules. PATIENTS Based on the clinical diagnosis, patients were divided into four groups: AIT with nodules (N-AIT, 14.9%); nodular Graves disease (N-GD, 2.8%); nodular goiter and negative thyroid antibodies (NGAb-, 68.4%); and nodular goiter with positive thyroid antibodies (NGAb+, 13.9%). RESULTS The prevalence of patients with cytological features suggestive (Thy4) or indicative of malignancy (Thy5) was 4.5 % in the N-AIT group, not different compared with the other groups (N-GD, 5.6%; NGAb-, 5.0%; NGAb+, 4.3%). No difference was also found in the other categories (Thy2 and Thy3). When the same analysis was performed in the subgroup of patients (14.3%) with a histological confirmation, we found that the prevalence of differentiated thyroid cancer was significantly higher (P = .01) in the N-AIT group (67.8%) compared with the other groups (N-GD, 40.0%; NGAb-, 37.2%; NGAb+, 36.9%). CONCLUSIONS The results of our cytological series do not support a link between N-AIT and thyroid cancer. The association between cancer and N-AIT found in the histology-based series is likely due to a selection bias represented by the fact that the prevalent indication for surgery in the N-AIT group was suspicious cytology (60.7% of patients) more frequently than in the other groups.
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Affiliation(s)
- Maria Grazia Castagna
- Departments of Medical, Surgical, and Neurological Sciences (M.G.C., V.B., S.M., F.M., A.F.C., G.C., F.P.) and Medical Biotechnology (A.D.S., P.T.), University of Siena, 53100 Siena, Italy
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Brose MS, Nutting CM, Jarzab B, Elisei R, Siena S, Bastholt L, de la Fouchardiere C, Pacini F, Paschke R, Shong YK, Sherman SI, Smit JWA, Chung J, Kappeler C, Peña C, Molnár I, Schlumberger MJ. Sorafenib in radioactive iodine-refractory, locally advanced or metastatic differentiated thyroid cancer: a randomised, double-blind, phase 3 trial. Lancet 2014; 384:319-28. [PMID: 24768112 PMCID: PMC4366116 DOI: 10.1016/s0140-6736(14)60421-9] [Citation(s) in RCA: 986] [Impact Index Per Article: 98.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Patients with radioactive iodine ((131)I)-refractory locally advanced or metastatic differentiated thyroid cancer have a poor prognosis because of the absence of effective treatment options. In this study, we assessed the efficacy and safety of orally administered sorafenib in the treatment of patients with this type of cancer. METHODS In this multicentre, randomised, double-blind, placebo-controlled, phase 3 trial (DECISION), we investigated sorafenib (400 mg orally twice daily) in patients with radioactive iodine-refractory locally advanced or metastatic differentiated thyroid cancer that had progressed within the past 14 months. Adult patients (≥18 years of age) with this type of cancer were enrolled from 77 centres in 18 countries. To be eligible for inclusion, participants had to have at least one measurable lesion by CT or MRI according to Response Evaluation Criteria In Solid Tumors (RECIST); Eastern Cooperative Oncology Group performance status 0-2; adequate bone marrow, liver, and renal function; and serum thyroid-stimulating hormone concentration lower than 0·5 mIU/L. An interactive voice response system was used to randomly allocate participants in a 1:1 ratio to either sorafenib or matching placebo. Patients, investigators, and the study sponsor were masked to treatment assignment. The primary endpoint was progression-free survival, assessed every 8 weeks by central independent review. Analysis was by intention to treat. Patients in the placebo group could cross over to open-label sorafenib upon disease progression. Archival tumour tissue was examined for BRAF and RAS mutations, and serum thyroglobulin was measured at baseline and at each visit. This study is registered with ClinicalTrials.gov, number NCT00984282, and with the EU Clinical Trials Register, number EudraCT 2009-012007-25. FINDINGS Patients were randomly allocated on a 1:1 basis to sorafenib or placebo. The intention-to-treat population comprised 417 patients (207 in the sorafenib group and 210 in the placebo group) and the safety population was 416 patients (207 in the sorafenib group and 209 in the placebo group). Median progression-free survival was significantly longer in the sorafenib group (10·8 months) than in the placebo group (5·8 months; hazard ratio [HR] 0·59, 95% CI 0·45-0·76; p<0·0001). Progression-free survival improved in all prespecified clinical and genetic biomarker subgroups, irrespective of mutation status. Adverse events occurred in 204 of 207 (98·6%) patients receiving sorafenib during the double-blind period and in 183 of 209 (87·6%) patients receiving placebo. Most adverse events were grade 1 or 2. The most frequent treatment-emergent adverse events in the sorafenib group were hand-foot skin reaction (76·3%), diarrhoea (68·6%), alopecia (67·1%), and rash or desquamation (50·2%). INTERPRETATION Sorafenib significantly improved progression-free survival compared with placebo in patients with progressive radioactive iodine-refractory differentiated thyroid cancer. Adverse events were consistent with the known safety profile of sorafenib. These results suggest that sorafenib is a new treatment option for patients with progressive radioactive iodine-refractory differentiated thyroid cancer. FUNDING Bayer HealthCare Pharmaceuticals and Onyx Pharmaceuticals (an Amgen subsidiary).
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Affiliation(s)
- Marcia S Brose
- Department of Otorhinolaryngology: Head and Neck Surgery, and Abramson Cancer Center of the University of Pennsylvania, Philadelphia, PA, USA.
| | | | - Barbara Jarzab
- Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, Gliwice, Poland
| | - Rossella Elisei
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Salvatore Siena
- Niguarda Cancer Center, Ospedale Niguarda Ca' Granda, Milan, Italy
| | - Lars Bastholt
- Department of Oncology, Odense University Hospital, Odense C, Denmark
| | | | - Furio Pacini
- Unit of Endocrinology, University of Siena, Siena, Italy
| | - Ralf Paschke
- Department for Endocrinology and Nephrology, Leipzig University, Leipzig, Germany
| | - Young Kee Shong
- Division of Endocrinology, Asan Medical Center, Seoul, Korea
| | - Steven I Sherman
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - John Chung
- Bayer HealthCare Pharmaceuticals, Whippany, NJ, USA
| | | | - Carol Peña
- Bayer HealthCare Pharmaceuticals, Whippany, NJ, USA
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Schlumberger M, Brose M, Elisei R, Leboulleux S, Luster M, Pitoia F, Pacini F. Definition and management of radioactive iodine-refractory differentiated thyroid cancer. Lancet Diabetes Endocrinol 2014; 2:356-8. [PMID: 24795243 DOI: 10.1016/s2213-8587(13)70215-8] [Citation(s) in RCA: 190] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Martin Schlumberger
- Department of Nuclear Medicine and Endocrine Oncology, Institut Gustave Roussy and University Paris Sud, Villejuif, France.
