Speciality
Spotlight

 




 


Endocrinology


   

  




Thyroid

 

  


  • JH
    Dussault, DA Fisher 
    (CHUL, Quebec; Nichols Inst, San Juan
    Capistrano, Calif; Harbor UCLA Med Ctr, Torrence,
    California)

    Thyroid Function in Mothers of
    Hypothyroid Newborns.


    Obstet Gynecol  93:15-20, 1999.

        

    Background:  autoimmune
    thyroid disease is relatively common in women in
    their childbearing years.
    The etiologic significance of maternal
    autoimmune thyroid disease in the incidence of
    transient congenital hypothyroidism in newborns was
    investigated.

        

    It
    was found that if not all, cases of transient
    congenital hypothyroidism could be attributed to
    maternal autoimmune thyroid disease and, presumably,
    to maternal TSH receptor-blocking antibody. 
    Maternal autoimmune thyroid disease appears
    to be associated with a much greater prevalence of
    autoimmune thyroid disease and thyroid dysfunction
    in the mothers of congenitally hypothyroid infants
    was 20%, thyroid assessment is indicated in such
    women.

       

  • Q Liu, G
    Djuricin, RA Prinz (Rush-Presbyterian-St.Luke’s Med
    Ctr, Chicago):

    Total thyroidectomy for benign thyroid disease.

    Surgery 123:2-7, 1998.

      


    The safety and efficacy of the above controversial surgery for gross benign disease involving both lobes, were evaluated in 106 consecutive patients.

       


    Total thyroidectomy can be performed safely and with a low complication rate in patients with nodular
    goitre, hyperparathyroidism and thyroiditis to prevent recurrence and eliminate malignant disease in patients with irradiated glands.

      


    Total thyroidectomy is safe and effective for patients with benign bilateral disease. There is a small risk of permanent hypoparathyroidism or recurrent laryngeal nerve injury.

       

  • S Noguchi, N Murakami, H Yamashita et al (Oita Med
    Univ, Japan) :

    Papillary thyroid carcinoma: Modified radical neck dissection improves prognosis. 

    Arch Surg 133:276-280, 1998.

          


    Patients with thyroid cancer who have nodal metastases or invasive disease and women who are over age 60, can benefit from modified radical neck surgery.

        

  • Mirallie E, Visset J, Sagan C, et al (centre Hospitalo-Universitaire, Nantes, France)

    Localization of Cervical Node Metastasis of Papillary Thyroid Carcinoma.

    World J Surg 23 : 970-974, 1999

        

    Node sites in 119 patients of papillary thyroid carcinoma were retrospectively examined to determine a possible dissection procedure and to define the extent of neck dissection.

        

    60.5% was incidence of cervical node metastasis and bilateral in 40.8% patients. The most commonly involved sites were ipsilateral paratracheal and jugular sites. Occasional involvement of lateral compartment was present and was independent of central involvement.

         

  • Alam MDS, Kasagi K, et al (Kyoto Univ, Japan)

    Diagnostic Value of Technetium-99m Methoxyisobutyl Isonitrile (99mTc-MIBI) Scintigraphy in Detecting Thyroid Cancer Metastases: A Critical Evaluation.

    Thyroid 8: 1091 – 110, 1998

       

    68 patients who underwent total thyroidectomy and radioiodine ablation were included for study.

       

    The above procedure is recommended as first line choice to detect metastases. Advantages over I131 scintigraphy is better sensitivity, no need to restrict dietary iodide intake and no need to discontinue administration of thyroid hormones. Its limitations are detection of small lung metastasis. In this situation I131 scintigraphy and serum Tg level measurements are recommended.

       

    Editor, R.A. Otto, agrees with the findings.

        

  • Grigsby
    PW, Baglan K, Siegel BA (Washington Univ, St. Louis)

    Surveillance of Patients to Detect Recurrent Thyroid Carcinoma

    Cancer 85: 945-951, 1999

       

    Seventy Six patients undergoing total thyroidectomy and I131 ablation had at least one negative whole body I131 scintigraphy at 1yr follow up. I131 imaging should be performed for surveillance until 2 negative annual studies are observed, after which repeat imaging at 3 to 5 yrs seen satisfactory.

        

  • Wang W, Macapinlac H, Larson SM, et al (Mem Sloan-Kettering Cancer Ctr, New York)

    [18F]-2-Fluoro-2-Deoxy-D-Glucose Positron Emission Tomography Localizes Residual Thyroid Cancer in Patients with Negative Diagnostic 131I Whole Body Scans and Elevated Serum Thyroglobulin Levels.

    J Clin Endocrinol Metab 84: 2291-2302, 1999

        

    37 patients treated with surgery and radioiodine ablation and whose follow-up DxWBS (131I Whole Body Scans) results were negative, and patients were studied by FDG-PET, measurements of serum Tg levels. This has high predictive value in localizing residual thyroid cancer. Shortcomings are detection of minimum residual disease present in cervical nodes.

       

    For clinicians faced with dilemma of residual disease inspite of Whole Body Scan and elevated Tg levels setting FDG-PET may prove useful – R.A. Otto.

       

  • Thyrotoxicosis

    Khoo
    DHC, Parma J, Rajasoorya C, et al [Singapore Gen Hosp;
    Alexandra Hosp, Singapore; Universite Libre de
    Bruxelles, Brussels, Belgium]

    A Germiline Mutation of the Thyrotropin
    Receptor Gene Associated with Thyrotoxicosis and
    Mitral Valve Prolapse in a Chinese Family


    J
    Clin Endocrinol Metab 84: 1459-1462, 1999

       

    Background
    – In 1993, it was discovered that mutations of the TSH
    receptor [TSH-R] gene cause hyperfunctioning thyroid
    adenomas. Subsequent studies have identified families
    with nonautoimmune, autosomal dominant hyperthyroidism
    caused by TSH-R germline mutations, as well as
    activating TSH-R mutations leading to sporadic
    neonatal hyperthyroidism and toxic multinodular
    goiter.

     

    Patients – 
    In the study family, thyrotoxicosis developed
    in the father at age 38 years, and in all 3 children.
    An investigation identified MVP with regurgitation in
    the father and 2 of the children. In the children,
    thyrotoxicosis was manifested by prominent eyes. 
    The onset of thyrotoxicosis and the diagnosis
    of MVP occurred  close
    in time to each other. Genetic studies in this family
    found a germline proline to serine substitution in
    position 639, a constitutively activating mutation
    previously associated  
    with a hyperfunctioning thyroid nodule.

