Thyroid Cancer

The oncogenic fusion protein RET/PTC3 (RP3) that is expressed in papillary thyroid carcinoma (PTC) and thyroid epithelia in Hashimoto's thyroiditis activates nuclear factor-kappa B (NF-κB) and induces pro-inflammatory gene expression; however, the mechanism of this activation is unknown. To address this, we expressed RP3 in murine embryonic fibroblasts (MEFs) lacking key classical and noncanonical NF-κB signaling components. In wild-type MEFs, RP3 upregulated CCL2, CXCL1, granulocyte-macrophage colony-stimulating factor and tumor necrosis factor expression and activated classical but not noncanonical NF-κB. RP3-activated NF-κB in IκB kinase (IKK)β(-/-) MEFs but not IKKα- or NF-κB essential modulator (NEMO)-deficient cells and activation was inhibited by a peptide that blocks NEMO binding to the IKKs. RP3 increased the levels of NF-κB-inducing kinase (NIK) and did not activate NF-κB in NIK-deficient MEFs. Notably, NIK stabilization was not accompanied by TRAF3 degradation demonstrating that RP3 disrupts normal basal NIK regulation. Dominant-negative NIK blocked RP3-induced NF-κB activation and an RP3 signaling mutant (RP3(Y588F)) did not stabilize NIK. Finally, examination of PTC specimens revealed strong positive staining for NIK. We therefore conclude that RP3 activates classical NF-κB via NIK, NEMO and IKKα. Importantly, our findings reveal a novel mechanism for oncogene-induced NF-κB activation via stabilization of NIK.

Thyroid cancer (TC), comprising less than 1% of all cancers in the Netherlands, has a good prognosis in general. Controversy still remains on the extent of surgical treatment and the indication for additional Iodine-131 (131I) therapy in the management of differentiated TC. The aim of this study was to describe (changes in) the treatment of TC and to determine independent

According to the data of the clinico-morphological register of the Institute of Endocrinology and Metabolism in Ukraine, for the post-Chernobyl period in Ukraine (1986-2000), 472 cases of thyroid cancer have been reported in children who have been operated at the age of up to 15 years, among which, 431 were born before the Chernobyl accident, 11 were ''in utero'' at the time of the accident, and 30 were born after the Chernobyl accident. The largest number of cases (57) has been reported in 1996, which made up 0.57 per 100 000 children aged 0-14, and exceeded by 11.4 times the average pre-Chernobyl incidence rate (0.05) in this age group. The highest incidence rate has been reported in six regions of Ukraine which have been the most contaminated by iodine radionuclides (Kiev, Chernigov, Zhitomir, Rovno, Cherkassy regions, and Kiev City). The additional incidence in these regions was rising with increasing thyroid exposure dose, and this is most evident for a dose over 0.5 Gy. Morphological studies showed that in most of cases, the tumors under study (92.1%) represented papillary carcinoma (with a dominant solid-follicular structure) that were characterized by a high incidence of regional metastastic spreading (62% of cases).

According to the data of the clinico-morphological register of the Institute of Endocrinology and Metabolism in Ukraine, for the post-Chernobyl period in Ukraine (1986 -2000), 472 cases of thyroid cancer have been reported in children who have been operated at the age of up to 15 years, among which, 431 were born before the Chernobyl accident, 11 were ''in utero'' at the time of the accident, and 30 were born after the Chernobyl accident. The largest number of cases (57) has been reported in 1996, which made up 0.57 per 100 000 children aged 0 -14, and exceeded by 11.4 times the average pre-Chernobyl incidence rate (0.05) in this age group. The highest incidence rate has been reported in six regions of Ukraine which have been the most contaminated by iodine radionuclides (Kiev, Chernigov, Zhitomir, Rovno, Cherkassy regions, and Kiev City). The additional incidence in these regions was rising with increasing thyroid exposure dose, and this is most evident for a dose over 0.5 Gy. Morphological studies showed that in most of cases, the tumors under study (92.1%) represented papillary carcinoma (with a dominant solid -follicular structure) that were characterized by a high incidence of regional metastastic spreading (62% of cases).

A thyroid carcinoma cell line, BHT-101, has been established in vitro from a metastatic lymph node deposit in a female patient with a non-hormone producing anaplastic, partly thyroglobulin-and thyroxine (T4)-positive papillary thyroid cancer. The cell population is heterogeneous, containing epithelial-like and fibroblast-like cells, and has a doubling time of 24 h. The cell line is polyploid with hypertetraploid predominance and the karyotype showed trisomies, tetrasomies, pentasomies as well as many marker chromosomes. The majority of the cells are negative or weakly positive for thyroglobulin and thyroxine and estrogen and progesterone receptors are present in the cells. BHT-101 cells produce tumours when injected into immunosuppressed CBA/Ca mice. The cells are sensitive to adriamycin, methotrexate and tamoxifen but not to methimazole (Favistan). The epithelial-like clone 1 and the fibroblastlike clone 3, isolated from the parental line, differed in drug sensitivity. This new cell line is suitable for studying the biology of thyroid carcinoma and for parallel in vivo and in vitro studies of drug activity against thyroid cancer.

