Effects of low-iodide diet on postsurgical radioiodide ablation therapy in patients with differentiated thyroid carcinoma.

Objective: Most patients with differentiated thyroid carcinoma (DTC) undergo total thyroidectomy followed by routine radioiodide thyroid remnant ablation. Most centres that routinely perform radioiodide ablation prescribe a low-iodide diet (LID) to increase the radioiodide accumulation in thyroid remnants. The efficacy of an LID on thyroid remnant ablation, however, has never been demonstrated convincingly.

[A thyroglossal duct cyst with ectopic thyroid carcinoma].

An asymptomatic swelling in the neck of a 15-year-old boy, was revealed after resection to be due to a papillary thyroid carcinoma. He was treated with a near-total thyroidectomy, radiotherapy at an ablation dosage due to a scintigraphically demonstrated remnant thyroid tissue, and thyroid hormone supplement. Almost 2 years after the tumour resection, a recurrent carcinoma was found in the neck.

Clinical outcome after standardized versus dosimetric radioiodine treatment of hyperthyroidism: an equivalence study.

The aim of this study was to investigate the equivalence in outcome of standardized versus uptake-adjusted dosing of radioactive iodine (131I) for hyperthyroidism. We performed a 1-year follow-up study of two patient cohorts: 326 patients referred for 131I treatment of hyperthyroidism in Graves' disease (GD; n=216) or toxic multinodular goitre (TMG; n=110) in the period June 1995 to January 1998. Of these patients 128 were treated according to a standardized regimen, based on palpated thyroid volume and diagnosis, and 198 with a 131I uptake-adjusted dosimetric method.

Reestablishment of in vitro and in vivo iodide uptake by transfection of the human sodium iodide symporter (hNIS) in a hNIS defective human thyroid carcinoma cell line.

Uptake of iodide is a prerequisite for radioiodine therapy in thyroid cancer. However, loss of iodide uptake is frequently observed in metastasized thyroid cancer, which may be explained by diminished expression of the human sodium iodide symporter (hNIS). Strategies to restore iodide uptake in thyroid cancer include the exploration of hNIS gene transfer into hNIS defective thyroid cancer.

Beneficial effects of retinoic acid on extracellular matrix degradation and attachment behaviour in follicular thyroid carcinoma cell lines.

The prognosis of patients with metastasised follicular thyroid carcinoma (FTC) is limited, necessitating the search for new treatment options. Beneficial effects of retinoids have been suggested in thyroid cancer and the present study was performed to investigate the effects of retinoic acid (RA) on important determinants of metastatic behaviour in FTC: the disengagement of tumour cells from the primary tumour and the degradation of extracellular matrix, focusing on the role of the plasmin activation system and the integrin and E-cadherin families of attachment molecules. Three FTC cell lines were studied: FTC-133, derived from the primary tumour; and FTC-236 and FTC-238, derived from metastases.

[Embolization of skeletal metastases in patients with differentiated thyroid carcinoma].

Treatment options in patients with bone metastases of differentiated thyroid carcinoma are limited and mostly aimed at palliation. Conventional treatment modalities are: radioiodine therapy, surgery or external irradiation. A lesser known option is selective embolization of tumour metastases.

Embolization for vertebral metastases of follicular thyroid carcinoma.

The technique of selective embolization has been applied for years in the treatment of vascular anomalies, severe hemorrhage and benign or malignant tumors, notably vertebral metastases of renal cell carcinoma. Because this technique is relatively easy to perform and offers immediate relief of symptoms, it is an attractive option for patients with vertebral metastases of thyroid carcinoma with signs of spinal cord compression. In these patients, other treatment modalities like radioactive iodine, external irradiation, or surgery are more cumbersome or less effective in the short term.

Degradation of extracellular matrix by metastatic follicular thyroid carcinoma cell lines: role of the plasmin activation system.

The plasmin activation system plays a key role in extracellular matrix degradation in many malignant tumors. Because no data are available on the involvement of the plasmin activation system in matrix degradation by thyroid carcinoma, the present study was performed using follicular thyroid carcinoma cell lines obtained from a primary tumor (FTC-133) and metastases (FTC-236 and FTC-238) of one patient. Matrix degradation by these cell lines was studied assessing the release of radioactivity from S35-methionine labeled extracellular matrix coated onto plastic.

Role of fine-needle aspiration biopsy and frozen section examination in determining the extent of thyroidectomy.

Traditionally the extent of thyroidectomy in patients with nodular thyroid disease has been based on peroperative frozen section examination (FS). Fine-needle aspiration biopsy (FNAB) and FS were evaluated with regard to the reliability to determine whether an operation for cancer is necessary. Both methods were performed in 240 patients operated for nodular thyroid disease and compared with the final histology on paraffin sections.

The role of radioactive iodine in the treatment of advanced differentiated thyroid carcinoma.

Objective: 131I therapy may be beneficial for patients with advanced differentiated thyroid cancer (DTC) but there have been relatively few studies of the prognostic factors which influence the outcome. We have evaluated differences in outcome in relation to histology, localization of tumour, differentiation grade, age and sex after 131I as the only secondary treatment for advanced stages of DTC.

Design: Retrospective study of a selected patient group treated according to a fixed protocol.

Role of integrins in the attachment of metastatic follicular thyroid carcinoma cell lines to bone.

One of the principle targets for metastasis of follicular thyroid carcinoma (FTC) is the skeleton. Because no data are available on the role of the integrin adhesion molecule family in the attachment of FTC to bone, we studied the attachment characteristics of three FTC cell lines to bone and the role of integrins. Three cell lines were used from the same patient, one (FTC-133) from the primary tumor and two (FTC-236 and FTC-238) from metastases.

