Lenvatinib Therapy for Advanced Thyroid Cancer: Real-Life Data on Safety, Efficacy, and Some Rare Side Effects.

Context: The SELECT trial led to the approval of lenvatinib for the treatment of advanced radioiodine-refractory differentiated thyroid carcinomas (DTCs) but also revealed an important adverse event (AE) profile which may limit its use in clinical practice.

Objective: We aim to describe the efficacy and toxicity profiles of lenvatinib in real life.

Methods: We included all patients who received lenvatinib for an advanced DTC at our institution, enrolling 27 patients.

Seasonal Difference in Postthyroidectomy Hypocalcemia: A Montreal-Based Study.

Objective: Hypocalcemia following thyroidectomy often prolongs hospital stay and is potentially life-threatening. The objective of this study is to determine whether the season when thyroidectomy is performed is associated with postoperative hypocalcemia.

Study Design: Retrospective case series of patients undergoing thyroid surgery from 2009 to 2015.

Serum thyroglobulin improves the sensitivity of the McGill Thyroid Nodule Score for well-differentiated thyroid cancer.

Background: The McGill Thyroid Nodule Score (MTNS) is a scoring system devised to help physicians to assess the preoperative risk that a thyroid nodule is malignant. It uses 22 different known risk factors for thyroid cancer (radiation exposure, microcalcifications on ultrasound, positive HBME-1 stain on biopsy, etc.) and attributes a percentage risk that the nodule is malignant.

Selumetinib-enhanced radioiodine uptake in advanced thyroid cancer.

Background: Metastatic thyroid cancers that are refractory to radioiodine (iodine-131) are associated with a poor prognosis. In mouse models of thyroid cancer, selective mitogen-activated protein kinase (MAPK) pathway antagonists increase the expression of the sodium-iodide symporter and uptake of iodine. Their effects in humans are not known.

Estimating risk of recurrence in differentiated thyroid cancer after total thyroidectomy and radioactive iodine remnant ablation: using response to therapy variables to modify the initial risk estimates predicted by the new American Thyroid Association staging system.

Background: A risk-adapted approach to management of thyroid cancer requires risk estimates that change over time based on response to therapy and the course of the disease. The objective of this study was to validate the American Thyroid Association (ATA) risk of recurrence staging system and determine if an assessment of response to therapy during the first 2 years of follow-up can modify these initial risk estimates.

Methods: This retrospective review identified 588 adult follicular cell-derived thyroid cancer patients followed for a median of 7 years (range 1-15 years) after total thyroidectomy and radioactive iodine remnant ablation.

Radioactive iodine administered for thyroid remnant ablation following recombinant human thyroid stimulating hormone preparation also has an important adjuvant therapy function.

Background: In December 2007, the USFDA approved recombinant human thyroid stimulating hormone (rhTSH) for radioiodine remnant ablation after total thyroidectomy in patients with well-differentiated thyroid cancer without evidence of metastatic disease. Because previously undetected radioactive iodine (RAI)-avid metastatic lesions can be identified during remnant ablation, we sought to determine if rhTSH-stimulated uptake of RAI into these incidentally discovered metastases is associated with a significant therapeutic (tumoricidal) effect.

Methods: This retrospective review describes the clinical outcome of 84 well-differentiated thyroid cancer patients in whom RAI-avid lesions outside the thyroid bed were first identified at the time of RAI remnant ablation (64 rhTSH stimulated, 20 thyroid hormone withdrawal [THW]) on either the diagnostic (63/84, 75%) or posttherapy (21/84, 25%) whole body scan (76 with locoregional metastasis only and 8 with pulmonary uptake).

Mild decreases in white blood cell and platelet counts are present one year after radioactive iodine remnant ablation.

Background: Bone marrow suppression after multiple, high-dose radioactive iodine (RAI) therapies is well described. However, changes in the peripheral complete blood count (CBC) that may occur after a single treatment of RAI such as that commonly used for routine remnant ablation is much less well studied. In this retrospective trial, we examined the rate of persistent anemia, leukopenia, and thrombocytopenia 1 year after a single RAI administration.

Follow up approaches in thyroid cancer: a risk adapted paradigm.

The primary goal in the follow up of thyroid cancer patients is to identify and treat persistent and recurrent disease at a time that minimizes morbidity and disease specific mortality. This article presents a risk-adapted follow-up paradigm to guide both intensity and methodology of follow-up testing based on initial risk stratification, ongoing risk stratification, and secondary risk stratification that incorporates each of the well-known risk factors for recurrence and death from thyroid cancer, with a response to therapy variable as well as duration of disease-free survival. With a proper understanding of the biology of the disease and with accurate assessments of response to therapy, clinicians are better able to tailor a risk-appropriate follow-up approach to individual patients, minimizing excessive testing while still providing adequate testing to detect clinically significant disease recurrence in a timely fashion.

