Risk of malignant tumors in first-degree relatives of patients with differentiated thyroid cancer -- a hospital based study.

In presented study the risk of incidence of familial differentiated thyroid cancer as well as the risk of other malignant tumors in families of DTC patients was evaluated. 999 patients with differentiated thyroid cancer and 825 persons without any history of malignant disease were evaluated on the occurrence of malignant neoplasm within their families. Information about 6614 first degree relatives of DTC index patients and 4939 first degree relatives of control persons were recorded. The incidence of cancers at various sites was compared between first-degree relatives of index patients and control persons and odds ratio with 95% confidence intervals (CI) were calculated for thyroid cancer and other cancer sites. Within 999 families of thyroid cancer index patients 23 families with more than one case of DTC were found. The risk of the development of thyroid cancer in the first degree was 6 (95% CI 1.8-19) times greater in the index group than in the control group. No increased risk for development of other malignancies was observed. Results of our study confirm previous reports of increased risk of thyroid cancer in first-degree relatives of differentiated thyroid cancer patients. However, the relatively small number of first-degree relatives affected with thyroid cancer (24/6614) does not justify at present any screening in the first-degree relatives of patients affected with differentiated thyroid cancer. Simultaneously, no increased risk of other malignant neoplasm was observed in the differentiated cancer families.

The role of FDG-PET in localization of recurrent lesions of differentiated thyroid cancer (DTC) in patients with asymptomatic hyperthyroglobulinemia in a real clinical practice.

INTRODUCTION: Available methods, including serum thyroglobulin (Tg) measurement and whole-body scan (WBS) performed after radioiodine administration, allow for a precise diagnostics in differentiated thyroid cancer (DTC). However, some asymptomatic patients demonstrate negative WBS despite a high Tg serum concentration. In these subjects, fluorodeoxyglucose-positron emission tomography (FDG-PET) should be considered. The primary aim of our study was to evaluate a diagnostic value of FDG-PET in asymptomatic hyperthyroglobulinemia. The secondary one was to determine a prognostic value of a negative FDG-PET result in DTC patients with elevated Tg level. MATERIAL: One hundred and ten FDG-PET/CT scans were retrospectively analyzed, 85 scans were done under TSH stimulation and 25 on LT4 suppressive therapy. Follow-up ranged between 4 and 9 years. RESULTS: The first FDG-PET/CT detected cancer foci in 49 subjects with a global sensitivity of 45%. When the sensitivity was evaluated with reference to TSH stimulation and suppression, its values were 50 and 28% respectively. In 42 patients, FDG-PET failed to diagnose the reason for elevated Tg level. During further follow-up, in 17 of them, DTC recurrence was detected by other methods (CT, MRI, US). Fourteen subjects with asymptomatic hyperthyroglobulinemia were free of DTC progression for at least 4 years. CONCLUSIONS: FDG-PET in DTC patients with asymptomatic hyperthyroglobulinemia constitutes a valuable diagnostic tool. Negative FDG-PET demonstrated a limited prognostic significance, as only every third patient did not show DTC progression. Moreover, negative FDG-PET does not justify less strict DTC monitoring, because it is related to 40% risk of relapse during the 5-year follow-up.

Recombinant human TSH for the treatment of differentiated thyroid cancer metastatic to the spine.

The diagnostic use of recombinant human TSH (rhTSH) in follow- up of differentiated thyroid cancer (DTC) is already approved, however its application in (131)I therapy is still to be evaluated. We report results obtained in four patients with DTC metastatic to central skeleton, in whom 5 courses of rtTSH aided 131I therapy were administered.

[Early evaluation of treatment effectiveness using 131I iodine radiotherapy in patients with differentiated thyroid cancer]. / Ocena wczesnej skutecznosci leczenia uzupelniajacego jodem promieniotwórczym 131I chorych na zróznicowane raki tarczycy.

