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Moroto D, Torquato-Vieira ICO, Fiorin LB, Camacho CP, Castiglioni MLV, Maciel RMB, Furlanetto RP, Matsumura LK, Janovsky CCPS, Lindsey SC, Martins JRM. Long-Term Follow-up of Patients With Autonomous Thyroid Nodules Treated With Radioiodine. Clin Nucl Med 2024; 49:529-535. [PMID: 38619976 DOI: 10.1097/rlu.0000000000005189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/17/2024]
Abstract
PURPOSE This article aims to describe the presentation of Plummer disease and its evolution after radioiodine treatment and determine factors that may influence treatment efficacy. PATIENTS AND METHODS The sample included retrospective medical records of 165 adult patients with toxic nodular goiter treated with radioiodine between 1997 and 2017, followed up at a single thyroid center. RESULTS The efficacy of treatment with a single dose of radioiodine was higher than 90%. The mean radioiodine activity was 28.9 ± 3.4 mCi. The mean time between radioiodine performance and hyperthyroidism resolution was 3.6 ± 3.0 months, ranging from 1-12 months. After the first year, 33.9% of the patients were under hypothyroidism, 59.4% under euthyroidism, and 6.7% under hyperthyroidism. Among the nonresponders, the variables that showed statistical difference were the presence of multinodular goiter and the radioiodine activity (mean, 25.5 ± 6.5 mCi; median, 30 [15-30 mCi]). The cumulative rate of hypothyroidism was 48.9% over 20 years of follow-up. CONCLUSIONS Radioiodine therapy is an effective and safe treatment. In Plummer disease, high rates of euthyroidism are expected after the radioiodine treatment. Therapeutic failure was observed mainly in patients with larger multinodular goiters treated with lower doses of radioiodine. The evolution to hypothyroidism was mostly observed in younger patients with larger and uninodular goiters.
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Affiliation(s)
- Débora Moroto
- From the Thyroid Diseases Center and Laboratory of Molecular and Translational Endocrinology, Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo
| | - Isabel C O Torquato-Vieira
- From the Thyroid Diseases Center and Laboratory of Molecular and Translational Endocrinology, Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo
| | - Lia B Fiorin
- From the Thyroid Diseases Center and Laboratory of Molecular and Translational Endocrinology, Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo
| | | | - Mário Luiz V Castiglioni
- Division of Nuclear Medicine, Department of Diagnostic Imaging, Escola Paulista de Medicina, Universidade Federal de São Paulo
| | - Rui M B Maciel
- From the Thyroid Diseases Center and Laboratory of Molecular and Translational Endocrinology, Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo
| | - Reinaldo P Furlanetto
- From the Thyroid Diseases Center and Laboratory of Molecular and Translational Endocrinology, Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo
| | - Luiza K Matsumura
- From the Thyroid Diseases Center and Laboratory of Molecular and Translational Endocrinology, Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo
| | | | - Susan C Lindsey
- From the Thyroid Diseases Center and Laboratory of Molecular and Translational Endocrinology, Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo
| | - João Roberto M Martins
- From the Thyroid Diseases Center and Laboratory of Molecular and Translational Endocrinology, Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo
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Campennì A, Avram AM, Verburg FA, Iakovou I, Hänscheid H, de Keizer B, Petranović Ovčariček P, Giovanella L. The EANM guideline on radioiodine therapy of benign thyroid disease. Eur J Nucl Med Mol Imaging 2023; 50:3324-3348. [PMID: 37395802 PMCID: PMC10542302 DOI: 10.1007/s00259-023-06274-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 05/18/2023] [Indexed: 07/04/2023]
Abstract
This document provides the new EANM guideline on radioiodine therapy of benign thyroid disease. Its aim is to guide nuclear medicine physicians, endocrinologists, and practitioners in the selection of patients for radioiodine therapy. Its recommendations on patients' preparation, empiric and dosimetric therapeutic approaches, applied radioiodine activity, radiation protection requirements, and patients follow-up after administration of radioiodine therapy are extensively discussed.
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Affiliation(s)
- Alfredo Campennì
- Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, Unit of Nuclear Medicine, University of Messina, Messina, Italy
| | - Anca M Avram
- Departments of Radiology and Medicine, MetroHealth Hospital, Case Western Reserve University, Cleveland, OH, USA
| | - Frederik A Verburg
- Department of Radiology & Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands.
| | - Ioannis Iakovou
- Academic Department of Nuclear Medicine, University Hospital AHEPA, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
- Academic Department of Nuclear Medicine, General Hospital Papageorgiou, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Heribert Hänscheid
- Department of Nuclear Medicine, University Hospital Würzburg, Würzburg, Germany
| | - Bart de Keizer
- Department of Radiology and Nuclear Medicine, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Petra Petranović Ovčariček
- Department of Oncology and Nuclear Medicine, University Hospital Center Sestre Milosrdnice, Zagreb, Croatia
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Luca Giovanella
- Clinic for Nuclear Medicine, Ente Ospedaliero Cantonale, Imaging Institute of Southern Switzerland, Bellinzona, Switzerland
- Clinic for Nuclear Medicine, University Hospital and University of Zurich, Zurich, Switzerland
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Wang Y, Sun Y, Yang B, Wang Q, Kuang H. The management and metabolic characterization: hyperthyroidism and hypothyroidism. Neuropeptides 2023; 97:102308. [PMID: 36455479 DOI: 10.1016/j.npep.2022.102308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 10/21/2022] [Accepted: 11/08/2022] [Indexed: 11/13/2022]
Abstract
Hyperthyroidism and hypothyroidism are common diseases resulting from thyroid dysfunction, and are simple to diagnose and treat. The traditional treatment for hypothyroidism is thyroid hormone replacement therapy. The traditional treatments for hyperthyroidism include antithyroid drug, iodine radiotherapy, and surgery. Thyroid disease can be fatal in severe cases if untreated. Current statistical reference ranges used for diagnosis based on relevant biochemical parameters have been debated, and insufficient treatment can result in long-term thyroid hormone deficiency, which is associated with increased risk of cardiovascular disease and persistent symptoms. In contrast, overtreatment can result in heart disease and osteoporosis, particularly in older people and pregnant women. Therefore, under- or over-treatment should be avoided and treatment regimens should be monitored closely. A significant proportion of patients who achieve biochemical treatment goals still complain of significant symptoms. Systematic literature review was performed through the Embase (Elsevier), PubMed and Web of Science databases, and studies summarized evidence regarding treatment and management of hypothyroidism and hyperthyroidism, and reviewed clinical practice guidelines. We also reviewed the latest research on the metabolic mechanisms of hyperthyroidism and hypothyroidism, which contributed to understanding of thyroid diseases in the clinic. A reliable algorithm is needed to management, assessment, and treatment patients with hyperthyroidism and hypothyroidism, which can not only improve management efficiency, but also providing a broad application. In addition, the thyroid disorder showed a lipid metabolism tissue specificity in the Ventromedial Hypothalamus, and effect oxidative stress and energy metabolism of whole body. This review summarizes an algorithm for thyroid disease and the latest pathogenesis that would be useful to generalist and subspecialty physicians and others providing care for patients with this condition.
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Affiliation(s)
- Yangyang Wang
- Key Laboratory of Basic and Application Research of Beiyao (Heilongjiang University of Chinese Medicine), Ministry of Education, Harbin, China
| | - YanPing Sun
- Key Laboratory of Basic and Application Research of Beiyao (Heilongjiang University of Chinese Medicine), Ministry of Education, Harbin, China
| | - Bingyou Yang
- Key Laboratory of Basic and Application Research of Beiyao (Heilongjiang University of Chinese Medicine), Ministry of Education, Harbin, China
| | - Qiuhong Wang
- School of Traditional Chinese Medicine, Guangdong Pharmaceutical University, Guangzhou, China.
| | - Haixue Kuang
- Key Laboratory of Basic and Application Research of Beiyao (Heilongjiang University of Chinese Medicine), Ministry of Education, Harbin, China.
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Sjölin G, Watt T, Byström K, Calissendorff J, Cramon PK, Nyström HF, Hallengren B, Holmberg M, Khamisi S, Lantz M, Planck T, Törring O, Wallin G. Long term outcome after toxic nodular goitre. Thyroid Res 2022; 15:20. [PMID: 36316779 PMCID: PMC9624053 DOI: 10.1186/s13044-022-00138-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 09/21/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The purpose of treating toxic nodular goitre (TNG) is to reverse hyperthyroidism, prevent recurrent disease, relieve symptoms and preserve thyroid function. Treatment efficacies and long-term outcomes of antithyroid drugs (ATD), radioactive iodine (RAI) or surgery vary in the literature. Symptoms often persist for a long time following euthyroidism, and previous studies have demonstrated long-term cognitive and quality of life (QoL) impairments. We report the outcome of treatment, rate of cure (euthyroidism and hypothyroidism), and QoL in an unselected TNG cohort. METHODS TNG patients (n = 638) de novo diagnosed between 2003-2005 were invited to engage in a 6-10-year follow-up study. 237 patients responded to questionnaires about therapies, demographics, comorbidities, and quality of life (ThyPRO). Patients received ATD, RAI, or surgery according clinical guidelines. RESULTS The fraction of patients cured with one RAI treatment was 89%, and 93% in patients treated with surgery. The rate of levothyroxine supplementation for RAI and surgery, at the end of the study period, was 58% respectively 64%. Approximately 5% of the patients needed three or more RAI treatments to be cured. The patients had worse thyroid-related QoL scores, in a broad spectrum, than the general population. CONCLUSION One advantage of treating TNG with RAI over surgery might be lost due to the seemingly similar incidence of hypothyroidism. The need for up to five treatments is rarely described and indicates that the treatment of TNG can be more complex than expected. This circumstance and the long-term QoL impairments are reminders of the chronic nature of hyperthyroidism from TNG.
