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Zheng H, Lai V, Lu J, Burman KD, Wartofsky L, Rosen JE. Improved sexual function after parathyroidectomy in women with primary hyperparathyroidism. Am J Surg 2024; 232:17-23. [PMID: 37940438 DOI: 10.1016/j.amjsurg.2023.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 07/30/2023] [Revised: 10/24/2023] [Accepted: 11/01/2023] [Indexed: 11/10/2023]
Abstract
BACKGROUND The study aimed to evaluate whether women with primary hyperparathyroidism (PHPT) experience improvement in their sexual function after parathyroidectomy. METHODS Women with PHPT or benign thyroid nodules (controls) undergoing surgery were administered the validated Parathyroidectomy Assessment Score (PAS), Patient-Reported Outcomes Measurement Information System-29 (PROMIS-29) and Female Sexual Function Index (FSFI) pre-operatively, at 3 months and 6 months postoperatively. RESULTS Of the 26 PHPT and 18 control patients, PHPT patients were older (53.1 vs 45.3 years, p = 0.008). Post-operatively, both PHPT (pre-op 2.4 vs 3-month 3.0 vs 6-month 2.4, p = 0.022) and control patients (pre-operative 2.4 vs 3-month 3.3 vs 6-month 3.6, p = 0.032) reported increased desire for sexual activities. In addition, PHPT patients experienced increased arousal (pre-operative 2.7 vs 3-month 3.9 vs 6-month 3.6, p = 0.047) and satisfaction (pre-operative 3.0 vs 3-month 4.8 vs 6-month 4.0, p = 0.006). CONCLUSIONS The current study indicates that women with PHPT may experience improved sexual function after parathyroidectomy.
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Affiliation(s)
- Hui Zheng
- MedStar-Washington Hospital Center, Division of Endocrine Surgery, 110 Irving St NW, Washington, DC, 20010, USA.
| | - Victoria Lai
- MedStar-Washington Hospital Center, Division of Endocrine Surgery, 110 Irving St NW, Washington, DC, 20010, USA
| | - Jana Lu
- Georgetown University School of Medicine, 3900 Reservoir Rd NW, Washington, DC, 20007, USA
| | - Kenneth D Burman
- MedStar-Washington Hospital Center, Section of Endocrinology, 110 Irving St NW, Washington, DC, 20010, USA
| | - Leonard Wartofsky
- MedStar Health Research Institute, Thyroid Cancer Unit, 100 Irving St NW, Washington, DC, 20010, USA
| | - Jennifer E Rosen
- MedStar-Washington Hospital Center, Division of Endocrine Surgery, 110 Irving St NW, Washington, DC, 20010, USA
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2
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Kuenstner W, Zhao P, Lee W, Garcia C, Burman KD, Shobab L. A Rare Case of Persistent Multifocal Cribriform-Morular Thyroid Carcinoma. AACE Clin Case Rep 2024; 10:63-66. [PMID: 38523848 PMCID: PMC10958640 DOI: 10.1016/j.aace.2024.01.002] [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] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 01/04/2024] [Accepted: 01/09/2024] [Indexed: 03/26/2024] Open
Abstract
Background/Objective Cribriform-morular thyroid carcinoma (CMTC) was considered a variant of papillary thyroid carcinoma (PTC) but is a separate entity in the 2022 World Health Organization classification. CMTC has an association with familial adenomatous polyposis (FAP). Our objective is to report a case of CMTC who was subsequently diagnosed with FAP, to highlight these associated entities and implications for management. Case Report A 15-year-old female with a history of iron-deficiency anemia and alpha-gal syndrome presented with several years of goiter and dysphagia. She also noted unintentional weight loss, abdominal pain, melena and hematochezia, and symptomatic anemia. Physical examination was significant for multiple thyroid nodules. Laboratory results revealed normal thyroid function and iron deficiency. Multiple nodules were visualized on thyroid ultrasound, and fine needle aspiration biopsy was consistent with PTC. Total thyroidectomy was performed with a revised diagnosis of multifocal CMTC, with administration of adjuvant radioactive iodine due to persistent disease. Genetic testing confirmed FAP and she was referred for upper endoscopy, colonoscopy, and an evaluation for colectomy. Discussion There are no best practice guidelines for management of CMTC. Management of CMTC is guided by FAP status; sporadic cases can be managed with hemithyroidectomy, while FAP-associated cases are better managed with total thyroidectomy. Recurrence is usually managed with surgical resection. The decision to treat with adjuvant radioactive iodine is often extrapolated from management of classic PTC. Conclusion Thyroid carcinoma in the setting of extensive family history of colorectal carcinoma should arouse suspicion for CMTC. Patients with CMTC should receive a referral for colonoscopy and genetic testing for FAP.
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Affiliation(s)
| | - Po Zhao
- MedStar Georgetown University Hospital, Washington, D.C
| | - Wen Lee
- MedStar Washington Hospital Center, Washington, D.C
| | | | | | - Leila Shobab
- MedStar Washington Hospital Center, Washington, D.C
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3
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Sachmechi I, Lucas KJ, Stonesifer LD, Ansley JF, Sack P, Celi FS, Scarsi C, Lanzi G, Wartofsky L, Burman KD. Efficacy of Levothyroxine Sodium Soft Gelatin Capsules in Thyroidectomized Patients Taking Proton Pump Inhibitors: An Open-Label Study. Thyroid 2023; 33:1414-1422. [PMID: 37885233 PMCID: PMC10754356 DOI: 10.1089/thy.2023.0382] [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: 10/28/2023]
Abstract
Background: Treatment with proton pump inhibitors (PPIs) and antacids affects the gastrointestinal absorption of levothyroxine sodium (LT4) tablets. Patients with hypothyroidism taking LT4 and PPIs or antacids, thus, require appropriate monitoring. The objective of this study was to determine whether a soft gelatin capsule of LT4 (Tirosint®) would obviate the effect of PPIs on LT4 absorption. The objective was achieved by assessing the effects of a switch from a conventional LT4 tablet form to the same dose as soft capsules in thyroidectomized patients on treatment with LT4 and PPIs. Methods: Patients with history of hypothyroidism due to total thyroidectomy on stable treatment with LT4 tablets, and with gastrointestinal disease treated with PPIs, were switched to a 12-week treatment with Tirosint at the same dose of the LT4 tablets, while maintaining treatment with PPIs. Serum thyrotropin (TSH) levels were the primary endpoint of the study. Secondary efficacy endpoints were: serum levels of free thyroxine (fT4), total thyroxine (TT4), free triiodothyronine (fT3), total triiodothyronine (TT3), creatine-phosphokinase (CPK), sex-hormone binding globulin, ferritin, angiotensin converting enzyme, and a lipid panel. Results: Forty-seven patients (36 females and 11 males, mean age 55.4 years) were enrolled and 45 of them completed the study (2 patients withdrew consent). During treatment with Tirosint, mean TSH levels demonstrated a statistically significant decrease (mean changes from baseline: -0.32 mIU/L at week 6 and -0.68 mIU/L at week 12) and concomitant increases in thyroid hormone (TH) levels from baseline to week 12, which were statistically significant for fT3 and TT3 (mean changes from baseline: 0.26 pmol/L and 0.10 nmol/L, respectively). Significant decreases of serum low-density lipoprotein, total cholesterol, and CPK levels were observed at week 12. No signs/symptoms arose during the study that could be specifically correlated to either hypo- or hyperthyroidism. Conclusions: In thyroidectomized patients taking PPIs and replacement LT4, a switch from conventional LT4 tablets to LT4 soft capsules at the same dose was associated with a significant decrease in TSH and increase in TH, indicating that LT4 absorption may be less affected by PPIs when given in the form of soft capsules. Clinical Trial Registration: NCT03094416.
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Affiliation(s)
- Issac Sachmechi
- Mount Sinai Services—NYC Health+Hospitals/Queens, Jamaica, New York, USA
| | - Kathryn Jean Lucas
- LucasResearch, Inc., Diabetes & Endocrinology Consultants, Morehead City, North Carolina, USA
| | | | | | - Paul Sack
- MedStar Union Memorial Hospital, Baltimore, Maryland, USA
| | - Francesco S. Celi
- Division of Endocrinology and Metabolism, Department of Medicine, UConn Health, Farmington, Connecticut, USA
| | | | | | - Leonard Wartofsky
- MedStar Health Research Institute, Washington, District of Columbia, USA
| | - Kenneth D. Burman
- Endocrine Section, MedStar Washington Hospital Center, Washington, District of Columbia, USA
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4
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Gopinath C, Crow H, Panthi S, Bantis L, Burman KD, Choudhary C. Characteristics, staging and outcomes of differentiated thyroid cancer in patients with and without Graves' disease. J Clin Transl Endocrinol 2023; 33:100321. [PMID: 37547825 PMCID: PMC10400462 DOI: 10.1016/j.jcte.2023.100321] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 07/18/2023] [Indexed: 08/08/2023] Open
Abstract
Background The incidence of thyroid cancer has increased over the last three decades with studies showing incidence of thyroid cancer is higher among patients with Graves' Disease (GD) when compared to Toxic multinodular goiter.1 We conducted a retrospective study to further investigate characteristics and outcomes in patients with thyroid cancer and GD. Methods We retrospectively reviewed 62 patients with a diagnosis of Differentiated Thyroid Cancer (DTC). We compared age at diagnosis, type, size of tumor, radioactive iodine (RAI) use, and DTC recurrence amongst patients with GD, non-GD patients. We used Chi-square to test for independence among categorical variables at a nominal level of 0.05; comparison was based on t-test. Results Out of 62 patients, 29 patients had GD and DTC (47%). 94% had papillary thyroid cancer. Patients with GD were diagnosed with DTC at a younger age (mean 46 years) in comparison to patients without GD (mean 53 years). There was no difference in the type of DTC. Patients with GD had significantly smaller tumor size (mean size 1.035 cm; p value = 0.002), more Stage 1 and 2 compared to patients without GD (p-value = 0.009). Both groups of patients had similar rates of recurrence on follow up and RAI use. Conclusion We found patients with GD had smaller tumor size, early-stage DTC when compared to patients without GD and potentially favorable prognosis. More data is needed to understand whether this is due to pathogenesis like Graves antibodies promoting tumor formation or merely earlier detection of DTC in GD.
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Affiliation(s)
| | - Hanna Crow
- Ascension St. Thomas Medical Group, Nashville, TN, USA
| | | | - Leonidas Bantis
- Department of Biostatistics & Data Science, University of Kansas Medical Center, Kansas City, KS, USA
| | - Kenneth D Burman
- Medstar Washington Hospital Center/Georgetown University, Washington, DC, USA
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5
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Zheng H, Lai V, Lu J, Hu D, Kang JK, Burman KD, Wartofsky L, Rosen JE. Efficacy of machine learning to identify clinical factors influencing levothyroxine dosage after total thyroidectomy. Am J Surg 2023; 225:694-698. [PMID: 36464545 DOI: 10.1016/j.amjsurg.2022.11.025] [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] [Received: 09/10/2022] [Revised: 10/26/2022] [Accepted: 11/19/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND We employed Machine Learning (ML) to evaluate potential additional clinical factors influencing replacement dosage requirements of levothyroxine. METHOD This was a retrospective study of patients who underwent total or completion thyroidectomy with benign pathology. Patients who achieved an euthyroid state were included in three different ML models. RESULTS Of the 487 patients included, mean age was 54.1 ± 14.1 years, 86.0% were females, 39.0% were White, 53.0% Black, 2.7% Hispanic, 1.4% Asian, and 3.9% Other. The Extreme Gradient Boosting (XGBoost) model achieved the highest accuracy at 61.0% in predicting adequate dosage compared to 47.0% based on 1.6 mcg/kg/day (p < 0.05). The Poisson regression indicated non-Caucasian race (p < 0.05), routine alcohol use (estimate = 0.03, p = 0.02), and osteoarthritis (estimate = -0.10, p < 0.001) in addition to known factors such as age (estimate = -0.003, p < 0.001), sex (female, estimate = -0.06, p < 0.001), and weight (estimate = 0.01, p < 0.001) were associated with the dosing of levothyroxine. CONCLUSIONS Along with weight, sex, age, and BMI, ML algorithms indicated that race, ethnicity, lifestyle and comorbidity factors also may impact levothyroxine dosing in post-thyroidectomy patients with benign conditions.
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Affiliation(s)
- Hui Zheng
- MedStar Washington Hospital Center, Division of Endocrine Surgery, USA; MedStar Georgetown University Hospital, Department of Surgery, USA.
| | - Victoria Lai
- MedStar Washington Hospital Center, Division of Endocrine Surgery, USA
| | - Jana Lu
- Georgetown University School of Medicine, USA
| | - Di Hu
- MedStar Health Research Institute, Center of Biostatistics, Informatics and Data Science, USA
| | - Jin K Kang
- MedStar Washington Hospital Center, Division of Endocrine Surgery, USA; MedStar Georgetown University Hospital, Department of Surgery, USA
| | - Kenneth D Burman
- MedStar Washington Hospital Center, Section of Endocrinology, USA
| | | | - Jennifer E Rosen
- MedStar Washington Hospital Center, Division of Endocrine Surgery, USA
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Van Nostrand D, Veytsman I, Kulkarni K, Heimlich L, Burman KD. Redifferentiation of Differentiated Thyroid Cancer: Clinical Insights from a Narrative Review of Literature. Thyroid 2023. [PMID: 36792922 DOI: 10.1089/thy.2022.0632] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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] [Indexed: 02/17/2023]
Abstract
Background: Patients who have metastatic differentiated thyroid cancer (mDTC) frequently have negative diagnostic and/or post-therapy radioiodine scans. As a result, 131I therapy is frequently no longer considered a therapeutic option for these patients. However, with the knowledge of genomic alterations of patients with mDTC, the use of selected agents in specific patient groups may be used with the intention to re-establish 131I uptake (i.e., redifferentiation) and additional 131I therapy. The objectives of this narrative review are to present definitions of related terminology, a brief overview of the molecular mechanisms of redifferentiating agents, and a narrative review of the literature for redifferentiation in patients who have radioiodine refractory mDTC. Summary: We searched multiple electronic databases and reviewed the relevant English-language literature reported after 2010. Fourteen articles were included in this narrative review. Conclusions: Preliminary data suggest that select agents may offer potential for re-establishing 131I uptake in selected patients with radioiodine refractory mDTC (e.g., negative diagnostic and/or post-therapy radioiodine scans). These agents may also enhance uptake (e.g., uptake enhancement) in patients who have 131I uptake in mDTC on a diagnostic and/or post-therapy radioiodine scan. As a result, this may facilitate higher absorbed dose delivered (Gy (rad]) per 131I activity administered [GBq (mCi)]. This in turn may increase the likelihood of a better therapeutic effect for the planned administered 131I activity or a reduction in the originally planned administered 131I activity, while achieving the same intended therapeutic effect with potentially less untoward effects. Further studies are warranted to confirm these preliminary observations and to confirm acceptable subsequent 131I therapy responses after redifferentiation and/or uptake enhancement.
