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Latest & greatest articles for thyroid
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Educational Case: Endocrine Neoplasm: Medullary Thyroid Carcinoma Medullary thyroid cancer is a rare neuroendocrine tumor that arises the neural crest-derived parafollicular C cells and accounts for approximately 5% to 10% of thyroid cancers worldwide. These tumor can occur sporadically or as part of hereditary tumor syndromes, such as multiple endocrine neoplasia 2 and familial medullary thyroid cancer. The most common clinical presentation is a solitary thyroid nodule. The genetic defect (...) in these disorders involves the RET proto-oncogene which is important for diagnosis of medullary thyroid cancer (including screening for hereditary medullary thyroid cancer) and for treatment guidance. This review summarizes the molecular basis and clinicopathologic features of medullary thyroid carcinoma.
Educational Case: Medullary Thyroid Carcinoma The following fictional case is intended as a learning tool within the Pathology Competencies for Medical Education (PCME), a set of national standards for teaching pathology. These are divided into three basic competencies: Disease Mechanisms and Processes, Organ System Pathology, and Diagnostic Medicine and Therapeutic Pathology. For additional information, and a full list of learning objectives for all three competencies, see http
Randomized clinical trial of platysma muscle suture versus no suture for wound closure after thyroid surgery Suturing the platysma muscle during wound closure after thyroid surgery is frequently described in the literature. There is no prospective evidence to support its use or benefit. The aim of this study was to evaluate how a platysma muscle suture influences initial postoperative pain following thyroid surgery.Patients were assigned randomly to receive a platysma suture or no platysma (...) suture in this prospective, patient-blinded trial. The duration of follow-up was 6 months. The primary endpoint was wound-specific pain 24 h after thyroid resection. Secondary endpoints were intraoperative and perioperative analgesia requirement, postoperative pain and complications until postoperative day 14, and Patient and Observer Scar Assessment Score (POSAS) 6 months after surgery.Forty-one patients were randomized to each group. Visual analogue scale scores for wound-specific pain were lower
Randomized clinical trial of intraoperative parathyroid gland angiography with indocyanine green fluorescence predicting parathyroid function after thyroid surgery Hypoparathyroidism, the most common complication after thyroid surgery, leads to hypocalcaemia and significant medical problems. An RCT was undertaken to determine whether intraoperative parathyroid gland angiography with indocyanine green (ICG) could predict postoperative hypoparathyroidism, and obviate the need for systematic blood (...) after thyroidectomy. The primary endpoint was hypocalcaemia on POD 10-15.A total of 196 patients underwent ICG angiography during thyroid surgery, of whom 146 had at least one well perfused parathyroid gland on ICG angiography and were randomized. None of these patients presented with hypoparathyroidism, including those who did not receive calcium supplementation. The intervention group was statistically non-inferior to the control group (exact 95 per cent c.i. of the difference in proportion
Management of recurrent or metastatic thyroid cancer Recently, vascular endothelial growth factor receptor (VEGFR)-targeted tyrosine kinase inhibitors (TKIs) have become available for the treatment of recurrent or metastatic thyroid cancer. However, a number of clinical challenges that impact the use of VEGFR-targeted TKI in daily clinical practice have arisen. Toxicity is considerable, to the extent that most physicians hesitate to start VEGFR-targeted TKI and prefer to continue a watch (...) -and-wait approach until the patient's disease markedly worsens. This delayed use of VEGFR-targeted TKI leads to a higher incidence of serious adverse events than was reported in clinical trials. Moreover, the watch-and-wait approach has several demerits, including a worsening of quality of life, worsening of outcomes in patients of older age or with follicular thyroid cancer and increased risk of brain metastasis or bleeding. Thus, optimal timing for the start of VEGFR-targeted TKI requires careful
