SIMULTANEOUS METASTASES OF PAPILLARY THYROID CARCINOMA AND NEUROENDOCRINE TUMOR OF THE CECUM TO CERVICAL LYMPH NODES: A CASE REPORT.

We present a case of a patient with simultaneous cervical lymph node metastasis of papillary thyroid cancer (PTC) and cecum neuroendocrine tumor (NET). A 45-year-old male patient with the diagnosis of metastatic NET of the cecum underwent fine needle aspiration (FNA) of a positron emission tomography with 18F-fluorodeoxyglucose (18F-FDG PET) positive nodule in the left thyroid lobe. Due to FNA finding suspect of PTC, the patient underwent total thyroidectomy with central neck dissection. Histopathologic finding revealed PTC of the left thyroid lobe and small solitary lymph node PTC metastasis in the central neck region. Postoperative evaluation with neck ultrasound (US) revealed two enlarged suspected lymph nodes in cervical regions III and IV on the left side of the neck and the patient underwent FNA with measurement of thyroglobulin (Tg) in the aspirates. The FNA finding of the cervical lymph node in the region III revealed PTC metastasis with high Tg value in the aspirate, while FNA finding of the cervical lymph node in the region IV revealed NET metastasis with low Tg value in the aspirate. Postoperative serum Tg value was 17.75 µg/L and the patient underwent 5550 MBq iodine-131 (I-131) therapy. A year after I-131 therapy, follow-up neck US demonstrated complete cure of PTC cervical lymph node metastasis in the region III and stable in size NET cervical lymph node metastasis in the region IV. To our knowledge, this is the first report of simultaneous occurrence of cervical lymph node metastases of PTC and NET of the cecum.

Quantitative Analysis of Galectin-3 Expression in Benign and Malignant Thyroid Nodules.

In this study, galectin-3 was analyzed as a potential marker for preoperative detection of malignant thyroid lesions. Galectin-3 expression was analyzed by quantitative real-time reverse transcription polymerase chain reaction (RT-PCR) in preoperative thyroid fine-needle aspirates from 245 patients with thyroid nodules. Out of 245 samples, 238 were adequate for analysis by RT-PCR. Galectin-3 was positive in 34 (89.5%) of 38 papillary carcinomas, 3 (89.5%) of 4 follicular carcinomas, 17 (53.1%) of 32 follicular adenomas, 2 (33.3%) of 6 Hurthle cell adenoma, 11 (28.2%) of 39 Hashimoto thyroiditis, and 69 (57.9%) of 119 nodular goiter samples. Galectin-3 showed specificity of 49.5%, sensitivity of 88.1%, positive predictive value of 27.2%, and negative predictive value of 95.1% as a marker for detection of malignant thyroid nodules. Owing to the relatively low positive predictive value due to the relatively high false positive rate, the clinical value of galectin-3 analyzed by quantitative real-time RT-PCR as a marker for preoperative detection of malignant thyroid lesions is limited.

The impact of familial predisposition on the development of Hashimoto's thyroiditis.

Objectives: Hashimoto's thyroiditis (HT) is a common autoimmune disease. Available data show that HT develops as a result of interaction between genetic susceptibility and environmental factors, but the exact pathogenesis of the disease is not yet fully understood. The aim of this investigation is to evaluate the potential relationship between family history of HT and the development of HT.Methods: Data regarding family history of all patients who were referred for a diagnostic evaluation of thyroid function for any reason between May 2014 and May 2018 was analyzed. Only first-degree relatives were considered significant, whereas the data of distant relatives was not collected.Results: A total of 39 patients with positive family history of HT were extracted (Hashimoto group). As a control group, 39 patients with negative family history of HT were randomly chosen from the same database for the final analysis. When analyzing cytological diagnoses, there were 17 patients with confirmed HT in the Hashimoto group, and 7 in the control group (p = 0.0262).Conclusion: To the best of our knowledge, this is the first study directly showing that there is genetic predisposition for the development of HT in patients with positive family history of the disease (43.59% of patients with positive family history developed HT themselves). Assessment of a patient's family history in detail should become a standard procedure when a patient with any thyroid disorder is referred for diagnostic evaluation.

Malignancy risk with atypia of undetermined significance finding on thyroid nodule FNA: clinical experience from a tertiary institution.

