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  • 1
    ISSN: 1432-2323
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Résumé Le traitement chirurgical de la Maladie de Basedow se doit d'être non seulement sûr mais doit aussi éviter un taux excessif de récidive d'hyperthyroïdie. La récidive précoce est particulièrement fâcheuse. Nous avons étudié 728 patients atteints de Maladie de Basedow, traités par thyroïdectomie subtotale, en analyse multifactorielle, de façon à détecter les facteurs éventuels de récidive précoce. On a analysé les facteurs suivants: âge, sexe, durée du traitement médical, le poids del la pièce réséquée, la taille du moignon restant, les niveaux préopératoires de TSH binding inhibitory immunoglobuline (TBII) et des anticorps antimicrosomial hemagglutination (MCHA). On a utilisé le test Chi2 en analyse monofactorielle et, par modèle logistique, pour l'analyse multifactorielle. La récidive précoce a été définie par l'existence d'une suppression de la TSH observée pendant la première année après la chirugie et durant au moins 6 mois. Cent six patients (14.67%) ont eu une récidive précoce. Les facteurs significatifs étaient la taille du moignon, le MCHA et 1 TBII. Ces résultats indiquent que TBII et MCHA sont des facteurs de récidive précoce. Chez le patient ayant des taux élevés de TBII et MCHA, il vaut mieux réduire d'avantage la taille du moignon pour éviter les risques de récidive précoce.
    Abstract: Resumen Un prerrequisito para el tratamiento quirúrgico de la enfermedad de Graves es que pueda ser realizado no sólo con seguridad sino también con una baja incidencia de hipertiroidismo recurrente. La recurrencia temprana es especialmente indeseable. Hemos estudiado 728 pacientes con enfermedad de Graves tratados mediante tiroidectomía subtotal utilizando análisis multivariable con miras a identificar los factores que se relacionan con recurrencia temprana. Los siguientes factores fueron analizados: edad, sexo, duración del tratmiento médico, peso del tejido tiroideo resecado, tamaño del remanente tiroideo, nivel sérico preoperatorio de inmunoglobulina inhibidora de la ligadura de TSH (TBII) y de anticuerpo antimicrosomal de hemaglutinación MCHA). Se definió la “recurrencia temprana” como la supresión de TSH que ocurre en el curso del primer año luego de la cirugía y que se continúa por lo menos por 6 meses. Ciento seis pacientes, 14.6%, presentaron recurrencia temprana. El análisis estadístico demostró que el remanente de tiroides, el MCHA y la TBII fucron los factores de significación. Estos resultados indican que la TBII y el MCHA están relacionados con el fenómeno de la recurrencia temprana del hipertiroidismo y por ello se recomienda, para evitar tal recurrencia, un remanente tiroideo menor en los pacientes con MCHA elevada y/o nivel elevado de TBII.
    Notes: Abstract Prerequistes for surgical treatment of Graves' disease are that it can be done safely and that it is associated with a low incidence of recurrent hyperthyroidism. Early recurrence is especially undesirable. We studied 728 patients with Graves' disease treated by subtotal thyroidectomy using multivariate analysis in order to determine the factors related to early recurrence. The following factors were analyzed: age, sex, duration of medical treatment, weight of resected thyroid tissue, thyroid remnant size, preoperative level of thyroid-stimulating hormone (TSH) binding inhibitory immunoglobulin (TBII), and antimicrosomal hemagglutination antibody (MCHA). “Early recurrence” was defined as TSH suppression observed within the first year after surgery and continuing for at least 6 months. A total of 106 patients (14.6%) had early recurrence. Statistical analyses were performed by the chi-square test for univariate analysis and a logistic model for multivariate analysis. Significant factors were thyroid remnant size, MCHA, and TBII. These results indicated that TBII and MCHA are related to early recurrence of hyperthyroidism, and smaller remnant size is recommended for patients with a high MCHA titer or a high TBII level (or both) in order to avoid early recurrence.
