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Journal Cover European Thyroid Journal
  [SJR: 0.38]   [H-I: 2]   [0 followers]  Follow
   Full-text available via subscription Subscription journal
   ISSN (Print) 2235-0640 - ISSN (Online) 2235-0802
   Published by Karger Homepage  [101 journals]
  • Effect of an Outreach Programme on Vandetanib Safety in Medullary Thyroid
    • Abstract: Objectives: Effective management of adverse events (AEs) following vandetanib treatment is important to maximize clinical benefits. We examined whether more frequent contact with vandetanib-treated patients reduced AEs of CTCAE grade 2 or higher. Study Design: In this open-label, multicentre, phase III study, patients with locally advanced or metastatic medullary thyroid cancer were randomized to a patient outreach programme (outreach) or a standard AE monitoring schedule (vandetanib control) for 52 weeks. In addition to standard AE monitoring, patients in the outreach arm were contacted every 2 weeks by telephone/during their clinic visit for specific AE questioning related to diarrhoea, nausea, vomiting, fatigue, headache and rash. Patients received vandetanib at 200 or 300 mg/day, depending on the creatinine levels at screening. Results: Altogether, 205 patients were randomized (outreach, n = 103; vandetanib control, n = 102). This study did not meet its primary objective; the mean percentage of time patients experienced at least one AE of grade 2 or higher was higher for the outreach group (51.65%) than for the vandetanib control group (45.19%); the difference was not statistically significant (t statistic: 1.29; 95% CI -3.44 to 16.37%; p = 0.199). The most frequently reported AEs were diarrhoea (56.9% for the outreach group vs. 46.6% for the vandetanib controls), hypertension (36.3 vs. 31.1%), rash (25.5 vs. 24.3%) and nausea (25.5% vs. 18.4%), and the most frequently reported AEs of grade 2 or higher were hypertension (33.3 vs. 23.3%), diarrhoea (26.5 vs. 24.3%) and dermatitis acneiform (11.8 vs. 9.7%). Conclusions: Additional outreach to patients treated with vandetanib had no impact on the rate or severity of AEs compared to the standard AE monitoring schedule. AEs were consistent with the known safety profile of vandetanib.
      Eur Thyroid J 2016;5:187-194
      PubDate: 2016-09-10T00:00:00+02:00
  • An Unusual Case of Malignant Struma Ovarii Causing Thyrotoxicosis
    • Abstract: Background: Struma ovarii (SO) is a specialized monodermal teratoma predominantly composed of mature thyroid tissue, accounting for approximately 5% of all ovarian teratomas. Thyrotoxicosis is seen in about 8% of patients with SO. Most SO cases are benign with only 5-10% being malignant, and malignant SO causing thyrotoxicosis is very uncommon. Case: A 64-year-old woman had been diagnosed with thyrotoxicosis 2 years previously. The thyroid gland was palpable with a micronodular texture, and the patient was euthyroid under carbimazole. She presented with abdominal pain and progressive enlargement of the abdomen over a 2-month period. An abdominal ultrasonography revealed a pelvic mass and a large fluid collection. Additional imaging confirmed the presence of a complex right ovarian mass measuring 13 cm. The patient underwent a total abdominal hysterectomy and bilateral salpingo-oophorectomy, omentectomy and appendectomy. The histological examination revealed the presence of ‘follicular thyroid-type carcinoma arising in an SO of the right ovary, with metastatic infiltration in the tissue fragments from the pouch of Douglas'. Antithyroid treatment was discontinued 1 month after surgery in light of the pathology result. During the 4-year follow-up, the patient remained euthyroid. Conclusion: There has been controversy about the management of malignant SO, which is a rare entity. Malignant SO causing thyrotoxicosis is even more uncommon. As clinical signs are nonspecific, other causes of thyrotoxicosis must be considered for a differential diagnosis. Our case is one of the very few cases ever reported.