| | - Marcia Brose
- Abramson Cancer Center of the University of Pennsylvania, Philadelphia, PA, USA
| | - Rosella Elisei
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Sophie Leboulleux
- Department of Nuclear Medicine and Endocrine Oncology, Institut Gustave Roussy and University Paris Sud, Villejuif, France
| | - Markus Luster
- Department of Nuclear Medicine, University of Marburg, Marburg, Germany
| | - Fabian Pitoia
- División Endocrinología, Hospital de Clínicas, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Furio Pacini
- Unit of Endocrinology, University of Siena, Siena, Italy
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Fast S, Hegedüs L, Pacini F, Pinchera A, Leung AM, Vaisman M, Reiners C, Wemeau JL, Huysmans DA, Harper W, Rachinsky I, de Souza HN, Castagna MG, Antonangeli L, Braverman LE, Corbo R, Düren C, Proust-Lemoine E, Marriott C, Driedger A, Grupe P, Watt T, Magner J, Purvis A, Graf H. Long-term efficacy of modified-release recombinant human thyrotropin augmented radioiodine therapy for benign multinodular goiter: results from a multicenter, international, randomized, placebo-controlled, dose-selection study. Thyroid 2014; 24:727-35. [PMID: 24341527 PMCID: PMC3993022 DOI: 10.1089/thy.2013.0370] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Enhanced reduction of multinodular goiter (MNG) can be achieved by stimulation with recombinant human thyrotropin (rhTSH) before radioiodine ((131)I) therapy. The objective was to compare the long-term efficacy and safety of two low doses of modified release rhTSH (MRrhTSH) in combination with (131)I therapy. METHODS In this phase II, single-blinded, placebo-controlled study, 95 patients (57.2 ± 9.6 years old, 85% women, 83% Caucasians) with MNG (median size 96.0 mL; range 31.9-242.2 mL) were randomized to receive placebo (n=32), 0.01 mg MRrhTSH (n=30), or 0.03 mg MRrhTSH (n=33) 24 hours before a calculated (131)I activity. Thyroid volume (TV) and smallest cross-sectional area of trachea (SCAT) were measured (by computed tomography scan) at baseline, six months, and 36 months. Thyroid function and quality of life (QoL) was evaluated at three-month and yearly intervals respectively. RESULTS At six months, TV reduction was enhanced in the 0.03 mg MRrhTSH group (32.9% vs. 23.1% in the placebo group; p=0.03) but not in the 0.01 mg MRrhTSH group. At 36 months, the mean percent TV reduction from baseline was 44 ± 12.7% (SD) in the placebo group, 41 ± 21.0% in the 0.01 mg MRrhTSH group, and 53 ± 18.6% in the 0.03 mg MRrhTSH group, with no statistically significant differences among the groups, p=0.105. In the 0.03 mg MRrhTSH group, the subset of patients with basal (131)I uptake <20% had a 24% greater TV reduction at 36 months than the corresponding subset of patients in the placebo group (p=0.01). At 36 months, the largest relative increase in SCAT was observed in the 0.03 mg MRrhTSH group (13.4 ± 23.2%), but this was not statistically different from the increases observed in the placebo or the 0.01 mg MRrhTSH group (p=0.15). Goiter-related symptoms were reduced and QoL improved, without any enhanced benefit from using MRrhTSH. At three years, the prevalence of permanent hypothyroidism was 13%, 33%, and 45% in the placebo, 0.01 mg, and 0.03 mg MRrhTSH groups respectively. The overall safety profile of the study was favorable. CONCLUSIONS When used as adjuvant to (131)I, enhanced MNG reduction could not be demonstrated with MRrhTSH doses ≤ 0.03 mg, indicating that the lower threshold for efficacy is around this level.
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Affiliation(s)
- Søren Fast
- Department of Endocrinology and Metabolism, Odense University Hospital, Odense, Denmark
| | - Laszlo Hegedüs
- Department of Endocrinology and Metabolism, Odense University Hospital, Odense, Denmark
| | - Furio Pacini
- Section of Endocrinology and Metabolism, University of Siena, Siena, Italy
| | - Aldo Pinchera
- WHO Collaborating Center for the Diagnosis and Treatment of Thyroid Cancer and Other Thyroid Diseases, Department of Endocrinology, University Hospital of Pisa, Pisa, Italy
| | - Angela M. Leung
- Section of Endocrinology, Diabetes, and Nutrition, Boston University School of Medicine, Boston, Massachusetts
| | - Mario Vaisman
- Department of Internal Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Christoph Reiners
- Department of Nuclear Medicine, University of Wuerzburg, Wuerzburg, Germany
| | - Jean-Louis Wemeau
- Department of Endocrinology, Clinique Marc Linquette, Hôpital Huriez, CHRU Lille, Lille, France
| | - Dyde A. Huysmans
- Department of Nuclear Medicine, Catharina Hospital, Eindhoven, The Netherlands
| | - William Harper
- Department of Internal Medicine, Hamilton General Hospital, Hamilton, Canada
| | - Irina Rachinsky
- Nuclear Medicine Department, London Health Sciences Center, London, Canada
| | - Hevelyn Noemberg de Souza
- Service of Endocrinology and Metabolism (SEMPR), Clinics Hospital of the Federal University of Paraná, Curitiba, Brazil
| | - Maria G. Castagna
- Section of Endocrinology and Metabolism, University of Siena, Siena, Italy
| | - Lucia Antonangeli
- WHO Collaborating Center for the Diagnosis and Treatment of Thyroid Cancer and Other Thyroid Diseases, Department of Endocrinology, University Hospital of Pisa, Pisa, Italy
| | - Lewis E. Braverman
- Section of Endocrinology, Diabetes, and Nutrition, Boston University School of Medicine, Boston, Massachusetts
| | - Rossana Corbo
- Department of Internal Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Christian Düren
- Department of Nuclear Medicine, University of Wuerzburg, Wuerzburg, Germany
| | | | | | - Albert Driedger
- Nuclear Medicine Department, London Health Sciences Center, London, Canada
| | - Peter Grupe
- Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark
| | - Torquil Watt
- Department of Endocrinology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - James Magner
- Department of Endocrinology, Genzyme, (a Sanofi Company), Cambridge, Massachusetts
| | - Annie Purvis
- Department of Biostatistics, Genzyme, (a Sanofi Company), Cambridge, Massachusetts
| | - Hans Graf
- Service of Endocrinology and Metabolism (SEMPR), Clinics Hospital of the Federal University of Paraná, Curitiba, Brazil
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Rosato L, Raffaelli M, Bellantone R, Pontecorvi A, Avenia N, Boniardi M, Brandi ML, Cetani F, Chiofalo MG, Conzo G, De Palma M, Gasparri G, Giordano A, Innaro N, Leopaldi E, Mariani G, Marcocci C, Marini P, Miccoli P, Nasi P, Pacini F, Paragliola R, Pelizzo MR, Testini M, De Toma G. Diagnostic, therapeutic and healthcare management protocols in parathyroid surgery: II Consensus Conference of the Italian Association of Endocrine Surgery Units (U.E.C. CLUB). J Endocrinol Invest 2014; 37:149-65. [PMID: 24497214 DOI: 10.1007/s40618-013-0022-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2013] [Accepted: 11/16/2013] [Indexed: 02/08/2023]
Abstract
AIM To update the Diagnostic-Therapeutic-Healthcare Protocol (Protocollo Diagnostico-Terapeutico-Assistenziale, PDTA) created by the U.E.C. CLUB (Association of the Italian Endocrine Surgery Units) during the I Consensus Conference in 2008. METHODS In the preliminary phase, the II Consensus involved a selected group of experts; the elaboration phase was conducted via e-mail among all members; the conclusion phase took place during the X National Congress of the U.E.C. CLUB. The following were examined: diagnostic pathway and clinical evaluation; mode of admission and waiting time; therapeutic pathway (patient preparation for surgery, surgical treatment, postoperative management, management of major complications); hospital discharge and patient information; outpatient care and follow-up. CONCLUSIONS The PDTA for parathyroid surgery approved by the II Consensus Conference (June 2013) is the official PDTA of the U.E.C. CLUB.
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Affiliation(s)
- L Rosato
- Department of Surgery, ASL TO/4 Ivrea Hospital (TO), Piazza della Credenza, 2, 10015, IVREA, TO, Italy,
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Essig GF, Porter K, Schneider D, Debora A, Lindsey SC, Busonero G, Fineberg D, Fruci B, Boelaert K, Smit JW, Meijer JAA, Duntas L, Sharma N, Costante G, Filetti S, Sippel RS, Biondi B, Topliss DJ, Pacini F, Maciel RMB, Walz PC, Kloos RT. Fine needle aspiration and medullary thyroid carcinoma: the risk of inadequate preoperative evaluation and initial surgery when relying upon FNAB cytology alone. Endocr Pract 2013; 19:920-7. [PMID: 23757627 DOI: 10.4158/ep13143.or] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To evaluate the diagnostic accuracy of fine-needle aspiration biopsy (FNAB) to preoperatively diagnose medullary thyroid cancer (MTC) among multiple international centers and evaluate how the cytological diagnosis alone could impact patient management. METHODS We performed a retrospective chart review of sporadic MTC (sMTC) patients from 12 institutions over the last 29 years. FNAB cytology results were compared to final pathologic diagnoses to calculate FNAB sensitivity. To evaluate the impact of cytology sensitivity for MTC according to current practice and to avoid confounding results by local treatment protocols, changes in treatment patterns over time, and the influence of ancillary findings (e.g., serum calcitonin), therapeutic interventions based on FNAB cytology alone were projected into 1 of 4 treatment categories: total thyroidectomy (TT) and central neck dissection (CND), TT without CND, diagnostic hemithyroidectomy, or observation. RESULTS A total of 313 patients from 4 continents and 7 countries were included, 245 of whom underwent FNAB. FNAB cytology revealed MTC in 43.7% and possible MTC in an additional 2.4%. A total of 113 (46.1%) patients with surgical pathology revealing sMTC had FNAB findings that supported TT with CND, while 37 (15.1%) supported TT alone. In the remaining cases, diagnostic hemithyroidectomy and observation were projected in 32.7% and 6.1%, respectively. CONCLUSION FNAB is an important diagnostic tool in the evaluation of thyroid nodules, but the low sensitivity of cytological evaluation alone in sMTC limits its ability to command an optimal preoperative evaluation and initial surgery in over half of affected patients.
