101
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Xiaoyin T, Ping L, Dan C, Min D, Jiachang C, Tao W, Yaoping S, Zhi W, Bo Z. Risk Assessment and Hydrodissection Technique for Radiofrequency Ablation of Thyroid Benign Nodules. J Cancer 2018; 9:3058-3066. [PMID: 30210628 PMCID: PMC6134818 DOI: 10.7150/jca.26060] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 07/02/2018] [Indexed: 12/19/2022] Open
Abstract
Purpose: This retrospective study aimed to explore the importance of risk assessment and hydrodissection pre-treatment for radiofrequency ablation of thyroid nodules and initially establish the concept of thyroid nodule risk assessment and the corresponding ablation norms. Method: Based on the specific location of thyroid nodules, risk assessment and the corresponding preventive measures for thyroid ablation were established. During the period of 2015.10-2017.5, a total of 382 patients were enrolled to compare the safety and efficacy of the ablation for patients with or without risk assessment and the corresponding preventive measures. Statistical analysis encompassed Independent T test for continuous variables and Fisher's exact test/Chi-square test for categorical variables. Result: Of all 382 patients, 188 patients underwent ablation with risk assessment and the corresponding preventive measures before ablation and 194 without, respectively. The patient characteristics, risk grading, ablation time, thyroid function after ablation and the complete ablation rate showed no statistical differences exsisted between two groups (P>0.05). The complication in very high risk nodules was avoided in the group of patients with risk assessment and preventive measures before ablation. Conclusion: It is a very safe and effective way to carry out radiofrequency ablation after pre-treatment of thyroid nodules by hydrodissection technique according to risk assessment. It will provide clinicians with greater help in the ablation treatment of thyroid nodules, and improve the safety of the thyroid ablation.
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Affiliation(s)
- Tang Xiaoyin
- Department of Tumor Interventional Oncology, Renji Hospital, School of Medicine, Shanghai Jiaotong University,160# Pujian Road, Shanghai, 200127, China
| | - Li Ping
- Department of Tumor Interventional Oncology, Renji Hospital, School of Medicine, Shanghai Jiaotong University,160# Pujian Road, Shanghai, 200127, China
| | - Cui Dan
- Department of Tumor Interventional Oncology, Renji Hospital, School of Medicine, Shanghai Jiaotong University,160# Pujian Road, Shanghai, 200127, China
| | - Ding Min
- Department of Tumor Interventional Oncology, Renji Hospital, School of Medicine, Shanghai Jiaotong University,160# Pujian Road, Shanghai, 200127, China
| | - Chi Jiachang
- Department of Tumor Interventional Oncology, Renji Hospital, School of Medicine, Shanghai Jiaotong University,160# Pujian Road, Shanghai, 200127, China
| | - Wang Tao
- Department of Tumor Interventional Oncology, Renji Hospital, School of Medicine, Shanghai Jiaotong University,160# Pujian Road, Shanghai, 200127, China
| | - Shi Yaoping
- Department of Tumor Interventional Oncology, Renji Hospital, School of Medicine, Shanghai Jiaotong University,160# Pujian Road, Shanghai, 200127, China
| | - Wang Zhi
- Department of Tumor Interventional Oncology, Renji Hospital, School of Medicine, Shanghai Jiaotong University,160# Pujian Road, Shanghai, 200127, China
| | - Zhai Bo
- Department of Tumor Interventional Oncology, Renji Hospital, School of Medicine, Shanghai Jiaotong University,160# Pujian Road, Shanghai, 200127, China
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Swan KZ, Nielsen VE, Godballe C, Thrane JF, Mortensen MR, Schytte S, Pedersen HB, Christiansen P, Bonnema SJ. Is serum TSH a biomarker of thyroid carcinoma in patients residing in a mildly iodine-deficient area? Endocrine 2018; 61:308-316. [PMID: 29855783 DOI: 10.1007/s12020-018-1637-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 05/14/2018] [Indexed: 10/14/2022]
Abstract
PURPOSE To investigate the association between the pre-operative serum TSH (s-TSH) level and differentiated thyroid carcinoma (DTC) in a mildly iodine-deficient area. METHODS Patients undergoing surgery for thyroid nodular disease (TND) were included from three tertiary surgical departments. Data were collected from a national thyroid surgery database (THYKIR) and from patient charts. Individuals with overtly coexisting thyroid disorders were excluded for subgroup analyses. Patients were compared with the Danish background population, employing previous data from DanThyr, a study initiated to monitor the iodine fortification program in Denmark. RESULTS Nine-hundred ninety-eight patients [cases/controls: 265/733; female/male: 794/204; age (mean ± SD): 51 ± 15 years] were included. S-TSH was significantly higher in the DTC group [median (IQR): 1.3 (0.9-1.9 mIU/L)] compared with the benign TND group [0.9 (0.6-1.5 mIU/L)] (p < 0.0001). The median s-TSH in the background population was similar to that found among DTC patients (p = 1.00), but markedly higher than the s-TSH level in the benign TND group (p < 0.0001). There was no association between s-TSH and DTC disease stage (p = 0.08-0.87). CONCLUSIONS s-TSH was significantly higher in patients with DTC than in those with benign TND. However, this difference can be explained by abnormally lower s-TSH level in the latter group, probably caused by subtle nodular functional autonomy. Due to the huge overlap and the small difference in median s-TSH between patients with benign and malignant TND, s-TSH is not suitable as a biomarker of DTC in a clinical setting.
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Affiliation(s)
- Kristine Zøylner Swan
- Department of Oto-rhino-laryngology (ORL) Head & Neck Surgery, Aarhus University Hospital, Nørrebrogade 44, 8000, Aarhus C, Denmark.
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, 8200, Aarhus N, Denmark.
| | - Viveque Egsgaard Nielsen
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, 8200, Aarhus N, Denmark
| | - Christian Godballe
- Department of ORL Head & Neck Surgery, Odense University Hospital, J.B. Winsløws Vej 4, 5000, Odense C, Denmark
| | - Jens Faunø Thrane
- Department of Oto-rhino-laryngology (ORL) Head & Neck Surgery, Aarhus University Hospital, Nørrebrogade 44, 8000, Aarhus C, Denmark
- Department of ORL Head & Neck Surgery, Aalborg University Hospital, Hobrovej 18-22, 9000, Aalborg, Denmark
| | - Marie Riis Mortensen
- Department of Endocrinology, Odense University Hospital, Kløvervænget 6, 5000, Odense C, Denmark
| | - Sten Schytte
- Department of Oto-rhino-laryngology (ORL) Head & Neck Surgery, Aarhus University Hospital, Nørrebrogade 44, 8000, Aarhus C, Denmark
| | - Henrik Baymler Pedersen
- Department of ORL Head & Neck Surgery, Aalborg University Hospital, Hobrovej 18-22, 9000, Aalborg, Denmark
| | - Peer Christiansen
- Department of Plastic and Breast surgery, Aarhus University Hospital, Nørrebrogade 44, 8000, Aarhus C, Denmark
| | - Steen Joop Bonnema
- Department of Endocrinology, Odense University Hospital, Kløvervænget 6, 5000, Odense C, Denmark
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Trimboli P, Bini F, Marinozzi F, Baek JH, Giovanella L. High-intensity focused ultrasound (HIFU) therapy for benign thyroid nodules without anesthesia or sedation. Endocrine 2018; 61:210-215. [PMID: 29453658 DOI: 10.1007/s12020-018-1560-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 02/04/2018] [Indexed: 01/07/2023]
Abstract
BACKGROUND Thermal ablation of thyroid nodules has gained momentum due to the possibility to avoid surgery. High-intensity focused ultrasound (HIFU) allows thermal treatment by energy ultrasound beam inside the targeted zone. Aim of our study was to evaluate the effects of HIFU treatment using Beamotion mode without anesthesia. METHODS Since 2016, patients with normal thyroid function, benign thyroid nodules with diameter no larger than 4 cm, and presenting local discomfort and/or compressive symptoms were treated by HIFU. We performed Beamotion HIFU and did not use anesthesia. Nodule size and thyroid function were evaluated before HIFU and 6 and 12 months later. Complications to therapy and tolerability of patients were also recorded. According to local ethical committee, for this retrospective study formal consent was not required. RESULTS The final series included 26 nodules from 26 patients with estimated volume of 2.81 ± 2.04 mL, treated by a power of 33.3 ± 10.3 W/site and energy of 2.1 ± 1.1 kJ. Nodules volume was significantly (p < 0.0001) reduced at 6 months of follow-up (1.83 ± 1.63 mL), and further at 1 year (1.57 ± 1.47 mL). Mean percentage of reduction over time of nodules was 48%. A 73% of patients described good comfort during treatment, 100% experienced good comfort just after therapy, and tolerability was high. No complications were recorded. At one 1 year of follow-up, 85% of subjects reported a reduction of local symptoms. CONCLUSIONS HIFU therapy is effective in reducing size of thyroid nodules with major diameter below 4 cm and can be performed without anesthesia.
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Affiliation(s)
- Pierpaolo Trimboli
- Department of Nuclear Medicine and Thyroid Centre, Oncology Institute of Southern Switzerland, Bellinzona, 6500, Switzerland.
| | - Fabiano Bini
- Department of Mechanical and Aerospace Engineering, "Sapienza" University of Rome, Rome, 00184, Italy
| | - Franco Marinozzi
- Department of Mechanical and Aerospace Engineering, "Sapienza" University of Rome, Rome, 00184, Italy
| | - Jung Hwan Baek
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, 05505, Korea
| | - Luca Giovanella
- Department of Nuclear Medicine and Thyroid Centre, Oncology Institute of Southern Switzerland, Bellinzona, 6500, Switzerland
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Li S, Nie Y, Zhan J, Wang Y, Huang W, Wang Y, He J, Liu Y. The analysis of correlation between frailty index and postoperative complications of aged patients with nodular goiter. Aging Med (Milton) 2018; 1:18-22. [PMID: 31942475 PMCID: PMC6880665 DOI: 10.1002/agm2.12016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 04/02/2018] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVE To explore the correlation between frailty index (FI) and postoperative complications of aged patients with nodular goiter (NG). METHODS A total of 120 aged patients with NG undergoing operative treatment from May 2013 to October 2015 in our hospital were selected. All of them were divided into 3 groups according to the FI as follows: nonfrail group (FI < 0.2), intermediately frail group (0.2 ≤ FI < 0.4), and frail group (FI ≥ 0.4). Clinical data of patients about general data, body mass index, American Society of Anesthesiology (ASA) classification, hospital stays, and postoperative complications were examined. Then, the correlations between the indexes above and FI were examined. RESULTS Frailty index and the ASA classification have some relevance (r = .265, P = .007). The postoperative complication rates of total nonfrail group, intermediately frail group, and frail group were, respectively, 4 cases (11.4%), 11 cases (31.4%), and 24 cases (48.0%). With the increase in FI, the incidence of postoperative complications and hospital stays had also significantly increased. The area under receiver operating characteristic curve examining frailty's ability to forecast postoperative complications was 0. 815 (95% CI: 0.675-0.954, P = .000). CONCLUSION The level of frailty index is a risk factor for postoperative complications of aged patients with NG. The preoperative frailty index evaluation can provide reference evidence for the treatment of aged NG patients undergoing surgery.
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Affiliation(s)
- Shuang Li
- Department of Geriatricsthe Second Xiangya HospitalCentral South UniversityChangshaChina
| | - Yue Nie
- Department of Geriatricsthe Third Hospital of ChangshaChangshaChina
| | - Junkun Zhan
- Department of Geriatricsthe Second Xiangya HospitalCentral South UniversityChangshaChina
| | - Yanjiao Wang
- Department of Geriatricsthe Second Xiangya HospitalCentral South UniversityChangshaChina
| | - Wu Huang
- Department of Geriatricsthe Second Xiangya HospitalCentral South UniversityChangshaChina
| | - Yi Wang
- Department of Geriatricsthe Second Xiangya HospitalCentral South UniversityChangshaChina
| | - Jieyu He
- Department of Geriatricsthe Second Xiangya HospitalCentral South UniversityChangshaChina
| | - Youshuo Liu
- Department of Geriatricsthe Second Xiangya HospitalCentral South UniversityChangshaChina
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105
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Pacella CM, Mauri G. Is there a role for minimally invasive thermal ablations in the treatment of autonomously functioning thyroid nodules? Int J Hyperthermia 2018; 34:636-638. [DOI: 10.1080/02656736.2018.1462537] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Affiliation(s)
- Claudio M. Pacella
- Dipartimento di Diagnostica per Immagini, “Regina Apostolorum” Hospital, Albano, Laziale, Italy
| | - Giovanni Mauri
- Divisione di Radiologia Interventistica, Istituto Europeo di Oncologia, Milano, Italy
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106
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Buscemi S, Massenti FM, Vasto S, Galvano F, Buscemi C, Corleo D, Barile AM, Rosafio G, Rini N, Giordano C. Association of obesity and diabetes with thyroid nodules. Endocrine 2018; 60:339-347. [PMID: 28836113 DOI: 10.1007/s12020-017-1394-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2017] [Accepted: 08/12/2017] [Indexed: 12/20/2022]
Abstract
AIM There are conflicting data concerning the possibility that obesity and diabetes raise the risk of thyroid nodules. The incidence of thyroid nodules is increasing, as is that of obesity and diabetes; therefore, understanding whether these metabolic and nutritional disorders influence nodular thyroid disease is important for organizing prevention strategies. This study investigated the association between thyroid nodules, obesity, diabetes, and dietary habits. MATERIALS AND METHODS A cohort of randomly selected adults (455 males, 746 females; age: 18-90 years) living in Palermo (Italy), a mild iodine deficiency area, was cross-sectionally investigated. Participants underwent high-resolution ultrasonographic evaluation of the thyroid, and answered a food frequency questionnaire. Laboratory blood measurements were obtained in 587 participants. RESULTS AND DISCUSSION Thyroid nodules were detected in 475 (39.5%) participants. The number of thyroid nodules was correlated with age (r = 0.19; P < 0.001), gender (r = 0.08; P = 0.005), and body mass index (r = 0.07; P = 0.02). No significant correlation was observed between the number of nodules and glycated hemoglobin, serum insulin concentrations, and homeostasis model assessment of insulin resistance. Age-adjusted and gender-adjusted prevalence of both overweight/obesity and type 2 diabetes of each group of participants divided according to the number of nodules significantly increased with the number of nodules (P < 0.05 in both cases). The group of participants with nodules exhibited a significantly lower age-adjusted and gender-adjusted habitual intake of milk (P = 0.02). Multivariate regression analysis showed that age, gender, body mass index, diabetes, and habitual consumption of milk were independently correlated with presence of thyroid nodules. CONCLUSION This study seems to indicate that an association exists between obesity, diabetes, and thyroid nodules.
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Affiliation(s)
- Silvio Buscemi
- Dipartimento Biomedico di Medicina Interna e Specialistica (DIBIMIS) - University of Palermo (Italy), Via del Vespro 129, 90127, Palermo, Italy.