UNLABELLED: This paper presents the preliminary results of a prospective randomized trial on early effectiveness of 30 mCi versus 60 mCi for ablation of thyroid remnants in patients with WDTC after total thyroidectomy. Since April 1998 to January 2000, 220 patients with papillary thyroid cancer in stage T1b-3, N0-x, M0 had entered the study. 106 patients received 60 mCi and 114 received 30 mCi as the first ablation dose. The subject for the analysis was the uptake over the neck, post-therapeutic whole body scintigraphy and Tg level 6 months after ablation. The early effectiveness of ablation was estimated using a 5-degree scale: 0--very good effect, 1--good effect, 2--dubious effect-required repetition of WBS and Tg assessment in 6-12 months, 3--insufficient ablation--required repetition of radioiodine treatment, 4--for evident dissemination or local recurrence. RESULTS: Grades 0 were obtained in 29 (53%) after 30 mCi (group I) and in 38 patients (86%) after 60 mCi (group II). Grades 1 were obtained in group I in 15 patients (28%) and in 4 patients (9%) of group II. Grades 2 were obtained in group I in 9 patients (17%) and in group II in 1 (2.3%). Grade 3 was obtained only in 1 (2%) patient after 30 mCi. Grade 4 was obtained in one patient after 60 mCi (2.3%). The difference in uptake over the neck in the two groups was statistically significant (p < 0.05), although the differences in early effectiveness between the both groups according to the 5-degree scale were on the borderline of significance (p = 0.075). There was a correlation between uptake before and after ablation in 30 mCi group, which was not seen present in 60 mCi group. CONCLUSION: For the ablation of thyroid remnants 60 mCi should be considered as a standard dose.

[The usefulness of MIBI scintigraphy for postoperative monitoring of patients with thyroid cancer]. / Przydatnosc scyntygrafii MIBI w monitorowaniu pooperacyjnym chorych na zróznicowanego raka tarczycy.

Metoxyizobutyloizonitrile labelled with technetium 99mTc is a radio-pharmaceutical that was shown to accumulate in benign and cancerous thyroid tissue. As it can be applied without thyroid hormone withdrawal this gave a stimulus to the investigations on its usefulness in diagnostic and follow up procedures for thyroid cancer patients. The goal of this study is to evaluate the efficacy and benefit of 99mTc-MIBI whole body scintigrams in post surgery follow-up of patients with differentiated thyroid cancer. One hundred and twenty eight 99mTc MIBI scintigraphy were performed and evaluated. Sensitivity of MIBI scans was the highest for bone metastases--79%. Good results were also obtained for lymph node metastases (sensitivity--73%, specificity--90%). In case of lung metastases the sensitivity and specificity were 21% and 94% respectively. Sensitivity of detection of clinically apparent recurrent disease in thyroid bed was 70% and specificity of visualization 78%. Results of our study demonstrate that 99mTC-MIBI is valuable tool in follow up of thyroid cancer patients, but can not replace 131I scintygraphy.

Multivariate analysis of prognostic factors for differentiated thyroid carcinoma in children.

At most centres, the standard treatment for differentiated thyroid cancer (DTC) comprises total thyroidectomy, radioiodine treatment and thyroid-stimulating hormone (TSH) suppressive therapy. There is, however, considerable disagreement over the appropriate treatment for DTC in children. Some dispute the use of total thyroidectomy and/or question the routine application of iodine-131 therapy in children. The aim of this study was to perform a retrospective analysis of treatment results and prognostic factors for DTC in children treated at our centre. The study included 109 children with DTC (aged 6-17 years). The primary treatment comprised total thyroidectomy in 81 cases, radioiodine therapy in 85 cases and TSH suppressive therapy with L-thyroxine in all patients. Uni- and multivariate analysis of prognostic factors for disease-free survival was performed using the Cox regression method. The actuarial survival rate was 100%, and the 5- and 10-year actuarial disease-free survival rates were 80% and 61% respectively. Univariate analysis revealed that older age, total thyroidectomy and radioiodine treatment had a positive impact on disease-free survival whereas there were no statistical differences with regard to the child's sex, histological type of cancer or lymph node status. On multivariate analysis, radical surgery was estimated to be the most significant factor (P=0.007) for disease-free survival, while less than total thyroidectomy increased the relative risk of relapse by a factor of 10. Radioiodine treatment decreased the relative risk of relapse by a factor of 5, but with borderline significance (P=0.07). Permanent postoperative complications were observed in 17% of children: in 11 laryngeal palsy occurred, in six there was hypoparathyroidism, and one suffered from both. It is concluded that total thyroidectomy and radioiodine treatment significantly improve recurrence-free survival in children and should be routinely applied even in young children as the primary treatment of DTC.