Lobectomy is a more Cost-Effective Option than Total Thyroidectomy for 1 to 4 cm Papillary Thyroid Carcinoma that do not Possess Clinically Recognizable High-Risk Features

2016 ◽  
Vol 23 (11) ◽  
pp. 3641-3652 ◽  
Author(s):  
Brian Hung-Hin Lang ◽  
Carlos K. H. Wong
Keyword(s):  
High Risk ◽  
Papillary Thyroid Carcinoma ◽  
Thyroid Carcinoma ◽  
Total Thyroidectomy ◽  
Cost Effective ◽  
Papillary Thyroid ◽  
Effective Option

scholarly journals MON-438 Papillary Thyroid Carcinoma Arising in a Thyroglossal Duct Cyst: A Case Report

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Gabriela Zuniga ◽  
Gliceida Galarza Fortuna ◽  
Alejandro Guzman-Davant ◽  
Juan Paramo ◽  
Michael Pagacz
Keyword(s):  
High Risk ◽  
Papillary Thyroid Carcinoma ◽  
Thyroid Carcinoma ◽  
Total Thyroidectomy ◽  
Neck Mass ◽  
Papillary Thyroid ◽  
Thyroglossal Duct ◽  
Risk Patients ◽  
Sistrunk Procedure ◽  
Solid Area

Abstract Introduction: Thyroglossal duct cysts (TGDCs) are uncommon benign congenital entities. Rarely, thyroid carcinoma can arise from a TGDC; the most common being papillary thyroid carcinoma (PTC). Similar to TGDC, carcinomas originating within them can present as an asymptomatic midline neck mass. Signs of malignancy include dysphagia, dysphonia, weight loss, and rapid growth. Given the rarity of TGDC carcinomas, clinical management remains controversial, particularly regarding the requirement for total thyroidectomy. Case: A 52-year-old female with history of an anterior central neck mass initially noted in 2017. A 0.3-cm left lobe mid-segment cyst and a complex thyroglossal avascular simple cyst measuring 2.4 × 1.1 × 1.8 cm was observed during ultrasound (US). She presented to the endocrinology clinic in April 2019 due to progressive enlargement of the mass. Repeat thyroid US revealed that the cystic structure had become complex with a peripheral solid component and measured 3.3 × 2.1 × 2.2 cm. FNA was performed and found to be suspicious for PTC (Bethesda category V) and positive for the BRAF V600E mutation. Patient was referred for surgical evaluation. Physical examination revealed a midline anterior 10-cm, painless, and fixed mass above the thyroid that moved with deglutition and tongue protrusion. Contrast computed tomography scan showed a large multiloculated cystic structure measuring 4.1 × 4.4 × 5.9 cm. A lobulated soft tissue mass measuring 2.2 × 2.4 × 3.0 cm was noted internally along the inferior margin of the cyst. She underwent en-block resection of the TGDC in addition to a total thyroidectomy. Histopathological examination identified a 7.5 × 5.5 × 5.0 cm cystic mass with fluctuation and a firm, solid area in the lower portion measuring 2.6 × 2.4 cm. Thyroid gland examination was otherwise unremarkable. No areas of extension of the mass into the thyroid tissue were clearly identified and no other gross lesions were observed. The solid area within TGDC contained a tumor with findings characteristic of PTC. Postoperatively, she was placed on thyroid hormone replacement therapy. Conclusion: The main difficulty encountered with cancer developing from TGDC is that the diagnosis is usually made during surgery and from definitive pathological samples. The most common surgical procedure used is the Sistrunk procedure. Some studies have suggested that this procedure alone is an adequate therapy, but others advocate the need for total thyroidectomy. The Sistrunk procedure is considered to be appropriate for low-risk patients, but high-risk patients must undergo total thyroidectomy. The decision to perform a total thyroidectomy in this patient was based on her high-risk classification due to: age, sex, cyst size, and a positive FNA for malignancy. Follow-up includes an annual physical examination, thyroglobulin levels, and an US every 6 months during the first year and annually thereafter.

Papillary Thyroid Carcinoma: How Radical Lymphadenectomy Should be Performed?