- Laboratorio di Metabolismo e Nutrizione Clinica - AOU Policlinico "P. Giaccone", Palermo, Italy.
| | - Fatima Maria Massenti
- Dipartimento di Scienze per la Promozione della Salute e Materno Infantile - University of Palermo, (Italy) - AOU Policlinico "P. Giaccone", Palermo, Italy
| | - Sonya Vasto
- Dipartimento di Scienze e Tecnologie Biologiche, Chimiche e Farmaceutiche (STEBICEF), University of Palermo (Italy), Palermo, Italy
| | - Fabio Galvano
- Dipartimento di Scienze del Farmaco, University of Catania (Italy), Catania, Italy
| | - Carola Buscemi
- Dipartimento Biomedico di Medicina Interna e Specialistica (DIBIMIS) - University of Palermo (Italy), Via del Vespro 129, 90127, Palermo, Italy
- Laboratorio di Metabolismo e Nutrizione Clinica - AOU Policlinico "P. Giaccone", Palermo, Italy
| | - Davide Corleo
- Dipartimento Biomedico di Medicina Interna e Specialistica (DIBIMIS) - University of Palermo (Italy), Via del Vespro 129, 90127, Palermo, Italy
- Laboratorio di Metabolismo e Nutrizione Clinica - AOU Policlinico "P. Giaccone", Palermo, Italy
| | - Anna Maria Barile
- Dipartimento Biomedico di Medicina Interna e Specialistica (DIBIMIS) - University of Palermo (Italy), Via del Vespro 129, 90127, Palermo, Italy
- Laboratorio di Metabolismo e Nutrizione Clinica - AOU Policlinico "P. Giaccone", Palermo, Italy
| | - Giuseppe Rosafio
- Dipartimento Biomedico di Medicina Interna e Specialistica (DIBIMIS) - University of Palermo (Italy), Via del Vespro 129, 90127, Palermo, Italy
- Laboratorio di Metabolismo e Nutrizione Clinica - AOU Policlinico "P. Giaccone", Palermo, Italy
| | - Nadia Rini
- Dipartimento Biomedico di Medicina Interna e Specialistica (DIBIMIS) - University of Palermo (Italy), Via del Vespro 129, 90127, Palermo, Italy
- Laboratorio di Metabolismo e Nutrizione Clinica - AOU Policlinico "P. Giaccone", Palermo, Italy
| | - Carla Giordano
- Dipartimento Biomedico di Medicina Interna e Specialistica (DIBIMIS) - University of Palermo (Italy), Via del Vespro 129, 90127, Palermo, Italy
- Sezione di Malattie Cardio-Respiratorie ed Endocrino-Metaboliche, Roma, Italy
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107
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Gül N, Temel B, Ustek D, Sirma-Ekmekçi S, Kapran Y, Tunca F, Giles-Şenyürek Y, Özbek U, Alagöl F. Association of Pro-apoptotic Bad Gene Expression Changes with Benign Thyroid Nodules. ACTA ACUST UNITED AC 2018; 32:555-559. [PMID: 29695560 DOI: 10.21873/invivo.11275] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 03/14/2018] [Accepted: 03/19/2018] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM This study aimed to investigate the role of the mitochondrial apoptotic pathway in benign thyroid nodules. MATERIALS AND METHODS Paired samples of nodular and normal tissues were collected from 26 patients with nodular goiters undergoing thyroidectomy. Variable expression of Bcl-2, Bax and Bad genes were evaluated by quantitative PCR. RESULTS Expression level of Bad gene in nodules was found to be significantly decreased compared to normal tissues (p=0.049). A positive correlation was observed between nodule size and Bad expression levels (correlation coefficient=0.563, p=0.004); and this correlation was stronger in hot nodules (n=18, correlation coefficient=0.689, p=0.003). No significant difference was observed between nodular and normal tissue expressions of Bax and Bcl-2. CONCLUSION These results suggest that Bad expression correlates with the size of benign thyroid nodules and also its relatively lower expression in nodules, warrant further investigation.
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Affiliation(s)
- Nurdan Gül
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Berna Temel
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Duran Ustek
- Department of Genetics, Institute for Experimental Medical Research, Istanbul University, Istanbul, Turkey
| | - Sema Sirma-Ekmekçi
- Department of Genetics, Institute for Experimental Medical Research, Istanbul University, Istanbul, Turkey
| | - Yersu Kapran
- Department of Pathology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Fatih Tunca
- Department of Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Yasemin Giles-Şenyürek
- Department of Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Uğur Özbek
- Department of Genetics, Institute for Experimental Medical Research, Istanbul University, Istanbul, Turkey
| | - Faruk Alagöl
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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108
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Bini F, Trimboli P, Marinozzi F, Giovanella L. Treatment of benign thyroid nodules by high intensity focused ultrasound (HIFU) at different acoustic powers: a study on in-silico phantom. Endocrine 2018. [PMID: 28638983 DOI: 10.1007/s12020-017-1350-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND The non-surgical therapies of benign thyroid nodules are gaining momentum due to the possibility to reduce the nodule's volume and avoid surgery. As the last technique introduced, high intensity focused ultrasound allows the thermal tissue treatment by directing energy inside the targeted nodule with no invasive instruments. In the present study we applied the Food and Drug Administration high intensity focused ultrasound simulator to in-silico phantom to evaluate the effects obtained by different acoustic powers. METHODS The simulated layers were water and thyroid tissue. The source was a spherically curved circular transducer with radius r = 2.3 cm generating a continuous wave beam at a frequency of 3 MHz. The focal distance was 6.5 cm. The sequence included a pulse (8 s) with acoustic power at different value from 5 to 50 W, and a cooling-off interval (32 s). RESULTS The use of acoustic power of 5 W allowed to achieve the threshold of temperature for coagulative necrosis (55 °C) at 1 s. The simulation with 50 W showed that temperature was significantly higher (above 300 °C) at 1 s and is maintained at high levels for a long interval. CONCLUSION Since 2016, we treated patients according to the present experience, and a significant reduction of nodule's volume was observed with good patent's comfort and no complications (unpublished data). Also, no anesthesia was practiced. We feel that the present data could contribute to develop a high intensity focused ultrasound therapy of benign thyroid nodules free from potential complications.
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Affiliation(s)
- Fabiano Bini
- Department of Nuclear Medicine and Thyroid Centre, Oncology Institute of Southern Switzerland, Via Ospedale 12, 6500, Bellinzona, Switzerland
- Department of Mechanical and Aerospace Engineering, "Sapienza" University of Rome, Rome, Italy
| | - Pierpaolo Trimboli
- Department of Nuclear Medicine and Thyroid Centre, Oncology Institute of Southern Switzerland, Via Ospedale 12, 6500, Bellinzona, Switzerland.
| | - Franco Marinozzi
- Department of Mechanical and Aerospace Engineering, "Sapienza" University of Rome, Rome, Italy
| | - Luca Giovanella
- Department of Nuclear Medicine and Thyroid Centre, Oncology Institute of Southern Switzerland, Via Ospedale 12, 6500, Bellinzona, Switzerland
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109
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Zhang Y, Li Y, Mao X, Yan C, Guo X, Guo Q, Liu Z, Song Z, Lin N. Thyroid hormone synthesis: a potential target of a Chinese herbal formula Haizao Yuhu Decoction acting on iodine-deficient goiter. Oncotarget 2018; 7:51699-51712. [PMID: 27384475 PMCID: PMC5239508 DOI: 10.18632/oncotarget.10329] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Accepted: 06/17/2016] [Indexed: 11/25/2022] Open
Abstract
Haizao Yuhu Decoction (HYD), a famous multi-component herbal formula, has been widely used to treat various thyroid-related diseases, including iodine-deficient goiter. Herb pair Thallus Sargassi Pallidi (HZ) and Radix Glycyrrhizae (GC), one of the so-called “eighteen antagonistic medicaments”, contains in HYD. To explore pharmacological mechanisms of HYD acting on iodine-deficient goiter and to provide evidence for potential roles of herb pair HZ and GC in HYD, our genome-wide microarray detection and network analysis identified a list of goiter-related genes, mainly involved into the alterations in hypothalamus-pituitary-thyroid/gonad/growth axes. Then, the disease genes-drug genes interaction network illustrated the links between HYD regulating genes and goiter-related genes, and identified the candidate targets of HYD acting on goiter. Functionally, these candidate targets were closely correlated with thyroid hormone synthesis. Moreover, the potential regulating genes of herb pair HZ and GC were revealed to be crucial components in the pathway of thyroid hormone synthesis. The prediction results were all verified by following experiments based on goiter rats. Collectively, this integrative study combining microarray gene expression profiling, network analysis and experimental validations offers the convincing evidence that HYD may alleviate iodine-deficient goiter via regulating thyroid hormone synthesis, and explains the necessity of herb pair HZ and GC in HYD. Our work provides a novel and powerful means to clarify the mechanisms of action for multi-component drugs such as herbal formulae in a holistic way, which may improve drug development and applications.
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Affiliation(s)
- Yanqiong Zhang
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing 100700, China
| | - Yuting Li
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing 100700, China
| | - Xia Mao
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing 100700, China
| | - Chen Yan
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing 100700, China
| | | | - Qiuyan Guo
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing 100700, China
| | - Zhenli Liu
- Institute of Basic Theory, China Academy of Chinese Medical Sciences, Beijing 100700, China
| | - Zhiqian Song
- Institute of Basic Theory, China Academy of Chinese Medical Sciences, Beijing 100700, China
| | - Na Lin
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing 100700, China
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110
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Cesareo R, Naciu AM, Iozzino M, Pasqualini V, Simeoni C, Casini A, Campagna G, Manfrini S, Tabacco G, Palermo A. Nodule size as predictive factor of efficacy of radiofrequency ablation in treating autonomously functioning thyroid nodules. Int J Hyperthermia 2018; 34:617-623. [PMID: 29357717 DOI: 10.1080/02656736.2018.1430868] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
CONTEXT No defined pre-treatment factors are able to predict the response to radiofrequency ablation (RFA) of an autonomously functioning thyroid nodule (AFTN). OBJECTIVE Primary endpoint was to evaluate the success rate of RFA to restore euthyroidism in a cohort of adult patients with small solitary AFTN compared with medium-sized nodules. Secondary endpoints included nodule volume reduction and rate of conversion from hot nodules to cold using scintiscan. METHODS This was a 24-month prospective monocentric open parallel-group trial. Twenty-nine patients with AFTN were divided into two groups based on thyroid volume: 15 patients with small nodules (<12 mL) in group A and 14 patients with medium nodules (>12 mL) in group B. All patients underwent a single session of RFA and were clinically, biochemically, and morphologically evaluated at baseline and at 1, 6, 12 and 24 months after treatment. RESULTS After RFA, there was greater nodule volume reduction in group A compared with group B (p < 0.001 for each follow-up point). In group A, there was a greater increase in TSH levels than in group B at 6 (p = 0.01), 12 (p = 0.005), and 24 months (p < 0.001). At 24 months, the rate of responders was greater in group A than in group B (86 vs. 45%; p < 0.001). In group A, 86% of nodules converted from hot to cold compared with 18% in group B (p < 0.001). CONCLUSIONS A single session of RFA was effective in restoring euthyroidism in patients with small AFTNs. Nodule volume seems to be a significant predictive factor of the efficacy of RFA in treating AFTN.
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Affiliation(s)
- R Cesareo
- a Thyroid Disease Center , "S. M. Goretti" Hospital , Latina , Italy
| | - A M Naciu
- b Unit of Endocrinology and Diabetes , Campus Bio-Medico University , Rome , Italy
| | - M Iozzino
- c Department of Radiology , "S. M. Goretti" Hospital , Latina , Italy
| | - V Pasqualini
- c Department of Radiology , "S. M. Goretti" Hospital , Latina , Italy
| | - C Simeoni
- d Workers Compensation Authority (INAIL) - Research Area , Roma , Italy
| | - A Casini
- a Thyroid Disease Center , "S. M. Goretti" Hospital , Latina , Italy
| | - G Campagna
- a Thyroid Disease Center , "S. M. Goretti" Hospital , Latina , Italy
| | - S Manfrini
- b Unit of Endocrinology and Diabetes , Campus Bio-Medico University , Rome , Italy
| | - G Tabacco
- b Unit of Endocrinology and Diabetes , Campus Bio-Medico University , Rome , Italy
| | - A Palermo
- b Unit of Endocrinology and Diabetes , Campus Bio-Medico University , Rome , Italy
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111
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Menene NMD, Yixuan WMD, Bidingija MMD, Fei LMD, Bei WMD, Kasangye KMD, Geoffrey JCMD, Lin LMD, Mvuezolo MMD, Hongyu DMD, Hongjun SMD. Ultrasonographic Assessment of Thyroid Nodules in Two Groups of Pregnant Women: Is the Nodular Phenotypic Expression Dependent on Obstetric and/or Environmental Factors? ADVANCED ULTRASOUND IN DIAGNOSIS AND THERAPY 2018. [DOI: 10.37015/audt.2018.180002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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112
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Kaniuka-Jakubowska S, Lewczuk A, Majkowicz M, Piskunowicz M, Mizan-Gross K, Zapaśnik A, Kaszubowski M, Lass P, Sworczak K. Nontoxic Goiter (NTG) and Radioiodine: What Do Patients Think About It? Quality of Life in Patients with NTG Before and After 131-I Therapy. Front Endocrinol (Lausanne) 2018; 9:114. [PMID: 29713309 PMCID: PMC5912045 DOI: 10.3389/fendo.2018.00114] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2017] [Accepted: 03/07/2018] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE Despite numerous publications regarding nontoxic goiter (NTG) treatment and an increasing interest in patients' quality of life, few studies present the outcome of 131-I treatment from the patients' perspective. Our study's main aim was to verify whether there is any improvement in life quality following 131-I treatment. MATERIALS AND METHODS Thirty-five patients with NTG qualified to participate in the study. All patients completed a Thyroid-Related Health-Related Quality of Life (Thy-R-HRQoL) questionnaire created by us and the Medical Outcomes Study 36-item Short Form (SF-36), right before and 1 year after 131-I. RESULTS We observed an improvement in six out of eight SF-36 and three out of seven Thy-R-HRQoL domains. In comparison with the control group, we observed worse results in two out of eight, prior to treatment, and one out of eight SF-36 afterward, as well as in all Thy-R-HRQoL domains. We did not find any correlation between improvement of Thy-R-HRQoL and SF-36 and goiter size reduction, except for Bodily Pain. There was also no correlation between improvement of SF-36 and Thy-R-HRQoL domains, and goiter size before treatment. The older the patient, the less noticeable improvement was observed in Physical and Social Functioning, and Vitality in SF-36, but age had no influence on the assessment by Thy-R-HRQoL. CONCLUSION Radioiodine treatment improves life quality in patients with NTG. Use of the Health-Related Quality of Life questionnaire should be taken into consideration when evaluating life quality of patients with NTG. Relentless pursuit of maximal goiter size reduction in 131-I treatment is worth consideration. In our study, life quality improvement did not depend directly on the goiter size reduction. Life quality improvement after 131-I might not depend on initial goiter size, and for certain domains of SF-36 might be less clearly expressed in older patients.
