The Bethesda System for Reporting Thyroid Cytopathology from 2009 introduced a new category in thyroid nodule fine-needle aspiration (FNA) findings named atypia of undetermined significance (AUS), ...which usually appears in around 5% of FNA findings. Our study aimed to assess the utility of AUS finding in determining the risk of malignancy in thyroid nodules. In our study, 160 patients with AUS finding on initial FNA were regularly followed-up. Total and specific malignancy rates were calculated after receiving histopathologic confirmation or histopathologic/cytologic exclusion of malignancy. Eventually 80 (50%) patients were referred to surgery, with malignancy rate of 37.5% on histopathology. Another 52 (32.5%) patients were confirmed to have benign nodules on repeat FNA. After combining results obtained from histopathologic reports with those obtained from cytologic follow-up, total malignancy rate was 22.72%. However, malignancy was confirmed in only one (5.26%) of 19 patients with AUS finding on repeat FNA with surgical and histopathologic follow-up. In conclusion, FNA is an extremely useful tool for clinicians to discriminate patients to be referred to surgery and those that can be followed-up safely without the need for further invasive procedures.
The worldwide incidence of differentiated thyroid cancer (DTC) has increased in recent decades, likely due to frequent use of cervical ultrasonography (US) and US-guided fine needle aspiration biopsy ...(FNA)., US is performed during follow-up after thyroidectomy, and US-guided FNA with cytology is used if suspicious cervical lymph nodes (LN) or thyroid bed masses are detected. Knowing that serum anti-Tg antibodies (sTgAb) affect the use of serum Tg (sTg) as a tumor marker, the aim of our study was to assess the usefulness of Tg determination in needle aspirates (FNA-Tg) in presence of sTgAb. This retrospective study included 149 patients with DTC and 159 aspirations of suspicious LN and thyroid bed masses. As expected, there was a negative correlation between sTg and sTgAb levels (p<0.05), while FNA-Tg levels had a positive correlation with FNA-TgAb levels (p<0.05). Furthermore, we found a positive correlation between sTg and FNA-Tg levels (p<0.05), but not between sTgAb and FNA-TgAb or sTgAb and FNA-Tg. In conclusion, these results show that FNA-Tg values were not affected by sTgAb and that FNA-Tg measurement were highly effective in detecting cervical DTC metastases. However, combined use with cytology is suggested for neck evaluation because cytology could reveal metastases from other tumor sites.
The incidence of thyroid nodules has been rising steadily during the last 30 years, since the introduction of new diagnostic methods such as ultrasonography and computerized tomography, thus posing a ...real challenge in determining the best approach strategy for treatment of this new 'epidemic'. We analyzed and compared data from several studies showing the prevalence of thyroid nodules on autopsy, palpation and ultrasonography to be 13%-60%, 0.5%-6.5% and 13.4%-46%, respectively. This demonstrates that thyroid ultrasonography is a very sensitive and accurate diagnostic tool the use of which, however, entails an increased number of incidentally discovered thyroid nodules without clinical significance. Therefore, ultrasonography of the thyroid should not be performed without clinical indication determined by thyroid specialist.
In the management of large number of patients with differentiated thyroid cancer, the radioactive iodine (131-I) administration plays an important role. The guidelines of numerous international and ...national medical societies regarding the issue of postoperative 131-I administration have been published and updated in the last few years. The guidelines differ in the shape and content, and contain some specific features. The different methods for evaluation and analysis of clinical evidence level and resulting grades of recommendations have been used in line with the very guidelines. The postoperative 131-I administration refers to the radioiodine ablation as a form of adjuvant treatment and radioiodine therapy in the management of patients with recurrent cancer, persistent disease and regional or distant metastases. According to the indications for the postoperative 131-I administration, the patients could be divided into the three risk groups: the very low risk group in which there is no indication for the postoperative 131-I administration, the low risk group in which the indication could be considered, and the high risk group in which there is a clear indication for the 131-I administration. The different criteria for distribution of patients into these three groups are expressed in a certain guidelines. There are different opinions about the necessary dosage of 131-I for the efficient ablation in the low risk group. Moreover, the opinions are also divided regarding the conduction of postoperative (preablative or pretherapeutic) scintigraphy with 131-I. As regards the instructions on preparation of patients for the radioiodine ablation and therapy, all the guidelines recommend the low iodine diet and endogenous or exogenous stimulation of TSH. The endogenous stimulation is accomplished by the withdrawal of thyroid hormones, whereas the recombinant human TSH (rhTSH) is used for exogenous stimulation. For conducting the therapy with 131-I the level of TSH has to be > 25-30 mU/L.