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Affiliation(s)
- Douglas Van Nostrand
- MedStar Health Research Institute, Washington, District of Columbia, USA
- MedStar Washington Hospital Center, Washington, District of Columbia, USA
| | - Irina Veytsman
- MedStar Cancer Institute, Washington, District of Columbia, USA
| | - Kanchan Kulkarni
- MedStar Washington Hospital Center, Washington, District of Columbia, USA
| | - Layla Heimlich
- MedStar Washington Hospital Center, Washington, District of Columbia, USA
| | - Kenneth D Burman
- MedStar Washington Hospital Center, Washington, District of Columbia, USA
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Gomes-Lima CJ, Chittimoju S, Wehbeh L, Dia S, Pagadala P, Al-Jundi M, Jhawar S, Tefera E, Mete M, Klubo-Gwiezdzinska J, Van Nostrand D, Jonklaas J, Wartofsky L, Burman KD. Response to Letter to the Editor from Zandee and Links: "Metastatic Differentiated Thyroid Cancer Survival Is Unaffected by Mode of Preparation for 131I Administration". J Endocr Soc 2023; 7:bvad005. [PMID: 36777465 PMCID: PMC9909159 DOI: 10.1210/jendso/bvad005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Indexed: 01/26/2023] Open
Affiliation(s)
- Cristiane J Gomes-Lima
- MedStar Clinical Research Center, MedStar Health Research Institute (MHRI),Hyattsville, MD 20782-2031, USA
- Section of Endocrinology, MedStar Washington Hospital Center, Washington, DC 20010, USA
| | - Sanjita Chittimoju
- Department of Internal Medicine, MedStar Washington Hospital Center, Washington, DC 20010, USA
| | - Leen Wehbeh
- Department of Internal Medicine, MedStar Washington Hospital Center, Washington, DC 20010, USA
| | - Sunita Dia
- Department of Internal Medicine, MedStar Washington Hospital Center, Washington, DC 20010, USA
| | - Prathyusha Pagadala
- Department of Internal Medicine, MedStar Washington Hospital Center, Washington, DC 20010, USA
| | - Mohammad Al-Jundi
- Department of Internal Medicine, MedStar Washington Hospital Center, Washington, DC 20010, USA
| | - Sakshi Jhawar
- Department of Internal Medicine, Sinai Hospital of Baltimore, Research Volunteer, Baltimore, MD 21215, USA
| | - Eshetu Tefera
- Department of Biostatistics, MedStar Health Research Institute (MHRI), Hyattsville, MD 20782-2031, USA
| | - Mihriye Mete
- Department of Biostatistics, MedStar Health Research Institute (MHRI), Hyattsville, MD 20782-2031, USA
| | - Joanna Klubo-Gwiezdzinska
- Thyroid Tumors and Functional Thyroid Disorders Section, National Institutes of Health/National Institute of Diabetes and Digestive and Kidney Diseases (NIH/NIDDK), Bethesda, MD 20892, USA
| | - Douglas Van Nostrand
- MedStar Clinical Research Center, MedStar Health Research Institute (MHRI),Hyattsville, MD 20782-2031, USA
- Nuclear Medicine Research, MedStar Washington Hospital Center, Washington, DC 20010, USA
| | - Jacqueline Jonklaas
- Division of Endocrinology, Department of Medicine, Georgetown University, Washington, DC 20057, USA
| | - Leonard Wartofsky
- Section of Endocrinology, MedStar Washington Hospital Center, Washington, DC 20010, USA
| | - Kenneth D Burman
- Section of Endocrinology, MedStar Washington Hospital Center, Washington, DC 20010, USA
- Division of Endocrinology, Department of Medicine, Georgetown University, Washington, DC 20057, USA
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8
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Sachmechi I, Burman KD, Mautone G, Lanzi G, Moriarty PL, Scarsi C, Wartofsky L. RF23 | PSAT365 An Open-Label Therapeutic Efficacy Study of Tirosint (Levothyroxine Sodium) Capsules in Thyroidectomized Patients Taking Proton Pump Inhibitors. J Endocr Soc 2022. [PMCID: PMC9629167 DOI: 10.1210/jendso/bvac150.1777] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Levothyroxine sodium (LT4) absorption is known to be affected by proton pump inhibitors (PPIs). Normal gastric acid secretion is important for the subsequent intestinal absorption of LT4. A reduced gastric acidity may diminish the dissolution of the LT4 tablet in the stomach and the release of LT4 to the gut. The dissolution profile of LT4 soft capsules has been reported to be less affected by pH than that of tablets. Previous studies in healthy subjects administered with LT4 and PPIs, as well as in hypothyroid patients with atrophic gastritis confirmed little or no impact of increased gastric pH on LT4 absorption when administered in soft capsule formulation. The present study was aimed at evaluating whether LT4 soft capsules may provide better control of thyroid stimulating hormone (TSH) in thyroidectomized patients undergoing chronic replacement therapy with LT4, who were also on chronic use of PPIs.Forty-seven (47) patients were enrolled in this multicenter study. Upon switching to Tirosint capsules at the same previous dose of LT4 tablets and while maintaining the same dose of PPI, TSH (when measured on week 12 of treatment) was significantly reduced from a mean±SD of 1.34±1.51 mIU/L to 0.75±1.08 mIU/L (p<0.0001) in the Intention-To-Treat population analysis on original data. No significant changes were detected in the level of free and total thyroxine (T4), while slight but significant (p<0.05) increases were measured in free and total triiodothyronine (T3). The measured extent of TSH decrease is consonant with the extent of TSH increase previously reported by other authors upon start of PPI therapy in hypothyroid patients treated with LT4 tablets.In conclusion, these data confirm previous reports that LT4 soft capsules absorption is not affected by increased gastric pH due to PPIs. This may be relevant to improve TSH stabilization in patients who take PPIs intermittently or those with gastric pH altered by concomitant pathologies. Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m., Sunday, June 12, 2022 1:00 p.m. - 1:05 p.m.
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Premji R, Nylen ES, Naser N, Gandhi S, Burman KD, Sen S. Lipid Profile Changes Associated with SGLT-2 Inhibitors and GLP-1 Agonists in Diabetes and Metabolic Syndrome. Metab Syndr Relat Disord 2022; 20:321-328. [PMID: 35452324 DOI: 10.1089/met.2022.0004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 01/03/2023] Open
Abstract
The introduction of sodium glucose transporter-2 inhibitors and glucagon-like peptide-1 receptor agonists in type 2 diabetes mellitus treatment has shown an unexpectedly significant improvement in heart disease outcome trials. Although they have very different modes of action, a portion of the salutary cardiovascular disease improvement may be related to their impact on diabetic dyslipidemia. As discussed in this focused review, the sodium glucose transporter-2 inhibitors as a class show a mild increase in low-density lipoprotein (LDL) and high-density lipoprotein (HDL) cholesterol levels, while triglycerides (TG) decrease inconsistently. In particular, the rise in LDL appears to be related to the less atherogenic, large buoyant LDL particles. The glucagon-like peptide-1 receptor agonists show more of an impact on weight loss and improvement in the underlying low HDL and high TG dyslipidemia. The effect of sodium glucose transporter-2 inhibitors and glucagon-like peptide 1 receptor agonists when used in combination remains largely unknown. Also unexplored is difference in effect of these medications among various ethnicities and metabolic syndrome.
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Affiliation(s)
- Resmi Premji
- Montage Medical Group, Monterey, California, USA
| | - Eric S Nylen
- Department of Endocrinology, VAMC and George Washington University School of Medicine, Washington, District of Columbia, USA
| | - Nejat Naser
- Department of Endocrinology, VAMC and George Washington University School of Medicine, Washington, District of Columbia, USA
| | - Shruti Gandhi
- Department of Endocrinology, VAMC and George Washington University School of Medicine, Washington, District of Columbia, USA
| | - Kenneth D Burman
- Department of Endocrinology, Georgetown University School of Medicine, Washington Hospital Center, Washington, District of Columbia, USA
| | - Sabyasachi Sen
- Department of Endocrinology, VAMC and George Washington University School of Medicine, Washington, District of Columbia, USA
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Gomes-Lima CJ, Chittimoju S, Wehbeh L, Dia S, Pagadala P, Al-Jundi M, Jhawar S, Tefera E, Mete M, Klubo-Gwiezdzinska J, Van Nostrand D, Jonklaas J, Wartofsky L, Burman KD. Metastatic Differentiated Thyroid Cancer Survival Is Unaffected by Mode of Preparation for 131I Administration. J Endocr Soc 2022; 6:bvac032. [PMID: 35356009 PMCID: PMC8962448 DOI: 10.1210/jendso/bvac032] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [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: 10/05/2021] [Indexed: 01/13/2023] Open
Abstract
Context Recombinant human thyrotropin (rhTSH) is currently not Food and Drug Administration approved for the treatment of high-risk patients with differentiated thyroid cancer (DTC). Objective The goal of our study was to compare the outcomes in higher-risk patients with metastatic DTC prepared for radioiodine (RAI) therapy with rhTSH vs thyroid hormone withdrawal (THW). Methods A retrospective chart review was performed of patients with metastatic DTC in follow-up at MedStar Washington Hospital Center and MedStar Georgetown University Hospital from 2009 to 2017. Patients were divided according to their preparation for RAI therapy, with assessment of progression-free survival (PFS) and overall survival (OS). Results Fifty-five patients with distant metastases (16 men, 39 women) were prepared for RAI therapy exclusively either with rhTSH (n = 27) or with THW (n = 28). There were no statistically significant differences between the groups regarding clinicopathological features and history of RAI therapies. The median follow-up time for patients with rhTSH-aided therapies was 4.2 years (range, 3.3-5.5 years) and for patients with THW-aided therapies was 6.8 years (range, 4.2-11.6 years) (P = .002). Multivariate analysis showed that the method of thyrotropin stimulation was not associated with a difference in PFS or OS. Conclusion As has been shown previously for low-risk DTC, this study indicates that the mode of preparation for RAI therapy does not appear to influence the outcomes of patients with metastatic DTC. PFS and OS were similar for patients with THW-aided or rhTSH-aided RAI therapies.
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Affiliation(s)
- Cristiane J Gomes-Lima
- MedStar Clinical Research Center, MedStar Health Research Institute (MHRI), Hyattsville 20782-2031, Maryland, USA,Section of Endocrinology, MedStar Washington Hospital Center, Washington, District of Columbia 20010, USA
| | - Sanjita Chittimoju
- Internal Medicine - MedStar Washington Hospital Center, Washington, District of Columbia 20010, USA
| | - Leen Wehbeh
- Internal Medicine - MedStar Washington Hospital Center, Washington, District of Columbia 20010, USA
| | - Sunita Dia
- Internal Medicine - MedStar Washington Hospital Center, Washington, District of Columbia 20010, USA
| | - Prathyusha Pagadala
- Internal Medicine - MedStar Washington Hospital Center, Washington, District of Columbia 20010, USA
| | - Mohammad Al-Jundi
- Internal Medicine - MedStar Washington Hospital Center, Washington, District of Columbia 20010, USA
| | - Sakshi Jhawar
- Internal Medicine, Sinai Hospital of Baltimore, Baltimore, Maryland 21215, USA
| | - Eshetu Tefera
- MedStar Health Research Institute (MHRI), Hyattsville 20782-2031, Maryland, USA
| | - Mihriye Mete
- MedStar Health Research Institute (MHRI), Hyattsville 20782-2031, Maryland, USA
| | - Joanna Klubo-Gwiezdzinska
- National Institutes of Health/National Institute of Diabetes and Digestive and Kidney Diseases (NIH/NIDDK), Bethesda, Maryland 20892, USA
| | - Douglas Van Nostrand
- MedStar Clinical Research Center, MedStar Health Research Institute (MHRI), Hyattsville 20782-2031, Maryland, USA,Nuclear Medicine Research, MedStar Washington Hospital Center, Washington, District of Columbia 20010, USA
| | - Jacqueline Jonklaas
- Division of Endocrinology, Department of Medicine Georgetown University, Washington, District of Columbia 20057, USA
| | - Leonard Wartofsky
- Section of Endocrinology, MedStar Washington Hospital Center, Washington, District of Columbia 20010, USA
| | - Kenneth D Burman
- Section of Endocrinology, MedStar Washington Hospital Center, Washington, District of Columbia 20010, USA,Division of Endocrinology, Department of Medicine Georgetown University, Washington, District of Columbia 20057, USA,Correspondence: Kenneth D. Burman, MD, Section of Endocrinology, MedStar Washington Hospital Center, Suite 2A-72, 110 Irving St NW, Washington, DC 20010, USA.
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Abstract
Background: Sex dimorphism strongly impacts tumor biology, with most cancers having a male predominance. Uniquely, thyroid cancer (TC) is the only nonreproductive cancer with striking female predominance with three- to four-fold higher incidence among females, although males generally have more aggressive disease. The molecular basis for this observation is not known, and current approaches in treatment and surveillance are not sex specific. Summary: Although TC has overall good prognosis, 6-20% of patients develop regional or distant metastasis, one third of whom are not responsive to conventional treatment approaches and suffer a 10-year survival rate of only 10%. More efficacious treatment strategies are needed for these aggressive TCs, as tyrosine kinase inhibitors and immunotherapy have major toxicities without demonstrable overall survival benefit. Emerging evidence indicates a role of sex hormones, genetics, and the immune system in modulation of both risk for TC and its progression in a sex-specific manner. Conclusion: Greater understanding of the molecular mechanisms underlying sex differences in TC pathogenesis could provide insights into the development of sex-specific, targeted, and effective strategies for prevention, diagnosis, and management. This review summarizes emerging evidence for the importance of sex in the pathogenesis, progression, and response to treatment in differentiated TC with emphasis on the role of sex hormones, genetics, and the immune system.
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Affiliation(s)
- Leila Shobab
- MedStar Washington Hospital Center, Washington, District of Columbia, USA
| | - Kenneth D Burman
- MedStar Washington Hospital Center, Washington, District of Columbia, USA
| | - Leonard Wartofsky
- Medstar Health Research Institute, Washington, District of Columbia, USA
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12
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Figge JJ, Gooding WE, Steward DL, Yip L, Sippel RS, Yang SP, Scheri RP, Sipos JA, Mandel SJ, Mayson SE, Burman KD, Folek JM, Haugen BR, Sosa JA, Parameswaran R, Tan WB, Nikiforov YE, Carty SE. Do Ultrasound Patterns and Clinical Parameters Inform the Probability of Thyroid Cancer Predicted by Molecular Testing in Nodules with Indeterminate Cytology? Thyroid 2021; 31:1673-1682. [PMID: 34340592 PMCID: PMC8917891 DOI: 10.1089/thy.2021.0119] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background: Molecular testing (MT) is commonly used to refine cancer probability in thyroid nodules with indeterminate cytology. Whether or not ultrasound (US) patterns and clinical parameters can further inform the risk of thyroid cancer in nodules predicted to be positive or negative by MT remains unknown. The aim of this study was to test if clinical parameters, including patient age, sex, nodule size (by US), Bethesda category (III, IV, V), US pattern (American Thyroid Association [ATA] vs. American College of Radiology Thyroid Image Reporting and Data System [TI-RADS] systems), radiation exposure, or family history of thyroid cancer can modify the probability of thyroid cancer or noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) predicted by MT. Methods: We studied 257 thyroid nodules in 232 patients from 10 study centers with indeterminate fine needle aspiration cytology and informative MT results using the ThyroSeq v3 genomic classifier (TSv3). Univariate and multivariate logistic regression was used for data analysis. Results: The presence of cancer/NIFTP was associated with positive TSv3 results (odds ratio 61.39, p < 0.0001). On univariate regression, patient sex, age, and Bethesda category were associated with cancer/NIFTP probability (p < 0.05 for each). Although ATA (p = 0.1211) and TI-RADS (p = 0.1359) US categories demonstrated positive trends, neither was significantly associated with cancer/NIFTP probability. A multivariate regression model incorporating the four most informative non-MT covariates (sex, age, Bethesda category, and ATA US pattern; Model No. 1) yielded a C index of 0.653; R2 = 0.108. When TSv3 was added to Model number 1, the C index increased to 0.888; R2 = 0.572. However, age (p = 0.341), Bethesda category (p = 0.272), and ATA US pattern (p = 0.264) were nonsignificant, and other than TSv3 (p < 0.0001), male sex was the only non-MT parameter that potentially contributed to cancer/NIFTP risk (p = 0.095). The simplest and most efficient clinical model (No. 3) incorporated TSv3 and sex (C index = 0.889; R2 = 0.588). Conclusions: In this multicenter study of thyroid nodules with indeterminate cytology and MT, neither the ATA nor TI-RADS US scoring systems further informed the risk of cancer/NIFTP beyond that predicted by TSv3. Although age and Bethesda category were associated with cancer/NIFTP probability on univariate analysis, in sequential nomograms they provided limited incremental value above the high predictive ability of TSv3. Patient sex may contribute to cancer/NIFTP risk in thyroid nodules with indeterminate cytology.
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Affiliation(s)
- James J. Figge
- Diabetes & Endocrine Care, St. Peter's Health Partners/Trinity Health, Rensselaer, New York, USA
- Address correspondence to: James J. Figge, MD, MBA, Diabetes & Endocrine Care, St. Peter's Health Partners/Trinity Health, 279 Troy Road, Rensselaer, NY 12144, USA
| | - William E. Gooding
- Biostatistics Facility, UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania, USA
| | - David L. Steward
- Department of Otolaryngology, Head and Neck Surgery, University of Cincinnati Medical Center, Cincinnati, Ohio, USA
| | - Linwah Yip
- Division of Endocrine Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Rebecca S. Sippel
- Division of Endocrine Surgery, University of Wisconsin, Madison, Wisconsin, USA
| | - Samantha Peiling Yang
- Endocrinology Division, Department of Medicine, National University Hospital, Singapore, Singapore
- Endocrinology Division, Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Randall P. Scheri
- Section of Endocrine Surgery, Department of Surgery, Duke University, Durham, North Carolina, USA
| | - Jennifer A. Sipos
- Division of Endocrinology, Diabetes, and Metabolism, Ohio State University School of Medicine, Columbus, Ohio, USA
| | - Susan J. Mandel
- Division of Endocrinology, Diabetes and Metabolism, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sarah E. Mayson
- Division of Endocrinology, Metabolism and Diabetes, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Kenneth D. Burman
- Endocrinology Section, Department of Medicine, MedStar Washington Hospital Center, Washington, District of Columbia, USA
| | | | - Bryan R. Haugen
- Division of Endocrinology, Metabolism and Diabetes, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Julie A. Sosa
- Department of Surgery, University of California San Francisco, San Francisco, California, USA
| | - Rajeev Parameswaran
- Division of Endocrine Surgery, Department of Surgery, National University Hospital, Singapore, Singapore
- Division of Endocrine Surgery, Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Wee Boon Tan
- Division of Endocrine Surgery, Department of Surgery, National University Hospital, Singapore, Singapore
- Division of Endocrine Surgery, Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Yuri E. Nikiforov
- Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Sally E. Carty
- Division of Endocrine Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Sally E. Carty, MD, Division of Endocrine Surgery, University of Pittsburgh, 101 Kauffmann, 3471 Fifth Avenue, Pittsburgh, PA 15213, USA
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13
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Zheng H, Lai V, Lu J, Kang JK, Felger EA, Carroll NM, Burman KD, Wartofsky L, Rosen JE. Comparing the rate and extent of malignancy in surgically excised thyroid nodules across race and ethnicity. Am J Surg 2021; 223:617-623. [PMID: 34600740 DOI: 10.1016/j.amjsurg.2021.09.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 05/30/2021] [Revised: 08/23/2021] [Accepted: 09/22/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND Few studies have compared the features of thyroid cancer among races and ethnicities. We hypothesized that race and ethnicity may influence the frequency and features of thyroid malignancy in thyroid nodules. METHOD This was a retrospective chart review of patients between 2013 and 2020 who underwent thyroidectomy. RESULTS In the analysis of 2737 patients, thyroid cancer was less prevalent among Blacks (24.0% vs Whites 52.1%, Hispanics 58.7%, Asians 71.7%, and Others 57.9%, p < 0.001). Thyroid cancer in Blacks was less likely to have extrathyroidal extension (9.7% vs Whites 18.6%, Hispanics 25.8%, Asians 18.2%, and Others 17.8%, p = 0.01), overall nodal involvement (12.4% vs Whites 31.1%, Hispanics 37.5%, Asians 36.3%, and Others 30.1%, p < 0.01), and lateral neck metastasis (4.4% vs Whites 10.8%, Hispanics 6.3%, Asians 13.2%, and Others 9.6%, p = 0.02). CONCLUSIONS Race and ethnicity may play important roles in the risk of malignancy as well as in the extent of thyroid cancer.