Between 1966 and 1974, France performed 41 atmospheric nuclear weapon tests in the Mururoa and Fangataufa atolls in French Polynesia. We performed a geographic analysis of thyroid cancer incidence, using data from the cancer registry of French Polynesia, medical evacuation files, insurance records and hospital and pathology laboratory files. A total of 153 thyroid cancers were diagnosed between 1985 and 1995 in the population born before 1976 and residing in French Polynesia. The incidence of thyroid cancer was 2-3 times larger in French Polynesia than in Maoris of New Zealand and Hawaiians of Hawaii. Based on few cases, a nonsignificant (p = 0.1) increase with decreasing distance between Mururoa and the birth place was observed in women born between 1950 and 1975 for thyroid cancer. Because the difference between Polynesian and reference populations was not larger for Polynesians who were children during the tests than for Polynesians born earlier; as would be expected in the case ...

When identified at early stages, most well-differentiated thyroid cancers are readily treated and yield excellent outcomes. Follicular thyroid cancer (FTC) however, when diagnosed at a late stage, may be very resistant to treatment, and exhibits 10-year survival rates less than 40%. Despite substantial progress in recent years, we still have limited understanding of the molecular and biological interrelationships between the various subtypes of benign and malignant follicular thyroid neoplasms. In contrast to the wealth of information available regarding papillary thyroid carcinoma (PTC), the triggering mechanisms of FTC development and the major underlying genetic alterations leading to follicular thyroid carcinogenesis remain obscure. Recent studies have focused on a chromosomal translocation, t(2;3) (q13;p25), fusing PAX8, a transcription factor that is essential for normal thyroid gland development, with the peroxisome proliferator-activated receptor gamma (PPAR␥), a member of the steroid/thyroid nuclear receptor family. This chromatin rearrangement results in the expression of a PAX8/PPAR␥ fusion protein, designated PPFP, whose incidence is relatively common in FTC and may represent an initiating event in the genesis of FTC. Here we review progress on the studies of PPFP that assess its involvement in FTC tumorigenesis.

Les tumeurs endocrines sont des tumeurs rares caractérisées par la production de protéines de structures ou de produits de sécrétion communs aux neurones et aux cellules endocrines. Elles peuvent être responsables de modifications du fonctionnement de l'organisme ou de complications périopératoires spécifiques qui doivent être connues pour optimiser la prise en charge anesthésique et minimiser les complications. Le but de cette revue est de décrire ces modifications et de discuter les protocoles de surveillance et de traitement qui ont été proposés dans la littérature depuis 30 ans afin de donner un support de réflexion aux praticiens qui prendront en charge ces patients. Parmi les modalités discutées, on retiendra que : (1) le contrôle tensionnel préopératoire par alpha-bloquant ou inhibiteur calcique est essentiel dans la préparation du phéochromocytome. Il doit être suivi d'une prise en charge peropératoire associant remplissage massif, agents anesthésiques et traitements symptomatiques réversibles (par exemple rémifentanil, sévoflurane, inhibiteur calcique et esmolol) et d'une surveillance postopératoire étroite et prolongée ; (2) les principales complications du cancer (médullaire) de la thyroïde sont l'hématome cervical et la lésion des nerfs récurrents, et sont liés à la localisation et non à l'histologie ; (3) la chirurgie hypophysaire doit faire guetter en peropératoire l'embolie gazeuse et en postopératoire le diabète insipide, l'insuffisance corticotrope et la brèche méningée ; (4) l'acromégalie peut présenter des difficultés d'intubation ; (5) un syndrome de Cushing sévère doit faire craindre une cardiopathie hypertensive des difficultés de cicatrisation, des complications infectieuses ou thromboemboliques ; (6) l'utilisation d'analogues de la somatostatine en pré-et peropératoire a transformé la stabilité des tumeurs carcinoïdes. # 2009 Elsevier Masson SAS. Tous droits réservés.

The need for time and attention, given by the doctor to the patient, due to the increased volume of medical data to be interpreted and filtered for diagnostic and therapeutic purposes has encouraged the development of the option to support, constructively and effectively, deep learning models. Deep learning (DL) has experienced an exponential development in recent years, with a major impact on interpretations of the medical image. This has influenced the development, diversification and increase of the quality of scientific data, the development of knowledge construction methods and the improvement of DL models used in medical applications. All research papers focus on description, highlighting, classification of one of the constituent elements of deep learning models (DL), used in the interpretation of medical images and do not provide a unified picture of the importance and impact of each constituent in the performance of DL models. The novelty in our paper consists primarily in t...

