Thyroid carcinoma
	Capezzone et al., Pisa, Italy, did a retrospective study in 464 patients who were treated with different doses of 131-I for post-surgical thyroid-remnant ablation in the period between 1970 to 1996. Group 1 (187 patients) were treated with 30 mCi 131-I, group 2 (148 patients) with 31–80 mCi 131-I, and group 3 (129 patients) with >80 mCi 131-I. The total percentage of successful ablation was 65 %. No difference was found in success rate between the three treatment groups. A significant correlation was found between successful ablation and lower basal serum Tg and lower 131-I tracer dose (50µCi vs 1 mCi) administered before ablation. The authors found that the dose of 30 mCi of 131-I resulted in a successful ablation in 84 % of patients when this dose is not preceded by a diagnostic whole body scanning even with 1 mCi tracer dose of 131-I as this dose may cause stunning. Several studies were reported using recombinant human TSH (rhTSH) in patients with thyroid carcinoma. Thus, Lippi et al., Pisa, Italy, showed that rhTSH can induce 131-I uptake in most metastatic lesions of 25 selected patients with differentiated thyroid carcinoma. After a mean follow-up period of 16 months, 16 % of patients were cured by one treatment. rhTSH was safe and swelling and pain of metastatic tissue were experienced by several patients be it of shorter duration than after stimulation by endogenous TSH. Bournaud et al., Lyon, France, reported their experience in 8 patients treated with rhTSH before administration of 131-I and conclude that in this small study rhTSH is of definite value in treatment of functional metastases of thyroid carcinoma. Barbaro et al., Livorno, Italy, tested the efficacy of 30 mCi 131-I in ablation of postsurgical thyroid remnants in 5 patients with “low risk” differentiated thyroid carcinoma by pretreatment with rhTSH . This regimen resulted in complete ablation of remnants in all patients with a single dose of 131-I. Kalarritou et al., Athens, Greece, tested in 19 patients after treatment for differentiated thyroid carcinoma if rhTSH stimulated serum Tg (s-Tg) can serve as a single method for detection of any persistent tumor or of metastases. In 12/19 patients basal Tg levels were found at or < 0.5 ng/ml showing no response to rhTSH. Of the remaining (7/19) patients with a higher serum Tg all basal parameters showed stimulation after rhTSH and 4/7 also had a positive WBS and MRI. In the 3/7 patients without positive visualization of any tumor, basal Tg levels were still very low (0.5–1.1 ng/ml). Comment: Although the patients sample is small these results suggest that rhTSH stimulation, if confirmed in a larger group, may serve as a single test in the follow-up of low risk patients treated for differentiated thyroid carcinoma. Van Tol et al., Groningen, The Netherlands, retrospectively studied 504 patients initially treated by total thyroidectomy and in 97% of cases with additional 131-I ablation during a mean follow-up of 9 years. At 3 months after initial treatment ablation was successful in 85 % of patients. After 6 months no further intervention was done in 59 % of patients. At the end of the study survival was 87 %. Tumor recurrence rate was 8.5 %. Risk factors for recurrence were older age, extrathyroidal growth, and follicular or Hürthle cell subtype. Malinsky et al., Strasbourg, France, report the results of radiofrequency treatment of bone metastases of differentiated thyroid carcinoma in 4 patients. Two patients were followed for more than one year and showed a decrease in Tg level from 13,600 to 866 ng/ml and from 390 to 4.3 ng/ml. Comment: Although really very preliminary the findings in these two patients are encouraging and should stimulate others to expand this experience in patients who can not otherwise be treated for bone metastases). Schvartz et al., Reims, France, analyzed the thyroid cancer registry from an administrative area of 850,000 inhabitants in France. In 1,462 patients thyroid cancer was histologically confirmed. The patients were detected between1975 and 2001. In this period the age standardized incidence rate for all thyroid cancer increased from 4.99 to 12.59 per 100,000 for females and from 1.04 to 3.69 for males. The proportion of papillary cancer increased from 47.7 % to 78.9 %, and of follicular cancer decreased from 25.3% to 12.2 %. There was a tremendous increase for small thyroid cancers (pT1) from 9% to 42 % and a small decrease for larger cancers (pT2) from 39.3% to 36.8 %. Comment: The authors mention several factors as an explanation for the increase in total cancer rate, all related to better diagnostic criteria and tools. It would be interesting to analyze as well if there are differences in mortality. I would not be surprised if a decrease would be the case. Because if diagnostic methods become more sensitive and more specific, and therefore treatment results improve one may expect a decrease in mortality. However if, despite this, overall mortality appears to be increased this may then be explained by an absolute increase incidence and/or aggressiveness of thyroid carcinoma. Newbold et al., Sutton, UK, compared survival of patients with familial (54 patients) or sporadic medullary thyroid carcinoma (MTC) (72 patients). Survival at 10 years was significantly better in patients with MEN syndrome (83%) compared with isolated familial MTC (67 %) or with sporadic MTC (54.6 %). This difference persisted at 15 and 20 years (p=0.04). The authors conclude that the prognosis of familial disease is better and explained this because of earlier age at diagnosis (because of the genetic suspicion) and therefore the earlier stage of the disease when treated.