Treating subclinical thyroid dysfunction in pregnancy probably has no benefit Treating subclinical thyroid dysfunction in pregnancy probably has no benefit Discover Portal Discover Portal Treating subclinical thyroid dysfunction in pregnancy probably has no benefit Published on 8 August 2017 doi: Testing for and then treating pregnant women with mild or “subclinical” underactive thyroid did not improve pregnancy outcomes, newborn baby outcomes, or the child’s IQ at three to five years (...) . A clearly underactive thyroid (clinical hypothyroidism) in pregnancy has been linked with various adverse outcomes for the mother and baby, including pre-eclampsia, preterm birth, congenital defects and neurodevelopmental delay. This needs treatment. However, there has been debate around the harms and benefits from treating only mildly abnormal blood test results in women who do not show signs of thyroid problems, subclinical hypothyroidism. These two linked trials randomised 1,203 women with borderline
Retrospective Analysis of Patients with Synchronous Primary Breast and Thyroid Carcinoma Breast and thyroid cancers are commonly encountered malignancies. Increased risk of breast cancer in follow-up period of thyroid cancer or vice versa has been reported. However, they have some associations, synchronous presentation of these tumors is rare. We presented 12 patients diagnosed as breast and thyroid cancer and treated at the same time.Mastectomy and thyroidectomy were performed in 19 patients (...) at the same time. 7 patients were excluded because of benign thyroid pathology. Therefore 12 patients who had diagnosis of synchronous breast and thyroid cancer were included. Data regarding clinical, pathological, treatment and prognostic factors was retrospectively analyzed.Total thyroidectomy was performed in all patients. The mean age of patients was 54 years (min. 44-max. 70). Only one patient was male. Thyroid pathology was detected preoperatively by FDG PET-CT scan in 11 patients. Breast
Uptake of 99mTc-MIBI by Sclerosing Pneumocytoma Raising a False Suspicion of Metastasis From Medullary Thyroid Carcinoma Technetium-99m methoxy isobutyl isonitrile (99mTc-MIBI; sestamibi) single-photon emission computed tomography (SPECT)/computed tomography (CT) performed for preoperative localization of parathyroid adenomas or for other indications can reveal incidentalomas. Interpretation of such findings can be challenging, particularly when thyroid or other endocrine tumors are also (...) present. Preoperative staging of a 59-year-old female patient with medullary thyroid carcinoma (MTC) showing moderate hypermetabolism on 18F-fluorodeoxyglucose positron emission tomography/CT also detected a slightly hypermetabolic pulmonary nodule (standardized uptake value normalized by body weight max = 2.0 g/mL). A sestamibi SPECT/CT performed because of concomitant primary hyperparathyroidism showed increased uptake by both the MTC and the pulmonary nodule, raising suspicion of MTC metastasis
The Diagnosis and Management of Thyroid Nodules: A Review. Thyroid nodules are common, being detected in up to 65% of the general population. This is likely due to the increased use of diagnostic imaging for purposes unrelated to the thyroid. Most thyroid nodules are benign, clinically insignificant, and safely managed with a surveillance program. The main goal of initial and long-term follow-up is identification of the small subgroup of nodules that harbor a clinically significant cancer (≈10 (...) %), cause compressive symptoms (≈5%), or progress to functional disease (≈5%).Thyroid function testing and ultrasonographic characteristics guide the initial management of thyroid nodules. Certain ultrasound features, such as a cystic or spongiform appearance, suggest a benign process that does not require additional testing. Suspicious sonographic patterns including solid composition, hypoechogenicity, irregular margins, and microcalcifications should prompt cytological evaluation. Additional
Cuttingâ€edge endonasal surgical approaches to thyroid ophthalmopathy Thyroid orbitopathy is a poorly understood extrathyroidal manifestation of Graves' disease that can cause disfiguring proptosis and vision loss. Orbital decompression surgery for Graves' orbitopathy (GO) can address both cosmetic and visual sequelae of this autoimmune condition. Endonasal endoscopic orbital decompression provides unmatched visualization and access to inferomedial orbital wall and orbital apex. This review