The accident at the Chernobyl nuclear power plant was the worst industrial accident of the last century that involved radiation. The unprecedented release of multiple different radioisotopes led to radioactive contamination of large areas surrounding the accident site. The exposure of the residents of these areas was varied and therefore the consequences for health and radioecology could not be reliably estimated quickly. Even though some studies have now been ongoing for 25 years and have provided a better understanding of the situation, these are yet neither complete nor comprehensive enough to determine the long-term risk. A true assessment can only be provided after following the observed population for their natural lifespan. Here we review the technical aspects of the accident and provide relevant information on radioactive releases that resulted in exposure of this large population to radiation. A number of different groups of people were exposed to radiation: workers involved in the initial clean-up response, and members of the general population who were either evacuated from the settlements in the Chernobyl nuclear power plant vicinity shortly after the accident, or continued to live in the affected territories of Belarus, Russia and Ukraine. Through domestic efforts and extensive international co-operation, essential information on radiation dose and health status for this population has been collected. This has permitted the identification of high-risk groups and the use of more specialised means of collecting information, diagnosis, treatment and follow-up. Because radiation-associated thyroid cancer is one of the major health consequences of the Chernobyl accident, a particular emphasis is placed on this malignancy. The initial epidemiological studies are reviewed, as are the most significant studies and/or aid programmes in the three affected countries.

Purpose Using 123 I for diagnostic purposes avoids the risk of stunning for subsequent radioiodine treatment and affords an excellent image quality. In this study we assessed the role of 123 I in comparison with 131 I post-treatment imaging in patients with thyroid cancer. Methods We compared a total of 292 123 I scans with their corresponding post-treatment 131 I images. Patients received a therapeutic dose of 131 I following diagnostic scanning with 50-111 MBq of 123 I. All patients were in a hypothyroid state (>30 μIU/l) before radioiodine administration for either diagnostic or therapeutic purposes. Results In 228 out of 263 patients with a positive diagnostic scan, 123 I whole-body scan findings were concordant with those of corresponding post-treatment 131 I images (concordance rate 87%). However, there were 44 additional foci of abnormal uptake on post-treatment 131 I scans in 22 discordant cases with no impact on therapeutic management of the patients. In 13 patients, there was at least one new site on post-treatment images that had been missed on pretreatment 123 I images. Twenty-nine patients with a negative diagnostic scan were treated with 131 I owing to a high serum thyroglobulin level (range 11.3-480 ng/ml). Radioiodine uptake sites were seen in eight post-treatment scans. In 21 pairs of whole-body scans, both the pre-and the post-treatment scan were negative (concordance rate 72.4%). Conclusion 123 I scanning is comparable to high-dose 131 I post-treatment imaging in thyroid carcinoma patients, and 123 I offers excellent image quality as a diagnostic agent. It avoids disadvantages such as stunning before treatment and delivery of a high radiation dose to patients.

During 20 years after the Chernobyl catastrophe (1986-2005 inclusive) thyroid cancer was diagnosed in more than 12,000 patients of Belarus. The peak incidence in children was observed in 1995 and since 2001 only sporadic cases occur in the age group under 15 years old. In adolescents, the maximum was registered in 2001. By contrast, in the age group of 46 years or over, the current tendency is a marked increase in the number of primary thyroid cancers that dictates a correspondent intensification of special kinds of treatment. Despite a great number of patients, disease-associated mortality remains stably low; the increasing incidence indicates that thyroid malignancies have proved an actual medical problem in 5 of the 6 administrative regions of Belarus.

The accident at the Chernobyl nuclear power plant was the worst industrial accident of the last century that involved radiation. The unprecedented release of multiple different radioisotopes led to radioactive contamination of large areas surrounding the accident site. The exposure of the residents of these areas was varied and therefore the consequences for health and radioecology could not be reliably estimated quickly. Even though some studies have now been ongoing for 25 years and have provided a better understanding of the situation, these are yet neither complete nor comprehensive enough to determine the long-term risk. A true assessment can only be provided after following the observed population for their natural lifespan. Here we review the technical aspects of the accident and provide relevant information on radioactive releases that resulted in exposure of this large population to radiation. A number of different groups of people were exposed to radiation: workers involved in the initial clean-up response, and members of the general population who were either evacuated from the settlements in the Chernobyl nuclear power plant vicinity shortly after the accident, or continued to live in the affected territories of Belarus, Russia and Ukraine. Through domestic efforts and extensive international co-operation, essential information on radiation dose and health status for this population has been collected. This has permitted the identification of high-risk groups and the use of more specialised means of collecting information, diagnosis, treatment and follow-up. Because radiation-associated thyroid cancer is one of the major health consequences of the Chernobyl accident, a particular emphasis is placed on this malignancy. The initial epidemiological studies are reviewed, as are the most significant studies and/or aid programmes in the three affected countries.