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Affiliation(s)
- Garth F Essig
- Department of Otolaryngology-Head and Neck Surgery, Ohio State University, Columbus, Ohio
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Pacini F. Reply to letter: Post-surgical thyroid ablation in intermediate risk-differentiated thyroid cancer patients. Eur J Endocrinol 2013; 169:L2. [PMID: 24084444 DOI: 10.1530/eje-13-0654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Furio Pacini
- Section of Endocrinology and Metabolism, Department of Internal Medicine, Endocrinology and Metabolism and Biochemistry, University of Siena, Policlinico Santa Maria alle Scotte, Viale Bracci 1, 53100 Siena, Italy
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Collodel G, Cantara S, Di Cairano G, Moretti E, Taglianetti S, Pacini F. Alterations of the FSH and LH receptor genes and evaluation of sperm ultrastructure in men with idiopathic hypergonadotropic hypogonadism. J Assist Reprod Genet 2013; 30:1101-8. [PMID: 23884663 PMCID: PMC3800530 DOI: 10.1007/s10815-013-0055-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2013] [Accepted: 07/10/2013] [Indexed: 02/08/2023] Open
Abstract
PURPOSE Gonadotropins, interacting with their gonadal receptors, play a key role in sexual development, reproductive functions and metabolism. In this study we performed the genetic analysis of FSHR and LHR and semen investigation in 14 infertile men with normal level of T and elevated levels of FSH and/or LH in the absence of other causes of infertility. METHODS Sperm parameters were analysed following WHO (2010) guidelines and sperm morphology by Transmission Electron Microscopy (TEM) analysis mathematically elaborated. FSHR and LHR gene mutations have been searched by PCR technique, followed by DHPLC analysis and direct sequencing. RESULTS In FSHR, we found no difference in the frequency between Ala or Thr at position 307, Ser was at codon 680 in all subjects. Three patients had an heterozygous mutation at codon 419. Three intronic polymorphisms (rs2091787, rs6708637, rs1922464) were significantly found compared to controls; the single allele frequency and the odds ratio were calculated. Two new variants: the Cys338Arg and the Gln123Glu were detected in two different patients. Regarding LHR, three patients were heterozygous for the known variant Glu354Lys and two for Ile374Thr. Intronic polymorphisms were not identified. A new variant, the Val144Ile was found. By the routine semen analysis, variable seminal conditions in this group of patients was observed, on the contrary TEM data mathematically elaborated showed a homogeneous decrease in fertility index and increase in sperm pathologies such as apoptosis and immaturity. CONCLUSIONS The obtained results suggest that a deeper examination of spermatozoa, achieved by the use of more powerful tools such as TEM or molecular analysis, are advisable in patients with hypergonadotropic hypogonadism.
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Affiliation(s)
- G. Collodel
- Department of Molecular and Developmental Medicine, University of Siena, Viale Bracci, 14, 53100 Siena, Italy
| | - S. Cantara
- Department of Medical and Surgical Sciences and Neurosciences, University of Siena, Siena, Italy
| | - G. Di Cairano
- Department of Medical and Surgical Sciences and Neurosciences, University of Siena, Siena, Italy
| | - E. Moretti
- Department of Molecular and Developmental Medicine, University of Siena, Viale Bracci, 14, 53100 Siena, Italy
| | - S. Taglianetti
- Department of Medical and Surgical Sciences and Neurosciences, University of Siena, Siena, Italy
| | - Furio Pacini
- Department of Medical and Surgical Sciences and Neurosciences, University of Siena, Siena, Italy
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Kloos RT, Sipos JA, Tzagournis M, Miyauchi A, Vaisman M, Benbassat C, Pacini F, Schlumberger M, Mazzaferri F, Jhiang SM, Gharib H, Surks M, Randolph GW, Tuttle RM. Ernest L. Mazzaferri, MD, MACP (1936-2013). Thyroid 2013; 23:917-23. [PMID: 23964768 DOI: 10.1089/thy.2013.2308.ob] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Professor and physician Dr. Ernest L. Mazzaferri Sr. passed away on May 14, 2013, at 76 years of age ( 1 , 2 ). Ernie is remembered as a caring and talented physician, an accomplished scholar and educator, as well as a loving husband, father, and grandfather. He was a luminary figure, and few people have had a greater impact in thyroidology in recent decades. Here we include reflections from a few of us that knew him, as well as commentaries from people who did not. Ernie's passion was caring for patients and how to improve their care. Our goal is to pay tribute and memorialize the person we knew and the impact that he had on patients around the world through his dedication to research, lecturing, and writing that achieved remarkable global influence.
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Affiliation(s)
- Richard T Kloos
- Department of Endocrinology, Veracyte, Inc., South San Francisco, California, USA.
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Abstract
CONTEXT Over the last decade, our knowledge of the multiple endocrine neoplasia (MEN) type 2 syndromes MEN2A and MEN2B and familial medullary thyroid carcinoma (FMTC) has expanded greatly. In this manuscript, we summarize how recent discoveries have enhanced our understanding of the molecular basis of these diseases and led to improvements in the diagnosis and management of affected patients. EVIDENCE ACQUISITION We reviewed the English literature through PubMed from 2000 to the present, using the search terms medullary thyroid carcinoma, multiple endocrine neoplasia type 2, familial medullary thyroid carcinoma, RET proto-oncogene, and calcitonin. EVIDENCE SYNTHESIS Over 70 RET mutations are known to cause MEN2A, MEN2B, or FMTC, and recent findings from studies of large kindreds with these syndromes have clouded the relationship between genotype and phenotype, primarily because of the varied clinical presentation of different families with the same RET mutation. This clinical variability has also confounded decisions about the timing of prophylactic thyroidectomy for MTC, the dominant endocrinopathy associated with these syndromes. A distinct advance has been the demonstration through phase II and phase III clinical trials that molecular targeted therapeutics are effective in the treatment of patients with locally advanced or metastatic MTC. CONCLUSIONS The effective management of patients with MEN2A, MEN2A, and FMTC depends on an understanding of the variable behavior of disease expression in patients with a specific RET mutation. Information gained from molecular testing, biochemical analysis, and clinical evaluation is important in providing effective management of patients with either early or advanced-stage MTC.
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Affiliation(s)
- Samuel A Wells
- Cancer Genetics Branch, National Cancer Institute, National Institutes of Health, Building 37, Room 10106A, 37 Convent Drive, Bethesda, Maryland 20814, USA.
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Molinaro E, Giani C, Agate L, Biagini A, Pieruzzi L, Bianchi F, Brozzi F, Ceccarelli C, Viola D, Piaggi P, Vitti P, Pacini F, Elisei R. Patients with differentiated thyroid cancer who underwent radioiodine thyroid remnant ablation with low-activity ¹³¹I after either recombinant human TSH or thyroid hormone therapy withdrawal showed the same outcome after a 10-year follow-up. J Clin Endocrinol Metab 2013; 98:2693-700. [PMID: 23626005 DOI: 10.1210/jc.2012-4137] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND No long-term follow-up data are available for differentiated thyroid carcinoma (DTC) patients prepared with either exogenous or endogenous TSH and treated with low-activity (1.1 GBq [30 mCi]) radioiodine (¹³¹I). AIM The aim of this study was to evaluate the 10-year follow-up of DTC patients who underwent remnant ablation with 1.1 GBq ¹³¹I after l-T4 withdrawal, recombinant human TSH (rhTSH) administration, or both. PATIENTS A total of 159 DTC patients treated with total thyroidectomy and 1.1 GBq (30 mCi) of ¹³¹I for remnant ablation and stimulated with rhTSH and/or endogenous TSH were separated into ablated (n = 115) and not ablated (n = 44) patients and prospectively followed-up for at least 10 years. In addition, we evaluated several features that could correlate with the final status of patients. RESULTS During the follow-up, 4 of 115 (3.5%) ablated patients showed a recurrence and 1 was successfully cured. Among not ablated patients, 16 of 44 (36.4%) had a persistent disease. At the end of the 10-year follow-up, 140 of 159 (88.1%) patients were disease-free, whereas 19 of 159 (11.9%) remained affected. No correlation was found with the type of TSH stimulation, and no other clinical and pathological features showed any correlation with the final status. However, low levels of stimulated serum thyroglobulin (<5.4 ng/mL) at first control after remnant ablation identified a subgroup of not ablated patients who became spontaneously cured. CONCLUSIONS Long-term outcomes are similar in DTC patients treated with 1.1 GBq (30 mCi) ¹³¹I and prepared either with rhTSH or endogenous TSH. It is of interest that serum thyroglobulin at first control after ablation can have a prognostic role.