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Affiliation(s)
- Hui Zheng
- MedStar-Washington Hospital Center, Division of Endocrine Surgery, 110 Irving St NW, Washington, DC, 20010, USA; MedStar-Georgetown University Hospital, Department of Surgery, 3800 Reservoir Rd NW, Washington, DC, 20007, USA.
| | - Victoria Lai
- MedStar-Washington Hospital Center, Division of Endocrine Surgery, 110 Irving St NW, Washington, DC, 20010, USA
| | - Jana Lu
- Georgetown University School of Medicine, 3900 Reservoir Rd NW, Washington, DC, 20007, USA
| | - Jin K Kang
- MedStar-Washington Hospital Center, Division of Endocrine Surgery, 110 Irving St NW, Washington, DC, 20010, USA; MedStar-Georgetown University Hospital, Department of Surgery, 3800 Reservoir Rd NW, Washington, DC, 20007, USA
| | - Erin A Felger
- MedStar-Washington Hospital Center, Division of Endocrine Surgery, 110 Irving St NW, Washington, DC, 20010, USA
| | - Nancy M Carroll
- MedStar-Washington Hospital Center, Division of Endocrine Surgery, 110 Irving St NW, Washington, DC, 20010, USA
| | - Kenneth D Burman
- MedStar-Washington Hospital Center, Section of Endocrinology, 110 Irving St NW, Washington DC, 20010, USA
| | - Leonard Wartofsky
- MedStar Health Research Institute, Thyroid Cancer Unit, 100 Irving St NW, Washington, DC, 20010, USA
| | - Jennifer E Rosen
- MedStar-Washington Hospital Center, Division of Endocrine Surgery, 110 Irving St NW, Washington, DC, 20010, USA
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14
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Ylli D, Soldin SJ, Stolze B, Wei B, Nigussie G, Nguyen H, Mendu DR, Mete M, Wu D, Gomes-Lima CJ, Klubo-Gwiezdzinska J, Burman KD, Wartofsky L. Biotin Interference in Assays for Thyroid Hormones, Thyrotropin and Thyroglobulin. Thyroid 2021; 31:1160-1170. [PMID: 34042535 PMCID: PMC8420951 DOI: 10.1089/thy.2020.0866] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 01/02/2023]
Abstract
Background: Biotin has been reported to interfere with several commonly used laboratory assays resulting in misleading values and possible erroneous diagnosis and treatment. This report describes a prospective study of possible biotin interference in thyroid-related laboratory assays, with a comparison of different commonly used assay platforms. Materials and Methods: Thirteen adult subjects (mean age 45 ± 13 years old) were administered biotin 10 mg/day for eight days. Blood specimens were collected at three time points on day 1 and on day 8 (baseline, two, and five hours after biotin ingestion). Thyrotropin (TSH), free triiodothyronine (fT3), free thyroxine (fT4), total triiodothyronine (TT3), total thyroxine (TT4), thyroxine binding globulin (TBG), and thyroglobulin (Tg) levels were analyzed with four different platforms: Abbott Architect, Roche Cobas 6000, Siemens IMMULITE 2000, and liquid chromatography with tandem mass spectrometry (LC-MS/MS). TSH, fT3, fT4, TT3, and TT4 were measured with Abbott Architect and Roche Cobas 6000. fT3, fT4, TT3, and TT4 were also measured by LC-MS/MS. Tg was measured by Siemens IMMULITE 2000. TBG was assessed with Siemens IMMULITE 2000. Results: Significant changes in TSH, fT4, and TT3 measurements were observed after biotin exposure when the Roche Cobas 6000 platform was used. Biotin intake resulted in a falsely lower Tg level when measurements were performed with Siemens IMMULITE 2000. At the time points examined, maximal biotin interference was observed two hours after biotin exposure both on day 1 and day 8. Conclusions: A daily dose of 10 mg was shown to interfere with specific assays for TSH, fT4, TT3, and Tg. Physicians must be aware of the potential risk of erroneous test results in subjects taking biotin supplements. Altered test results for TSH and Tg can be particularly problematic in patients requiring careful titration of levothyroxine therapy such as those with thyroid cancer.
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Affiliation(s)
- Dorina Ylli
- MedStar Health Research Institute, MedStar Washington Hospital Center, Washington, District of Columbia, USA
- Faculty of Medicine, University of Medicine, Tirana, Albania
| | - Steven J. Soldin
- Department of Laboratory Medicine, NIH Clinical Center, Bethesda, Maryland, USA
| | - Brian Stolze
- Department of Laboratory Medicine, NIH Clinical Center, Bethesda, Maryland, USA
| | - Bin Wei
- Department of Laboratory Medicine, NIH Clinical Center, Bethesda, Maryland, USA
| | - Girum Nigussie
- Department of Laboratory Medicine, NIH Clinical Center, Bethesda, Maryland, USA
| | - Hung Nguyen
- Department of Laboratory Medicine, NIH Clinical Center, Bethesda, Maryland, USA
| | - Damodara Rao Mendu
- Department of Laboratory Medicine, Mount Sinai Hospital NY, New York, New York, USA
| | - Mihriye Mete
- MedStar Health Research Institute, MedStar Washington Hospital Center, Washington, District of Columbia, USA
| | - Di Wu
- MedStar Health Research Institute, MedStar Washington Hospital Center, Washington, District of Columbia, USA
| | - Cristiane J. Gomes-Lima
- MedStar Health Research Institute, MedStar Washington Hospital Center, Washington, District of Columbia, USA
| | - Joanna Klubo-Gwiezdzinska
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Kenneth D. Burman
- MedStar Health Research Institute, MedStar Washington Hospital Center, Washington, District of Columbia, USA
| | - Leonard Wartofsky
- MedStar Health Research Institute, MedStar Washington Hospital Center, Washington, District of Columbia, USA
- Address correspondence to: Leonard Wartofsky, MD, Endocrinology Division, MedStar Washington Hospital Center, 110 Irving Street Northwest, Washington, DC 20010, USA
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15
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Ylli D, Wartofsky L, Burman KD. Response to Letter to the Editor from Sukor et al.: "Evaluation and Treatment of Amiodarone-induced Thyroid Disorders". J Clin Endocrinol Metab 2021; 106:e2839-e2840. [PMID: 33624808 PMCID: PMC8208675 DOI: 10.1210/clinem/dgab105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Dorina Ylli
- Endocrine Section, MedStar Washington Hospital Center and MedStar Health Research Institute, Washington, DC, USA
- Faculty of Medicine, University of Medicine, Tirana, Albania
| | - Leonard Wartofsky
- Endocrine Section, MedStar Washington Hospital Center and MedStar Health Research Institute, Washington, DC, USA
| | - Kenneth D Burman
- Endocrine Section, MedStar Washington Hospital Center and MedStar Health Research Institute, Washington, DC, USA
- Correspondence: Kenneth D. Burman, Room 2A72, MedStar Washington Hospital Center, 110 Irving Street Northwest, Washington, DC 20010, USA.
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16
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Wu D, Plyku D, Kulkarni K, Garcia C, Atkins F, Tefera E, Burman KD, Wartofsky L, Van Nostrand D. Optimal Time for 124I PET/CT Imaging in Metastatic Differentiated Thyroid Cancer. Clin Nucl Med 2021; 46:283-288. [PMID: 33492859 DOI: 10.1097/rlu.0000000000003505] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 11/26/2022]
Abstract
BACKGROUND The objective of this study was to determine the optimal time for 124I PET/CT imaging to maximize the detection of locoregional and/or distant metastases of differentiated thyroid cancer. METHODS Differentiated thyroid cancer patients suspected of having metastatic disease were prepared with low-iodine diet and appropriate thyroid-stimulating hormone stimulation. 124I PET and low-dose localization CT were performed over 4 days after oral administration of 31.5 or 62.9 MBq (0.85 or 1.7 mCi) of 124I. Each scan was independently reviewed by 2 nuclear medicine physicians. All foci of activity were categorized, and the visual intensity of uptake was scored by a semiquantitative 3-point grading system (1: mild uptake, 2: moderate uptake, 3: intense uptake). Lesion volumes were determined on the CT image or on the PET images. Background (bkg) was also measured for each lesion and on each individual PET image. For each lesion, the mean activity concentration rate per unit administered activity (ACRmean/AA) and lesion-to-bkg ratios were compared across the 5 different time points. The semiquantitative grade and the quantitative measurements were compared. RESULTS A total of 45 124I PET/CT scans were reviewed for 9 patients. In the visual assessment, a total of 31 foci suggestive for or highly suggestive of metastasis were identified on 124I PET/CT. Of these, 6 were seen on the 2-h, 18 on the 24-h, 27 on the 48-h, 24 on the 72-h, and 20 on the 96-h scan. There was a significant difference between the 24- and 48-h scans in the total number of foci (ie, locoregional and distant metastasis) (P < 0.05) and in the number of distant metastases (P < 0.05). The 24-, 48-, and 72-h scans identified the same number of locoregional foci. The 48-h scan visualized more of the distant metastases than any other time point. 124I PET/CT with dual-time-point imaging was superior to single-time-point imaging (97% vs 87%). In the quantitative analysis, the median ACRmean/AA was highest at 24 and 48 h, and the median lesion-to-bkg ratio was variable for different lesion locations. For lung metastases, the highest median lesion-to-bkg ratio was at 72 and 96 h. CONCLUSIONS 124I PET/CT with dual-time-point imaging was superior to any single-time-point imaging (P < 0.10). Based on the visual assessment, dual time points at 48 + 72 h or 48 + 96 h yielded the highest lesion detection rate, whereas for single-time-point imaging, the 48-h images had the highest lesion detection rate. If the 48-h scan is completely negative or has negative 124I uptake in the region of interest, then a 72- or 96-h scan may be valuable. If lung metastases are suspected, then one should consider additional imaging at 72 or 96 h.
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Affiliation(s)
| | | | - Kanchan Kulkarni
- Division of Nuclear Medicine, MedStar Health Washington Hospital Center, Washington, DC
| | - Carlos Garcia
- Division of Nuclear Medicine, MedStar Health Washington Hospital Center, Washington, DC
| | | | - Eshetu Tefera
- Department of Biostatistics and Biomedical informatics, MedStar Health Research Institute, Hyattsville, MD
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17
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Gomes-Lima CJ, Shobab L, Wu D, Ylli D, Bikas A, McCoy M, Feldman R, Lee W, Rao SN, Jensen K, Vasko V, Castro LC, Jonklaas J, Wartofsky L, Burman KD. Do Molecular Profiles of Primary Versus Metastatic Radioiodine Refractory Differentiated Thyroid Cancer Differ? Front Endocrinol (Lausanne) 2021; 12:623182. [PMID: 33716974 PMCID: PMC7949910 DOI: 10.3389/fendo.2021.623182] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 01/18/2021] [Indexed: 12/13/2022] Open
Abstract
Management of metastatic radioiodine refractory differentiated thyroid cancer (DTC) can be a therapeutic challenge. Generally, little is known about the paired molecular profile of the primary tumor and the metastases and whether they harbor the same genetic abnormalities. The present study compared the molecular profile of paired tumor specimens (primary tumor/metastatic sites) from patients with radioiodine refractory DTC in order to gain insight into a possible basis for resistance to radioiodine. Twelve patients with radioiodine refractory metastases were studied; median age at diagnosis of 61 years (range, 25-82). Nine patients had papillary TC (PTC), one had follicular TC (FTC), and two had Hürthle cell TC (HTC). Distant metastases were present in the lungs (n = 10), bones (n = 4), and liver (n = 1). The molecular profiling of paired tumors was performed with a panel of 592 genes for Next Generation Sequencing, RNA-sequencing, and immunohistochemistry. Digital microfluidic PCR was used to investigate TERT promoter mutations. The genetic landscape of all paired sites comprised BRAF, NRAS, HRAS, TP53, ATM, MUTYH, POLE, and NTRK genes, including BRAF and NTRK fusions. BRAF V600E was the most common point mutation in the paired specimens (5/12). TERT promoter mutation C228T was detected in one case. PD-L1 expression at metastatic sites was highly positive (95%) for one patient with HTC. All specimens were stable for microsatellite instability testing, and the tumor mutation burden was low to intermediate. Therefore, the molecular profile of DTC primary and metastatic lesions can show heterogeneity, which may help explain some altered responses to therapeutic intervention.
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Affiliation(s)
- Cristiane J. Gomes-Lima
- Department of Internal Medicine, MedStar Clinical Research Center, MedStar Health Research Institute (MHRI), Washington, DC, United States
- Section of Endocrinology, MedStar Washington Hospital Center, Washington, DC, United States
- University of Brasilia School of Health Sciences, Postgraduate Program, Brasilia, Brazil
| | - Leila Shobab
- Section of Endocrinology, MedStar Washington Hospital Center, Washington, DC, United States
| | - Di Wu
- Department of Internal Medicine, MedStar Clinical Research Center, MedStar Health Research Institute (MHRI), Washington, DC, United States
- Section of Endocrinology, MedStar Washington Hospital Center, Washington, DC, United States
| | - Dorina Ylli
- Department of Internal Medicine, MedStar Clinical Research Center, MedStar Health Research Institute (MHRI), Washington, DC, United States
- Section of Endocrinology, MedStar Washington Hospital Center, Washington, DC, United States
| | - Athanasios Bikas
- Department of Internal Medicine, MedStar Georgetown University Hospital, Washington, DC, United States
| | - Matthew McCoy
- Innovation Center for Biomedical Informatics, Georgetown University Medical Center, Washington, DC, United States
| | - Rebecca Feldman
- Caris Life Sciences, Medical Affairs, Phoenix, AZ, United States
| | - Wen Lee
- Department of Internal Medicine, MedStar Georgetown University Hospital, Washington, DC, United States
| | - Sarika N. Rao
- Division of Endocrinology, Mayo Clinic, Jacksonville, FL, United States
| | - Kirk Jensen
- Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
| | - Vasily Vasko
- Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
| | - Luiz Claudio Castro
- Department of Pediatrics, University of Brasilia School of Medicine, Brasilia, Brazil
| | - Jacqueline Jonklaas
- Department of Medicine, Georgetown University, Washington, DC, United States
| | - Leonard Wartofsky
- Department of Internal Medicine, MedStar Clinical Research Center, MedStar Health Research Institute (MHRI), Washington, DC, United States
- Section of Endocrinology, MedStar Washington Hospital Center, Washington, DC, United States
| | - Kenneth D. Burman
- Section of Endocrinology, MedStar Washington Hospital Center, Washington, DC, United States
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18
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Abstract
Amiodarone is a class III antiarrhythmic drug containing 37% iodine by weight, with a structure similar to that of thyroid hormones. Deiodination of amiodarone releases large amounts of iodine that can impair thyroid function, causing either hypothyroidism or thyrotoxicosis in susceptible individuals reflecting ~20% of patients administered the drug. Not only the excess iodine, but also the amiodarone (or its metabolite, desethylamiodarone) itself may cause thyroid dysfunction by direct cytotoxicity on thyroid cells. We present an overview of the epidemiology and pathophysiology of amiodarone-induced thyroid disorders, with a focus on the various forms of clinical presentation and recommendations for personalized management of each form.
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Affiliation(s)
- Dorina Ylli
- Endocrine Section, MedStar Washington Hospital Center, Washington, DC
- Faculty of Medicine, University of Medicine, Tirana, Albania
| | - Leonard Wartofsky
- Endocrine Section, MedStar Washington Hospital Center, Washington, DC
| | - Kenneth D Burman
- Endocrine Section, MedStar Washington Hospital Center, Washington, DC
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19
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Wartofsky L, Burman KD. Yolanda Castillo Oertel, MD: Humanitarian, Diagnostician, Educator, Pathologist (December 14, 1938-September 16, 2020). Thyroid 2021; 31:2. [PMID: 32948111 DOI: 10.1089/thy.2020.0766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Leonard Wartofsky
- Department of Medicine, Washington Hospital Center, Washington, District of Columbia, USA
| | - Kenneth D Burman
- Department of Medicine, Washington Hospital Center, Washington, District of Columbia, USA
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20
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Gubbi S, Thakur S, Avadhanula S, Araque KA, Filie AC, Raffeld M, Welch J, Del Rivero J, Kebebew E, Burman KD, Wartofsky L, Klubo-Gwiezdzinska J. Comprehensive guidance on the diagnosis and management of primary mesenchymal tumours of the thyroid gland. Lancet Oncol 2020; 21:e528-e537. [PMID: 33152312 DOI: 10.1016/s1470-2045(20)30332-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 05/26/2020] [Accepted: 06/05/2020] [Indexed: 02/06/2023]
Abstract
Most primary thyroid tumours are of epithelial origin. Primary thyroid mesenchymal tumours are rare but are being increasingly detected. A vast majority of thyroid mesenchymal tumours occur between the fourth and seventh decades of life, presenting as progressively enlarging thyroid nodules that often yield non-diagnostic results or spindle cells on fine needle aspiration biopsy. Surgery is the preferred mode of treatment, with adjuvant chemoradiotherapy used for malignant thyroid mesenchymal tumours. Benign thyroid mesenchymal tumours have excellent prognosis, whereas the outcome of malignant thyroid mesenchymal tumours is variable. Each thyroid mesenchymal tumour is characterised by its unique histopathology and immunohistochemistry. Because of the rarity and aggressive nature of malignant thyroid mesenchymal tumours, a multidisciplinary team-based approach should ideally be used in the management of these tumours. Comprehensive guidelines on the management of thyroid mesenchymal tumours are currently lacking. In this Review, we provide a detailed description of thyroid mesenchymal tumours, their clinical characteristics and tumour behaviour, and provide recommendations for the optimal management of these tumours.