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Affiliation(s)
- Gabriel Sjölin
- grid.412367.50000 0001 0123 6208Faculty of Medicine and Health, Örebro University Hospital, Örebro, Sweden ,grid.15895.300000 0001 0738 8966Dept. of Surgery, Örebro University and University Hospital, 701 85 Örebro, Sweden
| | - Torquil Watt
- grid.475435.4Department of Medical Endocrinology Rigshospitalet, Copenhagen, Denmark ,grid.4973.90000 0004 0646 7373Internal Medicine Herlev Gentofte Hospital, Copenhagen University Hospital, Copenhagen, Denmark
| | - Kristina Byström
- grid.15895.300000 0001 0738 8966Dept. of Medicine, Örebro University and University Hospital, Örebro, Sweden
| | - Jan Calissendorff
- grid.4714.60000 0004 1937 0626Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden ,grid.24381.3c0000 0000 9241 5705Dept. of Endocrinology, Metabolism and Diabetes, Karolinska University Hospital, Stockholm, Sweden
| | - Per Karkov Cramon
- grid.475435.4Department of Medical Endocrinology Rigshospitalet, Copenhagen, Denmark ,grid.4973.90000 0004 0646 7373Internal Medicine Herlev Gentofte Hospital, Copenhagen University Hospital, Copenhagen, Denmark
| | - Helena Filipsson Nyström
- grid.8761.80000 0000 9919 9582Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden ,grid.1649.a000000009445082XDept. of Endocrinology, Sahlgrenska University Hospital, Göteborg, Sweden ,Wallenberg Center for Molecular and Translational Medicine, Göteborg, Sweden
| | - Bengt Hallengren
- grid.411843.b0000 0004 0623 9987Dept. of Endocrinology, Skåne University Hospital, Malmö, Sweden ,grid.4514.40000 0001 0930 2361Dept. of Clinical Sciences, Lund University, Lund, Sweden
| | - Mats Holmberg
- grid.8761.80000 0000 9919 9582Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden ,grid.24381.3c0000 0000 9241 5705ANOVA, Karolinska University Hospital, Stockholm, Sweden
| | - Selwan Khamisi
- grid.412354.50000 0001 2351 3333Dept. of Endocrinology, Uppsala University Hospital, Uppsala, Sweden ,grid.8993.b0000 0004 1936 9457Dept. of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Mikael Lantz
- grid.411843.b0000 0004 0623 9987Dept. of Endocrinology, Skåne University Hospital, Malmö, Sweden ,grid.4514.40000 0001 0930 2361Dept. of Clinical Sciences, Lund University, Lund, Sweden
| | - Tereza Planck
- grid.411843.b0000 0004 0623 9987Dept. of Endocrinology, Skåne University Hospital, Malmö, Sweden ,grid.4514.40000 0001 0930 2361Dept. of Clinical Sciences, Lund University, Lund, Sweden
| | - Ove Törring
- grid.4714.60000 0004 1937 0626Institution for Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden
| | - Göran Wallin
- grid.412367.50000 0001 0123 6208Faculty of Medicine and Health, Örebro University Hospital, Örebro, Sweden ,grid.15895.300000 0001 0738 8966Dept. of Surgery, Örebro University and University Hospital, 701 85 Örebro, Sweden
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Mohamed TZ, Sultan AAEA, Tag El-din M, Mostafa AAE, Nafea MA, Kalmoush A, Nassar MS, Abdalgaleel MA, Hegab AM, Ibrahim AH, Baheeg M, Yip CH. Incidence and Risk Factors of Thyroid Malignancy in Patients with Toxic Nodular Goiter. Int J Surg Oncol 2022; 2022:1-5. [PMID: 35656410 PMCID: PMC9152398 DOI: 10.1155/2022/1054297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 05/12/2022] [Indexed: 11/17/2022] Open
Abstract
Background. Although hyperfunctioning thyroid disorders were thought to be protective against malignancy, some recent studies reported a high incidence of incidentally discovered cancer in patients with hyperfunctioning benign thyroid disorders. We performed this study to estimate the incidence and predictors of malignant thyroid disease in patients with toxic nodular goiter (TNG). Patients and Methods. The data of 98 patients diagnosed with TNG were reviewed (including toxic multinodular goiter SMNG and single toxic nodule STN). The collected data included patients age, gender, systemic comorbidities, family history of thyroid malignancy, previous neck radiation, type of disease (multinodular or single), size of the dominant nodule by the US, operative time, and detection of significant lymph nodes during operation. Based on the histopathological analysis, the cases were allocated into benign and malignant groups. Results. Malignancy was detected in 21 patients (21.43%). Although age distribution was comparable between the two groups, males showed a significant increase in association with malignancy. Medical comorbidities and family history of cancer did not differ between the two groups. However, TMNG showed a statistically higher prevalence in the malignant group. Operative data, including operative time and lymph node detection, were comparable between the two groups. On regression analysis, both male gender and TMNG were significant predictors of malignancy. Conclusion. The presence of thyroid hyperfunction is not a protective factor against malignancy, as malignancy was detected in about 1/5 of cases. Male gender and TMNG were significant risk factors of malignancy in such patients.
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Goonoo MS, Arshad MF, Tahir F, Balasubramanian SP. Toxic adenoma: to biopsy or not to biopsy? Ann R Coll Surg Engl 2021; 103:e319-e323. [PMID: 34435917 DOI: 10.1308/rcsann.2021.0008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Toxic adenoma nodules rarely harbour cancer. Fine-needle aspiration (FNA) is often not done because of the rarity of these lesions being cancer, the difficulty in interpreting cytology in hyperthyroid patients and the rare precipitation of thyrotoxicosis. We present two young, Caucasian female patients aged 29 and 13 years who were each diagnosed with a toxic nodule categorised as benign and indeterminate respectively. They underwent hemithyroidectomy after being rendered euthyroid, however their histology unexpectedly revealed differentiated follicular cancer. Despite thyroid cancer being rare in patients with toxic adenomas, it should be considered when planning treatment, especially if there are risk factors for cancer, or suspicious features on ultrasound examination. A review of the literature shows that compared with adenomas in euthyroid patients, patients in this group are generally younger and predominately female. If an FNA is considered, it should be performed after the patient is rendered euthyroid.
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Affiliation(s)
- M S Goonoo
- Sheffield Teaching Hospitals NHS Foundation Trust, UK
| | - M F Arshad
- Sheffield Teaching Hospitals NHS Foundation Trust, UK
| | - F Tahir
- Sheffield Teaching Hospitals NHS Foundation Trust, UK
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7
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Buehler L, Movahed A, Zhou K, Lansang MC. Serum thyroid stimulating hormone level for predicting utility of thyroid uptake and scan. Endocr Res 2021; 46:10-13. [PMID: 32875953 DOI: 10.1080/07435800.2020.1810064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Thyroid uptake and scan (TUS) is a clinical tool used for differentiation of thyrotoxicosis etiologies. Although guidelines recommend ordering a TUS for evaluation of low TSH levels, no specific value is defined. This study aimed to determine a TSH cutoff at which TUSs yield a greater likelihood of successful determination of etiology to avoid unnecessary testing. METHODS This was a retrospective study on 137 patients seen by an endocrinologist who underwent TUS for evaluation of low TSH (<0.4 μU/mL). A receiver operating curve analysis was performed to determine the TSH cutoff with maximal sensitivity and specificity for prediction of diagnostic utility. RESULTS Ninety percent of TUSs (n = 123) led to a diagnosis, while 10% (n = 14) were inconclusive or normal. Diagnoses included Graves' diseases (52%), toxic multinodular goiter (19%), thyroiditis (12%), and solitary toxic adenoma (7%). The median TSH value was 0.008 μU/mL (IQR 0.005, 0.011), and the median free T4 value was 1.7 μU/mL (IQR 1.3, 2.8). The ROC analysis produced an area under the curve of 0.86. The optimal TSH cutoff value was 0.02 μU/mL (sensitivity 80%, specificity 93%) for prediction of diagnostic yield. CONCLUSION This study demonstrates that TSH is a useful predictor of the utility of TUS in yielding an etiology of thyrotoxicosis. Our analysis showed that TUS had a greater likelihood of determining an etiology when TSH was ≤0.02 μU/mL. This information can help clinicians avoid unnecessary cost and patient time burden when TUS is unlikely to aid in determining the etiology of thyrotoxicosis.
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Affiliation(s)
- Lauren Buehler
- Department of Endocrinology & Metabolism, Cleveland Clinic Foundation , Cleveland, OH, USA
| | - Alireza Movahed
- Department of Internal Medicine, Cleveland Clinic Foundation , Cleveland, OH, USA
| | - Keren Zhou
- Department of Endocrinology & Metabolism, Cleveland Clinic Foundation , Cleveland, OH, USA
| | - M Cecilia Lansang
- Department of Endocrinology & Metabolism, Cleveland Clinic Foundation , Cleveland, OH, USA
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8
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Apostolou K, Zivaljevic V, Tausanovic K, Zoric G, Chelidonis G, Slijepcevic N, Jovanovic M, Paunovic I. Prevalence and risk factors for thyroid cancer in patients with multinodular goitre. BJS Open 2020; 5:6054049. [PMID: 33688954 PMCID: PMC7944849 DOI: 10.1093/bjsopen/zraa014] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 08/25/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Rates of thyroid cancer in patients with multinodular goitre (MNG) vary widely, from 3 per cent in older studies to 35 per cent in more recent studies. The purpose of the present study was to evaluate the prevalence of thyroid cancer in patients operated on for MNG, and to determine risk factors for incidental thyroid malignancy. METHODS A prospectively developed database of all patients who underwent thyroidectomy for a benign MNG at the high-volume endocrine surgery unit of a tertiary referral university hospital was interrogated. RESULTS A total of 3233 patients were analysed, separated into three groups according to their functional thyroid status (hypothyroid, hyperthyroid or euthyroid). There were 2788 women (86.2 per cent); the mean patient age was 56.4 years and mean preoperative disease duration was 106.2 months. Incidental thyroid cancer was identified in 1026 patients (31.7 per cent), of which 917 (89.4 per cent) were papillary cancers. Multivariable regression analysis identified functional thyroid status, younger age, male sex, smaller adenoma size, smaller thyroid glands, Hashimoto's thyroiditis and chronic non-specific thyroiditis as independent risk factors for thyroid cancer. CONCLUSION MNG was associated with a considerable rate of incidental thyroid cancer, which has been underestimated. A variety of factors should be taken into account when considering the malignant potential of a presumed benign MNG.