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  • 2
    ISSN: 1432-2323
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. Graves’ ophthalmopathy is a complex disease whose pathogenesis is thought to be autoimmune. The treatment of Graves’ disease is considered to be related to the progression of Graves’ ophthalmopathy. There have been no long-term prospective studies on the natural course of Graves’ ophthalmopathy. In this study we assessed the influence of subtotal thyroidectomy on the outcome of Graves’ ophthalmopathy, comparing it with that of radioactive iodine treatment. Altogether 287 untreated patients with Graves’ disease referred to Ito hospital in 1989 were followed prospectively for 5 years. A group of 67 patients were treated with radioactive iodine, and 18 patients underwent surgery. Proptosis of the eyes was measured in all patients using Hertel’s exophthalmometer. The mean value of proptosis in patients with untreated Graves’ disease was 14.8 ± 0.2 mm (mean ± SEM), and after 5 years it increased slightly to 15.0 ± 0.2 mm. The mean changes of proptosis in patients treated surgically and patients given radioactive iodine were −0.01 ± 0.22 and 0.93 ± 0.28 mm, respectively ( p 〈 0.05). In patients treated by subtotal thyroidectomy, ophthalmopathy did not change in 77.8%; it progressed in 5.6% and was alleviated in 16.7%. In patients treated with radioactive iodine, the ophthalmopathy did not change in 86.6%, progressed in 10.4%, and was alleviated in 3.0%. These findings indicate that surgery can be a better treatment than radioactive iodine for Graves’ patients with ophthalmopathy.
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  • 3
    ISSN: 1436-2813
    Keywords: leiomyosarcoma ; thyroid gland ; α-smooth muscle actin
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Primary leiomyosarcoma of the thyroid gland is extremely rare, and to the best of our knowledge only five well-documented cases have been reported in the world literature. We herein report a 58-year-old female patient with primary leiomyosarcoma of the thyroid who was successfully treated by total thyroidectomy with a modified neck dissection. Immunohistochemically, the tumor cells showed positive reactivity to α-smooth muscle actin and vimentin. Radical surgery was thus considered to be essential in the treatment of this rare but rather aggressive malignancy.
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  • 4
    ISSN: 1432-2323
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Résumé Cette étude a été élaborée pour identifier 11 antigènes différents, y compris la calcitonine (CT), la peptide codée par le gène calcitonine (PCGC), la peptide de stimulation de la gastrine (PSG), et ACE dans les tumeurs de 36 patients ayant un cancer médullaire de la thyroïde (CMT) avec la technique de coloration immunopéroxidase. La clinique des patients ayant un CMT a été comparée aux données immunohistochimiques pour établir des facteurs influençant le pronostic. Les CMT contenaient de nombreuse substances chimiques chez la plupart des patients. La CT et ACE étaient positifs chez tous les patients. La PCGC et la PSG se coloraient positivement chez 96.6 et 82.9% des patients à CMT, respectivement, suggérant que la PCGC et la PSG sont des marqueurs tumoraux potentiels pour le CMT. Dans les cellules tumorales, CT, PSGC., et PSG ont été souvent identifiées dans les mêmes cellules. En général on a trouvé plus d'antigènes chez les patients à CMT familiaux que chez les patients à CMT sporadiques. Chez les 2 patients inopérables chez qui l'évolution était extrêmement agressive, ces tumeurs étaient histologiquement indifférenciéés et la coloration pour ces hormones, pauvres, suggèrant une perte des caractères spécifiques neurendocrines de la tumeur. Chez ces 2 patients, la distribution de CT et d'ACE était inversement proportionnelle l'une par rapport à l'autre: la quantité de CT était réduite dans les cellules alors que la coloration pour l'ACE était homogène. Les résultats de cette étude suggèrent que la PCGC et la PSG, comme le sont déjà la CT et l'ACE, sont peut-être des marqueurs tumoraux pour le CMT. Il est possible que la CT et l'ACE puissent être utilisés pour différencier les patients à haut degré de malignité.