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Affiliation(s)
- Sonia Kaniuka-Jakubowska
- Department of Endocrinology and Internal Medicine, Medical University of Gdansk, Gdansk, Poland
- *Correspondence: Sonia Kaniuka-Jakubowska,
| | - Anna Lewczuk
- Department of Endocrinology and Internal Medicine, Medical University of Gdansk, Gdansk, Poland
| | - Mikołaj Majkowicz
- Department for Quality of Life Research, Medical University of Gdansk, Gdansk, Poland
- Department of Public Health, Pomeranian University in Slupsk, Slupsk, Poland
| | | | | | - Adam Zapaśnik
- Department of Radiology, Medical University of Gdansk, Gdansk, Poland
| | - Mariusz Kaszubowski
- Department of Economic Sciences, Faculty of Management and Economics, Gdansk University of Technology, Gdansk, Poland
| | - Piotr Lass
- Department of Nuclear Medicine, Medical University of Gdansk, Gdansk, Poland
- Institute of Experimental Physics, University of Gdansk, Gdansk, Poland
| | - Krzysztof Sworczak
- Department of Endocrinology and Internal Medicine, Medical University of Gdansk, Gdansk, Poland
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Răcătăianu N, Leach N, Bondor CI, Mârza S, Moga D, Valea A, Ghervan C. Thyroid disorders in obese patients. Does insulin resistance make a difference? ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2017; 61:575-583. [PMID: 29412382 PMCID: PMC10522069 DOI: 10.1590/2359-3997000000306] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 06/07/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the association between insulin resistance and thyroid pathology in obese patients, and compare the results between insulin-resistant and noninsulin-resistant patients. SUBJECTS AND METHODS Obese/nondiabetic patients, aged 18-70 years, attending the outpatient endocrinology service for 2 years were consecutively included. We evaluated the patients' fasting plasma glucose, insulin, homeostasis model assessment of insulin resistance index (HOMA-IR), thyroid-stimulating hormone (TSH), free thyroxine (FT4), antithyroperoxidase antibodies (TPO-Ab), antithyroglobulin antibodies (Tg-Ab), and thyroid ultrasound. RESULTS We included 82 patients with a mean age 44.21 ± 12.67 years. The thyroid disorders encountered and their prevalences were: hypothyroidism (14.6%, 95% confidence interval [CI] 8.6-23.8%), hyperthyroidism (1.2%, 95% CI 2.0-6.6%), goiter (28.0%, 95% CI 19.5-3.6%), thyroid nodules (35.4%, 95% CI 25.9-46.2%), and Hashimoto's thyroiditis (32.9%, 95% CI 23.7-43.7%). HOMA-IR correlated positively with TSH levels (r = 0.24, p = 0.028), and this correlation remained after adjustment for body mass index (BMI), waist/hip ratio (WHR), serum cortisol, subcutaneous fat thickness (SFT), visceral fat thickness (VFT), triglycerides, γ-glutamyl transpeptidase (GGT), and alanine aminotransferase (ALT) in multivariate regression analysis (b = 0.207, 95% CI, 0.09-0.385, p = 0.023). TSH levels were significantly higher in patients with HOMA-IR ≥ 2.5 than in those with HOMA-IR < 2.5 (2.03 μIU/mL, interquartile range [IQR] 1.59-2.69 μIU/mL) versus 1.59 μIU/mL, IQR 0.94-2.26 μIU/mL, p = 0.023). CONCLUSIONS The most prevalent thyroid disorder in patients attending our endocrinology clinic for investigation of obesity was thyroid nodules. One in seven patients had hypothyroidism. Our findings suggest that TSH levels correlate with insulin resistance in obese patients.
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Affiliation(s)
- Nicoleta Răcătăianu
- Iuliu Haţieganu University of Medicine and PharmacyDepartment of EndocrinologyClujNapocaRomaniaDepartment of Endocrinology, Iuliu Haţieganu University of Medicine and Pharmacy Cluj-Napoca, Romania
| | - Nicoleta Leach
- Iuliu Haţieganu University of Medicine and Pharmacy5 Department of Internal MedicineClujNapocaRomania5 Department of Internal Medicine, Iuliu Haţieganu University of Medicine and Pharmacy Cluj-Napoca, Romania
| | - Cosmina Ioana Bondor
- Iuliu Haţieganu University of Medicine and PharmacyDepartment of Medical Informatics and BiostatisticsClujNapocaRomaniaDepartment of Medical Informatics and Biostatistics, Iuliu Haţieganu University of Medicine and Pharmacy Cluj-Napoca, Romania
| | - Smaranda Mârza
- Infectious Diseases Clinical Hospital-Integrated AmbulatoryPediatricsClujNapocaRomaniaPediatrics, Infectious Diseases Clinical Hospital-Integrated Ambulatory, Cluj-Napoca, Romania
| | - Daniela Moga
- Infectious Diseases Clinical Hospital-Integrated AmbulatoryLaboratory DepartmentClujNapocaRomaniaLaboratory Department, Infectious Diseases Clinical Hospital-Integrated Ambulatory, Cluj-Napoca, Romania
| | - Ana Valea
- Iuliu Haţieganu University of Medicine and PharmacyDepartment of EndocrinologyClujNapocaRomaniaDepartment of Endocrinology, Iuliu Haţieganu University of Medicine and Pharmacy Cluj-Napoca, Romania
| | - Cristina Ghervan
- Iuliu Haţieganu University of Medicine and PharmacyDepartment of EndocrinologyClujNapocaRomaniaDepartment of Endocrinology, Iuliu Haţieganu University of Medicine and Pharmacy Cluj-Napoca, Romania
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114
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Kir S, Aydin Y, Coskun H. Relationship between metabolic syndrome and nodular thyroid diseases. Scandinavian Journal of Clinical and Laboratory Investigation 2017; 78:6-10. [DOI: 10.1080/00365513.2017.1402363] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Seher Kir
- Faculty of Medicine, Internal Medicine Department, Duzce University, Duzce, Turkey
| | - Yusuf Aydin
- Faculty of Medicine, Internal Medicine Department, Endocrinology and Metabolism Division, Duzce University, Duzce, Turkey
| | - Hulya Coskun
- Faculty of Medicine, Internal Medicine Department, Duzce University, Duzce, Turkey
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Sorensen JR, Lauridsen JF, Døssing H, Nguyen N, Hegedüs L, Bonnema SJ, Godballe C. Thyroidectomy Improves Tracheal Anatomy and Airflow in Patients with Nodular Goiter: A Prospective Cohort Study. Eur Thyroid J 2017; 6:307-314. [PMID: 29234624 PMCID: PMC5704720 DOI: 10.1159/000480348] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 08/14/2017] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE A large goiter may cause compression of the trachea. The aim of this study was to investigate the impact of thyroidectomy on tracheal anatomy and airflow and to correlate this with changes in health-related quality of life (HRQoL) in patients with benign nodular goiter. METHODS Magnetic resonance images of the neck and respiratory flow-volume curves, including both inspiration and expiration, were performed prior to and 6 months following surgery. HRQoL was measured by selected scales from the thyroid-specific patient-reported outcome (ThyPRO). Cohen's effect size (ES) was calculated as mean change divided by standard deviation at baseline. ES of 0.2-0.5 were defined as small, 0.5-0.8 as moderate, and values >0.8 as large. RESULTS Sixty-five patients completed all examinations. Median goiter volume was 58 mL (range, 14-642 mL) before surgery with surgical removal of a median of 43 g (range, 8-607 g). Six months after surgery, tracheal narrowing and deviation were diminished by a median of 26% (ES = 0.67, p < 0.001) and 33% (ES = 0.61, p < 0.001), respectively. Correspondingly, each 10% decrease in goiter volume resulted in 1.0% less tracheal narrowing (p < 0.001). Concomitantly, a small improvement was seen in forced inspiratory flow at 50% of forced vital capacity (ES = 0.32, p < 0.001). A reduction in tracheal narrowing was associated with improvements in the Impaired Daily Life scale (0.33 points per 1% decrease in tracheal narrowing, p = 0.03) of the ThyPRO questionnaire. CONCLUSIONS In patients with symptomatic benign nodular goiter, thyroidectomy resulted in substantial improvements in tracheal anatomy and improvements in inspiratory flow, which were followed by gains in HRQoL. This information is pertinent when counseling patients before choice of treatment.
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Affiliation(s)
- Jesper Roed Sorensen
- Department of ORL Head and Neck Surgery, Odense University Hospital, Odense, Denmark
- OPEN, Odense Patient Data Explorative Network, Odense University Hospital, Odense, Denmark
- *Jesper Roed Sorensen, MD, Department of ORL Head and Neck Surgery, Odense University Hospital, J.B. Winsløws Vej 4, DK-5000 Odense C (Denmark), E-Mail
| | | | - Helle Døssing
- Department of ORL Head and Neck Surgery, Odense University Hospital, Odense, Denmark
| | - Nina Nguyen
- Department of Radiology, Odense University Hospital, Odense, Denmark
| | - Laszlo Hegedüs
- Department of Endocrinology and Metabolism, Odense University Hospital, Odense, Denmark
| | - Steen Joop Bonnema
- Department of Endocrinology and Metabolism, Odense University Hospital, Odense, Denmark
| | - Christian Godballe
- Department of ORL Head and Neck Surgery, Odense University Hospital, Odense, Denmark
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Grani G, Bruno R, Lucisano G, Costante G, Meringolo D, Puxeddu E, Torlontano M, Tumino S, Attard M, Lamartina L, Nicolucci A, Cooper DS, Filetti S, Durante C. Temporal Changes in Thyroid Nodule Volume: Lack of Effect on Paranodular Thyroid Tissue Volume. Thyroid 2017; 27:1378-1384. [PMID: 28806880 DOI: 10.1089/thy.2017.0201] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The term "nodular goiter" has long been used to refer to a nodular thyroid gland, based on the assumption that nodule growth may be associated with hyperplasia of the surrounding non-nodular tissue. The aim of this prospective, multicenter, observational study was to determine whether nodule growth is accompanied by growth in the non-nodular tissue. METHODS Eight Italian thyroid-disease referral centers enrolled 992 consecutive patients with one to four benign nodules. Nodular and non-nodular thyroid tissue volumes were assessed for five years with annual ultrasound examinations. RESULTS In participants whose nodules remained stable (n = 839), thyroid volumes did not change (baseline 15.0 mL [confidence interval (CI) 14.5-15.6]; five-year evaluation 15.1 mL [CI 14.5-15.7]). In participants with significant growth of one or more nodule (n = 153), thyroid volumes increased and by year 5 were significantly greater than those of the former group (17.4 mL [CI 16-18.7]). In 76 individuals with unilateral nodules that grew, the mean nodular lobe volume significantly exceeded that of the contralateral lobe (8.6 mL [CI 7.4-9.8] vs. 6.7 mL [CI 6-7.4]). The unaffected lobe volumes remained stable over time, while nodular lobes grew steadily and were significantly greater at the end of follow-up (10.1 mL [CI 8.9-11.3]). Excluding the volume of the largest growing nodule in these cases, the remaining volume of the affected lobe remained virtually unchanged with respect to its baseline value. Furthermore, there was no significant difference in the non-nodular tissue volume between the unaffected lobe and the affected lobe (with the largest growing nodule volume subtracted), both at baseline and at the end of follow-up. CONCLUSIONS The growth of thyroid nodules is a local process, not associated with growth of the surrounding non-nodular tissue. Therefore, a normal-sized thyroid containing nodules should be referred to as a "uni- or multinodular thyroid gland" and considered a distinct entity from "uni- or multinodular goiter."
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Affiliation(s)
- Giorgio Grani
- 1 Dipartimento di Medicina Interna e Specialità Mediche, Università di Roma Sapienza , Rome, Italy
| | - Rocco Bruno
- 2 Unità di Endocrinologia , Ospedale di Tinchi-Pisticci, Matera, Italy
| | - Giuseppe Lucisano
- 3 Center for Outcomes Research and Clinical Epidemiology , Pescara, Italy
| | - Giuseppe Costante
- 4 Dipartimento di Scienze della Salute, Università di Catanzaro Magna Graecia , Catanzaro, Italy
- 5 Department of Internal Medicine, Institut Jules Bordet Comprehensive Cancer Center , Brussels, Belgium
| | - Domenico Meringolo
- 6 Unità Operativa Semplice Dipartimentale di Endocrinologia , Ospedale di Bentivoglio, Bologna, Italy
| | - Efisio Puxeddu
- 7 Dipartimento di Medicina, Università di Perugia , Perugia, Italy
| | - Massimo Torlontano
- 8 Unità Operativa di Endocrinologia, Istituto di Ricovero e Cura a Carattere Scientifico , Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Salvatore Tumino
- 9 Dipartimento di Scienze Mediche e Pediatriche, Università di Catania , Catania, Italy
| | - Marco Attard
- 10 Unità Operativa di Endocrinologia , Azienda Ospedaliera Ospedali Riuniti Villa Sofia-Cervello, Palermo, Italy
| | - Livia Lamartina
- 1 Dipartimento di Medicina Interna e Specialità Mediche, Università di Roma Sapienza , Rome, Italy
| | - Antonio Nicolucci
- 3 Center for Outcomes Research and Clinical Epidemiology , Pescara, Italy
| | - David S Cooper
- 11 Division of Endocrinology, Diabetes, and Metabolism, The Johns Hopkins University School of Medicine , Baltimore, Maryland
| | - Sebastiano Filetti
- 1 Dipartimento di Medicina Interna e Specialità Mediche, Università di Roma Sapienza , Rome, Italy
| | - Cosimo Durante
- 1 Dipartimento di Medicina Interna e Specialità Mediche, Università di Roma Sapienza , Rome, Italy
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Pustelnik FS, Gronbek C, Døssing H, Nguyen N, Bonnema SJ, Hegedüs L, Godballe C, Sorensen JR. The compensatory enlargement of the remaining thyroid lobe following hemithyroidectomy is small and without impact on symptom relief. Eur Arch Otorhinolaryngol 2017; 275:161-167. [PMID: 29043478 DOI: 10.1007/s00405-017-4777-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 10/11/2017] [Indexed: 10/18/2022]
Abstract
According to previous studies, hemithyroidectomy results in growth of the remaining thyroid lobe by up to 30% in first 12 months after surgery. However, this estimate is based on imprecise methods, high inter- and intra-observer variability, and lack of blinding of the measurements. Furthermore, it is unknown whether enlargement of the remaining hemi-thyroid interferes with the improvement in symptoms after surgery for goiter. We aimed to assess the impact of postoperative thyroid growth on goiter symptom relief following hemithyroidectomy in patients with benign nodular goiter. Outcomes were measured before and 6 months after hemithyroidectomy in 44 patients. Thyroid volumes were determined by two independent and blinded observers using magnetic resonance imaging (MRI). Inter- and intra-observer variability was visualized by Bland-Altman plots. Goiter symptoms were assessed by the Thyroid-Specific Patient-Reported-Outcome Questionnaire (ThyPRO) on a scale from 0 to 100 points. After hemithyroidectomy, the remaining thyroid lobe was 13.7 ± 6.4 mL, and enlarged by a mean of 1.8 mL over 6 months [95% confidence interval (CI) (1.6; 2.1), p < 0.001], corresponding to an increase of 17% [95% CI (12; 22)]. The Goiter Symptom score improved by 27 points [95% CI (21; 34), p < 0.0001] from median 39 points (range 2-86) at baseline, and was unaffected by the compensatory thyroid growth. Six months after hemithyroidectomy, using blinded MRI evaluations, we demonstrated a small but significant postoperative growth of the remaining hemi-thyroid, which did not significantly affect the considerable improvement in goiter symptoms.
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Affiliation(s)
- Frederik Schultz Pustelnik
- Department of ORL Head & Neck Surgery, Odense University Hospital, J.B. Winsløws vej 4, 5000, Odense C, Denmark
| | - Casper Gronbek
- Department of ORL Head & Neck Surgery, Odense University Hospital, J.B. Winsløws vej 4, 5000, Odense C, Denmark
| | - Helle Døssing
- Department of ORL Head & Neck Surgery, Odense University Hospital, J.B. Winsløws vej 4, 5000, Odense C, Denmark
| | - Nina Nguyen
- Department of Radiology, Odense University Hospital, J.B. Winsløws vej 4, 5000, Odense C, Denmark
| | - Steen Joop Bonnema
- Department of Endocrinology, Odense University Hospital, Kløvervænget 6, 5000, Odense C, Denmark
| | - Laszlo Hegedüs
- Department of Endocrinology, Odense University Hospital, Kløvervænget 6, 5000, Odense C, Denmark
| | - Christian Godballe
- Department of ORL Head & Neck Surgery, Odense University Hospital, J.B. Winsløws vej 4, 5000, Odense C, Denmark
| | - Jesper Roed Sorensen
- Department of ORL Head & Neck Surgery, Odense University Hospital, J.B. Winsløws vej 4, 5000, Odense C, Denmark. .,OPEN, Odense Patient Data Explorative Network, Odense University Hospital, 5000, Odense C, Denmark.