Thyroid carcinomas are rare and represent 1% of malignant tumours. Women are more likely to have thyroid cancer, at a ratio of three to one. Thyroid cancer may occur in any age group, although it is most common after the age of 30, and its aggressiveness increases significantly in older patients. Most patients present with a thyroid nodule. Thyroid nodules are frequent but only 5% of them are malignant. Over the last two decades, the widespread of diagnostic tools (ultrasonography, cytology) and changes in the surgical and pathological management of thyroid diseases have led to the increase of thyroid cancer, especially papillary microcarcinomas. Thyroid cancer is more frequent in people who have a history of thyroid exposure to radiation during childhood. The diagnosis is based on the histopathological examination that remains difficult in some cases. The most frequent thyroid cancers (papillary and follicular) are cured in 80-90 % of the cases if treated appropriately. Anaplastic cancer is rare and has a very poor prognosis. The primary therapy for thyroid cancer is total or near total thyroidectomy. Lymph node dissection is not systematically undertaken. Radioiodine treatment is advised for high risk patients and needs high levels of TSH to be effective. Then, patients must remain on thyroid hormone therapy for the rest of their lives. Prognosis factors are well defined and prognosis is good in case of differentiated thyroid cancer. Distant metastases are observed in 10% of the patients, and lung and bones are the most common sites. Locoregional recurrences are observed in 7% of the cases. Prolonged follow-up is recommended, based on physical examination, serum thyroglobulin assessment with TSH stimulation (L-thyroxin off or use of human recombinant TSH), ultrasonography and post therapeutic whole body scan.

17.10 – 17.20 pm
Role of Ultrasonography in characterising benign and malignant thyroid nodules
Ayman Elsayed (short oral presentation)
Diana Princess Of Wales Hospital, Northern Lincolnshire and Goole NHS foundation Trust, Radiology Department, North East Lincolnshire, United Kingdom
Co-Authors: Awad M, Abdulquader H
OBJECTIVES
: The aim of our study is to evaluate
the role of Ultrasonography (US) in predicting
benign and malignant thyroid nodules by corre-lating US findings with US- guided Fine Needle
Aspiration Biopsy (FNAB) and post operative
pathology results.
MATERIALS AND METHODS
: In this study we
looked retrospectively at four hundred and eight US and US-guided FNAB reports done for three hundred and forty consecutive patients; referred to the radiology department for evaluation of thy-
roid lumps in a five-year period. We reviewed
the US features including colour Doppler of the
thyroid nodules and correlated them with US
guided FNAB results and post operative histol-
ogy. All US scans and US guided FNAB were performed by the same consultant radiologist
and the FNAB were reported by two consultant cyto-pathologists.
RESULTS
: US characteristics including size, shape, contour, echogenicity, micro- and mac-
ro-calcifications and vascularity were evaluated
for every nodule sampled and correlated with benign and malignant pathology. Results were
studied statistically.
CONCLUSIONS
: Our study suggests US characCONCLUSIONS
: Our study suggests US characteristics of benign and malignant thyroid nodules
with review of the literature.

Abstract This research introduces Sorush Cancer Treatment Ptotocol (SCTP) based on successful cancer treatment methodology which has done by Dr. Somayeh Zaminpira and Dr. Sorush Niknamian in 54 cancer patients in Violet Cancer Institute (VCI), Combining Specific Ketogenic Diet (SKD)- which has 80% saturated fat, 15% Protein with the lowest glutamine and 5% complex-high fiber carbohydrate- and intravenous ozone therapy which has had marvelous results in the treatment of several cancers in human models. The aim of this protocol is to weaken and starve cancer cells, decreasing acidity, increasing the immune system response, decreasing the possibility of metastasis and decreasing the cachexia without any serious side effects in cancer patients. This protocol introduces mega vitamins and minerals plus several supplements based on some tried and true protocols mainly the Budwig and Bill Henderson Protocol (BHP) with serious revisions. The BHP incorporates principal components of the Budwig Diet which was developed in the early 1950s by German chemist Dr. Johanna Budwig (1908-2003). Budwig’s theory is based upon the work of Otto Warburg (1883-1970). Warburg was an earlier Nobel Prize Laureate (1931) for the discovery of the nature and action of the respiratory enzyme, the first of the so-called yellow enzymes, or flavoproteins. Warburg’s scientific efforts produced a large body of work and publications in highly respected journals such as Science (1928, 1956). According to Budwig, Warburg theorized that cellular respiration, like many chemical reactions, was dependent upon substrate availability, specifically a sulphydryl group and an unknown saturated fatty acid, which he failed to identify. According to Dr. S. Zaminpira and Dr. S. Niknamian, Cancer is an Evolutionary Metabolic disease (EMHC) and the main cause of cancer is the Butterfly Effect inside normal cells as a result of increasing the amounts of Reactive Oxygen Species (ROS).