      

    Discussion
    – The activating TSH-R mutation in this family appears
    to be associated with both thyrotoxicosis and MVP. 
    Although a clinical association of MVP with
    Graves’ disease and chronic lymphocytic mechanisms
    remain unclear.  The
    study family appears to have a genetic predisposition
    to MVP, with TSH-R activation contributing to earlier
    manifestation.

       



  • Vestergaard P, Rejumark L et al (Aarhus Univ., Denmark)

    Fracture Risk in Patients Treated for Hyperthyroidism


    Thyroid 10:341-347, 2000

          


    Excess thyroid hormones stimulate turnover in trabecular and cortical bone, resulting in an increased risk of fractures.

           


    864 patients with diffuse toxic or toxic nodular goiter were asked to complete a questionnaire. Their responses were compared with those of an age and sex-matched group selected randomly from background population.

          


    After diagnosis of hyperthyroidism, the patient’s fracture risk was increased, especially among those 50 yrs or older, who had a relative risk of 2.2.

          


    Risk was increased for fracture of the spine and forearms, but not other skeletal sites.

          


    Treatment with radioactive iodine alone was correlated with an increased fracture risk. Patients receiving methimazole in addition to radioactive iodine did not have an increased risk.

            



  • Kraimps JL, Bouin-Pineau MH, et al (Jean Bernard Hosp, Poitiers, France; Dupuytren Hosp, Limoges, France; Bretonneau Hosp, Tours, France; et al)

    Multicentre Study of Thyroid Nodules in Patients with Graves’ Disease

    Br J Surg 87:1111-1113, 2000

          


    The incidence of thyroid nodules and thyroid carcinoma (Ca) in patients with Graves’ disease (GD) is increasing.

          


    The authors conducted a retrospective study of 55% patients undergoing surgery in 5 endocrinology surgical departments. None of the patients had radioactive iodine therapy or external irradiation previously. Subtotal or total thyroidectomy was performed.

          


    Thyroid Ca, always inside a nodule, was diagnosed in 15% of patients.

          


    In this series of patients (undergoing thyroidectomy) the authors found that incidence of carcinoma was 3.8%. The rate of Ca in cold nodules was 15% and hence all patients with Graves’ disease and a thyroid nodule should undergo total
    thyroidectomy.

            



  • Lien EA, Nedrebo BG, Varhaug JE, et al (Univ. Hosp of Bergen, Norway)

    Plasma Total Homocysteine Levels During Short-term Iatrogenic Hypothyroidism.

    J Clin Endocrinol Metab 85: 1049-1053, 2000

          


    Patients with hypothyroidism have an “atherogenic” lipid profile, with high cholesterol and lipid levels.

            


    The authors previously reported that patients with hypothyroidism have raised plasma total homocysteine
    (tHcy)

           


    A longitudinal study was done including 17 patients (11 women and 6 men; mean age 49 yrs) who underwent total thyroidectomy for thyroid cancer.

         


    The authors state that post thyroidectomy patients undergoing temporary hypothyroidism have reversible increases in plasma tHcy and serum cholesterol.

          


    Increase in plasma tHcy results from alteration of renal function.

            


    Interactive effect of increases in plasma tHcy and serum cholesterol may account for the increased cardiovascular risk associated with hypothyroidism.

            



  • Watemberg N, Willis D et al (Virginia Commonwealth Univ, Richmond)

    Encephalopathy as the Presenting Symptom of Hashimoto’s Thyroiditis

    J Child Neurol 15: 67-69, 2000

           


    Hashimoto’s thyroiditis occurring most often in females has many neurologic manifestations including encephalopathy.

           


    The authors present a case report of a 9-yr girl who presented with sudden unexplained encephalopathy, later diagnosed as Hashimoto’s thyroiditis after analysis of antimicrosomal antibodies and antithyroid antibodies.

          


    Once diagnosed, Hashimoto’s encephalopathy responds to
    corticosteroids.

          

  • Singh N, Singh PN, Hershman JM (Univ. of California, Los Angeles; Loma Linda Med Ctr, Calif).

    Effect of Calcium Carbonate on the Absorption of Levothyroxine

    JAMA 283: 2822-2825, 2000

          

    Absorption of Levothyroxine Na is affected by a wide range of other drugs. The effects of calcium carbonate (used by many of the same postmenopausal women who take levothyroxine), on absorption of levothyroxine were assessed in 20 patients with secondary hypothyroidism.

           

    All patients took calcium carbonate, 1200mg/day for 3 months.

           

    The findings support the hypothesis that calcium carbonate treatment reduces absorption of levothyroxine.

          

  • Mercuro G, Panzuto MG, Bina A, et al (Univ. of Cagliari, Italy)

    Cardiac Function, Physical Exercise Capacity, and Quality of Life During Long-term Thyrotropin-Suppressive Therapy With Levothyroxine: Effect of Individual Dose Tailoring.

    J Clin Endocrinol Metab 85: 159-164, 2000

          

    Therapy employing Levothyroxine (L-T4) may adversely affect the cardiovascular system.

           

    It was found that individually tailoring the dosage of
    L-T4 to the minimum required by each person, improved or ameliorated totally, the morphological heart abnormalities developing with the use of
    L-T4.

          

  • Pedersen OM, Aardal NP, Larssen TB, et al (Univ. of Bergen, Norway)

    The Value of Ultrasonogrpahy in Predicting Autoimmune Thyroid Disease.

    Thyroid 10: 251-259, 2000.

           

    The diagnosis of autoimmune thyroid disease (AITD) may be aided by the use of ultrasonography (US) which can detect reduced echogenecity (often accompanying AITD).

          

    Prospective examinations were carried out for 3077 patients having US of the thyroid for various complaints including goiter, thyroid dysfunction, neck discomfort and swallowing difficulty.

          

    The authors conclude that diffuse reduced thyroid echogenecity occurs early in the course of AITD and is also a useful predictor of patients who may develop this disorder.

          

  • Bussen S, Steck T, Diethl J (Univ of Wuerzburg, Germany)

    Increased Prevalence of Thryoid antibodies in Euthyroid Women with a History of Recurrent In-Vitro Fertilization Failure.

    Hum Reprod 15; 545-548, 2000.

      

    Euthyroid nonpregnant women who have had several spontaneous abortions have a significant increase of thyroid antibodies, compared with women of child bearing age, who have had no children or have had several children.

      

    The authors evaluated serum concentrations of thyroglobul in (Tg), thyroid peroxidase (TPO) and anticardiolipin antibodies.

      

    The authors feel that the presence of thyroid antibodies may be responsible for adverse pregnancy outcome in women who have had recurrent IVF failure.