Swiss Surgery ◽  
2003 ◽  
Vol 9 (2) ◽  
pp. 63-68
Author(s):  
Schweizer ◽  
Seifert ◽  
Gemsenjäger
Keyword(s):  
High Risk ◽  
Papillary Thyroid Carcinoma ◽  
Thyroid Carcinoma ◽  
Low Risk ◽  
Papillary Thyroid ◽  
Sentinel Nodes ◽  
Fand Sich ◽  
Radical Lymphadenectomy ◽  
N Status

Fragestellung: Die Bedeutung von Lymphknotenbefall bei papillärem Schilddrüsenkarzinom und die optimale Lymphknotenchirurgie werden kontrovers beurteilt. Methodik: Retrospektive Langzeitstudie eines Operateurs (n = 159), prospektive Dokumentation, Nachkontrolle 1-27 (x = 8) Jahre, Untersuchung mit Bezug auf Lymphknotenbefall. Resultate: Staging. Bei 42 Patienten wurde wegen makroskopischem Lymphknotenbefall (cN1) eine therapeutische Lymphadenektomie durchgeführt, mit pN1 Status bei 41 (98%) Patienten. Unter 117 Patienten ohne Anhalt für Lymphknotenbefall (cN0) fand sich okkulter Befall bei 5/29 (17%) Patienten mit elektiver (prophylaktischer) Lymphadenektomie, und bei 2/88 (2.3%) Patienten ohne Lymphadenektomie (metachroner Befall) (p < 0.005). Lymphknotenrezidive traten (1-5 Jahre nach kurativer Primärtherapie) bei 5/42 (12%) pN1 und bei 3/114 (2.6%) cN0, pN0 Tumoren auf (p = 0009). Das 20-Jahres-Überleben war bei TNM I + II (low risk) Patienten 100%, d.h. unabhängig vom N Status; pN1 vs. pN0, cN0 beeinflusste das Überleben ungünstig bei high risk (>= 45-jährige) Patienten (50% vs. 86%; p = 0.03). Diskussion: Der makroskopische intraoperative Lymphknotenbefund (cN) hat Bedeutung: - Befall ist meistens richtig positiv (pN1) und erfordert eine ausreichend radikale, d.h. systematische, kompartiment-orientierte Lymphadenektomie (Mikrodissektion) zur Verhütung von - kurablem oder gefährlichem - Rezidiv. - Okkulter Befall bei unauffälligen Lymphknoten führt selten zum klinischen Rezidiv und beeinflusst das Überleben nicht. Wir empfehlen eine weniger radikale (sampling), nur zentrale prophylaktische Lymphadenektomie, ohne Risiko von chirurgischer Morbidität. Ein empfindlicherer Nachweis von okkultem Befund (Immunhistochemie, Schnellschnitt von sampling Gewebe oder sentinel nodes) erscheint nicht rational. Bei pN0, cN0 Befund kommen Verzicht auf 131I Prophylaxe und eine weniger intensive Nachsorge in Frage.

High expression and localization of β-catenin and epidermal growth factor receptor identify high risk papillary thyroid carcinoma patients

2018 ◽  
Vol 105 (2) ◽  
pp. 181-189 ◽  
Author(s):  
Tijana Išić Denčić ◽  
Aleksandar Bartolome ◽  
Sonja Šelemetjev ◽  
Ilona Đorić ◽  
Svetislav Tatić ◽  
...  
Keyword(s):  
Epidermal Growth Factor Receptor ◽  
Growth Factor ◽  
High Risk ◽  
Papillary Thyroid Carcinoma ◽  
Epidermal Growth Factor ◽  
Thyroid Carcinoma ◽  
Growth Factor Receptor ◽  
High Expression ◽  
Papillary Thyroid ◽  
Epidermal Growth

scholarly journals Predictors of thyroglobulin in the lymph nodes recurrence of papillary thyroid carcinoma undergoing total thyroidectomy

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Zhichao Xing ◽  
Yuxuan Qiu ◽  
Zhe Li ◽  
Lingyun Zhang ◽  
Yuan Fei ◽  
...  
Keyword(s):  
Papillary Thyroid Carcinoma ◽  
Thyroid Carcinoma ◽  
Lymph Nodes ◽  
Total Thyroidectomy ◽  
Radioactive Iodine ◽  
Independent Predictor ◽  
Central Neck Dissection ◽  
American Thyroid Association ◽  
Papillary Thyroid ◽  
Serum Thyroglobulin