The Bethesda System for Reporting Thyroid Cytopathology from 2009 introduced a new category in thyroid nodule fine-needle aspiration (FNA) findings named atypia of undetermined significance (AUS), which usually appears in around 5% of FNA findings. Our study aimed to assess the utility of AUS finding in determining the risk of malignancy in thyroid nodules. In our study, 160 patients with AUS finding on initial FNA were regularly followed-up. Total and specific malignancy rates were calculated after receiving histopathologic confirmation or histopathologic/cytologic exclusion of malignancy. Eventually 80 (50%) patients were referred to surgery, with malignancy rate of 37.5% on histopathology. Another 52 (32.5%) patients were confirmed to have benign nodules on repeat FNA. After combining results obtained from histopathologic reports with those obtained from cytologic follow-up, total malignancy rate was 22.72%. However, malignancy was confirmed in only one (5.26%) of 19 patients with AUS finding on repeat FNA with surgical and histopathologic follow-up. In conclusion, FNA is an extremely useful tool for clinicians to discriminate patients to be referred to surgery and those that can be followed-up safely without the need for further invasive procedures.

HMGA2 Gene Expression in Fine-needle Aspiration Samples of Thyroid Nodules as a Marker for Preoperative Diagnosis of Thyroid Cancer.

There is a great interest in molecular markers that would help in the preoperative diagnosis of malignant thyroid nodules in cases of indeterminate fine-needle aspiration cytology. The aim of this study was to determine the diagnostic accuracy of HMGA2 gene expression in discriminating benign from malignant thyroid nodules. In this study, 237 preoperative thyroid fine-needle aspiration samples were analyzed prospectively for the expression of the HMGA2 gene by real-time reverse transcription polymerase chain reaction. The results were evaluated against the postoperative histopathologic diagnosis or definitive cytologic diagnosis in cases of nodular goiter and Hashimoto thyroiditis. Among 237 samples from patients with thyroid nodules that were analyzed, 231 were adequate for real-time reverse transcription polymerase chain reaction analysis. With a cutoff value of 8.71 for relative gene expression, HMGA2 was positive in 19 (16.4%) of 116 nodular goiter, 1 (2.6%) of 39 Hashimoto thyroiditis, 9 (28.1%) of 32 follicular adenoma, 0 (0%) of 5 Hurthle cell adenoma, 32 (88.9%) of 36 papillary carcinoma, and 3 (100%) of 3 follicular carcinoma samples. In discriminating between malignant and benign thyroid nodules, HMGA2 has shown specificity of 84.5%, sensitivity of 91.9%, positive predictive value of 53.1%, and negative predictive value of 98.2%. High sensitivity and negative predictive value of HMGA2 for preoperative detection of malignant thyroid nodules shown in this study indicate that it may have a role as an ancillary marker in cytology in the management of patients with thyroid nodules.

Clinical and prognostic significance of anisocytosis measured as a red cell distribution width in patients with colorectal cancer.

PURPOSE: : colorectal cancer (CRC) is the third most commonly diagnosed cancer worldwide, and detection of new prognostic markers is mandatory for patients to receive optimal oncological treatment. The aim of the study was to assess clinical and prognostic value of red cell distribution width (RDW) in patients with CRC. METHODS: : RDW values in 90 patients with CRC undergoing surgery for primary disease were analyzed in pre- and postoperative setting, and correlated with clinical and hematological parameters. RESULTS: : Both pre- and postoperative RDW measurements were found to be associated with features of iron deficiency anemia, inflammatory response to tumor, advanced age and depth of tumor invasion. Optimal cutoff points were calculated to be 14% for preoperative and 13.6% for postoperative RDW measurements. Elevations in both pre- and postoperative RDW values had significant effects on survival in univariate and multivariate analyses. Effects were found to be independent of tumor related features, stage of the disease, development of anemia and aberrant inflammatory response to tumor. CONCLUSIONS: : RDW is an integrative parameter reflecting tumor specific features and shows significant association with overall survival in patients with CRC. This is especially important in patients with stage 2 disease where elevation in preoperative RDW values can contribute to recognition of higher risk patients.

PRIMARY FIBROSARCOMA OF THE THYROID GLAND: CASE REPORT.