People of all ages can be affected by iodine deficiency, however, pregnant women and children are especially at a high risk. Because of changes that occur in maternal thyroid hormone economy during ...pregnancy and the potential unfavorable effects of iodine deficiency on the offspring, an adequate dietary iodine intake throughout the pregnancy is highly important. Therefore, the World Health Organization, United Nations Children's Fund and International Council for the Control of Iodine Deficiency Disorders have proposed that dietary intake of iodine during pregnancy should be 200-300 microg/day to compensate for the augmented T4 requirements in pregnant women. It has been shown that in countries with a longstanding and well-established universal salt iodination program where iodine sufficiency has been reached, there is a fraction of pregnant women that still have low median urinary iodine concentration, which indicates insufficient dietary iodine. Studies performed in such countries emphasize that pregnant women should use multivitamin and/ or mineral tablets specifically prepared for the needs of pregnancy and containing iodine supplements. Only the United States of America and Canada have official recommendations concerning iodine supplementation. In other countries, no such firm decisions have yet been made by medical community and public health authorities. In Croatia, an iodine sufficient country, the situation is the same. There is a need to collect adequate data on iodine supplementation and urinary iodine during pregnancy, along with the universal salt iodination program, so that definitive conclusions can be made.
Objective
To assess efficiency of various I-131 activities on thyroid remnant ablation in thyroid cancer patients. The significance of patients’ characteristics, pathologic features and levels of Tg ...were analyzed.
Patients and methods
This study included 259 consecutive differentiated thyroid cancer patients, with disease confined to the thyroid, treated with I-131 after total thyroidectomy. Patients were divided into the three groups: 80 patients receiving low 1110–1850 MBq (30–50 mCi), 121 intermediate 2775 MBq (75 mCi) and 58 high 3700 MBq (100 mCi) postoperative I-131 activities. Six to eight months after the application of radioiodine, measurements of TSH, Tg, anti-Tg antibodies (in hypothyroid state) together with ultrasound exam and whole-body scintigraphy were performed.
Results
The ablation was significantly more effective (after the first application) in patients receiving 100 mCi of I-131—89.7 % than in patients receiving lower activities (
P
= 0.016). There was no significant difference in ablation rate between the 30–50 mCi (77.5 %) and 75 mCi (70.2 %) groups. In the group receiving 30–50 mCi, patients with solitary tumors had significantly higher ablation rate (
P
= 0.038). In patients receiving 75 mCi ablation rates were higher among older patients (
P
= 0.005), with infiltration of the single lobe (
P
= 0.005), and with solitary tumor (
P
= 0.012). The rates of successful ablation after the second application of I-131 (after 12–16 months) amounted to 96, 97 and 96 % in the 30–50, 75 and 100 mCi groups, respectively. The activity of I-131 and age were independent factors for thyroid ablation failure after the first application of I-131 (model of binary logistic regression).
Conclusion
The results of remnant ablation were satisfactory with all activities applied. Although after the first application of I-131 the activity of 100 mCi is significantly more effective in thyroid ablation than the administration of 30–50 mCi and 75 mCi, the ablation rates between all the three groups are similar (almost equal) after the second application. Thus, the activity to be administered may depend on patients’ characteristics and a detailed consideration of the merits and demerits of each I-131 activity.
AMIODARON I FUNKCIJA ŠTITNJAČE Jukić, Tomislav; Punda, Marija; Franceschi, Maja ...