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Affiliation(s)
- Eleonora Molinaro
- Unit of Endocrinology, Department of Clinical and Experimental Medicine, World Health Organization Collaborating Center for the Study and Treatment of Thyroid Diseases and Other Endocrine and Metabolic Disorders, University of Pisa, 56100 Pisa, Italy
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Castagna MG, Cevenini G, Theodoropoulou A, Maino F, Memmo S, Claudia C, Belardini V, Brianzoni E, Pacini F. Post-surgical thyroid ablation with low or high radioiodine activities results in similar outcomes in intermediate risk differentiated thyroid cancer patients. Eur J Endocrinol 2013; 169:23-9. [PMID: 23594687 DOI: 10.1530/eje-12-0954] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND In differentiated thyroid cancer (DTC) patients at intermediate risk of recurrences, no evidences are provided regarding the optimal radioactive iodine (RAI) activity to be administered for post-surgical thyroid ablation. METHODS This study aimed to evaluate the impact of RAI activities on the outcome of 225 DTC patients classified as intermediate risk, treated with low (1110-1850 MBq) or high RAI activities (≥3700 MBq). RESULTS Six to 18 months after ablation, remission was observed in 60.0% of patients treated with low and in 60.0% of those treated with high RAI activities, biochemical disease was found in 18.8% of patients treated with low and in 14.3% of patients treated with high RAI activities, metastatic disease was found in 21.2% of patients treated with low and in 25.7% of patients treated with high RAI activities (P=0.56). At the last follow-up (low activities, median 4.2 years; high activities, median 6.9 years), remission was observed in 76.5% of patients treated with low and in 72.1% of patients treated with high RAI activities, persistent disease was observed in 18.8% of patients treated with low and in 23.5% of patients treated with high RAI activities, recurrent disease was 2.4% in patients treated with low and 2.1% in patients treated with high RAI activities, deaths occurred in 2.4% of patients treated with low and in 2.1% of patients treated with high RAI activities (P=0.87). CONCLUSION Our study provides the first evidence that in DTC patients at intermediate risk, high RAI activities at ablation have no major advantage over low activities.
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Affiliation(s)
- Maria Grazia Castagna
- Section of Endocrinology and Metabolism, Department of Internal Medicine, Endocrinology and Metabolism and Biochemistry, University of Siena, Policlinico Santa Maria alle Scotte, Viale Bracci 1, 53100 Siena, Italy
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Li LC, Jayarama S, Pilli T, Qian L, Pacini F, Prabhakar BS. Down-modulation of expression, or dephosphorylation, of IG20/MADD in tumor necrosis factor-related apoptosis-inducing ligand-resistant thyroid cancer cells makes them susceptible to treatment with this ligand. Thyroid 2013; 23:70-8. [PMID: 22998497 PMCID: PMC3539253 DOI: 10.1089/thy.2012.0155] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND The IG20/MADD gene is overexpressed in thyroid cancer tissues and cell lines, and can contribute to tumor necrosis factor-related apoptosis-inducing ligand (TRAIL) resistance. The ability of the MADD protein to resist TRAIL-induced apoptosis is dependent upon its phosphorylation by Akt. Interestingly, while TRAIL induces a significant reduction in the levels of phospho-Akt (pAkt) and phospho-MADD (pMADD) in TRAIL-sensitive cells, it fails to do so in TRAIL-resistant cells. In this study, we investigated if MADD phosphorylation by Akt was contributing to TRAIL resistance in thyroid cancer cells. METHODS We determined the susceptibility of different thyroid cancer cell lines to TRAIL-induced apoptosis by fluorescence-activated cell sorting (FACS) analysis. We tested for various TRAIL resistance factors by FACS analyses or for IG20/MADD expression by quantitative reverse transcription-polymerase chain reaction. We determined the levels of pAkt and pMADD upon TRAIL treatment in thyroid cancer cells by Western blotting. We tested if down-modulation of IG20/MADD gene expression using shRNA or phosphorylation using a dominant negative Akt (DN-Akt) or pretreatment with LY294002, a PI3 kinase inhibitor, could help overcome TRAIL resistance. RESULT BCPAP and TPC1 cells were susceptible, while KTC1 and FTC133 cells were resistant, to TRAIL-induced apoptosis. The differential susceptibility to TRAIL was not related to the levels of expression of death receptors, decoy receptors, or TRAIL. KTC1 and FTC133 cells showed higher levels of IG20/MADD expression relative to BCPAP and TPC1, and were rendered susceptible to TRAIL treatment upon IG20/MADD knockdown. Interestingly, upon TRAIL treatment, the pAkt and pMADD levels were reduced in TRAIL-sensitive BCPAP and TPC1 cells, while they remained unchanged in the resistant KTC1 and FTC133 cells. While expression of a constitutively active Akt in BCPAP and TPC1 cells rendered them resistant to TRAIL, pretreating KTC1 and FTC133 cells with LY294002 rendered them TRAIL-sensitive. Moreover, expression of a DN-Akt in KTC1 and FTC133 cells reduced the levels of pAkt and pMADD and sensitized them to TRAIL-induced apoptosis. CONCLUSION Our results show that pMADD is an important TRAIL resistance factor in certain thyroid cancer cells and suggest that down-modulation of either IG20/MADD expression or phosphorylation can render TRAIL-resistant thyroid cancer cells sensitive to TRAIL.
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Affiliation(s)
- Liang-Cheng Li
- Department of Microbiology and Immunology, College of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Shankara Jayarama
- Department of Microbiology and Immunology, College of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Tania Pilli
- Department of Microbiology and Immunology, College of Medicine, University of Illinois at Chicago, Chicago, Illinois
- Section of Endocrinology & Metabolism, Department of Internal Medicine, Endocrinology & Metabolism and Biochemistry, University of Siena, Siena, Italy
| | - Lixia Qian
- Department of Microbiology and Immunology, College of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Furio Pacini
- Section of Endocrinology & Metabolism, Department of Internal Medicine, Endocrinology & Metabolism and Biochemistry, University of Siena, Siena, Italy
| | - Bellur S. Prabhakar
- Department of Microbiology and Immunology, College of Medicine, University of Illinois at Chicago, Chicago, Illinois
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76
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Pacini F. Management of differentiated thyroid cancer of the follicular epithelium. Ann Med 2012; 44:651-5. [PMID: 21668295 DOI: 10.3109/07853890.2011.590145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
The incidence of thyroid cancer has been increasing in many countries over the last 30 years (from 3.6/100,000 people in 1973 to 8.7/100,000 people in 2002) while mortality has been slowly decreasing ( 1 , 2 ). The increase is mainly represented by papillary thyroid cancer, while follicular and anaplastic histotypes remained stable. It is a general opinion that the increase is attributable to better detection of small papillary carcinomas as a result of improved diagnostic accuracy (neck ultrasound and fine-needle aspiration cytology). Consequently, it is common experience in thyroid cancer referral centers that nearly 60%-80% of thyroid carcinomas detected nowadays are micropapillary thyroid carcinomas (less than 1 cm in size) carrying an excellent long-term prognosis. In view of this change in the presentation of the disease, the objective of thyroid cancer management should be aimed at achieving complete cure using the less aggressive diagnostic and therapeutic procedures.
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Affiliation(s)
- Furio Pacini
- Department of Internal Medicine, Endocrinology & Metabolism and Biochemistry, Section of Endocrinology & Metabolism, University of Siena, Italy.