Due to progressive dyspnea, a male patient aged 59 underwent medical examination in 2003 in a local hospital. Neck ultrasound and fine-needle aspiration biopsy (FNAB) of a suspect lesion in the thyroid gland revealed the presence of a malignant neoplasm, i.e. mesenchymal tumor. Immunocytochemistry for epithelial membrane antigen, chromogranin A and leukocyte common antigen (CD45) was negative, while vimentin and S-100 were positive. The patient was referred to a university hospital center, where further oncologic work-up was done. Neck ultrasound revealed a tumor in the left lobe of the thyroid, with extension to the aortic arch. After repeated FNAB, cytologic diagnosis of primary thyroid fibrosarcoma was established. Due to the locally advanced and consequently inoperable disease, primary radiotherapy to the neck region (64 Gy in 32 fractions) was applied, followed by 6 cycles of chemotherapy with doxorubicin. After completion of therapy, computed tomography scan demonstrated significant regression of primary disease, but it was still not amenable to surgical treatment. Thus, the decision of the oncology board was active surveillance of the patient. During 9-year follow up, no signs of progression or activity of the disease were found.

Clinical Significance of Multinodularity in Patients with Papillary Thyroid Carcinoma.

UNLABELLED: Backgroud/Aim: To assess the clinical significance of nodules in multinodular thyroid if one nodule is diagnosed as papillary carcinoma (PC), we investigated 97 patients with a multinodular thyroid and histopathological diagnosis of PC. PATIENTS AND METHODS: We assessed the following variables: age and gender, fine-needle aspiration diagnosis, PC nodule size and dominance, intraglandular dissemination (ID), regional lymph node (RLN) status, and distribution of diagnoses of the other nodules. RESULTS: Among 97 patients with PC, additional diagnoses were: nodular goiter (NG) in 64 patients, ID in 28, Hashimoto's thyroiditis (HT) in 26, and follicular or Hürthle cell adenoma in seven. CONCLUSION: Patients with ID, and without NG or HT more often had RLN metastases. Lower rates of RLN metastases in patients with NG and HT are probably due to smaller PC nodule sizes found during routine follow-up of these benign diseases.

[Croatian Society for Clinical Cytology guidelines for thyroid cytology]. / Smjernice u citoloskoj dijagnostici stitnjace Hrvatskoga drustva za klinicku citologiju.

The main purpose of thyroid FNA (fine needle aspiration) is to separate malignant and possibly malignant nodules from benign thyroid lesions. Every patient with thyroid nodule is a candidate for FNA. Before a decision to perform an FNA, a complete history, a physical examination directed to the thyroid and cervical lymph nodes, a serum thyrotropin level, and thyroid ultrasound should be obtained. Thyroid lesion with a maximum diameter greater than 1.5 cm or nodule of any size with sonographically suspicious features is an indication for FNA. Ultrasound-guided FNA of the thyroid is recommended. The requisition form that accompanies FNA should contain the identifying data, location and size of the nodule, and relevant laboratory and clinical data. FNA diagnosis of thyroid disease is a clinicocytologic diagnosis, and correlation with clinical findings is mandatory for success. Thyroid FNA classification scheme consists of a four diagnostic categories according to the risk of malignancy: benign lesions, indeterminate lesions according to malignancy, malignant tumors, and non-diagnostic. Ancillary studies (immunocytochemistry, RT-PCR, flow cytometry) are usually helpful in borderline cases.

Intensity and distribution of immunohistochemical expression of galectin-3 in thyroid neoplasms.