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Affiliation(s)
- K Apostolou
- Centre for Endocrine Surgery, Clinical Centre of Serbia, Belgrade, Serbia
| | - V Zivaljevic
- Centre for Endocrine Surgery, Clinical Centre of Serbia, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - K Tausanovic
- Centre for Endocrine Surgery, Clinical Centre of Serbia, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - G Zoric
- Centre for Endocrine Surgery, Clinical Centre of Serbia, Belgrade, Serbia
| | | | - N Slijepcevic
- Centre for Endocrine Surgery, Clinical Centre of Serbia, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - M Jovanovic
- Centre for Endocrine Surgery, Clinical Centre of Serbia, Belgrade, Serbia
| | - I Paunovic
- Centre for Endocrine Surgery, Clinical Centre of Serbia, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
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Frank ED, Park JS, Watson W, Chong E, Yang S, Simental AA. Total thyroidectomy: Safe and curative treatment option for hyperthyroidism. Head Neck 2020; 42:2123-2128. [PMID: 32199035 DOI: 10.1002/hed.26148] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Revised: 02/24/2020] [Accepted: 03/10/2020] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND While use of total thyroidectomy has increased in management of hyperthyroidism, concerns exist about increased surgical complication rates; most notably, hematoma, recurrent laryngeal nerve (RLN) injury, and hypocalcemia. METHODS Retrospective cohort study of 454 patients undergoing total thyroidectomy between 2003 and 2015. All patients had surgery for hyperthyroidism, benign euthyroid disease, or thyroid malignancy. RESULTS Total thyroidectomy for hyperthyroidism was not associated with an increased risk for any postoperative complication. Transient hypocalcemia, temporary dysphonia, and postoperative hematoma rates were not significantly different for patients with hyperthyroid (n = 91), euthyroid benign (n = 237), and malignant (n = 126) disease. Permanent hypocalcemia and recurrent laryngeal nerve injury were not noted in any hyperthyroid patients. Complication rates were similar for hyperthyroid patients with Graves' disease vs toxic multinodular goiter. CONCLUSION This study affirms safety and efficacy of total thyroidectomy as standard treatment for hyperthyroidism.
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Affiliation(s)
- Ethan D Frank
- Department of Otolaryngology, Loma Linda University Medical Center, Loma Linda, California, USA
| | - Joshua S Park
- Department of Otolaryngology, Loma Linda University Medical Center, Loma Linda, California, USA
| | - WayAnne Watson
- Loma Linda University School of Medicine, Loma Linda, California, USA
| | - Esther Chong
- Loma Linda University School of Medicine, Loma Linda, California, USA
| | - Sara Yang
- Department of Otolaryngology, Head and Neck Surgery, Loyola University Medical Center, Maywood, Illinois, USA
| | - Alfred A Simental
- Department of Otolaryngology, Loma Linda University Medical Center, Loma Linda, California, USA
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10
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Bilginer MC, Ozdemir D, Seyrek FNC, Yildirim N, Yazgan AK, Kilic M, Ersoy R, Cakir B. Evaluation of ultrasonographical and cytological features of thyroid nodules in patients treated with radioactive iodine for hyperthyroidism. Diagn Cytopathol 2019; 48:3-9. [PMID: 31674156 DOI: 10.1002/dc.24319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 09/03/2019] [Accepted: 09/06/2019] [Indexed: 11/12/2022]
Abstract
BACKGROUND In this study, we aimed to evaluate ultrasonographical and cytological features of thyroid nodules in patients who were treated with radioactive iodine (RAI) for hyperthyroidism years ago. METHODS Patients who had a history of RAI treatment for hyperthyroidism and had thyroid nodules that were evaluated with fine-needle aspiration biopsy (FNAB) were included in the study. RESULTS There were 27 patients (22 female and 5 male) with a mean age of 59.3 ± 13.5. The indication for RAI treatment was Graves in 5 (18.6%), toxic nodular or multinodular goiter in 16 (69.2%), and unknown in 6 (22.2%) patients. A total of 48 thyroid nodules were evaluated with FNAB and cytological diagnosis were benign in 24 (50.0%), nondiagnostic in 15 (31.2%), atypia of undetermined significance in 5 (10.4%), suspicous for malignancy in 2 (4.2%), and malignant in 2 (4.2%) nodules. Thyroidectomy was performed in 10 patients, 5 were benign (50.0%), and 5 (50.0%) were malignant histopathologically. Ultrasonography features of 31 cytologically/histopathologically benign and five cytologically/histopathologically malignant nodules were compared. Prevalence of isoechoic nodules was higher in benign nodules (P = .025). Macrocalcification was observed in 4 (80.0%) of malignant and 10 (32.3%) of benign nodules (P = .042). CONCLUSION In patients with a history of RAI treatment for hyperthyroidism, thyroid nodules with suspicious ultrasonography features, particulary hypoechoic appearence and macrocalcification, should be evaluated with FNAB irrespective of the time elapsed after RAI treatment.
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Affiliation(s)
- Muhammet C Bilginer
- Department of Endocrinology and Metabolism, SBU Kanuni Training and Research Hospital, Trabzon, Turkey
| | - Didem Ozdemir
- Department of Endocrinology and Metabolism, Ankara Yildirim Beyazit University Faculty of Medicine, Ankara, Turkey
| | - Fatma N C Seyrek
- Department of Endocrinology and Metabolism, Ankara Yildirim Beyazit University Faculty of Medicine, Ankara, Turkey
| | - Nilufer Yildirim
- Department of Nuclear Medicine, Ankara Yildirim Beyazit University Faculty of Medicine, Ankara, Turkey
| | - Aylin K Yazgan
- Department of Pathology Ankara, Ankara City Hospital, Ankara, Turkey
| | - Mehmet Kilic
- Department of General Surgery, Ankara Yildirim Beyazit University Faculty of Medicine, Ankara, Turkey
| | - Reyhan Ersoy
- Department of Endocrinology and Metabolism, Ankara Yildirim Beyazit University Faculty of Medicine, Ankara, Turkey
| | - Bekir Cakir
- Department of Endocrinology and Metabolism, Ankara Yildirim Beyazit University Faculty of Medicine, Ankara, Turkey
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Tam AA, Ozdemir D, Alkan A, Yazicioglu O, Yildirim N, Kilicyazgan A, Ersoy R, Cakir B. Toxic nodular goiter and thyroid cancer: Is hyperthyroidism protective against thyroid cancer? Surgery 2019; 166:356-361. [DOI: 10.1016/j.surg.2019.03.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 02/21/2019] [Accepted: 03/06/2019] [Indexed: 11/28/2022]
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Abstract
Thyrotoxicosis with concomitant thyroid cancer is rare and poorly recognized, which may result in delayed diagnosis, inappropriate treatment and even poor prognosis. To provide a comprehensive guidance for clinicians, the etiology, pathogenesis, diagnosis and treatment of this challenging setting were systematically reviewed. According to literatures available, the etiologies of thyrotoxicosis with concomitant thyroid cancer were categorized into Graves' disease with concurrent differentiated thyroid cancer (DTC) or medullary thyroid cancer, Marine-Lenhart Syndrome with coexisting DTC, Plummer's disease with concomitant DTC, amiodarone-induced thyrotoxicosis with concomitant DTC, central hyperthyroidism with coexisting DTC, hyperfunctioning metastases of DTC and others. The underlying causal mechanisms linking thyrotoxicosis and thyroid cancer were elucidated. Medical history, biochemical assessments, radioiodine uptake, anatomic and metabolic imaging and ultrasonography-guided fine-needle aspiration combined with pathological examinations were found to be critical for precise diagnosis. Surgery remains a mainstay in both tumor elimination and control of thyrotoxicosis, while anti-thyroid drugs, beta-blockers, 131I, glucocorticoids, plasmapheresis, somatostatin analogs, dopamine agonists, radiation therapy, chemotherapy and tyrosine kinase inhibitors should also be appropriately utilized as needed.
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Affiliation(s)
- Hao Fu
- Department of Nuclear Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, People's Republic of China
| | - Lin Cheng
- Department of Nuclear Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, People's Republic of China
| | - Yuchen Jin
- Department of Nuclear Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, People's Republic of China
| | - Libo Chen
- Department of Nuclear Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, People's Republic of China
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13
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Baser H, Topaloglu O, Bilginer MC, Ulusoy S, Kılıcarslan A, Ozdemir E, Ersoy R, Cakir B. Are cytologic and histopathologic features of hot thyroid nodules different from cold thyroid nodules? Diagn Cytopathol 2019; 47:898-903. [DOI: 10.1002/dc.24251] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 05/05/2019] [Accepted: 05/28/2019] [Indexed: 11/05/2022]
Affiliation(s)
- Husniye Baser
- Department of Endocrinology and Metabolism; Yildirim Beyazit University Faculty of Medicine; Ankara Turkey
| | - Oya Topaloglu
- Department of Endocrinology and Metabolism; Yildirim Beyazit University Faculty of Medicine; Ankara Turkey
| | - Muhammet C. Bilginer
- Department of Endocrinology and Metabolism; Yildirim Beyazit University Faculty of Medicine; Ankara Turkey
| | - Serap Ulusoy
- Department of General Surgery; Yildirim Beyazit University Faculty of Medicine; Ankara Turkey
| | - Aydan Kılıcarslan
- Department of Pathology; Yildirim Beyazit University Faculty of Medicine; Ankara Turkey
| | - Elif Ozdemir
- Department of Nuclear Medicine; Yildirim Beyazit University Faculty of Medicine; Ankara Turkey
| | - Reyhan Ersoy
- Department of Endocrinology and Metabolism; Yildirim Beyazit University Faculty of Medicine; Ankara Turkey
| | - Bekir Cakir
- Department of Endocrinology and Metabolism; Yildirim Beyazit University Faculty of Medicine; Ankara Turkey
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14
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Abstract
Thyrotoxicosis is the clinical manifestation of excess thyroid hormone action at the tissue level due to inappropriately high circulating thyroid hormone concentrations. Hyperthyroidism, a subset of thyrotoxicosis, refers specifically to excess thyroid hormone synthesis and secretion by the thyroid gland. We performed a review of the literature on these topics utilizing published data in PubMed and MEDLINE. In this review, we discuss the more common etiologies of thyrotoxicosis, focusing on the current approach to diagnosis and management, new trends in those directions, and potential upcoming changes in the field.