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77
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Cantara S, D'Angeli F, Toti P, Lignitto L, Castagna MG, Capuano S, Prabhakar BS, Feliciello A, Pacini F. Expression of the ring ligase PRAJA2 in thyroid cancer. J Clin Endocrinol Metab 2012; 97:4253-9. [PMID: 22948757 DOI: 10.1210/jc.2012-2360] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
INTRODUCTION In thyroid cells, binding of TSH to its receptor increases cAMP levels, sustaining thyrocytes growth and hormone production. The main cAMP effector enzyme is protein kinase A (PKA). Praja2 is a widely expressed RING (Really Interesting New Gene) ligase, which degrades the regulatory subunits of PKA, thus controlling the strength and duration of PKA signaling in response to cAMP. Differentiated thyroid cancer expresses a functional TSH receptor, and its growth and progression are positively regulated by TSH and cAMP signaling. AIM We aimed to analyze the expression of praja2 in a group of 36 papillary thyroid cancer (PTC), 14 benign nodules, and six anaplastic thyroid cancers (ATC). METHODS We measured praja2 mRNA levels by quantitative RT-PCR and praja2 expression by Western blot and immunohistochemistry. Possible association between praja2 mRNA and the presence of known mutations was evaluated. RESULTS We found a statistical significant increase of mRNA levels in PTC tissue samples, compared with benign nodules and ATC. In particular, mRNA levels were maximal in differentiated thyroid cancer (PTC), progressively decreasing in more aggressive tumors, ATC having the lowest amount of praja2 mRNA. Accordingly, higher levels of praja2 protein were detected in lysates from PTC, compared with ATC. By immunohistochemistry, in PTC sections we observed a marked increase of cytoplasmic praja2 signal, which significantly decreased in less differentiated thyroid tumors, completely disappearing in ATC. Studies in cultured cells stably expressing RET/PTC1 oncogene or mutant BRAF revealed a direct correlation between praja2 mRNA levels and malignant phenotype of transformed cells. Similar results were obtained using thyroid cancer tissues carrying the same mutations. CONCLUSIONS praja2 is markedly overexpressed in differentiated thyroid cancer, and its levels inversely correlate with the malignant phenotype of the tumor. Thus, praja2 is a novel cancer-related gene whose expression is linked to the histotype and mutational status of the thyroid tumor.
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Affiliation(s)
- Silvia Cantara
- Section of Endocrinology and Metabolism, Department of Internal Medicine, Endocrinology, and Metabolism and Biochemistry, Policlinico Santa Maria alle Scotte, Viale Bracci 1, University of Siena, 53100 Siena, Italy
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Pacini F, Castagna MG, Brilli L, Pentheroudakis G. Thyroid cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2012; 23 Suppl 7:vii110-9. [PMID: 22997443 DOI: 10.1093/annonc/mds230] [Citation(s) in RCA: 167] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Affiliation(s)
- F Pacini
- Department of Internal Medicine, Section of Endocrinology and Metabolism, University of Siena, Sienna, Italy
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Pacini F, Ito Y, Luster M, Pitoia F, Robinson B, Wirth L. Radioactive iodine-refractory differentiated thyroid cancer: unmet needs and future directions. Expert Rev Endocrinol Metab 2012; 7:541-554. [PMID: 30780891 DOI: 10.1586/eem.12.36] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Approximately 90% of thyroid cancers are differentiated (DTCs) and have papillary, follicular or Hürthle cell morphology. Although treatment with surgery and radioactive iodine (I-131; RAI), as appropriate, is associated with significant cure rates and survival benefits, clonal disease progression with development of refractoriness to RAI poses a major therapeutic challenge in about 15% of patients. Traditional chemotherapeutic agents are relatively ineffective and are associated with significant toxicities. Molecular studies have demonstrated that the development and progression of DTC are associated with a series of consistent abnormalities in pathways such as MAPK/ERK and PI3/Akt, which govern cellular growth, proliferation, apoptosis and angiogenesis. Small molecular inhibitors that target these pathogenic pathways, without many of the impairments associated with cytotoxic chemotherapy, have demonstrated efficacy in a variety of malignancies, including renal cell carcinoma, hepatocellular carcinoma, non-small-cell lung cancer and chronic myelogenous leukemia. Several targeted therapeutic agents are in development for the treatment of RAI-refractory DTC. Sorafenib and lenvatinib are being studied in placebo-controlled Phase III trials based on encouraging efficacy results observed in single-arm Phase II studies.
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Affiliation(s)
| | | | | | - Fabian Pitoia
- d University of Buenos Aires, Buenos Aires, Argentina
| | | | - Lori Wirth
- f Massachusetts General Hospital, Boston, MA, USA
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Abstract
Nowadays the most commonly occurring differentiated thyroid cancer in many countries is a microcarcinoma in patients older than 45 years, incidentally found during neck ultrasound. In view of their low morbidity and mortality, the crucial point is how to manage such microcarcinomas. Recently published European and American guidelines aim to minimize the diagnostic and therapeutic procedures without affecting the diagnostic accuracy and the therapeutic effectiveness, keeping in mind that we are dealing with patients who have a normal life expectancy and to whom we have to guarantee an excellent quality of life. The present review will summarize the clinical and pathological features of thyroid microcarcinoma, including its definition, prevalence, presentation, pathology, genetic, clinical impact and will try to derive from them a rationale for therapeutic and diagnostic intervention.
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Affiliation(s)
- Furio Pacini
- Department of Internal Medicine, Endocrinology & Metabolism and Biochemistry, Section of Endocrinology and Metabolism, University of Siena, Via Bracci, 53100 Siena, Italy.
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Sargentini V, Mariani P, D' Alessandro M, Pistolesi V, Lauretta MP, Pacini F, Tritapepe L, Morabito S, Bachetoni A. Assessment of NGAL as an early biomarker of acute kidney injury in adult cardiac surgery patients. J BIOL REG HOMEOS AG 2012; 26:485-93. [PMID: 23034268 DOI: pmid/23034268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Early and predictive acute kidney injury (AKI) markers may be decisive for the clinical outcome of heart surgery. Hence, this study set out to evaluate the biological variability of urinary neutrophil gelatinase-associated lipocalin (uNGAL) levels in adult cardiac surgery patients, to test their feasibility as a biomarker of early AKI in a routine laboratory setting. uNGAL levels were measured with an automated immunoassay in urine samples from patients undergoing cardiac surgery using cardiopulmonary bypass, at the time of admission (T0) and 4 hours (T1) and 24 hours (T2) after surgery. Patients without post-operative AKI did not show significant differences in urine NGAL levels after surgery. In contrast, patients developing AKI displayed a significant increase (P=0.011) in uNGAL levels compared to T0. This increase was detectable at an earlier time point (T1, 4 hours) with respect to serum creatinine (T2, 24 hours). Confirming its utility as a biomarker, at T1 the uNGAL levels were significantly higher in AKI patients than in non-AKI patients (P=0.021). A receiver operating characteristic curve analysis of the uNGAL assay gave a sensitivity of 55.3 (95percent confidence interval, 26.59-78.73), a specificity of 72.9 (95 percent CI, 55.88-86.21), and a cut-off value for AKI prediction of 55.2. These results support the notion that urinary NGAL is an earlier marker of AKI than serum creatinine. However, the cut-off value of the assay was too low to consider it as a positive or negative diagnostic marker in AKI patients with moderate degree of severity. Likewise, its sensitivity and specificity were not high enough for it to be considered better than the others currently in use.
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Affiliation(s)
- V Sargentini
- Dipartimento di Medicina Sperimentale, Sapienza Università di Roma, Rome, Italy.
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83
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Cantara S, Pisu M, Frau DV, Caria P, Dettori T, Capezzone M, Capuano S, Vanni R, Pacini F. Telomere abnormalities and chromosome fragility in patients affected by familial papillary thyroid cancer. J Clin Endocrinol Metab 2012; 97:E1327-31. [PMID: 22539583 DOI: 10.1210/jc.2011-2096] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Genomic instability has been proposed to play a role in cancer development and can occur through different mechanisms including telomere association and telomere loss. Studies carried out in our unit have demonstrated that familial papillary thyroid cancer (fPTC) patients display an imbalance, at the germinal level, in telomere-telomerase complex. AIM We aimed to verify whether familial fPTC patients show an increased spontaneous chromosome fragility. METHODS To this purpose, we compared telomeric fusions and associations as well as other chromosomal fragility features by conventional and molecular cytogenetic analyses, in phytohemagglutinin stimulated T-lymphocytes from fPTC patients, unaffected family members, sporadic papillary thyroid cancer patients, and healthy subjects. RESULTS We demonstrate that fPTC patients have a significant increase in spontaneous telomeric associations and telomeric fusions compared with healthy subjects and sporadic cases in the frame of an otherwise common spontaneous chromosome fragility pattern. A quantitative fluorescence in situ hybridization analysis demonstrates that familial cases display a significant decrease in the telomeric peptide nucleic acid-fluorescence in situ hybridization signal intensity in the metaphase chromosome. Moreover, three copies of the hTERT gene were found only in familial cases, although the result was not statistically significant. CONCLUSIONS These results contribute in defining familial thyroid cancer as a clinical entity characterized by an altered telomere stability, which may be associated with the predisposition to develop the familial form of thyroid cancer.
