scholarly journals Lithium as a Potential Adjuvant to 131I Therapy of Metastatic, Well Differentiated Thyroid Carcinoma1

1999 ◽  
Vol 84 (3) ◽  
pp. 912-916 ◽  
Author(s):  
Sung-Soo Koong ◽  
James C. Reynolds ◽  
Edward G. Movius ◽  
Andrew M. Keenan ◽  
Kenneth B. Ain ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Half Life ◽  
Control Period ◽  
Metastatic Tumor ◽  
Differentiated Thyroid Carcinoma ◽  
131I Therapy ◽  
Metastatic Lesions ◽  
Well Differentiated ◽  
Iodine Release ◽  
Isotope Decay

As lithium inhibits the release of iodine from the thyroid but does not change iodine uptake, it may potentiate 131I therapy of thyroid cancer. The effects of lithium on the accumulation and retention of 131I in metastatic lesions and thyroid remnants were evaluated in 15 patients with differentiated thyroid carcinoma. Two 131I turnover studies were performed while the patients were hypothyroid. One was performed while the patient received lithium; the second served as a control study. From a series of γ-camera images, it was found that lithium increased 131I retention in 24 of 31 metastatic lesions and in 6 of 7 thyroid remnants. A comparison of 131I retention during lithium with that during the control period showed that the mean increase in the biological or retention half-life was 50% in tumors and 90% in remnants. This increase occurred in at least 1 lesion in each patient and was proportionally greater in lesions with poor 131I retention. When the control biological half life was less than 3 days, lithium prolonged the effective half-life, which combines both biological turnover and isotope decay, in responding metastases by more than 50%. More 131I also accumulated during lithium therapy, probably as a consequence of its effect on iodine release. The increase in the accumulated 131I and the lengthening of the effective half-life combined to increase the estimated 131I radiation dose in metastatic tumor by 2.29 ± 0.58 (mean ± sem) times. These studies suggest that lithium may be a useful adjuvant for 131I therapy of thyroid cancer, augmenting both the accumulation and retention of 131I in lesions.

Conservative surgical management of invasive differentiated thyroid cancer

1985 ◽  
Vol 99 (12) ◽  
pp. 1255-1260 ◽  
Author(s):  
Y. Shvili ◽  
Y. Zohar ◽  
N. Buller ◽  
N. Laurian
Keyword(s):  
Thyroid Cancer ◽  
Thyroid Carcinoma ◽  
Surgical Management ◽  
Upper Airway ◽  
Differentiated Thyroid Carcinoma ◽  
Tracheal Resection ◽  
Low Grade ◽  
Tracheal Defect ◽  
Airway Invasion ◽  
Well Differentiated

AbstractThe majority of well differentiated thyroid carcinoma are tumours of low grade malignancy. Laryngotracheal invasion by well differentiated thyroid carcinoma is an uncommon occurrence. The surgical management of patients with thyroid cancer invading the upper airway has primarily been by total laryngectomy. Other surgeons recommend in selected cases partial laryngeal and/or tracheal resection.A total of 122 patients with thyroid carcinoma were treated in our department between 1967 and 1982. Only seven patients with well differentiated tumours had airway invasion. In these seven patients we used a partial laryngeal and/or tracheal resection. In three of the patients with tracheal invasion a myoperichondrial flap was used for closing the tracheal defect. A partial resection of the larynx and trachea, and end to end anastomosis between the trachea and the remaining part of the larynx was performed in another four patients.

scholarly journals Radioiodine-resistant metastases of well-differentiated thyroid cancer, analysis of tumor characteristics and primary surgical intervention

2021 ◽  
Vol 23 (5) ◽  
pp. 670-676
Author(s):  
M. V. Ostafiychuk ◽  
A. Ye. Kovalenko ◽  
Yu. M. Tarashchenko
Keyword(s):  
Thyroid Cancer ◽  
Surgical Treatment ◽  
Differentiated Thyroid Cancer ◽  
Radioactive Iodine ◽  
131I Therapy ◽  
Control Group ◽  
Endocrine Gland ◽  
Age Group ◽  
Well Differentiated ◽  
The Impact