The aim of the study was to assess the intensity and distribution of galectin-3 expression in benign and malignant thyroid neoplasms by immunohistochemical method. Immunohistochemical expression of galectin-3 was analyzed in surgical thyroid specimens from 82 patients with histopathologic diagnosis of follicular adenoma (n = 32), Hürthle cell adenoma (n = 10) and papillary carcinoma (n = 40). Results of intracytoplasmatic and intranuclear expression of galectin-3 were scored using a semi-quantitative scale for intensity. Intracytoplasmatic expression ofgalectin-3 was positive in 18 (43%) benign neoplasms and in all 40 malignant neoplasms. The accuracy, sensitivity and specificity of intracytoplasmatic expression of galectin-3 as a malignant marker in thyroid neoplasms were 78.1%, 100% and 57.1%, respectively. Intracytoplasmatic expression of galectin-3 was positive in 10 (31%) cases of follicular adenoma and 8 (80%) cases of Hürthle cell adenoma. The accuracy, sensitivity and specificity of intranuclear expression of galectin-3 as a malignant marker in thyroid neoplasms were 84.1%, 100% and 69%, respectively. There was no strong intensity of either intracytoplasmatic or intranuclear expression ofgalectin-3 in benign thyroid neoplasms, and no weak intensity of either intracytoplasmatic or intranuclear expression of galectin-3 in malignant neoplasms. There was no statistically significant difference between intracytoplasmatic and intranuclear expression of galectin-3 in benign thyroid neoplasms. The results of our study indicate that the immunohistochemical expression of galectin-3 is a highly sensitive marker of malignancy, with low specificity in differentiating malignant from benign thyroid neoplasms. The analysis of intensity and distribution ofgalectin-3 expression could improve the specificity of the method.

When to repeat thyroid fine needle aspiration cytology?

The aim of of the study was to investigate the possible changes of primary fine needle aspiration (FNA) diagnoses after subsequent check ups. We investigated 948 thyroid nodules and the main indications for repeat FNAs were inadequate/indeterminate FNA findings and growing nodules at ultrasound check up. FNA findings were subdivided into inadequate, benign, low-risk lesion (includes cellular follicular lesion, suspicious of follicular/Hürthle cell neoplasm, atypical Hürthle cell hyperplasia), follicular/Hürthle cell neoplasm, high-risk lesion (includes lesions suspicious of malignancy), and malignant. Of the total of 948 nodules, repeat FNA diagnoses remained within the same category in 709 (75%) nodules. Out of 38 primary inadequate FNAs, 7 (18%) remained inadequate, 24 (63%) were benign, and 3 (8%) were categorized as high-risk/malignant. Out of 659 primary benign FNAs, 587 (89%) remained benign, and 11 (2%) were categorized as high-risk/malignant. Out of 169 primary low-risk lesion FNAs, 66 (39%) remained low-risk, 65 (38%) were benign, and 10 (6%) were categorized as high-risk/malignant. Out of 43 primary high-risk lesion FNAs, 20 (46%) remained high-risk, 2 (5%) were benign, 3 (7%) were categorized as a low-risk lesion, and 13 (30%) were categorized as malignant. Out of 35 FNAs that were primary follicular/Hürthle cell neoplasm, 27 (77%) remained follicular/Hürthle cell neoplasm, 1 (3%) was categorized as benign, 4 (11%) were categorized as a low-risk lesion, and 3 (8%) as high-risk/malignant. In conclusion, repeat thyroid FNA is useful in most cases of primary inadequate/indeterminate FNA findings, as well as in the evaluation of growing nodules.

Galectin-3 and CD44v6 as markers for preoperative diagnosis of thyroid cancer by RT-PCR.

The aim of the study was to determine the diagnostic value of reverse transcriptase polymerase chain reaction (RT-PCR) analysis of galectin-3 and CD44v6 as markers for preoperative diagnosis of malignancy in lesions of the thyroid. RT-PCR analysis of galectin-3 and CD44v6 expression was performed on RNA isolated from fine-needle aspirates of thyroid lesions from 428 patients. The results were evaluated against the postoperative histopathological diagnosis or definitive cytological diagnosis in cases of nodular goiter and Hashimoto thyroiditis. A total of 57 (13%) samples were inadequate for RT-PCR. Galectin-3 and CD44v6 were positive in 167 (45%) and 158 (43%) out of 371 adequate samples, respectively. Galectin-3 and CD44v6 were positive in 56 (86%) and 54 (83%) out of 65 papillary carcinomas, in 16 (29%) and 18 (32%) out of 56 Hashimoto's thyroiditis, in 61 (34%) and 52 (29%) out of 181 nodular goiters, in 23 (43%) and 23 (43%) out of 53 follicular adenomas, in 3 (100%) and 3 (100%) out of 3 follicular carcinomas, and in 8 (62%) and 8 (62%) out of 13 Hurthle cell adenomas, respectively. Specificity, sensitivity, and positive and negative predictive values in discriminating between malignant and benign thyroid nodules were 64, 87, and 35 and 96% for galectin-3; 67, 84, and 36 and 95% for CD44v6; and 79, 82, and 47 and 95% for the analysis of both markers (considered positive only if both galectin-3 and CD44v6 were positive), respectively. Owing to relatively low specificity, the clinical value of galectin-3 and CD44v6 analysis by RT-PCR as a marker for preoperative diagnosis of malignancy in thyroid lesions is limited.