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Affiliation(s)
- Sriram Gubbi
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Shilpa Thakur
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Shirisha Avadhanula
- Department of Endocrinology, Diabetes, and Metabolism, Cleveland Clinic, Cleveland, OH, USA
| | - Katherine A Araque
- Department of Endocrinology, Pacific Neuroscience Institute, John Wayne Cancer Institute, Santa Monica, CA, USA
| | - Armando C Filie
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Mark Raffeld
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - James Welch
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Jaydira Del Rivero
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Electron Kebebew
- Department of General Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Kenneth D Burman
- Department of Endocrinology, MedStar Washington Hospital Center, Washington, DC, USA
| | - Leonard Wartofsky
- Department of Endocrinology, MedStar Health Research Institute, Washington, DC, USA
| | - Joanna Klubo-Gwiezdzinska
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA.
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Wu D, Gomes-Lima CJ, Kulkarni K, Burman KD, Wartofsky L, Van Nostrand D. 30 mCi exploratory scan for two-step dosimetric 131I therapy in differentiated thyroid cancer patients: A novel approach and case report. World J Nucl Med 2020; 19:266-270. [PMID: 33354183 PMCID: PMC7745862 DOI: 10.4103/wjnm.wjnm_35_19] [Citation(s) in RCA: 1] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 09/17/2019] [Indexed: 11/04/2022] Open
Abstract
Differentiated thyroid cancer patients with significantly elevated or rapidly rising serum thyroglobulin (Tg) levels and negative diagnostic radioiodine scans (DxScan) often present a therapeutic dilemma in deciding whether or not to administer an 131I treatment. In this report, we describe a novel two-step approach of a 30 mCi 131I exploratory scan before a dosimetric 131I therapy to help “un-blind” the treating physician of the benefit/risk ratio of a further “blind” 131I treatment. A 51-year-old man presented with rising Tg levels, a negative DxScan, and a history of widely metastatic follicular thyroid cancer. He had undergone total thyroidectomy, remnant ablation with 3.8 GBq (103.5 mCi) of 131I, Gammaknife®, and treatment with 12.1 GBq (326 mCi) of 131I for multiple metastases. However, at 19 months after the treatments, his Tg levels continued to rise, and scans demonstrated no evidence of radioiodine-avid metastatic disease. In anticipation of a “blind” 131I treatment, the medical team and the patient opted for a 30 mCi exploratory scan. The total dosimetrically guided prescribed activity (DGPA) was decided based on the whole-body dosimetry. The patient was first given 30 mCi of 131I, and the exploratory scan was performed 22 h later, which demonstrated 131I uptake in the left lung, left humeral head, T10, and right proximal thigh muscle. Based on the positive exploratory scan, the remainder of the DGPA was administered within several hours after the scan. On the post-DGPA treatment scan performed at 5–7 days, the lesions seen on the ~ 22 h exploratory scan were confirmed, and an additional lesion was observed in the left kidney. The 30 mCi exploratory scan suggested the potential for a response in the radioiodine-avid lesions despite a negative diagnostic scan. This method allows 131I treatment to be administered to patients who may have a greater potential for a therapeutic response while avoiding unwarranted side effects in those patients with nonavid disease.
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Affiliation(s)
- Di Wu
- Medstar Health Research Institute, Hyattsville, MD, USA.,Department of Nuclear Medicine Research, Medstar Washington Hospital Center, Washington, DC, USA
| | - Cristiane Jeyce Gomes-Lima
- Medstar Health Research Institute, Hyattsville, MD, USA.,Division of Endocrinology, Medstar Washington Hospital Center, Washington, DC, USA
| | - Kanchan Kulkarni
- Division of Nuclear Medicine, Medstar Washington Hospital Center, Washington, DC, USA
| | - Kenneth D Burman
- Division of Endocrinology, Medstar Washington Hospital Center, Washington, DC, USA
| | - Leonard Wartofsky
- Medstar Health Research Institute, Hyattsville, MD, USA.,Division of Endocrinology, Medstar Washington Hospital Center, Washington, DC, USA
| | - Douglas Van Nostrand
- Medstar Health Research Institute, Hyattsville, MD, USA.,Department of Nuclear Medicine Research, Medstar Washington Hospital Center, Washington, DC, USA
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Peravali M, Gomes-Lima C, Tefera E, Baker M, Sherchan M, Farid S, Burman KD, Constantinescu F, Veytsman I. Racial disparities in immune-related adverse events (irAE) of immune checkpoint inhibitors (ICPi) and association with survival based on clinical and biochemical responses. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.7025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
7025 Background: ICPi cause various irAE with thyroid dysfunction as a commonly reported abnormality. There is increasing evidence showing positive association with development of irAE and survival. However, prior trials with ICPi had underrepresentation of minorities with <5% African Americans (AA). Methods: We retrospectively reviewed patients (pts) with stage IV solid malignancies treated with PD1/PDL1 blockers between 1/2013-12/2018 across MedStar Georgetown Cancer Institute facilities. Pts treated with CTLA-4 inhibitors were excluded. Progression free survival (PFS) and overall survival (OS) were primary endpoints and were calculated using Kaplan-Meier methods and Wilcoxon rank sum test for comparison. Results: 293 pts met eligibility criteria. 91 pts (31%) had any grade irAE; most common AE were endocrine (40.7%) specifically TSH elevation, dermatological (23.1%) and rheumatologic (18.7%). Proportion of irAE was significantly higher in Caucasians versus AA (60.4% vs 30.8%), in pts with low PDL1, lower LDH, older age, and those who had more treatment cycles with ICPi. Rate of progression was lower in pts with irAE (30.8% vs 46.0%, p-0.0140). Median PFS (5.8 vs 3.0 months (mo), p- 0.0204) and OS (17.1 vs 7.2 mo, p value- <0.0001) were higher with irAE. Statistically significant difference in OS (17.1 vs 8.6 mo, p- 0.0002) but not in PFS (5.8 vs 3.3 mo, p: 0.0545) was noted with endocrine irAE. No differences in survival were observed among other commonly reported irAE. Differences in survival among subgroups of pts with irAE are detailed in table. Conclusions: Development of irAE positively correlated with improved PFS and OS as reported in previous studies. To our knowledge, this is the first study observing differences in OS favoring endocrine AE and Caucasian race. These factors may be potential surrogate markers of prognosis pending replication of these results in large-scale studies. [Table: see text]
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Affiliation(s)
| | | | | | | | | | - Saira Farid
- MedStar Washington Hospital Center, Washington, DC
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23
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Ylli D, Patel A, Mendoca-Torres MC, Costello J, Bikas A, Wartofsky L, Burman KD, Jensen K, Vasko VV. MON-514 Detection of RAS Mutations and RET/PTC Fusions in Thyroid Cancer Using Microfluidic Digital PCR. J Endocr Soc 2020. [PMCID: PMC7209185 DOI: 10.1210/jendso/bvaa046.1774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
Background:
The identification of somatic mutations and gene fusions is crucial for guiding therapeutic decisions in patients with thyroid cancer. Microfluidic digital PCR is currently considered as a technique of choice for highly sensitive detection of gene mutations/fusion. We recently demonstrated that dPCR is a useful tool for detection of BRAFV600E and TERT promoter mutations in thyroid tumors.
Objectives:
This study aimed to determine the analytic and clinical validity of dPCR for detection of RAS mutations and RET/PTC fusions in thyroid cancer tissue.
Material and Methods:
Thyroid tissues from 75 patients with PTCs (58 classical PTC (CPTC) and 17 follicular variant (FVPTC) were used for DNA and RNA extraction. The rare mutation SNP genotyping assays which were multiplexed for detection of mutant and wild type NRASQ61; as well as RET/PTC1 and RET/PTC3 were synthesized by Thermo Fisher Scientific. Digital PCR was performed using a QuantStudio 3D Digital PCR platform. QuantStudio Software was used for relative and quantitative data analysis.
Results:
NRASQ61 was detected in 0/58 CPTC and in 6/17 (35%) FVPTC. The ratios of mutant/total varying from 11.7% to 61.5%. Among patients with FVPTC there were no significant associations between the presence of NRASQ61 and patient’s age, sex, multifocal growth, extra-thyroidal invasion and lymph node metastases. The ratios mutant/total correlated with tumor size in patients harboring NRASQ61. In 23 cases, RET/PTC1 and RET/PTC3 transcripts were examined. RET/PTC1 and RET/PTC3 transcripts were detected in 3 and 1 case, respectively. RET/PTCs were detected in CPTC, but not in FVPTC. RET/PTC positive tumors were characterized by multi-focal patterns of growth, presence of extra-thyroidal invasion, and presence of lymph node metastases (4 of 4 cases with RET/PTC). There were not RET/PTCs positive tumors harboring simultaneously anomalies in RAS oncogene.
Conclusions:
Microfluidic digital PCR allows specific, sensitive and rapid detection of RAS mutations and RET/PTC fusions in thyroid tissue samples. Implementation of dPCR-based assays may facilitate analysis of thyroid tumors and support research in patients with thyroid cancer.
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Affiliation(s)
- Dorina Ylli
- MedStar Health Research Institute, Washington, DC, USA
| | - Aneeta Patel
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | | | - John Costello
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | | | | | | | - Kirk Jensen
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Vasyl V Vasko
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA
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24
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Figge JJ, Gooding WE, Burman KD, Mayson S, Scheri RP, Sipos JA, Sippel RS, Steward DL, Yang SP, Yip L, Nikiforov YE, Carty SE. MON-LB79 Do Ultrasound Patterns and Clinical Parameters Modify the Probability of Thyroid Cancer Predicted by Molecular Testing in Thyroid Nodules With Indeterminate Cytology? J Endocr Soc 2020. [PMCID: PMC7209362 DOI: 10.1210/jendso/bvaa046.2118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background: Molecular testing (MT) is commonly used to refine cancer probability in thyroid nodules with indeterminate cytology. Whether or not ultrasound (US) patterns and clinical parameters can further modify the risk of cancer in nodules predicted to be positive or negative by molecular testing remains unknown. Aim: To test if clinical parameters, including age, gender, nodule size (by US), Bethesda category (III, IV, V), US pattern (American Thyroid Association [ATA] system vs American College of Radiology TIRADS), radiation exposure, and family history of thyroid cancer (TC) can modify the probability of TC or NIFTP predicted by MT in thyroid nodules with indeterminate cytology. Methods: We studied 257 thyroid nodules from 10 study centers with fine-needle aspiration (FNA) yielding indeterminate cytology and informative MT results using the ThyroSeq v3 genomic classifier (TSv3). Univariate and multivariate logistic regression were used for data analysis. Results: In this group of thyroid nodules, out of all parameters studied using univariate regression, patient gender, age, and Bethesda category were significantly associated with TC/NIFTP probability (P<0.05 for each). The ATA US patterns showed a positive trend (P=0.1211), whereas TIRADS was not predictive (P=0.3135). A multivariate regression model incorporating the four most informative covariates (gender, age, Bethesda category, and ATA US patterns) (model #1) yielded a C index=0.653; R2=0.108. Male gender and Bethesda category V significantly increased risk, and age demonstrated a nonlinear risk profile. When TSv3 was added to model #1, the C index increased to 0.888; R2=0.572. However, age (P=0.341), Bethesda category (P=0.272), and the ATA US patterns (P=0.264) had limited predictive ability in comparison with TSv3, which dominated the predictive performance (P<0.001). Gender was the only parameter showing tendency for significance beyond MT (P=0.095). The most parsimonious model incorporated gender and TSv3 (C index=0.889; R2=0.588). Conclusions: While often useful in selecting thyroid nodules for FNA, neither the ATA US nor the TIRADS scoring systems were informative in further predicting TC/NIFTP in thyroid nodules with indeterminate FNA cytology. Although age and Bethesda category were associated with TC/NIFTP probability on univariate analysis, they had limited incremental value above the high predictive ability of TSv3. Gender was the only parameter with potential contribution to predicting TC/NIFTP in addition to MT.
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Affiliation(s)
- James J Figge
- Department of Medicine, Division of Endocrinology, St Peter’s Hospital, Albany, NY, USA
| | - William E Gooding
- Biostatistics Facility, UPMC Hillman Cancer Center, Pittsburgh, PA, USA
| | - Kenneth D Burman
- Department of Medicine, Endocrinology Section, Medstar Washington Hospital Center, Washington, DC, USA
| | - Sarah Mayson
- Division of Endocrinology, Metabolism and Diabetes, University of Colorado Denver-Anschutz Medical Campus, Aurora, CO, USA
| | | | - Jennifer A Sipos
- Division of Endocrinology, Diabetes and Metabolism, Ohio State University, Columbus, OH, USA
| | - Rebecca S Sippel
- Division of Endocrine Surgery, University of Wisconsin, Madison, WI, USA
| | - David L Steward
- Department of Otolaryngology, Head and Neck Surgery, University of Cincinnati, Cincinnati, OH, USA
| | - Samantha Peiling Yang
- Endocrinology Division, Department of Medicine, National University Hospital, Singapore, Singapore
| | - Linwah Yip
- Division of Endocrine Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Yuri E Nikiforov
- Department of Pathology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Sally E Carty
- Division of Endocrine Surgery, University of Pittsburgh, Pittsburgh, PA, USA
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25
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Avadhanula S, Introne WJ, Auh S, Soldin SJ, Stolze B, Regier D, Ciccone C, Hannah-Shmouni F, Filie AC, Burman KD, Klubo-Gwiezdzinska J. Assessment of Thyroid Function in Patients With Alkaptonuria. JAMA Netw Open 2020; 3:e201357. [PMID: 32202644 PMCID: PMC7090965 DOI: 10.1001/jamanetworkopen.2020.1357] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
IMPORTANCE Alkaptonuria is an autosomal recessive disorder caused by pathogenic variants in the HGD gene. Deficiency of the HGD enzyme leads to tissue deposition of homogentisic acid (HGA), causing severe osteoarthropathies and cardiac valve degeneration. Although HGD is vital for the catabolism of tyrosine, which provides the basis for thyroid hormone synthesis, the prevalence of thyroid dysfunction in alkaptonuria is unknown. OBJECTIVE To assess thyroid structure and function in patients with alkaptonuria. DESIGN, SETTING, AND PARTICIPANTS A single-center cohort study was conducted in a tertiary referral center including patients with alkaptonuria followed up for a median of 93 (interquartile range, 48-150) months between February 1, 2000, and December 31, 2018. The alkaptonuria diagnosis was based on clinical presentation and elevated urine HGA levels. A total of 130 patients were considered for participation. MAIN OUTCOMES AND MEASURES Prevalence of thyroid dysfunction in adults with alkaptonuria compared with the general population. Thyrotropin and free thyroxine levels were measured by immunoassay and repeated in each patient a median of 3 (interquartile range, 2-22) times. Neck ultrasonographic scans were analyzed in a subset of participants. Logistic regression was used to test the association of thyroid dysfunction with age, sex, thyroid peroxidase (TPO) antibodies, serum tyrosine levels, and urine HGA levels. RESULTS Of the 130 patients, 5 were excluded owing to thyroidectomy as the cause of hypothyroidism. The study cohort consisted of 125 patients; the median age was 45 (interquartile range, 35-51) years. Most of the patients were men (72 [57.6%]). The prevalence of primary hyperthyroidism was 0.8% (1 of 125 patients), similar to 0.5% observed in the general population (difference, 0.003; 95% CI, -0.001 to 0.04; P = .88). The prevalence of primary hypothyroidism was 16.0% (20 of 125 patients), which is significantly higher than 3.7% reported in the general population (difference, 0.12; 95% CI, 0.10-0.24; P < .001). Women were more likely to have primary hypothyroidism than men (odds ratio, 10.99; 95% CI, 3.13-38.66; P < .001). Patients with TPO antibodies had a higher likelihood of primary hypothyroidism than those without TPO antibodies (odds ratio, 7.36; 95% CI, 1.89-28.62; P = .004). There was no significant difference in the prevalence of thyroid nodules between patients in this study (29 of 49 [59.2%]) vs the general population (68%) (difference, 0.088; 95% CI, -0.44 to 0.73; P = .20) or of cancer (7% vs 5%; difference, 0.01; 95% CI, -0.01 to 0.17; P = .86). CONCLUSIONS AND RELEVANCE The high prevalence of primary hypothyroidism noted in patients with alkaptonuria in this study suggests that serial screening in this population should be considered and prioritized.