Thyroid cancers cover a large spectrum of disease with diametrically opposite prognosis. At one end of the spectrum we have the well differentiated cancers which carry an excellent prognosis, while at the other end there is anaplastic cancer with high mortality rates and dismal prognosis. Management of thyroid cancers still has some controversial issues due to lack of randomized controlled trials. Extent of surgery, extent of neck dissection, role of radioiodine treatment and thyroid stimulating hormone suppression are still debatable. In this review, we highlight these controversial issues and give guidelines for the management and follow up of patients with thyroid cancer.

Verbal Presentation at: General Surgeons Australia Annual Scientific Meeting 2017 (29/9-1/10, Canberra)

Authors: David Roshan, Earl Abraham, Bryan Tran, Susannah Graham, Christopher Lehane, James Wykes, Peter Campbell, Ardalan Ebrahimi

Institution: Liverpool Hospital

Purpose: Various prognostic systems have been developed to stratify risk of cause-specific death in papillary thyroid cancer (PTC), with little consensus on the preferred approach. Although survival rates in PTC are excellent, disease recurrence requiring further treatment impacts a significant proportion of patients. In this study, we aimed to determine which system best predicts risk of disease recurrence.

Methodology: Eight staging systems (TNM8, AMES, MACIS, EORTC, OSU, GAMES, UABMDA and NTCTCS) were applied to determine risk of recurrence in a retrospective cohort of 573 patients with PTC using Cox regression analysis. Staging systems were compared using proportion of variation explained (PVE), Harrell’s concordance index (C-index), Akaike information criterion (AIC) and visual inspection for stratification into distinct prognostic categories on Kaplan-Meier (KM) curves.

Results: All systems significantly predicted recurrence risk (p=.004 to p<.001). The Metastases, Age, Completeness of Resection, Invasion, Size (MACIS) system performed best based on highest PVE (28%), lowest AIC, moderate C-index and reasonable stratification on KM curves though Groups 3 and 4 had a similar prognosis. AMES and TNM8 also performed well with PVEs of 28% and 26%, respectively, but had inferior AIC and C-index. In addition, TNM8 had prognostic overlap of intermediate stages and AMES provides only two risk categories, reducing the potential for precise risk stratification in individual patients.

Conclusion: Of the currently available prognostic systems, MACIS appears best suited to predicting recurrence risk in PTC. However, the prognostic performance of all systems was modest at best suggesting further study is needed in this area.

Background: There has been considerable difference in the mode of the imaging procedure and approach for the workup and post-surgery surveillance of thyroid cancer. Determination of serum thyroglobulin is recommended in the follow-up for monitoring the patients with differentiated thyroid carcinoma. Herein, the precise clinical role of individual imaging modalities is discussed, including ultrasound, computerized tomography (CT), magnetic resonance imaging (MRI) and scintigraphic procedures for the diagnosis of recurrent or metastatic thyroid cancer. Method: A review is presented of the scientific papers published in the literature between 1982 and 2007. Relevant articles for this review were identified by searching PubMed using the following search terms: thyroid cancer, ultrasound, computerized tomography, magnetic resonance imaging and scintigraphy. The papers were analyzed and categorized in tabular form by date, subject, author and the type of scientific paper (e.g., randomized controlled trial, meta-analysis, clinical cases and review articles). Conclusion: Sonographic features of malignancy include microcalcifications, solid mass, absence of halo and internal blood flow, and these are helpful to predict thyroid malignancy in a nodule. Ultrasound is used for guiding fine needle aspiration to improve the accuracy of cytological analysis. However, biopsy is often necessary for a definitive diagnosis. This modality is also useful for postoperative neck evaluation of patients with elevated serum thyroglobulin levels to search for local recurrence or regional lymph node metastasis, which are the most common sites of recurrence. Tumor extension to the neighboring musculature, trachea, larynx and retropharyngeal, parapharyngeal and retrotracheal nodes are better defined by other anatomical imaging methods, such as CT or MRI. Anatomical imaging procedures are highly sensitive but not specific for postoperative evaluation of these patients and have few implications for deciding on subsequent I-131 therapy in patients with differentiated thyroid carcinoma. In addition to radioiodine scan, which has been the cornerstone of managing patients with differentiated thyroid cancer, nuclear imaging (scintigraphy) with technetium-99m sestamibi and tetrofosmin have all been used for determination of recurrent or metastatic differentiated thyroid cancer. Meta-iodo-benzylguanidine labeled either with I-123 or with I-131, 99mTc sestamibi and tetrofosmin and In-111 labeled somatostatin receptor analogues have been used for determination of recurrent or metastatic disease of medullary thyroid cancer. Over the last decade, positron emission tomography using 18-F-fluorodeoxyglucose has emerged as a useful tool in detecting non-iodine avid dedifferentiated and/or poorly differentiated thyroid cancer and plays a principal role in such settings.