      Eur Thyroid J 2016;5:207-211
      PubDate: 2016-09-08T00:00:00+02:00
  • Correction of Hypothyroidism Leads to Change in Lean Body Mass without
           Altering Insulin Resistance
    • Abstract: Background: Hypothyroidism is associated with insulin resistance, dyslipidemia, and abnormal body composition. This study assessed changes in body composition and insulin resistance after thyroxine (T4) replacement in overt hypothyroidism. Methods: In this prospective longitudinal study carried out in a tertiary care center, adult nondiabetic patients with overt hypothyroidism were rendered euthyroid on T4. Anthropometry including skinfold thickness (SFT) at the triceps and subscapularis was recorded. Patients underwent testing for fasting plasma glucose, creatinine, serum insulin, T4, thyrotropin (TSH) and body composition analysis by dual-energy X-ray absorptiometry (DEXA) both before and at 2 months after restoration to the euthyroid state. Results: Twenty-seven patients (20 female and 7 male) aged 35.3 ± 11.0 years (min-max: 17-59 years) with overt hypothyroidism were recruited. Serum T4 at the time of recruitment was 48.9 ± 24.6 nmol/l (normal range = 64.4-142 nmol/l). All patients had TSH ≥50 µIU/l. Following treatment, there was a mean body weight reduction of 1.7 kg (p = 0.01). Waist circumference as well as triceps and subscapularis SFT decreased significantly (p < 0.001). There was no change in fat mass (FM), percentage of fat (%FM) or bone mineral content in any of the specified regions or in the body as a whole. In contrast, mean lean body mass (LBM) decreased significantly by 0.8 kg (p < 0.01) in the trunk and 1.3 kg (p < 0.01) in the whole body. Insulin resistance and level of glycemia were not affected by treatment with T4. Conclusion: LBM decreases significantly without affecting FM after correction of hypothyroidism. Insulin resistance was not influenced by T4 treatment.
      Eur Thyroid J
      PubDate: 2016-09-08T00:00:00+02:00
  • Origin of Thyroid C Cells: Clinical Interpretation
    • Abstract:
      Eur Thyroid J
  • Trends and Predictors of Chemotherapy Use among Thyroid Cancer Patients in
           the National Cancer Database (2004-2013)
    • Abstract: Background/Aim: Beginning in 2011, the Food and Drug Administration (FDA) approved the use of multikinase inhibitors (MKIs) for medullary thyroid cancers (MTCs), and in 2013 MKIs were approved for metastatic differentiated thyroid cancers (DTCs). However, little is known about the use of chemotherapy in thyroid cancer patients. Thus, the goal of our study was to describe patterns of chemotherapy use, including MKIs, among DTC and MTC patients in the National Cancer Database (NCDB). Methods: Chemotherapy use, along with other treatment types (surgery and radiation), was assessed between 2004 and 2013. The primary predictor was the year of diagnosis (2004-2010 and 2011-2013), based on the FDA's approval of chemotherapy for MTC (2011). Baseline use of MKIs in DTCs in 2013 was also examined. Multivariable logistic regression was used to estimate odds ratios (OR) and 95% CI of receipt of chemotherapy. Results: Overall, 199,654 patients were included in our analytic sample with 194,667 nonmetastatic DTCs, 1,633 metastatic DTCs, and 3,354 MTCs. Among MTCs, chemotherapy use significantly increased from 3.1% in 2004-2010 to 5.0% in 2011-2013 (p = 0.018) in unadjusted and adjusted (OR = 1.54, 95% CI: 1.00, 2.36) analyses. In metastatic DTCs, 4.9% of patients received chemotherapy in 2013, which was not significantly higher than in previous years (p = 0.755). Conclusions: Overall, chemotherapy use among MTCs increased marginally following the FDA's approval of MKIs in 2011, although their use remains very low. MKIs were infrequently used in metastatic DTCs in 2013. Future studies examining patterns of chemotherapy in thyroid cancer patients are warranted.
