Evaluation of the role of magnetic resonance spectroscopy in the diagnosis of follicular malignancies of thyroid

OBJECTIVES

To evaluate role of magnetic resonance spectroscopy in differentiating benign from malignant follicular nodules.

DESIGN

Prospective study.

SETTING

Department of Surgery in collaboration with Department of Radio Diagnosis, Maulana Azad Medical College, Delhi, India.

PATIENTS

Twenty-five patients with a solitary thyroid nodule with follicular etiology.

INTERVENTIONS

Magnetic resonance spectroscopy was carried out in all the cases, and its findings were compared with the final diagnosis based on histopathological examination of sample obtained at surgery.

MAIN OUTCOME MEASURES

Choline peak detected on MRS.

RESULTS

There were 17 benign cases, 16 follicular adenomas, and 1 colloid goiter. Of the 17 benign cases, only 1 showed choline peak; however, all 8 follicular carcinoma cases showed prominent choline peak. Hence, the sensitivity is 100% while the specificity is 94.11%.

CONCLUSION

Magnetic resonance spectroscopy may prove to be a sensitive diagnostic tool in differentiating follicular adenomas from carcinomas.

Fine needle aspiration cytology of amyloid goiter. A report of four cases

BACKGROUND

Amyloid goiter is a very rare clinical entity. It can be confused easily with a neoplastic goiter both clinically and cytologically.

CASES

In four cases of amyloid goiter the diagnosis was established preoperatively by fine needle aspiration cytology. Abundant violet to pink amorphous material with staining characteristics of amyloid was obtained in all cases. This material was morphologically distinct from colloid. Abdominal fat aspiration was done in all four cases. Two of the four abdominal fat aspirates were positive for amyloid.

CONCLUSION

Attention to the morphology of cells accompanying amyloid allows exclusion of medullary thyroid carcinoma, thereby avoiding unnecessary surgery. Moreover, aspirates from the abdominal pad of fat and the thyroid and salivary glands, when enlarged, are useful in the workup of suspected amyloidosis, especially since it is a safe, easily performed procedure.

Evaluation of long-term results of two schedules of treatment for toxic multinodular goitre with radioiodine therapy (I 131)

Results of the long term effects of two schedules of radioine therapy (I131) in 130 toxic multinodular goitre patients were evaluated. Seventy five patients (group I) were treated with low doses and 55 patients (group II) with calculated high doses adjusted for thyroid weight (0.5-1 mu ci/g) and radioiodine uptake. Follow up (mean +/- SEM) was 4.5 +/- 0.4 years and 4.8 +/- 0.6 years respectively (p > 0.1). At the end of followup hyperthyroidism was successfully reversed in 87% (Group I) and 82% (Group II). In group I hypothyroidism was present in 5% of patients while it was 12.5% in group II patients. The total dose per gram of thyroid tissue was not significantly different in both the groups (0.058 mu ci +/- 0.0054 VS 0.073 +/- 0.0054 ci/g.) However in group II the number of I131 administration was significantly lower (1.5 +/- 0.2) than in group I (3.2 +/- 0.4) and the percentage of patients who were adequately treated in Group II with single dose was more as compared in group I (62% in group II versus 49% in group I) Hypothyroidism was reached in a shorter time after treatment in group II (median time 0.8 year in group II Vs 1.1 yrs in group I). Patients with positive thyroid antibodies showed a significant earlier development of hypothyroidism within six months. It is concluded that radioiodine is an effective treatment for toxic multinodular goitre with a significant low incidence of post therapy hypothyroidism in patients treated with low doses as compared to higher doses of radioiodine therapy.

Long-term results of two schedules of treatment for toxic multinodular goitre with radioiodine therapy

Results of the long-term effects of two schedules of radioiodine therapy I131 in 130 toxic multinodular goitre patients were evaluated. Seventy five patients (group I) were treated with low doses and 55 patients (group II) with calculated high doses adjusted for thyroid weight (0.5-1 mci/g) and radioiodine uptake. Follow up (mean +/- SEM) was 4.5 +/- 0.4 years and 4.8 +/- 0.6 years respectively (P > 0.1). At the end of follow up, hyperthyroidism was successfully reversed in 78% (Group I) and 82% (Group II). In group I hypothyroidism was present in 5% of patients, while it was 12.5% in group II patients. The total dose per gram of thyroid tissue was not significantly different in both the groups (.058 mci +/- .0054 VS .073 +/- .0054 mci/g). However in group II the number of I131 administration was significantly lower (1.5 +/- 0.2) than in group I (3.2 +/- 0.4). The percentage of patients who were adequately treated in Group II with single dose was more as compared in group I (62% in group II versus 40% in group I). Euthyroidism was reached in a shorter time after treatment in group II (median time 0.8 year in group II Vs 1.1 yrs in group I) It is concluded that radioiodine is an effective treatment for toxic multinodular goitre with a significant low incidence of post therapy hypothyroidism in patients treated with low doses as compared to higher doses of radioiodine therapy.