    Abstract: Resumen Este estudio fue diseñado con el fín de identificar 11 antígenos diferentes, incluyendo calcitonina (CT), péptido calcitonina gen-relacionada (PCGR), péptido liberador de gastrina (PLG), y antígeno carcinoembriónico (ACE), en los tumores de 36 pacientes con carcinoma medular de tiroides (CMT) utilizando técnicas de coloración con inmunoperoxidasa. Además, se compararon las características clínicas del CMT con los hallazgos inmunohistoqufmicos para definir factores que tengan influencia sobre el pronóstico. Se encontró que el CMT contiene una variedad de productos en muchos de los pacientes y que la CT y el ACE fueron positivos en la totalidad de los pacientes. El PCGR y PLG mostraron coloración positiva en 96.6% y 82.9% de los pacientes, respectivamente, lo cual sugiere que el PCGR y el PLG son noveles marcadores tumorales del CMT. En las células tumorales comparadas en secciones adyacentes apareadas, las 3 hormonas, CT, PCGR, y PLG fueron frecuentemente demostrados en células idénticas. Los pacientes con enfermedad de tipo familiar exhibieron mayor número de sustancias múltiples que los pacientes con enfermedad esporádica. En los 2 pacientes inoperables con progresión tumoral de extrema agresividad, los tumores mostraron indiferenciación en la histología y pobre coloración para las hormonas péptidos, lo cual sugiere que se habían perdido sus cualidades específicas como tumores neuroendocrinos. Estos 2 pacientes, en particular, revelaron una relación inversa entre la distribución de CT y de ACE, tal que pequeñas cantidades de CT estaban presentes en células que exhibían coloración homogénica para ACE. Este estudio sugiere que el PCGR y el PLG, además de la CT y el ACE, pueden ser potenciales marcadores tumorales para CMT. La CT y el ACE pueden ser posibles marcadores para diferenciar los pacientes con severo grado de malignidad de aquellos con malignidad ordinaria.
    Notes: Abstract This study was designed to identify 11 different antigens including calcitonin (CT), calcitonin gene-related peptide (CGRP), gastrin-releasing peptide (GRP), and carcinoembryonic antigen (CEA), in the tumors of 36 patients with medullary thyroid carcinoma (MTC) using immunoperoxidase staining techniques. In addition, clinical features of MTC patients were compared with the immunohistochemical findings to establish factors influencing prognosis. MTC was found to contain various products in many patients and CT and CEA were positive in all patients. CGRP and GRP showed positive staining in 96.6% and 82.9% of MTC patients, respectively, suggesting that CGRP and GRP are novel tumor markers for MTC. In tumor cells, CT, CGRP, and GRP were often revealed in identical cells. Familial patients showed more multiple substances than sporadic patients. In the 2 inoperable patients with extremely aggressive progression, tumors showed undifferentiated histology and poor staining for peptide hormones, suggesting that specific qualities such as neuroendocrine tumor had been lost. These 2 patients particularly revealed an inverse relationship between CT and CEA distribution such that small amounts of CT were present in cells which have homogenous staining for CEA. This study suggests that CGRP and GRP, in addition to CT and CEA, may be a histologically potential tumor marker for MTC. CT and CEA may be possible markers for differentiating patients with high malignancy from those with ordinary malignancy.
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  • 5
    ISSN: 1432-2323
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Résumé Bien que le rapport entre la radioiodothérapie (RIT) pour maladie de Basedow et la survenue de cancer ne soit pas clair, n'importe quel chirurgien peut un jour être confronté à ce problème. Nous avons étudié les caractéristiques clinicopathologiques de 11 patients ayant un cancer de la thyroïde un an ou plus après une RIT pour maladie de Basedow observés entre 1983 et Décembre 1991 et opérés à l'Hôpital Ito. Ces 11 patients représentaient 0.51% des 2146 cas de cancer de la thyroïde et 0.17% des 6419 cas de maladie de Basedow traités pendant cette même période. Il s'agissait dans tous les cas de femmes, d'âge moyen au moment de la RIT et de la chirurgie respectivement de 44.3 et 51.4 ans. La dose moyenne de RIT était de 222.1 MBq et la dose absorbée, de 45.3 Gy. La thyroïdectomie totale a été réalisée chez deux patients, la thyroïdectomie subtotale chez 3 et al lobectomie chez 6 autres. Le curage cervical était bilatéral dans deux cas, et homolatéral dans 7. L'histologie a mis en évidence 10 cancers papillaires et un cancer folliculaire. Le diamètre moyen de la tumeur était de 18.5 mm. La dissémination intraglandulaire de la glande a été notée dans un cas et une tumeur pleine dans deux. Des métastases lymphatiques ont été notées dans 6 cas, mais dans 5 des 6 cas, un ganglion seulement a été envahi. Cette étude indique que le cancer de la thyroïde aprés RIT pour malade de Basedow n'est pas un cancer agressif; la lobectomie associée à un curage homolatéral devrait suffire pour traiter ces patients.
