Thyroid

Thyroid
  

• 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.