Variability of Serum Thyroglobulin Levels in Post- Thyroidectomy Patients with Well-Differentiated Thyroid Cancer: the ATA Guidelines.

OBJECTIVE: Evaluate the variability of stimulated serum thyroglobulin (Tg) levels in post-thyroidectomy patients with well-differentiated thyroid cancer (WDTC) and determine the frequency of undetectable Tg in patients with evidence of functional thyroid tissue after a 131-I whole-body scan (WBS). METHODS: A retrospective record review of patients with WDTC referred to our clinic from 1990 to 2010. Demographic data, histology, staging, imaging studies, stimulated Tg values, and the presence if applicable of Tg antibodies (TgAb) were documented. The images of whole-body radioiodine scans were reviewed to assess the extent of functional thyroid tissue. RESULTS: A total of 142 cases were evaluated with 417 studies. There were 112 women and 30 men; the median age was 47 years. The tumor histologies included 97 papillary (4 had the Hurthle cell variant), 33 papillary-follicular tumor, and 12 follicular tumors; 7 were multifocal. ATA classification was used; groups were divided into low (55%) and intermediate-high risk (45%). The final analysis comprised 84 patients, having among them 170 studies that included Tg values in their records. The cut-off value for Tg was 2.0 ng/ml, and for TgAb, it was 20 IU/ml or more. Residual functional tissue was present in 105 (62%) cases. Discordant Tg results were found in 55% of the low-risk patients; of those, only 3 had TgAb. In the intermediate- and high-risk group, 47% had discordant results; 2 cases had TgAb. CONCLUSION: The variability of the Tg levels and the high frequency of discordant results (positive WBSs with undectable Tg levels) bring into question the standard recommendation of conservative management for low-risk patients. Follow-ups should include a Tg assay and imaging studies.

THE ROLE OF NUCLEAR IMAGING IN TRAUMATIC HEPATOPLEURAL FISTULA: A CASE REPORT.

Penetrating injuries are a major cause of mortality and morbidity. The most common diagnostic tool used in this setting is CT scan. We present a case of a traumatic hepatopleural fistula demonstrated by hepatobiliary scintigraphy. Traumatic abdominal injuries to the liver and diaphragm can result in complications, whose detection by CT scan is not always straightforward. Hepatobiliary scintigraphy is very useful in the search of bilious pleural effusions.

The cardiology and endocrinology connection between amiodarone and thyrotoxicosis: case report and review of the literature.

Amiodarone is used in a large number of cardiac conditions. Amiodarone-induced thyroid dysfunction has been reported to affect up to 20% of users. Amiodarone can lead to both amiodarone-induced hypothyroidism (AIH) and less commonly amiodarone-induced thyrotoxicosis (AIT). There are two main forms of AIT. Type 1 AIT, a form of io-dine-induced hyperthyroidism, and type 2, a drug-induced destructive thyroiditis. Type 1 AIT develops on individuals with underlying thyroid disease. Treatment of Type 1 AIT includes the use of antithyroid drugs and discontinuation of amiodarone. Type 2 AIT is commonly self-limiting in nature. In this article wedescribe a patient with Amiodarone-induced thyrotoxicosis discussing its clinical features and medical therapeutic approach.

Pediatric thyroid cancer with extensive disease in a Hispanic population: outcome and long-term survival.

The purpose of this study was to describe the characteristics of well differentiated thyroid carcinoma (WTC) in Hispanic children and analyze treatment response. Retrospective evaluation of records seen at our institution from 1970-2007 was undertaken. Twenty-seven cases were evaluated, 24 were treated with radioiodine, followed for a mean period of 15 years. There were 18 females, 9 males, median age 11 years. Eleven tumors were papillary, 15 papillary-follicular variant and one follicular. All had total thyroidectomy and iodine scan. Initially 75% of the tumors were T2, 79% were N1, and 29% had distant metastases. Radioiodine was given to 89%. The cumulative radiation dose ranged from 110-925 mCi. Residual disease was present in 25% at last follow up, maximal follow up 37 years without tumor recurrence. Patients were all alive, 75% were disease-free. WTC in pediatrics is extensive at diagnosis; treatment outcome and long-term survival are excellent.

Ectopic Papillary Thyroid Cancer with Distant Metastasis.

Ectopic thyroid tissue is a rare clinical entity wherein malignant lesions may arise, the most common one being papillary carcinoma. We present a case of a 68-year-old female who presented with a growing mass in the right clavicle. An MR of the shoulder showed a soft tissue mass arising from the anterior margin of the right distal clavicle. A fine needle aspiration of the mass showed papillary thyroid carcinoma. PET/CT confirmed the clavicular and mediastinal mass. Excision of the clavicular mass and total thyroidectomy with modified right neck dissection were performed. Pathology revealed no evidence of malignancy in the thyroid; lymph nodes were positive for metastatic thyroid carcinoma. Postsurgery CT showed the superior mediastinal mass with surrounding adenopathy; radioiodine (RAI) treatment with dose of 142.1 mCi [5257.7 MBq] was recommended. Posttherapy whole-body scan (WBS) showed RAI avid tissue in the neck and superior mediastinum. Follow-up chest CT revealed pulmonary nodules that increased in number and size; a second RAI therapeutic dose was given. The posttherapy RAI WBS was negative. Repeat PET/CT showed multiple hypermetabolic lesions in the mediastinum, neck, lymph nodes, pulmonary nodes, and right shoulder. The FDG avid lesions with no RAI uptake suggested tumor dedifferentiation.

Scintigraphic findings in schistosomiasis

Schistosomiasis mansoni is a tropical parasitic disease caused by a blood fluke which inhabits the portal system of humans. Fifteen pediatric patients with the acute disease were evaluated with liver and spleen scintigraphy (LSS). Clinical history, physical examination, and serum chemistries failed to reveal any other underlying systemic disease. Liver and spleen scintigraphies were performed before therapy, 7 months and 9 years after therapy with oxamniquine. LSS initially showed hepatomegaly in 93percent of the patients. In the first follow up study a reactive spleen was evident in 78 percent of the cases, with an unchanged hepatic image. Long term follow up revealed that from the initially enlarged livers, 93 percent became normal. However, 47 percent of the spleens were abnormal. The scintigraphic changes observed in the liver over the years were those expected for an acute infection. The findings in the spleen might indicate the persistence of an immunologic reaction with a continuous trigger, probably an antibody. These observations suggest that the LSS can be used in the evaluation and follow-up of these patients

Localization of parathyroid lesions: blind study for surgeons

Success in the treatment of primary hyperparathyroidism rest in the accurate localization and removal of the diseased gland or glands. Computerized tomography and nuclear imaging scans are being used to localize abnormal parathyroid tissue. In the present study, fifteen consecutive patients undergoing surgery for primary hyperparathyroidism were all subjected to these ancillary studies. Results were not revealed to the operating team. In all instances an adenoma was localized during neck exploration. CT Scan failed to localize 73% of the affected glands. Nuclear scans missed almost fifty percent of the parathyroid adenomas. The low yield of these ancillary localizing tests makes them unnecessary in the routine evaluation of patients undergoing surgery for primary hyperparathyroidism