Intrathyroid parathyroid carcinoma with intrathyroidal metastasis to the contralateral lobe: source of diagnostic and treatment pitfalls.

Intrathyroidal parathyroid carcinoma is extremely rare clinical entity with potentially multiple diagnostic pitfalls. We report a case of 40-year-old man presented with classical manifestations of primary hyperparathyroidism, severe hypercalcemia and profoundly increased serum parathyroid hormone level. Neck ultrasonography demonstrated multinodular goiter with predominant 34 mm nodule in left thyroid lobe. Additional 16 mm nodule was found beneath the left lobe. Routine percutaneous fine-needle aspiration of predominant nodule indicated follicular thyroid carcinoma, while left inferior nodule was confirmed to be of parathyroid origin. The patient underwent surgery, during which frozen sections identified medullary thyroid carcinoma with metastasis to upper mediastinal lymph node. Permanent sections of the predominant left lobe nodule revealed intrathyroidal parathyroid carcinoma surrounded with multiple microscopic metastases. Left inferior nodule was metastatic lymph node. Additional 10 mm intrathyroidal metastasis of primary parathyroid carcinoma was found within right thyroid lobe. This case indicates that fine-needle-aspiration and intraoperative biopsy are of limited value in diagnosing parathyroid carcinoma, especially if localized intrathyroidally. Oncological en-block resection is treatment of choice, implying ipsilateral lobectomy in case of thyroid invasion. This firstly described case of intrathyroidal parathyroid carcinoma causing intrathyroidal dissemination may influence future treatment strategies.

Malignancy risk assessment in adenomatoid nodules and suspicious follicular lesions of the thyroid obtained by fine needle aspiration cytology.

Our aim was to assess malignancy risk in adenomatoid nodules and suspicious follicular lesions of the thyroid obtained by fine needle aspiration (FNA) cytology. Retrospective research was performed of 276 patients who underwent thyroid surgery after preoperative ultrasound-guided FNA diagnosis of either adenomatoid nodule, cellular follicular lesion, "suspicious for follicular neoplasm" or follicular neoplasm. Out of 276 patients, FNA reports showed 15 diagnoses (5%) of adenomatoid nodules, 73 (26%) cellular follicular lesions, 76 (28%) "suspicious for follicular neoplasm", and 112 diagnoses (41%) of follicular neoplasm. FNA reports were compared with pathohistological findings. In FNA reports of adenomatoid nodule (N = 15), there were seven (47%) pathohistological diagnoses (PHDs) of nodular goiter, and eight (53%) PHDs of follicular adenoma. In FNA reports of cellular follicular lesion (N = 73), there were 2 (3%) PHDs of thyroiditis, 32 (44%) PHDs of nodular goiter, 38 (52%) PHDs of follicular adenoma, and one (1%) PHD of papillary carcinoma. In FNA reports of "suspicious for follicular neoplasm" (N = 76), there was one (1%) PHD of thyroiditis, 24 (32%) PHDs of nodular goiter, 47 (62%) PHDs of follicular adenoma and four (5%) diagnoses of papillary carcinoma. In FNA reports of follicular neoplasm (N = 112), there were 25 (22%) PHDs of nodular goiter, 72 (64%) PHDs of follicular adenoma, and 15 (14%) PHDs of thyroid carcinoma. We found significant difference (p < 0.01) between investigated FNA report groups according to malignancy risk. Stratification of cytologic diagnoses of follicular thyroid lesions into different subcategories with various probabilities of malignancy allows more accurate estimation of malignancy risk and individualized patient treatment, when deciding between immediate operation and close follow-ups with repeat FNA.

Thyroid fine needle aspiration cytology in children and adolescents.