    Abstract: Resumen Aunque no se ha definido la relación causal entre la terapia con yodo radioactivo (TRA) para enfermedad de Graves y el desarrollo ulterior de cáncer tiroideo, el cirujano, en su práctica profesional, puede verse enfrentado a tal problema. Hemos analizado las características clinicopatológicas de pacientes con carcinoma tiroideo aparecido luego de TRA para enfermedad de Graves. Entre enero de 1983 y diciembre de 1991, 11 pacientes con carcinoma tiroideo diagnosticado un año o más luego de TRA, fueron sometidos a cirugía en el Hospital Ito. Estos 11 pacientes representaron el 0.51% de 2.146 casos quirúrgicos de carcinoma tíroideo y el 0.17% de 6.419 casos de TRA por enfermedad de Graves regístrados durante tal período. Todos los pacientes fueron del sexo femenino y sus edades en el momento del TRA y de la cirugía fueron 44.3 y 51.4 años, respectivamente. La dosis administrada de yodo radioactivo fue 222.1 MBq y la dosis absorbida fue 45.3 Gy, en promedio. Se practicó tiroidectomía total en 2 pacientes, tiroidectomía subtotal en 3 y lobectomía en 6. Se añadió disección cervical bilateral modificada en 2 casos, e ipsilateral en 7. La histología reveló 10 carcinomas papilares y 1 folicular. El diámetro promedio del tumor fue 18.5 mm. En un caso se observó diseminación intraglandular del tumor y en dos casos un patrón de crecimiento sólido. Metástasis ganglionares fueron observadas en 6, pero en 5 de estos pacientes sólo había un ganglio afectado. El presente estudio señala que el carcinoma tiroideo que se desarrolla luego de TRA por enfermedad de Graves no es una variedad agresiva y que una lobectomía con disección cervical modificada unilateral puede ser suficiente tratamiento quirúrgico en los pacientes que lo albergan.
    Notes: Abstract Although the causal relation between radioactive iodine therapy (RIT) for Graves' disease and the subsequent occurence of thyroid carcinoma is not definite, surgeons may be faced with the treatment of such patients. We studied the clinicopathologic features of patients with thyroid carcinoma following RIT for Graves' disease. From January 1983 to December 1991, 11 patients with thyroid carcinoma occurring 1 year or more after RIT for Graves' disease underwent surgery at Ito Hospital. These 11 patients accounted for 0.51% of 2146 surgical cases of thyroid carcinoma and 0.17% of 6419 RIT cases of Graves' disease during the period. They were all women, and their mean ages at RIT and surgery were 44.3 and 51.4 years, respectívely. The administered dose of RI was 222.1 MBq and the absorbed dose 45.3 Gy on average. Total thyroidectomy was performed in two patients, subtotal thyroidectomy in three, and lobectomy in six. Bilateral modified neck dissection (MND) was added in two patients, and ipsilateral MND in seven. Histology revealed 10 papillary and 1 follicular carcinoma. The mean diameter of the tumor was 18.5 mm. Intraglandular dissemination of the tumor was noted in only one case and solid growth patern in two. Nodal metastasis was disclosed in six cases, but in five of them only one node was involved. The present study indicated that thyroid carcinoma occurring after RIT for Graves' disease is not an aggressive variety, and thyroid lobectomy with ípsilateral MND would be sufficient as surgical treatment for such patients.
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  • 6
    ISSN: 1432-2323
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. To make the surgical treatment for Graves’ disease more ideal, it is important to elucidate factors related to postoperative thyroid dysfunction in addition to thyroid remnant. Because TSH receptor antibody (TRAb) is thought to be one of the essential causes of Graves’ disease, we investigated whether preoperative changes in serum TRAb levels are related to postoperative recurrent hyperthyroidism. Between 1987 and 1992 a total of 1520 patients with Graves’ disease were treated by subtotal thyroidectomy. Of these patients 335 visited Ito Hospital with no history of drug treatment of their disease and were treated surgically after several courses of antithyroid drug (ATD) therapy. There were 68 males and 267 females with a mean age of 25.8 years. The mean follow-up period was 48 months (range 12–84 months). Factors analyzed by univariate and multivariate analysis were as follows: age, sex, duration of ATD treatment, weight of resected thyroid, weight of thyroid remnant, preoperative titer of MCHA, TRAb at the time of initial examination (TRAb1), TRAb at the time of surgery (TRAb2), and ΔTRAb, the difference between TRAb1 and TRAb2 (ΔTRAb = TRAb1 − TRAb2). The chi-square test was used for univariate analysis and a logistic model for multivariate analysis. Of this group, 119 patients were euthyroid (35.5%), 50 were hyperthyroid (14.9%), and 166 were hypothyroid (49.3%). Significant factors related to recurrent hyperthyroidism were weight of thyroid remnant and ΔTRAb in both univariate and multivariate analyses. ΔTRAb is a possible new marker for predicting postoperative recurrent hyperthyroidism. If the preoperative TRAb level is not improved by ATDs in patients with Graves’ disease, the thyroid remnant should be made smaller.
