Algorithm of stepwise medical rehabilitation of patients with differentiated thyroid cancer

Four stages of medical rehabilitation of patients with differentiated thyroid cancer in Russia are described. Specific rehabilitation programs and methods are described for every stage. The pre-rehabilitation program includes psychological and nutritional support, exercise therapy, consultations by the surgeon and anesthesiologist, correction of concomitant disorders, prevention of thromboembolic complications and local hemodynamic abnormalities. At the rehabilitation stage in the ICU antibacterial therapy, patient positioning, percussion massage of the chest, passive mobilization, massage of the extremities are performed. The rehabilitation program at the specialized surgical department includes psychological rehabilitation, adequate pain management, exercise therapy, massage, nutritional support, prevention of thromboembolic complications, treatment of early postoperative complications. The in-hospital rehabilitation at medical facilities additionally includes treatment of delayed and late surgical complications, correction of radioiodine therapy consequences. The outpatient rehabilitation program also involves correction of hypothyroidism and minimization of adverse effects of suppressive hormone therapy, health resort treatment.

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Scientific Basis of the Use of Medical Rehabilitation and Botulinum Therapy during Rehabilitation Post-Stroke Spasticity

Journal of New Medical Technologies ◽

10.12737/3305 ◽

2014 ◽

Vol 21 (1) ◽

pp. 25-29

Author(s):

Королев ◽

A. Korolev

Keyword(s):

Botulinum Toxin ◽

Physical Therapy ◽

Exercise Therapy ◽

Botulinum Toxin Type A ◽

Rehabilitation Program ◽

Additional Treatment ◽

Medical Rehabilitation ◽

Comprehensive Treatment ◽

Post Stroke ◽

Spastic Paresis

Among the factors contributing to disability after stroke is the most important movement disorder, major clinical manifestation of which is the central spastic paresis. Spasticity is revealed in the study of passive movements of the limbs as increased resistance to muscle in response to its rapid stretching. Once developed spastic paresis usually persists throughout the life of the patient. The treatment of spastic paresis is intractable problem. In recent years the treatment of post-stroke spasticity started using botulinum toxin type A. In comparison with the existing methods of treating muscle hyper local administration of botulinum toxin has a number of obvious advantages. According to the latest recommendations in all cases after botulinum therapy require active physical therapy and physical rehabilitation. Botulinum therapy is not a substitute for physical therapy and exercise therapy, which is the basis of the rehabilitation program and is an integrated part of a comprehensive treatment to improve motor functions. Using a special additional treatment measures such as physical therapy and exercise therapy is often part of the overall treatment but their formal evaluation was carried out in only a few studies. The article presents the author´s concept of rehabilitation post-stroke spastic muscle hypertonus in neuro-rehabilitation with the use of medical rehabilitation and botulinum therapy.

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Abstract #805414: Poorly-Differentiated Thyroid Cancer in a Family With Multiple Members with a Novel Dicer1 Mutation, C.3675C > A (P.TYR1225*)

Endocrine Practice ◽

10.1016/s1530-891x(20)39625-7 ◽

2020 ◽

Vol 26 ◽

pp. 276

Author(s):

Diana Chang

Keyword(s):

Thyroid Cancer ◽

Differentiated Thyroid Cancer ◽

Poorly Differentiated

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No Reason for Hypothyroidism. Five year follow-up results after combined thyroidectomy and Radio Ablation Therapy for differentiated thyroid cancer

Zeitschrift für Gastroenterologie ◽

10.1055/s-0031-1285752 ◽

2011 ◽

Vol 49 (08) ◽

Author(s):

N Emmanouilidis ◽

WH Knapp ◽

J Klempnauer ◽

GFW Scheumann

Keyword(s):

Thyroid Cancer ◽

Differentiated Thyroid Cancer ◽

Ablation Therapy

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Radioiodide Treatment of Pulmonary Metastases of Differentiated Thyroid Cancer

Nuklearmedizin ◽

10.1055/s-0037-1620881 ◽

1979 ◽

Vol 18 (02) ◽

pp. 86-90 ◽

Cited By ~ 26

Author(s):

V. Zamrazil ◽

D. Pohunková ◽

S. Röhling ◽

J. Němec

Keyword(s):

Thyroid Cancer ◽

Bone Metastases ◽

Differentiated Thyroid Cancer ◽

Pulmonary Metastases ◽

Survival Rates ◽

Younger Patients ◽

131I Uptake ◽

Young Subjects ◽

Radioiodide Therapy ◽

Diagnosis Of Thyroid Cancer

Pulmonary metastases were found in 123 out of 840 patients with thyroid cancer between 1955-1977. 87 patients with pulmonary metastases of differentiated cancer were studied in detail, including an evaluation of prognostically important factors. In 66 of them, the induction of 131I uptake in metastases was attempted, in half of them successfully. Uptake was achieved more frequently in younger subjects, in papillary cancers and in patients with fine pulmonary metastases on chest films. Survival (not corrected for age) was evaluated 10 and 15 years following the diagnosis of thyroid cancer and was found to be 29,1 % and 12,2%, respectively. Significantly higher survival rates were seen in younger patients, in patients with the fine type of pulmonary metastases, in the absence of bone metastases and, particularly, in patients with induced 131I uptake in metastases. Papillary cancers were found to have higher survival rates in males and in young subjects only, in the whole group the survival rates were independent of either microscopic type or sex. It is believed that biologic behaviour of distant (pulmonary) metastases may be influenced by radioiodide therapy.