       

  • Engelbach M, Gorges R, et al (Univ Hosp of Mainz, Germany; Univ Hosp of Essen, Germany)

    Improved Diagnostic Methods in the Follow-up of Medullary Thyroid Carcinoma by Highly Specific Calcitonin Measurements.

    J Clin Endocrinol Metab 85: 1890-1894, 2000.

      

    Medullary thyroid carcinoma (MTC), a rare thyroid tumor, secretes calcitonin (CT). Recently developed CT assays recognize the monomeric form of CT
    (mCT).

      

    Compared with an unspecific CT-radioimmunoassay, the more specific mCT determination by immunoluminometric assay enables more precise differentiation between postoperative normal and pathologic values enabling an earlier diagnosis of recurrent
    MTC.

       

  • Pitas AG, Adler M, et al (Mem Sloan Kettering Cancer Ctr, New York)

    Bone Metastases from Thyroid Carcinoma: Clinical Characteristics and Prognostic Variables in One Hundred Forty-Six Patients

    Thyroid 10: 261-268, 2000

      

    Bone metastases from thyroid carcinoma carry a poor prognosis.

      

    In this retrospective review of 146 patients, data was collected from medical records of patients with documented bone metastases from 1960 to 1998.

      

    Significant prognostic factors were:

    1) Radio-iodine uptake by skeletal metastases

    2) Absence of non-osseous metastases

    3) Treatment with radioiodine.

      

    The authors conclude that when bone metastases were associated with thyroid cancer, survival is reduced.

      

    If nonosseous metastases develop and the lesions do NOT take up radio-iodine, the prognosis declines further.

      

    Hürthle cell carcinoma is associated with the best prognosis. The undifferentiated histologic type carries the worst outlook.

       

  • Hak AE, Pols HAP, et al (Erasmus Univ, Rotterdam, The Netherlands)

    Subclinical Hypothyroidism is an Independent Risk Factor for Atherosclerosis and Myocardial Infarction in Elderly Women: The Rotterdam Study.

    Ann Intern Med 132: 270-278, 2000.

         

    The Rotterdam Study was a population-based cross-sectional study of chronic diseases in old age including data on 1149 women (mean age 69 years).

         

    The authors found that women with subclinical hypothyroidism were more likely to have both aortic atherosclerosis and myocardial infarction. These relationships were unaffected by adjustments for other risk factors, including body mass index, cholesterol levels, blood pressure, smoking and
    b-blocker use.

        

    Women with BOTH subclinical hypothyroidism and thyroid autoimmunity, were at a higher risk for aortic atherosclerosis and myocardial infarction, than those with thyroid autoimmunity alone.

          

    The authors conclude that subclinical hypothyroidism is a significant and independent cardiovascular disease risk factor in elderly women.

            

  • Sera N, Ashizawa K, Ando T, et al (Nagasaki Univ, Japan)

    Treatment with Prophylthiouracil is Associated with Appearance of Antineutrophil Cytoplasmic Antibodies in some patients with Graves’ Disease.

    Thyroid 10: 595-599, 2000

             

    Prophylthiouracil (PTU) therapy for Graves’ disease has been found to be associated with

           


    1) Skin Eruption

    2) Liver Dysfunction

    3) Agranulocytosis

          


    Antineutrophil cytoplasmic antibody (ANCA)-related glomerulonephritis and vasculitis have been reported in patients given PTU.

         


    Serum samples from 117 patients with Graves’ disease were analysed. Elisa Kits were used to assess myeloperoxidase (MPO) -ANCA.

           


    56 patients were treated with PTU, (group 2)

    21 patients were treated with methimazole (MMI) (group 3)

    42 patients were untreated (group 1)

            


    37.5% patients treated with PTU had detectable MPO-ANCA. 

    The proportion of patients with positive results for MPO-ANCA increased with PTU prolongation. Out of 21 patients with MPO-ANCA positive results, 12 had no symptoms, 9 reported myalgia, arthralgia, or common cold like symptoms. Agranulocytosis or granulocytopenia developed in 3
    patients.

                

  • Premawardhana LDKE, Parkes AB, Ammari F, et al (Univ of Wales, Cardiff)

    Postpartum Thyroiditis and Long-term Thyroid Status: Prognostic Influence of Thyroid Peroxidase Antibodies and Ultrasound Echogenicity

    J Clin Endocrinol Metab 85: 71-75, 2000

           


    One fourth of the women who have postpartum thyroid dysfunction (PPTD) develop hypothyroidism in 3 to 5 years. 25% to 30% of these women runs the risk for early permanent hypothyroidisim.

           


    The authors concluded that thyroid dysfunction occurs with increased prevalence among women who were thyroid peroxidase antibodies (TPOAb) positive, than among those who were either TPOAb negative or without
    PPTD.  

           

  • Gardner RE, Tuttle RM, Burman KD, et al (Georgetown Univ, Washington, DC; Walter Reed Army Med Ctr, Washington, DC; Washington Hosp Ctr, Washington, DC; et al)

    Prognostic Importance of Vascular Invasion in Papillary Thyroid Carcinoma

    Arch Otolaryngol Head Neck Surg 126: 309-213, 2000.

            


    Four hundred ten patients with a diagnosis of papillary thyroid carcinoma (PTC) were followed up for more than 1 year. The median follow-up was 5.5 years.

             


    Patients were divided into 3 groups (i) No vascular invasion (ii) Intrathyroidal vascular invasion and (iii) Extrathyroidal vascular invasion.

           


    It was found that presence of vascular invasion in patients with PTC, even within the thyroid gland, appears to be correlated with more aggressive disease at diagnosis and a greater incidence of tumor recurrence.   

            

  • Bennedbaek FN, Hegedus L (Odense Univ, Denmark)

    Management of the Solitary Thyroid Nodule : Results of a North American Survey.

    J Clin Endocrinol Metab 85: 2493-98, 2000

            


    The authors surveyed the current trends in the treatment of nontoxic solitary thyroid nodules by expert endocrinologists in North America (N.A.), and compared with trends in Europe.

           


    One hundred and forty-two evaluable surveys were returned. It was found that North American endocrinologists rely heavily on the results of fine needle aspiration biopsy (FNAB) but rely less on imaging and serum calcitonin measures than European endocrinologists.

           


    Primary treatment strategy in N.A. is nonsurgical. More than 40% both N.American and European endocrinologists support the use of
    L-T4 treatment.    

           

  • Hatipoglu BA, Gierlowski T, Shore-Freedman E, et al (Univ of Illinois, Chicago; Univ of Chicago)

    Fine-Needle Aspiration of Thyroid Nodules in Radiation-Exposed Patients.