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Affiliation(s)
- Silvia Cantara
- Section of Endocrinology and Metabolism, Department of Internal Medicine, Endocrinology and Metabolism, and Biochemistry, University of Siena, Policlinico Santa Maria alle Scotte, Viale Bracci 1, 53100 Siena, Italy
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Abstract
Nowadays the most commonly occurring differentiated thyroid cancer in many countries is a microcarcinoma in patients older than 45 years, incidentally found during neck ultrasound. In view of their low morbidity and mortality, the crucial point is how to manage such microcarcinomas. Recently published European and American guidelines aim to minimize the diagnostic and therapeutic procedures without affecting the diagnostic accuracy and the therapeutic effectiveness, keeping in mind that we are dealing with patients who have a normal life expectancy and to whom we have to guarantee an excellent quality of life. The present review will summarize the clinical and pathological features of thyroid microcarcinoma, including its definition, prevalence, presentation, pathology, genetic, clinical impact and will try to derive from them a rationale for therapeutic and diagnostic intervention.
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Affiliation(s)
- Furio Pacini
- Department of Internal Medicine, Endocrinology & Metabolism and Biochemistry, Section of Endocrinology and Metabolism, University of Siena, Via Bracci, 53100 Siena, Italy.
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85
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Affiliation(s)
- Furio Pacini
- Section of Endocrinology, Department of Internal Medicine, Endocrinology and Metabolism and Biochemistry, University of Siena, Viale Bracci, 53100 Siena, Italy.
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Cantara S, Capuano S, Capezzone M, Benigni M, Pisu M, Marchisotta S, Pacini F. Lack of mutations of the telomerase RNA component in familial papillary thyroid cancer with short telomeres. Thyroid 2012; 22:363-8. [PMID: 22304389 DOI: 10.1089/thy.2011.0109] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND The occurrence of familial papillary thyroid cancer (FPTC) is well established but no susceptibility genes for this disease have been discovered. Our group has recently demonstrated that patients with FPTC have shorter telomeres, not associated with mutations in telomerase reverse transcriptase, gene than patients with sporadic papillary thyroid cancer (SPTC), healthy subjects (HS), and unaffected family members (UFMs). Several diseases, however, have short telomeres associated with mutations in the telomerase RNA component (TERC) gene or in the shelterin complex (POT1, RAP1, TIN2, TPP1, TRF1, and TRF2) genes. The objective of the present study was to verify whether short telomeres observed in FPTC patients were related to mutations in TERC or shelterin genes. METHODS Sixty-six patients with FPTC, 46 UFMs, 111 patients with SPTC, and 153 HS were analyzed by polymerase chain reaction followed by denaturing high performance liquid chromatography analysis and direct sequencing for the presence of TERC or shelterin gene mutations. When present, single-nucleotide polymorphisms were tested by χ(2) analysis at the genotypic, allelic, and haplotypic levels. RESULTS The entire sequence of the TERC gene was analyzed with particular attention to known mutations known to be associated with short telomeres. All samples appeared to be homozygous wild type for A-771G, C-99G, G305A, G322A, C323T, C408G, G450A, T467C, G508A, A514G, G623A, and C727G substitutions and for the 378Δ→3' deletion in the TERC gene. In addition, upon analysis of all samples for shelterin proteins, we observed a significant decrease in POT1 and RAP1 protein expression in the blood of FPTC patients compared with SPTC subjects. However, no mutations or polymorphisms were found when in the coding sequences of both genes. CONCLUSIONS To our knowledge this is the first study of TERC mutations or alterations in the shelterin complex in relation to FPTC. Shorter telomeres observed in FPTC are not linked to mutations or polymorphisms in TERC, POT1, or RAP1 genes.
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Affiliation(s)
- Silvia Cantara
- Section of Endocrinology & Metabolism, Department of Internal Medicine, Endocrinology & Metabolism, and Biochemistry, University of Siena, Siena, Italy.
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Zullino A, Maiuolo A, Fumarola A, Gargiulo P, Mercuri V, Pacini FM, Ruggieri M. Minimally invasive thyroidectomy and the differentiated lesions: the way to follow. Eur Rev Med Pharmacol Sci 2012; 16:519-24. [PMID: 22696880 DOI: pmid/22696880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND OBJECTIVES Nowadays, the conventional thyroidectomy may appear an overly aggressive treatment in patients undergoing intervention for small suspicious lesions harboring in low volume glands. In these cases a minimally invasive approach may be a safe and appropriate option. This work aims to evaluate the effectiveness of minimally invasive thyroidectomy in patients indicated to surgery for small lesions with preoperative suspicion of malignancy. PATIENTS AND METHODS 71 patients, undergoing minimally invasive total thyroidectomy as a single procedure between May 2005 and April 2009, were enrolled in this study. They were indicated to surgery for small suspicious or malignant lesions (up to 20 mm lenght by US; cT1 according to UICC 2002) and satisfied the inclusion criteria of minimally invasive thyroidectomy, with gland volume up to 25 ml, no evidence of locally advanced disease and no previous neck surgery. The outcomes were considered in terms of complication rate, postoperative pain, hospitalisation stay, cosmetic results and completeness of surgical resection in malignancies. RESULTS A low complication rate was registered. The surgical completeness, with mean serum thyroglobulin of 4.41 +/- 4.03 ng/ml and radioiodine uptake of 2.91 +/- 2.46%, was considered acceptable if compared with other experiences reported in literature. Excellent results with respect to patient comfort, postoperative pain and cosmetic outcome were obtained. CONCLUSION This study confirms, where a correct selection of patients is made, the safety and the effectiveness of minimally invasive approach in the treatment of small suspicious and malignant nodules, which seem to represent its best indication.
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Affiliation(s)
- A Zullino
- Department of Surgery "Francesco Durante", Sapienza University, Rome, Italy
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Abstract
Thyroid cancer is the most common endocrine malignancy, although representing fewer than 1% of all human tumors. Differentiated thyroid carcinoma (DTC) includes the papillary and follicular histotypes and their variants, accounting for more than 90% of all thyroid cancers. Given the changing presentation of DTC in the last years, the aim of DTC management is to ensure the most effective but least invasive treatment, and adequate follow-up for a disease that nowadays is mostly cured just with surgery and is rarely fatal. This review addresses the multiple steps of current management, based on previous assumptions.
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Affiliation(s)
- Furio Pacini
- Section of Endocrinology and Metabolism, Department of Internal Medicine, Endocrinology & Metabolism and Biochemistry, University of Siena, Policlinico Santa Maria alle Scotte, VialeBracci 1, 53100 Siena, Italy.
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Pacini F, Castagna MG. New insight in the follow-up strategies of differentiated thyroid cancer. J Endocrinol Invest 2012; 35:36-9. [PMID: 23014072 DOI: pmid/23014072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Differentiated thyroid carcinoma (DTC), either papillary or follicular, has usually a very good prognosis with an overall mortality of less than 10%. In recent decades, the clinical presentation of DTC has been changing from advanced cases requiring intense treatment and surveillance to cancer detected by fortuitous neck ultrasonography requiring less aggressive treatment and follow-up. Given the changing presentation of DTC in the last years, the aim of DTC follow-up is to ensure the most effective and less invasive follow-up for a disease that nowadays is mostly cured just with surgery and is rarely fatal. The concept of "Ongoing Risk Stratification" or "Delayed Risk Stratification" which better define the patient risk based on the results of the initial treatment, can maximize the beneficial effects of aggressive therapy in patients with DTC who are likely to benefit from it, while minimizing potential complications and side effects in low-risk patients who will achieve complete remission.
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Affiliation(s)
- F Pacini
- Section of Endocrinology and Metabolism, University of Siena, Siena, Italy.