Thyroid fine needle aspiration cytology (FNAC) is the most accurate and cost effective method in the evaluation of the thyroid nodule and has been commonly used in adults. Thyroid nodules are uncommon in younger patients (1-2%). Our aim was to determine some relevant clinical and cytological parameters in this demographic group. Ultrasound-guided thyroid FNACs performed from May 1995 to June 2008 in patients under 18 years of age were retrospectively reviewed. The following clinical parameters were retrieved: age and gender, number of nodules, and nodule size. Cytological parameters included cytologic diagnosis and cyto-pathohistological correlation. Total of 236 cases, representing 206 patients under 18 years of age, were retrieved from a total of 11748 thyroid FNAC cases (2.0%). The patient's age ranged from 2 to 18 years (mean 14). There were 180 (87.4%) females and 26 (12.6%) males with a female/male ratio 4:1. For 56 patients data concerning the number of nodules were recorded. 20 (35.7%) patients did not have any nodules, 20 (35.7%) patients had solitary thyroid nodule and 16 (28.6%) patients had multiple nodules. The size of nodules ranged from 0.4-5.4 cm (mean 1.4 cm). The cytologic diagnoses were: unsatisfactory (9), cyst fluid (7), benign (204), cellular follicular lesion/follicular neoplasm (9) and papillary thyroid carcinoma (7). The prevalence of malignancy among cytologic diagnoses was 3.4%. 21 patients had surgical follow up. 5 patients (23.8%) had thyroid malignancies (all papillary carcinomas). The remainder had benign thyroid lesions; follicular adenomas (8), multinodular goiters (5), diffuse goiters (2) and Hashimoto thyreoiditis (1). There were no false negative or false positive cytologic diagnoses. The prevalence of thyroid malignancies among cytologic diagnoses was similar to those reported in adults. In limited number of patients with surgical follow up there were no false negative or false positive cytologic diagnoses.

Accuracy of fine needle aspiration biopsy with and without the use of tumor markers in cytologically indeterminate thyroid lesions.

We investigated if the use of two tumor markers, galectin-3 and CD44v6, could improve diagnostic accuracy of thyroid fine needle aspiration biopsy (FNAB) in cytologically indeterminate lesions (CIL). 351 patients with CIL [cellular follicular lesion/suspicious follicular neoplasm/suspicious Hürthle cell neoplasm (CFL/sFN/sHCN), Hürthle cell neoplasm (HCN), and follicular neoplasm (FN)] and surgical follow-up were investigated. 251 patients had FNAB diagnoses made without help of tumor markers and the rest of 100 patients had FNAB diagnoses made with a known expression of tumor markers determined by the reverse transcription (RT)-PCR. Risk of malignancy in all 351 patients with CIL was 6.8%. In the group with FNAB made without RT-PCR, there were 140 CFL/sFN/sHCN with the risk of malignancy of 4.2%, 92 FN with the risk of malignancy of 13.0%, and 19 HCN with the risk of malignancy of 5.2%. In the group with FNAB made with RT-PCR, there were 49 CFL/sFN/sHCN with the risk of malignancy of 2.0%, 40 FN with the risk of malignancy of 7.5%, and 11 HCN with the risk of malignancy of 9.0%. In the group with at least one positive tumor marker (N = 69), the risk of malignancy was 3.1% for CFL/sFN/sHCN, 11.1% for FN, and 10.0% for HCN. In the group with negative tumor markers (N = 31) there were no malignancies. The use of tumor markers, galectin-3 and CD44v6, determined by RT-PCR improves only sensitivity of thyroid FNAB in CIL. In most patients with CIL, and negative both tumor markers, conservative approach is advisable.

Coexistence of papillary carcinoma and Hashimoto's thyroiditis.