      Eur Thyroid J
  • Can the American Thyroid Association Risk of Recurrence Predict
           Radioiodine Refractory Disease in Differentiated Thyroid Cancer'
    • Abstract: Objective: The aim of this study was to compare the TNM staging system and the American Thyroid Association (ATA) recurrence risk classification in predicting radioiodine refractory disease (RRD) in differentiated thyroid cancer (DTC) and to analyze the correlation of stimulated thyroglobulin (Tg) levels and rate of Tg elevation with the standardized uptake value on 18F-fludeoxyglucose (FDG) PET/CT scan. Methods: RRD was indicated through the retrospective analysis of consecutive 18F-FDG PET/CT scans in DTC with stimulated Tg >10 ng/ml and negative 131I NaI whole-body scans (WBS). Tg elevation velocity was compared to the likelihood of a positive scan. The ATA recurrence risk and TNM staging system were compared to see which of them better predicted the subsequent development of RRD. Results: Fifty-eight of 636 subjects developed RRD: 52 papillary and 6 follicular thyroid cancer. The median time between diagnosis and a negative WBS was 24 months (range 12-240). RRD developed in 11 low-risk, 32 intermediate-risk and 15 high-risk patients. A better response to therapy was seen in the low-risk versus the intermediate- and high-risk groups. 18F-FDG PET/CT scans had a diagnostic accuracy of 94.8%, sensitivity of 97.7%, specificity of 85.7%, positive predictive value of 95.6% and negative predictive value of 92%. There was no correlation between the Tg level or rate of rise and a positive scan. Overall, PET-CT upstaged 18 (31%) cases, leading to a change in management in 20 (35%) cases. Conclusion: The TNM and ATA staging systems show no significant difference in predicting the development of RRD. RRD is less likely in stage I, II and low-risk patients. There is no correlation between the level or rate of Tg rise and a positive 18F-FDG PET/CT scan.
      Eur Thyroid J
  • Van Wyk-Grumbach Syndrome with Kocher-Debré-Sémélaigne Syndrome: Case
           Report of a Rare Association
    • Abstract: Background: Van Wyk-Grumbach syndrome (VWGS) is a rare presentation of juvenile hypothyroidism which manifests in females as chronic autoimmune hypothyroidism, isosexual pseudoprecocious puberty, and multicystic ovaries. It uniquely presents with short stature and delayed bone age unlike other causes of precocious puberty. Kocher-Debré-Sémélaigne (KDSS) is a rare presentation of juvenile hypothyroidism manifesting as calf muscle pseudohypertrophy, delayed contraction and relaxation of reflexes, and percussion myxedema. Objectives: To diagnose the rare association of VWGS and KDSS and to conduct a follow-up of the patient on replacement therapy. Methods: We present a case of a 9-year-old female child who presented to the endocrine department with complaints of intermittent vaginal bleeding, short stature, and difficulty in walking. On evaluation she was found to be having autoimmune hypothyroidism, FSH-dominated isosexual pseudoprecocious puberty, delayed bone age, secondary pituitary macroadenoma, delayed relaxation of deep tendon reflexes, and pseudohypertrophy of calf muscles. The diagnosis of VWGS associated with KDSS was made. The patient was initially put on 25 μg thyroxine replacement, which was titrated accordingly, and was followed up after 6 months and 1 year. Results: All the features of the syndrome improved after 12 months of adequate thyroxine replacement. Conclusions: VWGS and KDSS are rare presentations of juvenile hypothyroidism, and their association is even rarer. Early diagnosis and prompt replacement therapy can avoid unnecessary investigations and surgical interventions.
      Eur Thyroid J
  • Patients with Multifocal Macroscopic Papillary Thyroid Carcinoma Have a
           Low Risk of Recurrence at Early Follow-Up after Total Thyroidectomy and
           Radioactive Iodine Treatment
    • Abstract: Background: Multifocal thyroid cancer involvement is a common presentation in papillary thyroid cancer. The risk of recurrence of intrathyroidal multifocal papillary microcarcinoma (1 cm) without gross extrathyroidal extension, we examined the clinical outcomes of patients in the first 2 years after the initial therapy and at the end of the follow-up period (median: 5 years). Results: Half of the patients presenting with multifocal macroscopic PTC had nodal involvement at diagnosis. Only 4 patients had a recurrence on long-term follow-up, all with classic or tall-cell variant PTC with bulky nodal involvement at diagnosis. The number of tumor foci did not influence the risk of recurrence in this cohort. The median time to recurrence in these 4 patients was 11 years, with all patients having a recurrence after 9 years of follow-up. None of patients developed distant metastasis or died from thyroid cancer. Conclusions: Patients presenting with multifocal macroscopic papillary thyroid cancer without bulky nodal involvement or gross extrathyroidal extension have a low risk of thyroid cancer recurrence.
