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  • 1
    Electronic Resource
    Electronic Resource
    Solid cell nests of the thyroid gland: Precursor of mucoepidermoid carcinoma? (1992)
    Springer
    World journal of surgery 16 (1992), S. 685-688 
    Details
    ISSN: 1432-2323
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Résumé On trouve des Ilôts de cellules solides (NCS) dans le parenchyme thyroïdien pendant des examens anatomopathologiques systématiques, mais leur histogénèse et signification clinique restent obscures. De Novembre 1987 à Mai 1991, un total de 3260 patients ont été opérés de leur thyroïde à l'Hôpital Ito, Japon, et des NCS ont été notés dans 42 (1.3%) des cas. Des coupes sériées des pièces provenant de ces patients ont été étudiées morphologiquement et immunohistochimiquement. La localization et le type de croissance des NCS dans le parenchyme thyroïde étaient bien distincts des cellules-C hyperplastiques. Les NCS étaient localisées dans l'isthme dans un cas, et dans la pyramide dans trois cas. Dans un autre cas, une prolifération néoplasique de NCS a été observée. Du point de vue immunohistochimique, les NCS étaient négatifs pour l'énolase neuronospécifique, la chromogranine A et la protéine 100-S. Ces données suggèrent que les NCS sont d'origine endodermale et qu'ils peuvent avoir un rapport intime avec le carcinome mucoépidermoïde de la thyroïde.
    Abstract: Resumen La presencia de nidos celulares (NCS) en el parenquima tiroideo es un hallazgo que aparece en los reportes de exámenes clínicopathológicos rutinarios, pero su histogénesis y significación clínica siguen siendo oscuros. Tres mil doscientos sesenta pacientes fueron sometidos a cirugía tiroidea en el Hospital Ito de Tokio, entre noviembre de 1987 y mayo de 1991, habiéndose hallado NCS en 42 (1.3%) de ellos. Se realizaron estudios morfológicos e inmunohistologicos en secciones seriadas de los especímenes tiroideos y se encontró que la lozalización y el patrón de crecimiento de los NCS dentro del parenquima tiroideo eran diferentes de la localización y patrón de crecimiento de las células C hiperplásicas. Los NCD aparecieron ubicados en el istmo tiroideo en un caso y aún en el lóbulo piramidal en tres casos; en otro caso se observó proliferación neoplásica de los NCS. Desde el punto de vista immunohistoquímico, los NCS aparecieron negativos para la enolasa neurona-específica, la cromogranina y la proteína S-100. Tales hallazgos sugieren fuertemente que los NCS son de origen endodérmico y que pueden estar íntimamente relacionados con el carcinoma mucoepidermoide de la glándula tiroides.
    Notes: Abstract Solid cell nests (SCN) are found within the thyroid parenchyma on routine clinical pathological examinations, but their histogenesis and clinical significance are still obscure. From November 1987 to May 1991, a total of 3,260 patients underwent thyroid surgery at Ito Hospital and SCN were noted in 42 (1.3%) patients. Serial sections of the specimens from these patients were studied morphologically and immunohistochemically. The location and growth pattern of SCN within the thyroid parenchyma were distinct from those of hyperplastic C-cells. SCN were located in the isthmus lobe in 1 patient and even in the pyramidal lobe in 3 patients. In another patient neoplastic proliferation of SCN was observed. Immunohistochemically, SCN were negative for neuron-specific enolase, chromogranin A, and S-100 protein. These findings strongly suggest that SCN are of endodermal origin and that they may be closely related to mucoepidermoid carcinoma of the thyroid gland.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02067357
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  • 2
    Electronic Resource
    Electronic Resource
    Letters to the editor (1993)
    Springer
    World journal of surgery 17 (1993), S. 417-418 
    Details
    ISSN: 1432-2323
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01658717
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  • 3
    Electronic Resource
    Electronic Resource
    Early recurrence of hyperthyroidism in patients with Graves' disease treated by subtotal thyroidectomy (1995)
    Springer
    World journal of surgery 19 (1995), S. 648-652 
    Details
    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.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00294748
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  • 4
    Electronic Resource
    Electronic Resource
    Effect of Subtotal Thyroidectomy on Natural History of Ophthalmopathy in Graves’ Disease (1998)
    Springer
    World journal of surgery 22 (1998), S. 714-717 
    Details
    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.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002689900458
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  • 5
    Electronic Resource
    Electronic Resource
    Prediction of distant metastasis in follicular adenocarcinoma of the thyroid (1990)
    Springer
    World journal of surgery 14 (1990), S. 425-429 
    Details
    ISSN: 1432-2323
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Résumé L'adénocarcinome folliculaire de la thyroïde présente parfois des métastases à distance malgré son faible degré histologique de malignité. Nous avons chercher à savoir si les métastases à distance peuvent être soupçonnées par la présence d'envahissement des vaisseaux sanguins. Nous avons également examiné le problème du point de vue de conjugaison cellulaire. Cette étude intéresse 160 cas d'adénocarcinome folliculaire de la thyroïde. On a pris des échantillons histologiques en sectionnant les tumeurs selon leur diamètre le plus grand. L'endothélium des vaisseaux sanguins a été spécifiquement coloré immunohistochimiquement à l'aide de l'antigène facteur VIII et l'agglutinine Ulex europeaus et on a cherché en particulier la présence de l'envahissement des vaisseaux sanguins. En outre, on a examiné la conjugaison entre l'agglutinine du germe de blé dérivée de la lectine (WGA) et la cellule tumorale ainsi que celle des cellules en utilisant l'acide sialique comme marqueur. On a décelé un envahissement des vaisseaux sanguins chez 95 (59.4%) des 160 cas étudiés. On a identifié des métastases à distance dans 25 (15.6%) cas où on avait également trouvé un envahissement des vaisseaux sanguins. Comparé au groupe des patients sans métastases à distance celui des patients avec métastases à distance présentait non seulement un contenu d'acide sialique plus important mais aussi plus de protéine de liaison WGA dans les tissus. Le risque de métastases à distance chez les patients ayant un adénocarcinome folliculaire de la thyroïde semble être en rapport étroit à la fois avec l'étendue et la fréquence de l'envahissement des vaisseaux sanguins. De plus, l'évaluation de la conjugaison des cellules semble présenter une valeur prédictive en ce qui concerne la survenue des métastases à distance.
