Virtual evaluation of selected cervical lymph nodes with three-dimensional ultrasound in thyroid cancer patients after thyroidectomy.

Background: We evaluated the usefulness of three-dimensional (3D) ultrasound of cervical lymph nodes (LN), when two-dimensional (2D) ultrasound evaluation is not sufficient to clearly evaluate lymph node characteristics, in thyroid cancer patients being followed after thyroidectomy.

Methods: Two readers retrospectively analyzed 2D and 3D images of 147 LNs; LNs were categorized as normal, reactive, suspicious, or indeterminate, and confidence level was rated. Results were compared to cytological/clinical data.

An Unusual Case of Metastatic Functional Thyroid Carcinoma With a Remarkable Treatment Response to Radioactive Iodine.

Functional thyroid carcinoma is an unusual cause of thyrotoxicosis. We describe the clinical presentation and treatment of a patient with thyrotoxicosis due to functional thyroid carcinoma and Graves disease, and discuss potential mechanisms causing the thyrotoxicosis. A 79-year-old woman with a remote history of hemithyroidectomy and current hyperthyroidism came to the hospital with upper and lower extremity weakness.

MEDULLARY THYROID CANCER THAT STAINS NEGATIVE FOR CA 19-9 HAS DECREASED METASTATIC POTENTIAL.

Objective: Presently, no clinical tools are available to diagnose the metastatic potential of medullary thyroid cancer (MTC) at disease presentation. Surveillance with calcitonin (Ct) and carcinoembryonic antigen (CEA) is currently recommended for the observation and diagnosis of metastatic disease after initial treatment of MTC. Recently, carbohydrate antigen (CA)19-9 staining has been associated with aggressive forms of MTC and metastatic spread.

Medullary thyroid cancer with undetectable serum calcitonin.

Context: Calcitonin is a sensitive biomarker that is used for diagnosis and follow-up in medullary thyroid cancer (MTC). In patients with tumors > 1 cm, it is uncommon for preoperative serum calcitonin to be in the normal laboratory reference range in patients with MTC, and even more unusual for serum calcitonin to be undetectable.

The Case: A 39-year-old woman was found to have a left thyroid nodule on magnetic resonance imaging done for neck pain.

Ernie Mazzaferri.

NA.

An approach for development of age-, gender-, and ethnicity-specific thyrotropin reference limits.

Background: The use of age- and ethnicity-specific thyrotropin (TSH) reference limits decreases misclassification of patients with thyroid dysfunction. Developing such limits requires TSH measurements in different subpopulations.

Methods: We determined, in the National Health and Nutrition Examination Survey III, the TSH median, 2.

Age- and race-based serum thyrotropin reference limits.

Context: TSH reference limits, particularly the upper limit, are controversial. The traditional and prevailing method for setting limits uses TSH distribution of thyroid disease-free individuals. The curve is not Gaussian, but skewed to higher concentrations, even after log-transformation; values in the skewed area are assumed to reflect mild hypothyroidism.

Genetic predisposition to elevated serum thyrotropin is associated with exceptional longevity.

Context: Exceptional longevity is associated with raised serum TSH.

Objective: The aim of this study was to examine whether offspring of people with exceptional longevity have elevated serum TSH and whether specific single nucleotide polymorphisms (SNPs) in the TSH-B gene and TSH receptor (TSHR) gene are associated with this phenotype.

Design/setting/patients: We measured serum TSH and free T(4) in Ashkenazi Jewish centenarians (n = 232; median age, 97 yr), their offspring (n = 366; median age, 69 yr), and age-matched controls without familial longevity (n = 163; median age, 70 yr).

Extreme longevity is associated with increased serum thyrotropin.

Context: The distribution of serum TSH shifts progressively to higher concentrations with age.

Objective: The aim of the study was to determine whether the population shift in TSH distribution to higher concentrations with aging extends to people of exceptional longevity, namely centenarians, and to assess the relationship between concentrations of TSH and free T(4) (FT4).

Design/setting/patients: We analyzed TSH, FT4, and TSH frequency distribution curves in thyroid disease-free Ashkenazi Jews with exceptional longevity (centenarians; median age, 98 yr), in younger Ashkenazi controls (median age, 72 yr), and in a population of thyroid disease-free individuals (median age, 68 yr) from the U.