    Thyroid 10: 63-69, 2000

            


    External radiation in the treatment of benign conditions in the head and neck area increases the risk of thyroid cancer.

            


    Suspicious thyroid nodules are routinely assessed by fine-needle aspiration (FNA) biopsy. Little is known about FNA in irradiated patients.

           


    Though sensitivity of FNA in irradiated patients is comparable to that in the general population, smaller malignant nodules, are not diagnosed by FNA and the FNA diagnosis of follicular neoplasm is commonly inaccurate. Aspirations in this patients group are often inadequate.

          

  • Merchant SH, Izquierdo R, Khurana KK (State Univ of New York, Syracuse)

    Is Repeated Fine-Needle Aspiration Cytology Useful in the Management of Patients with Benign Nodular Thyroid Disease?

    Thyroid 10:489-492, 2000

             


    Routine repeated FNA cytologic study in the follow-up of patients with benign nodular thyroid disease, with or without clinical changes, does not appear to be useful.

          


    Clinical features as opposed to repeat FNA may be more important to determine the need for surgery in patients with benign nodular thyroid disease.   

           

  • Grigsby PW, Siegel BA, Baker S, et al (Washington Univ, St.Louis)

    Radiation Exposure From Outpatient Radioactive Iodine
    (131I) Therapy for Thyroid Carcinoma

    JAMA 283: 2272-2274, 2000

            


    Patients after receiving 131I doses, considerably larger than previously permitted (before May 1997), were allowed to return home.

           


    The effect of these large doses on persons then exposed to the patient were studied.

            


    Thirty patients, 65 household participants and 17 pets were studied. It was concluded that patients CAN be given
    131I therapy for thyroid cancer and released without fear that household contacts would be exposed to radiation levels exceeding limits set by the nuclear regulatory commission.   

              

  • Cheung CC, Ezzat S, Ramyar L, et al (Univ of Toronto)

    Molecular Basis of Hürthle Cell Papillary Thyroid Carcinoma

    J Clin Endocrinol Metab 85: 878-882, 2000

           


    Hürthle cell adenomas are benign encapsulated follicular lesions. Hürthle cell carcinomas exhibit unequivocal capsular or vascular invasion, behave aggressively and have a poor prognosis.

           


    A subset of Hürthle cell tumors (HCTs) may represent papillary thyroid carcinomas (PTCs), with histological, clinical and immunohistochemical characteristics based on specific molecular events.

           


    The features of PTC can be attributed to specific gene rearrangements. The authors recommend that HCTs should be subclassified into 3 groups: Hürthle cell adenomas, Hürthle cell carcinomas, and Hürthle cell
    PTC.           

           

  • Luster M, Lassmann M, et al (Univ of Wuerzburg, Germany, Genzyme Europe, Naarden, The Netherlands)

    Use of Recombinant Human Thyrotropin Before Radioiodine Therapy for Patients with Advanced Differentiated Thyroid Carcinoma

    J Clin Endocrinol Metab 85: 3640-3645, 2000

           


    Patients suffering from advanced differentiated thyroid carcinoma and who are in very poor physical condition are unable to discontinue TSH therapy.

           


    Recombinant human (rh) TSH was used to increase serum levels of TSH; in conjunction with use of radioactive Iodine. Therapeutic benefit was shown in most of the patients who receive rh TSH and
    131I therapy.  

            

  • Brander AEE, Viikinkoski VP, Nickels JI, et al (Helsinki Univ; Hyvinkaa District Hosp, Finland)

    Importance of Thyroid Abnormalities Detected at US Screening : A 5-Year Follow-up.

    Radiology 215: 801-806, 2000

            


    Screening with high frequency US has proved very useful in the detection of NONPALPABLE thyroid abnormalities.

           


    In a random adult population (253 adults), a 5-year follow-up study was carried out in patients who had previous US screening.

           


    Evaluation in this follow-up study included thyroid US, fine-needle aspiration biopsy, blood tests and clinical examination.

          


    None of the nodules were found to be malignant. 12 out of 34 nodules originally detected had grown.

          


    Biopsy specimens from 10 of the nodules that had grown showed 9 benign and 1 adenomatous.

           


    Most nodules found by thyroid US screening are benign. After 5 years, none of the patients developed malignancy.    

          

  • Marqusee E, Benson CB, Frates MC, et al (Harvard Med School, Boston)

    Usefulness of Ultrasonography in the Management of Nodular Thyroid Disease

    Ann Intern Med 133: 696-700, 2000

          


    One hundred fifty sixty patients underwent a total of 209 fine needle aspiration biopsies. Of 114 patients referred for a solitary nodule, additional nonpalpable nodules at least 1cm in diameter were identified on US in 27 patients.

          


    Of 59 patients referred for a diffuse goiter or a multinodular gland, US identified discrete nodules at least one cm diameter, needing aspiration in 39 patients.

           


    The authors conclude that US changed the clinical management of 63% of patients referred after abnormal clinical findings of the thyroid.               

                                                     

  • Derringer GA, Thompson LDR, et al (Armed Forces Inst of Pathology, Washington, DC)

    Malignant Lymphoma of the Thyroid Gland: A Clinicopathologic Study of 108 cases.

    Am J Surg Pathol 24: 623-639, 2000

                                  

    A retrospective study of 108 primary thyroid gland lymphomas was conducted on patients who all had a thyroid mass on initial assessment.   

                         

    This study was conducted to characterize the clinical, histomorphological, immunophenotypic and molecular features of these
    tumours.        

                                              

    Tumours were classified as:

    1) Marginal zone B-cell lymphoma (MZBL)

    2) Diffuse large B-cell lymphoma (DLBCL) with MZBL

    3) DLBCL without MZBL

    4) Follicle center lymphoma

                                                          

    Primary thyroid gland lymphomas have a predilection for women, and most of these tumors are of the mucosa-associated lymphoid tissue type, arising in a lymphocytic thyroiditis setting. Mixed DLBCL and MZBL were common in this series.    

                                                                                                                        

  • Ramos-Casals M, Garcia-Carrasco M, Cervera R, et al (Univ of Barcelona, Molins de Rei, Barcelona; Benemerita Univ, Puebla, Mexico)

    Thyroid Disease in Primary Sjögren Syndrome: Study in a Series of 160 Patients.

    Medicine 79: 103-108, 2000

                                                                            

    One hundred sixty consecutive patients with primary Sjögren syndrome (SS) were studied.

                                                                

    SS is an autoimmune disorder which primarily affects exocrine glands.

                                                  

    36% of patients with primary SS had evidence of thyroid disease. Autoimmune thyroid disease (ATD) was diagnosed in 20% patients; nonautoimmune thyroid disease (NATD) was diagnosed in 16%.