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Hu X, Liu Y, Qian L. Diagnostic potential of real-time elastography (RTE) and shear wave elastography (SWE) to differentiate benign and malignant thyroid nodules: A systematic review and meta-analysis. Medicine (Baltimore) 2017; 96:e8282. [PMID: 29068996 PMCID: PMC5671829 DOI: 10.1097/md.0000000000008282] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Real-time elastography (RTE) and shear wave elastography (SWE) are noninvasive and easily available imaging techniques that measure the tissue strain, and it has been reported that the sensitivity and the specificity of elastography were better in differentiating between benign and malignant thyroid nodules than conventional technologies. METHODS Relevant articles were searched in multiple databases; the comparison of elasticity index (EI) was conducted with the Review Manager 5.0. Forest plots of the sensitivity and specificity and SROC curve of RTE and SWE were performed with STATA 10.0 software. In addition, sensitivity analysis and bias analysis of the studies were conducted to examine the quality of articles; and to estimate possible publication bias, funnel plot was used and the Egger test was conducted. RESULTS Finally 22 articles which eventually satisfied the inclusion criteria were included in this study. After eliminating the inefficient, benign and malignant nodules were 2106 and 613, respectively. The meta-analysis suggested that the difference of EI between benign and malignant nodules was statistically significant (SMD = 2.11, 95% CI [1.67, 2.55], P < .00001). The overall sensitivities of RTE and SWE were roughly comparable, whereas the difference of specificities between these 2 methods was statistically significant. In addition, statistically significant difference of AUC between RTE and SWE was observed between RTE and SWE (P < .01). CONCLUSION The specificity of RTE was statistically higher than that of SWE; which suggests that compared with SWE, RTE may be more accurate on differentiating benign and malignant thyroid nodules.
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Affiliation(s)
- Xiangdong Hu
- Department of Ultrasound, Beijing Friendship Hospital, Capital Medical University, Beijing, China
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119
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Sorensen JR, Watt T, Cramon P, Døssing H, Hegedüs L, Bonnema SJ, Godballe C. Quality of life after thyroidectomy in patients with nontoxic nodular goiter: A prospective cohort study. Head Neck 2017; 39:2232-2240. [PMID: 28872214 DOI: 10.1002/hed.24886] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Revised: 04/18/2017] [Accepted: 06/15/2017] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Using the thoroughly validated Thyroid-Related Quality-of-Life Patient-Reported Outcome (ThyPRO) questionnaire, the purpose of this study was to investigate changes in disease-specific quality of life (QOL) after surgical treatment in patients with benign nontoxic multinodular goiters. METHOD Patients with goiters scheduled for thyroid surgery (n = 106) and individuals from the general population (n = 739) were studied. The ThyPRO data before, 3 months, and 6 months after surgery were compared with normative scores from the general population using a linear mixed model and t tests. RESULTS Before surgery, patients with goiters experienced poorer scores on all scales compared to the general population. After surgery, moderate to large improvements were seen in goiter symptoms, tiredness, anxiety, and overall QOL. After surgery, all scales returned to values equal to the general population. The degree of anxiety was, in fact, lower than in the general population. CONCLUSION Thyroid surgery leads to significant benefit among patients with benign nontoxic goiters by restoring QOL equal to that in the general population.
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Affiliation(s)
- Jesper Roed Sorensen
- Department of ORL Head & Neck Surgery, Odense University Hospital, Odense, Denmark
| | - Torquil Watt
- Department of Medical Endocrinology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Per Cramon
- Department of Medical Endocrinology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Helle Døssing
- Department of ORL Head & Neck Surgery, Odense University Hospital, Odense, Denmark
| | - Laszlo Hegedüs
- Department of Endocrinology and Metabolism, Odense University Hospital, Odense, Denmark
| | - Steen Joop Bonnema
- Department of Endocrinology and Metabolism, Odense University Hospital, Odense, Denmark
| | - Christian Godballe
- Department of ORL Head & Neck Surgery, Odense University Hospital, Odense, Denmark.,OPEN, Odense Patient data Explorative Network, Odense University Hospital, Odense, Denmark
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Folkestad L, Brandt F, Brix T, Vogsen M, Bastholt L, Grupe P, Krogh Petersen J, Hegedüs L. Total Thyroidectomy for Thyroid Cancer Followed by Thyroid Storm due to Thyrotropin Receptor Antibody Stimulation of Metastatic Thyroid Tissue. Eur Thyroid J 2017; 6:276-280. [PMID: 29071241 PMCID: PMC5649237 DOI: 10.1159/000479061] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 06/27/2017] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Graves disease (GD) is an autoimmune condition characterized by the presence of antibodies against the thyrotropin receptor (TRAB), which stimulate the thyroid gland to produce excess thyroid hormone. Theoretically, TRAB could stimulate highly differentiated thyroid cancer tissue and/or metastases to produce thyroid hormone. CASE A 68-year-old male, with weight loss and palpitations, was diagnosed with thyrotoxicosis. A later MRI, due to persistent shoulder pain, revealed multiple bone metastases. A biopsy was diagnostic for follicular variant of papillary thyroid carcinoma, and total thyroidectomy was performed. One week after thyroidectomy the patient was admitted with severe hyperthyroidism. TRAB was >40 IU/mL (normal <0.7 IU/mL). High-dose antithyroid drug treatment was followed by high-dose radioactive iodine-131 (RAI) and local radiotherapy covering the right shoulder. Antithyroid drug treatment continued until after the fourth RAI dose. Hypothyroidism did not occur until following the fifth RAI treatment. SUMMARY AND CONCLUSIONS We present a patient initially diagnosed with thyrotoxicosis and subsequently with metastatic follicular variant of papillary thyroid cancer. It is suggested that TRAB stimulated the highly differentiated extrathyroidal metastatic thyroid tissue to produce excessive amounts of thyroid hormone, delayed diagnosis, and potential aggravation of the course of thyroid cancer.
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Affiliation(s)
- Lars Folkestad
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
- Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
- *Lars Folkestad, MD, PhD, Endocrine Elite Research Center, Odense University Hospital, Kløvervænget 10, 6. sal, DK–5000 Odense C (Denmark), E-Mail
| | - Frans Brandt
- Department of Internal Medicine, Hospital of Southern Jutland, Sønderborg, Denmark
| | - Thomas Brix
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
| | - Marianne Vogsen
- Department of Oncology, Odense University Hospital, Odense, Denmark
| | - Lars Bastholt
- Department of Oncology, Odense University Hospital, Odense, Denmark
| | - Peter Grupe
- Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark
| | | | - Laszlo Hegedüs
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
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Liu YJ, Qian LX, Liu D, Zhao JF. Ultrasound-guided microwave ablation in the treatment of benign thyroid nodules in 435 patients. Exp Biol Med (Maywood) 2017; 242:1515-1523. [PMID: 28847173 DOI: 10.1177/1535370217727477] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
The objective of the present study was to investigate the effectiveness and safety of ultrasound-guided microwave ablation in the treatment of benign thyroid nodules. A total of 474 benign thyroid nodules in 435 patients who underwent ultrasound-guided microwave ablation from September 2012 to August 2015 were included. Nodule volume and thyroid function were measured before treatment and at 1, 3, 6, and 12 months and subsequently after every 6 months. The nodule volume reduction rate and changes of thyroid function were evaluated. The volume of all thyroid nodules significantly decreased after ultrasound-guided microwave ablation. The average volume was 13.07 ± 0.95 ml before treatment, and 1.14 ± 0.26 ml at 12-months follow-up. The mean volume reduction rate was 90% and the final volume reduction rate was 94%. The volume reduction rate of mainly cystic nodules was significantly higher than that of simple solid and mainly solid nodules (all P < 0.05). The pretreatment volume of nodules was positively correlated with the final volume reduction rate at final follow-up ( P = 0.004). No serious complications were observed after treatment. In conclusion, ultrasound-guided microwave ablation is an effective and safe technique for treatment of benign thyroid nodules, and has the potential for clinical applications. Impact statement Ultrasound-guided MWA is an effective and safe technique for the treatment of benign thyroid nodules. It can significantly reduce the nodule volume, improve the patients' clinical symptoms, has less complication, guarantees quick recovery, meets patients' aesthetic needs, and shows less interference on the physiological and psychological aspects of the body. MWA should be a good complement to traditional open surgery and has potentials in clinical applications.
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Affiliation(s)
- Yu-Jiang Liu
- Department of Ultrasound, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Lin-Xue Qian
- Department of Ultrasound, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Dong Liu
- Department of Ultrasound, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Jun-Feng Zhao
- Department of Ultrasound, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
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Comparative Efficacy and Toxicity of Different Species of Sargassum in Haizao Yuhu Decoction in PTU-Induced Goiter Rats. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2017; 2017:3526186. [PMID: 28713435 PMCID: PMC5497638 DOI: 10.1155/2017/3526186] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Accepted: 05/18/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND Haizao Yuhu Decoction has been widely used to treat thyroid-related diseases especially goiter with few side effects in traditional Chinese medicine (TCM), including herb pair Sargassum (HZ) and Glycyrrhizae Radix et Rhizoma (GC), as one of "eighteen antagonistic medicaments." The two different species of Sargassum, Sargassum fusiforme (Sf) and Sargassum pallidum (Sp), are not clearly differentiated in clinical use, so that herb pair Sf-GC and Sp-GC could show different effect and toxicity. METHODS We investigated the antigoitrous effect and toxicity and clarified the potential underlying mechanism of the two different species of Sargassum in HYD (HYDf and HYDp) in PTU-reduced goiter rats. RESULTS The results demonstrated that both HYDf and HYDp could exhibit antigoitrous effect through alterations in hypothalamus-pituitary-thyroid (HPT) axis and inhibition of the TPO gene expression; there is no difference in the antigoitrous effects between the two different species of Sargassum application in HYD. CONCLUSION This study evaluated the safety and efficacy of herb pair HZ-GC applied in HYD in goiter rats at molecular, cellular, and whole level and compared the two species of Sargassum further. We provide a reliable way to clarify the possible mechanism of the antagonistic medicament herb pair HZ-GC for its application.
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Zhao CK, Xu HX, Lu F, Sun LP, He YP, Guo LH, Li XL, Bo XW, Yue WW. Factors associated with initial incomplete ablation for benign thyroid nodules after radiofrequency ablation: First results of CEUS evaluation. Clin Hemorheol Microcirc 2017; 65:393-405. [PMID: 27983547 DOI: 10.3233/ch-16208] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Chong-Ke Zhao
- Department of Medical Ultrasound, Shanghai Tenth People’s Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China
- Thyroid Institute, Tongji University School of Medicine, Shanghai, China
- Shanghai Research Center for Thyroid Diseases, Shanghai, China
| | - Hui-Xiong Xu
- Department of Medical Ultrasound, Shanghai Tenth People’s Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China
- Thyroid Institute, Tongji University School of Medicine, Shanghai, China
- Shanghai Research Center for Thyroid Diseases, Shanghai, China
| | - Feng Lu
- Department of Medical Ultrasound, Shanghai Tenth People’s Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China
- Thyroid Institute, Tongji University School of Medicine, Shanghai, China
- Shanghai Research Center for Thyroid Diseases, Shanghai, China
| | - Li-Ping Sun
- Department of Medical Ultrasound, Shanghai Tenth People’s Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China
- Thyroid Institute, Tongji University School of Medicine, Shanghai, China
- Shanghai Research Center for Thyroid Diseases, Shanghai, China
| | - Ya-Ping He
- Department of Medical Ultrasound, Shanghai Tenth People’s Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China
- Thyroid Institute, Tongji University School of Medicine, Shanghai, China
- Shanghai Research Center for Thyroid Diseases, Shanghai, China
| | - Le-Hang Guo
- Department of Medical Ultrasound, Shanghai Tenth People’s Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China
- Thyroid Institute, Tongji University School of Medicine, Shanghai, China
- Shanghai Research Center for Thyroid Diseases, Shanghai, China
| | - Xiao-Long Li
- Department of Medical Ultrasound, Shanghai Tenth People’s Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China
- Thyroid Institute, Tongji University School of Medicine, Shanghai, China
- Shanghai Research Center for Thyroid Diseases, Shanghai, China
| | - Xiao-Wan Bo
- Department of Medical Ultrasound, Shanghai Tenth People’s Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China
- Thyroid Institute, Tongji University School of Medicine, Shanghai, China
- Shanghai Research Center for Thyroid Diseases, Shanghai, China
| | - Wen-Wen Yue
- Department of Medical Ultrasound, Shanghai Tenth People’s Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China
- Thyroid Institute, Tongji University School of Medicine, Shanghai, China
- Shanghai Research Center for Thyroid Diseases, Shanghai, China
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Alexander EK, Pearce EN, Brent GA, Brown RS, Chen H, Dosiou C, Grobman WA, Laurberg P, Lazarus JH, Mandel SJ, Peeters RP, Sullivan S. 2017 Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and the Postpartum. Thyroid 2017; 27:315-389. [PMID: 28056690 DOI: 10.1089/thy.2016.0457] [Citation(s) in RCA: 1323] [Impact Index Per Article: 189.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Thyroid disease in pregnancy is a common clinical problem. Since the guidelines for the management of these disorders by the American Thyroid Association (ATA) were first published in 2011, significant clinical and scientific advances have occurred in the field. The aim of these guidelines is to inform clinicians, patients, researchers, and health policy makers on published evidence relating to the diagnosis and management of thyroid disease in women during pregnancy, preconception, and the postpartum period. METHODS The specific clinical questions addressed in these guidelines were based on prior versions of the guidelines, stakeholder input, and input of task force members. Task force panel members were educated on knowledge synthesis methods, including electronic database searching, review and selection of relevant citations, and critical appraisal of selected studies. Published English language articles were eligible for inclusion. The American College of Physicians Guideline Grading System was used for critical appraisal of evidence and grading strength of recommendations. The guideline task force had complete editorial independence from the ATA. Competing interests of guideline task force members were regularly updated, managed, and communicated to the ATA and task force members. RESULTS The revised guidelines for the management of thyroid disease in pregnancy include recommendations regarding the interpretation of thyroid function tests in pregnancy, iodine nutrition, thyroid autoantibodies and pregnancy complications, thyroid considerations in infertile women, hypothyroidism in pregnancy, thyrotoxicosis in pregnancy, thyroid nodules and cancer in pregnant women, fetal and neonatal considerations, thyroid disease and lactation, screening for thyroid dysfunction in pregnancy, and directions for future research. CONCLUSIONS We have developed evidence-based recommendations to inform clinical decision-making in the management of thyroid disease in pregnant and postpartum women. While all care must be individualized, such recommendations provide, in our opinion, optimal care paradigms for patients with these disorders.