Liječnički vjesnik,
06/2015, Letnik:
137, Številka:
5-6
Journal Article
Recenzirano
Odprti dostop
Amiodaron je derivat benzofurana koji sadržava do 40% joda. Primjenjuje se za liječenje i prevenciju supraventrikularnih i ventrikularnih tahiaritmija opasnih po život. Učinak na štitnjaču očituje se ...od poremećaja funkcionalnih testova štitnjače do klinički izražene hipotireoze potaknute amiodaronom (AIH) i tirotoksikoze (AIT). Bolesnici s AIH liječe se supstitucijskom terapijom L-tiroksinom, a terapija amiodaronom može se nastaviti. Moramo razlikovati dva oblika AIT-a: hipertireoza potaknuta amiodaronom (AIT I) i tiroiditis (AIT II). AIT I liječi se tirostaticima, a metode definitivnog liječenja jesu jod-131 ili totalna tiroidektomija. Oblik II AIT-a liječi se glukokortikoidima. Bolesnici s AIT-om moraju prekinuti terapiju amiodaronom. Dronedaron je manje učinkovit antiaritmik koji je strukturno i farmakološki sličan amiodaronu, ali ne sadržavaju jod, a toksične nuspojave su rjeđe. Dronedaron se može rabiti za liječenje bolesnika s povećanim rizikom od razvoja AIT-a ili AIH.
The worldwide incidence of differentiated thyroid cancer (DTC) has increased in recent decades, likely due to frequent use of cervical ultrasonography (US) and US-guided fine needle aspiration biopsy ...(FNA)., US is performed during follow-up after thyroidectomy, and US-guided FNA with cytology is used if suspicious cervical lymph nodes (LN) or thyroid bed masses are detected. Knowing that serum anti-Tg antibodies (sTgAb) affect the use of serum Tg (sTg) as a tumor marker, the aim of our study was to assess the usefulness of Tg determination in needle aspirates (FNA-Tg) in presence of sTgAb. This retrospective study included 149 patients with DTC and 159 aspirations of suspicious LN and thyroid bed masses. As expected, there was a negative correlation between sTg and sTgAb levels (p<0.05), while FNA-Tg levels had a positive correlation with FNA-TgAb levels (p<0.05). Furthermore, we found a positive correlation between sTg and FNA-Tg levels (p<0.05), but not between sTgAb and FNA-TgAb or sTgAb and FNA-Tg. In conclusion, these results show that FNA-Tg values were not affected by sTgAb and that FNA-Tg measurement were highly effective in detecting cervical DTC metastases. However, combined use with cytology is suggested for neck evaluation because cytology could reveal metastases from other tumor sites. Key words: neck ultrasonography, differentiated thyroid carcinoma, fine needle aspiration (FNA), serum thyroglobulin (sTg), serum anti-Tg antibodies (sTg-Ab), thyroglobulin (Tg) in FNA (FNA-Tg), FNA Svjetska incidencija diferenciranog karcinoma stitnjace (DTC) u porastu je posljednjih desetljeca najvjerojatnije zbog povecane uporabe ultrazvuka (US) i US vodene aspiracijske biopsije tankom iglom (FNA). Nakon provedene tireoidektomije, onkolosko pracenje ukljucuje US i US vodenu FNA i citolosku analizu aspirata ukoliko se otkriju sumnjivi cervikalni limfni cvorovi (LN) ili tkivo u lezistu stitnjace. Kako je poznato da serumska protutijela na tireoglobulin (sTgAb) utjecu na vrijednost serumskog Tg (sTg) kao tumorskog markera, cilj naseg istrazivanja je procijeniti korisnost odredivanja Tg u aspiratima suspektnih lezija (FNA-Tg) u prisutnosti sTgAb. Ova retrospektivna studija obuhvatila je 149 bolesnika s DTC-om i 159 uzoraka sumnjivih LN ili tkiva u lezistu stitnjace. Ocekivano su razine sTg pokazale obrnutu korelaciju s razinom sTgAb (p <0,05), ali su vrijednosti FNA-Tg imale znacajnu pozitivnu korelaciju s vrijednoscu FNA-TgAb (p <0,05). Nasim rezultatima smo pokazali pozitivnu korelaciju vrijednosti sTg i FNA-Tg (p <0,05), ali ne i korelaciju izmedu sTgAb i FNA-TgAb, kao niti sTgAb i FNA-Tg. Zakljucujemo da vrijednosti sTgAb ne utjecu na FNA-Tg te da je odredivanje FNA-Tg visoko ucinkovita metoda dijagnostike regionalnih metastaza DTC. Medutim, preporucuje se kombinirana upotreba s citologijom za procjenu suspektnih cvorova vrata jer se citolologijom mogu istodobno otkriti metastaze i drugih tumora. Kljucne rijeci: ultrazvuk vrata, diferencirani karcinom stitnjace, aspiracijska biopsija tankom iglom (FNA), serumski tireoglobulin (sTg), serumska anti-Tg protutijela (sTg-Ab), tireoglobulin (Tg) u aspiratu (FNA-Tg), anti-Tg protutijela u aspiratu (FNA-TgAb)
Kroz Sustav Bethesda za citološku analizu štitnjače 2009. godine uvedena je nova kategorija u nalazima citološke punkcije čvorova u štitnjači pod nazivom atipija neodređene značajnosti (AUS), koja se ...obično pojavljuje u oko 5% nalaza. Ovom studijom željeli smo procijeniti korist nalaza AUS u određivanju rizika maligniteta u čvorovima štitnjače. U našoj studiji pratili smo ukupno 160 bolesnika s nalazom AUS na početnoj citološkoj punkciji. Nakon patohistološke potvrde ili citološkog/patohistološkog isključivanja maligniteta u navedenom čvoru izračunali smo ukupni i specifični rizik maligniteta.
Ukupno je 80 (50%) bolesnika bilo upućeno na operacijski zahvat, od čega je ukupno 37,5% imalo patohistološki potvrđen rak štitnjače. Benigni čvorovi bili su dokazani ponovljenom citološkom punkcijom u još 52 (32,5%) bolesnika. Ukupni udio malignih čvorova nakon udruživanja rezultata patohistologije s rezultatima ponovljene citološke punkcije iznosio je 22,72%. Ipak, samo je jednom (5,26%) od 19 bolesnika koji su bili poslani na operaciju nakon višestrukog nalaza AUS na ponovljenim punkcijama patohistološki potvrđen karcinom štitnjače. Citološka punkcija je izrazito koristan dijagnostički postupak za odabir bolesnika koje bi trebalo uputiti na operaciju štitnjače nasuprot onima koji se mogu sigurno pratiti bez rizika provođenja invazivnih zahvata.
AMIODARONE AND THE THYROID FUNCTION Jukić, Tomislav; Punda, Marija; Franceschi, Maja ...
Liječnički vjesnik,
2015 May-Jun, 20150501, Letnik:
137, Številka:
5-6
Journal Article
Recenzirano
Amiodarone is a benzofuran derivative that contains up to 40% of iodine. Amiodarone is used for treatment and prevention of life threatening supraventricular and ventricular tachyarrhythmias. The ...effects on thyroid gland vary from abnormalities in thyroid function tests to overt amiodarone induced hypothyroidism (AIH) and thyrotoxicosis (AIT). Patients with AIH are treated with L-thyroxine and may continue treatment with amiodarone. Two different forms of AIT have to be distinguished: amiodarone induced hyperthyroidism (AIT I) and thyroiditis (AIT II). AIT I is treated with antithyroid drugs, while total thyroidectomy and iodine-131 are used for definitive treatment. AIT II is treated with glucocorticoids. Patients with AIT have to stop treatment with amiodarone. Dronedarone is a less potent antiarrhythmic agent with structural and pharmacological properties similar to amiodarone. Dronedarone is devoid of iodine with fewer adverse effects and therefore it may be used in high risk patients for development of AIT or AIH.
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