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Affiliation(s)
- Anu Sharma
- Division of Endocrinology, Metabolism and Diabetes, University of Utah School of Medicine, Salt Lake City, UT
| | - Marius N Stan
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN.
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Özdemir D, Beştepe N, Dellal FD, Gümüşkaya Öcal B, Kılıç İ, Ersoy R, Çakır B. Thyroid Cancer Incidence in Patients with Toxic Nodular and Multinodular Goiter. Ankara Medical Journal 2018. [DOI: 10.17098/amj.497505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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16
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Lee R, So Y, Song YS, Lee WW. Evaluation of Hot Nodules of Thyroid Gland Using Tc-99m Pertechnetate: a Novel Approach Using Quantitative Single-Photon Emission Computed Tomography/Computed Tomography. Nucl Med Mol Imaging 2018; 52:468-472. [PMID: 30538779 DOI: 10.1007/s13139-018-0554-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 10/08/2018] [Accepted: 10/25/2018] [Indexed: 11/26/2022] Open
Abstract
Planar scintigraphy using Tc-99m pertechnetate is useful for snapshot evaluation of hot thyroid nodules, which are pathologically follicular adenoma and seldom, if ever, malignant. The autonomy of the hot nodules has been demonstrated by the presence of thyroid-stimulating hormone-dependent extra-nodular thyroid tissue besides the hot nodules. Here, we present two cases of hot thyroid nodules in patients who underwent quantitative single-photon emission computed tomography/computed tomography (SPECT/CT). In addition to the nodules, contralateral normal thyroid parenchyma was evaluated based on standardized uptake values. One patient had a traditional follicular adenoma suppressing other thyroid tissue, whereas the other patient seemed to have a nodule erupting from underlying hyperfunctioning, not suppressed, thyroid tissue. This novel approach using quantitative SPECT/CT unveils a new pathology of hot thyroid nodule that does not suppress, but coincides with hyperfunctioning thyroid tissue.
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Affiliation(s)
- Reeree Lee
- 1Department of Nuclear Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do 13620 South Korea
| | - Young So
- 2Department of Nuclear Medicine, Konkuk University Medical Center, Seoul, South Korea
| | - Yoo Sung Song
- 1Department of Nuclear Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do 13620 South Korea
| | - Won Woo Lee
- 1Department of Nuclear Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do 13620 South Korea
- 3Institute of Radiation Medicine, Medical Research Center, Seoul National University, Seoul, South Korea
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17
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DİRİKOÇ A, FAKI S, BAŞER H, ÖZDEMİR D, AYDIN C, ERSOY R, KILIÇ M, KILIÇARSLAN A, ÇAKIR B. Thyroid malignancy risk in different clinical thyroid diseases. Turk J Med Sci 2017; 47:1509-1519. [DOI: 10.3906/sag-1611-67] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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18
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Ly S, Frates MC, Benson CB, Peters HE, Grant FD, Drubach LA, Voss SD, Feldman HA, Smith JR, Barletta J, Hollowell M, Cibas ES, Moore FD, Modi B, Shamberger RC, Huang SA. Features and Outcome of Autonomous Thyroid Nodules in Children: 31 Consecutive Patients Seen at a Single Center. J Clin Endocrinol Metab 2016; 101:3856-3862. [PMID: 27501280 PMCID: PMC5052348 DOI: 10.1210/jc.2016-1779] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
CONTEXT Most thyroid nodules are benign and their accurate identification can avoid unnecessary procedures. In adult patients, documentation of nodule autonomy is accepted as reassurance of benign histology and as justification to forgo biopsy or thyroidectomy. In contrast, the negative predictive value of nodule autonomy in children is uncertain. Some recent publications recommend surgical resection as initial management, but few address the degree of TSH suppression or the specific scintigraphic criteria used to diagnose autonomy. OBJECTIVE The objective of the study was to study the presenting features and cancer risk of children with autonomous nodules. DESIGN AND SETTING Medical records of all 31 children diagnosed with autonomous nodules at our center from 2003 to 2014 were retrospectively reviewed. PATIENTS AND RESULTS All children met full diagnostic criteria for autonomous nodules, defined by both autonomous 123I uptake into the nodule and the suppression of uptake in the normal thyroid parenchyma on scintigraphy performed during hypothyrotropinemia. The median age of presentation was 15 years (range 3-18 y) with a female to male ratio of 15:1. Fifty-eight percent of patients had solitary nodules and 42% had multiple nodules. The median size of each patient's largest autonomous nodule was 39 mm (range 18-67 mm). Most of the children in this series (68%) had diagnostic biopsies and/or operative pathology of their largest autonomous nodule, which showed benign cytology or histology in all cases. CONCLUSIONS In this pediatric series, the cancer rate observed in biopsied or resected autonomous nodules was 0%. Whereas larger studies are needed to confirm our findings, these results agree with earlier reports suggesting that thyroid cancer is rare in rigorously defined autonomous nodules and support that conservative management may be offered to selected children who meet strict diagnostic criteria for autonomous nodules, deferring definitive therapies until adulthood when the risks of thyroidectomy and 131I ablation are lower.
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Affiliation(s)
- Samantha Ly
- Thyroid Program of the Division of Endocrinology (S.L., F.D.G., H.A.F., J.R.S., S.A.H.), Clinical Research Center (H.A.F.), and Departments of Radiology (F.D.G., L.A.D., S.D.V., S.A.H.), Pathology (M.H., E.S.C.), and Surgery (B.M., R.C.S.), Boston Children's Hospital, and Thyroid Section of the Division of Endocrinology, Diabetes, and Hypertension (S.A.H.), and Departments of Radiology (M.C.F., C.B.B., H.E.P.), Pathology (J.B., E.S.C.), and Surgery (F.D.M.), Brigham and Women's Hospital, and the Dana Farber Cancer Institute (S.A.H.), Boston, Massachusetts 02115
| | - Mary C Frates
- Thyroid Program of the Division of Endocrinology (S.L., F.D.G., H.A.F., J.R.S., S.A.H.), Clinical Research Center (H.A.F.), and Departments of Radiology (F.D.G., L.A.D., S.D.V., S.A.H.), Pathology (M.H., E.S.C.), and Surgery (B.M., R.C.S.), Boston Children's Hospital, and Thyroid Section of the Division of Endocrinology, Diabetes, and Hypertension (S.A.H.), and Departments of Radiology (M.C.F., C.B.B., H.E.P.), Pathology (J.B., E.S.C.), and Surgery (F.D.M.), Brigham and Women's Hospital, and the Dana Farber Cancer Institute (S.A.H.), Boston, Massachusetts 02115
| | - Carol B Benson
- Thyroid Program of the Division of Endocrinology (S.L., F.D.G., H.A.F., J.R.S., S.A.H.), Clinical Research Center (H.A.F.), and Departments of Radiology (F.D.G., L.A.D., S.D.V., S.A.H.), Pathology (M.H., E.S.C.), and Surgery (B.M., R.C.S.), Boston Children's Hospital, and Thyroid Section of the Division of Endocrinology, Diabetes, and Hypertension (S.A.H.), and Departments of Radiology (M.C.F., C.B.B., H.E.P.), Pathology (J.B., E.S.C.), and Surgery (F.D.M.), Brigham and Women's Hospital, and the Dana Farber Cancer Institute (S.A.H.), Boston, Massachusetts 02115
| | - Hope E Peters
- Thyroid Program of the Division of Endocrinology (S.L., F.D.G., H.A.F., J.R.S., S.A.H.), Clinical Research Center (H.A.F.), and Departments of Radiology (F.D.G., L.A.D., S.D.V., S.A.H.), Pathology (M.H., E.S.C.), and Surgery (B.M., R.C.S.), Boston Children's Hospital, and Thyroid Section of the Division of Endocrinology, Diabetes, and Hypertension (S.A.H.), and Departments of Radiology (M.C.F., C.B.B., H.E.P.), Pathology (J.B., E.S.C.), and Surgery (F.D.M.), Brigham and Women's Hospital, and the Dana Farber Cancer Institute (S.A.H.), Boston, Massachusetts 02115
| | - Frederick D Grant
- Thyroid Program of the Division of Endocrinology (S.L., F.D.G., H.A.F., J.R.S., S.A.H.), Clinical Research Center (H.A.F.), and Departments of Radiology (F.D.G., L.A.D., S.D.V., S.A.H.), Pathology (M.H., E.S.C.), and Surgery (B.M., R.C.S.), Boston Children's Hospital, and Thyroid Section of the Division of Endocrinology, Diabetes, and Hypertension (S.A.H.), and Departments of Radiology (M.C.F., C.B.B., H.E.P.), Pathology (J.B., E.S.C.), and Surgery (F.D.M.), Brigham and Women's Hospital, and the Dana Farber Cancer Institute (S.A.H.), Boston, Massachusetts 02115
| | - Laura A Drubach