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Affiliation(s)
- Erik K Alexander
- 1 Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital and Harvard Medical School , Boston, Massachusetts
| | - Elizabeth N Pearce
- 2 Section of Endocrinology, Diabetes, and Nutrition, Boston University School of Medicine , Boston, Massachusetts
| | - Gregory A Brent
- 3 Department of Medicine, VA Greater Los Angeles Healthcare System and David Geffen School of Medicine at UCLA , Los Angeles, California
| | - Rosalind S Brown
- 4 Division of Endocrinology, Boston Children's Hospital , Harvard Medical School, Boston, Massachusetts
| | - Herbert Chen
- 5 Department of Surgery, University of Alabama at Birmingham , Birmingham, Alabama
| | - Chrysoula Dosiou
- 6 Division of Endocrinology, Stanford University School of Medicine , Stanford, California
| | - William A Grobman
- 7 Department of Obstetrics and Gynecology, Northwestern University , Chicago, Illinois
| | - Peter Laurberg
- 8 Departments of Endocrinology & Clinical Medicine, Aalborg University Hospital , Aalborg, Denmark
| | - John H Lazarus
- 9 Institute of Molecular Medicine, Cardiff University , Cardiff, United Kingdom
| | - Susan J Mandel
- 10 Division of Endocrinology, Diabetes and Metabolism, Perelman School of Medicine, University of Pennsylvania , Philadelphia, Pennsylvania
| | - Robin P Peeters
- 11 Department of Internal Medicine and Rotterdam Thyroid Center, Erasmus Medical Center , Rotterdam, The Netherlands
| | - Scott Sullivan
- 12 Department of Obstetrics and Gynecology, Medical University of South Carolina , Charleston, South Carolina
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Tang X, Cui D, Chi J, Wang Z, Wang T, Zhai B, Li P. Evaluation of the safety and efficacy of radiofrequency ablation for treating benign thyroid nodules. J Cancer 2017; 8:754-760. [PMID: 28382137 PMCID: PMC5381163 DOI: 10.7150/jca.17655] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 11/27/2016] [Indexed: 01/04/2023] Open
Abstract
Background: Radiofrequency ablation (RFA) is a relatively new procedure for treating benign thyroid nodules. The purpose of this study was to evaluate the safety and efficacy of RFA for treating benign thyroid nodules so as to serve as a reference for future clinical practice. Methods: This study retrospectively analyzed the clinical data of patients receiving percutaneous RFA for treating thyroid nodules from November 2014 to July 2015 in our medical center. One hundred and eight patients with a total of 380 nodules received ultrasound-guided RFA for treating thyroid nodules. Comparisons of the volume change of thyroid nodules before and after RFA treatment, post-treatment complication, and change of thyroid function, were carried out afterwards. Results: Before treatments, all patients received fine needle aspiration biopsy (FNA) which supported the diagnosis of benign tumor. There were 13 males and 95 females included in the study. Twenty-six cases (24.07%) had single nodule, and 82 cases (75.93%) had multiple nodules. Before treatments, the thyroid functions (FT3, FT4, and TSH) were normal originally or adjusted to normal range by endocrinology treatment. The preoperative nodules had minimum volume of 0.01mL, maximum volume of 70.89 mL, and mean volume of 1.02 ± 4.24mL. The volume of nodules one month and three months after RFA were 0.29 ± 0.72mL and 0.15 ± 0.87mL, respectively. In addition, volume reduction ratio (VRR) of nodules one month and three months after RFA were 64.12% and 85.54%, respectively. Both volume of nodules and VRR had statistically significant differences for pre-operative and post-operative comparison (P<0.05). Thyroid functions were in normal range after treatments, and there was no serious complications. Conclusions: Ultrasound-guided RFA treating benign thyroid nodules had the advantages of definite efficacy, safety, strong in control ability, no incision, less damage to surrounding normal tissues and no effect on thyroid function. It can be used as one of the main treatment methods for treating benign thyroid nodules.
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Affiliation(s)
- Xiaoyin Tang
- Department of Interventional Oncology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Dan Cui
- Department of Interventional Oncology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Jiachang Chi
- Department of Interventional Oncology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Zhi Wang
- Department of Interventional Oncology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Tao Wang
- Department of Interventional Oncology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Bo Zhai
- Department of Interventional Oncology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Ping Li
- Department of Interventional Oncology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
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126
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Gong X, Zhou Q, Wang F, Wu W, Chen X. Efficacy and Safety of Ultrasound-Guided Percutaneous Polidocanol Sclerotherapy in Benign Cystic Thyroid Nodules: Preliminary Results. Int J Endocrinol 2017; 2017:8043429. [PMID: 28642791 PMCID: PMC5470016 DOI: 10.1155/2017/8043429] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To evaluate the efficacy and safety of percutaneous polidocanol injection (PPI) in treating cystic thyroid nodules. MATERIALS AND METHODS A total of 158 cystic or predominantly cystic thyroid nodules (>80% cystic component) in 143 patients were evaluated. 114 patients with compressive symptoms or aesthetic complaints were offered PPI. 44 individuals without compressive symptoms and aesthetic complaints who were only followed up clinically were used as the control group. The efficacy and safety of PPI were evaluated for 1 month, 3 months, 6 months, 9 months, and 12 months of follow-up. RESULTS In the PPI group, the mean baseline volume of 15.6 ± 18.9 cm3 reduced at the 1-month follow-up to 5.1 ± 5.6 cm3 (p < 0.001) and 0.6 ± 0.9 (p < 0.001), and nodules shrunk according to the time after PPI (p < 0.001). A complete response (if ≥70% decrease) to PPI at the 12-month follow-up occurred in 100% of the cystic or predominant cystic nodules. None of the nodules recurred at the 12-month follow-up after PPI. The side effects were mild. Twenty patients (17.5%) developed mild localized pain, and fourteen cases (12.3%) experienced mild or moderate fever after PPI. CONCLUSIONS PPI is a safe and effective alternative to treat benign cystic or predominant cystic thyroid nodules.
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Affiliation(s)
- Xiaohua Gong
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of Wenzhou Medical University, Ouhai District, Wenzhou, Zhejiang 325015, China
| | - Qi Zhou
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of Wenzhou Medical University, Ouhai District, Wenzhou, Zhejiang 325015, China
| | - Fang Wang
- Department of Pathology, The First Affiliated Hospital of Wenzhou Medical University, Ouhai District, Wenzhou, Zhejiang 325015, China
| | - Wenjun Wu
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of Wenzhou Medical University, Ouhai District, Wenzhou, Zhejiang 325015, China
- *Wenjun Wu: and
| | - Xiaojun Chen
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of Wenzhou Medical University, Ouhai District, Wenzhou, Zhejiang 325015, China
- *Xiaojun Chen:
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Dauksiene D, Petkeviciene J, Klumbiene J, Verkauskiene R, Vainikonyte-Kristapone J, Seibokaite A, Ceponis J, Sidlauskas V, Daugintyte-Petrusiene L, Norkus A, Zilaitiene B. Factors Associated with the Prevalence of Thyroid Nodules and Goiter in Middle-Aged Euthyroid Subjects. Int J Endocrinol 2017; 2017:8401518. [PMID: 28356911 PMCID: PMC5357546 DOI: 10.1155/2017/8401518] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2016] [Revised: 12/17/2016] [Accepted: 01/04/2017] [Indexed: 01/19/2023] Open
Abstract
The aim of the present study was to determine associations of thyroid hormone levels and different metabolic parameters and anthropometric measurements with volume of nodular and nonnodular thyroid as well as with prevalence of goiter and thyroid nodules in middle-aged euthyroid subjects. Methods. The study consisted of 317 euthyroid subjects aged 48-49 from the Kaunas Cardiovascular Risk Cohort study. Thyroid-stimulating hormone (TSH), free thyroxine (FT4), and antithyroid peroxidase antibody (ATPO) levels, as well as anthropometric and metabolic parameters and smoking information, were evaluated. Results. In subjects with and without thyroid nodules, thyroid volume correlated with components of metabolic syndrome, body mass index (BMI), smoking, and TSH levels. In the nonnodular thyroid group, thyroid volume was also positively related to serum insulin and HOMA-IR, whereas a negative correlation between thyroid volume and leptin was identified in the nodular thyroid group. The goiter was identified in 12.3% of subjects. Female gender, thyroid nodules, smoking, BMI, and levels of TSH were independent predictors for goiter. Thyroid nodules were found in 31.2% of participants. Female gender, higher TSH levels, and thyroid volume were independent risk factors for thyroid nodules. Conclusions. Female gender, thyroid nodules, smoking, BMI, and TSH levels were identified as potential predictors of goiter. Female gender, TSH levels, and thyroid volume predicted the presence of thyroid nodules.
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Affiliation(s)
- Dalia Dauksiene
- Institute of Endocrinology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
- *Dalia Dauksiene:
| | - Janina Petkeviciene
- Faculty of Public Health, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Jurate Klumbiene
- Faculty of Public Health, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Rasa Verkauskiene
- Institute of Endocrinology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | | | - Audrone Seibokaite
- Institute of Endocrinology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Jonas Ceponis
- Institute of Endocrinology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Vygantas Sidlauskas
- Institute of Endocrinology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | | | - Antanas Norkus
- Institute of Endocrinology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Birute Zilaitiene
- Institute of Endocrinology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
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Giovanella L, D'Aurizio F, Campenni' A, Ruggeri RM, Baldari S, Verburg FA, Trimboli P, Ceriani L. Searching for the most effective thyrotropin (TSH) threshold to rule-out autonomously functioning thyroid nodules in iodine deficient regions. Endocrine 2016; 54:757-761. [PMID: 27628737 DOI: 10.1007/s12020-016-1094-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 08/13/2016] [Indexed: 01/08/2023]
Abstract
The purpose of this study is to evaluate the distribution of thyrotropin (TSH) values in patients with autonomously functioning thyroid nodules and to set a TSH threshold above which thyroid scintigraphy would be obviated. Four hundred fifty one patients were included in the present study. Inclusion criteria were age > 18 years, TSH levels between 0.40 and 4.0 mIU/L, detection of a single solid or predominantly solid thyroid nodule >10 mm in the longest diameter. Thyroid ultrasound and thyroid scintigraphy with 99mTc-pertechnetate were performed concurrently in all patients. Among 451 enrolled patients, 173 (38 %) had an autonomously functioning thyroid nodules, of which 137 (79 %) with a normal TSH level. Demographic data and nodules' volume were not significantly different in patients with autonomously functioning thyroid nodules and non-functioning nodules, respectively. However, TSH levels were nonetheless significantly lower in patients with autonomously functioning thyroid nodules compared to those with non-functioning nodules (p < 0.001). Adopting a TSH cutoff level at 2.38 mUI/L, all autonomously functioning thyroid nodules were correctly identified (i.e., 100 % sensitivity) with a 100 % negative predictive value. Our study showed a very high prevalence of autonomously functioning thyroid nodules in mildly iodine-deficient regions and confirmed that serum TSH is not an effective screening test to diagnose an autonomously functioning thyroid nodules. Our data add arguments in favor of the first-line use of thyroid scintigraphy to assess thyroid nodules, at least in iodine deficient areas. As all scintigraphically detected autonomously functioning thyroid nodules had a TSH level below 2.38 mUI/L, a thyroid scintigraphy should be omitted when higher TSH values are found in patients carrying a thyroid nodule.
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Affiliation(s)
- Luca Giovanella
- Deparment of Nuclear Medicine and Thyroid Centre, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland.
- Thyroid Committee - European Association of Nuclear Medicine, Vienna, Austria.
| | - Federica D'Aurizio
- Clinical Pathology Laboratory, Department of Laboratory Medicine, General Hospital "Santa Maria degli Angeli", Pordenone, Italy
| | - Alfredo Campenni'
- Department of Nuclear Medicine, University Hospital Messina, Messina, Italy
| | | | - Sergio Baldari
- Department of Nuclear Medicine, University Hospital Messina, Messina, Italy
| | - Frederik Anton Verburg
- Thyroid Committee - European Association of Nuclear Medicine, Vienna, Austria
- Department of Nuclear Medicine, University Hospital Marburg, Marburg, Germany
| | - Pierpaolo Trimboli
- Deparment of Nuclear Medicine and Thyroid Centre, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Luca Ceriani
- Deparment of Nuclear Medicine and Thyroid Centre, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
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Brusca N, Virili C, Cellini M, Capriello S, Gargano L, Salvatori R, Centanni M, Santaguida MG. Early detection of biochemically occult autonomous thyroid nodules. Eur J Endocrinol 2016; 175:615-622. [PMID: 27647872 DOI: 10.1530/eje-16-0568] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 09/09/2016] [Accepted: 09/19/2016] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Autonomously functioning thyroid areas may be associated with subclinical or overt hyperthyroidism, but may exist even in the presence of normal TSH. This study was aimed at comparing the rate of autonomously functioning areas and their cardiac sequelae in patients with nodular goitre studied with the usual and a novel approach. DESIGN AND METHODS In total 490 adult outpatients with thyroid nodular goitre, living in a mild iodine-deficient area, were selected in our referral centre for thyroid diseases from 2009 to 2014 on the basis of a suspicion of thyroid functional autonomy. They were divided in three groups according to a non-conventional approach (excessive response to thyroxine treatment: group 1) or conventional approach (low/normal TSH with clinical suspicion or low TSH: groups 2 and 3). All patients of the study with the suspicion of thyroid functional autonomy underwent thyroid scan with radioactive iodine (I131) uptake (RAIU). RESULTS The percentage of confirmed thyroid functional autonomy was 319/490, being significantly higher in group 3 than in groups 1 and 2 (81.5 vs 64.7 vs 52.6%; chi-square P < 0.0001). However, the diagnosis with non-conventional approach was made at a significant earlier age (P < 0.0001). Cardiac arrhythmias as well as atrial fibrillation were similarly detected by conventional and non-conventional approaches (chi-square test: P = 0.2537; P = 0.8425). CONCLUSIONS The hyper-responsiveness to thyroxine treatment should induce the suspicion of thyroid functional autonomy at an early stage, allowing to detect autonomous functioning areas in apparently euthyroid patients.
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Affiliation(s)
- N Brusca
- Department of Medico-Surgical Sciences and Biotechnologies'Sapienza' University of Rome, Latina, Italy
| | - C Virili
- Department of Medico-Surgical Sciences and Biotechnologies'Sapienza' University of Rome, Latina, Italy
| | - M Cellini
- Department of Medico-Surgical Sciences and Biotechnologies'Sapienza' University of Rome, Latina, Italy
| | - S Capriello
- Department of Medico-Surgical Sciences and Biotechnologies'Sapienza' University of Rome, Latina, Italy
| | - L Gargano
- Endocrinology UnitAUSL Latina, Latina, Italy
| | - R Salvatori
- Department of Nuclear MedicineAUSL Latina, Latina, Italy
| | - M Centanni
- Department of Medico-Surgical Sciences and Biotechnologies'Sapienza' University of Rome, Latina, Italy
- Endocrinology UnitAUSL Latina, Latina, Italy
| | - M G Santaguida
- Department of Medico-Surgical Sciences and Biotechnologies'Sapienza' University of Rome, Latina, Italy
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Affiliation(s)
- A Frilling
- Department of General Surgery and Transplantation, University Hospital Essen, Essen, Germany.