Abstract Background To investigate the association between postoperative lymph nodes (LNs) recurrence and distinct serum thyroglobulin (Tg) levels in patients with papillary thyroid carcinoma (PTC). Methods This study included PTC patients who underwent total thyroidectomy (TT) with at least central neck dissection and then re-operated due to recurrence of LNs between January 2013 and June 2018. These patients were grouped by negative or positive serum Tg levels according to the American Thyroid Association guidelines. Results Of the 60 included patients, 49 underwent radioactive iodine (RAI) treatment. Maximum unstimulated Tg (uTg) ≥ 0.2 ng/mL were associated with larger diameter of recurrent LNs (P = 0.027), and higher rate of metastatic LNs (P < 0.001). Serum-stimulated Tg (off-Tg) ≥ 1 ng/mL (P = 0.047) and unstimulated Tg (on-Tg) ≥ 0.2 ng/Ml (P = 0.013) were associated with larger diameter of recurrent LNs. Number of metastatic LNs ≥ 8 was an independent predictor for postoperative maximum uTg ≥ 0.2 ng/mL (OR = 8.767; 95% CI = 1.392–55.216; P = 0.021). Ratio of metastatic LNs ≥ 25% was an independent predictor for off-Tg ≥ 1 ng/mL (OR = 20.997; 95% CI = 1.649–267.384; P = 0.019). Conclusion Postoperative Tg-positive status was associated with larger size of recurrent LNs. Number of metastatic LNs ≥ 8 and ratio of metastatic LNs ≥ 25% were independent predicators for uTg-positive and off-Tg-positive status, respectively.

P-204 Case report of cutaneous papillary thyroid carcinoma 16 years post total thyroidectomy for benign goiter

Oral Oncology ◽  
2021 ◽  
Vol 118 ◽  
pp. 4-5
Author(s):  
Kefalogianni Thiresia ◽  
Klonaris Dionysios ◽  
Oikonomou Dimitris ◽  
Psomadaki Lydia ◽  
Mastorakis Georgios ◽  
...  
Keyword(s):  
Case Report ◽  
Papillary Thyroid Carcinoma ◽  
Thyroid Carcinoma ◽  
Total Thyroidectomy ◽  
Papillary Thyroid ◽  
Benign Goiter

scholarly journals The oncogene BRAFV600E is associated with a high risk of recurrence and less differentiated papillary thyroid carcinoma due to the impairment of Na+/I− targeting to the membrane

2006 ◽  
Vol 13 (1) ◽  
pp. 257-269 ◽  
Author(s):  
G Riesco-Eizaguirre ◽  
P Gutiérrez-Martínez ◽  
M A García-Cabezas ◽  
M Nistal ◽  
P Santisteban
Keyword(s):  
High Risk ◽  
Papillary Thyroid Carcinoma ◽  
Thyroid Carcinoma ◽  
Prognostic Impact ◽  
Erk Pathway ◽  
Papillary Thyroid ◽  
Thyroid Cells ◽  
Genetic Event ◽  
Total Body

The oncogene BRAFV600E is the most frequent genetic event in papillary thyroid carcinoma (PTC) but its prognostic impact still remains to be elucidated. We evaluated a representative series of 67 individuals with PTC who underwent total thyroidectomy. BRAF-positive tumours correlated with early recurrences (32% vs 7.6%; P=0.02) during a median postoperative follow-up period of 3 years. Interestingly, within the recurrences, a significant majority had negative radioiodine (131I) total body scans, predicting a poorer outcome as treatment with 131I is not effective. This last observation led us to investigate the role of BRAFV600E and the MEK-ERK pathway in thyroid dedifferentiation, particularly in Na+/I− symporter (NIS) impairment, as this thyroid-specific plasma membrane glycoprotein mediates active transport of I− into the thyroid follicular cells. A subset of 60 PTC samples was evaluated for NIS immunoreactivity and, accordingly, we confirmed a significant low NIS expression and impaired targeting to membranes in BRAF-positive samples (3.5% vs 30%; P=0.005). Furthermore, experiments with differentiated PCCl3 thyroid cells demonstrated that transient expression of BRAFV600E sharply impaired both NIS expression and targeting to membrane and, surprisingly, this impairment was not totally dependent on the MEK-ERK pathway. We have concluded that BRAFV600E is a new prognostic factor in PTC that correlates with a high risk of recurrences and less differentiated tumours due to the loss of NIS-mediated 131I uptake.

scholarly journals Surgical completeness of total thyroidectomy using harmonic scalpel: comparison with conventional total thyroidectomy in papillary thyroid carcinoma patients

2012 ◽  
Vol 83 (5) ◽  
pp. 267 ◽  
Author(s):  
Jong Ju Jeong ◽  
Kyu Hyung Kim ◽  
Yoon Woo Koh ◽  
Kee-Hyun Nam ◽  
Woong Youn Chung ◽  
...  
Keyword(s):  
Papillary Thyroid Carcinoma ◽  
Thyroid Carcinoma ◽  
Total Thyroidectomy ◽  
Harmonic Scalpel ◽  
Papillary Thyroid
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