Thyroid tumors include those that originate from follicular cells and those that arise from parafollicular cells (C cells). Differentiated thyroid cancer, which originates from follicular cells, includes papillary carcinoma, follicular carci-noma, oncocytic cell carcinoma (Hürthle), poorly differentiated carcinoma, and anaplastic carcinoma. The incidence of thyroid cancer has been increasing significantly, with an estimated incidence in the United States of America of 53,990 cases by the year 2018. This neoplasm is listed as the most common endocrine tumor and represents approximately 3% of all malignant tumors in humans, with 75% of cases occurring in women, and two-thirds of cases occurring in people under 55 years. The increase in the prevalence/incidence of low-risk thyroid cancer over the last 10 to 20 years has required a re-appraisal of the standard one-size-fits-all approach to differentiated thyroid cancer. This adaptation to a more individualized management of the patient with thyroid cancer has led to a much more risk-adapted approach to the diagnosis, initial therapy, adjuvant therapy, and follow-up of patients with differentiated thyroid cancer. This paper with review the current understanding of the clinical presentation, diagnostic workup, and management of thyroid cancer centered on evidence-based and personalized medicine.

Aim: the purpose of the paper is to determine the frequency of multifocal thyroid cancer wide-spreading for tumors with different characteristics. Materials and Methods: a retrospective study of patients’ cohort has been carried out including persons operated because of thyroid cancer. The patients were divided into groups according to such characteristics as uni- and multifocality. While analyzing patients’ age and sex, as well as histological types of carcinomas, their sizes, tumor  characteristics according to the TNM (tumor, nodus, metastasis) classification  and invasive properties, clinical stage of disease, volume of surgical intervention, prognosis according to the MACIS scale, and mortality levels have been taken into account.
Results: the significant difference between unifocal and multifocal papillary and follicular carcinomas was observed in the elderly (above 60 years) patients, whereas multifocal follicular carcinomas are almost absent in patients below 18. It has been found that the wide-spreading of papillary multifocal carcinomas with aggressive characteristics is higher comparing to unifocal carcinoma. The changes
among cohort patients’ percent with follicular carcinomas when multifocal growth is present or absent are similar to papillary carcinomas-associated changes. But the degree of these probability changes is not so marked, especially concerning the changes of patients percent with follicular carcinomas of different sizes, different T categories, different clinical stages. Simultaneously, the mortality of patients with multifocal follicular carcinomas exceeds this index for cases with multifocal papillary carcinomas. It may be due to two times higher percent of elderly patients
with multifocal follicular carcinomas comparing to patients with papillary. This is a cause of higher risk degree for relapse development and requency, of poorer prognosis as well as of differences for patients treatment tactics with multifocal tumors.
Conclusion: multifocality is an important factor determining the survival prognosis for patients with differentiated thyroid carcinomas.
Key Words: multifocal differentiated thyroid carcinomas, invasion, metastases, relapses, МАСIS.

Medullary Thyroid Cancer (MTC) accounts for approximately 1.7% of all thyroid malignancies. The vast majority of MTC are sporadic, but 15% to 25% of the cases result from a germline mutation in the RET proto-oncogene. Familial Medul-lary Thyroid Cancer (FMTC) can be seen as an element of the Multiple Endocrine Neoplasia Syndrome (MENS) type 2A or 2B or as part of FMTC. This review discusses the contemporary approaches available for the evaluation and diagnosis of a patient with believed to have MTC. The current therapeutic approach to MTC is chiefly surgical, consisting of a total thyroidectomy and lymph node dissection. The degree and timing of the surgery are discussed centered on evidence-based medicine. Systemic treatment options are limited for MTC, but some therapeutic targets show promise for the development of new treatment option in the near future. In this manuscript, we discuss the epidemiology, pathophysiologic mechanisms, diagnostic challenges and the innovative therapeutic interventions of diabetic neurotrophic keratopathy, an entity with potentially serious implications for diabetic patients, both type 1 as well as type 2 alike.