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131
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Nieto H, Boelaert K. WOMEN IN CANCER THEMATIC REVIEW: Thyroid-stimulating hormone in thyroid cancer: does it matter? Endocr Relat Cancer 2016; 23:T109-T121. [PMID: 27633516 DOI: 10.1530/erc-16-0328] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 09/15/2016] [Indexed: 12/23/2022]
Abstract
Differentiated thyroid cancer is the most common endocrine malignancy and the incidence is increasing rapidly worldwide. Appropriate diagnosis and post-treatment monitoring of patients with thyroid tumours are critical. Fine needle aspiration cytology remains the gold standard for diagnosing thyroid cancer, and although there have been significant refinements to this technique, diagnostic surgery is often required for patients suspected to have malignancy. Serum thyroid-stimulating hormone (TSH) is higher in patients with malignant thyroid nodules than in those with benign disease, and TSH is proportionally increased in more aggressive tumours. Importantly, we have shown that the pre-operative serum TSH concentration independently predicts the presence of malignancy in subjects presenting with thyroid nodules. Establishing the use of TSH measurements in algorithms identifying high-risk thyroid nodules in routine clinical practice represents an exciting, cost-efficient and non-invasive approach to optimise thyroid cancer diagnosis. Binding of TSH to receptors on thyrocytes stimulates a number of growth promoting pathways both in normal and malignant thyroid cells, and TSH suppression with high doses of levothyroxine is routinely used after thyroidectomy to prevent cancer recurrence, especially in high-risk tumours. This review examines the relationship between serum TSH and thyroid cancer and reflects on the clinical potential of TSH measurements in diagnosis and disease monitoring.
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Affiliation(s)
- Hannah Nieto
- Institute of Metabolism and Systems ResearchUniversity of Birmingham, Edgbaston, Birmingham, UK
- Centre for EndocrinologyDiabetes and Metabolism, Birmingham Health Partners, Birmingham, UK
| | - Kristien Boelaert
- Institute of Metabolism and Systems ResearchUniversity of Birmingham, Edgbaston, Birmingham, UK
- Centre for EndocrinologyDiabetes and Metabolism, Birmingham Health Partners, Birmingham, UK
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Mainini AP, Monaco C, Pescatori LC, De Angelis C, Sardanelli F, Sconfienza LM, Mauri G. Image-guided thermal ablation of benign thyroid nodules. J Ultrasound 2016; 20:11-22. [PMID: 28298940 DOI: 10.1007/s40477-016-0221-6] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 08/22/2016] [Indexed: 12/22/2022] Open
Abstract
Benign thyroid nodules are a common disease in the general population. Most often, they are completely asymptomatic and discovered occasionally during routine ultrasound examinations, and do not require any treatment. When thyroid nodules become symptomatic, surgical excision is still considered standard treatment. In the last few years, several experiences in the treatment of benign thyroid nodules through image-guided percutaneous thermal ablation have been reported with encouraging results, so that currently, these treatments are often proposed as first-choice options for patients with symptomatic benign thyroid nodules. In this paper, we discuss the present literature on the topic, focusing on different techniques available for image-guided percutaneous ablation, particularly radiofrequency (RFA), laser (LA), microwave (MWA), and high-intensity-focus ultrasound (HIFU). Little evidence about the efficacy of MWA and HIFU is now available. According to the literature, good results have been obtained with RFA and LA. Regarding RFA, volume reduction after ablative treatment has been found to range from 47 to 84 % at 3-6 months, and from 62 to 93 % at 1 year; LA also seems to be effective in achieving shrinkage of thyroid nodules, with volume reduction from 37 to 81 % at 3-6 months, and from 13 to 82 % at 1-year follow-up. Moreover, applications of advanced image-guidance modality, such as contrast-enhanced ultrasound and virtual navigation with fusion imaging, are discussed.
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Affiliation(s)
- Anna Pisani Mainini
- Scuola di Specializzazione in Radiodiagnostica, Università degli Studi di Milano, Via Festa del Perdono 7, 20122 Milan, Italy
| | - Cristian Monaco
- Scuola di Specializzazione in Radiodiagnostica, Università degli Studi di Milano, Via Festa del Perdono 7, 20122 Milan, Italy
| | - Lorenzo Carlo Pescatori
- Scuola di Specializzazione in Radiodiagnostica, Università degli Studi di Milano, Via Festa del Perdono 7, 20122 Milan, Italy
| | - Chiara De Angelis
- Scuola di Specializzazione in Radiodiagnostica, Università degli Studi di Milano, Via Festa del Perdono 7, 20122 Milan, Italy
| | - Francesco Sardanelli
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Pascal 36, 20100 Milan, Italy.,Unità di Radiologia, IRCCS Policlinico San Donato, Via Morandi 30, San Donato Milanese, 20097 Milan, Italy
| | - Luca Maria Sconfienza
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Pascal 36, 20100 Milan, Italy.,Radiologia/Diagnostica per immagini con servizio di radiologia Interventistica, IRCCS Istituto Ortopedico Galeazzi, via Riccardo Galeazzi 4, 20161 Milan, Italy
| | - Giovanni Mauri
- Dipartimento di Radiologia Interventistica, Istituto Europeo di Oncologia, Via Ripamonti 435, 20100 Milan, Italy
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133
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Papini E, Gugliemi R, Pacella CM. Laser, radiofrequency, and ethanol ablation for the management of thyroid nodules. Curr Opin Endocrinol Diabetes Obes 2016; 23:400-6. [PMID: 27504993 DOI: 10.1097/med.0000000000000282] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE OF REVIEW The majority of benign thyroid nodules are nearly asymptomatic, remain stable in size, and do not require treatment. However, a minority of patients with growing nodules may complain of local symptoms or have cosmetic concerns, and thus seek surgical consultation. RECENT FINDINGS The timely use of ultrasound-guided minimally invasive procedures can change the natural history of benign enlarging thyroid nodules. The procedures produce persistent shrinkage of thyroid nodules and are associated with improvement of local symptoms. Among the various procedures, percutaneous ethanol injection represents the first-line treatment for relapsing thyroid cysts. In solid nonfunctioning nodules, laser and radiofrequency ablation produces a more than 50% reduction in nodular volume that remains persistent over several years. For hyperfunctioning nodules, thermal ablation techniques are not appropriate unless radioactive iodine is contraindicated or not accessible. SUMMARY MITs are best suited for the management of medium or large-sized nodules that are sonographically well visualized. Conversely, large nodules or nodular goiters that extend into the chest are difficult to treat. MITs are performed in outpatient clinics, are less expensive, and have a lower risk of complications, compared to surgery, and usually do not induce thyroid dysfunction. However, malignancy should be ruled out with a dedicated ultrasound neck assessment and repeat fine needle aspiration of the lesion before treatment.
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Affiliation(s)
- Enrico Papini
- aDepartment of Endocrinology and Metabolism bDepartment of Diagnostic Imaging, Regina Apostolorum Hospital, Via San Francesco, Albano, Rome, Italy
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134
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Virili C, Trimboli P, Romanelli F, Centanni M. Liquid and softgel levothyroxine use in clinical practice: state of the art. Endocrine 2016; 54:3-14. [PMID: 27473098 DOI: 10.1007/s12020-016-1035-1] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 06/22/2016] [Indexed: 12/23/2022]
Abstract
Levothyroxine is recognized as the treatment of choice for hypothyroidism. So far, the tablet levothyroxine has been the formulation almost exclusively used, even though an optimal daily dose of levothyroxine has been unsuccessfully sought and a consensus not achieved. Due to progressive use of a more individually tailored levothyroxine dose, increasing evidence has instead displayed that many gastrointestinal disorders, polypharmacy, and food interference may raise the daily levothyroxine requirement. In recent years, alternative levothyroxine formulations have become available and have rapidly gained attention because of their pharmacokinetic properties. This study aims to provide an overview regarding the use of softgel capsule and/or liquid levothyroxine solution while performing a review of published studies about such topic. A comprehensive computer literature search of the PubMed/MEDLINE, Scopus, and Google Scholar databases has been conducted to find published articles on this topic. The search algorithm was based on the combinations of the following terms: "oral solution" or "soft gel" or "liquid", and "levothyroxine". The computer search resulted in 75 articles; through a critical review of such titles and abstracts and a screening of their references lists, the review included 18 original articles relating to 800 patients treated with alternative formulations. Despite some limits, the results obtained using softgel and liquid levothyroxine were consistent with each other. In selected categories of levothyroxine-treated patients (pediatric, suffering from hypo-achlorhydria, polypharmacy, undergone bariatric surgery, fed through enteric tube) these new formulations have shown promising attributes in improving a treatment that needs to be individually tailored.
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Affiliation(s)
- Camilla Virili
- Department of Medico-surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
| | - Pierpaolo Trimboli
- Department of Nuclear Medicine and Thyroid Centre, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Francesco Romanelli
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Marco Centanni
- Department of Medico-surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy.
- Endocrinology Unit, AUSL Latina, Latina, Italy.
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135
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Walsh JP. Managing thyroid disease in general practice. Med J Aust 2016; 205:179-84. [DOI: 10.5694/mja16.00545] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Accepted: 06/20/2016] [Indexed: 01/01/2023]
Affiliation(s)
- John P Walsh
- Sir Charles Gairdner Hospital, Perth, WA
- University of Western Australia, Perth, WA
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136
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Gharib H, Papini E, Garber JR, Duick DS, Harrell RM, Hegedüs L, Paschke R, Valcavi R, Vitti P. AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS, AMERICAN COLLEGE OF ENDOCRINOLOGY, AND ASSOCIAZIONE MEDICI ENDOCRINOLOGI MEDICAL GUIDELINES FOR CLINICAL PRACTICE FOR THE DIAGNOSIS AND MANAGEMENT OF THYROID NODULES--2016 UPDATE. Endocr Pract 2016; 22:622-39. [PMID: 27167915 DOI: 10.4158/ep161208.gl] [Citation(s) in RCA: 692] [Impact Index Per Article: 86.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Thyroid nodules are detected in up to 50 to 60% of healthy subjects. Most nodules do not cause clinically significant symptoms, and as a result, the main challenge in their management is to rule out malignancy, with ultrasonography (US) and fine-needle aspiration (FNA) biopsy serving as diagnostic cornerstones. The key issues discussed in these guidelines are as follows: (1) US-based categorization of the malignancy risk and indications for US-guided FNA (henceforth, FNA), (2) cytologic classification of FNA samples, (3) the roles of immunocytochemistry and molecular testing applied to thyroid FNA, (4) therapeutic options, and (5) follow-up strategy. Thyroid nodule management during pregnancy and in children are also addressed. On the basis of US features, thyroid nodules may be categorized into 3 groups: low-, intermediate-and high-malignancy risk. FNA should be considered for nodules ≤10 mm diameter only when suspicious US signs are present, while nodules ≤5 mm should be monitored rather than biopsied. A classification scheme of 5 categories (nondiagnostic, benign, indeterminate, suspicious for malignancy, or malignant) is recommended for the cytologic report. Indeterminate lesions are further subdivided into 2 subclasses to more accurately stratify the risk of malignancy. At present, no single cytochemical or genetic marker can definitely rule out malignancy in indeterminate nodules. Nevertheless, these tools should be considered together with clinical data, US signs, elastographic pattern, or results of other imaging techniques to improve the management of these lesions. Most thyroid nodules do not require any treatment, and levothyroxine (LT4) suppressive therapy is not recommended. Percutaneous ethanol injection (PEI) should be the first-line treatment option for relapsing, benign cystic lesions, while US-guided thermal ablation treatments may be considered for solid or mixed symptomatic benign thyroid nodules. Surgery remains the treatment of choice for malignant or suspicious nodules. The present document updates previous guidelines released in 2006 and 2010 by the American Association of Clinical Endocrinologists (AACE), American College of Endocrinology (ACE) and Associazione Medici Endocrinologi (AME).
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137
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Baser H, Topaloglu O, Tam AA, Evranos B, Alkan A, Sungu N, Dumlu EG, Ersoy R, Cakir B. Higher TSH can be used as an additional risk factor in prediction of malignancy in euthyroid thyroid nodules evaluated by cytology based on Bethesda system. Endocrine 2016; 53:520-9. [PMID: 26972701 DOI: 10.1007/s12020-016-0919-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 03/07/2016] [Indexed: 10/22/2022]
Abstract
Recently, it has been suggested that thyrotropin (TSH) concentration can be used as a marker for prediction of thyroid malignancy. In this study, we aimed to investigate the association between TSH levels and prediction of malignancy in euthyroid patients with different Bethesda categories. The data of 1433 euthyroid patients with 3206 thyroid nodules who underwent thyroidectomy were screened retrospectively. The preoperative cytology results, thyroid function tests, thyroid autoantibodies, and presence of histopathological Hashimoto's thyroiditis (HT) were recorded. Of the 1433 patients, 585 (40.8 %) had malignant and 848 (59.2 %) had benign histopathology. Malignant group had smaller nodule size, elevated TSH levels, and higher rate of presence of HT compared to benign group (p < 0.001, all). Cytology results of 3206 nodules were as follows: 832 nondiagnostic (ND), 1666 benign, 392 atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS), 68 follicular neoplasm/suspicious for follicular neoplasm (FN/SFN), 133 suspicious for malignancy (SM), and 115 malignant. Both SM and malignant cytology groups had higher TSH levels than other 4 Bethesda categories (p < 0.05, all). Benign cytology group had significantly lower TSH levels compared to other cytology groups (p < 0.05, all). Patients with malignant final histopathology in ND and AUS/FLUS cytology groups had significantly higher TSH levels compared to patients with benign final histopathology (p < 0.05, all). Moreover, TSH levels showed to increase from Bethesda categories II to VI. In addition to cytology, higher TSH levels can be used as a supplementary marker in prediction of malignancy in certain Bethesda categories.
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Affiliation(s)
- Husniye Baser
- Department of Endocrinology and Metabolism, Ataturk Education and Research Hospital, Ovecler, 1297 Sokak, No: 1/22, 06460, Ankara, Turkey.
| | - Oya Topaloglu
- Department of Endocrinology and Metabolism, Faculty of Medicine, Yildirim Beyazit University, Ankara, Turkey
| | - Abbas Ali Tam
- Department of Endocrinology and Metabolism, Faculty of Medicine, Yildirim Beyazit University, Ankara, Turkey
| | - Berna Evranos
- Department of Endocrinology and Metabolism, Ataturk Education and Research Hospital, Ovecler, 1297 Sokak, No: 1/22, 06460, Ankara, Turkey
| | - Afra Alkan
- Department of Biostatistics, Faculty of Medicine, Yildirim Beyazit University, Ankara, Turkey
| | - Nuran Sungu
- Department of Pathology, Faculty of Medicine, Yildirim Beyazit University, Ankara, Turkey
| | - Ersin Gurkan Dumlu
- Department of General Surgery, Faculty of Medicine, Yildirim Beyazit University, Ankara, Turkey
| | - Reyhan Ersoy
- Department of Endocrinology and Metabolism, Faculty of Medicine, Yildirim Beyazit University, Ankara, Turkey
| | - Bekir Cakir
- Department of Endocrinology and Metabolism, Faculty of Medicine, Yildirim Beyazit University, Ankara, Turkey
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138
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Hegedüs L. Down-sizing the overzealous search for low-risk thyroid malignancy. Endocrine 2016; 52:408-10. [PMID: 27083176 DOI: 10.1007/s12020-016-0954-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 04/06/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Laszlo Hegedüs
- Department of Endocrinology and Metabolism, Odense University Hospital, 5000, Odense C, Denmark.
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139
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Moreno-Reyes R, Kyrilli A, Lytrivi M, Bourmorck C, Chami R, Corvilain B. Is there still a role for thyroid scintigraphy in the workup of a thyroid nodule in the era of fine needle aspiration cytology and molecular testing? F1000Res 2016; 5. [PMID: 27158470 PMCID: PMC4850874 DOI: 10.12688/f1000research.7880.1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/20/2016] [Indexed: 01/01/2023] Open
Abstract
Thyroid scintigraphy is now rarely used in the work-up of a thyroid nodule except in the presence of a low TSH value. Therefore, autonomously functioning thyroid nodules (AFTNs) with a normal TSH value are diagnosed only in the rare medical centers that continue to use thyroid scan systematically in the presence of a thyroid nodule. In this review, we discuss the prevalence of AFTN with a normal TSH level and the possible consequences of performing fine needle aspiration cytology (FNAC) in an undiagnosed AFTN. We also discuss the risk of malignant AFTN which may be higher than previously stated.