Medical management of thyroid cancer: a risk adapted approach.

Risk adapted treatment recommendations are dependent on accurate predictions of the risk of recurrence, risk of death, and likely sites of recurrence. When combined with response to therapy assessments and secondary risk stratification during follow-up, this risk adapted approach will allow the clinician to tailor the aggressiveness of therapy and follow up to the risk of recurrence and death in individual patients.

BRAFV600E mutation is associated with preferential sensitivity to mitogen-activated protein kinase kinase inhibition in thyroid cancer cell lines.

Context: Mutually exclusive mutations of RET, RAS, or BRAF are present in about 70% of papillary thyroid carcinomas, whereas only the latter two are seen in poorly differentiated and anaplastic cancers. Although the signal output common to these oncoproteins is ERK, a recent report showed that only BRAF mutations consistently predicted responsiveness to MAPK kinase (MEK) inhibitors.

Objectives: Here we investigated whether sensitivity to MEK inhibition was determined by oncogene status in 13 human thyroid cancer cell lines: four with BRAF mutations, four RAS, one RET/PTC1, and four wild type.

Tall cell variant of papillary thyroid carcinoma without extrathyroid extension: biologic behavior and clinical implications.

Background: The tall cell variant (TCV) is a histologic subtype of papillary thyroid carcinoma (PTC) that is more aggressive than "classical" PTC. Most authors believe that TCV's worse prognosis is related to older age at presentation, larger tumor size, and high frequency of extrathyroid tumor extension (ETE). To assess the biologic and clinical behavior of TCV without ETE, we performed a detailed comparative clinicopathologic analysis of classical PTC and TCV without ETE.

Papillary thyroid cancer: monitoring and therapy.

The last 10 years have seen a major paradigm shift in the management of thyroid cancer, with greater reliance on serum thyroglobulin and neck ultrasonography, and less emphasis on routine diagnostic whole-body radioactive iodine scanning for detection of recurrent disease. As our follow-up tests become more sensitive for detection of recurrent disease, we are finding many asymptomatic patients who have low-level persistent disease many years after initial therapy that may or may not benefit from additional testing and therapy. These difficult issues have been addressed by at least five different sets of guidelines published recently by various thyroid specialty organizations around the world.

L-T3 preparation for whole-body scintigraphy: a randomized-controlled trial.

Background: Patients with thyroid cancer often need whole-body scintigraphy (WBS) under TSH stimulation after 4-6 weeks withdrawal from levothyroxine (L-T(4)). Patients often become severely hypothyroid with impaired quality of life. Liothyronine (L-T(3)) substitution is used empirically to prepare patients; however, no data exist to prove its benefit.

Impact of pregnancy on serum thyroglobulin and detection of recurrent disease shortly after delivery in thyroid cancer survivors.

Objective: Since pregnancy can stimulate thyroid growth, we examined the effect of pregnancy on recurrence and serum thyroglobulin (Tg) shortly after delivery in thyroid cancer survivors.

Design: Retrospective analysis of thyroid cancer survivors who became pregnant after completing initial therapy.

Main Outcome: 36 women (age 34 +/- 4 years) who became pregnant a median of 4.

Empiric radioactive iodine dosing regimens frequently exceed maximum tolerated activity levels in elderly patients with thyroid cancer.

Unlabelled: Although 131I-iodine (RAI) therapy is a mainstay in the treatment of metastatic thyroid cancer, there is controversy regarding the maximum activity that can safely be administered without dosimetric determination of the maximum tolerable activity (MTA). At most institutions, a fixed empiric dosing strategy is often used, with administered activities ranging from 5.55 to 9.

Thyroid cancer presenting as a PET incidentaloma in a patient with concomitant breast cancer metastases to the thyroid.

Introduction: Metastases to the thyroid gland are considered a rare cause of thyroid tumor. Furthermore, a relationship between breast and thyroid carcinoma has been previously proposed.

Case Description: We describe the case of a 59-year-old woman who presented with simultaneous papillary and breast carcinoma within the thyroid gland.

"Hook effect" in calcitonin immunoradiometric assay in patients with metastatic medullary thyroid carcinoma: case report and review of the literature.

Context: Calcitonin is a well-established tumor marker for medullary thyroid carcinoma (MTC). Because surgery is the only effective treatment for patients with MTC, the postoperative level of serum calcitonin will dictate whether residual disease was left behind and whether reintervention is necessary.

Results: We describe here the case of a 41-yr-old man with metastatic MTC.