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Affiliation(s)
- Shirisha Avadhanula
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
- National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
| | - Wendy J. Introne
- National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland
| | - Sungyoung Auh
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | - Steven J. Soldin
- Department of Laboratory Medicine, National Institutes of Health, Bethesda, Maryland
| | - Brian Stolze
- National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland
| | - Debra Regier
- Children’s National Rare Disease Institute, Children’s National Medical Center, Washington, DC
| | - Carla Ciccone
- National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland
| | - Fady Hannah-Shmouni
- National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
| | - Armando C. Filie
- National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Kenneth D. Burman
- Endocrine Section, Medstar Washington Hospital Center, Washington, DC
| | - Joanna Klubo-Gwiezdzinska
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
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26
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Fu J, Korwutthikulrangsri M, Gönç EN, Sillers L, Liao XH, Alikaşifoğlu A, Kandemir N, Menucci MB, Burman KD, Weiss RE, Dumitrescu AM. Clinical and Molecular Analysis in 2 Families With Novel Compound Heterozygous SBP2 (SECISBP2) Mutations. J Clin Endocrinol Metab 2020; 105:5743519. [PMID: 32084277 PMCID: PMC7034949 DOI: 10.1210/clinem/dgz169] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 02/17/2020] [Indexed: 11/19/2022]
Abstract
CONTEXT Selenocysteine insertion sequence binding protein 2 (SECISBP2, SBP2) is an essential factor for selenoprotein synthesis. Individuals with SBP2 defects have characteristic thyroid function test (TFT) abnormalities resulting from deficiencies in the selenoenzymes deiodinases. Eight families with recessive SBP2 gene mutations have been reported to date. We report 2 families with inherited defect in thyroid hormone metabolism caused by 4 novel compound heterozygous mutations in the SBP2 gene. CASE DESCRIPTIONS Probands 1 and 2 presented with growth and developmental delay. Both had characteristic TFT with high T4, low T3, high reverse T3, and normal or slightly elevated TSH. The coding region of the SBP2 gene was sequenced and analysis of in vitro translated wild-type and mutant SBP2 proteins was performed. Sequencing of the SBP2 gene identified novel compound heterozygous mutations resulting in mutant SBP2 proteins E679D and R197* in proband 1, and K682Tfs*2 and Q782* in proband 2. In vitro translation of the missense E679D demonstrated all four isoforms, whereas R197* had only 2 shorter isoforms translated from downstream ATGs, and Q782*, K682Tfs*2 expressed isoforms with truncated C-terminus. Reduction in serum glutathione peroxidase enzymatic activity was also demonstrated in both probands. CONCLUSIONS We report 2 additional families with mutations in the SBP2 gene, a rare inherited condition manifesting global selenoprotein deficiencies. Report of additional families with SBP2 deficiency and their evaluation over time is needed to determine the full spectrum of clinical manifestations in SBP2 deficiency and increase our understanding of the role played by SBP2 and selenoproteins in health and disease.
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Affiliation(s)
- Jiao Fu
- Department of Medicine, The University of Chicago, Chicago, Illinois
- Department of Endocrinology, First Affiliated Hospital of Xi’an Jiaotong University School of Medicine, Xi’an, China
| | - Manassawee Korwutthikulrangsri
- Department of Medicine, The University of Chicago, Chicago, Illinois
- Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - E Nazli Gönç
- Division of Pediatric Endocrinology, Hacettepe University, Ankara, Turkey
| | - Laura Sillers
- Department of Medicine, The University of Chicago, Chicago, Illinois
- Division of Neonatology, The Children Hospital of Philadelphia, Pennsylvania
| | - Xiao-Hui Liao
- Department of Medicine, The University of Chicago, Chicago, Illinois
| | - Ayfer Alikaşifoğlu
- Division of Pediatric Endocrinology, Hacettepe University, Ankara, Turkey
| | - Nurgün Kandemir
- Division of Pediatric Endocrinology, Hacettepe University, Ankara, Turkey
| | | | - Kenneth D Burman
- Department of Medicine, MedStar Washington Hospital Center, Washington, DC
| | - Roy E Weiss
- Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida
| | - Alexandra M Dumitrescu
- Department of Medicine, The University of Chicago, Chicago, Illinois
- Committee of Molecular Metabolism and Nutrition, The University of Chicago, Chicago, Illinois
- Correspondence and Reprint Requests: Alexandra M. Dumitrescu, MD PhD, Department of Medicine, The University of Chicago, 5841 S. Maryland Ave, Room M367, MC3090, Chicago, Ilinois 60637. E-mail:
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Affiliation(s)
- Cecilia C Low Wang
- Division of Endocrinology, Metabolism, and Diabetes, University of Colorado School of Medicine, Aurora (C.C.L.W.).,CPC Clinical Research, Aurora (C.C.L.W.)
| | - Brendan M Everett
- Divisions of Cardiovascular and Preventive Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (B.M.E.)
| | - Kenneth D Burman
- Endocrine Section, Medstar Washington Hospital Center and Georgetown University, Washington, DC (K.D.B.)
| | - Peter W F Wilson
- Atlanta VA Medical Center and Emory Cardiovascular Research Institute, GA (P.W.F.W.)
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28
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Gomes-Lima CJ, Auh S, Thakur S, Zemskova M, Cochran C, Merkel R, Filie AC, Raffeld M, Patel SB, Xi L, Wartofsky L, Burman KD, Klubo-Gwiezdzinska J. A Novel Risk Stratification System for Thyroid Nodules With Indeterminate Cytology-A Pilot Cohort Study. Front Endocrinol (Lausanne) 2020; 11:53. [PMID: 32132976 PMCID: PMC7040241 DOI: 10.3389/fendo.2020.00053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 01/28/2020] [Indexed: 01/21/2023] Open
Abstract
Background: Thyroid ultrasound (US), fine needle aspiration biopsy (FNAB), and molecular testing have been widely used to stratify the risk of malignancy in thyroid nodules. The goal of this study was to investigate a novel diagnostic approach for cytologically indeterminate thyroid nodules (ITN) based upon a combination of US features and genetic alterations. Methods: We performed a pilot cohort study of patients with ITN (Bethesda III/IV), who underwent surgical treatment. Based on standardized sonographic patterns established by the American Thyroid Association (ATA), each ITN received an US score (XUS), ranging between 0 and 0.9 according to its risk of thyroid cancer (TC). DNA and RNA were extracted from pathologic material, available for all patients, and subjected to Oncomine™ Comprehensive Assay v2 (OCAv2) next-generation sequencing. Each genetic alteration was annotated based on its strength of association with TC and its sum served as the genomic classifier score (XGC). The total risk score (TRS) was the sum of XUS and XGC. ROC curves were generated to assess the diagnostic accuracy of XUS, XGC, and TRS. Results: The study cohort consisted of 50 patients (39 females and 11 males), aged 47.5 ± 14.8 years. Three patients were excluded due to molecular testing failure. Among the remaining 47 patients, 28 (59.6%) were diagnosed with TC. BRAFV600E was the most common mutation in papillary TC, PAX8-PPARG fusion was present in NIFTP, pathogenic variants of SLX4, ATM, and NRAS were found in Hürthle cell TC and RET mutations in medullary TC. The diagnostic accuracy of XGC and TRS was significantly higher compared with XUS (88 vs. 62.5%, p < 0.001; 85.2 vs. 62.5%, p < 0.001, respectively). However, this increased accuracy was due to significantly better sensitivity (80.7 vs. 34.6%, p < 0.001; 84.6 vs. 34.6%, p < 0.001, respectively) without improved specificity (94.7 vs. 90%, p = 0.55; 85.7 vs. 90%, p = 0.63, respectively). Conclusion: Molecular testing might not be necessary in ITN with high-risk US pattern (XUS = 0.9), as specificity of TC diagnosis based on Xus alone is sufficient and not improved with molecular testing. OCAv2 is useful in guiding the management of ITN with low-to-intermediate risk US features (XUS < 0.9), as it increases the accuracy of TC diagnosis.
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Affiliation(s)
- Cristiane J. Gomes-Lima
- National Institutes of Health/National Institute of Diabetes and Digestive and Kidney Diseases (NIH/NIDDK), Bethesda, MD, United States
- MedStar Clinical Research Center, MedStar Health Research Institute (MHRI), Washington, DC, United States
| | - Sungyoung Auh
- National Institutes of Health/National Institute of Diabetes and Digestive and Kidney Diseases (NIH/NIDDK), Bethesda, MD, United States
| | - Shilpa Thakur
- National Institutes of Health/National Institute of Diabetes and Digestive and Kidney Diseases (NIH/NIDDK), Bethesda, MD, United States
| | - Marina Zemskova
- National Institutes of Health/National Institute of Diabetes and Digestive and Kidney Diseases (NIH/NIDDK), Bethesda, MD, United States
| | - Craig Cochran
- National Institutes of Health/National Institute of Diabetes and Digestive and Kidney Diseases (NIH/NIDDK), Bethesda, MD, United States
| | - Roxanne Merkel
- National Institutes of Health/National Institute of Diabetes and Digestive and Kidney Diseases (NIH/NIDDK), Bethesda, MD, United States
| | - Armando C. Filie
- National Institutes of Health/National Cancer Institute (NIH/NCI), Bethesda, MD, United States
| | - Mark Raffeld
- National Institutes of Health/National Cancer Institute (NIH/NCI), Bethesda, MD, United States
| | - Snehal B. Patel
- National Institutes of Health/National Cancer Institute (NIH/NCI), Bethesda, MD, United States
| | - Liqiang Xi
- National Institutes of Health/National Cancer Institute (NIH/NCI), Bethesda, MD, United States
| | - Leonard Wartofsky
- Division of Endocrinology, Department of Medicine Georgetown University, Washington, DC, United States
| | - Kenneth D. Burman
- Division of Endocrinology, Department of Medicine Georgetown University, Washington, DC, United States
| | - Joanna Klubo-Gwiezdzinska
- National Institutes of Health/National Institute of Diabetes and Digestive and Kidney Diseases (NIH/NIDDK), Bethesda, MD, United States
- *Correspondence: Joanna Klubo-Gwiezdzinska
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29
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Steward DL, Carty SE, Sippel RS, Yang SP, Sosa JA, Sipos JA, Figge JJ, Mandel S, Haugen BR, Burman KD, Baloch ZW, Lloyd RV, Seethala RR, Gooding WE, Chiosea SI, Gomes-Lima C, Ferris RL, Folek JM, Khawaja RA, Kundra P, Loh KS, Marshall CB, Mayson S, McCoy KL, Nga ME, Ngiam KY, Nikiforova MN, Poehls JL, Ringel MD, Yang H, Yip L, Nikiforov YE. Performance of a Multigene Genomic Classifier in Thyroid Nodules With Indeterminate Cytology: A Prospective Blinded Multicenter Study. JAMA Oncol 2019; 5:204-212. [PMID: 30419129 PMCID: PMC6439562 DOI: 10.1001/jamaoncol.2018.4616] [Citation(s) in RCA: 259] [Impact Index Per Article: 51.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Question Can the diagnosis of benign disease or cancer in thyroid nodules with indeterminate cytology be established by molecular testing instead of diagnostic surgery? Findings This prospective, blinded, multicenter cohort study of a multigene genomic classifier (ThyroSeq v3) test included 257 indeterminate cytology thyroid nodules with informative test results. It demonstrated a high sensitivity (94%) and reasonably high specificity (82%), with 61% of the nodules yielding a negative test result and only 3% residual cancer risk in these nodules. Meanings Up to 61% of patients with indeterminate cytology thyroid nodules may avoid diagnostic surgery by undergoing multigene genomic classifier testing. Importance Approximately 20% of fine-needle aspirations (FNA) of thyroid nodules have indeterminate cytology, most frequently Bethesda category III or IV. Diagnostic surgeries can be avoided for these patients if the nodules are reliably diagnosed as benign without surgery. Objective To determine the diagnostic accuracy of a multigene classifier (GC) test (ThyroSeq v3) for cytologically indeterminate thyroid nodules. Design, Setting, and Participants Prospective, blinded cohort study conducted at 10 medical centers, with 782 patients with 1013 nodules enrolled. Eligibility criteria were met in 256 patients with 286 nodules; central pathology review was performed on 274 nodules. Interventions A total of 286 FNA samples from thyroid nodules underwent molecular analysis using the multigene GC (ThyroSeq v3). Main Outcomes and Measures The primary outcome was diagnostic accuracy of the test for thyroid nodules with Bethesda III and IV cytology. The secondary outcome was prediction of cancer by specific genetic alterations in Bethesda III to V nodules. Results Of the 286 cytologically indeterminate nodules, 206 (72%) were benign, 69 (24%) malignant, and 11 (4%) noninvasive follicular thyroid neoplasms with papillary-like nuclei (NIFTP). A total of 257 (90%) nodules (154 Bethesda III, 93 Bethesda IV, and 10 Bethesda V) had informative GC analysis, with 61% classified as negative and 39% as positive. In Bethesda III and IV nodules combined, the test demonstrated a 94% (95% CI, 86%-98%) sensitivity and 82% (95% CI, 75%-87%) specificity. With a cancer/NIFTP prevalence of 28%, the negative predictive value (NPV) was 97% (95% CI, 93%-99%) and the positive predictive value (PPV) was 66% (95% CI, 56%-75%). The observed 3% false-negative rate was similar to that of benign cytology, and the missed cancers were all low-risk tumors. Among nodules testing positive, specific groups of genetic alterations had cancer probabilities varying from 59% to 100%. Conclusions and Relevance In this prospective, blinded, multicenter study, the multigene GC test demonstrated a high sensitivity/NPV and reasonably high specificity/PPV, which may obviate diagnostic surgery in up to 61% of patients with Bethesda III to IV indeterminate nodules, and up to 82% of all benign nodules with indeterminate cytology. Information on specific genetic alterations obtained from FNA may help inform individualized treatment of patients with a positive test result.
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Affiliation(s)
- David L Steward
- Department of Otolaryngology, Head and Neck Surgery, University of Cincinnati Medical Center, Cincinnati, Ohio
| | - Sally E Carty
- Division of Endocrine Surgery, University of Pittsburgh, Pittsburgh, Pennslyvania
| | | | - Samantha Peiling Yang
- Endocrinology Division, Department of Medicine, National University Hospital, Singapore, Singapore
| | - Julie A Sosa
- Section of Endocrine Surgery, Department of Surgery, Duke Cancer Institute and Duke Clinical Research Institute, Duke University, Durham, North Carolina.,Department of Surgery, University of California, San Francisco
| | - Jennifer A Sipos
- Division of Endocrinology, Diabetes, and Metabolism, The Ohio State University School of Medicine, Columbus
| | - James J Figge
- Diabetes & Endocrine Care, St Peter's Health Partners, Rensselaer, New York
| | - Susan Mandel
- Division of Endocrinology, Diabetes and Metabolism, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Bryan R Haugen
- Division of Endocrinology, Metabolism and Diabetes, University of Colorado School of Medicine, Aurora
| | - Kenneth D Burman
- Department of Medicine, Endocrinology Section, MedStar Washington Hospital Center, Washington, DC
| | - Zubair W Baloch
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Ricardo V Lloyd
- Department of Pathology and Laboratory Medicine, University of Wisconsin, Madison
| | - Raja R Seethala
- Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - William E Gooding
- Biostatistics Facility, UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania
| | - Simion I Chiosea
- Department of Medicine, Endocrinology Section, MedStar Washington Hospital Center, Washington, DC
| | - Cristiane Gomes-Lima
- Department of Medicine, Endocrinology Section, MedStar Washington Hospital Center, Washington, DC
| | - Robert L Ferris
- Departments of Otolaryngology and Immunology, UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania
| | - Jessica M Folek
- Diabetes & Endocrine Care, St Peter's Health Partners, Rensselaer, New York
| | - Raheela A Khawaja
- Division of Endocrinology, Diabetes, and Metabolism, The Ohio State University School of Medicine, Columbus
| | - Priya Kundra
- Department of Medicine, Endocrinology Section, MedStar Washington Hospital Center, Washington, DC
| | - Kwok Seng Loh
- Department of Otolaryngology-Head and Neck Surgery, National University Hospital, Singapore
| | - Carrie B Marshall
- Department of Pathology, University of Colorado School of Medicine, Aurora, Colorado
| | - Sarah Mayson
- Division of Endocrinology, Metabolism and Diabetes, University of Colorado School of Medicine, Aurora
| | - Kelly L McCoy
- Division of Endocrine Surgery, University of Pittsburgh, Pittsburgh, Pennslyvania
| | - Min En Nga
- Department of Pathology, National University Hospital, Singapore
| | - Kee Yuan Ngiam
- Department of General Surgery, University Surgical Cluster, National University Hospital, Singapore
| | | | - Jennifer L Poehls
- Division of Endocrinology, Diabetes & Metabolism, University of Wisconsin, Madison
| | - Matthew D Ringel
- Division of Endocrinology, Diabetes, and Metabolism, The Ohio State University School of Medicine, Columbus
| | - Huaitao Yang
- Department Pathology, University of Cincinnati Medical Center, Cincinnati, Ohio
| | - Linwah Yip
- Division of Endocrine Surgery, University of Pittsburgh, Pittsburgh, Pennslyvania
| | - Yuri E Nikiforov
- Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania
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30
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Fazeli S, Paal E, Maxwell JH, Burman KD, Nylen ES, Khosla SG. Salutary Response to Targeted Therapy in Anaplastic Thyroid Cancer. J Investig Med High Impact Case Rep 2019; 7:2324709619890942. [PMID: 31766881 PMCID: PMC6880026 DOI: 10.1177/2324709619890942] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Context. Anaplastic thyroid cancer (ATC) is an aggressive tumor
with a median survival of 3 to 9 months, a 1-year survival of less than 10% and
without definitive therapies. Recently, in BRAF V600E mutated
ATCs, new targeted therapy using a combination of a BRAF inhibitor, dabrafenib
(Dab), with a mitogen-activated extracellular protein kinase (MEK) inhibitor,
trametinib (Tram), has shown significant promise. Case
Description. We report a case of aggressive ATC with 5 sequence
mutations: BRAF V600E (mutation fraction [MF] 34%),
TERT E441del (MF 37%), RET N579K (MF 55%),
EZH2 D154E (MF 60%), and CDK4 S259L (MF
48%). The patient had a dramatic response to the Dab/Tram combination with near
complete resolution of his lung, bone, hepatic, and splenic lesions soon after
starting therapy. Unfortunately, intolerable side effects (grade 2-3) on this
regimen required tapering and discontinuation of the treatment. He had a quick
resurgence of disease after stopping the combination therapy. The patient died
approximately 3 months after discontinuing Dab/Tram. Autopsy revealed an
atrophic thyroid gland with microscopic subcapsular focus of well-differentiated
papillary thyroid carcinoma. There was extensive lymphatic spread of the tumor
throughout bilateral lungs with fibrosis. No other metastatic site was
identified. Conclusion. We report a unique case of ATC with 2
new mutations of EZH2 D154E and CDK S529L.