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Affiliation(s)
- Rodrigo Moreno-Reyes
- Department of Nuclear Medicine, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Aglaia Kyrilli
- Department of Endocrinology, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Maria Lytrivi
- Department of Endocrinology, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Carole Bourmorck
- Department of Endocrinology, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Rayan Chami
- Department of Endocrinology, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Bernard Corvilain
- Department of Endocrinology, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
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140
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Sun D, Han S, Liu C, Zhou R, Sun W, Zhang Z, Qu J. Microrna-199a-5p Functions as a Tumor Suppressor via Suppressing Connective Tissue Growth Factor (CTGF) in Follicular Thyroid Carcinoma. Med Sci Monit 2016; 22:1210-7. [PMID: 27062921 PMCID: PMC4830201 DOI: 10.12659/msm.895788] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background The objective of this study was to explore the role of miR-199a-5p in the development of thyroid cancer, including its anti-proliferation effect and downstream signaling pathway. Material/Methods We conducted qRT-PCR analysis to detect the expressions of several microRNAs in 42 follicular thyroid carcinoma patients and 42 controls. We identified CTGF as target of miR-491, and viability and cell cycle status were determined in FTC-133 cells transfected with CTGF siRNA, miR-199a mimics, or inhibitors. Results We identified an underexpression of miR-199a-5p in follicular thyroid carcinoma tissue samples compared with controls. Then we confirmed CTGF as a target of miR-199a-5p thyroid cells by using informatics analysis and luciferase reporter assay. Additionally, we found that mRNA and protein expression levels of CTGF were both clearly higher in malignant tissues than in benign tissues. miR-199a-5p mimics and CTGF siRNA similarly downregulated the expression of CTGF, and reduced the viability of FTC-133 cells by arresting the cell cycle in G0 phase. Transfection of miR-199a-5p inhibitors increased the expression of CTGF and promoted the viability of the cells by increasing the fraction of cells in G2/M and S phases. Conclusions Our study proves that the CTGF gene is a target of miR-199a-5p, demonstrating the negatively related association between CTGF and miR-199a. These findings suggest that miR-199a-5p might be a novel therapeutic target in the treatment of follicular thyroid carcinoma.
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Affiliation(s)
- Dawei Sun
- Thyroid Department of Affiliated Hospital of Qingdao University, Qingdao Key Laboratory of Thyroid Diseases, Qingdao, Shandong, China (mainland)
| | - Shen Han
- , Guizhou Tongren Vocational and Technical College of Pharmaceutical Sciences, Guizhou, China (mainland)
| | - Chao Liu
- Department of General Surgery, People's Hospital of Zhangqiu City, Jinan, Shandong, China (mainland)
| | - Rui Zhou
- , Teaching and Research Section of Medicine and Health Management of Medical College of Qingdao University, Qingdao, Shandong, China (mainland)
| | - Weihai Sun
- Thyroid Department of Affiliated Hospital of Qingdao University, Qingdao Key Laboratory of Thyroid Diseases, Qingdao, Shandong, China (mainland)
| | - Zhijun Zhang
- , Linzi District of Zibo City People's Hospital of Hepatobiliary Surgery, Zibo, Shangdong, China (mainland)
| | - Jianjun Qu
- Department of Oncology, Weifang People's Hospital, Weifang, Shandong, China (mainland)
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141
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Knobel M. Etiopathology, clinical features, and treatment of diffuse and multinodular nontoxic goiters. J Endocrinol Invest 2016; 39:357-73. [PMID: 26392367 DOI: 10.1007/s40618-015-0391-7] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Accepted: 09/11/2015] [Indexed: 10/23/2022]
Abstract
Goiter, an enlargement of the thyroid gland, is a common problem in clinical practice associated with iodine deficiency, increase in serum thyroid-stimulating hormone (TSH) level, natural goitrogens, smoking, and lack of selenium and iron. Evidence suggests that heredity also has an important role in the etiology of goiter. The current classification divides goiter into diffuse and nodular, which may be further subdivided into toxic (associated with symptoms of hyperthyroidism, suppressed TSH or both), or nontoxic (associated with a normal TSH level). Nodular thyroid disease with the presence of single or multiple nodules requires evaluation due to the risk of malignancy, toxicity, and local compressive symptoms. Measurement of TSH, accurate imaging with high-resolution ultrasonography or computed tomography, and fine-needle aspiration biopsy are the appropriate methods for evaluation and management of goiter. This review discusses the clinical presentation, diagnostic evaluation, and treatment considerations of nontoxic diffuse and nodular goiters.
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Affiliation(s)
- M Knobel
- Thyroid Unit, Division of Endocrinology and Metabolism, Hospital das Clínicas, University of São Paulo Medical School, Av. Dr. Enéas de Carvalho Aguiar, 155 - 8th floor, bl 3, PAMB, São Paulo, 05403-900, Brazil.
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142
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Aysan E, Idiz UO, Akbulut H, Elmas L. Single-session radiofrequency ablation on benign thyroid nodules: a prospective single center study : Radiofrequency ablation on thyroid. Langenbecks Arch Surg 2016; 401:357-63. [PMID: 27013327 DOI: 10.1007/s00423-016-1408-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2015] [Accepted: 03/14/2016] [Indexed: 10/22/2022]
Abstract
PURPOSE The activity of the application of single-session ultrasonography (US)-guided percutaneous radio frequency ablation (RFA) in benign thyroid nodules was investigated in this prospective clinical study. METHODS RFA treatment was applied to 100 nodules in 100 patients (78 women, 22 men; average age 44.5 years old; age range 18-71) who had euthyroid condition, nodule size larger than 1 cm in the ultrasonography, proven to be benign by fine needle aspiration cytology. The nodules were separated into three groups according to the content: solid, cystic and mixed. In first 73 cases, the process performed under local anesthesia and the other 27 cases were performed under general anesthesia. RFA process was standardized to 70 W in all of the patients, and a moving shot technique was used. The results acquired in the third and sixth months of the controls were evaluated, and the volume of the nodules was screened. RESULTS No differences between the thyroid function tests performed before and after RFA were detected (p > 0.05). The mean volume of the nodules before the process, in the third month after the process, and in the sixth month were 16.8, 4.8, and 2.6 ml, respectively (p < 0.001). The decrease in cystic nodules was greater than solid and mixed structures. Temporary hoarseness occurred in one case and skin edema was detected in a patient at the isthmus. CONCLUSIONS RFA is an option for treatment, with minimal invasiveness and a low complication rate, and it is effective primarily in cases with benign nodules and nodular goiter. In cases with good compliance, the likelihood of success is greater. General anesthesia can be a good option for anxious cases to gather better results.
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Affiliation(s)
- Erhan Aysan
- Department of General Surgery, Bezmialem Vakif University, Faculty of Medicine, Fatih, Istanbul, Turkey
| | - Ufuk Oguz Idiz
- Department of General Surgery, Bezmialem Vakif University, Faculty of Medicine, Fatih, Istanbul, Turkey. .,Sisli Etfal Training and Research Hospital, Department of General Surgery, Istanbul, Turkey.
| | - Huseyin Akbulut
- Department of General Surgery, Bezmialem Vakif University, Faculty of Medicine, Fatih, Istanbul, Turkey
| | - Leyla Elmas
- Department of General Surgery, Bezmialem Vakif University, Faculty of Medicine, Fatih, Istanbul, Turkey
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143
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Colchicum autumnale in Patients with Goitre with Euthyroidism or Mild Hyperthyroidism: Indications for a Therapeutic Regulative Effect-Results of an Observational Study. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2016; 2016:2541912. [PMID: 26955394 PMCID: PMC4756131 DOI: 10.1155/2016/2541912] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Revised: 12/22/2015] [Accepted: 12/30/2015] [Indexed: 11/18/2022]
Abstract
Introduction. Goitre with euthyroid function or with subclinical or mild hyperthyroidism due to thyroid autonomy is common. In anthroposophic medicine various thyroid disorders are treated with Colchicum autumnale (CAU). We examined the effects of CAU in patients with goitre of both functional states. Patients and methods. In an observational study, 24 patients with goitre having suppressed thyroid stimulating hormone (TSH) levels with normal or slightly elevated free thyroxine (fT4) and free triiodothyronine (fT3) (group 1, n = 12) or normal TSH, fT3, and fT4 (group 2, n = 12) were included. After 3 months and after 6 to 12 months of CAU treatment, we investigated clinical pathology using the Hyperthyroid Symptom Scale (HSS), hormone status (TSH, fT4, and fT3), and thyroidal volume (tV). Results. After treatment with CAU, in group 1 the median HSS decreased from 4.5 (2.3–11.8) to 2 (1.3–3) (p < 0.01) and fT3 decreased from 3.85 (3.5–4.78) to 3.45 (3.3–3.78) pg/mL (p < 0.05). In group 2 tV (13.9% (18.5%–6.1%)) and TSH (p < 0.01) were reduced. Linear regression for TSH and fT3 in both groups indicated a regulative therapeutic effect of CAU. Conclusions. CAU positively changed the clinical pathology of subclinical hyperthyroidism and thyroidal volume in patients with euthyroid goitre by normalization of the regulation of thyroidal hormones.
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144
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Ferreira MC, Piaia C, Cadore AC. Percutaneous ethanol injection versus conservative treatment for benign cystic and mixed thyroid nodules. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2016; 60:211-6. [PMID: 26910622 PMCID: PMC10522299 DOI: 10.1590/2359-3997000000120] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2015] [Accepted: 09/09/2015] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To evaluate the efficacy and safety of percutaneous ethanol injection (PEI) in reducing the volume of cystic and mixed thyroid nodules. MATERIALS AND METHODS A total of 36 patients with nodules treated with PEI and 13 individuals who declined PEI and were followed clinically or received other non surgical treatment (control group). Assessments were performed at baseline (immediately before treatment in the PEI group or evaluation of the nodule on ultrasonography in the control group) at short-term (on average 30 days after the last injection in the PEI group), and long-term (on average 14 months after baseline in the PEI group or 26 months after baseline in the control group). RESULTS In the PEI group, the mean baseline volume of 10.4 ± 9.8 cm3 reduced at short-term follow-up to 2.9 ± 3.1 cm3 (67.7 ± 19.9%, p < 0.001) and at long-term follow-up to 2.0 ± 2.5 cm3 (78.2 ± 19.5%, p < 0.01 versus baseline and p = 0.009 versus short-term follow-up). Both types of nodules showed similar degrees of reduction. In the control group, mean volume was 5.8 ± 3.4 cm3 at baseline and 6.2 ± 3.0 cm3 at long-term follow-up (p = 0.507). Compared with the control group, the PEI group showed larger reduction (p < 0.001). CONCLUSIONS PEI is effective in reducing the volume of cystic and mixed benign thyroid nodules, with sustained long-term efficacy and better outcome when compared with conservative therapies. Treatment with PEI is a safe alternative, with minimal, transient and self-limited adverse events.
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Affiliation(s)
- Mari Cassol Ferreira
- Faculdade de Medicina da Universidade de São PauloLaboratório de Carboidratos LIM-18Faculdade de Medicina da Universidade de São Paulo (FMUSP), Laboratório de Carboidratos LIM-18;
- Universidade Comunitária da Região de ChapecóChapecóSCBrasilUniversidade Comunitária da Região de Chapecó (Unochapecó), Chapecó, SC, Brasil
| | - Camila Piaia
- Universidade Comunitária da Região de ChapecóChapecóSCBrasilUniversidade Comunitária da Região de Chapecó (Unochapecó), Chapecó, SC, Brasil
| | - Ana Carolina Cadore
- Universidade Comunitária da Região de ChapecóChapecóSCBrasilUniversidade Comunitária da Região de Chapecó (Unochapecó), Chapecó, SC, Brasil
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145
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Knobel M. Which Is the Ideal Treatment for Benign Diffuse and Multinodular Non-Toxic Goiters? Front Endocrinol (Lausanne) 2016; 7:48. [PMID: 27242669 PMCID: PMC4876491 DOI: 10.3389/fendo.2016.00048] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Accepted: 05/11/2016] [Indexed: 11/30/2022] Open
Abstract
Patients with large benign goiters often present local compressive symptoms that require surgical treatment, including dysphagia, neck tightness, and airway obstruction. In contrast, patients with such goiters who remain asymptomatic may be observed after exclusion of malignancy. The use of levothyroxine (LT4) to reduce the volume of the goiter is still a controversial treatment for large goiters, and the optimal surgical procedure for multinodular goiter is still debatable. Radioiodine is a safe and effective treatment option when used alone or in combination with recombinant human TSH. This review discusses current therapeutic options to treat diffuse and multinodular non-toxic benign goiters.
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Affiliation(s)
- Meyer Knobel
- Thyroid Unit, Division of Endocrinology and Metabolism, University of São Paulo Medical School, Hospital das Clínicas, São Paulo, Brazil
- *Correspondence: Meyer Knobel,
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146
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Ultrasonography of thyroid nodules: a pictorial review. Insights Imaging 2015; 7:77-86. [PMID: 26611469 PMCID: PMC4729706 DOI: 10.1007/s13244-015-0446-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2015] [Revised: 10/15/2015] [Accepted: 10/21/2015] [Indexed: 12/27/2022] Open
Abstract
Abstract Thyroid nodules are a common occurrence in the general population, and these incidental thyroid nodules are often referred for ultrasound (US) evaluation. US provides a safe and fast method of examination. It is sensitive for the detection of thyroid nodules, and suspicious features can be used to guide further investigation/management decisions. However, given the financial burden on the health service and unnecessary anxiety for patients, it is unrealistic to biopsy every thyroid nodule to confirm diagnosis. The British Thyroid Association (BTA) has recently produced a US classification (U1–U5) of thyroid nodules to facilitate the decision-making process regarding the need to perform fine-needle aspiration cytology (FNAC) for suspicious cases. In this pictorial review, we provide a complete series of sonographic images to illustrate benign and malignant features of thyroid nodules according to the U1–5 classification. Specifically, we highlight morphologic characteristic of the nodule, including its echo signal in relation to its consistency, nodular size, number and contour. Additional diagnostic features such as halo, colloid, calcification and vascular patterns are also discussed in detail. The aim is to assist radiologists and clinicians in recognising sonographic patterns of benign, suspicious and malignant nodules based on U1–5 criteria, and in planning for further investigations. Main messages • Ultrasound is sensitive in identifying suspicious features, which require aspiration. • Whether nodules require aspiration should be based on sonographic features and clinical findings. • U1–5 classification of sonographic findings can help determine whether aspiration is necessary.