                                                                

    The authors postulate that thyroid function should be assessed periodically in middle-aged women with or without SS.      





          

 



 

 

Speciality Spotlight

 

 
Endocrinology
   

  

Thyroid
 

  

  • JH Dussault, DA Fisher  (CHUL, Quebec; Nichols Inst, San Juan Capistrano, Calif; Harbor UCLA Med Ctr, Torrence, California)
    Thyroid Function in Mothers of Hypothyroid Newborns.
    Obstet Gynecol  93:15-20, 1999.
        
    Background:  autoimmune thyroid disease is relatively common in women in their childbearing years. The etiologic significance of maternal autoimmune thyroid disease in the incidence of transient congenital hypothyroidism in newborns was investigated.
        
    It was found that if not all, cases of transient congenital hypothyroidism could be attributed to maternal autoimmune thyroid disease and, presumably, to maternal TSH receptor-blocking antibody.  Maternal autoimmune thyroid disease appears to be associated with a much greater prevalence of autoimmune thyroid disease and thyroid dysfunction in the mothers of congenitally hypothyroid infants was 20%, thyroid assessment is indicated in such women.
       

  • Q Liu, G Djuricin, RA Prinz (Rush-Presbyterian-St.Luke’s Med Ctr, Chicago):
    Total thyroidectomy for benign thyroid disease.
    Surgery 123:2-7, 1998.
      
    The safety and efficacy of the above controversial surgery for gross benign disease involving both lobes, were evaluated in 106 consecutive patients.
       
    Total thyroidectomy can be performed safely and with a low complication rate in patients with nodular goitre, hyperparathyroidism and thyroiditis to prevent recurrence and eliminate malignant disease in patients with irradiated glands.
      
    Total thyroidectomy is safe and effective for patients with benign bilateral disease. There is a small risk of permanent hypoparathyroidism or recurrent laryngeal nerve injury.
       

  • S Noguchi, N Murakami, H Yamashita et al (Oita Med Univ, Japan) :
    Papillary thyroid carcinoma: Modified radical neck dissection improves prognosis. 
    Arch Surg 133:276-280, 1998.
          
    Patients with thyroid cancer who have nodal metastases or invasive disease and women who are over age 60, can benefit from modified radical neck surgery.
        

  • Mirallie E, Visset J, Sagan C, et al (centre Hospitalo-Universitaire, Nantes, France)
    Localization of Cervical Node Metastasis of Papillary Thyroid Carcinoma.
    World J Surg 23 : 970-974, 1999
        
    Node sites in 119 patients of papillary thyroid carcinoma were retrospectively examined to determine a possible dissection procedure and to define the extent of neck dissection.
        
    60.5% was incidence of cervical node metastasis and bilateral in 40.8% patients. The most commonly involved sites were ipsilateral paratracheal and jugular sites. Occasional involvement of lateral compartment was present and was independent of central involvement.
         

  • Alam MDS, Kasagi K, et al (Kyoto Univ, Japan)
    Diagnostic Value of Technetium-99m Methoxyisobutyl Isonitrile (99mTc-MIBI) Scintigraphy in Detecting Thyroid Cancer Metastases: A Critical Evaluation.
    Thyroid 8: 1091 – 110, 1998
       
    68 patients who underwent total thyroidectomy and radioiodine ablation were included for study.
       
    The above procedure is recommended as first line choice to detect metastases. Advantages over I131 scintigraphy is better sensitivity, no need to restrict dietary iodide intake and no need to discontinue administration of thyroid hormones. Its limitations are detection of small lung metastasis. In this situation I131 scintigraphy and serum Tg level measurements are recommended.
       
    Editor, R.A. Otto, agrees with the findings.
        

  • Grigsby PW, Baglan K, Siegel BA (Washington Univ, St. Louis)
    Surveillance of Patients to Detect Recurrent Thyroid Carcinoma
    Cancer 85: 945-951, 1999
       
    Seventy Six patients undergoing total thyroidectomy and I131 ablation had at least one negative whole body I131 scintigraphy at 1yr follow up. I131 imaging should be performed for surveillance until 2 negative annual studies are observed, after which repeat imaging at 3 to 5 yrs seen satisfactory.
        

  • Wang W, Macapinlac H, Larson SM, et al (Mem Sloan-Kettering Cancer Ctr, New York)
    [18F]-2-Fluoro-2-Deoxy-D-Glucose Positron Emission Tomography Localizes Residual Thyroid Cancer in Patients with Negative Diagnostic 131I Whole Body Scans and Elevated Serum Thyroglobulin Levels.
    J Clin Endocrinol Metab 84: 2291-2302, 1999
        
    37 patients treated with surgery and radioiodine ablation and whose follow-up DxWBS (131I Whole Body Scans) results were negative, and patients were studied by FDG-PET, measurements of serum Tg levels. This has high predictive value in localizing residual thyroid cancer. Shortcomings are detection of minimum residual disease present in cervical nodes.
       
    For clinicians faced with dilemma of residual disease inspite of Whole Body Scan and elevated Tg levels setting FDG-PET may prove useful – R.A. Otto.
       

  • Thyrotoxicosis
    Khoo DHC, Parma J, Rajasoorya C, et al [Singapore Gen Hosp; Alexandra Hosp, Singapore; Universite Libre de Bruxelles, Brussels, Belgium]
    A Germiline Mutation of the Thyrotropin Receptor Gene Associated with Thyrotoxicosis and Mitral Valve Prolapse in a Chinese Family
    J Clin Endocrinol Metab 84: 1459-1462, 1999
       
    Background – In 1993, it was discovered that mutations of the TSH receptor [TSH-R] gene cause hyperfunctioning thyroid adenomas. Subsequent studies have identified families with nonautoimmune, autosomal dominant hyperthyroidism caused by TSH-R germline mutations, as well as activating TSH-R mutations leading to sporadic neonatal hyperthyroidism and toxic multinodular goiter.
     
    Patients –  In the study family, thyrotoxicosis developed in the father at age 38 years, and in all 3 children. An investigation identified MVP with regurgitation in the father and 2 of the children. In the children, thyrotoxicosis was manifested by prominent eyes.  The onset of thyrotoxicosis and the diagnosis of MVP occurred  close in time to each other. Genetic studies in this family found a germline proline to serine substitution in position 639, a constitutively activating mutation previously associated   with a hyperfunctioning thyroid nodule.
      
    Discussion – The activating TSH-R mutation in this family appears to be associated with both thyrotoxicosis and MVP.  Although a clinical association of MVP with Graves’ disease and chronic lymphocytic mechanisms remain unclear.  The study family appears to have a genetic predisposition to MVP, with TSH-R activation contributing to earlier manifestation.
       