The aim of this article is to assess the initial status, characteristics of the tumor process and initial surgical treatment in patients with well-differentiated thyroid carcinomas who subsequently showed resistance to 131I therapy, comparing with the control group of patients who achieved a positive effect of 131I therapy. Materials and methods. In total, 156 cases of well-differentiated thyroid cancer were analyzed. The control group consisted of 189 patients who showed complete responses to treatment of metastases after 131I therapy and the confirmed relapse-free period. The patients were operated and followed up in the Department of Endocrine Gland Surgery of SI “V. P. Komisarenko Institute of Endocrinology and Metabolism of the National Academy of Medical Sciences of Ukraine” between 1990 and 2019. Results. Based on our study, in the group of radioiodine-resistant metastases, there was a 3.1:1.0 predominance of women over men; whereas in the control group, this ratio was 1.4:1.0. It was noted that resistance to radioactive iodine in patients under 20 years of age was 4 times significantly lower (10.26 %) comparing with the radiosensitive group (41.90 %). In the age group of 41–60 years, radioiodine resistance was 6.5 times higher than that in the comparison group (39.10 % and 6.35 %), and in the age group over 61 years – 11 times (11.54 % and 1.05 %). The impact analysis of radiation exposure on the radioiodine refractoriness occurrence revealed that among patients living in radiation-contaminated areas of Ukraine in 1986 following the Chornobyl accident, there were no significant differences in the development of resistance to radioactive iodine (resistance to 131I – 51.92 % (n = 81), treatment response 131I – 64.02 % (n = 121)). These differences may be due to the younger age of patients affected by radiation and better sensitivity to radioiodine compared to the main group patients. The maximum number of radioiodine-resistant observations was in the intermediate risk group (71.15 %; n = 111). Worth noting is the significant number of radioiodine-resistant metastases in the group where their absence was initially diagnosed (11.53 %; n = 18) and in the group where the proper assessment of lymph collectors was not performed (29.49 %; n = 46). Radioiodine resistance was significantly more common (33.97 %; n = 53) in observations where the prophylactic central dissection was not performed. Conclusions. The main risk factors in the development of radioiodine-resistant metastases were the age of patients older than 40 years, the limited primary surgery on regional lymphatic collectors of the neck, tumor aggressiveness. Careful pre- and intraoperative assessment of regional collectors of the lymph outflow, preventive central neck dissection and extensive therapeutic dissections can reduce the risk of residual and radioiodine-resistant metastases. Timely diagnosis of metastases can improve the results of primary surgical treatment for patients with differentiated thyroid carcinoma and reduce the incidence of radioiodine resistance.

Procedure guidelines for radioiodine therapy of differentiated thyroid cancer (version 3)

2007 ◽  
Vol 46 (05) ◽  
pp. 213-219 ◽  
Author(s):  
J. Dressler ◽  
W. Eschner ◽  
F. Grünwald ◽  
M. Lassmann ◽  
B. Leisner ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Differentiated Thyroid Cancer ◽  
Radioiodine Therapy ◽  
Differentiated Thyroid Carcinoma ◽  
Whole Body ◽  
131I Therapy ◽  
131I Ablation ◽  
Procedure Guidelines ◽  
Lower Blood ◽  
Higher Sensitivity

SummaryThe procedure guideline for radioiodine therapy (RIT) of differentiated thyroid cancer (version 3) is the counterpart to the procedure guideline for 131I whole-body scintigraphy (version 3) and specify the interdisciplinary guideline for thyroid cancer of the Deutsche Krebsgesellschaft concerning the nuclear medicine part. Recommendation for ablative 131I therapy is given for all differentiated thyroid carcinoma (DTC) >1 cm. Regarding DTC ≤1 cm 131I ablation may be helpful in an individual constellation. Preparation for 131I ablation requires low iodine diet for two weeks and TSHstimulation by withdrawal of thyroid hormone medication or by use of recombinant human TSH (rhTSH). The advantages of rhTSH (no symptoms of hypothyroidism, lower blood activity) and the advantages of endogenous TSHstimulation (necessary for 131I-therapy in patients with metastases, higher sensitivity of 131I whole-body scan) are discussed. In most centers standard activities are used for 131I ablation. If pretherapeutic dosimetry is planned, the diagnostic administration of 131I should not exceed 1–10 MBq, alternative tracers are 123I or 124I. The recommendations for contraception and family planning are harmonized with the recommendation of ATA and ETA. Regarding the best possible protection of salivary glands the evidence is insufficient to recommend a specific setting. To minimize the risk of dental caries due to xerostomia patients should use preventive strategies for dental hygiene.

scholarly journals Clinicopathological and Survival Outcomes of Well-Differentiated Thyroid Carcinoma Undergoing Dedifferentiation: A Retrospective Study from FUSCC