- Thyroid Program of the Division of Endocrinology (S.L., F.D.G., H.A.F., J.R.S., S.A.H.), Clinical Research Center (H.A.F.), and Departments of Radiology (F.D.G., L.A.D., S.D.V., S.A.H.), Pathology (M.H., E.S.C.), and Surgery (B.M., R.C.S.), Boston Children's Hospital, and Thyroid Section of the Division of Endocrinology, Diabetes, and Hypertension (S.A.H.), and Departments of Radiology (M.C.F., C.B.B., H.E.P.), Pathology (J.B., E.S.C.), and Surgery (F.D.M.), Brigham and Women's Hospital, and the Dana Farber Cancer Institute (S.A.H.), Boston, Massachusetts 02115
| | - Stephan D Voss
- Thyroid Program of the Division of Endocrinology (S.L., F.D.G., H.A.F., J.R.S., S.A.H.), Clinical Research Center (H.A.F.), and Departments of Radiology (F.D.G., L.A.D., S.D.V., S.A.H.), Pathology (M.H., E.S.C.), and Surgery (B.M., R.C.S.), Boston Children's Hospital, and Thyroid Section of the Division of Endocrinology, Diabetes, and Hypertension (S.A.H.), and Departments of Radiology (M.C.F., C.B.B., H.E.P.), Pathology (J.B., E.S.C.), and Surgery (F.D.M.), Brigham and Women's Hospital, and the Dana Farber Cancer Institute (S.A.H.), Boston, Massachusetts 02115
| | - Henry A Feldman
- Thyroid Program of the Division of Endocrinology (S.L., F.D.G., H.A.F., J.R.S., S.A.H.), Clinical Research Center (H.A.F.), and Departments of Radiology (F.D.G., L.A.D., S.D.V., S.A.H.), Pathology (M.H., E.S.C.), and Surgery (B.M., R.C.S.), Boston Children's Hospital, and Thyroid Section of the Division of Endocrinology, Diabetes, and Hypertension (S.A.H.), and Departments of Radiology (M.C.F., C.B.B., H.E.P.), Pathology (J.B., E.S.C.), and Surgery (F.D.M.), Brigham and Women's Hospital, and the Dana Farber Cancer Institute (S.A.H.), Boston, Massachusetts 02115
| | - Jessica R Smith
- Thyroid Program of the Division of Endocrinology (S.L., F.D.G., H.A.F., J.R.S., S.A.H.), Clinical Research Center (H.A.F.), and Departments of Radiology (F.D.G., L.A.D., S.D.V., S.A.H.), Pathology (M.H., E.S.C.), and Surgery (B.M., R.C.S.), Boston Children's Hospital, and Thyroid Section of the Division of Endocrinology, Diabetes, and Hypertension (S.A.H.), and Departments of Radiology (M.C.F., C.B.B., H.E.P.), Pathology (J.B., E.S.C.), and Surgery (F.D.M.), Brigham and Women's Hospital, and the Dana Farber Cancer Institute (S.A.H.), Boston, Massachusetts 02115
| | - Justine Barletta
- Thyroid Program of the Division of Endocrinology (S.L., F.D.G., H.A.F., J.R.S., S.A.H.), Clinical Research Center (H.A.F.), and Departments of Radiology (F.D.G., L.A.D., S.D.V., S.A.H.), Pathology (M.H., E.S.C.), and Surgery (B.M., R.C.S.), Boston Children's Hospital, and Thyroid Section of the Division of Endocrinology, Diabetes, and Hypertension (S.A.H.), and Departments of Radiology (M.C.F., C.B.B., H.E.P.), Pathology (J.B., E.S.C.), and Surgery (F.D.M.), Brigham and Women's Hospital, and the Dana Farber Cancer Institute (S.A.H.), Boston, Massachusetts 02115
| | - Monica Hollowell
- Thyroid Program of the Division of Endocrinology (S.L., F.D.G., H.A.F., J.R.S., S.A.H.), Clinical Research Center (H.A.F.), and Departments of Radiology (F.D.G., L.A.D., S.D.V., S.A.H.), Pathology (M.H., E.S.C.), and Surgery (B.M., R.C.S.), Boston Children's Hospital, and Thyroid Section of the Division of Endocrinology, Diabetes, and Hypertension (S.A.H.), and Departments of Radiology (M.C.F., C.B.B., H.E.P.), Pathology (J.B., E.S.C.), and Surgery (F.D.M.), Brigham and Women's Hospital, and the Dana Farber Cancer Institute (S.A.H.), Boston, Massachusetts 02115
| | - Edmund S Cibas
- Thyroid Program of the Division of Endocrinology (S.L., F.D.G., H.A.F., J.R.S., S.A.H.), Clinical Research Center (H.A.F.), and Departments of Radiology (F.D.G., L.A.D., S.D.V., S.A.H.), Pathology (M.H., E.S.C.), and Surgery (B.M., R.C.S.), Boston Children's Hospital, and Thyroid Section of the Division of Endocrinology, Diabetes, and Hypertension (S.A.H.), and Departments of Radiology (M.C.F., C.B.B., H.E.P.), Pathology (J.B., E.S.C.), and Surgery (F.D.M.), Brigham and Women's Hospital, and the Dana Farber Cancer Institute (S.A.H.), Boston, Massachusetts 02115
| | - Francis D Moore
- Thyroid Program of the Division of Endocrinology (S.L., F.D.G., H.A.F., J.R.S., S.A.H.), Clinical Research Center (H.A.F.), and Departments of Radiology (F.D.G., L.A.D., S.D.V., S.A.H.), Pathology (M.H., E.S.C.), and Surgery (B.M., R.C.S.), Boston Children's Hospital, and Thyroid Section of the Division of Endocrinology, Diabetes, and Hypertension (S.A.H.), and Departments of Radiology (M.C.F., C.B.B., H.E.P.), Pathology (J.B., E.S.C.), and Surgery (F.D.M.), Brigham and Women's Hospital, and the Dana Farber Cancer Institute (S.A.H.), Boston, Massachusetts 02115
| | - Biren Modi
- Thyroid Program of the Division of Endocrinology (S.L., F.D.G., H.A.F., J.R.S., S.A.H.), Clinical Research Center (H.A.F.), and Departments of Radiology (F.D.G., L.A.D., S.D.V., S.A.H.), Pathology (M.H., E.S.C.), and Surgery (B.M., R.C.S.), Boston Children's Hospital, and Thyroid Section of the Division of Endocrinology, Diabetes, and Hypertension (S.A.H.), and Departments of Radiology (M.C.F., C.B.B., H.E.P.), Pathology (J.B., E.S.C.), and Surgery (F.D.M.), Brigham and Women's Hospital, and the Dana Farber Cancer Institute (S.A.H.), Boston, Massachusetts 02115
| | - Robert C Shamberger
- Thyroid Program of the Division of Endocrinology (S.L., F.D.G., H.A.F., J.R.S., S.A.H.), Clinical Research Center (H.A.F.), and Departments of Radiology (F.D.G., L.A.D., S.D.V., S.A.H.), Pathology (M.H., E.S.C.), and Surgery (B.M., R.C.S.), Boston Children's Hospital, and Thyroid Section of the Division of Endocrinology, Diabetes, and Hypertension (S.A.H.), and Departments of Radiology (M.C.F., C.B.B., H.E.P.), Pathology (J.B., E.S.C.), and Surgery (F.D.M.), Brigham and Women's Hospital, and the Dana Farber Cancer Institute (S.A.H.), Boston, Massachusetts 02115
| | - Stephen A Huang
- Thyroid Program of the Division of Endocrinology (S.L., F.D.G., H.A.F., J.R.S., S.A.H.), Clinical Research Center (H.A.F.), and Departments of Radiology (F.D.G., L.A.D., S.D.V., S.A.H.), Pathology (M.H., E.S.C.), and Surgery (B.M., R.C.S.), Boston Children's Hospital, and Thyroid Section of the Division of Endocrinology, Diabetes, and Hypertension (S.A.H.), and Departments of Radiology (M.C.F., C.B.B., H.E.P.), Pathology (J.B., E.S.C.), and Surgery (F.D.M.), Brigham and Women's Hospital, and the Dana Farber Cancer Institute (S.A.H.), Boston, Massachusetts 02115
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Ross DS, Burch HB, Cooper DS, Greenlee MC, Laurberg P, Maia AL, Rivkees SA, Samuels M, Sosa JA, Stan MN, Walter MA. 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis. Thyroid 2016; 26:1343-1421. [PMID: 27521067 DOI: 10.1089/thy.2016.0229] [Citation(s) in RCA: 1268] [Impact Index Per Article: 158.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Thyrotoxicosis has multiple etiologies, manifestations, and potential therapies. Appropriate treatment requires an accurate diagnosis and is influenced by coexisting medical conditions and patient preference. This document describes evidence-based clinical guidelines for the management of thyrotoxicosis that would be useful to generalist and subspecialty physicians and others providing care for patients with this condition. METHODS The American Thyroid Association (ATA) previously cosponsored guidelines for the management of thyrotoxicosis that were published in 2011. Considerable new literature has been published since then, and the ATA felt updated evidence-based guidelines were needed. The association assembled a task force of expert clinicians who authored this report. They examined relevant literature using a systematic PubMed search supplemented with additional published materials. An evidence-based medicine approach that incorporated the knowledge and experience of the panel was used to update the 2011 text and recommendations. The strength of the recommendations and the quality of evidence supporting them were rated according to the approach recommended by the Grading of Recommendations, Assessment, Development, and Evaluation Group. RESULTS Clinical topics addressed include the initial evaluation and management of thyrotoxicosis; management of Graves' hyperthyroidism using radioactive iodine, antithyroid drugs, or surgery; management of toxic multinodular goiter or toxic adenoma using radioactive iodine or surgery; Graves' disease in children, adolescents, or pregnant patients; subclinical hyperthyroidism; hyperthyroidism in patients with Graves' orbitopathy; and management of other miscellaneous causes of thyrotoxicosis. New paradigms since publication of the 2011 guidelines are presented for the evaluation of the etiology of thyrotoxicosis, the management of Graves' hyperthyroidism with antithyroid drugs, the management of pregnant hyperthyroid patients, and the preparation of patients for thyroid surgery. The sections on less common causes of thyrotoxicosis have been expanded. CONCLUSIONS One hundred twenty-four evidence-based recommendations were developed to aid in the care of patients with thyrotoxicosis and to share what the task force believes is current, rational, and optimal medical practice.