This case exemplifies the significant promise Dab/Tram therapy holds, the
potential side effects that limit their use, and autopsy findings status post
use of this combination therapy.
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Affiliation(s)
- Sasan Fazeli
- George Washington University Medical Faculty Associates, Washington, DC, USA.,Washington DC VA Medical Center, Washington, DC, USA
| | - Edina Paal
- Washington DC VA Medical Center, Washington, DC, USA.,George Washington University, Washington, DC, USA
| | - Jessica H Maxwell
- Washington DC VA Medical Center, Washington, DC, USA.,MedStar Georgetown University Medical Center, Washington, DC, USA
| | - Kenneth D Burman
- MedStar Georgetown University Medical Center, Washington, DC, USA.,MedStar Washington Hospital Center, Washington, DC, USA
| | - Eric S Nylen
- George Washington University Medical Faculty Associates, Washington, DC, USA.,Washington DC VA Medical Center, Washington, DC, USA
| | - Shikha G Khosla
- George Washington University Medical Faculty Associates, Washington, DC, USA.,Washington DC VA Medical Center, Washington, DC, USA
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31
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Wu D, Ylli D, Heimlich SL, Burman KD, Wartofsky L, Van Nostrand D. 124I Positron Emission Tomography/Computed Tomography Versus Conventional Radioiodine Imaging in Differentiated Thyroid Cancer: A Review. Thyroid 2019; 29:1523-1535. [PMID: 31452449 DOI: 10.1089/thy.2018.0598] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [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: 01/23/2023]
Abstract
Background: Studies report a wide spectrum of 124I positron emission tomography (PET)/computed tomography (CT) sensitivity and specificity in the detection of differentiated thyroid cancer (DTC) lesions. This study reviews the lesion detection rate of pretherapy 124I PET/CT in different patient populations and further analyzes the factors necessary for a better detection on 124I PET/CT. Methods: A literature search was performed using multiple different databases (MEDLINE, EMBASE, Northern Lights, and handsearching) covering 1996 to April 2018. Two reviewers reviewed and extracted study data for 124I, 123I, and 131I scans in DTC. Results: This review includes 4 retrospective and 10 prospective studies in which 495 DTC patients underwent 124I and 131I imaging; no studies made comparisons with 123I. In the reports that compared 124I PET/CT with diagnostic 131I scans, there were a total of 72 patients in whom 120 lesions were detected on 124I imaging, whereas only 52 were detected on diagnostic 131I scans. In publications that compared 124I with post-therapy 131I scans in 266 patients, 410 lesions were detected with 124I PET, whereas 390 were detected on post-therapy 131I scans. Based on 124I PET/CT in six studies, TNM staging was revised in 15-21% of patients, and disease management was altered in 5-29% of patients. Conclusions:124I PET/CT is able to identify a greater number of foci compared with diagnostic 131I scans. 124I PET may have better detection compared with post-therapy 131I scans in patients who are 131I therapy naive, have less aggressive pathology, or do not have disseminated lung metastases. Additional metastatic lesion detection by 124I PET may have a significant clinical impact in the management of patients before 131I therapy in some patients.
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Affiliation(s)
- Di Wu
- MedStar Health Research Institute, Hyattsville, Maryland
- Nuclear Medicine Research, MedStar Washington Hospital Center, Washington, District of Columbia
| | - Dorina Ylli
- MedStar Health Research Institute, Hyattsville, Maryland
- Division of Endocrinology, MedStar Washington Hospital Center, Washington, District of Columbia
| | - S Layla Heimlich
- William. B. Glew, MD, Health Sciences Library, MedStar Washington Hospital Center, Washington, District of Columbia
| | - Kenneth D Burman
- Division of Endocrinology, MedStar Washington Hospital Center, Washington, District of Columbia
| | - Leonard Wartofsky
- Division of Endocrinology, MedStar Washington Hospital Center, Washington, District of Columbia
| | - Douglas Van Nostrand
- MedStar Health Research Institute, Hyattsville, Maryland
- Nuclear Medicine Research, MedStar Washington Hospital Center, Washington, District of Columbia
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32
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Shobab L, Gomes-Lima C, Zeymo A, Feldman R, Jonklaas J, Wartofsky L, Burman KD. Clinical, Pathological, and Molecular Profiling of Radioactive Iodine Refractory Differentiated Thyroid Cancer. Thyroid 2019; 29:1262-1268. [PMID: 31319763 DOI: 10.1089/thy.2019.0075] [Citation(s) in RCA: 25] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background: Six to 20% of thyroid cancer (TC) patients develop distant metastases, and one-third become radioiodine refractory (RAIR). Available targeted therapies increase progression-free survival but are associated with toxicities. This study aims to characterize clinical, pathological, and molecular profiles of patients with RAIR TC. Methods: Data of TC patients seen during 2013-2017 at two tertiary care centers were retrospectively analyzed. Patients were considered RAIR according to American Thyroid Association guidelines. The control cohort was sex matched and age matched and had either regression or stable disease (by Response Evaluation Criteria in Solid Tumors) on follow-up at least three years after initial therapy. Molecular profiles on a subset of RAIR patients were reviewed. Results: Compared with 22 matched controls, 54 RAIR patients had an average age of 57 years (standard deviation [SD] = 13), 56% were male (41% in the control group); the average tumor size was 4 cm (SD = 2.5); tumors were multifocal in 54%, with involved surgical margins in 42%, focal invasion in 79%, and extrathyroidal extension (ETE) in 61%. Sixty-six percent had distant metastases at initial presentation with metastases to the lungs in 85%, bone in 56%, both sites in 43%, brain in 9%, and liver in 4%. There were no statistically significant differences between RAIR and controls in tumor size, focal invasion, ETE, and histology. The RAIR group received a higher cumulative radioactive iodine (RAI) dose and number of therapies compared with the controls (518 mCi vs. 302 mCi, p = 0.002 and 2.2 vs. 1.3 treatments, p = 0.001). Overall, patients >46 years had 4.5 times higher odds ratio (OR) of being RAIR; white race/ethnicity was associated with a reduced OR of RAIR disease (OR 0.33, p = 0.079). Molecular profiling data in the RAIR subgroup indicated that 50% of patients harbored mutations in the RAS/RAF pathway (11/22). Among 19 patients with a more extensive molecular panel, median tumor mutational burden was 5 megabase (range 3-16) and 26% (5/19) exhibited strong PD-L1 positivity. Conclusion: Among patients with metastatic differentiated thyroid carcinomas, patients with RAIR have similar histopathological and clinical characteristics as patients with RAI avid cancer. The risk of having RAIR TC is increased at age ≥46 and reduced in Caucasians.
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Affiliation(s)
- Leila Shobab
- MedStar Washington Hospital Center, Division of Endocrinology, Washington, District of Columbia
| | - Cristiane Gomes-Lima
- MedStar Washington Hospital Center, Division of Endocrinology, Washington, District of Columbia
| | - Alexander Zeymo
- Medstar Health Research Institute, Department of Research Biostatistics, Washington, District of Columbia
| | | | - Jacqueline Jonklaas
- MedStar Georgetown University Hospital, Division of Endocrinology, Washington, District of Columbia
| | - Leonard Wartofsky
- MedStar Washington Hospital Center, Division of Endocrinology, Washington, District of Columbia
| | - Kenneth D Burman
- MedStar Washington Hospital Center, Division of Endocrinology, Washington, District of Columbia
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33
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Wu D, Gomes Lima CJ, Bloom G, Burman KD, Wartofsky L, Van Nostrand D. Nationwide Survey on Implementation of 2011 Nuclear Regulatory Commission Policy on Release of Patients After 131I Therapy for Thyroid Cancer. J Nucl Med 2019; 61:397-404. [PMID: 31451488 DOI: 10.2967/jnumed.119.230730] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 05/02/2019] [Accepted: 08/05/2019] [Indexed: 11/16/2022] Open
Abstract
The objective of this nationwide survey was to evaluate whether there has been a change in the practice regarding hospital release of differentiated thyroid cancer patients treated with 131I since the publication of Nuclear Regulatory Commission Regulatory Issue Summary 2011-01 addressing patient release. Methods: A survey was emailed to approximately 25,000 members of ThyCa: Thyroid Cancer Survivors' Association, Inc., and was available online from March to August 2018. Responses were included from adult patients regarding their most recent 131I therapy received between 2011 and 2018 ("after 2011"). Responses to this survey were compared with those of a similar previous survey for 131I therapies received between 1997 and 2009 ("before 2009"). Results: Of the 2,136 responses, 1,111 met the inclusion criteria. A similar percentage (∼98%) of patients were given oral or written radiation safety instructions (RSIs) after 2011 and before 2009, with a shift away from nuclear medicine physicians providing instructions after 2011 (43%) in comparison with before 2009 (54%; P < 0.001). More patients were able to discuss and individualize the RSIs after 2011 (67%) than before 2009 (29%; P < 0.001). However, 2% of patients do not recall ever receiving RSIs after 2011. After 2011, more patients were treated as outpatients (87%) than before 2009 (66%; P < 0.001). For outpatients, more patients were discharged within 30 min after receiving 131I therapy after 2011 (78%) than before 2009 (72%; P = 0.002). The same percentage (0.6%) of patients traveled more than 2 h with at least 2 occupants in the vehicle within approximately 1 m of the patient after 2011 and before 2009. Immediately after therapy, a similar percentage of patients stayed in a nonprivate residence after 2011 (4%) and before 2009 (5%; P = 0.28). Of the 27 outpatients released within 30 min to nonprivate residences, 2 patients received 5.55-11.1 GBq (150-299 mCi) of 131I. Conclusion: This survey suggests that since publication of the Nuclear Regulatory Commission Regulatory Issue Summary 2011-01 on patient release after radioiodine therapy, there have been improvements in some radiation safety practices on release of outpatients, as well as improvements in patient compliance on travel and lodging.
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Affiliation(s)
- Di Wu
- MedStar Health Research Institute, Hyattsville, Maryland.,Nuclear Medicine Research, MedStar Washington Hospital Center, Washington, District of Columbia
| | - Cristiane J Gomes Lima
- MedStar Health Research Institute, Hyattsville, Maryland.,Division of Endocrinology, MedStar Washington Hospital Center, Washington, District of Columbia; and
| | - Gary Bloom
- ThyCa: Thyroid Cancer Survivors' Association, Inc., New York, New York
| | - Kenneth D Burman
- Division of Endocrinology, MedStar Washington Hospital Center, Washington, District of Columbia; and
| | - Leonard Wartofsky
- MedStar Health Research Institute, Hyattsville, Maryland.,Division of Endocrinology, MedStar Washington Hospital Center, Washington, District of Columbia; and
| | - Douglas Van Nostrand
- MedStar Health Research Institute, Hyattsville, Maryland .,Nuclear Medicine Research, MedStar Washington Hospital Center, Washington, District of Columbia
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34
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Wu D, Gomes Lima CJ, Moreau SL, Kulkarni K, Zeymo A, Burman KD, Wartofsky L, Van Nostrand D. Improved Survival After Multimodal Approach with 131I Treatment in Patients with Bone Metastases Secondary to Differentiated Thyroid Cancer. Thyroid 2019; 29:971-978. [PMID: 31017051 DOI: 10.1089/thy.2018.0582] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [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: 11/13/2022]
Abstract
Background: The objective of this study was to evaluate the overall survival (OS) of radioiodine (131I) treatments alone or combined with non-131I treatments in patients with bone metastases (BM) of differentiated thyroid cancer (DTC). Methods: This was a retrospective study of patients who were evaluated between 2001 and 2018 at MedStar Washington Hospital Center and who had DTC, BM, and at least one 131I treatment after the diagnosis of BM. The OS was analyzed by Kaplan-Meier survival curves and was compared by log-rank test between two groups: patients who received 131I treatments alone and those who received treatments combining 131I with non-131I treatments (CombTx). Non-131I treatments include surgery, radiofrequency ablation, cryotherapy, arterial embolization, external beam radiation, Cyberknife, systemic targeted therapy, and anti-resorptive medication. Results: A total of 77 patients met the above criteria and were followed up to 41 years. Thirty percent (23/77) of patients received 131I treatment alone, and 70% (54/77) received CombTx. For 131I treatment alone, the median survival was 3.9 years, and the 1-, 2-, 3-, 5-, and 10-year OS rates were 86%, 81%, 61%, 35%, and 23%, respectively. For CombTx, the median survival was 7.7 years, and the 1-, 2-, 3-, 5-, and 10-year OS rates were 96%, 92%, 86%, 69%, and 30%, respectively. Patients who had undergone initial 131I therapy within six months post thyroidectomy demonstrated a better median survival after BM diagnosis than those whose initial 131I therapy was six months or more after thyroidectomy (6.5 vs. 0.5 years; p < 0.001). Patients who received external beam radiation therapy demonstrated a better median survival than those who did not (7.8 vs. 4.4 years; p = 0.016). Patients who received denosumab demonstrated a better median survival than those who did not (7.7 vs. 5.2 years; p = 0.03). Patients who were <55 years of age at the initial diagnosis of DTC or at the initial diagnosis of BM had a better median OS than those diagnosed at ≥55 years of age (both p = 0.01). In the multivariate analysis, only age at initial diagnosis of DTC and initial 131I therapy within six months post thyroidectomy, and multiple 131I treatments were independent prognostic factors. Conclusions: In patients with DTC with BM, 131I treatment in combination with one or more non-131I direct and systemic treatments was associated with a significant increase in OS compared with those patients who were treated by 131I treatment alone.
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Affiliation(s)
- Di Wu
- 1MedStar Clinical Research Center, MedStar Health Research Institute, Hyattsville, Maryland
- 2Nuclear Medicine Research, MedStar Washington Hospital Center, Washington, DC
| | - Cristiane J Gomes Lima
- 1MedStar Clinical Research Center, MedStar Health Research Institute, Hyattsville, Maryland
- 3Division of Endocrinology, MedStar Washington Hospital Center, Washington, DC
| | - Shari L Moreau
- 4Division of Nuclear Medicine, MedStar Washington Hospital Center, Washington, DC
| | - Kanchan Kulkarni
- 4Division of Nuclear Medicine, MedStar Washington Hospital Center, Washington, DC
| | - Alexander Zeymo
- 5Department of Biostatistics and Biomedical Informatics, MedStar Health Research Institute, Hyattsville, Maryland
| | - Kenneth D Burman
- 3Division of Endocrinology, MedStar Washington Hospital Center, Washington, DC
| | - Leonard Wartofsky
- 3Division of Endocrinology, MedStar Washington Hospital Center, Washington, DC
| | - Douglas Van Nostrand
- 1MedStar Clinical Research Center, MedStar Health Research Institute, Hyattsville, Maryland
- 2Nuclear Medicine Research, MedStar Washington Hospital Center, Washington, DC
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Gomes-Lima CJ, Kwagyan J, King F, Fernandez SJ, Burman KD, Veytsman I. A comprehensive meta-analysis of endocrine immune-related adverse events of immune checkpoint inhibitors and outcomes in head and neck cancer and lung cancer. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.e14096] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
e14096 Background: Immune checkpoint inhibitors (ICPi) have emerged as an effective treatment for a variety of cancers. However, important immune-related adverse events (irAEs) can occur. The aim of this study was to determine the prevalence of endocrine irAEs in patients with head and neck cancer and lung cancer that have used a ICPi and outcomes. Methods: A systematic literature review was performed within PubMed and EMBASE databases. Search terms included “durvalumab”, “atezolizumab”, “nivolumab”, “pembrolizumab”, “ipilimumab”, “head & neck cancer”, “lung cancer”. Studies published before September 2018 were included. The search was limited to randomized controlled trials (RCTs) phase III written in English. Data were extracted about patient characteristics, interventions, overall survival (OS), progression free survival (PFS), and endocrine irAEs. A summary hazard ratio (HR) and 95% confidence interval were calculated using the software Comprehensive Meta-Analysis and a scatter plot was generated. Results: Twelve RCTs comprising 7060 patients were reviewed; 3815 used an ICPi (treatment arm). The mean follow-up time of 12.2 months ± 7.1 SD. The survival rate of the treatment arm was enhanced (HR, 0.75; 95% CI, 0.70-0.80), compared to the alternate arm. Similarly, the PFS of the treatment arm was improved (HR, 0.77; 95% CI, 0.72-0.81) but with a higher incidence of endocrine irAEs. The most common endocrine irAE reported was hypothyroidism;193 patients in the treatment arm vs. 29 in the alternate arm (p < 0.001); grade 3/4 AE was observed in 10 patients vs. 1 patient, respectively. Other endocrine irAEs were reported in 168 patients in the treatment arm vs. 26 patients in the alternate arm (p < 0.001); grade 3/4 AE was observed in 28 patients vs. 3 patients, respectively. A significant positive correlation between endocrine irAEs and OS was observed (p = 0.019). Conclusions: ICPi are a powerful tool in the treatment of cancer. The prevalence of endocrine irAEs in this meta-analysis was 9%. There is evidence of improved overall survival in patients who developed endocrine irAEs. Further studies are needed to correlate the development of irAEs and OS advantage.
