Thyroid carcinoma
	Antonelli et al., Pisa, Italy, evaluated the role of neck ultrasonography (US) in the follow-up of 161 patients who had total thyroidectomy for differentiated thyroid cancer and who were at the start of the investigation negative on whole body scan (WBS) for lymphnode metastases (LM) or local recurrence (LR). All patients were on T4 suppressive therapy and in 36 cases US showed LR and/or LM. In 11/36 fine needle aspiration biopsy (FNAB), WBS, TG, and subsequent US in a follow-up period of at least one year were all negative. In 25/36 patients carcinoma was confirmed by at least one procedure (24 cases by FNAB). After withdrawal of T4 suppressive therapy in this group, WBS and TG were negative in 5 patients (2 with positive TGab) but diagnosis was confirmed by FNAB and a second surgical intervention. WBS was negative but TG was elevated in 14 patients and the diagnosis was confirmed by FNAB or second surgery. It is concluded that US detected recurrence or lymphnode metastases in 25/161 patients and was essential for diagnosis in 5 patients with negative WBS and TG, and 14 patients with negative WBS and elevated TG. Sisson et al., Ann Arbor, MI, USA, tested the effect of different dosages of 131 used for diagnosis of differentiated thyroid cancer on the impairment of uptake of subsequent therapeutic 131 doses. As this effect was already reported for doses between 3- 10 mCi 131 they tested doses of 1 and 2 mCi and found that even a dose of 1 mCi impaired subsequent uptake of therapeutical 131 doses. They, however, comment that using lower doses for diagnostic procedures decrease sensitivity and 1 mCi 131 as a diagnostic dose appears to be a reasonable compromise. DeMello et al., Worcester, MA, USA, evaluated the value of preoperative FNAB and of frozen section (FS) in 124 patients undergoing thyroidectomy for nodular goiter. They found that sensitivity of FNAB was 74%, specificity 64.2%, and accuracy 64.5%, whereas these figures for FS were 63.6%, 73.1%, and 68.8% respectively. They conclude from their study that basing surgical therapy on FNAB and limited use of FS can be cost effective without compromising patient care. Vassilopoulou- Sellin et al., Houston, TX, USA, reported outcome and mortality of differentiated thyroid carcinoma in 113 patients who were diagnosed at an age less than 20 years and were followed for at least 10 years. 99/113 Patients presented with local/regional disease and 22/113 with distant metastases. Surgery alone or combined with 131 or X-ray was used in most cases. Patients were registered between 1944-1986. At the time of most recent contact, 99/113 patients were alive and 14/113 had died. The alive patients had a mean follow-up of 25 years and a mean age of 40 years. Of the 14 patients who died, 6 patients died of thyroid carcinoma and 2 to causes related to radiotherapy. It is noteworthy that 5/6 patients who died of thyroid carcinoma, had a disease-free period of 2-20 years. Kim et al. and Saito et al., Japan, did preliminary studies on the expression of mRNA of the sodium-iodide symporter (NIS) and of the protein itself in different thyroid tumors. Normal and benign adenomatous goiters showed expression of mRNA in all cases, while variable expression was seen in differentiated thyroid carcinoma in the study of Kim et al. In the study of Saito et al. more abundant expression of the mRNA was seen in 5/5 papillary carcinomas as compared to 4 normal thyroids, but the protein was expressed more abundantly than normal in 3/7 papillary carcinomas. Stal et al., Providence, RI, USA, performed post 131 treatment scans after 4 and 10 days in 29 patients with differentiated thyroid carcinoma to evaluate optimal time to detect all ectopic activity. None of the patients had positive scans in brain or bone detected at 4 or 10 days. When activity was present in the thyroid bed, there were no differences between 4 and 10 days. However, additional information regarding abnormal uptake in neck other than the thyroid bed and in the lungs, is obtained by scanning at both times. However, if only one scan be done the yield is slightly higher at 10 days, i.e. at 4 days extrathyroidal neck uptake was found in 9 patients, but in 10 patients at 10 days, and for lung uptake these figures were 1 and 2 respectively. Farahati et al., Lübeck, Germany, compared characteristics