The thyroid was, so to speak, the Womb of clinical nuclear medicine, which was born when scientists in the United Kingdom and the United States attempted to quantitate the percentage of iodine-131 taken up by the thyroid gland in 1940s with the help of the Geiger-Müller tube . Subsequently, various radiopharmaceutical agents became available for thyroid imaging and the diagnosis of different thyroid disorders. At the same time, other imaging modalities were developed in an effort to make possible the definitive diagnosis of thyroid diseases by means of nontraumatic as well as noninvasive methodology. Nuclear medicine remains an indispensable part of thyroidology, particularly in the diagnosis, treatment, and follow-up of thyroid cancer.

formation médicale continue le point sur… Conduite à tenir devant un nodule thyroïdien : échographie, cytoponction J Tramalloni, H Monpeyssen, JM Correas et O Hélénon Objectifs 1) Connaître les signes échographiques d'un nodule thyroïdien suspect.

The aims of these recommendations were to develop clinical guidelines for evaluation and management of patients with differentiated thyroid cancer applicable to Latin American countries. The panel was composed by 13 members of the Latin American Thyroid Society (LATS) involved with research and management of thyroid cancer from different medical centers in Latin America. The recommendations were produced on the basis of the expert opinion of the panel with use of principles of Evidence-Based Medicine. Following a group meeting, a first draft based on evidences and the expert opinions of the panel was elaborated and, later, circulated among panel members, for further revision. After, this document was submitted to the LATS members, for commentaries and considerations, and, finally, revised and refined by the authors. The final recommendations presented in this paper represent the state of the art on management of differentiated thyroid cancer applied to all Latin American countries. Arq Bras Endocrinol Metab. 2009;53 :884-97.

... 3 )S ite of active rad io iod ine transport Uptak e may be intense; breastfeed in g m u st stop ( 4,15,18,64,67–69,71,72,75,80–82,85,87,93 ) before scintig raphy, ... Major ro u te of rad io iod ine excretion Cloth in g m u st be chan g ed ju st before scann in g; attempts to w ash aw ay ...

Thyroid nodules are a major health problem worldwide. The prevalence of palpable thyroid nodules in the general population is approximately 5% in women and 1% in men living in parts of the world with sufficient iodine. High resolution neck and thyroid ultrasound can detect thyroid nodules in a significant proportion of randomly selected individuals, with higher frequencies in women and the elderly population. The importance of thyroid nodules lies in the need to rule out cancer. The majority of thyroid nodules is benign, clinically irrelevant, and can be safely managed with a good surveillance program. The detection and diagnosis of differentiated thyroid cancer have evolved over the years with increased use of high resolution cervical and thyroid ultra-sound, fine needle aspiration biopsy (FNAB), molecular testing, and thyrog-lobulin as a serum tumor marker. An algorithm that utilizes high resolution ultrasound and, when indicated, FNAB, and molecular testing for the diagnosis of thyroid nodules, facilitates a personalized, risk-based protocol that promotes high-quality care and minimizes cost and unnecessary testing. Our paper reviews the current, evidence-based management of newly diagnosed thyroid nodules.

Objective: To investigate any abnormalities of the menstrual cycle and/or pregnancy in women Ͻ40 years old who had received radioiodine (I-131) therapy for thyroid cancer. Design: Case-control study. Setting: General military hospital in Athens, Greece. Patient(s): Forty-five women of childbearing age with thyroid cancer that were treated with I-131 from December 1996 to May 2003 were compared to 83 age-matched control females. Intervention(s): The patients' charts were reviewed, and in addition patients were contacted by telephone and asked detailed questions about their previous gynecologic history and any problems after treatment (menstrual cycle and pregnancy). Main Outcome Measure(s): Abnormalities of menstrual cycle and/or pregnancy. Result(s): Overall, 14 of 45 women (31.1%) had menstrual cycle irregularities after treatment. Eight patients (17.8%) had normal menstrual cycles before therapy and six (13.3%) had pretreatment menstrual cycle irregularities that persisted or were exaggerated after therapy. In the control group, 12 of 83 women (14.5%) reported menstrual cycle irregularities. The patients' menstrual cycle and menses irregularities were significantly increased after I-131 therapy (Pϭ.02) compared with the control group and seemed to increase with age. After therapy a total of seven children were borne by 6 of the 45 patients (13.3%). No premature births or miscarriages were noted.

Thyroid is one of the largest endocrine gland. It is a small butterfly shaped gland which is located in the front portion of the neck.It is located just below the Adams apple. Thyroid gland produces hormones that help the body to control metabolism. There are various thyroid disorders. It includes Hyperthyroidism, Hypothyroidism, goiter and thyroid nodules (benign/malignant). Various modalities that are used to detect and classify abnormalities of the thyroid gland are Ultrasound imaging, Computer Tomography(CT),Magnetic Resonance Imaging(MRI) and Computer Aided Diagnosis (CAD).CAD help radiologists and doctors to increase the diagnosis accuracy, reduce biopsy ratio and save their time and effort. Medical image analysis has played an important role in many clinical procedures for detecting different types of human diseases.Thyroid medical images are utilized for the diagnosis process.