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Affiliation(s)
| | | | - Fred King
- MedStar Washington Hospital Center, Washington, DC
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Affiliation(s)
- Kenneth A. Newkirk
- Department of Otolaryngology, Georgetown University Medical Center and Washington Hospital Center, Washington, D.C
| | - Matthew D. Ringel
- Section of Endocrinology, Department of Medicine, Medlantic Research Institute, Washington Hospital Center, Washington, D.C
| | - Leonard Wartofsky
- Section of Endocrinology, Department of Medicine, Medlantic Research Institute, Washington Hospital Center, Washington, D.C
| | - Kenneth D. Burman
- Department of Otolaryngology, Georgetown University Medical Center and Washington Hospital Center, Washington, D.C
- Section of Endocrinology, Department of Medicine, Medlantic Research Institute, Washington Hospital Center, Washington, D.C
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37
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Gomes-Lima CJ, Wu D, Rao SN, Punukollu S, Hritani R, Zeymo A, Deeb H, Mete M, Aulisi EF, Van Nostrand D, Jonklaas J, Wartofsky L, Burman KD. Brain Metastases From Differentiated Thyroid Carcinoma: Prevalence, Current Therapies, and Outcomes. J Endocr Soc 2019; 3:359-371. [PMID: 30706042 PMCID: PMC6348752 DOI: 10.1210/js.2018-00241] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [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: 08/08/2018] [Accepted: 11/16/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND AND OBJECTIVE The brain is an unusual site for distant metastases of differentiated thyroid carcinoma (DTC). The aim of this study was to document the prevalence of brain metastases from DTC at our institutions and to analyze the current therapies and the outcomes of these patients. METHODS We performed a retrospective chart review of patients with DTC and secondary neoplasia of the brain. RESULTS From 2002 to 2016, 9514 cases of thyroid cancer were evaluated across our institutions and 24 patients met our inclusion criteria, corresponding to a prevalence of 0.3% of patients with DTC. Fourteen (58.3%) were female and 10 (41.7%) were male. Fifteen patients had papillary thyroid cancer (PTC) (62.5%). Brain metastases were diagnosed 0 to 37 years (mean ± SD, 10.6 ± 10.4 years) after the initial diagnosis of thyroid cancer. Patients undergoing surgery had a median survival time longer than those that did not undergo surgery (27.3 months vs 6.8 months; P = 0.15). Patients who underwent stereotactic radiosurgery (SRS) had a median survival time longer than those that did not receive SRS (52.5 months vs 6.7 months; P = 0.11). Twelve patients (50%) were treated with tyrosine kinase inhibitors (TKIs), and they had a better survival than those who have not used a TKI (median survival time, 27.2 months vs 4.7 months; P < 0.05). CONCLUSION The prevalence of brain metastases of DTC in our institutions was 0.3% over 15 years. The median survival time after diagnosis of brain metastases was 19 months. In our study population, the use of TKI improved the survival rates.
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Affiliation(s)
- Cristiane J Gomes-Lima
- MedStar Clinical Research Center, MedStar Health Research Institute, Washington, District of Columbia
- Section of Endocrinology, MedStar Washington Hospital Center, Washington, District of Columbia
| | - Di Wu
- MedStar Clinical Research Center, MedStar Health Research Institute, Washington, District of Columbia
- Nuclear Medicine Research, MedStar Washington Hospital Center, Washington, District of Columbia
| | - Sarika N Rao
- Section of Endocrinology, MedStar Washington Hospital Center, Washington, District of Columbia
- Division of Endocrinology, Department of Medicine, Georgetown University, Washington, District of Columbia
| | - Sree Punukollu
- Resident Internal Medicine - MedStar Washington Hospital Center, Washington, District of Columbia
| | - Rama Hritani
- Resident Internal Medicine - MedStar Washington Hospital Center, Washington, District of Columbia
| | - Alexander Zeymo
- Department of Biostatistics and Biomedical Informatics, MedStar Health Research Institute, Washington, District of Columbia
| | - Hala Deeb
- Department of Biostatistics and Biomedical Informatics, MedStar Health Research Institute, Washington, District of Columbia
| | - Mihriye Mete
- Department of Biostatistics and Biomedical Informatics, MedStar Health Research Institute, Washington, District of Columbia
| | - Edward F Aulisi
- Department of Neurosurgery, MedStar Washington Hospital Center, Washington, District of Columbia
| | - Douglas Van Nostrand
- MedStar Clinical Research Center, MedStar Health Research Institute, Washington, District of Columbia
- Nuclear Medicine Research, MedStar Washington Hospital Center, Washington, District of Columbia
| | - Jacqueline Jonklaas
- Division of Endocrinology, Department of Medicine, Georgetown University, Washington, District of Columbia
| | - Leonard Wartofsky
- Section of Endocrinology, MedStar Washington Hospital Center, Washington, District of Columbia
| | - Kenneth D Burman
- Section of Endocrinology, MedStar Washington Hospital Center, Washington, District of Columbia
- Division of Endocrinology, Department of Medicine, Georgetown University, Washington, District of Columbia
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Saini S, Maker AV, Burman KD, Prabhakar BS. Molecular aberrations and signaling cascades implicated in the pathogenesis of anaplastic thyroid cancer. Biochim Biophys Acta Rev Cancer 2018; 1872:188262. [PMID: 30605717 DOI: 10.1016/j.bbcan.2018.12.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 12/05/2018] [Accepted: 12/06/2018] [Indexed: 01/16/2023]
Abstract
Anaplastic Thyroid Cancer (ATC) accounts for >40% thyroid cancer-related deaths and has a dismal prognosis. In the past decade, significant efforts have been made towards understanding the pathogenesis of this disease and developing novel therapeutics. Unfortunately, effective treatment is still lacking and a more thorough understanding of ATC pathogenesis may provide new opportunities to improve ATC therapeutics. This review provides insights into ATC clinical presentation and pathology, and the putative role of genetic aberrations and alterations in molecular signaling pathways in ATC pathogenesis. We reviewed prevalent mutations, chromosomal abnormalities and fusions, epigenetic alterations and dysregulations in ATC, and highlighted several signaling cascades which appeared to be integral to ATC pathogenesis. Moreover, these features offer insights into de-differentiated, aggressive and drug-resistant phenotype of ATC, and thus may help in exploring potential new molecular targets for developing novel therapeutics.
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Affiliation(s)
- Shikha Saini
- Department of Microbiology and Immunology, University of Illinois-College of Medicine, Chicago, IL, United States
| | - Ajay V Maker
- Department of Surgery, Division of Surgical Oncology, University of Illinois-College of Medicine, Chicago, IL, United States
| | - Kenneth D Burman
- Medstar Washington Hospital Medical Center, Washington, DC, United States
| | - Bellur S Prabhakar
- Department of Microbiology and Immunology, University of Illinois-College of Medicine, Chicago, IL, United States; Jesse Brown VA Medical Center, Chicago, IL, United States.
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Affiliation(s)
- Cristiane Gomes-Lima
- Research Fellow, MedStar Health Research Institute, MedStar Washington Hospital Center, Washington, DC, USA
| | - Kenneth D Burman
- Division of Endocrinology, MedStar Washington Hospital Center, Washington, DC, USA.
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40
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Bikas A, Wu D, Bethancourt E, Orquiza M, Bloom G, Burman KD, Wartofsky L, Van Nostrand D. Detection at Public Facilities of 131I in Patients Treated for Differentiated Thyroid Cancer: Frequency, Sites, Management by Security Agents, and Physician Documentation Recommended for Patients. J Nucl Med 2018; 60:638-643. [PMID: 30361377 DOI: 10.2967/jnumed.118.213256] [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: 04/19/2018] [Accepted: 10/03/2018] [Indexed: 11/16/2022] Open
Abstract
Patients treated with 131I may be identified at security checkpoints at various public facilities. The objective of this survey was to determine the frequency of detection, the spectrum of public facilities, the various methods of management of the situation by security agents, and the spectrum of physician documentation for patients regarding their 131I therapy. Methods: Data were tabulated from a Thyroid Cancer Survivors' Association, Inc., survey emailed to approximately 15,000 associates and available online from December 2013 to December 2014. Responses were tabulated from respondents who reported that they were 18 y old or older, had received at least 1 131I treatment for differentiated thyroid cancer, and were responding regarding their last 131I treatment. Results: Of 621 respondents, 595 reported an attempt to pass through a public facility security checkpoint. Of these 595 patients, approximately 10% (57) were identified as being radioactive. The facility reported by 43 respondents was an airport for 35% (15), border crossing for 33% (14), government building for 19% (8), shopping mall for 7% (3), train station for 5% (2), and steel recycling plant for 2% (1). The security agent's management of the situation reported by 47 respondents included questioning for 81% (38), allowing them to proceed without a change in travel plans for 57% (27), requesting documentation of the therapy for 55% (26), rescanning for 55% (26), calling a member of the treating team for validation for 17% (8), "strip" searching for 4% (2), detaining such that a change in travel plans was required for 6% (3), and prohibiting continued travel for 4% (2). The period of detainment reported by these 47 respondents was less than 30 min for 57% (27), 30 to less than 60 min for 21% (10), 1 to less than 1.5 h for 15% (7), 1.5 to less than 2 h for 2% (1), 2-4 h for 0% (0), and greater than 4 h for 4% (2). Data regarding physician documentation are presented. Conclusion: The detection of radioactivity at a variety of security checkpoints at public facilities after131I therapy occurred in approximately 10% of respondents. Travel inconvenience is not infrequent and may require alteration of travel plans. Physicians should take steps to ensure that patients not only have appropriate documentation of their 131I therapy with them but also have instructions regarding how security agents may verify their 131I therapy.
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Affiliation(s)
- Athanasios Bikas
- Department of Internal Medicine, MedStar Georgetown University Hospital, Washington, District of Columbia
| | - Di Wu
- MedStar Clinical Research Center, MedStar Health Research Institute, Hyattsville, Maryland.,Nuclear Medicine Research, MedStar Washington Hospital Center, Washington, District of Columbia
| | - Evelyn Bethancourt
- Division of Nuclear Medicine, MedStar Washington Hospital Center, Washington, District of Columbia
| | - Michael Orquiza
- Division of Nuclear Medicine, MedStar Washington Hospital Center, Washington, District of Columbia
| | - Gary Bloom
- Thyroid Cancer Survivors' Association, Inc., New York, New York; and
| | - Kenneth D Burman
- Division of Endocrinology, MedStar Washington Hospital Center, Washington, District of Columbia
| | - Leonard Wartofsky
- MedStar Clinical Research Center, MedStar Health Research Institute, Hyattsville, Maryland.,Division of Endocrinology, MedStar Washington Hospital Center, Washington, District of Columbia
| | - Douglas Van Nostrand
- MedStar Clinical Research Center, MedStar Health Research Institute, Hyattsville, Maryland .,Division of Nuclear Medicine, MedStar Washington Hospital Center, Washington, District of Columbia
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Abstract
Thyroid cancer incidence is increasing at an alarming rate, almost tripling every decade. In 2017, it was the fifth most common cancer in women. Although the majority of thyroid tumors are curable, about 2-3% of thyroid cancers are refractory to standard treatments. These undifferentiated, highly aggressive and mostly chemo-resistant tumors are phenotypically-termed anaplastic thyroid cancer (ATC). ATCs are resistant to standard therapies and are extremely difficult to manage. In this review, we provide the information related to current and recently emerged first-line systemic therapy (Dabrafenib and Trametinib) along with promising therapeutics which are in clinical trials and may be incorporated into clinical practice in the future. Different categories of promising therapeutics such as Aurora kinase inhibitors, multi-kinase inhibitors, epigenetic modulators, gene therapy using oncolytic viruses, apoptosis-inducing agents, and immunotherapy are reviewed. Combination treatment options that showed synergistic and antagonistic effects are also discussed. We highlight ongoing clinical trials in ATC and discuss how personalized medicine is crucial to design the second line of treatment. Besides using conventional combination therapy, embracing a personalized approach based on advanced genomics and proteomics assessment will be crucial to developing a tailored treatment plan to improve the chances of clinical success.
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Affiliation(s)
- Shikha Saini
- Department of Microbiology and Immunology, University of Illinois-College of Medicine, Chicago, IL USA
| | - Kiara Tulla
- Department of Surgery, Division of Surgical Oncology, University of Illinois-College of Medicine, Chicago, IL USA
| | - Ajay V. Maker
- Department of Microbiology and Immunology, University of Illinois-College of Medicine, Chicago, IL USA
- Department of Surgery, Division of Surgical Oncology, University of Illinois-College of Medicine, Chicago, IL USA
| | | | - Bellur S. Prabhakar
- Department of Microbiology and Immunology, University of Illinois-College of Medicine, Chicago, IL USA
- Jesse Brown VA Medical Center, Chicago, IL USA
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42
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Wu D, Ylli D, Gomes Lima CJ, Lee W, Burman KD, Wartofsky L, Van Nostrand D. Use of 99mTc-sestamibi SPECT/CT when conventional imaging studies are negative for localizing suspected recurrence in differentiated thyroid cancer: a method and a lesson for clinical management. Endocrine 2018; 62:57-63. [PMID: 29797211 DOI: 10.1007/s12020-018-1636-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 03/22/2018] [Accepted: 05/14/2018] [Indexed: 10/16/2022]
Abstract
PURPOSE The detection of recurrent disease in differentiated thyroid cancer (DTC) patients with elevated or rising serum thyroglobulin (Tg) levels and multiple negative conventional imaging studies can be challenging, especially when 18F-FDG PET/CT scan is also negative. We report a patient and review the literature on the diagnostic use of 99mTc-sestamibi scans to identify the source of elevated or rising Tg in patients with negative conventional imaging including negative 18F-FDG PET/CT scans. PATIENT AND METHODS A 73-year-old woman was referred for widely-invasive metastatic follicular thyroid cancer with bone metastasis to her left mandible. She had a total thyroidectomy, left mandibular resection, and 131I therapy of 145 mCi (5.4 GBq) and her subsequent unstimulated serum Tg level was 29 ng/ml (TgAb negative). At six months' follow-up, her stimulated Tg was 527 ng/ml (TSH 188 mIU/L, TgAb negative). All imaging studies performed within the prior 12 months were reported as negative for recurrence or metastasis; this included neck ultrasound, diagnostic radioiodine scan, chest CT and, 18F-FDG PET/CT. The patient was injected with 24.6 mCi (910 MBq) of 99mTc-sestamibi intravenously, and whole-body and SPECT/CT images were acquired. RESULTS The 99mTc-sestamibi whole-body posterior image demonstrated abnormal focal uptake in the right posterior calvarium and corresponded to an occipital lytic bone lesion on the SPECT/CT. The patient underwent surgical resection of the skull metastasis, and pathology confirmed metastatic follicular thyroid cancer. Five months post-surgery, the suppressed Tg was markedly reduced and remained stable at ~3.2 ng/ml. With the knowledge of the DTC recurrence location, the two sets of 18F-FDG images were re-evaluated. The more thorough and targeted interpretation underscored the importance of structured image reporting. The current literature on the utility of 99mTc-sestamibi scans when radioiodine, 18F-FDG PET/CT, and other imaging studies are negative is sparse and inconsistent. CONCLUSIONS 99mTc-sestamibi may have a role in thyroid cancer localization when physical exam, neck ultrasound, radioiodine scan, chest/abdomen CT, and 18F-FDG PET/CT does not identify the source of elevated Tg levels in DTC.
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Affiliation(s)
- Di Wu
- MedStar Clinical Research Center, MedStar Health Research Institute, 6525 Belcrest Road #700, Hyattsville, MD, 20782, USA
- Nuclear Medicine Research, MedStar Washington Hospital Center, 110 Irving Street NW, Washington, DC, 20010, USA
| | - Dorina Ylli
- MedStar Clinical Research Center, MedStar Health Research Institute, 6525 Belcrest Road #700, Hyattsville, MD, 20782, USA
- Division of Endocrinology, MedStar Washington Hospital Center, 110 Irving Street NW, Washington, DC, 20010, USA
| | - Cristiane J Gomes Lima
- MedStar Clinical Research Center, MedStar Health Research Institute, 6525 Belcrest Road #700, Hyattsville, MD, 20782, USA
- Division of Endocrinology, MedStar Washington Hospital Center, 110 Irving Street NW, Washington, DC, 20010, USA
| | - Wen Lee
- Department of Pathology, MedStar Washington Hospital Center, 110 Irving St NW, Suite BB-21B, Washington, DC, 20010, USA
| | - Kenneth D Burman
- Division of Endocrinology, MedStar Washington Hospital Center, 110 Irving Street NW, Washington, DC, 20010, USA
| | - Leonard Wartofsky
- MedStar Clinical Research Center, MedStar Health Research Institute, 6525 Belcrest Road #700, Hyattsville, MD, 20782, USA
- Division of Endocrinology, MedStar Washington Hospital Center, 110 Irving Street NW, Washington, DC, 20010, USA
| | - Douglas Van Nostrand
- MedStar Clinical Research Center, MedStar Health Research Institute, 6525 Belcrest Road #700, Hyattsville, MD, 20782, USA.
- Nuclear Medicine Research, MedStar Washington Hospital Center, 110 Irving Street NW, Washington, DC, 20010, USA.
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43
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Wu D, Khorjekar G, Kharazi P, Moreau S, Kulkarni K, Burman KD, Wartofsky L, Van Nostrand D. Poor patient compliance with instructions for continuous sialogogues after 131 I therapy. Oral Dis 2018; 25:158-163. [PMID: 30169900 DOI: 10.1111/odi.12969] [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: 05/17/2018] [Revised: 07/05/2018] [Accepted: 08/22/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To analyze the role of patient compliance as a factor in evaluating the effectiveness of continuous sialogogues to prevent salivary side effects from 131 I therapy in differentiated thyroid cancer patients. METHODS Differentiated thyroid cancer patients who were clinically scheduled for an 131 I therapy at MedStar Washington Hospital Center between 2012 and 2013 were given instructions for continuous sialogogues per standard clinical protocol. The prospective survey was given at multiple time points. RESULTS Ninety-nine patients consented to participate of whom 94 participants had complete data. The mean prescribed 131 I activity was 121 ± 50 mCi (4.5 ± 1.9 GBq), range 27.5-288 mCi (1.0-10.7 GBq ). Overall, only 10% (9/94) of patients were compliant with continuous sialogogues. Even though all patients took sialogogues on the first day of post-therapy, 17% of participants did not continuously take sialogogues during the first day, 60% during the first night, and 72% on the second day despite rigorous instructions to continue for two days. CONCLUSION Despite repetitive instructions to use sialogogues continuously, most patients (90%) were not compliant. In future studies, strict monitoring and evaluation of patient compliance will be crucial when assessing the effect of continuous versus intermittent or delayed initiation of sialogogues.