2018 ◽  
Vol 2018 ◽  
pp. 1-11 ◽  
Author(s):  
Ben Ma ◽  
Weibo Xu ◽  
Wenjun Wei ◽  
Duo Wen ◽  
Zhongwu Lu ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Cox Regression ◽  
Information Criterion ◽  
Anaplastic Thyroid Cancer ◽  
Differentiated Thyroid Carcinoma ◽  
Clinicopathological Characteristics ◽  
Classification Systems ◽  
Cox Regression Analysis ◽  
Prognostic System ◽  
Well Differentiated

Background. Recently, several studies have reported that dedifferentiation occurs in fatal well-differentiated thyroid cancer (WDTC) cases. This study aimed at investigating the clinicopathological characteristics of WDTC undergoing dedifferentiation. Methods. A total of 63 WDTC patients harboring dedifferentiated phenotype were enrolled in the study. The Kaplan-Meier method and Cox regression analysis were used to perform survival analyses. Harrell index of concordance (C-index) and Akaike information criterion (AIC) were calculated to compare the predictive value for prognosis among several prognostic classification systems. Results. The median cause-specific survival (CSS) of patients was 138 months, with the CSS rate of 64.0% and 53.3% at 5 and 10 years, respectively. Presence of the anaplastic thyroid cancer (ATC) phenotype significantly increased the risk of poor CSS (P=0.033), and age was the only independent risk factor for disease progression (P=0.015). The C-index and AIC of the age, grade, extent, size (AGES) prognostic classification system for the CSS were 0.723 and 59.937, respectively. Conclusions. The presence of dedifferentiated phenotypes can be responsible for the poor outcomes in WDTC patients. The AGES system demonstrates to be an optimal prognostic system for WDTC undergoing dedifferentiation.

scholarly journals Therapeutic Outcome of Second Primary Malignancies in Patients with Well-Differentiated Thyroid Cancer

2016 ◽  
Vol 2016 ◽  
pp. 1-7 ◽  
Author(s):  
Miaw-Jene Liou ◽  
Ngan-Ming Tsang ◽  
Chuen Hsueh ◽  
Tzu-Chieh Chao ◽  
Jen-Der Lin
Keyword(s):  
Thyroid Cancer ◽  
Differentiated Thyroid Cancer ◽  
Remission Rate ◽  
Total Mortality ◽  
Differentiated Thyroid Carcinoma ◽  
Second Primary ◽  
External Radiotherapy ◽  
Advanced Tumor ◽  
Well Differentiated ◽  
Second Primary Malignancies

Background.The aims of this study were to analyze the clinical characteristics of SPM in patients with well-differentiated thyroid cancer and to determine the long-term prognosis in patients with double malignancies.Materials and Methods.We retrospectively analyzed 2,864 patients with well-differentiated thyroid cancer and a mean age of44.0±14.4years. Of these, 200 (7.0%) were diagnosed with SPM, 115 of which were diagnosed with metachronous SPM.Results.Of 2,864 patients, 163 (5.7%) patients died of thyroid cancer and 301 (10.5%) died of any cause by the end of the follow-up period. Multivariate analysis identified age, SPM, external radiotherapy, TNM stage, and postoperative serum Tg level to be factors independently associated with decreased survival. Of 200 patients with SPM, 74 (37.0%) died. In comparison to the anachronous and synchronous groups, the metachronous SPM group had a higher mean age; more advanced tumor, node, and metastasis stage; lower remission rate; higher postoperative radioactive iodide (131I) accumulated dose; a higher proportion of patients who underwent external radiotherapy; and higher thyroid cancer and total mortality rates.Conclusions.Patients with well-differentiated thyroid carcinoma and metachronous SPM had worse prognoses compared to patients without SPM.

scholarly journals Characteristics of thyroid carcinoma in Graves' disease, chronic lymphocitic thyroiditis and nodular goiter

2003 ◽  
Vol 50 (3) ◽  
pp. 135-139
Author(s):  
Aleksandar Filipovic ◽  
Ivan Paunovic
Keyword(s):  
Thyroid Cancer ◽  
Thyroid Carcinoma ◽  
Nodular Goiter ◽  
Differentiated Thyroid Carcinoma ◽  
Anaplastic Carcinoma ◽  
Graves Disease ◽  
Associated Diseases ◽  
Clinical Centre ◽  
Well Differentiated

