Diagnosis and treatment of thyroid cancer in adult patients - Recommendations of Polish Scientific Societies and the National Oncological Strategy. 2022 Update [Diagnostyka i leczenie raka tarczycy u chorych doroslych - Rekomendacje Polskich Towarzystw Naukowych oraz Narodowej Strategii Onkologicznej. Aktualizacja na rok 2022].

The guidelines Thyroid Cancer 2022 are prepared based on previous Polish recommendations updated in 2018. They consider international guidelines - American Thyroid Association (ATA) 2015 and National Comprehensive Cancer Network (NCCN); however, they are adapted according to the ADAPTE process. The strength of the recommendations and the quality of the scientific evidence are assessed according to the GRADE system and the ATA 2015 and NCCN recommendations. The core of the changes made in the Polish recommendations is the inclusion of international guidelines and the results of those scientific studies that have already proven themselves prospectively. These extensions allow de-escalation of the therapeutic management in low-risk thyroid carcinoma, i.e., enabling active surveillance in papillary microcarcinoma to be chosen alternatively to minimally invasive techniques after agreeing on such management with the patient. Further extensions allow the use of thyroid lobectomy with the isthmus (hemithyroidectomy) in low-risk cancer up to 2 cm in diameter, modification of the indications for postoperative radioiodine treatment toward personalized approach, and clarification of the criteria used during postoperative L-thyroxine treatment. At the same time, the criteria for the preoperative differential diagnosis of nodular goiter in terms of ultrasonography and fine-needle aspiration biopsy have been clarified, and the rules for the histopathological examination of postoperative thyroid material have been updated. New, updated rules for monitoring patients after treatment are also presented. The updated recommendations focus on ensuring the best possible quality of life after thyroid cancer treatment while maintaining the good efficacy of this treatment.

Normocalcemic, subclinical, asymptomatic primary hyperparathyroidism in patients with goiter or papillary thyroid cancer--preliminary report. Normocalcemic primary hyperparathyroidism and thyroid pathology.

UNLABELLED: The aim of the prospective study was the evaluation of primary, subclinical, normocalcemic hyperparathyroidism (PHPT) incidence in patients, operated on because of non-toxic (NTG), toxic (TG) goiter and papillary thyroid cancer (PTC). MATERIAL AND METHODS: The study was performed in the group of 196 patients operated on NTG (115 patients), TG (43 patients) and PTC (38 patients). All patients had never been operated because of goiter. No patient had clinical symptoms of PHPT. Calcium concentration (Ca), phosphorus concentration (P) and alkaline phosphatase activity (ALP) in blood serum were measured in all patients a day before operation. When those parameters were out of range, parathormone concentration (PTH) in blood serum was measured. In the case of elevated PTH concentration PHPT was diagnosed. Furthermore, in order to exclude renal failure and insufficiency tests for creatinine and urea concentrations in blood serum and urinalysis were performed. RESULTS: There was no case of increased Ca concentration among 158 patients with benign goiter. The values of at least one measured parameters (P or ALP) were abnormal in 47 out of 158 patients with benign goiter (29.7%). Increased PTH concentration (mean 101.5 pg/ml) was in 16 of 47 patients (10.1% of 158 patients). Normocalcemic PHPT was diagnosed in 12 (10.4%) NTG patients and 4 (9.3%) TG patients. In patients with PTC hypercalcemia was not affirmed. In 7 (18.42%) cases of 38 PTC patients P concentration and ALP activity were abnormal. Increased PTH concentration (84.85 pg/ml) was found in one female with PTC with normal values of P and ALP. Incidence of PHPT was observed in 2.63% of PTC patients. CONCLUSIONS: 1. There was no significant difference of PHPT incidence between various type of goiter. 2. In our study coexistence of PTC and normocalcemic, asymptomatic PHPT is rare.

[Prospective study on incidence of primary hyperparathyroidism in patients with goiter]. / Prospektywna ocena czestosci wystepowania pierwotnej nadczynnosci przytarczyc u chorych z wolem guzowatym.

UNLABELLED: Primary hyperparathyroidismus (PHPT) may coexist with goitre. Measurement of calcium concentration in blood serum is recommended before goiter operation. However, because of subclinical PHPT with normocalcemia this screening is insufficient for diagnosis of all PHPT cases. THE AIM: of the study is prospective evaluation of PHPT incidence in patients operated because of goitre. MATERIAL AND METHODS: The study was performed in group of 158 patients (145 women, 13 men) operated because of non-toxic goitre --115 patients--(SNN) and toxic--43 patients--(SNT). Calcium concentration (Ca), phosphorus concentration (P) and alkaline phosphatase activity (ALP) have been measured in all patients a day before operation. When this parameters has been out of normal range, parathormone concentration (PTH) was measured. PHPT was diagnosed, when PTH has been higher then normal range. Following Ca, P, ALP and PTH measurement was performed 3 months after operation to confirm or exclude the diagnosis of PHPT RESULTS: Values of Ca, P and ALP was out of normal range in 47 (37 with SNN and 10 with SNT) of 158 patients (29,7%). Higher PTH concentration (average 101,5 pg/ml) was in 16 of 47 patients (10, 1% of 158 patients). There was no hypercalcemia in any patient with PHPT PHPT was diagnosed in 12 (10,4%) patients with SNN and 4 (9,3%) with SNT. 12 patients were applied to following screening 3 months after operation. Among this patients value of Ca, P and ALP out of normal range was ascertained in 8 patients (66,7%). In 4 patients was higher PTH concentration. Increased PTH concentration and CA, P ALP concentration in normal range was observed in 1 patient three months after operation. In 5 of 12 (41,7%) patients was confirmed remaining PHPT although operation (average PTH 87,1 pg/ml). CONCLUSIONS: Primary hyperparathyroidismus coexist with similar incidence in patients with SNN and SNT Standard PHPT screening is proper because of PHPT incidence in up to 10% thyroid operated patients.