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Affiliation(s)
- Di Wu
- MedStar Clinical Research Center, MedStar Health Research Institute, Hyattsville, Maryland.,Nuclear Medicine Research, MedStar Washington Hospital Center, Washington, District of Columbia
| | - Gauri Khorjekar
- Department of Radiology and Nuclear Medicine, University of Maryland Medical Center, Baltimore, Maryland
| | | | - Shari Moreau
- Division of Nuclear Medicine, MedStar Washington Hospital Center, Washington, District of Columbia
| | - Kanchan Kulkarni
- Division of Nuclear Medicine, MedStar Washington Hospital Center, Washington, District of Columbia
| | - Kenneth D Burman
- Division of Endocrinology, MedStar Washington Hospital Center, Washington, District of Columbia
| | - Leonard Wartofsky
- Division of Endocrinology, MedStar Washington Hospital Center, Washington, District of Columbia.,MedStar Health Research Institute, Hyattsville, Maryland
| | - Douglas Van Nostrand
- Division of Nuclear Medicine, MedStar Washington Hospital Center, Washington, District of Columbia.,MedStar Health Research Institute, Hyattsville, Maryland
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Gomes-Lima CJ, Nikiforov YE, Lee W, Burman KD. Synchronous Independent Papillary Thyroid Carcinomas in Struma Ovarii and the Thyroid Gland With Different RAS Mutations. J Endocr Soc 2018; 2:944-948. [PMID: 30087949 PMCID: PMC6065485 DOI: 10.1210/js.2018-00132] [Citation(s) in RCA: 10] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 07/05/2018] [Indexed: 11/29/2022] Open
Abstract
Struma ovarii is a rare ovarian teratoma predominantly composed of thyroid tissue. The simultaneous presence of thyroid carcinoma in the struma ovarii and the thyroid gland is extremely rare. It remains unclear if these carcinomas represent independent primary tumors and whether the molecular mechanisms of the tumors developing in the thyroid and ovarian tissues are similar. We present the case of a patient with two independent papillary thyroid carcinomas (PTCs) in struma ovarii and the thyroid gland that are driven by different RAS mutations. A 62-year-old woman with a history of chronic lymphocytic leukemia/small lymphocytic lymphoma was diagnosed with a pelvic mass during a CT scan. She had surgery that included removal of her ovaries. A 7.2-cm classical variant of PTC arising in a struma ovarii was identified in the right ovary. Two months after the pelvic surgery, total thyroidectomy was performed, and a small nodule (0.8 cm) in the left lobe was diagnosed as a classical variant of PTC. Molecular analysis of tissues obtained from both the malignant struma ovarii and thyroid gland was performed. RAS mutations both in the PTC located in the thyroid and ovarian tissues were identified. However, whereas the thyroid gland tumor showed an HRAS Q61R mutation, the PTC in struma ovarii harbored an NRAS Q61R mutation. In this case, the finding of distinct types of RAS point mutation in thyroid cancers at two different locations provides definitive evidence that these cancers are synchronously developed independent primary tumors.
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Affiliation(s)
- Cristiane J Gomes-Lima
- MedStar Clinical Research Center, MedStar Health Research Institute, Hyattsville, MD.,Department of Medicine, Endocrinology Section, MedStar Washington Hospital Center, Washington, DC
| | - Yuri E Nikiforov
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Wen Lee
- Department of Pathology, MedStar Washington Hospital Center, Washington, DC
| | - Kenneth D Burman
- Department of Medicine, Endocrinology Section, MedStar Washington Hospital Center, Washington, DC
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45
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Ylli D, Burman KD, Van Nostrand D, Wartofsky L. Eliminating the Age Cutoff in Staging of Differentiated Thyroid Cancer: The Safest Road? J Clin Endocrinol Metab 2018; 103:1813-1817. [PMID: 29741712 DOI: 10.1210/jc.2017-02725] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [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] [Received: 12/15/2017] [Accepted: 02/16/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND Unlike virtually all other cancer types, thyroid cancer is unique in that patient age is a key component in its staging. Pathologists and clinicians worldwide have accepted an age cutoff of 45 years for staging; in 2018, this advances to age 55 years in the eighth edition of the American Joint Commission on Cancer staging system. EVIDENCE ACQUISITION Clinical and basic research studies, reviews, and previous editions of consensus statements regarding thyroid cancer staging were reviewed, with particular focus on the influence of age in thyroid cancer prognosis. PURPOSE This perspective briefly reviews the basis for this practice and challenges it as no more appropriate than for other malignancies. EVIDENCE SYNTHESIS The majority of findings report an association of age with thyroid cancer survival but do not support a specific age cutoff; rather, they suggest that outcome is affected by age as a continuous variable. Conceivably, other factors interact with age on a continuous basis over time, affecting prognosis. When identified, these factors could alter our current concept of the importance of an age cutoff in staging. CONCLUSIONS Among all cancers, age has an important role in only thyroid cancer staging. The consideration of age as a continuous variable and the search for age-associated prognostic variables could elucidate a more accurate staging system.
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Affiliation(s)
- Dorina Ylli
- MedStar Health Research Institute, Washington, DC
| | - Kenneth D Burman
- Endocrine Section, MedStar Washington Hospital Center, Washington, DC
- Department of Medicine, Georgetown University School of Medicine, Washington, DC
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Younis IR, Ahmed MA, Burman KD, Soldin OP, Jonklaas J. Stable Isotope Pharmacokinetic Studies Provide Insight into Effects of Age, Sex, and Weight on Levothyroxine Metabolism. Thyroid 2018. [DOI: 10.1089/thy.2017.0380 pmid: 29212434] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Islam R. Younis
- Office of Clinical Pharmacology, Office of Translational Sciences, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, Maryland
| | - Mariam A. Ahmed
- Office of Clinical Pharmacology, Office of Translational Sciences, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, Maryland
| | - Kenneth D. Burman
- Section of Endocrinology, MedStar Washington Hospital Center, Washington, DC
| | - Offie P. Soldin
- Departments of Medicine, Oncology, Physiology, and Biophysics, Georgetown University Medical Center, Washington, DC
| | - Jacqueline Jonklaas
- Division of Endocrinology, Georgetown University Medical Center, Washington, DC
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Abstract
BACKGROUND This study sought to determine whether levothyroxine pharmacokinetics (PKs) are affected by age, weight, and sex. METHODS A PK study was performed after administration of a tracer dose of carbon-13-labeled LT4 (13C-LT4). The study was conducted at an academic medical center. Adults of any age being treated with levothyroxine for hypothyroidism were enrolled in the study. A single dose of 13C-LT4 was administered. Eighteen serial plasma samples were collected. One sample was obtained before the 13C-LT4 dose, and the majority of the remaining samples were collected over the 120-hour period post dosing. 13C-LT4 concentration was quantified using liquid chromatography tandem mass spectrometry. PK analysis was conducted using a linear log trapezoidal non-compartmental analysis using Phoenix 6.4. RESULTS Eight males and 33 females with a median age of 50 years (range 22-78 years) and median weight of 65.9 kg (range 50-150 kg) were enrolled in the study. The median 13C-LT4 dose administered was 100 μg (range 70-300 μg). The median oral clearance rate (CL/F), apparent volume of distribution (V/F), time to peak concentration (Tmax), and dose-normalized peak concentration (Cmax) of 13C-LT4 were estimated to be 0.712 L/h, 164.9 L, 4 h, and 7.5 ng/L/μg, respectively. The dose-normalized area under the concentration-time curve from time 0 to 120 hours and half-life of the terminal distribution phase were 0.931 ng.h/mL/μg and 172.2 h, respectively. There was no significant difference in any 13C-LT4 PK parameter between patients aged >60 years (n = 10) and patients aged ≤60 years (n = 31), nor was there a relationship between age as a continuous variable and 13C-LT4 PK parameters. Sex only affected CL/F, V/F, and dose-normalized Cmax in univariate analyses. However, after adjusting for weight, sex was no longer a significant covariate. Weight was a significant predictor for CL/F, V/F and dose-normalized Cmax of 13C-LT4 in multivariate analyses. CONCLUSION Prior studies suggest that patient age affects levothyroxine dose requirement. This study did not identify an effect of age and suggests that age-related changes in levothyroxine pharmacokinetics may be mediated by age-related weight differences. Physicians should consider a patient's weight, rather than age, for estimating levothyroxine dosage requirement.
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Affiliation(s)
- Islam R. Younis
- Office of Clinical Pharmacology, Office of Translational Sciences, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, Maryland
| | - Mariam A. Ahmed
- Office of Clinical Pharmacology, Office of Translational Sciences, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, Maryland
| | - Kenneth D. Burman
- Section of Endocrinology, MedStar Washington Hospital Center, Washington, DC
| | - Offie P. Soldin
- Departments of Medicine, Oncology, Physiology, and Biophysics, Georgetown University Medical Center, Washington, DC
| | - Jacqueline Jonklaas
- Division of Endocrinology, Georgetown University Medical Center, Washington, DC
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Abstract
BACKGROUND The number of studies on venous thromboembolism (VTE) and thyroid cancer is very scarce and existing data are contradictory. This paper reviews VTE in thyroid cancer. METHODS The following words were used for a comprehensive literature review using MEDLINE database: Blood coagulation factors; thyroid hormones; blood coagulation tests; venous thromboembolism; receptors thyroid hormone; hemostasis; fibrinolysis; bleeding; blood coagulation disorders; thyroid neoplasms; Thyroid cancer, papillary; Thyroid cancer, follicular; Thyroid carcinoma, anaplastic; Thyroid cancer, Hurthle cell; Familial medullary thyroid carcinoma; venous thrombosis; Pulmonary embolism; Blood coagulation factors. The studies, which include any changes in hemostasis and thyroid cancer were included and reviewed. RESULTS Although few studies have shown a possible increase in VTE occurrence in thyroid cancer in patients ≥ 60 years old and in proximity to cancer diagnosis, other studies could not find any difference compared to general population. New thyroid cancer classification excluding common subtype(s) with benign nature, may affect the results of the future studies on association of VTE and thyroid cancer. CONCLUSIONS Prospective studies on the occurrence of VTE in various types and severities of thyroid cancer and in different age groups are warranted, as the results would affect clinical practice on the necessity of usage of anticoagulants in some thyroid cancer groups.
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Affiliation(s)
- Arash Ordookhani
- MD, Endocrine Section, Department of Internal Medicine, Providence Hospital, Washington, DC, 20017
| | - Abbas Motazedi
- MD, Endocrine Section, Department of Internal Medicine, Providence Hospital, Washington, DC, 20017
| | - Kenneth D. Burman
- MD, Endocrine Section, MedStar Washington Hospital Center, Washington, DC, 20010
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49
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Gomes-Lima CJ, Wu D, Kharazi PH, Khojekar GJ, Ringel MD, Vetter RJ, Bloom G, Burman KD, Wartofsky L, Van Nostrand D. Selected Radiation Safety Aspects Including Transportation and Lodging After Outpatient 131I Therapy for Differentiated Thyroid Cancer. Thyroid 2017; 27:1558-1565. [PMID: 29132255 PMCID: PMC7003059 DOI: 10.1089/thy.2017.0124] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Whether radioactive iodine (131I) treatments for differentiated thyroid cancer should be performed as an outpatient or inpatient remains controversial. The objective of this study was to survey selected aspects of radiation safety of patients treated with 131I for differentiated thyroid cancer as an outpatient. METHODS An e-mail invitation was sent to over 15,000 members of ThyCa: Thyroid Cancer Survivors' Association, Inc. to complete a web-based survey on selected aspects of radiation safety regarding their last outpatient 131I treatment. RESULTS A total of 1549 patients completed the survey. Forty-five percent (699/1541) of the respondents reported no discussion on the choice of an inpatient or outpatient treatment. Moreover, 5% (79/1541) of the respondents reported that their insurance company made the decision. Survey respondents recalled receiving oral and written radiation safety instructions 97% (1459/1504) and 93% (1351/1447) of the time, respectively. Nuclear medicine physicians delivered oral and written instructions to 54% (807/1504) and 41% (602/1462) of the respondents, respectively. Eighty-eight percent (1208/1370) of the respondents were discharged within 1 hour after receiving their 131I treatment, and 97% (1334/1373) traveled in their own car after being released from the treating facility. Immediately post-therapy, 94% (1398/1488) of the respondents stayed at their own home or a relative's home, while 5% (76/1488) resided in a public lodging. The specific recommendations received by patients about radiation precautions varied widely among the respondents. Ninety-nine percent (1451/1467) of the respondents believed they were compliant with the instructions. CONCLUSION This is the largest, patient-based survey published regarding selected radiation safety aspects of outpatient 131I treatment. This survey suggests several concerns about radiation safety, such as the decision process regarding inpatient versus outpatient treatment, instructions about radiation safety, transportation, and lodging after radioiodine therapy. These concerns warrant further discussion, guidelines, and/or policies.
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Affiliation(s)
- Cristiane J. Gomes-Lima
- MedStar Health Research Institute, Washington, DC
- Division of Endocrinology, MedStar Washington Hospital Center, Washington, DC
| | - Di Wu
- MedStar Health Research Institute, Washington, DC
- Division of Nuclear Medicine, MedStar Washington Hospital Center, Washington, DC
| | - Pejman H. Kharazi
- Division of Nuclear Medicine, MedStar Washington Hospital Center, Washington, DC
| | | | - Matthew D. Ringel
- Division of Endocrinology, Diabetes and Metabolism, Wexner Medical Center, The Ohio State University, Columbus, Ohio
| | | | - Gary Bloom
- ThyCa: Thyroid Cancer Survivors Association, Inc., Olney, Maryland
| | - Kenneth D. Burman
- Division of Endocrinology, MedStar Washington Hospital Center, Washington, DC
| | - Leonard Wartofsky
- Division of Endocrinology, MedStar Washington Hospital Center, Washington, DC
| | - Douglas Van Nostrand
- MedStar Health Research Institute, Washington, DC
- Division of Nuclear Medicine, MedStar Washington Hospital Center, Washington, DC
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Klubo-Gwiezdzinska J, Costello J, Jensen K, Patel A, Tkavc R, Van Nostrand D, Burman KD, Wartofsky L, Vasko V. Amifostine does not protect thyroid cancer cells in DNA damaging in vitro models. Endocr Connect 2017; 6:469-478. [PMID: 28790138 PMCID: PMC5597971 DOI: 10.1530/ec-17-0138] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [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: 07/28/2017] [Accepted: 08/08/2017] [Indexed: 11/08/2022]
Abstract
BACKGROUND Amifostine is a potent scavenger of reactive oxygen species that is used for the salivary gland protection during therapy with radioactive iodine for thyroid cancer. There are no data on the potential effect of amifostine on thyroid cancer cells. METHODS We investigated the effects of the active form of amifostine (WR-1065) on the response of thyroid cancer cells to treatment with DNA-damaging agents. WR-1065 was examined in human thyroid cancer cell lines (FTC133, TPC1, BCPAP and C643) and embryonic fibroblast cells NIH3T3. DNA damage was induced by exposure to H2O2 (0.1 mM), by treatment with the radiomimetic neocarzinostatin (NCS 250 ng/mL) and by γ-radiation (6 Gy). DNA damage, cell viability and apoptosis were examined. RESULTS We demonstrated the selective action of WR-1065 (0.1 mM), which prevented oxidative stress-induced DNA damage in fibroblasts, but did not protect thyroid cancer cells from DNA damage and apoptosis documented by caspase-3 and PARP cleavage after exposure to H2O2, NCS and γ-radiation. Prolonged exposure to WR-1065 (0.1 mM for 24 h) was toxic for thyroid cancer cells; this treatment decreased the number of viable cells by 8% in C643 cells, 47% in TPC cells, 92% in BCPAP cells and 82% in FTC 133 cells. The cytotoxic effects of WR-1065 were not associated with induction of apoptosis. CONCLUSIONS Our data show that amifostine has no protective effect on thyroid cancer cells against DNA-damaging agents in vitro and suggest that amifostine will not attenuate the efficacy of radioiodine treatment in patients with thyroid cancer.
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Affiliation(s)
- Joanna Klubo-Gwiezdzinska
- National Institute of HealthNIDDK, Office 10 Center Drive, Bethesda, Maryland, USA
- Division of EndocrinologyDepartment of Medicine, Medstar Washington Hospital Center, Washington Hospital Center, Northwest, Washington, District of Columbia, USA
| | - John Costello
- Department of PediatricsUniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Kirk Jensen
- Department of PediatricsUniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Aneeta Patel
- Department of PediatricsUniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Rok Tkavc
- Department of PathologyUniformed Services University of the Health Sciences, Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA
| | - Douglas Van Nostrand
- Division of EndocrinologyDepartment of Medicine, Medstar Washington Hospital Center, Washington Hospital Center, Northwest, Washington, District of Columbia, USA
| | - Kenneth D Burman
- Division of EndocrinologyDepartment of Medicine, Medstar Washington Hospital Center, Washington Hospital Center, Northwest, Washington, District of Columbia, USA
| | - Leonard Wartofsky
- Division of EndocrinologyDepartment of Medicine, Medstar Washington Hospital Center, Washington Hospital Center, Northwest, Washington, District of Columbia, USA
| | - Vasyl Vasko
- Department of PediatricsUniformed Services University of the Health Sciences, Bethesda, Maryland, USA
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