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Affiliation(s)
- Douglas S Ross
- 1 Massachusetts General Hospital , Boston, Massachusetts
| | - Henry B Burch
- 2 Endocrinology - Metabolic Service, Walter Reed National Military Medical Center , Bethesda, Maryland
| | - David S Cooper
- 3 Division of Endocrinology, Diabetes, and Metabolism, The Johns Hopkins University School of Medicine , Baltimore, Maryland
| | | | - Peter Laurberg
- 5 Departments of Clinical Medicine and Endocrinology, Aalborg University and Aalborg University Hospital , Aalborg, Denmark
| | - Ana Luiza Maia
- 6 Thyroid Section, Hospital de Clinicas de Porto Alegre, Federal University of Rio Grande do Sul , Porto Alegre, Brazil
| | - Scott A Rivkees
- 7 Pediatrics - Chairman's Office, University of Florida College of Medicine , Gainesville, Florida
| | - Mary Samuels
- 8 Division of Endocrinology, Diabetes and Clinical Nutrition, Oregon Health & Science University , Portland, Oregon
| | - Julie Ann Sosa
- 9 Section of Endocrine Surgery, Duke University School of Medicine , Durham, North Carolina
| | - Marius N Stan
- 10 Division of Endocrinology, Mayo Clinic , Rochester, Minnesota
| | - Martin A Walter
- 11 Institute of Nuclear Medicine, University Hospital Bern , Switzerland
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20
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Aktaş GE, Turoğlu HT, Erdil TY, İnanır S, Dede F. Long-Term Results of Fixed High-Dose I-131 Treatment for Toxic Nodular Goiter: Higher Euthyroidism Rates in Geriatric Patients. Mol Imaging Radionucl Ther 2016; 24:94-9. [PMID: 27529883 PMCID: PMC4745408 DOI: 10.4274/mirt.57060] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Objective: Geriatric patient population has special importance due to particular challenges. In addition to the increase in incidence of toxic nodular goiter (TNG) with age, it has a high incidence in the regions of low-medium iodine intake such as in our country. The aim of this study was to evaluate the overall outcome of high fixed dose radioiodine (RAI) therapy, and investigate the particular differences in the geriatric patient population. Methods: One hundred and three TNG patients treated with high dose I-131 (370-740 MBq) were retrospectively reviewed. The baseline characteristics; age, gender, scintigraphic patterns and thyroid function tests before and after treatment, as well as follow-up, duration of antithyroid drug (ATD) medication and achievement of euthyroid or hypothyroid state were evaluated. The patient population was divided into two groups as those=>65 years and those who were younger, in order to assess the effect of age. Results: Treatment success was 90% with single dose RAI therapy. Hyperthyroidism was treated in 7±7, 2 months after RAI administration. At the end of the first year, overall hypothyroidism rate was 30% and euthyroid state was achieved in 70% of patients. Age was found to be the only statistically significant variable effecting outcome. A higher ratio of euthyroidism was achieved in the geriatric patient population. Conclusion: High fixed dose I-131 treatment should be preferred in geriatric TNG patients in order to treat persistent hyperthyroidism rapidly. The result of this study suggests that high fixed dose RAI therapy is a successful modality in treating TNG, and high rates of euthyroidism can be achieved in geriatric patients.
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Affiliation(s)
- Gül Ege Aktaş
- Trakya University Faculty of Medicine, Department of Nuclear Medicine, Edirne, Turkey Phone: +90 284 235 76 41-10 42 E-mail:
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Dirikoc A, Polat SB, Kandemir Z, Aydin C, Ozdemir D, Dellal FD, Ersoy R, Cakir B. Comparison of ultrasonography features and malignancy rate of toxic and nontoxic autonomous nodules: a preliminary study. Ann Nucl Med 2015; 29:883-9. [DOI: 10.1007/s12149-015-1018-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 08/10/2015] [Indexed: 11/28/2022]
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Choong KC, McHenry CR. Thyroid cancer in patients with toxic nodular goiter—is the incidence increasing? Am J Surg 2015; 209:974-6. [DOI: 10.1016/j.amjsurg.2014.12.033] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Revised: 11/11/2014] [Accepted: 12/03/2014] [Indexed: 11/28/2022]
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Ucler R, Usluogulları CA, Tam AA, Ozdemir D, Balkan F, Yalcın S, Kıyak G, Ersoy PE, Guler G, Ersoy R, Cakır B. The diagnostic accuracy of ultrasound-guided fine-needle aspiration biopsy for thyroid nodules three centimeters or larger in size. Diagn Cytopathol 2015; 43:622-8. [PMID: 25914194 DOI: 10.1002/dc.23289] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Revised: 02/05/2015] [Accepted: 03/30/2015] [Indexed: 01/14/2023]
Abstract
BACKGROUND AND PURPOSE Whether under ultrasonography (US) guidance or not, fine-needle aspiration biopsy (FNAB) has some limitations, particularly in larger nodules. In this study, we aimed to evaluate the diagnostic value of US-guided fine-needle aspiration biopsy (US-FNAB) in thyroid nodules equal to or larger than 3 cm. MATERIALS AND METHODS Data of 267 patients operated for nodular goiter in the period of January 2006 and March 2012 were reviewed retrospectively. The study group (40 males, 104 females; mean age 42.3 ± 12.3, between 17 and 71) consisted of patients with nodules with a diameter of 3 cm or larger. Patients with nodules less than 3 cm in diameter were considered as the control group (27 males, 96 females; mean age 44.4 ± 11.9, between 18 and 71). RESULTS For nodules smaller than 3 cm, US-FNAB had an accuracy rate of 60% and a false negativity rate of 21.9%. In nodules equal to or larger than 3 cm, the accuracy rate of US-FNAB was 80%, with a false negativity rate of 6.7%. Malignancy was observed in 16% of the study group and 42.3% of the control group. CONCLUSION This study showed that increased nodule diameter is not associated with limitations in the diagnostic value of US-FNAB. We also found that the malignancy rate was smaller for larger nodules. This finding reflects the importance of accurate and rational diagnostic work-up and clinical management for detecting malignancy and surgical decision-making.
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Affiliation(s)
- Rıfkı Ucler
- Department of Endocrinology and Metabolism, Ataturk Education and Research Hospital, Ankara, Turkey
| | - Celil Alper Usluogulları
- Department of Endocrinology and Metabolism, Ataturk Education and Research Hospital, Ankara, Turkey
| | - Abbas Ali Tam
- Department of Endocrinology and Metabolism, Ataturk Education and Research Hospital, Ankara, Turkey
| | - Didem Ozdemir
- Department of Endocrinology and Metabolism, Ataturk Education and Research Hospital, Ankara, Turkey
| | - Fevzi Balkan
- Department of Endocrinology and Metabolism, Ataturk Education and Research Hospital, Ankara, Turkey
| | - Samet Yalcın
- Department of General Surgery, Ataturk Education and Research Hospital, Ankara, Turkey
| | - Gulten Kıyak
- Department of General Surgery, Ataturk Education and Research Hospital, Ankara, Turkey
| | - Pamir Eren Ersoy
- Department of General Surgery, Ataturk Education and Research Hospital, Ankara, Turkey
| | - Gulnur Guler
- Department of Pathology, Ataturk Education and Research Hospital, Ankara, Turkey
| | - Reyhan Ersoy
- Department of Endocrinology and Metabolism, Ataturk Education and Research Hospital, Ankara, Turkey
| | - Bekir Cakır
- Department of Endocrinology and Metabolism, Ataturk Education and Research Hospital, Ankara, Turkey
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Marcelino M, Marques P, Lopes L, Leite V, de Castro JJ. Anaplastic carcinoma and toxic multinodular goiter: an unusual presentation. Eur Thyroid J 2014; 3:278-82. [PMID: 25759806 PMCID: PMC4311301 DOI: 10.1159/000367893] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Revised: 08/25/2014] [Indexed: 11/19/2022] Open
Abstract
A 70-year-old male was referred with hyperthyroidism and multinodular goiter (MNG). Thyroid ultrasonography showed 2 nodules, one in the isthmus and the other in the left lobe, 51 and 38 mm in diameter, respectively. Neck CT showed a large MNG, thyroid scintigraphy showed increased uptake in the nodule in the left lobe, and fine-needle aspiration biopsy showed a benign cytology of the nodule in the isthmus. The patient declined surgery and was treated with methimazole. After being lost to follow-up for 3 years, the patient returned with complaints of dyspnea, dysphagia, and hoarseness; he was still hyperthyroid. Cervical CT showed a large mass in the isthmus and left lobe with invasion of surrounding tissues, the trachea, the esophagus, and the recurrent laryngeal nerve. Bronchoscopy showed extensive infiltration and compression of the trachea to 20% of its caliber. A tracheal biopsy revealed an anaplastic thyroid carcinoma. The tumor was considered unresectable, and radiotherapy was given. One month later, the patient died. The association between a toxic thyroid nodule and anaplastic thyroid carcinoma has apparently not been reported so far.
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Affiliation(s)
- Mafalda Marcelino
- Department of Endocrinology, Armed Forces University Hospital, Lisbon, Portugal
- Department of Endocrinology, Portuguese Institute of Oncology, Lisbon, Portugal
- *Mafalda Marcelino, Department of Endocrinology, Armed Forces University Hospital, Rua Professor Carlos Teixeira, No. 6, 8° C, PT-1600-608 Lisbon (Portugal), E-Mail
| | - Pedro Marques
- Department of Endocrinology, Portuguese Institute of Oncology, Lisbon, Portugal
| | - Luis Lopes
- Department of Endocrinology, Armed Forces University Hospital, Lisbon, Portugal
| | - Valeriano Leite
- Department of Endocrinology, Portuguese Institute of Oncology, Lisbon, Portugal
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Nawrot I, Pragacz A, Pragacz K, Grzesiuk W, Barczyński M. Total thyroidectomy is associated with increased prevalence of permanent hypoparathyroidism. Med Sci Monit 2014; 20:1675-81. [PMID: 25234952 PMCID: PMC4179543 DOI: 10.12659/msm.890988] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background Thyroid disorders are very common in adults. Despite advances in conservative management, surgery remains a treatment modality of choice in many cases. The mortality and morbidity of thyroidectomy are low, but long-term postoperative hypoparathyroidism (HPT) remains a prominent complication of the procedure. The aim of this study was to assess the incidence of permanent HPT and identify the risk factors for this complication in a cohort of post-thyroidectomy patients followed at a District Endocrine Clinic. Material/Methods This was a retrospective analysis of 401 patients followed up at a Regional/District Endocrine Clinic, who had undergone thyroid surgery in the years 1993–2011. The percentage of patients with permanent (>12 months) HPT was the primary endpoint of the study. The statistically analyzed data of patients with permanent HPT versus the remaining patients free from postoperative complications included their demographic data, indications for surgical treatment of their thyroid disorder, and extent of the thyroid resection. The risk factors for postoperative hypoparathyroidism were assessed using logistic regression analysis. Results Permanent HPT following surgery on the thyroid gland occurred in 8.5% of the patients. It was more frequent following total thyroidectomy (20.2%) than near-total thyroidectomy (6.7%) or subtotal thyroidectomy (4.2%); p<0.0001. A multivariate statistical regression analysis demonstrated that primary total thyroidectomy was a significant risk factor for permanent HPT (OR 6.5; 95% CI: 2.9–14.4; p<0.0001). Conclusions Total thyroidectomy was associated with increased prevalence of permanent hypoparathyroidism when compared to less extensive thyroid resection modes in patients with benign thyroid diseases.