      Eur Thyroid J
  • Pregnant Greek Women May Have a Higher Prevalence of Iodine Deficiency
           than the General Greek Population
    • Abstract: Background: Adequate dietary iodine consumption, predicted via the urinary iodine concentration (UIC), is necessary for normal thyroid function and for the neurodevelopment of fetuses and neonates. The general population of Greece is considered to be iodine sufficient, but our preliminary findings suggest that Greek pregnant women are at risk of iodine deficiency. Objective: Our aim was to estimate the thyroid function and UIC in a representative population of pregnant Greek women. Methods: UIC and thyroid function were assessed in 1,118 women from 19 representative areas of the country. Results: The median UIC was found to be 127.1 µg/l (range 7.8-2,296), which is indicative of insufficient iodine intake according to the standard of the World Health Organization (WHO) for pregnant women. The median UIC was below the minimal recommended value of 150 µg/l in 61% of the women, and below 100 or 50 µg/l in 32 and 7%, respectively. An optimal iodine intake (150-250 µg/l) was observed in 26%, and was over the cut-off of 500 µg/l in 2% of the subjects. Serum thyrotropin significantly increased between trimesters, from 1.57 ± 1.2, to 1.68 ± 1.0 and to 2.02 ± 1.2 mU/l (p < 0.001). Serum-free thyroxine decreased significantly between trimesters, from 1.22 ± 0.34, to 1.01 ± 0.21 and 0.96 ± 0.2 ng/ml (p < 0.05). Serum thyroglobulin levels remained unchanged over the trimesters and were not correlated with UIC. Conclusions: While the general population of Greece is iodine sufficient, these findings suggest that, according to the WHO, the majority of pregnant Greek women are iodine deficient. These data strongly suggest that a proactive policy should be developed to lower iodine deficiency risk in this population of women.
      Eur Thyroid J
  • Minimizing the Health Effects of the Nuclear Accident in Fukushima on
    • Abstract: Results of the Screening of Thyroids: Because of the March 2011 nuclear accident in Fukushima, Japan, the Fukushima Prefecture initiated a thyroid ultrasound examination program. The first cycle of examinations on all children (more than 300,000) of the Fukushima Prefecture identified 116 patients as having malignant or suspected malignant thyroid nodules, and in the second cycle 59 new cases were identified. According to the available data, the thyroid cancers found by the screening are unlikely to be due to radiation, but the possibility cannot be excluded. Urgent Measures: The current thyroid ultrasound examination program has been detecting thyroid cancers, regardless of the cause, in all children in the Fukushima Prefecture. Fukushima Prefecture is already taking measures against thyroid cancer, even if an increase occurs in radiation-induced thyroid cancer in Fukushima Prefecture. Therefore, the urgent challenge is how to treat children with thyroid cancer found by the screening. Future Directions of the Measures: At the end of each cycle, the findings must be carefully discussed with experts around the world and among stakeholders in Fukushima, and a consensus must be reached regarding whether the current program will be continued or needs improvement. In addition, the survey should be improved as an epidemiological follow-up research program. Before starting this, a consensus must be reached with the inhabitants with regard to carrying out epidemiological research for several decades. Dialogue absolutely must continue among all stakeholders to determine how best to formulate a program to deal with urgent matters and to determine the next stage of any epidemiological research.
      Eur Thyroid J
School of Mathematical and Computer Sciences
Heriot-Watt University
Edinburgh, EH14 4AS, UK
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