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147
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Bougacha-Elleuch N, Charfi N, Miled N, Bouhajja H, Belguith N, Mnif M, Jaurge P, Chikhrouhou N, Ayadi H, Hachicha M, Abid M. Segregation of S292F TPO gene mutation in three large Tunisian families with thyroid dyshormonogenesis: evidence of a founder effect. Eur J Pediatr 2015; 174:1491-501. [PMID: 25968604 DOI: 10.1007/s00431-015-2550-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Revised: 04/10/2015] [Accepted: 04/14/2015] [Indexed: 11/28/2022]
Abstract
UNLABELLED We aimed to identify causal mutation(s) in 13 patients with thyroid dyshormonogenesis (TD) from three consanguineous Tunisian families. A 12-year clinical follow-up showed phenotypic variability ranging from the presence to the absence of goiter, sensorineural deafness, and mental retardation. Genetic analysis using microsatellite markers within two candidate genes (TPO and PDS) gave evidence of linkage with the TPO gene. Sequencing of its 17 exons and their flanking intron-exon junctions revealed the previously described c.875C>T (p.S292F) mutation in homozygous state. No additional mutations were found in either a 900 bp of the TPO gene promoter or PDS gene. In silico analysis showed that p.S292F mutation might reduce the catalytic cavity of the TPO which would restrict access of a potential substrate to the catalytic pocket. Using 4SNPs and one microsatellite marker in the TPO gene, an associated haplotype: G-C-G-G-214 was found, giving evidence of a founder mutation. CONCLUSION This is the first description of a TD causing mutation in Tunisia and thus may help to develop a genetic screening protocol for congenital hypothyroidism in the studied region. Although structural modeling suggested a pathogenic effect of this mutation, functional studies are needed. Additional causing and/or modifier genes, together with late diagnosis could explain the clinical variability observed in our patients.
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Affiliation(s)
- Noura Bougacha-Elleuch
- Unité Cibles pour le Diagnostic et la Thérapie, Centre de Biotechnologie Sfax, BP 1177, 3018, Sfax, Tunisia.
| | - Nadia Charfi
- Service d'Endocrinologie, CHU Hédi Chaker, Sfax, Tunisia
| | - Nabil Miled
- Laboratoire de Biochimie et de Génie Enzymatique des Lipases, Ecole Nationale d'Ingénieurs de Sfax, Route Soukra BP W, Sfax, Tunisia
| | - Houda Bouhajja
- Unité Cibles pour le Diagnostic et la Thérapie, Centre de Biotechnologie Sfax, BP 1177, 3018, Sfax, Tunisia
| | - Neila Belguith
- Laboratoire de Génétique Moléculaire Humaine, Faculté de Médecine, Sfax, Tunisia
| | - Mouna Mnif
- Service d'Endocrinologie, CHU Hédi Chaker, Sfax, Tunisia
| | - Paula Jaurge
- Unidade de Genética Molecular, Centro de Genética Médica Doutor Jacinto Magalhães, Centro Hospitalar do Porto, Porto, Portugal.,Unit for Multidisciplinary Research in Biomedicine, UMIB, ICBAS-UP, Porto, Portugal
| | | | - Hammadi Ayadi
- Unité Cibles pour le Diagnostic et la Thérapie, Centre de Biotechnologie Sfax, BP 1177, 3018, Sfax, Tunisia
| | | | - Mohamed Abid
- Service d'Endocrinologie, CHU Hédi Chaker, Sfax, Tunisia
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148
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Lee YY, Tam KW, Lin YM, Leu WJ, Chang JC, Hsiao CL, Hsu MT, Hsieh AT. Recombinant human thyrotropin before (131)I therapy in patients with nodular goitre: a meta-analysis of randomized controlled trials. Clin Endocrinol (Oxf) 2015; 83:702-10. [PMID: 25370124 DOI: 10.1111/cen.12654] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Revised: 09/10/2014] [Accepted: 10/29/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Recombinant human thyrotropin (rhTSH) can be used to enhance radioiodine therapy for shrinking multinodular goitre. The aim of this meta-analysis was to compare the effectiveness of rhTSH pretreatment and radioiodine therapy with that of radioiodine alone for treating benign nodular goitre. METHODS The PubMed, EMBASE, Cochrane Library, Scopus and ClinicalTrials.gov databases were searched to identify studies published before September 2014. A meta-analysis was performed to calculate the pooled effect size using random-effects models. The primary outcome was the reduction in thyroid volume. Secondary outcomes included thyroid function, extent of tracheal compression, radioactive iodine uptake, incidence of hypothyroidism and other complications. RESULTS Nine RCTs including 416 patients were selected. The reductions in thyroid volume were significantly greater in the rhTSH pretreatment groups than those in the radioiodine alone groups at 12 months (weighted mean difference: 14·42%; 95% CI: 4·51-24·34% in high-dose rhTSH vs radioiodine alone; weighted mean difference: 19·66%; 95% CI: 3·67-35·65% in low-dose rhTSH vs radioiodine alone). The incidence of hypothyroidism in the high-dose rhTSH groups was significantly higher than that in the radioiodine alone groups. No significant difference in the incidence of hypothyroidism occurred between the low-dose rhTSH groups and the radioiodine alone groups. CONCLUSIONS The overall results indicated that using rhTSH before radioiodine therapy resulted in a greater thyroid volume reduction than radioiodine therapy alone. An increased incidence of hypothyroidism was observed in patients receiving high-dose rhTSH. Low-dose rhTSH before radioiodine therapy is more efficacious than radioiodine therapy alone for treating nontoxic benign thyroid nodules.
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Affiliation(s)
- Yen-Ying Lee
- Department of Pharmacy, Taipei Medical University - Shuang Ho Hospital, New Taipei City, Taiwan
- College of Pharmacy, Taipei Medical University, Taipei, Taiwan
| | - Ka-Wai Tam
- Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Division of General Surgery, Department of Surgery, Taipei Medical University - Shuang Ho Hospital, New Taipei City, Taiwan
- Center for Evidence-Based Medicine, Taipei Medical University, Taipei, Taiwan
| | - You-Meei Lin
- Department of Pharmacy, Taipei Medical University - Shuang Ho Hospital, New Taipei City, Taiwan
- College of Pharmacy, Taipei Medical University, Taipei, Taiwan
| | - Wuan-Jin Leu
- Department of Pharmacy, Taipei Medical University - Shuang Ho Hospital, New Taipei City, Taiwan
- College of Pharmacy, Taipei Medical University, Taipei, Taiwan
| | - Jui-Chia Chang
- Department of Pharmacy, Taipei Medical University - Shuang Ho Hospital, New Taipei City, Taiwan
- College of Pharmacy, Taipei Medical University, Taipei, Taiwan
| | - Chi-Lien Hsiao
- Department of Pharmacy, Taipei Medical University - Shuang Ho Hospital, New Taipei City, Taiwan
| | - Meng-Ting Hsu
- Department of Pharmacy, Taipei Medical University - Shuang Ho Hospital, New Taipei City, Taiwan
| | - An-Tsz Hsieh
- Division of Endocrinology & Metabolism, Department of Internal Medicine, Taipei Medical University - Shuang Ho Hospital, New Taipei City, Taiwan
- Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
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149
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Kaniuka-Jakubowska S, Piskunowicz M, Zapaśnik A, Lewczuk A, Kaniuka A, Mizan-Gross K, Kaszubowski M, Lass P, Sworczak K. US not bright but right method of thyroid volume estimation even in large and substernal extended goitres. Comparison of US and three methods of CT thyroid evaluation – prospective study. Clin Endocrinol (Oxf) 2015; 83:412-9. [PMID: 25308831 DOI: 10.1111/cen.12629] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Revised: 07/04/2014] [Accepted: 10/06/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Ultrasound is nowadays a method of choice for thyroid volume assessment. However, its disadvantage is some inaccuracy, which is said to be higher in huge, especially substernally extended goitres. AIMS The aim of the study was to compare the US and CT thyroid volumetric measurements: multi-observers (CT MO) and one-observer (CT OO) to CT planimetry results (CT Pl) in patients with large goitres. MATERIALS & METHODS The study material comprised 70 thyroid imaging examinations obtained from 35 patients with nontoxic goitres, scanned twice before and after radioiodine treatment. Mean thyroid volume was 88·97 ± 60·21 ml. Thirty-three thyroid scans revealed the extension below the jugular notch (mean of 2·46 cm). Thyroid volume in US, CT MO and CT OO was estimated using the ellipsoid formula. CT Pl was established a reference method. RESULTS The mean thyroid volume in CT Pl was 88·97 ml (median 80·73, range 11·81 to 315·97). US underestimates thyroid volume by 7·55 ml (7·7%) with a sufficient correlation (R(2) = 0·89) and precision (20·37). CT OO is the closest and CT MO the most distant from CT Pl, with US between them in thyroid volume estimation. The percentage US bias is constant through all range of thyroid volume. There is no difference for percentage bias between US and CT Pl for goitres with (8·67%), and without (6·70%) substernal part. CONCLUSION US examination is sufficient for epidemiological studies, radioiodine activity calculation and goitre size assessment in everyday medical practice. Neither initial size of the goitre nor its substernal extension affects US assessment precision.
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Affiliation(s)
| | | | - Adam Zapaśnik
- Department of Radiology, Medical University of Gdansk, Gdansk, Poland
| | - Anna Lewczuk
- Department of Endocrinology and Internal Medicine, Medical University of Gdansk, Gdansk, Poland
| | - Aneta Kaniuka
- Department of Diagnostic Imaging and Interventional Radiology, Pomeranian Medical University, Szczecin, Poland
| | | | - Mariusz Kaszubowski
- Department of Economic Sciences, Faculty of Management and Economics, Gdansk University of Technology, Gdansk, Poland
| | - Piotr Lass
- Department of Nuclear Medicine, Medical University of Gdansk, Gdansk, Poland
| | - Krzysztof Sworczak
- Department of Endocrinology and Internal Medicine, Medical University of Gdansk, Gdansk, Poland
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150
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Del Duca SC, Santaguida MG, Brusca N, Gatto I, Cellini M, Gargano L, Verga Falzacappa C, Frattaroli FM, Virili C, Centanni M. Individually-tailored thyroxine requirement in the same patients before and after thyroidectomy: a longitudinal study. Eur J Endocrinol 2015; 173:351-7. [PMID: 26092761 DOI: 10.1530/eje-15-0314] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Accepted: 06/15/2015] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Thyroxine (T4) requirement after total thyroidectomy for differentiated thyroid carcinoma (DTC) is a debated issue. As most of the studies in the area have been retrospective and/or performed with heterogeneous therapeutic approaches, we designed our study to determine T4 requirement in the same patients and treatment settings, before and after total thyroidectomy. DESIGN, PATIENTS AND METHODS This was a longitudinal study including 23 goitrous patients treated with T4 in an individually tailored fashion. All patients exhibited a stable TSH (median TSH = 0.28 mU/l) at a stable T4 dose for at least 1 year before surgery (median T4 dose = 1.50 μg/kg per day). The patients underwent total thyroidectomy based on cancer suspicion or compressive symptoms. Eventually diagnosed as having DTC (pT1b-pT2N0) and following surgical and radiometabolic treatment, they were treated with the same pre-surgical doses of T4. RESULTS Three months after surgery,using the same pre-surgical dose, median TSH increased up to 5.38 mU/l (P<0.0001) and so the T4 dose had to be increased (median T4 dose = 1.95 μg/kg per day; +30%; P < 0.0001). Once divided by patients' age, we observed that, after thyroidectomy and maintaining the same pre-surgical dose, serum TSH significantly increased both in younger and in older patients (median TSH = 4.57 and 6.11 mU/l respectively). Serum TSH was restored to the pre-surgical level by increasing the dose up to 1.95 and 1.77 μg/kg per day (+25 and +21%) respectively. CONCLUSIONS Following the same treatment regimen, a thyroidectomized patient requires one-third higher therapeutic T4 dose than before surgery. Despite this increase, the dose of T4 needed in our patients remains significantly lower than that previously described in athyreotic patients.
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Affiliation(s)
- S C Del Duca
- Department of Medico-Surgical Sciences and Biotechnologies'Sapienza' University of Rome, Corso della Repubblica 79, 04100 Latina, ItalyDepartment of Surgical Specialties and Organ Transplantation 'P. Stefanini'Policlinico Umberto I, 'Sapienza' University of Rome, Rome, ItalyEndocrinology UnitAUSL Latina, Latina, Italy
| | - M G Santaguida
- Department of Medico-Surgical Sciences and Biotechnologies'Sapienza' University of Rome, Corso della Repubblica 79, 04100 Latina, ItalyDepartment of Surgical Specialties and Organ Transplantation 'P. Stefanini'Policlinico Umberto I, 'Sapienza' University of Rome, Rome, ItalyEndocrinology UnitAUSL Latina, Latina, Italy
| | - N Brusca
- Department of Medico-Surgical Sciences and Biotechnologies'Sapienza' University of Rome, Corso della Repubblica 79, 04100 Latina, ItalyDepartment of Surgical Specialties and Organ Transplantation 'P. Stefanini'Policlinico Umberto I, 'Sapienza' University of Rome, Rome, ItalyEndocrinology UnitAUSL Latina, Latina, Italy
| | - I Gatto
- Department of Medico-Surgical Sciences and Biotechnologies'Sapienza' University of Rome, Corso della Repubblica 79, 04100 Latina, ItalyDepartment of Surgical Specialties and Organ Transplantation 'P. Stefanini'Policlinico Umberto I, 'Sapienza' University of Rome, Rome, ItalyEndocrinology UnitAUSL Latina, Latina, Italy
| | - M Cellini
- Department of Medico-Surgical Sciences and Biotechnologies'Sapienza' University of Rome, Corso della Repubblica 79, 04100 Latina, ItalyDepartment of Surgical Specialties and Organ Transplantation 'P. Stefanini'Policlinico Umberto I, 'Sapienza' University of Rome, Rome, ItalyEndocrinology UnitAUSL Latina, Latina, Italy
| | - L Gargano
- Department of Medico-Surgical Sciences and Biotechnologies'Sapienza' University of Rome, Corso della Repubblica 79, 04100 Latina, ItalyDepartment of Surgical Specialties and Organ Transplantation 'P. Stefanini'Policlinico Umberto I, 'Sapienza' University of Rome, Rome, ItalyEndocrinology UnitAUSL Latina, Latina, Italy
| | - C Verga Falzacappa
- Department of Medico-Surgical Sciences and Biotechnologies'Sapienza' University of Rome, Corso della Repubblica 79, 04100 Latina, ItalyDepartment of Surgical Specialties and Organ Transplantation 'P. Stefanini'Policlinico Umberto I, 'Sapienza' University of Rome, Rome, ItalyEndocrinology UnitAUSL Latina, Latina, Italy
| | - F M Frattaroli
- Department of Medico-Surgical Sciences and Biotechnologies'Sapienza' University of Rome, Corso della Repubblica 79, 04100 Latina, ItalyDepartment of Surgical Specialties and Organ Transplantation 'P. Stefanini'Policlinico Umberto I, 'Sapienza' University of Rome, Rome, ItalyEndocrinology UnitAUSL Latina, Latina, Italy
| | - C Virili
- Department of Medico-Surgical Sciences and Biotechnologies'Sapienza' University of Rome, Corso della Repubblica 79, 04100 Latina, ItalyDepartment of Surgical Specialties and Organ Transplantation 'P. Stefanini'Policlinico Umberto I, 'Sapienza' University of Rome, Rome, ItalyEndocrinology UnitAUSL Latina, Latina, Italy
| | - M Centanni
- Department of Medico-Surgical Sciences and Biotechnologies'Sapienza' University of Rome, Corso della Repubblica 79, 04100 Latina, ItalyDepartment of Surgical Specialties and Organ Transplantation 'P. Stefanini'Policlinico Umberto I, 'Sapienza' University of Rome, Rome, ItalyEndocrinology UnitAUSL Latina, Latina, Italy Department of Medico-Surgical Sciences and Biotechnologies'Sapienza' University of Rome, Corso della Repubblica 79, 04100 Latina, ItalyDepartment of Surgical Specialties and Organ Transplantation 'P. Stefanini'Policlinico Umberto I, 'Sapienza' University of Rome, Rome, ItalyEndocrinology UnitAUSL Latina, Latina, Italy
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