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Affiliation(s)
- Ireneusz Nawrot
- Department Of General, Vascular and Transplantation Surgery, Medical University of Warsaw, Warsaw, Poland
| | - Aneta Pragacz
- District Endocrine Clinic, Independent Public Healthcare Institution, Staszów, Poland
| | - Krzysztof Pragacz
- Department of General Surgery, Independent Public Healthcare Institution, Staszów, Poland
| | - Wiesław Grzesiuk
- Endocrine Clinic - Medical Center, Medical University of Warsaw, Warsaw, Poland
| | - Marcin Barczyński
- Department of Endocrine Surgery, Third Chair of General Surgery, Jagiellonian University Medical College, Cracow, Poland
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Maia AL, Scheffel RS, Meyer ELS, Mazeto GMFS, Carvalho GAD, Graf H, Vaisman M, Maciel LMZ, Ramos HE, Tincani AJ, Andrada NCD, Ward LS. The Brazilian consensus for the diagnosis and treatment of hyperthyroidism: recommendations by the Thyroid Department of the Brazilian Society of Endocrinology and Metabolism. ACTA ACUST UNITED AC 2014; 57:205-32. [PMID: 23681266 DOI: 10.1590/s0004-27302013000300006] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Accepted: 03/19/2013] [Indexed: 03/20/2023]
Abstract
INTRODUCTION Hyperthyroidism is characterized by increased synthesis and release of thyroid hormones by the thyroid gland. Thyrotoxicosis refers to the clinical syndrome resulting from excessive circulating thyroid hormones, secondary to hyperthyroidism or due to other causes. This article describes evidence-based guidelines for the clinical management of thyrotoxicosis. OBJECTIVE This consensus, developed by Brazilian experts and sponsored by the Department of Thyroid Brazilian Society of Endocrinology and Metabolism, aims to address the management, diagnosis and treatment of patients with thyrotoxicosis, according to the most recent evidence from the literature and appropriate for the clinical reality of Brazil. MATERIALS AND METHODS After structuring clinical questions, search for evidence was made available in the literature, initially in the database MedLine, PubMed and Embase databases and subsequently in SciELO - Lilacs. The strength of evidence was evaluated by Oxford classification system was established from the study design used, considering the best available evidence for each question. RESULTS We have defined 13 questions about the initial clinical approach for the diagnosis and treatment that resulted in 53 recommendations, including the etiology, treatment with antithyroid drugs, radioactive iodine and surgery. We also addressed hyperthyroidism in children, teenagers or pregnant patients, and management of hyperthyroidism in patients with Graves' ophthalmopathy and various other causes of thyrotoxicosis. CONCLUSIONS The clinical diagnosis of hyperthyroidism usually offers no difficulty and should be made with measurements of serum TSH and thyroid hormones. The treatment can be performed with antithyroid drugs, surgery or administration of radioactive iodine according to the etiology of thyrotoxicosis, local availability of methods and preferences of the attending physician and patient.
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Affiliation(s)
- Ana Luiza Maia
- Unidade de Tireoide, Serviço de Endocrinologia, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil.
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Feroci F, Rettori M, Borrelli A, Coppola A, Castagnoli A, Perigli G, Cianchi F, Scatizzi M. A systematic review and meta-analysis of total thyroidectomy versus bilateral subtotal thyroidectomy for Graves' disease. Surgery 2014; 155:529-40. [DOI: 10.1016/j.surg.2013.10.017] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2013] [Accepted: 10/11/2013] [Indexed: 11/19/2022]
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Smith JJ, Chen X, Schneider DF, Nookala R, Broome JT, Sippel RS, Chen H, Solorzano CC. Toxic Nodular Goiter and Cancer: A Compelling Case for Thyroidectomy. Ann Surg Oncol 2012; 20:1336-40. [DOI: 10.1245/s10434-012-2725-4] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2012] [Indexed: 11/18/2022]
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Bahn RS, Burch HB, Cooper DS, Garber JR, Greenlee MC, Klein I, Laurberg P, McDougall IR, Montori VM, Rivkees SA, Ross DS, Sosa JA, Stan MN. Hyperthyroidism and other causes of thyrotoxicosis: management guidelines of the American Thyroid Association and American Association of Clinical Endocrinologists. Endocr Pract 2011; 17:456-520. [PMID: 21700562 DOI: 10.4158/ep.17.3.456] [Citation(s) in RCA: 298] [Impact Index Per Article: 22.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Thyrotoxicosis has multiple etiologies, manifestations, and potential therapies. Appropriate treatment requires an accurate diagnosis and is influenced by coexisting medical conditions and patient preference. This article describes evidence-based clinical guidelines for the management of thyrotoxicosis that would be useful to generalist and subspeciality physicians and others providing care for patients with this condition. METHODS The development of these guidelines was commissioned by the American Thyroid Association in association with the American Association of Clinical Endocrinologists. The American Thyroid Association and American Association of Clinical Endocrinologists assembled a task force of expert clinicians who authored this report. The task force examined relevant literature using a systematic PubMed search supplemented with additional published materials. An evidence-based medicine approach that incorporated the knowledge and experience of the panel was used to develop the text and a series of specific recommendations. The strength of the recommendations and the quality of evidence supporting each was rated according to the approach recommended by the Grading of Recommendations, Assessment, Development, and Evaluation Group. RESULTS Clinical topics addressed include the initial evaluation and management of thyrotoxicosis; management of Graves' hyperthyroidism using radioactive iodine, antithyroid drugs, or surgery; management of toxic multinodular goiter or toxic adenoma using radioactive iodine or surgery; Graves' disease in children, adolescents, or pregnant patients; subclinical hyperthyroidism; hyperthyroidism in patients with Graves' ophthalmopathy; and management of other miscellaneous causes of thyrotoxicosis. CONCLUSIONS One hundred evidence-based recommendations were developed to aid in the care of patients with thyrotoxicosis and to share what the task force believes is current, rational, and optimal medical practice.
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Affiliation(s)
- Rebecca S Bahn
- Division of Endocrinology, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN, USA
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Bahn Chair RS, Burch HB, Cooper DS, Garber JR, Greenlee MC, Klein I, Laurberg P, McDougall IR, Montori VM, Rivkees SA, Ross DS, Sosa JA, Stan MN. Hyperthyroidism and other causes of thyrotoxicosis: management guidelines of the American Thyroid Association and American Association of Clinical Endocrinologists. Thyroid 2011; 21:593-646. [PMID: 21510801 DOI: 10.1089/thy.2010.0417] [Citation(s) in RCA: 501] [Impact Index Per Article: 38.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Thyrotoxicosis has multiple etiologies, manifestations, and potential therapies. Appropriate treatment requires an accurate diagnosis and is influenced by coexisting medical conditions and patient preference. This article describes evidence-based clinical guidelines for the management of thyrotoxicosis that would be useful to generalist and subspeciality physicians and others providing care for patients with this condition. METHODS The development of these guidelines was commissioned by the American Thyroid Association in association with the American Association of Clinical Endocrinologists. The American Thyroid Association and American Association of Clinical Endocrinologists assembled a task force of expert clinicians who authored this report. The task force examined relevant literature using a systematic PubMed search supplemented with additional published materials. An evidence-based medicine approach that incorporated the knowledge and experience of the panel was used to develop the text and a series of specific recommendations. The strength of the recommendations and the quality of evidence supporting each was rated according to the approach recommended by the Grading of Recommendations, Assessment, Development, and Evaluation Group. RESULTS Clinical topics addressed include the initial evaluation and management of thyrotoxicosis; management of Graves' hyperthyroidism using radioactive iodine, antithyroid drugs, or surgery; management of toxic multinodular goiter or toxic adenoma using radioactive iodine or surgery; Graves' disease in children, adolescents, or pregnant patients; subclinical hyperthyroidism; hyperthyroidism in patients with Graves' ophthalmopathy; and management of other miscellaneous causes of thyrotoxicosis. CONCLUSIONS One hundred evidence-based recommendations were developed to aid in the care of patients with thyrotoxicosis and to share what the task force believes is current, rational, and optimal medical practice.
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Affiliation(s)
- Rebecca S Bahn Chair
- Division of Endocrinology, Metabolism, and Nutrition, Mayo Clinic , Rochester, Minnesota 55905, USA.
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Raffaelli M, Bellantone R, Princi P, De Crea C, Rossi ED, Fadda G, Lombardi CP. Surgical treatment of thyroid diseases in elderly patients. Am J Surg 2010; 200:467-72. [PMID: 20887839 DOI: 10.1016/j.amjsurg.2009.12.020] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2009] [Revised: 12/08/2009] [Accepted: 12/08/2009] [Indexed: 10/19/2022]
Abstract
BACKGROUND We evaluated the safety of thyroid surgery in elderly patients, in whom surgical procedures usually are considered more hazardous than in younger patients. METHODS The medical records of all the patients who were aged 70 years or older who had undergone thyroid surgery between January 1998 and June 2008 were reviewed. RESULTS A total of 320 patients were included. The preoperative diagnosis was multinodular goiter in 171 cases, toxic goiter in 59 cases, suspicious or indeterminate thyroid nodule in 60 cases, and thyroid carcinoma in 30 patients. Total thyroidectomy was performed in 283 patients, thyroid lobectomy in 15 patients, and a completion thyroidectomy was performed in 22 patients. The final histology showed thyroid cancer in 86 patients and benign disease in 234. CONCLUSIONS Thyroid surgery in patients aged 70 years or older is safe and the relatively high rate of thyroid carcinoma and toxic goiter may justify an aggressive approach.