    Abstract: Resumen El adenocarcinoma de la glándula tiroides es capaz de producir metástasis distantes a pesar de su bajo grado histológico de malignidad. Nos propusimos estudiar si se podría predecir la ocurrencia de metástasis demonstrando la invasión de vasos sanguíneos; también procedimos a estudiar el problema desde el punto de vista de la conjugación de célula a célula. En el presente estudio se examinaron 160 casos de adenocarcinoma folicular de la glándula tiroides operados entre 1976 y 1987. Las secciones histológicas fueron realizadas cortando el tumor al nivel de su diámetro máximo; el endotelio vascular fue específicamente coloreado por tinción inmunohistoquímica para estudiar en detalle la invasión vascular. Además, se estudió la conjugación de la aglutinina derivada del germen de trigo con las células tumorales; también se estudió la conjugación celular utilizando ácido siálico como marcador. Se identificó invasión vascular en 95 (59.4%) de los 160 casos. Se identificaron metástasis en 25 casos (15.6%) en los cuales también se hallo invasión vascular. En comparación con el grupo libre de metástăsis, el grupo con metástasis distantes exhibió no sólo un contenido de ácido siálico significativamente mayor, sino también un mayor nivel de proteína ligadora de la aglutinina del germen de trigo en los tejidos. El riesgo de metástasis en pacientes con adenocarcinoma folicular de la glándula tiroides parece estar correlacionado tanto con el grado como con la frecuencia de invasión vascular. Además, la determinación de la conjugación celular parece tener un valor predictivo en cuanto la ocurrencia de metástasis.
    Notes: Abstract Follicular adenocarcinoma of the thyroid sometimes displays distant metastasis in spite of its low histological grade of malignancy. We have studied whether distant metastasis can be detected by the presence of blood vessel invasion. We have also examined the problem from the viewpoint of cell-to-cell conjugation. This study examined 160 cases of follicular adenocarcinoma of the thyroid. Histological specimens were made by sectioning tumors at their largest diameter. Blood vessel endothelia were specifically stained immunohistochemically with factor VIII-related antigen and Ulex europeaus agglutinin I (UEA-1). Then, the presence of blood vessel invasion was examined in detail. Furthermore, the conjugation of lectin-derived wheat germ agglutinin (WGA) to tumor cells was examined. Conjugation of tumor cells was also examined using sialic acid as a marker. Blood vessel invasion was recognized in 95 (59.4%) of 160 cases. Distant metastases were identified in 25 cases (15.6%) in which blood vessel invasion was also found. Relative to the group without distant metastases, the group with distant metastases showed not only a significantly higher sialic acid content but also higher levels of WGA-binding protein in the tissues. The risk of distant metastasis in patients with follicular adenocarcinoma of the thyroid appears to be related both to the extent and to the frequency of blood vessel invasion. Furthermore, assessment of the conjugation of cells appears to have predictive value for occurrence of distant metastases.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01658546
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  • 6
    Electronic Resource
    Electronic Resource
    Treatment of cystic lesions of the thyroid by ethanol instillation (1992)
    Springer
    World journal of surgery 16 (1992), S. 958-961 
    Details
    ISSN: 1432-2323
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Résumé Nous avons analysé les résusltats de la sclérothérapie à l'éthanol de 61 lésions kystiques de la thyroïde récidivantes après ponction. Il s' agissait toujours de lésions bénignes en cytologie. Tous les patients ont été revus cliniquement et échographiquement, un et six mois ou plus après leur traitement. Si la lésion kystique avait récidivé, une nouvelle ponction était proposée. Pendant le suivi, 36 patients (59.0%) n'ont pas récidivé après leur traitement initial, alors que cinq (8.2%) ont eu besoin d'au moins deux ponctions. Chez 44 (72.1%) des 61 patients, la lésion kystique avait disparu ou diminué de taille, mais dans 17 cas (27.9%), la lésion n'avait pas changé. Quatre patients ont eu besoin de chirurgie malgré la sclérothérapie. Il n'y a eu aucune complication sévère, mais 12 patients se sont plaints d'une douleur légère, un, d'une douleur sévère et un, d'ébréité. Nous estimons que l'injection d'éthanol dans les lésions kystiques de la thyroïde est un traitement simple, sûr, économique et efficace.
