[Positive antithyroglobulin antibodies in patients with differentiated thyroid carcinoma. What significance?]. / Présence d'anticorps antithyroglobuline chez les patients suivis pour cancer différencié de la thyroïde. Quelle signification?

The aim of this retrospective study was to determine the predictive value of antithyroglobulin antibodies (TgAb) in 238 patients with undetectable thyroglobulin after whole thyroidectomy for differentiated cancer and ablative dose of radioiodine. TgAb titers were elevated in 30 patients with undetectable Tg level after withdrawal of T4 treatment. In 21 patients, initially positive TgAb titers became undetectable without clinical event within 3-84 months after therapy (median 12 months). In 2 cases, TgAb levels became undetectable whereas scintigraphy detected pathologic fixations. In 7 cases, high levels of TgAb titles remained unchanged 5 years after primary diagnosis In 3 of them, clinical course and distant metastases, were associated with an increased TgAb level despite normal Tg values. The investigation confirmed that serum TgAb measurement is one of the most important tools for the follow-up of patients with differentiated thyroid cancer. The presence of metastatic thyroid tissue has to be suspected in positive TgAb patients.

[Cancers of the thyroid. Value of a regional registry on 627 patients diagnosed, treated and followed by a multidisciplinary team]. / Les cancers de la thyroïde. Intérêt d'un registre régional de 627 patients diagnostiqués, traités et suivis par une équipe multidisciplinaire.

Since 1966, data from 1536 patients with a thyroid carcinoma, living in the French region Champagne-Ardenne, a geographical area with 1,350,000 inhabitants were registered. The creation of a multidisciplinary group and the involvement of the general practitioners, allowed us to reach an exhaustive and continued registration process for the French administrative area of Marne and Ardennes (855,000 inhibitants, 627 patients). The sex-ratio F/M was 3.8 and the median ages were respectively equal to 46 [10-93] and 52 [13-82] in females and males. In the age groups 10-14 and 15-19, 3 cases and 13 cases were respectively registered. An history of external irradiation was noted in 2.9% of the patients. The study of the incidence around the Chooz nuclear plant (Ardennes) did not show an increase of the risk. For the French administrative area Marne and Ardennes, for the period 1975-1979, the incidence rates, standardized on the European population, were equal to 1.75/100,000 in males (SD = 0.15) and 6.38/100,000 (SD = 0.29) in females. These values among the highest from the data published by the other European registries should be explained by a more intensive diagnosis procedure and an improvement in the accuracy of histological diagnosis. An increase of the incidence rate was observed between the periods 1975-1983 and 1984-1992 from 1.04 to 2.05/100,000 and 4.99 to 6.39/100,000 in males and females respectively. This was associated with changes in clinical and histological features and an improvement in survival curves. For patients under the age of 19, we have compared both periods before and after the accident of Chernobyl. The incidence rates increased from 0.13 to 0.45/100,000 and 0.49 to 1.81/100,000 in the age groups 10-14 and 15-19 respectively. This change was at the order of magnitude to this observed in our adults population. We did not found the histological aggressiveness which characterized the Chernobyl-induced thyroid cancer in children. The knowledge of the significant prognostic factors determined by multifactorial analyses is a major foundation of our therapeutic strategy.

[Prevalence of ophthalmopathy in Basedow disease. Follow-up of patients one year following diagnosis of hyperthyroidism]. / Prévalence de l'ophtalmopathie dans la maladie de Basedow. Suivi des malades à un an après la découverte de leur hyperthyroïdie.

During a study performed to estimate the prevalence and evolution of ophthalmologic symptoms in Graves' disease, we examined 85 patients suffering from diffuse hyperfunctional goiter, which was recently discovered. Forty-seven of these patients came back to the one year ophthalmologic control examination. The patients classed 1 in the Nospecs at first examination rarely remained in the same class either worsening or ameliorating. The worsening or amelioration were independent from the treatment employed for hyperthyroidism and from the results of this treatment. The patients classed 0 in the Nospecs mostly remained in the same class. The patients in which first examination discovered more severe signs and especially inflammatory signs (eyelid oedema for example) should be carefully followed up.

[Prevalence of eye diseases in Basedow disease. Apropos of a prospective study with 85 cases]. / Prévalence de l'ophtalmopathie au cours de la maladie de Basedow. A propos d'une étude prospective portant sur 85 cas.

The authors report the results of a prospective study, conducted between March 1990 and March 1991, on 85 patients suffering from Graves' disease, who were systematically examined to evaluate the prevalence of ophthalmopathy in Graves' disease. They were graded according to the Nospecs classification: 32 patients had no ophthalmopathy; 21 had only eyelid retraction (grade I in the Nospecs); 32 had a real ophthalmopathy (Grade II) or more in the Nospecs: 27 patients had signs of inflammation (grade II), that were often minor, 14 patients a moderate or intermediate exophtalmos (grade III), 4 patients had corneal injuries (grade V). The authors discuss the problems caused by this classification.

[Treatment of hyperthyroidism by radioactive iodine. Development of methods and difficulties in the surveillance]. / Traitement des hyperthyroïdies par l'iode radioactif. Evolution des méthodes et difficultés de la surveillance.

The experience of treatment of hyperthyroidism with radioactive iodine in the Nuclear Medicine department of the J. Godinot Institute, Rheims, from 1967 till 1987, is described. One thousand one hundred and fifty patients (723 with diffuse and 427 with nodular hyperthyroidism) received a total of 1,565 doses. The dosage calculation method was considerably simplified, enabling a patient to be treated in 24 hours. Thyroid gland mass evaluation, initially based on the scintigraphic projection area, is now performed by ultrasonography. The mean total radioactivity administered is 370 +/- 320 MBq per patient. All patients are seen on the 8th post-treatment week for clinical examination and hormone control. Seven out of 10 patients are cured with a single dose. Long-term follow-up, based on a computer file, is effected by means of an annual letter sent to the patient and to his family doctor, but in spite of sustained efforts 36 per cent of the patients are lost sight of. The diagnosis of iodine 131-induced hypothyroidism is based on plasma levels of TSH which, since 1984, are measured by the ultrasensitive method. The overall incidence of hypothyroidism is 6.6 per cent in the first year and 3 per cent thereafter. Despite a simplified procedure, the results obtained by the authors are similar to those found in the literature, and the cost-efficiency ratio is excellent.

[Thyroid cancer in Champagne-Ardenne: 1967-1984. Epidemiologic findings in a regional register]. / Les cancers thyroïdiens en Champagne-Ardenne: 1967-1984. Exploitation épidémiologique d'un registre régional.

Between 1967 and 1984, 600 cases of clinically diagnosed thyroid carcinoma were collected in an area (Champagne-Ardenne) of about 1,500,000 inhabitants. During this period, the complete collection of the cases was progressively ensured by involving all the general practitioners and by creating a cooperative multidisciplinary group. The collected data were sex, age at diagnosis, histological classification and clinical extension in TNM system. We found 19 patients with previous neck irradiation. Thyroid cancer was diagnosed in association with thyrotoxicosis in 36 patients: 13 Graves disease and 23 nodular hyperthyroidism. Incidence rates were estimated on a well defined population of two districts (850,000 inhabitants) and limited to the last four years. The following results were obtained: incidence 4.3/100,000/year, age-specific incidence progressively increasing up to a value of 10/000,000/year in the course of the fifth decade. Sex-ratio was 0.26.