Background and Purpose: Salivary gland impairment following high-dose radioiodine treatment is well recognized. Since differentiated thyroid cancer has a good prognosis, reduction of long-term side effects is important. This study investigates the radioprotective effects of amifostine in salivary glands of rabbits receiving high-dose radioiodine therapy so as to obtain deeper insight in changes on the cellular and ultrastructural level. Material and Methods: A total of 20 rabbits were investigated. High-dose radioiodine therapy applying 1 GBq 131 I was performed in 16 animals. Eight of these 16 animals received 200 mg/m 2 body surface amifostine prior to high-dose radioiodine therapy. Four additional rabbits served as controls, two receiving amifostine, the other two no treatment at all. Subsequently, salivary glands (submandibular and parotid glands, respectively) of all animals were examined by light and transmission electron microscopy. Results: Parenchymal damage of both parotid and submandibular glands, specially acinar structures comprising cell organelles and nuclei, of animals pretreated with amifostine was much less pronounced than in animals without amifostine pretreatment.

The need for time and attention, given by the doctor to the patient, due to the increased volume of medical data to be interpreted and filtered for diagnostic and therapeutic purposes has encouraged the development of the option to support, constructively and effectively, deep learning models. Deep learning (DL) has experienced an exponential development in recent years, with a major impact on interpretations of the medical image. This has influenced the development, diversification and increase of the quality of scientific data, the development of knowledge construction methods and the improvement of DL models used in medical applications. All research papers focus on description, highlighting, classification of one of the constituent elements of deep learning models (DL), used in the interpretation of medical images and do not provide a unified picture of the importance and impact of each constituent in the performance of DL models. The novelty in our paper consists primarily in t...

La gammagrafía con tecnecio 99 (Tc99) sestamibi y la biopsia por aspiración permiten predecir de forma relativamente segura el resultado histopatológico de un nódulo tiroideo.Determinar la utilidad diagnóstica de la gammagrafía tiroidea con tecnecio 99 sestamibi para detección de malignidad en pacientes con nódulo tiroideo, confirmado por resultado histopatológico definitivo posterior a tiroidectomía.Se estudió un total de 69 pacientes con diagnóstico de nódulo tiroideo solitario que contaban con punción por aspiración con aguja fina y que fueron sometidos a tiroidectomía total ante sospecha de cáncer con análisis patológico posterior en todos.Cincuenta y cuatro pacientes con gammagrafía tiroidea positiva para malignidad; 25 pacientes con un histopatológico final de cáncer y 29 con un histopatológico negativo al mismo. Quince pacientes con gammagrafía tiroidea negativa para neoplasia tiroidea, con 3 presentando un diagnóstico de cáncer confirmado por patología y 12 confirmados con ausencia de malignidad.En el presente estudio se realizó un análisis estadístico para determinar la certeza diagnostica del Tc99 sestamibi para detectar malignidad en los nódulos tiroideos. El estudio con gammagrafía tiroidea con Tc99 sestamibi para cáncer de tiroides, tuvo una sensibilidad de 89,28%, con una especificidad de 29,25%. El Tc99 sestamibi mostró un valor predictor positivo de 46,29% y un valor predictor negativo de 80%.Consideramos que la práctica de la gammagrafía tiroidea con Tc99 sestamibi debe ser una técnica diagnóstica que se utilice de forma rutinaria en todo aquel paciente con un nódulo tiroideo que presente una punción aspiración con citología tiroidea indeterminada; siendo su mayor utilidad para descartar malignidad en aquellos que presentan captación baja en el estudio de medicina nuclear.99mTc sestamibi scanning and aspiration biopsy can predict the histopathological result of a thyroid nodule fairly accurately.To determine the accuracy of 99mTc sestamibi scanning in detecting malignancy in patients with thyroid nodule confirmed by definitive histopathological report after thyroidectomy.A total of 69 patients with a solitary thyroid nodule were studied. In all patients, fine needle aspiration, total thyroidectomy for suspected thyroid cancer, and histological analysis of the surgical specimen were performed. There were 54 patients with a positive 99mTc sestamibi scan; of these, malignancy was confirmed by histological analysis in 25 and excluded in 29. There were 15 patients with a negative 99mTc sestamibi scan; of these, three had a final diagnosis of cancer and 12 were confirmed as cancer-free.The diagnostic accuracy of 99mTc sestamibi scanning in detecting malignancy in thyroid nodules was determined through a statistical analysis. 99mTc sestamibi scan for thyroid cancer had a sensitivity of 89.28% and a specificity of 29.25%. The positive predictive value was 46.29% and the negative predictive value was 80%.We believe that 99mTc sestamibi scan should be routinely used in all patients with a thyroid nodule and an indeterminate result on fine needle aspiration. This procedure is most useful in excluding malignancy in patients with a negative 99mTc sestamibi scan.