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Confronting the practice of surgery on differentiated thyroid cancer with current guidelines in Germany

Nuklearmedizin ◽

10.1055/s-0038-1625203 ◽

2005 ◽

Vol 44 (05) ◽

pp. 185-191 ◽

Cited By ~ 4

Author(s):

H. Wieler ◽

S. Birtel ◽

E. Ostwald-Lenz ◽

K. P. Kaiser ◽

H. P. Becker ◽

...

Keyword(s):

Thyroid Cancer ◽

Differentiated Thyroid Cancer ◽

Survival Rates ◽

Perioperative Morbidity ◽

Referral Hospitals ◽

Principles Of Treatment ◽

Current Guidelines ◽

Papillary Microcarcinomas ◽

Retrospective Multicenter Study

Summary:Aim: For the surgical therapy of differentiated thyroid cancer precise guidelines are applied by the German medical societies. In a retrospective multicenter study, we investigated the following issues: Are the current guidelines respected?. Is there a difference concerning the surgical radicalism and the outcome?. Does the perioperative morbidity increase with the higher radicalism of the procedure?. Patients, methods: Data gained from 102 patients from 17 regional referral hospitals who underwent surgery for thyroid cancer and a following radioiodine treatment (mean follow up: 42.7 [24-79] months) were analyzed. At least 71 criterias were analyzed in a SPSS file. Results: 46.1% of carcinomas were incidentally detected during goiter surgery. The thyroid cancer (papillary n = 78; follicular n = 24) occurred in 87% unilateral and in 13% bilateral. Papillary carcinomas <1 cm were detected in 25 cases; in five of these cases (20%) contralateral carcinomas <1 cm were found. There were significant differences concerning the surgical radicalism: a range from hemithyroidectomy to radical thyroidectomy with lateral neck dissection. Analysis of the histopathologic reports revealed that lymph node dissection was not performed according to guidelines in 55% of all patients. The perioperative morbidity was lower in departments with a high case load. The postoperative dysfunction of the recurrent laryngeal nerve (mean: 7.9% total / 4.9% nerves at risk) variated highly, depending on differences in radicalism and hospitals. Up to now these variations in surgical treatment have shown no differences in their outcome and survival rates, when followed by radioiodine therapy. Conclusion: Current surgical regimes did not follow the guidelines in more than 50% of all cases. This low acceptance has to be discussed. The actual discussion about principles of treatment regarding, the socalled papillary microcarcinomas (old term) has to be respected within the current guidelines.

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Relationship between Thyroglobulin and Tumor Detectabilily with Thallium-201 in Differentiated Thyroid Cancer

Nuklearmedizin ◽

10.1055/s-0038-1632238 ◽

2000 ◽

Vol 39 (01) ◽

pp. 10-15 ◽

Cited By ~ 1

Author(s):

S. P. Müller ◽

Ch. Reiners ◽

A. Bockisch ◽

Katja Brandt-Mainz

Keyword(s):

Thyroid Cancer ◽

Differentiated Thyroid Cancer ◽

Roc Analysis ◽

Tsh Suppression ◽

Significant Difference ◽

Test Specificity ◽

The Relationship ◽

Tumor Scintigraphy ◽

Tsh Stimulation

Summary Aim: Tumor scintigraphy with 201-TICI is an established diagnostic method in the follow-up of differentiated thyroid cancer. We investigated the relationship between thyroglobulin (Tg) level and tumor detectability. Subject and methods: We analyzed the scans of 122 patients (66 patients with proven tumor). The patient population was divided into groups with Tg above (N = 33) and below (N = 33) 5 ng/ml under TSH suppression or above (N = 33) and below (N = 33) 50 ng/ml under TSH stimulation. Tumor detectability was compared by ROC-analysis (True-Positive-Fraction test, specificity 90%). Results: There was no significant difference (sensitivity 75% versus 64%; p = 0.55) for patients above and below 5 ng/ml under TSH suppression and a just significant difference (sensitivity 80% versus 58%; p = 0.04) for patients above and below 50 ng/ml under TSH stimulation. In 18 patients from our sample with tumor, Tg under TSH suppression was negative, but 201-TICI-scan was able to detect tumor in 12 patients. Conclusion: Our results demonstrate only a moderate dependence of tumor detectability on Tg level, probably without significant clinical relevance. Even in patients with slight Tg elevation 201-TICI scintigraphy is justified.

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