Thyroid : official journal of the American Thyroid Association
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Seventy-five percent of thyroid nodules with indeterminate fine-needle aspiration (FNA) cytology are found to be benign postoperatively. A novel genomic test, the Afirma gene expression classifier (AGEC), has been available for clinical use in the United States, since late 2010. In 2010, two modest-sized validation studies showed that the AGEC could identify a benign gene expression signature in indeterminate cytology thyroid FNA samples with a negative predictive value >95%. The objective of this study was to evaluate how the AGEC impacted the joint decision of the endocrinologist and patient to operate when FNA cytology was indeterminate, but the AGEC reading of the nodule was benign. ⋯ In a substantial group of medical practices, obtaining an AGEC test in patients with cytologically indeterminate nodules was associated with a striking reduction in the rate of diagnostic thyroidectomy. Approximately, one surgery was avoided for every two AGEC tests run on thyroid FNAs with indeterminate cytology.
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In the years 1985-1998, it was noted that mild iodine deficiency (MID) was a public health problem in Belgium. Therefore, an agreement was signed in 2009 between the bakery sector and the Ministry of Health, to fortify bread with iodized salt. We tested the hypothesis that the iodine status of Belgian children improved after the introduction of bread fortified with iodized salt. Since the dietary habits of children and adults may differ, we also investigated whether the median urinary iodine concentration (UIC) among the children in this study reflected the iodine status of their mothers. ⋯ Fortification of bread with iodized salt corrected iodine deficiency in Belgian children, but not in their mothers. To provide these women with an adequate iodine intake, the use of both iodized salt in bread and iodized instead of noniodized household salt needs to increase. Our findings suggest that the median UIC in children may not be an adequate surrogate of adults' iodine status. Therefore, monitoring iodine status should not be limited to children, but should be extended to women of child-bearing age.
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Although functioning thyroid cancer metastases have been reported, they have almost never been reported for the clear cell variant of papillary thyroid carcinoma (PTC). Here we describe a patient with disseminated lung metastases of the clear cell variant of PTC who presented in the euthyroid state despite discontinuance of levothyroxine after total thyroidectomy. ⋯ Functioning metastases from recurred PTC, particularly of the clear cell variant, are very rare. When they occur, rhTSH is required to prepare these patients for treatment with ablative doses of radioactive iodine (131I).
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Prophylactic central neck dissection (CND) has been proposed in the treatment of patients affected by papillary thyroid carcinoma (PTC) with clinically negative neck lymph nodes. The procedure allows pathologic staging of lymph nodes of the central compartment and treatment of the micrometastases. Nevertheless, the morbidity that its routine use adds to the total thyroidectomy must be taken into account. The aim of this study was to characterize the morbidity that CND adds to the total thyroidectomy. ⋯ The increased rates of transient and permanent hypoparathyroidism in our series suggest a critical review of indications for the routine use of prophylactic CND for PTC. Prophylactic CND ipsilateral to the tumor associated with total thyroidectomy may represent an effective strategy for reducing the rate of permanent hypoparathyroidism. Concomitant completion contralateral paratracheal lymph node neck dissection should be performed in presence of lymph node metastasis on intraoperative frozen-section pathology. This approach limits the use of bilateral CND to patients with intraoperative pathological findings of lymph node metastases.
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Distant metastases at presentation are rare in well-differentiated thyroid cancer (WDTC). The objective of this study was to report outcomes for patients presenting with distant metastases managed by thyroidectomy and radioactive iodine (RAI) therapy. ⋯ Approximately half of patients with WDTC presenting with distant metastases die of disease within 5 years of initial diagnosis despite thyroid surgery and RAI. Age over 45 years, extrapulmonary metastases, and follicular pathology were significant predictors of the poor outcome.