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Capezzone M, Cantara S, Marchisotta S, Busonero G, Formichi C, Benigni M, Capuano S, Toti P, Pazaitou-Panayiotou K, Caruso G, Carli AF, Palummo N, Pacini F. Telomere length in neoplastic and nonneoplastic tissues of patients with familial and sporadic papillary thyroid cancer. J Clin Endocrinol Metab 2011; 96:E1852-6. [PMID: 21865371 DOI: 10.1210/jc.2011-1003] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Many studies have found an association between altered telomere length (TL), both attrition or elongation, and cancer phenotype. Recently, we have reported that patients with the familial form of papillary thyroid cancer (FPTC) have short telomeres in blood leucocytes. AIM To evaluate relative TL (RTL) at somatic level in neoplastic and nonneoplastic tissues of patients with FPTC (n = 30) and sporadic PTC (n = 46). METHODS RTL was measured by quantitative PCR in neoplastic thyroid tissues, in the corresponding nontumor thyroid tissues (normal contralateral thyroid), and in other extrathyroidal tissues (lymph nodes, muscles, or buccal mucosa). RTL was also measured in adenomas and hyperplastic nodules. In a subset of samples, telomerase expression was measured by quantitative PCR. RESULTS Mean ± SD RTL of FPTC patients was short in neoplastic thyroid tissues (0.87 ± 0.2) with no difference from the normal contralateral thyroid tissues (0.85 ± 0.11) and extrathyroidal tissues (0.85 ± 0.31). On the contrary, in patients with sporadic PTC, the mean ± SD RTL in the neoplastic tissues (1.73 ± 0.63) was significantly shorter than that found in normal contralateral tissues (2.58 ± 0.89) and extrathyroidal tissues (2.5 ± 0.86). For all tissue samples (cancer, normal thyroid, and nonthyroidal tissues) the mean ± SD RTL of familial cases was shorter (P < 0.0001) than that found in tissues from sporadic PTC. RTL of FPTC was also lower (P < 0.0001) than that of 23 follicular adenomas (1.6 ± 0.7) and 24 hyperplastic nodules (2.2 ± 0.9). CONCLUSIONS Our results demonstrate that short telomeres are a consistent feature of PTC, which in familial cases, is not restricted to the tumor tissue. This finding suggests that FPTC has a distinct, heritable, genetic background.
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Affiliation(s)
- Marco Capezzone
- Section of Endocrinology and Metabolism, Department of Internal Medicine, Endocrinology and Metabolism and Biochemistry, University of Siena, Policlinico Santa Maria alle Scotte, Viale Bracci 1, 53100 Siena, Italy
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Castagna MG, Tala Jury HP, Cipri C, Belardini V, Fioravanti C, Pasqui L, Sestini F, Theodoropoulou A, Pacini F. The use of ultrasensitive thyroglobulin assays reduces but does not abolish the need for TSH stimulation in patients with differentiated thyroid carcinoma. J Endocrinol Invest 2011; 34:e219-23. [PMID: 21399390 DOI: 10.3275/7571] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Measurement of serum Tg using ultrasensitive assays is proposed to replace TSH-stimulated Tg measurement in the follow-up of differentiated thyroid cancer (DTC). Aim of our study was to verify this possibility using two ultrasensitive Tg assays. We selected 215 DTC patients with undetectable (<1 ng/ml) basal serum Tg at the time of a recombinant human TSH (rhTSH) stimulation. According to standard criteria, 173 (80.4%) patients were considered free of disease, 17 (7.9%) had documented disease and 25 (11.7%) had no evidence of disease but detectable serum rhTSH-stimulated Tg (biochemical disease). The sera of these patients were re-assayed with two commercial ultrasensitive assays and the results were compared with the clinical data. Basal Access and E-Iason Tg assays were able to distinguish patients with persistent disease or free of disease with a sensitivity of 82.3 and 82.3%, specificity of 85.5 and 86.1%, positive predictive value (PPV) of 35.8 and 36.8%, negative predictive value (NPV) of 98 and 98.6%, respectively. With both assays the addition of neck ultrasound to basal Tg increased the sensitivity and the NPV to 100% and decreased the false negative rate to 0%. In patients with detectable basal Tg without evidence of disease, serum Tg converted from detectable to undetectable in about 80% of the cases during 2-yr follow-up. Our study indicates that the combination of neck ultrasound and basal ultrasensitive Tg allows to identify all patients free of disease and can decrease the need for rhTSH stimulation in nearly 80% of the patients.
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Affiliation(s)
- M G Castagna
- Department of Internal Medicine, Endocrinology & Metabolism and Biochemistry, Section of Endocrinology & Metabolism, University of Siena, 53100 Siena, Italy
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Castagna MG, Maino F, Cipri C, Belardini V, Theodoropoulou A, Cevenini G, Pacini F. Delayed risk stratification, to include the response to initial treatment (surgery and radioiodine ablation), has better outcome predictivity in differentiated thyroid cancer patients. Eur J Endocrinol 2011; 165:441-6. [PMID: 21750043 DOI: 10.1530/eje-11-0466] [Citation(s) in RCA: 195] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
INTRODUCTION After initial treatment, differentiated thyroid cancer (DTC) patients are stratified as low and high risk based on clinical/pathological features. Recently, a risk stratification based on additional clinical data accumulated during follow-up has been proposed. OBJECTIVE To evaluate the predictive value of delayed risk stratification (DRS) obtained at the time of the first diagnostic control (8-12 months after initial treatment). METHODS We reviewed 512 patients with DTC whose risk assessment was initially defined according to the American (ATA) and European Thyroid Association (ETA) guidelines. At the time of the first control, 8-12 months after initial treatment, patients were re-stratified according to their clinical status: DRS. RESULTS Using DRS, about 50% of ATA/ETA intermediate/high-risk patients moved to DRS low-risk category, while about 10% of ATA/ETA low-risk patients moved to DRS high-risk category. The ability of the DRS to predict the final outcome was superior to that of ATA and ETA. Positive and negative predictive values for both ATA (39.2 and 90.6% respectively) and ETA (38.4 and 91.3% respectively) were significantly lower than that observed with the DRS (72.8 and 96.3% respectively, P<0.05). The observed variance in predicting final outcome was 25.4% for ATA, 19.1% for ETA, and 62.1% for DRS. CONCLUSIONS Delaying the risk stratification of DTC patients at a time when the response to surgery and radioiodine ablation is evident allows to better define individual risk and to better modulate the subsequent follow-up.
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Affiliation(s)
- Maria Grazia Castagna
- Department of Internal Medicine, Endocrinology and Metabolism and Biochemistry, Section of Endocrinology and Metabolism, Viale Bracci 1, 53100 Siena, Italy
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Graf H, Fast S, Pacini F, Pinchera A, Leung A, Vaisman M, Reiners C, Wemeau JL, Huysmans D, Harper W, Driedger A, de Souza HN, Castagna MG, Antonangeli L, Braverman L, Corbo R, Düren C, Proust-Lemoine E, Edelbroek MA, Marriott C, Rachinsky I, Grupe P, Watt T, Magner J, Hegedus L. Modified-release recombinant human TSH (MRrhTSH) augments the effect of (131)I therapy in benign multinodular goiter: results from a multicenter international, randomized, placebo-controlled study. J Clin Endocrinol Metab 2011; 96:1368-76. [PMID: 21346067 DOI: 10.1210/jc.2010-1193] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Recombinant human TSH (rhTSH) can be used to enhance (131)I therapy for shrinkage of multinodular goiter (MG). OBJECTIVE, DESIGN, AND SETTING The objective of the study was to compare the efficacy and safety of 0.01 and 0.03 mg modified-release (MR) rhTSH as an adjuvant to (131)I therapy, vs. (131)I alone, in a randomized, placebo-controlled, international, multicenter study. PATIENTS AND INTERVENTION Ninety-five patients (57.2 ± 9.6 yr old, 85% females, 83% Caucasians) with MG (median size 96.0, range 31.9-242.2 ml) were randomized to receive placebo (group A, n = 32), MRrhTSH 0.01 mg (group B, n = 30), or MRrhTSH 0.03 mg (group C, n = 33) 24 h before a calculated activity of (131)I. MAIN OUTCOME MEASURES The primary end point was a change in thyroid volume (by computerized tomography scan, at 6 months). Secondary end points were the smallest cross-sectional area of the trachea; thyroid function tests; Thyroid Quality of Life Questionnaire; electrocardiogram; and hyperthyroid symptom scale. RESULTS Thyroid volume decreased significantly in all groups. The reduction was comparable in groups A and B (23.1 ± 8.8 and 23.3 ± 16.5%, respectively; P = 0.95). In group C, the reduction (32.9 ± 20.7%) was more pronounced than in groups A (P = 0.03) and B. The smallest cross-sectional area of the trachea increased in all groups: 3.8 ± 2.9% in A, 4.8 ± 3.3% in B, and 10.2 ± 33.2% in C, with no significant difference among the groups. Goiter-related symptoms were effectively reduced and there were no major safety concerns. CONCLUSION In this dose-selection study, 0.03 mg MRrhTSH was the most efficacious dose as an adjuvant to (131)I therapy of MG. It was well tolerated and significantly augmented the effect of (131)I therapy in the short term. Larger studies with long-term follow-up are warranted.
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Affiliation(s)
- H Graf
- Serviço de Endocrinologia e Metabologia do Hospital de Clínicas da Universidade Federal do Paraná, 80810-070 Curitiba, Brazil.