  • Vestergaard P, Rejumark L et al (Aarhus Univ., Denmark)
    Fracture Risk in Patients Treated for Hyperthyroidism
    Thyroid 10:341-347, 2000
          
    Excess thyroid hormones stimulate turnover in trabecular and cortical bone, resulting in an increased risk of fractures.
           
    864 patients with diffuse toxic or toxic nodular goiter were asked to complete a questionnaire. Their responses were compared with those of an age and sex-matched group selected randomly from background population.
          
    After diagnosis of hyperthyroidism, the patient’s fracture risk was increased, especially among those 50 yrs or older, who had a relative risk of 2.2.
          
    Risk was increased for fracture of the spine and forearms, but not other skeletal sites.
          
    Treatment with radioactive iodine alone was correlated with an increased fracture risk. Patients receiving methimazole in addition to radioactive iodine did not have an increased risk.
            

  • Kraimps JL, Bouin-Pineau MH, et al (Jean Bernard Hosp, Poitiers, France; Dupuytren Hosp, Limoges, France; Bretonneau Hosp, Tours, France; et al)
    Multicentre Study of Thyroid Nodules in Patients with Graves’ Disease
    Br J Surg 87:1111-1113, 2000
          
    The incidence of thyroid nodules and thyroid carcinoma (Ca) in patients with Graves’ disease (GD) is increasing.
          
    The authors conducted a retrospective study of 55% patients undergoing surgery in 5 endocrinology surgical departments. None of the patients had radioactive iodine therapy or external irradiation previously. Subtotal or total thyroidectomy was performed.
          
    Thyroid Ca, always inside a nodule, was diagnosed in 15% of patients.
          
    In this series of patients (undergoing thyroidectomy) the authors found that incidence of carcinoma was 3.8%. The rate of Ca in cold nodules was 15% and hence all patients with Graves’ disease and a thyroid nodule should undergo total thyroidectomy.
            

  • Lien EA, Nedrebo BG, Varhaug JE, et al (Univ. Hosp of Bergen, Norway)
    Plasma Total Homocysteine Levels During Short-term Iatrogenic Hypothyroidism.
    J Clin Endocrinol Metab 85: 1049-1053, 2000
          
    Patients with hypothyroidism have an “atherogenic” lipid profile, with high cholesterol and lipid levels.
            
    The authors previously reported that patients with hypothyroidism have raised plasma total homocysteine (tHcy)
           
    A longitudinal study was done including 17 patients (11 women and 6 men; mean age 49 yrs) who underwent total thyroidectomy for thyroid cancer.
         
    The authors state that post thyroidectomy patients undergoing temporary hypothyroidism have reversible increases in plasma tHcy and serum cholesterol.
          
    Increase in plasma tHcy results from alteration of renal function.
            
    Interactive effect of increases in plasma tHcy and serum cholesterol may account for the increased cardiovascular risk associated with hypothyroidism.
            

  • Watemberg N, Willis D et al (Virginia Commonwealth Univ, Richmond)
    Encephalopathy as the Presenting Symptom of Hashimoto’s Thyroiditis
    J Child Neurol 15: 67-69, 2000
           
    Hashimoto’s thyroiditis occurring most often in females has many neurologic manifestations including encephalopathy.
           
    The authors present a case report of a 9-yr girl who presented with sudden unexplained encephalopathy, later diagnosed as Hashimoto’s thyroiditis after analysis of antimicrosomal antibodies and antithyroid antibodies.
          
    Once diagnosed, Hashimoto’s encephalopathy responds to corticosteroids.
          

  • Singh N, Singh PN, Hershman JM (Univ. of California, Los Angeles; Loma Linda Med Ctr, Calif).
    Effect of Calcium Carbonate on the Absorption of Levothyroxine
    JAMA 283: 2822-2825, 2000
          
    Absorption of Levothyroxine Na is affected by a wide range of other drugs. The effects of calcium carbonate (used by many of the same postmenopausal women who take levothyroxine), on absorption of levothyroxine were assessed in 20 patients with secondary hypothyroidism.
           
    All patients took calcium carbonate, 1200mg/day for 3 months.
           
    The findings support the hypothesis that calcium carbonate treatment reduces absorption of levothyroxine.
          

  • Mercuro G, Panzuto MG, Bina A, et al (Univ. of Cagliari, Italy)
    Cardiac Function, Physical Exercise Capacity, and Quality of Life During Long-term Thyrotropin-Suppressive Therapy With Levothyroxine: Effect of Individual Dose Tailoring.
    J Clin Endocrinol Metab 85: 159-164, 2000
          
    Therapy employing Levothyroxine (L-T4) may adversely affect the cardiovascular system.
           
    It was found that individually tailoring the dosage of L-T4 to the minimum required by each person, improved or ameliorated totally, the morphological heart abnormalities developing with the use of L-T4.
          

  • Pedersen OM, Aardal NP, Larssen TB, et al (Univ. of Bergen, Norway)
    The Value of Ultrasonogrpahy in Predicting Autoimmune Thyroid Disease.
    Thyroid 10: 251-259, 2000.
           
    The diagnosis of autoimmune thyroid disease (AITD) may be aided by the use of ultrasonography (US) which can detect reduced echogenecity (often accompanying AITD).
          
    Prospective examinations were carried out for 3077 patients having US of the thyroid for various complaints including goiter, thyroid dysfunction, neck discomfort and swallowing difficulty.
          
    The authors conclude that diffuse reduced thyroid echogenecity occurs early in the course of AITD and is also a useful predictor of patients who may develop this disorder.
          

  • Bussen S, Steck T, Diethl J (Univ of Wuerzburg, Germany)
    Increased Prevalence of Thryoid antibodies in Euthyroid Women with a History of Recurrent In-Vitro Fertilization Failure.
    Hum Reprod 15; 545-548, 2000.
      
    Euthyroid nonpregnant women who have had several spontaneous abortions have a significant increase of thyroid antibodies, compared with women of child bearing age, who have had no children or have had several children.
      
    The authors evaluated serum concentrations of thyroglobul in (Tg), thyroid peroxidase (TPO) and anticardiolipin antibodies.
      
    The authors feel that the presence of thyroid antibodies may be responsible for adverse pregnancy outcome in women who have had recurrent IVF failure.
       

  • Engelbach M, Gorges R, et al (Univ Hosp of Mainz, Germany; Univ Hosp of Essen, Germany)
    Improved Diagnostic Methods in the Follow-up of Medullary Thyroid Carcinoma by Highly Specific Calcitonin Measurements.
    J Clin Endocrinol Metab 85: 1890-1894, 2000.
      