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Affiliation(s)
- Marco Raffaelli
- Division of Endocrine Surgery-Department of Surgery, Università Cattolica del Sacro Cuore, L. go A. Gemelli 8, 00168 Rome, Italy.
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Abstract
Subclinical and overt hyperthyroidism have been associated with various negative clinical outcomes as for example an increased risk of atrial fibrillation or increased cardiovascular mortality, especially in old age. In order to avoid hyperthyroidism it is strongly recommended not to start any iodine containing drug therapy or to avoid application of contrast agents unless the patient presents with an unremarkable clinical course. TSH suppressive therapy for the treatment of endemic goiter or differentiated low risk thyroid carcinoma is unnecessary, since it favours the development of subclinical hyperthyroidism. Overt hyperthyroidism is treated with antithyroid drugs and/or radioiodine therapy or surgery according to the underlying disease (toxic nodular goiter, Graves' disease).
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Giles (Senyurek) Y, Fatih T, Harika B, Yersu K, Tarik T, Serdar T. The risk factors for malignancy in surgically treated patients for Graves' disease, toxic multinodular goiter, and toxic adenoma. Surgery 2008; 144:1028-37. [DOI: 10.1016/j.surg.2008.08.022] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2008] [Accepted: 08/25/2008] [Indexed: 11/17/2022]
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Porterfield JR, Thompson GB, Farley DR, Grant CS, Richards ML. Evidence-based management of toxic multinodular goiter (Plummer's Disease). World J Surg 2008; 32:1278-84. [PMID: 18357484 DOI: 10.1007/s00268-008-9566-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Toxic multinodular goiter (Plummer's disease) has posed challenges to surgeons, endocrinologists, and radiation oncologists since its description in 1913. A literature review with evidenced-based methodology has not yet been reported. METHODS A systematic review of the English literature from 1950 to 2007 and report of Mayo Clinic experience since 1950 was undertaken to establish evidence-based recommendations for management. RESULTS Surgery and radioactive iodine (RI) are both supported by level IV evidence in the treatment of solitary toxic nodules and toxic multinodular goiter, and treatment is determined by symptoms and co-morbidities. No evidence suggests a difference in treatment outcome based on pretreatment clinical or subclinical hyperthyroidism. Level IV evidence supports thyroidectomy over RI for large goiters. When compressive symptoms are present, level IV evidence supports thyroidectomy for maximal symptom relief in patients at moderate risk. Occult malignancies are found in 2-3% of thyroidectomy specimens for Plummer's disease. Despite technical reports of RI dose considerations, there are no prospective studies validating a dose formula. Ethanol ablation of toxic nodules in patients unfit for surgery is supported by level III evidence. Level V data suggest a cost benefit favoring surgery. CONCLUSIONS Treatment of Plummer's disease with antithyroid medications, ethanol ablation, RI ablation, or surgery must balance the goals of therapy, durability of cure, relief of symptoms, risk of malignancy, and risk of complications. Between 1950 and 2006, 948 (70%) of 1,356 patients with Plummer's disease have been treated surgically at Mayo Clinic.
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Affiliation(s)
- John R Porterfield
- Department of Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
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Hasegawa T, Araki A, Tamura Y, Sugawara T, Iwata A, Kamimiya F, Chiba Y, Horiuchi T, Mori S, Ito H. [A case of Plummer disease that appeared in older old age after 10-year course of subclinical hyperthyroidism]. Nihon Ronen Igakkai Zasshi 2007; 44:251-5. [PMID: 17527029 DOI: 10.3143/geriatrics.44.251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
A 81-year-old woman with a thyroid tumor and subclinical hyperthyroidism since ten years ago was admitted to our hospital for palpitations and hyperthyroidism (FT(4) 1.75 ng/dl, FT(3) 5.37 pg/ml, TSH<0.03 microIU/ml). Although thyroid stimulating antibody (TSAb) was transiently and mildly positive, anti-TSH receptor antibody (TRAb), microsome test, and thyroid test were negative. Thyroid echogram showed an isoechoic nodule in the left lobe (33 x 42 x 22 mm) and a small nodule (10 x 15 x 9 mm) in right lobe. Thyroid scintiscan showed a hyperfunctional (hot) nodule in left thyroid lobe with suppressed uptake in the remainder of the gland. The uptake rate of thyroidal radioiodine ((123)I) in 24 hours was within the normal range (7.3%). Based on the above findings, a diagnosis of Plummer disease was made. Since she refused invasive surgical or radioiodine treatment, she was treated with 10 mg thiamazole daily. After treatment with propranolol and thiamazole, the thyrotoxic symptoms disappeared and thyroid function returned to normal level. She had osteoporosis but she had neither atrial fibrillation nor cardiac symptoms. This was a rare case of Plummer disease that appeared in extremely old age after a long course of subclinical hyperthyroidism.
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Affiliation(s)
- Takashi Hasegawa
- Department of Endocrinology, Tokyo Metropolitan Geriatric Hospital
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Brunaud L, Ayav A, Chatelin J, Klein M, Bresler L, Boissel P. [Is radionuclide imaging still usefull for thyroid nodule management? A surgical point of view]. Ann Chir 2006; 131:514-7. [PMID: 16930528 DOI: 10.1016/j.anchir.2006.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2006] [Accepted: 06/22/2006] [Indexed: 05/11/2023]
Abstract
Preoperative management of thyroid nodule is still controversial. Since 25 years ago, preoperative evaluation of thyroid nodule has been modified and improved. The aim of this study was to review, from a surgical point of view, the role of radionuclide imaging results in the management of patients with thyroid nodules.
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Affiliation(s)
- L Brunaud
- Service de chirurgie générale et endocrinienne, hôpital Brabois-Adultes, CHU de Nancy, 11, allée du Morvan, 54511 Vandoeuvre-lès-Nancy, France.
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Abstract
Controversy remains regarding the best surgical approach for toxic multinodular goiter (MNG). The aim of this study was to evaluate the results of various thyroid operations for managing toxic MNG. A group of 100 patients with toxic MNG were divided into three groups and managed with total thyroidectomy (TT; group I, n-17), near-total thyroidectomy (NTT; group II, n = 48), or bilateral subtotal thyroidectomy (BST; group III, n = 35). Patients were compared with regard to age, gender, surgical operations, complications, thyroid hormone status, duration of hospitalization, and the reoperation rate for incidentally found thyroid carcinomas. There were 14 men (14%) and 86 women (86%) with a mean age of 47.03 +/- 13.56 years (range 19-77 years). After the operation two patients had a hematoma, and one patient had a seroma. Four patients had unilateral vocal cord paralysis, and one had permanent paralysis. Moreover, 18 patients had transient and 2 patients permanent hypocalcemia. There was no significant difference between the groups regarding complications (p < 0.05). Permanent hypothyroidism was achieved in all patients in group I and 44 patients (92%) in group II, whereas in group III only 10 (29%) patients had hypothyroidism. Conversely, hyperthyroidism, both subclinical and clinical, was noted only in group III (12 patients, 34%) during follow-up. We think that TT and NTT are safe, effective approaches in the treatment of toxic MNG, preventing recurrence of thyrotoxicosis and reoperation for incidentally found thyroid cancers. The complication rates for TT and NTT were similar to that for BST. Hence these operation should be considered for patients referred for surgical treatment of toxic MNG.
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Affiliation(s)
- Orhan Alimoglu
- First Department of Surgery, Vakif Gureba Training Hospital, Istanbul, Turkey.
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Ríos Zambudio A, Rodríguez González JM, Torregrosa Pérez NM, Piñero Madrona A, Canteras Jordana M, Parrilla Paricio P. [Hypoparathyroidism and hypocalcemia following thyroid surgery of multinodular goiter. Multivariant study of the risk factors]. Med Clin (Barc) 2004; 122:365-8. [PMID: 15033039 DOI: 10.1016/s0025-7753(04)74244-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND AND OBJECTIVE The hypoparathyroidism is one of the most important complications in the patients submitted to thyroid surgery. The aim is to analyze across a multivariate statistical analysis the risks factors for the development of transient and permanent hypoparathyroidism following the multinodular goiter (MG) surgery. PATIENTS AND METHOD Between 1970 and 1999, 672 thyroidectomies by MG were reviewed. It was considered transient hypoparathyroidism when the calcemia was minor of 7.5 mg/dl or when being minors of 8.5 mg/dl the patient was presenting symptomatology for the hipocalcemia. The hypoparathyroidsm was considered permanent when the calcemia was minor of 8.5 mg/dl to the year of the surgery. RESULTS The hypoparathyroidism appeared in 75 patients (11.2%), 20 with symptomatology (3%), persisting like permanent 6 cases (0.9%). The risk factors for the development of this were the hyperthyroidism (p = 0.0370), and the surgical technique (p < 0.00001) (unilateral versus bilateral surgery), persisting in the multivariate analysis both variables. With respect to the permanent hypoparathyroidism, the risk factor was the toxic MG (p = 0.0109), persisting as independent risk factor in the multivariate analysis (RR = 2.3). CONCLUSIONS The principal risk factor of permanent hypoparathyroidism in the MG surgery is the presence of hyperthyroidism.
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Affiliation(s)
- Antonio Ríos Zambudio
- Servicio de Cirugía General y del Aparato Digestivo I, Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain.
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Affiliation(s)
- Steven A De Jong
- Division of General Surgery, Department of Surgery, Loyola University Medical Center, Maywood, IL 60153, USA
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