Reference limits of serum TSH and free T4 are significantly influenced by race and age in an urban outpatient medical practice.

Objective: The suitability of TSH reference limits derived from national databases to outpatient practices has not been established. We aimed to determine whether race and age influence the distribution of TSH and free T4 (fT4).

Design: A cross-sectional study of an urban outpatient medical practice.

Age-specific distribution of serum thyrotropin and antithyroid antibodies in the US population: implications for the prevalence of subclinical hypothyroidism.

Context: Measurements from all age groups defined the upper limit of the TSH reference range in National Health and Nutrition Examination Survey III. The TSH median, 97.5 centile and prevalence of subclinical hypothyroidism (SCH), normal serum T(4) and TSH greater than 4.

Serum thyrotropin measurements in the community: five-year follow-up in a large network of primary care physicians.

Background: Subclinical thyroid disease is common; however, screening recommendations using serum thyrotropin (TSH) level determinations are controversial.

Methods: To study the use of serum TSH by primary care physicians and define populations at risk for having an abnormal TSH level at follow-up, based on initial TSH levels, we conducted an observational study of a large health care database in the setting of a health management organization. All outpatients without thyroid disease or pregnancy or taking medication that may alter thyroid function in whom the TSH level was measured in 2002 and during 5-year follow-up were included in this study.

The thyrotropin reference range should remain unchanged.

Context: Recent recommendations to decrease the upper limit of the TSH reference range from 4.5 to 2.5 mIU/liter, based on the high proportion of normal people whose serum TSH is less than 2.

Subclinical thyroid disease: clinical applications.

Subclinical hypothyroidism and hyperthyroidism are diagnoses based on laboratory evaluation with few if any clinical signs or symptoms. Subclinical hypothyroidism is defined as an elevation in serum thyroid-stimulating hormone (TSH) above the upper limit of the reference range (0.45-4.

Subclinical thyroid disease: scientific review and guidelines for diagnosis and management.

Context: Patients with serum thyroid-stimulating hormone (TSH) levels outside the reference range and levels of free thyroxine (FT4) and triiodothyronine (T3) within the reference range are common in clinical practice. The necessity for further evaluation, possible treatment, and the urgency of treatment have not been clearly established.

Objectives: To define subclinical thyroid disease, review its epidemiology, recommend an appropriate evaluation, explore the risks and benefits of treatment and consequences of nontreatment, and determine whether population-based screening is warranted.

A model to determine workforce needs for endocrinologists in the United States until 2020.

The objective of this study was to define the workforce needs for the specialty of Endocrinology, Diabetes, and Metabolism in the United States between 1999 and 2020. An interactive model of factors likely to influence the balance between the supply and demand of endocrinologists during the next 20 years was constructed. The model used data from a wide range of sources and was developed under the guidance of a panel of experts derived from sponsoring organizations of endocrinologists.

Sclerosing lymphocytic lobulitis of the breast in a patient with Graves' disease.

A 43-year-old woman presented to the endocrinologist with symptoms and signs of typical thyrotoxicosis caused by Graves' disease. Review of systems revealed that she had recently discovered a lump in her left breast. Evaluation of the left breast lesion led to a core biopsy that showed sclerosing lymphocytic lobulitis.

A model to determine workforce needs for endocrinologists in the United States until 2020.

The objective of this study was to define the workforce needs for the specialty of endocrinology, diabetes, and metabolism in the United States between 1999 and 2020. An interactive model of factors likely to influence the balance between the supply and demand of endocrinologists during the next 20 yr was constructed. The model used data from a wide range of sources and was developed under the guidance of a panel of experts derived from sponsoring organizations of endocrinologists.

A model to determine workforce needs for endocrinologists in the United States until 2020.

The objective of this study was to define the workforce needs for the specialty of Endocrinology, Diabetes, and Metabolism in the United States between 1999 and 2020. An interactive model of factors likely to influence the balance between the supply and demand of endocrinologists during the next 20 years was constructed. The model used data from a wide range of sources and was developed under the guidance of a panel of experts derived from sponsoring organizations of endocrinologists.