of differentiated thyroid carcinoma in children and adolescents with respect to type, age, and sex. They studied 114 children and adolescents (80 females) and found that the incidence of papillary carcinoma (PTC) correlated with age in females but not in the case of follicular carcinoma (FTC). FTC was associated with less advanced disease as based on lymphnode involvement and distant metastases as compared to PTC. (Comment: No age relationship was seen between FTC and age in male patients. The authors suggest that sex hormones in females may be important in the relationship found in this group. It is remarkable that PTC appeared to be more aggressive in this age group than FTC which is the opposite that is found in adults.) Evans et al., Houston, TX, USA, analyzed their surgical results with regard to residual disease in 3 groups of patients with medullary carcinoma: Eight patients (Gr.I) without previous surgery, 13 patients (Gr.II) who had undergone previous thyroidectomy and had residual disease as reflected by elevated serum calcitonin and positive neck MRI and 12 previously operated patients (Gr.III) with elevated serum calcitonin but negative MRI. After analyzing their results they conclude that compartment-orientated lymphadenectomy of the central neck is safe (still 6/33 postoperative hypoparathyroidism), normalizes calcitonin in 30% of patients (Gr. I + III) and maximizes the potential for local/regional tumor control. Georgitis et al., Washington, DC, USA, report results of treatment over a 50 year time span of 527 patients with thyroid carcinoma from Fitzsimons Army Medical Center: 80% was papillary, 15% follicular, 3% medullary, 1% anaplastic and 1% other. Mean survival was 46 years for papillary, 37.6 years for follicular, 19.3 years for medullary, and 1.6 years for anaplastic carcinoma. Cumulative recurrence rates were 27% and 14% for papillary and follicular carcinoma respectively. Considering these results, it should be noted that initial surgical intervention shifted from limited diagnostic operations such as lymphadenectomy or nodulectomy in the early decades to more extensive thyroidectomies more recently. Ashizawa et al., Nagasaki and Hiroshima, Japan, studied the prevalence of goiter and urinary iodine excretion in children around Chernobyl. As in iodine deficient areas uptake of iodine is increased and therefore radiation effects to the thyroid are increased as well, this survey was performed in order to further analyze the increase in thyroid carcinoma after the Chernobyl accident. Five regions were investigated. Goiter rate in Kiev was 54%, in Zhitomir region 38%, in Gomel 18%, in Mogilev region 22%, and in Bryansk region 41%. A significant inverse correlation was found between goiter rate and iodine intake as measured by urinary iodine excretion. The authors, however, found no iodine deficiency in the Gomel region that had the highest carcinoma rate, and questioned the present iodine data as reflection of iodine intake at the time of the incident. Fatemi et al., Los Angeles, CA, USA, assessed the value of serum TG determination in recurrence risk of differentiated papillary carcinoma in 332 patients who had initial near total thyroidectomy for papillary carcinoma, absent TG antibodies in the serum, and at least 2-6 years of serial serum TG measurements and who were on T4 suppressive therapy. In patients with a serum TG <2 ng/ml recurrence rate was 1.13% at 5 years vs 67% in patients with TG >2 ng/ml. The authors conclude that a serum TG persistently above 2 ng/ml after 2 years suggest a substantial risk for recurrence of papillary carcinoma. Mezosi et al., Debrecen, Hungary, tested the utility of technetium-99m-methoxyisobutylisonitrile (MIBI) scintigraphy in the differential diagnosis of cold thyroid nodules. They investigated 35 patients with at least 1 cold nodule on Tc-99m-pertechnetate scanning who were all operated later. Differentiated cancer was found in 10 patients and it appeared that 9/10 had high Tc-99m-MIBI uptake. Uptake in benign nodules was variable. The authors conclude that the relative risk for differentiated carcinoma in a cold nodule with Tc-99m-pertechnetate but hot with MIBI is 11, and the probability of differentiated carcinoma 57%. (Comment: These findings are interesting but should be confirmed by more studies with more patients.)