The biology of thyroid cancer represents a spectrum of behavior ranging from well - differentiated lesions with an excellent prognosis to anaplastic carcinoma, wich is almost fatal. For this reason, it is important that clinicians have methods at their disposal to asses the characteristics of patient's thyroid malignancy. In this work we discuss the behavior of differentiated thyroid cancer in associated diseases of thyroid as : Graves? disease, chronic lymphocitic thyroiditis - Hashimoto and nodular goiter. This is retrospectively reviewing of 50 patients treated for differentiated thyroid carcinoma at Department of surgery, Clinical Centre of Montenegro in Podgorica from 1998 until 2003. We evaluated occurrence, as well as the role of this diseases in patients with thyroid cancer.We found a more favorable course of thyroid cancer in the presence of chronic lymphocitic thyroiditis and nodular goiter, a contrary Graves? disease. In associated diseases of thyroid, a significantly greater proportion of patients with thyroid cancer, have modular goiter.

scholarly journals Therapeutic Outcomes of Recurrent Well-Differentiated Thyroid Carcinomas

2019 ◽  
Vol 104 (7-8) ◽  
pp. 304-313
Author(s):  
Chih-Yiu Tsai ◽  
Shu-Fu Lin ◽  
Szu-Tah Chen ◽  
Chuen Hsueh ◽  
Yann Sheng Lin ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Thyroid Carcinoma ◽  
Recurrent Disease ◽  
Differentiated Thyroid Carcinoma ◽  
Thyroid Carcinomas ◽  
Specific Mortality ◽  
Disease Specific Mortality ◽  
Well Differentiated ◽  
Disease Specific

Objective The aim of this study was to evaluate outcomes of the recurrent and non-recurrent groups including disease-specific mortality of patients with well-differentiated thyroid carcinoma after multimodality treatment. In addition, prognostic factors for disease-specific mortality were analyzed. Summary of Background Data Among 2,844, there were 166 patients with recurrent disease. Recurrent disease was defined as the presence of papillary or follicular thyroid cancer 6 months after the initial thyroidectomy, including locoregional or distant metastasis, diagnosed using diagnostic or therapeutic 131I scans or other imaging techniques. Methods The study was a retrospective analysis of prospectively collected data for a long-term follow-up result of well-differentiated thyroid carcinoma patients. Results The mean age of 166 patients was 45.8 ± 1.2 years, 116 (69.9%) were women, 111 (66.9%) had locoregional neck recurrence, and 55 (33.1%) had metastatic recurrence in distant organs. We found that when recurrences were observed, more than half were detected within the first 5 years following the initial therapy. The longest period of time before relapse was 29.8 years. After a mean follow-up period of 12.7 ± 0.5 years, 37 (22.3%) patients experienced disease-specific mortality. Multivariable analysis revealed that older age, male sex, and development of a second primary malignancy were associated with disease-specific mortality. Higher post-operative levels of thyroglobulin predicted a shorter time to relapse. Conclusions These data indicate that among the recurrent cases over 50% of recurrent well-differentiated thyroid carcinomas were diagnosed within 5 years after initial thyroidectomy. Additionally, more than 20% of the patients died of thyroid cancer.

scholarly journals Genetic Predisposition to Familial Nonmedullary Thyroid Cancer: An Update of Molecular Findings and State-of-the-Art Studies

2010 ◽  
Vol 2010 ◽  
pp. 1-7 ◽  
Author(s):  
Elena Bonora ◽  
Giovanni Tallini ◽  
Giovanni Romeo
Keyword(s):  
Thyroid Cancer ◽  
Thyroid Carcinoma ◽  
Association Studies ◽  
Disease Onset ◽  
Differentiated Thyroid Carcinoma ◽  
Extended Pedigrees ◽  
Complex Process ◽  
Well Differentiated ◽  
Successive Generations ◽  
High Degree

Familial thyroid cancer has become a well-recognized entity in patients with thyroid cancer originating from follicular cells, that is, nonmedullary thyroid carcinoma. The diagnosis of familial thyroid cancer provides an opportunity for early detection and possible prevention in family members. Understanding the syndromes associated with familial thyroid cancer allows clinicians to evaluate and treat patients for coexisting pathologic conditions. About five percents of patients with well-differentiated thyroid carcinoma have a familial disease. Patients with familial non-medullalry thyroid cancer have more aggressive tumors with increased rates of extrathyroid extension, lymph node metastases, and frequently show the phenomenon of “anticipation” (earlier age at disease onset and increased severity in successive generations). So far, four predisposition loci have been identified in relatively rare extended pedigrees, and association studies have identified multiple predisposing variants for differentiated thyroid cancer. This suggests that there is a high degree of genetic heterogeneity and that the development of this type of tumor is a multifactorial and complex process in which predisposing genetic variants interact with a number of incompletely understood environmental risk factors. Thus, the search for the causative variants is still open and will surely benefit from the new technological approaches that have been developed in recent years.

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