    Medullary thyroid carcinoma (MTC), a rare thyroid tumor, secretes calcitonin (CT). Recently developed CT assays recognize the monomeric form of CT (mCT).
      
    Compared with an unspecific CT-radioimmunoassay, the more specific mCT determination by immunoluminometric assay enables more precise differentiation between postoperative normal and pathologic values enabling an earlier diagnosis of recurrent MTC.
       

  • Pitas AG, Adler M, et al (Mem Sloan Kettering Cancer Ctr, New York)
    Bone Metastases from Thyroid Carcinoma: Clinical Characteristics and Prognostic Variables in One Hundred Forty-Six Patients
    Thyroid 10: 261-268, 2000
      
    Bone metastases from thyroid carcinoma carry a poor prognosis.
      
    In this retrospective review of 146 patients, data was collected from medical records of patients with documented bone metastases from 1960 to 1998.
      
    Significant prognostic factors were:
    1) Radio-iodine uptake by skeletal metastases
    2) Absence of non-osseous metastases
    3) Treatment with radioiodine.
      
    The authors conclude that when bone metastases were associated with thyroid cancer, survival is reduced.
      
    If nonosseous metastases develop and the lesions do NOT take up radio-iodine, the prognosis declines further.
      
    Hürthle cell carcinoma is associated with the best prognosis. The undifferentiated histologic type carries the worst outlook.
       

  • Hak AE, Pols HAP, et al (Erasmus Univ, Rotterdam, The Netherlands)
    Subclinical Hypothyroidism is an Independent Risk Factor for Atherosclerosis and Myocardial Infarction in Elderly Women: The Rotterdam Study.
    Ann Intern Med 132: 270-278, 2000.
         
    The Rotterdam Study was a population-based cross-sectional study of chronic diseases in old age including data on 1149 women (mean age 69 years).
         
    The authors found that women with subclinical hypothyroidism were more likely to have both aortic atherosclerosis and myocardial infarction. These relationships were unaffected by adjustments for other risk factors, including body mass index, cholesterol levels, blood pressure, smoking and
    b-blocker use.
        
    Women with BOTH subclinical hypothyroidism and thyroid autoimmunity, were at a higher risk for aortic atherosclerosis and myocardial infarction, than those with thyroid autoimmunity alone.
          
    The authors conclude that subclinical hypothyroidism is a significant and independent cardiovascular disease risk factor in elderly women.
            

  • Sera N, Ashizawa K, Ando T, et al (Nagasaki Univ, Japan)
    Treatment with Prophylthiouracil is Associated with Appearance of Antineutrophil Cytoplasmic Antibodies in some patients with Graves’ Disease.
    Thyroid 10: 595-599, 2000
             
    Prophylthiouracil (PTU) therapy for Graves’ disease has been found to be associated with
           
    1) Skin Eruption
    2) Liver Dysfunction
    3) Agranulocytosis
          
    Antineutrophil cytoplasmic antibody (ANCA)-related glomerulonephritis and vasculitis have been reported in patients given PTU.
         
    Serum samples from 117 patients with Graves’ disease were analysed. Elisa Kits were used to assess myeloperoxidase (MPO) -ANCA.
           
    56 patients were treated with PTU, (group 2)
    21 patients were treated with methimazole (MMI) (group 3)
    42 patients were untreated (group 1)
            
    37.5% patients treated with PTU had detectable MPO-ANCA. 
    The proportion of patients with positive results for MPO-ANCA increased with PTU prolongation. Out of 21 patients with MPO-ANCA positive results, 12 had no symptoms, 9 reported myalgia, arthralgia, or common cold like symptoms. Agranulocytosis or granulocytopenia developed in 3 patients.
                

  • Premawardhana LDKE, Parkes AB, Ammari F, et al (Univ of Wales, Cardiff)
    Postpartum Thyroiditis and Long-term Thyroid Status: Prognostic Influence of Thyroid Peroxidase Antibodies and Ultrasound Echogenicity
    J Clin Endocrinol Metab 85: 71-75, 2000
           
    One fourth of the women who have postpartum thyroid dysfunction (PPTD) develop hypothyroidism in 3 to 5 years. 25% to 30% of these women runs the risk for early permanent hypothyroidisim.
           
    The authors concluded that thyroid dysfunction occurs with increased prevalence among women who were thyroid peroxidase antibodies (TPOAb) positive, than among those who were either TPOAb negative or without PPTD.  
           

  • Gardner RE, Tuttle RM, Burman KD, et al (Georgetown Univ, Washington, DC; Walter Reed Army Med Ctr, Washington, DC; Washington Hosp Ctr, Washington, DC; et al)
    Prognostic Importance of Vascular Invasion in Papillary Thyroid Carcinoma
    Arch Otolaryngol Head Neck Surg 126: 309-213, 2000.
            
    Four hundred ten patients with a diagnosis of papillary thyroid carcinoma (PTC) were followed up for more than 1 year. The median follow-up was 5.5 years.
             
    Patients were divided into 3 groups (i) No vascular invasion (ii) Intrathyroidal vascular invasion and (iii) Extrathyroidal vascular invasion.
           
    It was found that presence of vascular invasion in patients with PTC, even within the thyroid gland, appears to be correlated with more aggressive disease at diagnosis and a greater incidence of tumor recurrence.   
            

  • Bennedbaek FN, Hegedus L (Odense Univ, Denmark)
    Management of the Solitary Thyroid Nodule : Results of a North American Survey.
    J Clin Endocrinol Metab 85: 2493-98, 2000
            
    The authors surveyed the current trends in the treatment of nontoxic solitary thyroid nodules by expert endocrinologists in North America (N.A.), and compared with trends in Europe.
           
    One hundred and forty-two evaluable surveys were returned. It was found that North American endocrinologists rely heavily on the results of fine needle aspiration biopsy (FNAB) but rely less on imaging and serum calcitonin measures than European endocrinologists.
           
    Primary treatment strategy in N.A. is nonsurgical. More than 40% both N.American and European endocrinologists support the use of L-T4 treatment.    
           

  • Hatipoglu BA, Gierlowski T, Shore-Freedman E, et al (Univ of Illinois, Chicago; Univ of Chicago)
    Fine-Needle Aspiration of Thyroid Nodules in Radiation-Exposed Patients.
    Thyroid 10: 63-69, 2000
            
    External radiation in the treatment of benign conditions in the head and neck area increases the risk of thyroid cancer.
            