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Abstract
Thyroid cancer refractory to conventional treatments lacks effective treatment. Targeted therapy is an emerging therapeutic strategy for these cancers, based on preliminary promising results. Tyrosine kinase inhibitors target both specific oncogenic pathways involved in thyroid cancer progression and aspecific mechanisms such as neoangiogenesis. They are generally well tolerated and most adverse events have low-to-moderate severity. Other classes of drugs have been tested, alone or in combination with tyrosine kinase inhibitors, but so far the results have been limited. The aim of this article is to describe the benefits and limitations of innovative drugs that are currently under investigation in patients with refractory thyroid cancer.
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Affiliation(s)
- Lucia Brilli
- Department of Internal Medicine, Endocrinology & Metabolism & Biochemistry, Section of Endocrinology & Metabolism, University of Siena, Viale Bracci 1, 53100 Siena, Italy
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Abstract
Telomeres are nucleoprotein complexes located at the ends of chromosomes that have a critical role in the maintenance of chromosomal integrity. This involvement is based on complex secondary and tertiary structures that rely on DNA-DNA, DNA-protein and protein-protein interactions. De novo synthesis and maintenance of telomere repeats is controlled by telomerase, a specialized complex that consists of a telomerase RNA component and a protein component--telomerase reverse transcriptase. When telomerase is silent (its default state in differentiated somatic cells), chromosomes shorten with every cell division, thus limiting the lifespan of the cells (the process of senescence) and preventing unlimited cell proliferation, which might eventually lead to the development of cancer. During this process, occasionally, a cell can activate telomerase, which stabilizes short telomeres and enables immortalization-a process essential for malignant transformation. Thus, although telomere erosion is a barrier to malignant progression, paradoxically, in certain circumstances it might also trigger tumorigenesis. A number of studies have demonstrated unequivocally that reactivation of telomerase in the presence of short telomeres is one of the most common features of human cancers, including those of the endocrine system.
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Affiliation(s)
- Furio Pacini
- Department of Internal Medicine, Endocrinology & Metabolism and Biochemistry, University of Siena, Siena 53100, Italy.
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Ciuoli C, Brusco L, Theodoropoulou A, Castagna MG, Neri O, Pasqui L, Pacini F. Effects of Acute Recombinant Human TSH on Serum Ghrelin Levels. Front Endocrinol (Lausanne) 2011; 2:94. [PMID: 22654834 PMCID: PMC3356021 DOI: 10.3389/fendo.2011.00094] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2011] [Accepted: 11/21/2011] [Indexed: 02/05/2023] Open
Abstract
UNLABELLED Recent findings showed the presence of a reciprocal relationship between thyroid hormones and ghrelin, although the exact mechanism is not known. DESIGN Our study is addressed to evaluate the effect of acute exogenous rhTSH administration on serum ghrelin levels in athyreotic patients on replacement l-thyroxine therapy. The study group included 50 patients (16 males and 34 females) submitted to total thyroidectomy and 131-iodine remnant ablation for differentiated thyroid cancer on l-thyroxine therapy. Mean age was 47.5 ± 16.5 years and mean BMI was 25.6 ± 5.01 kg/m(2). rhTSH was administrated at the dosage of 0.9 mg i.m. once daily for two consecutive days. Blood samples were taken between 08.00 and 09.00 after a overnight fasting for measurement of TSH, FT3, FT4, and ghrelin before the first administration of rhTSH and for measurement of TSH and ghrelin 24, 48, 72, and 96 h after the first administration of rhTSH. RESULTS Mean ± SD values of basal TSH were 0.54 ± 0.77 μU/ml without significant difference between females and males. As expected, after rhTSH administration TSH concentrations increased at 24 and 48 h with peak TSH values ranging from 20.20 to 313 μU/ml (mean ± SD 98.4 ± 66.7 μU/ml). Mean ± SD values of basal ghrelin were 1085 ± 373 pg/ml without significant difference between males and females. After rhTSH administration ghrelin concentrations decreased significantly (p < 0.01) at 24 h (mean ± SD 934 ± 314 pg/ml p < 0.01) and returned to pre-treatment levels at 96 h. CONCLUSION Our study demonstrates that acute exogenous TSH administration has a suppressive effect on ghrelin secretion independent from changes in thyroid status.
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Affiliation(s)
- Cristina Ciuoli
- Section of Endocrinology, Department of Internal Medicine, Endocrinology and Metabolism and Biochemistry, University of SienaSiena, Italy
| | - Lucia Brusco
- Section of Endocrinology, Department of Internal Medicine, Endocrinology and Metabolism and Biochemistry, University of SienaSiena, Italy
| | - Alexandra Theodoropoulou
- Section of Endocrinology, Department of Internal Medicine, Endocrinology and Metabolism and Biochemistry, University of SienaSiena, Italy
| | - Maria Grazia Castagna
- Section of Endocrinology, Department of Internal Medicine, Endocrinology and Metabolism and Biochemistry, University of SienaSiena, Italy
| | - Ornella Neri
- Section of Endocrinology, Department of Internal Medicine, Endocrinology and Metabolism and Biochemistry, University of SienaSiena, Italy
| | - Letizia Pasqui
- Section of Endocrinology, Department of Internal Medicine, Endocrinology and Metabolism and Biochemistry, University of SienaSiena, Italy
| | - Furio Pacini
- Section of Endocrinology, Department of Internal Medicine, Endocrinology and Metabolism and Biochemistry, University of SienaSiena, Italy
- *Correspondence: Furio Pacini, Section of Endocrinology, University of Siena, Via Bracci, 53100 Siena, Italy. e-mail:
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De Menis E, Giustina A, Colao A, Degli Uberti E, Ghigo E, Minuto F, Bogazzi F, Drigo R, Cattaneo A, Aimaretti G. Assessment of the awareness and management of sleep apnea syndrome in acromegaly. The COM.E.TA (Comorbidities Evaluation and Treatment in Acromegaly) Italian Study Group. J Endocrinol Invest 2011; 34:60-4. [PMID: 21406941 DOI: 10.1007/bf03346696] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
In 2007 the Italian COM.E.T.A. (COMorbidities Evaluation and Treatment in Acromegaly) study group started to assess the application in a clinical setting of the Versailles criteria for management of acromegaly complications by a first questionnaire focusing on cardiovascular co-morbidities. A further questionnaire on sleep apnea syndrome (SAS) was delivered by the COM.E.T.A. study group to 107 endocrine centers in Italy. The results of our survey suggest that SAS is a well-known comorbidity even if its estimated prevalence is lower than in the literature. Polysomnography is the preferred tool for diagnosis. Control of SAS is considered relevant both for quality of life and co-morbidities. Continuous positive airway pressure is the cornerstone of therapy, but patients' acceptance may be critical. Control of GH/IGF-I secretion is important to improve SAS. Management of SAS requires cooperation between specialists.
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Affiliation(s)
- E De Menis
- Department of Internal Medicine, General Hospital, v. Monte Grappa 30, 31044 Montebelluna, Italy.
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Checchi S, Montanaro A, Ciuoli C, Brusco L, Pasqui L, Fioravanti C, Sestini F, Pacini F. Prevalence of parietal cell antibodies in a large cohort of patients with autoimmune thyroiditis. Thyroid 2010; 20:1385-9. [PMID: 21054212 DOI: 10.1089/thy.2010.0041] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Autoimmune thyroiditis (AIT) may be associated with other organ-specific autoimmune disorders, including autoimmune gastritis, but the prevalence of this association is not entirely quantified. The aim of this study was to investigate the prevalence of parietal cell antibodies (PCA) in a large cohort of consecutive patients with AIT. METHODS We retrospectively studied 2016 consecutive women and 258 men with AIT seen at our referral center in the period from 2004 to 2008. All patients were screened for the presence of PCA in the serum. RESULTS The prevalence of serum PCA in female patients was 29.7% and progressively increased from 13% in the first-second decade of life to peak at 42% in the ninth decade. During follow up, 21.1% of the PCA-positive patients converted to PCA-negative status. Mean (±standard deviation) basal PCA levels in this group were significantly lower (32 ± 28 U/mL) compared with those remaining PCA positive (129 ± 200 U/mL). A similar prevalence (29.8%) with a similar age-dependency was found in male patients. CONCLUSIONS In conclusion, our study demonstrates a high, age-dependent prevalence of PCA in an unselected large population of patients with AIT.
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Affiliation(s)
- Serenella Checchi
- Section of Endocrinology and Metabolism, Department of Internal Medicine, Endocrinology and Metabolism and Biochemistry, University of Siena, Siena, Italy
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