Maternal thyroid function and child educational attainment: prospective cohort study. To determine if first trimester maternal thyroid dysfunction is a critical determinant of child scholastic performance and overall educational attainment.Prospective cohort study.Avon Longitudinal Study of Parents and Children cohort in the UK.4615 mother-child pairs with an available first trimester sample (median 10 weeks gestation, interquartile range 8-12).Free thyroxine, thyroid stimulating hormone (...) , and thyroid peroxidase antibodies assessed as continuous measures and the seven clinical categories of maternal thyroid function.Five age-specific national curriculum assessments in 3580 children at entry stage assessment at 54 months, increasing up to 4461 children at their final school assessment at age 15.No strong evidence of clinically meaningful associations of first trimester free thyroxine and thyroid stimulating hormone levels with entry stage assessment score or Standard Assessment Test scores
Patients With Antithyroid Antibodies Are Prone To Develop Destructive Thyroiditis by Nivolumab: A Prospective Study Immune checkpoint inhibitors, including anti-programmed cell death-1 (PD-1) antibodies, have become promising treatments for a variety of advanced malignancies. However, these medicines can cause immune-related adverse events (irAEs), including endocrinopathies.This study examined the incidence of endocrine irAEs induced by nivolumab.Sixty-six patients treated with nivolumab (...) at Nagoya University Hospital were prospectively evaluated for pituitary hormones, thyroid function, antithyroid antibodies (Abs), and glucose levels every 6 weeks after the initiation of nivolumab for 24 weeks.Four out of 66 patients developed destructive thyroiditis, and three patients developed hypothyroidism requiring levothyroxine replacement. The prevalence of positive anti-thyroglobulin Abs (TgAbs) and/or anti-thyroid peroxidase Abs (TPOAbs) at baseline was significantly higher in the group
From Consternation to Revelation: Discovery of a Role for IGSF1 in Pituitary Control of Thyroid Function Immunoglobulin superfamily, member 1 (IGSF1) is a transmembrane glycoprotein highly expressed in the mammalian pituitary gland. Shortly after its discovery in 1998, the protein was proposed to function as a coreceptor for inhibins (and was even temporarily renamed inhibin binding protein). However, subsequent investigations, both in vitro and in vivo, failed to support a role for IGSF1 (...) in inhibin action. Research on IGSF1 nearly ground to a halt until 2011, when next-generation sequencing identified mutations in the X-linked IGSF1 gene in boys and men with congenital central hypothyroidism. IGSF1 was localized to thyrotrope cells, implicating the protein in pituitary control of the thyroid. Investigations in two Igsf1 knockout mouse models converged to show that IGSF1 deficiency leads to reduced expression of the receptor for thyrotropin-releasing hormone (TRH) and impaired TRH
Thyroid function testing Thyroid function testing - Medical information | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search Thyroid function testing Last reviewed: February 2019 Last updated: February 2018 Summary Thyroid hormones thyroxine (T4) and tri-iodothyronine (T3) are produced, stored, and secreted by the thyroid gland. These hormones, particularly T3, play a major role in multiple biological and metabolic processes. They act by binding to thyroid (...) receptors that are distributed in almost every organ. Typically, this process regulates gene transcription and the subsequent production of various proteins that are involved in development, growth, and cellular metabolism. Kronenberg HM, Melmed S, Polonsky KS, et al, eds. Williams textbook of endocrinology. 12th ed. Philadelphia, PA: Saunders/Elsevier; 2011. Thyroid function tests (TFTs) are the most commonly used endocrine test. Details Thyroid hormone production Thyroid hormone-binding proteins