    Suspicious thyroid nodules are routinely assessed by fine-needle aspiration (FNA) biopsy. Little is known about FNA in irradiated patients.
           
    Though sensitivity of FNA in irradiated patients is comparable to that in the general population, smaller malignant nodules, are not diagnosed by FNA and the FNA diagnosis of follicular neoplasm is commonly inaccurate. Aspirations in this patients group are often inadequate.
          

  • Merchant SH, Izquierdo R, Khurana KK (State Univ of New York, Syracuse)
    Is Repeated Fine-Needle Aspiration Cytology Useful in the Management of Patients with Benign Nodular Thyroid Disease?
    Thyroid 10:489-492, 2000
             
    Routine repeated FNA cytologic study in the follow-up of patients with benign nodular thyroid disease, with or without clinical changes, does not appear to be useful.
          
    Clinical features as opposed to repeat FNA may be more important to determine the need for surgery in patients with benign nodular thyroid disease.   
           

  • Grigsby PW, Siegel BA, Baker S, et al (Washington Univ, St.Louis)
    Radiation Exposure From Outpatient Radioactive Iodine (131I) Therapy for Thyroid Carcinoma
    JAMA 283: 2272-2274, 2000
            
    Patients after receiving 131I doses, considerably larger than previously permitted (before May 1997), were allowed to return home.
           
    The effect of these large doses on persons then exposed to the patient were studied.
            
    Thirty patients, 65 household participants and 17 pets were studied. It was concluded that patients CAN be given 131I therapy for thyroid cancer and released without fear that household contacts would be exposed to radiation levels exceeding limits set by the nuclear regulatory commission.   
              

  • Cheung CC, Ezzat S, Ramyar L, et al (Univ of Toronto)
    Molecular Basis of Hürthle Cell Papillary Thyroid Carcinoma
    J Clin Endocrinol Metab 85: 878-882, 2000
           
    Hürthle cell adenomas are benign encapsulated follicular lesions. Hürthle cell carcinomas exhibit unequivocal capsular or vascular invasion, behave aggressively and have a poor prognosis.
           
    A subset of Hürthle cell tumors (HCTs) may represent papillary thyroid carcinomas (PTCs), with histological, clinical and immunohistochemical characteristics based on specific molecular events.
           
    The features of PTC can be attributed to specific gene rearrangements. The authors recommend that HCTs should be subclassified into 3 groups: Hürthle cell adenomas, Hürthle cell carcinomas, and Hürthle cell PTC.           
           

  • Luster M, Lassmann M, et al (Univ of Wuerzburg, Germany, Genzyme Europe, Naarden, The Netherlands)
    Use of Recombinant Human Thyrotropin Before Radioiodine Therapy for Patients with Advanced Differentiated Thyroid Carcinoma
    J Clin Endocrinol Metab 85: 3640-3645, 2000
           
    Patients suffering from advanced differentiated thyroid carcinoma and who are in very poor physical condition are unable to discontinue TSH therapy.
           
    Recombinant human (rh) TSH was used to increase serum levels of TSH; in conjunction with use of radioactive Iodine. Therapeutic benefit was shown in most of the patients who receive rh TSH and 131I therapy.  
            

  • Brander AEE, Viikinkoski VP, Nickels JI, et al (Helsinki Univ; Hyvinkaa District Hosp, Finland)
    Importance of Thyroid Abnormalities Detected at US Screening : A 5-Year Follow-up.
    Radiology 215: 801-806, 2000
            
    Screening with high frequency US has proved very useful in the detection of NONPALPABLE thyroid abnormalities.
           
    In a random adult population (253 adults), a 5-year follow-up study was carried out in patients who had previous US screening.
           
    Evaluation in this follow-up study included thyroid US, fine-needle aspiration biopsy, blood tests and clinical examination.
          
    None of the nodules were found to be malignant. 12 out of 34 nodules originally detected had grown.
          
    Biopsy specimens from 10 of the nodules that had grown showed 9 benign and 1 adenomatous.
           
    Most nodules found by thyroid US screening are benign. After 5 years, none of the patients developed malignancy.    
          

  • Marqusee E, Benson CB, Frates MC, et al (Harvard Med School, Boston)
    Usefulness of Ultrasonography in the Management of Nodular Thyroid Disease
    Ann Intern Med 133: 696-700, 2000
          
    One hundred fifty sixty patients underwent a total of 209 fine needle aspiration biopsies. Of 114 patients referred for a solitary nodule, additional nonpalpable nodules at least 1cm in diameter were identified on US in 27 patients.
          
    Of 59 patients referred for a diffuse goiter or a multinodular gland, US identified discrete nodules at least one cm diameter, needing aspiration in 39 patients.
           
    The authors conclude that US changed the clinical management of 63% of patients referred after abnormal clinical findings of the thyroid.               
                                                     

  • Derringer GA, Thompson LDR, et al (Armed Forces Inst of Pathology, Washington, DC)
    Malignant Lymphoma of the Thyroid Gland: A Clinicopathologic Study of 108 cases.
    Am J Surg Pathol 24: 623-639, 2000
                                  
    A retrospective study of 108 primary thyroid gland lymphomas was conducted on patients who all had a thyroid mass on initial assessment.   
                         
    This study was conducted to characterize the clinical, histomorphological, immunophenotypic and molecular features of these tumours.        
                                              
    Tumours were classified as:
    1) Marginal zone B-cell lymphoma (MZBL)
    2) Diffuse large B-cell lymphoma (DLBCL) with MZBL
    3) DLBCL without MZBL
    4) Follicle center lymphoma
                                                          
    Primary thyroid gland lymphomas have a predilection for women, and most of these tumors are of the mucosa-associated lymphoid tissue type, arising in a lymphocytic thyroiditis setting. Mixed DLBCL and MZBL were common in this series.    
                                                                                                                        

  • Ramos-Casals M, Garcia-Carrasco M, Cervera R, et al (Univ of Barcelona, Molins de Rei, Barcelona; Benemerita Univ, Puebla, Mexico)
    Thyroid Disease in Primary Sjögren Syndrome: Study in a Series of 160 Patients.
    Medicine 79: 103-108, 2000
                                                                            
    One hundred sixty consecutive patients with primary Sjögren syndrome (SS) were studied.
                                                                
    SS is an autoimmune disorder which primarily affects exocrine glands.
                                                  
    36% of patients with primary SS had evidence of thyroid disease. Autoimmune thyroid disease (ATD) was diagnosed in 20% patients; nonautoimmune thyroid disease (NATD) was diagnosed in 16%.
                                                                
    The authors postulate that thyroid function should be assessed periodically in middle-aged women with or without SS.      


          

 

 

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