Outcomes of patients with differentiated thyroid carcinoma following initial therapy.

This analysis was performed to determine the effect of initial therapy on the outcomes of thyroid cancer patients. The study setting was a prospectively followed multi-institutional registry. Patients were stratified as low risk (stages I and II) or high risk (stages III and IV). Treatments employed included near-total thyroidectomy, administration of radioactive iodine, and thyroid hormone suppression therapy. Outcome measures were overall survival, disease-specific survival, and disease-free survival. Near-total thyroidectomy, radioactive iodine, and aggressive thyroid hormone suppression therapy were each independently associated with longer overall survival in high-risk patients. Near-total thyroidectomy followed by radioactive iodine therapy, and moderate thyroid hormone suppression therapy, both predicted improved overall survival in stage II patients. No treatment modality, including lack of radioactive iodine, was associated with altered survival in stage I patients. Based on our overall survival data, we confirm that near-total thyroidectomy is indicated in high-risk patients. We also conclude that radioactive iodine therapy is beneficial for stage II, III, and IV patients. Importantly, we show for the first time that superior outcomes are associated with aggressive thyroid hormone suppression therapy in high-risk patients, but are achieved with modest suppression in stage II patients. We were unable to show any impact, positive or negative, of specific therapies in stage I patients.

Selected therapy-related clinical research topics in osteoporosis.

Effective antiresorptive treatment options are currently available for fracture prevention in patients with osteopenia and osteoporosis. Although orally administered bisphosphonates are most widely used, they demonstrate specific compliance requirements and potential side effects. Medical therapy targeting acute fractures is lacking. This paper reviews two recently published studies. The first readdresses the use of intravenous bisphosphonates as a primary choice for fracture prevention; it concludes that once yearly administration may be a practical option. The second study assesses the effects of short-term use of a subcutaneous infusion of insulin-like growth factor (IGF)-I bound to its primary binding protein, IGFBP-3, on blunting the catabolic events associated with hip fractures. The investigators suggest that this intervention merits additional evaluation as a potentially important modality to improve care in this patient population.