Overview of thyroid dysfunction Overview of thyroid dysfunction - Summary of relevant conditions | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search Overview of thyroid dysfunction Last reviewed: February 2019 Last updated: October 2018 Introduction The thyroid gland produces, stores, and secretes thyroxine (T4) and triiodothyronine (T3) through a negative feedback process involving the hypothalamus and pituitary gland. Thyroid dysfunction can result when (...) any part of this process is affected, and is usually characterised by the presence of high or low levels of thyroid-stimulating hormone (TSH, secreted by the pituitary gland) and free thyroid hormones. Causes of thyroid disorders include autoimmunity (e.g., Graves' disease), infections (e.g., post-viral inflammation), other systemic medical conditions, medications (e.g., lithium, amiodarone), nutritional excesses or deficiencies (e.g., of iodine), tumours (thyroid, or rarely pituitary), trauma
Painless lymphocytic thyroiditis Painless lymphocytic thyroiditis - Symptoms, diagnosis and treatment | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search Painless lymphocytic thyroiditis Last reviewed: February 2019 Last updated: May 2018 Summary Autoimmune-mediated inflammation of the thyroid gland with release of thyroid hormone resulting in transient hyperthyroidism, frequently followed by a hypothyroid phase before recovery of normal thyroid function (...) -mediated lymphocytic inflammation of the thyroid gland resulting in a destructive thyroiditis with release of thyroid hormone and transient thyrotoxicosis (hyperthyroidism). Woolf PD. Transient painless thyroiditis with hyperthyroidism: a variant of lymphocytic thyroiditis? Endocr Rev. 1980 Fall;1(4):411-20. http://www.ncbi.nlm.nih.gov/pubmed/7018893?tool=bestpractice.com Samuels MH. Subacute, silent and postpartum thyroiditis. Med Clin North Am. 2012 Mar;96(2):223-33. http://www.ncbi.nlm.nih.gov
Subacute granulomatous thyroiditis Subacute granulomatous thyroiditis - Symptoms, diagnosis and treatment | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search Subacute granulomatous thyroiditis Last reviewed: February 2019 Last updated: March 2018 Summary Inflammation of the thyroid characterised by a triphasic course of transient thyrotoxicosis, followed by hypothyroidism, followed by a return to euthyroidism. The thyrotoxic phase is due to thyroid (...) follicular damage and release of preformed hormone and is characterised by low thyroid uptake on nuclear scan and elevated ESR or CRP. Thyroid pain and tenderness, which may be migratory and affect different areas of the gland at different times, is typical of the thyrotoxic phase. Thyroid is often enlarged, firm, and tender to palpation. Ultrasound of the thyroid shows areas of hypoechoic echotexture with decreased or normal vascular flow by Doppler. The condition is self-limited, and no specific
Assessment of thyroid mass Assessment of thyroid mass - Differential diagnosis of symptoms | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search Assessment of thyroid mass Last reviewed: February 2019 Last updated: January 2019 Summary Thyroid parenchymal expansion can result from diffuse enlargement or infiltration of the thyroid gland or from the presence of one or more thyroid nodules. A thyroid nodule is a discrete lesion distinct from the surrounding (...) thyroid parenchyma. Enlargement of other nearby anatomical structures, such as the parathyroid glands or regional lymph nodes, as well as branchial cleft and thyroglossal duct cysts, may sometimes be confused with thyroid nodules. Thyroid nodules may be palpable at presentation or may be incidentally detected during an imaging procedure (40% are self-identified, 30% are physician-identified, and 30% are incidentally discovered on imaging Mevawalla N, McMullen T, Sidhu S, et al. Presentation
Update on Multiple Endocrine Neoplasia Type 2: Focus on Medullary Thyroid Carcinoma ISSN 2472-1972 Update on Multiple Endocrine Neoplasia Type 2: Focus on Medullary Thyroid Carcinoma Friedhelm Raue 1 and Karin Frank-Raue 1 1 Endocrine Practice Heidelberg, Molecular Genetic Laboratory, 69120 Heidelberg, Germany Multiple endocrine neoplasia type 2 (MEN2) is an autosomal dominant hereditary cancer syndrome causedbymissensegain-of-functionmutationsintheRETproto-oncogeneonchromosome10.Specific RET (...) mutations can predispose toward a particular phenotype and clinical course, with strong genotype–phenotype correlations. MEN2 is highly penetrant in medullary thyroid carcinoma (MTC), and it can be associated with bilateral pheochromocytoma and primary hyperparathyroidism. Two different clinical variants of MEN2 are known: MEN2A, which includes the familial subtype, and MEN2B. Treatment includes early thyroidectomy. Recommendations on the timing and extent