Graves' dermopathy: does octreotide scintigraphy predict the response to octreotide treatment?

We report on three patients with severe Graves' dermopathy who were treated with octreotide despite a negative octreotide scintigraphy. One patient showed a complete recovery while two others had a partial response. In contrast to active Graves' ophthalmopathy, an octreotide scintigraphy appears not to be useful for pretreatment identification of patients with Graves' dermopathy who are likely to respond to octreotide treatment.

Probable risk of tumour induction after retro-orbital irradiation for Graves' ophthalmopathy.

Retrobulbar irradiation for Graves' ophthalmopathy is considered as a safe treatment and has recently been recommended as the initial treatment for patients with moderately severe eye problems. However, calculations using risk factors presently known reveal a theoretical risk of radiation-induced cancer of 1.2%.

Optimal treatment of adrenocortical carcinoma with mitotane: results in a consecutive series of 96 patients.

Mitotane is considered to be the drug of choice for patients with inoperable, recurrent and metastatic adrenocortical carcinoma, although a favourable effect of this drug on survival has never been documented. We evaluated the efficacy of mitotane treatment of 96 patients with adrenocortical carcinoma followed up in our department between 1959 and 1992. Complete tumour resection was the goal of the initial treatment.

Comparison of serum thyroglobulin, 131I and 201Tl scintigraphy in the postoperative follow-up of differentiated thyroid cancer.

To evaluate the significance of 201Tl scintigraphy, 131I scintigraphy and serum thyroglobulin (Tg) levels in the postoperative follow-up of differentiated thyroid carcinoma, 86 patients were examined. Serum Tg was found to have the highest sensitivity (97%) as well as specificity (100%) for the detection of local tumour or metastases. Sensitivity and specificity of 131I scintigraphy after a therapeutic dose of 6100 MBq were 77 and 98%, respectively.

[The value of cytological studies in nodular goiter: results in 495 patients].

The accuracy of clinical diagnosis and fine-needle aspiration biopsy (FNAB) was evaluated in a total of 495 patients of whom 183 were operated upon within 6 months after FNAB and 312 were not. Operated patients were divided into three subgroups with high, moderate or low suspicion of malignant neoplasms on clinical grounds. Histological examination revealed an overall malignant neoplasm rate of 23%.

Should patients with medullary thyroid carcinoma undergo extensive lymph node (re)operation to improve long-term survival?

To investigate the role of primary and/or secondary modified radical neck dissection (MRND) in patients with medullary thyroid carcinoma (MTC), follow-up data on 43 patients operated on between 1972 and 1983 were analyzed retrospectively; patients included 16 with sporadic MTC (group 1) and 27 with multiple endocrine neoplasia type 2 (group 2). Primary surgical therapy consisted of (near-) total thyroidectomy and limited lymph node dissection; one patient in group 1 and two in group 2 underwent primary MRND. Positive nodes were found in nine patients of group 1 and in 12 of group 2.

Nuclear DNA content of medullary thyroid carcinoma in a large family with the MEN-2A syndrome.

Flow cytometry of medullary thyroid carcinoma (MCT) was performed in a large family with the MEN-2A syndrome. Of 15 family members with MCT five patients (10-27 yr) were without lymph node metastases. Six patients had a normal pentagastrin test after operation.

Frequency and degree of aneuploidy in benign and malignant thyroid neoplasms.

The frequency and degree of aneuploidy in 44 benign and 124 malignant thyroid neoplasms were analyzed by DNA flow cytometry. Single aneuploid cell populations were found in 72% of the undifferentiated carcinomas, 64% of the follicular carcinomas, 24% of the papillary carcinomas and in 24% of the follicular adenomas. Multiple aneuploid cell populations were detected in 4% of the papillary and in 36% of the follicular carcinomas but not in undifferentiated carcinomas.

The value of fine-needle aspiration biopsy in patients with nodular thyroid disease divided into groups of suspicion of malignant neoplasms on clinical grounds.

The accuracy of clinical diagnosis and fine-needle aspiration biopsy (FNAB) was evaluated in 169 patients surgically treated for nodular thyroid disease. Patients were divided into three groups with high, moderate, or low suspicion of malignant neoplasms on clinical grounds without previous knowledge of cytologic or histologic results. Histologic examination revealed an overall malignant neoplasm rate of 23%; the rate was 71%, 14%, and 11% for the groups with high, moderate, and low suspicion, respectively.

Prognosis and morbidity after total thyroidectomy for papillary, follicular and medullary thyroid cancer.

The prognosis and the morbidity results after total thyroidectomy are reported for 148 patients with differentiated thyroid cancer. Ninety-two patients (62%) had papillary cancer, 27 (18%) had follicular cancer and 29 (20%) had medullary cancer. In the latter group, 16 patients had no clinical signs of a tumour and underwent total thyroidectomy after elevated calcitonin levels were found in a family screening programme.

Peroperative diagnosis and treatment of metastases to the regional lymph nodes in papillary carcinoma of the thyroid gland.

The management of two groups of patients with papillary carcinoma of the thyroid gland (n = 165) was evaluated retrospectively. Total thyroidectomy was the standard procedure in both groups, but the peroperative diagnosis and treatment of metastases to the regional lymph nodes differed. In group 1 (n = 84), only clinically positive lymph nodes were resected, and if residual postoperative 131I uptake was found, an ablation dose of 131I was given.