    Abstract: Resumen Hemos analizado los resultados de la escleroterapia con etanol subsiguiente a la aspiración en 61 lesiones quísticas recurrente de la glándula tiroides. El estudio citológico indicó que todas eran benignas. Los pacientes fueron cuidadosamente seguidos mediante examen clínico y ultrasonografía al mes y a los 6 o más meses después de efectuado el tratamiento. El tratamiento fue repetido cuando so presentó recurrencia del quiste. En el curso del seguimiento se registraron 36 pacientes (59.0%) sin evidencia de recurrencia y 5 pacientes (8.2%) que requirieron tratamiento de repetición en dos o más ocasiones. En 44 del total de 61 pacientes (72.1%) se observó desaparición o reducción en el tamaño de la lesión quística, pero en 17 casos (27.9%) ésta no disminuyó de tamaño. Cuatro pacientes fueron sometidos a cirugía después de la escleroterapia con etanol; aunque no se presentaron complicaciones, sí hubo quejas de sensación de embriaguez en un caso. Nuestro grupo considera que la instilación de etanol en las lesiones quíticas recurrentes de la tiroides es una modalidad terapéutica simple, segura, económica y eficaz.
    Notes: Abstract We analyzed the results of ethanol sclerotherapy in 61 patients with cystic thyroid lesions which recurred after aspiration. Cytologic study showed all of the lesions to be benign. The patients were followed clinically and ultrasonically 1 month and 6 or more months after treatment. If the cystic lesions recurred, repeated treatment was offered. During the follow-up, 36 (59.0%) patients experienced no recurrence after the initial treatment and 5 (8.2%) patients received treatments 2 or more additional times. In 44 (72.1%) of the 61 patients, the cystic lesion almost disappeared or decreased in size, but in 17 (27.9%) patients it did not decrease. Four patients underwent surgery after the ethanol sclerotherapy. Although no severe complications were observed, there were complaints of slight pain in 12 patients, severe pain in 1 patient, and a drunken feeling in 1 patient. We consider instillation of ethanol into recurrent cystic lesions of the thyroid to be a simple, safe, economical, and effective treatment.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02067001
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  • 7
    Electronic Resource
    Electronic Resource
    Primary leiomyosarcoma of the thyroid gland (1997)
    Springer
    Surgery today 27 (1997), S. 177-180 
    Details
    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.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02385912
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  • 8
    Electronic Resource
    Electronic Resource
    Solid cell nests of the thyroid gland (1991)
    Springer
    Virchows Archiv 418 (1991), S. 201-205 
    Details
    ISSN: 1432-2307
    Keywords: Solid cell nests ; Thyroid gland
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The histogenesis and clinical significance of solid cell nests (SCN) of the thyroid are not fully understood. From August 1987 to December 1989 a total of 2544 patients with thyroid and parathyroid diseases underwent surgery at Ito Hospital, and SCN were revealed within the thyroid parenchyma in 21 (0.8%). Distribution of SCN was not limited to the upper one-third of the lateral lobe, and SCN were found even in the isthmus lobe. In 5 cases microcysts were also noted within SCN, and their content was thought to be acidic proteoglycan. Immunohistochemical study revealed that SCN were negative for thyroglobulin and calcitonin but positive for carcinoembryonic antigen. Thirteen of 21 cases showed positive immunostaining with cytokeratin. Scattered calcitonin-positive cells were noted around the SCN. It is suggested from these findings that SCN of the thyroid are closely related to certain cells of ultimobranchial body vestiges which may be not of neuroectodermal origin but of endodermal origin.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01606057
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  • 9
    Electronic Resource
    Electronic Resource
    Thyroid carcinoma after radioactive iodine therapy for Graves' disease (1994)
    Springer
    World journal of surgery 18 (1994), S. 518-521 
    Details
    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.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00353753
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  • 10
    Electronic Resource
    Electronic Resource
    Preoperative Change of Thyroid Stimulating Hormone Receptor Antibody Level: Possible Marker for Predicting Recurrent Hyperthyroidism in Patients with Graves’ Disease after Subtotal Thyroidectomy (1996)
    Springer
    World journal of surgery 20 (1996), S. 801-807 
    Details
    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.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002689900122
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