The aim of the study was to determine the incidence of coexistence of papillary carcinoma and Hashimoto's thyroiditis in cytologic material. Cytologic findings were collected from 10508 patients that underwent ultrasound-guided fine needle aspiration cytology (FNAC) of the thyroid. Hashimoto's thyroiditis was found in 2156 (20.5%) and papillary carcinoma in 269 (2.6%) of 10508 patients with FNAC, whereas both Hashimoto's thyroiditis and papillary carcinoma were present in 42 (0.4%) patients. Among patients with FNAC diagnosis of Hashimoto's thyroiditis, the prevalence of papillary carcinoma was 1.9%. Among patients with FNAC diagnosis of papillary carcinoma, the prevalence of Hashimoto's thyroiditis was 15.6%. There was no statistically significant association between the presence of papillary carcinoma and Hashimoto's thyroiditis in patients undergoing FNAC (p=0.0522). In conclusion, in a large series of patients, the incidence of Hashimoto's thyroiditis and papillary carcinoma coexistence in cytologic material was 0.4%. There was no statistically significant relationship between Hashimoto's thyroiditis and papillary carcinoma in cytologic material.

[Croatian Thyroid Society guidelines for rational detection of thyroid dysfunction]. / Smjernice hrvatskog drustva za stitnjacu za racionalnu dijagnostiku poremecaja funkcije stitnjace.

Thyroid dysfunction is common in the population, especially in women, and thyroid diagnostic tests are among the most often used diagnostic procedures nowadays. Many thyroid societies developed guidelines for the detection of thyroid dysfunction. An interdisciplinary team of experts from the Croatian Thyroid Society studied guidelines of other thyroid societies and international publications, and according to our tradition and clinical practice developed guidelines for rational detection of thyroid dysfunction; hypothyroidism and hyperthyroidism. The aim of these guidelines is to recommend evidence-based and rational approach to the detection of thyroid dysfunction.

Thyroid fine-needle aspiration samples inadequate for reverse transcriptase-polymerase chain reaction analysis.

BACKGROUND: Analysis of different tumor markers by reverse transcriptase-polymerase chain reaction (RT-PCR) in fine-needle aspiration samples of thyroid nodules has been studied with the objective of improving the accuracy of the preoperative diagnosis of thyroid lesions. The aim of the current study was to investigate thyroid fine-needle aspiration samples inadequate for RT-PCR analysis and to determine whether there is a correlation between their proportion and the method of sampling used or the greatest dimension of the nodules. METHODS: A total of 350 fine-needle aspiration samples from patients with thyroid nodules were analyzed. After the aspirate was smeared for conventional cytology, the leftover material in the needle was used for RT-PCR analysis in 1 group of 175 patients. In another group of 175 patients, a separate puncture was performed to obtain material for RT-PCR analysis only. Samples were considered adequate for RT-PCR analysis if the expression of both glyceraldehyde-3-phosphate dehydrogenase and thyroglobulin was found by RT-PCR. RESULTS: In total, 61 (17.4%) samples inadequate for RT-PCR were detected. All 12 samples that were inadequate for cytologic diagnosis were also found to be inadequate for RT-PCR analysis. The proportion of inadequate samples for RT-PCR was found to be significantly higher in samples taken from leftover material in the needle (21.7%) then in samples from a separate puncture (13.1%) (P = .049). No statistically significant correlation between the adequacy of samples for RT-PCR and the largest dimension of the nodule was found. CONCLUSIONS: The proportion of samples inadequate for RT-PCR was found to be higher in samples taken from leftover material in the needle than in samples obtained from a separate puncture.

Riedel's thyroiditis treated with tamoxifen.

A 46-year-old woman with clinical diagnosis of Riedel's thyroiditis was admitted to our Department, presenting with dyspnea, dysphagia, fatigue, and hoarseness. Previously, she had been diagnosed with Hashimoto's thyroiditis and hypothyroidism. The disease had a progressive course and had lasted for a year before the definitive diagnosis of Riedel's thyroiditis was confirmed and treated with methylprednisolone, 12 mg daily, without success. We started therapy with tamoxifen, 10 mg twice a day, together with methylprednisolone, 16 mg daily, and L-thyroxin substitution therapy. The follow-up lasted for one year. Treatment with tamoxifen led to a significant subjective improvement and objective changes, confirmed by regular clinical examinations, ultrasonography, and computed tomography of the neck. After 8 months of therapy, the patient had no compression symptoms and goiter decreased in estimated weight from 105 g to 63 g according to ultrasound measurements. The patient underwent partial thyroidectomy at 10 months after diagnosis of Riedel's thyroiditis. Histopathology confirmed the diagnosis of Riedel's thyroiditis. Our report indicates that tamoxifen can be a valuable drug therapy in the treatment of Riedel's thyroiditis.