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  • 7
    ISSN: 1432-2323
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. Thyroid-stimulating hormone (TSH)-binding inhibitory immunoglobulin (TBII) is thought to be one of the essential causes of Graves' disease, and most cases of neonatal hyperthyroidism can be explained by transplacental passage of TBII. Because surgery is often indicated for patients of childbearing age, it is important to elucidate how surgery reduces TBII levels. Between 1988 and 1991 a total of 946 female patients with Graves' disease underwent subtotal thyroidectomy. Follow-up examination was undertaken at 1, 2, 3, and 4 to 5 years after surgery. At 4 to 5 years after surgery, 76.8% of patients without recurrent overt hyperthyroidism had TBII 〈 20%. In patients with recurrent hyperthyroidism, TBII increased gradually during follow-up, and they had higher TBII levels than nonrecurrence patients. There were a few euthyroid and hypothyroid patients who had TBII 〉 60%, and the number of such patients decreased annually. In most of the patients, immunologic remission was obtained by subtotal thyroidectomy except for their having recurrent hyperthyroidism. To acquire immunologic remission, hormonal remission, at least, would be necessary. Because no definite factor other than the size of the thyroid remnant related to postoperative thyroid function was elucidated, near-total thyroidectomy rather than subtotal thyroidectomy is expected to be induced not only hormonal remission but also immunologic remission. It should be noted that a few patients achieved hormonal remission but not immunologic remission.
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  • 8
    ISSN: 1436-2813
    Keywords: Graves’ disease ; subtotal thyroidectomy ; endocrine response
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Changes in the serum levels of anterior pituitary, thyroid, parathyroid, and adrenal hormones following subtotal thyroidectomy in 31 patients with Graves’ disease were investigated. In 14 patients, rapid ACTH tests were performed on the preoperative and the first, third, and seventh postoperative days. Remarkable differences were not seen with regard to the changes in anterior pituitary hormones or cortisol, compared to those seen during general surgery. As to the thyroid hormones, the serum level of triioodothyronine (T3) decreased markedly after surgery and fell to half that of the preoperative value on the first postoperative day. Thereafter, a low value of T3 was maintained during the early postoperative period. Unlike T3, the serum level of thyroxine (T4) decreased gradually until the 7th post-operative day. The levels of both epinephrine and norepinephrine increased transiently during surgery, but the serum level of norepinephrine increased again on the third postoperative day. In the postoperative period, almost half the number of patients showed an inadequate cortisol response to rapid ACTH tests. It is suggested that the unique responses, such as the rise in serum norepinephrine or an inadequate response of cortisol to ACTH, or hypocalcemia, after subtotal thyroidectomy in patients with Graves’ disease is largely due to the rapid decrease of T3 in the hypothyroid state, as was noted during the postoperative period.
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  • 9
    ISSN: 1436-2813
    Keywords: esophageal varices ; goiter ; angiography ; Graves' disease
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract A 65-year-old woman presented with an episode of hematemesis and a recurrent cervical goiter due to Graves' disease. The angiogram revealed bleeding esophageal varices which had developed through a drainage vein of the vascular goiter. Total thyroidectomy resulted in eradication of the esophageal varices.
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  • 10
    Electronic Resource
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    Springer
    Surgery today 18 (1988), S. 146-151 
    ISSN: 1436-2813
    Keywords: adenomatous goiter ; hyperthyroidism
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Adenomatous goiter with hyperthyroidism is a rare disease entity in Japan. Over a five-year period, we operated on 20 patients with this disease. Pre-operatively, basal thyrotropin was not necessarily suppressed and the thyrotropin-binding inhibiting immunoglobulin activity, which had been recently measured in five patients, showed normal values. Uneven patches of cold areas were noted on131I thyroidal scintigrams. Thyroid function tests carried out three years after surgery in one lobectomy case and in eleven subtotal thyroidectomy cases revealed hypothyroidism in seven, hyperthyroidism in two and euthyroidism in only three cases. These results suggest that the pathogenesis and clinical features of adenomatous goiter with hyperthyroidism are quite different from those of Graves’ disease, and that routinely performing near-total thyroidectomy may be considered as the treatment of choice.
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