David V. Becker

Comparison of administration of recombinant human thyrotropin with withdrawal of thyroid hormone for radioactive iodine scanning in patients with thyroid carcinoma.

BACKGROUNDnTo detect recurrent disease in patients who have had differentiated thyroid cancer, periodic withdrawal of thyroid hormone therapy may be required to raise serum thyrotropin concentrations to stimulate thyroid tissue so that radioiodine (iodine-131) scanning can be performed. However, withdrawal of thyroid hormone therapy causes hypothyroidism. Administration of recombinant human thyrotropin stimulates thyroid tissue without requiring the discontinuation of thyroid hormone therapy.nnnMETHODSnOne hundred twenty-seven patients with thyroid cancer underwent whole-body radioiodine scanning by two techniques: first after receiving two doses of thyrotropin while thyroid hormone therapy was continued, and second after the withdrawal of thyroid hormone therapy. The scans were evaluated by reviewers unaware of the conditions of scanning. The serum thyroglobulin concentrations and the prevalence of symptoms of hypothyroidism and mood disorders were also determined.nnnRESULTSnSixty-two of the 127 patients had positive whole-body radioiodine scans by one or both techniques. The scans obtained after stimulation with thyrotropin were equivalent to the scans obtained after withdrawal of thyroid hormone in 41 of these patients (66 percent), superior in 3 (5 percent), and inferior in 18 (29 percent). When the 65 patients with concordant negative scans were included, the two scans were equivalent in 106 patients (83 percent). Eight patients (13 percent of those with at least one positive scan) were treated with radioiodine on the basis of superior scans done after withdrawal of thyroid hormone. Serum thyroglobulin concentrations increased in 15 of 35 tested patients: 14 after withdrawal of thyroid hormone and 13 after administration of thyrotropin. Patients had more symptoms of hypothyroidism (P<0.001) and dysphoric mood states (P<0.001) after withdrawal of thyroid hormone than after administration of thyrotropin.nnnCONCLUSIONSnThyrotropin stimulates radioiodine uptake for scanning in patients with thyroid cancer, but the sensitivity of scanning after the administration of thyrotropin is less than that after the withdrawal of thyroid hormone. Thyrotropin scanning is associated with fewer symptoms and dysphoric mood states.

Choice of therapy for Graves' hyperthyroidism.

Surgery, antithyroid drugs, and radioiodine are all effective for the treatment of adult Graves hypcrthyroidism. However, reports in the medical literature present widely varying and often conflic...

Patient perceptions of nonmelanoma skin cancer before diagnosis.

BACKGROUND There is a paucity of data regarding patient perceptions of nonmelanoma skin cancer (NMSC). OBJECTIVE To describe patients perceptions of skin lesions before a diagnosis of NMSC. METHODS This was a descriptive study in a private practice setting. Patients with a previous biopsy of NMSC who presented for treatment were eligible. A self‐administered questionnaire assessed what patient perceptions of lesions diagnosed as NMSCs had been before they were aware of the diagnosis. Medical records were reviewed for tumor type, size, and location. RESULTS One hundred sixty‐three consecutive patients undergoing treatment for NMSC completed the questionnaire. The most common initial impressions of the lesion were skin cancer (20%), acne (19%), sore (10%), unknown (9%), dry skin (7%), age spot (6%), and injury (6%). Seventy‐two percent of patients were the first to notice the lesion. Patients with a history of skin cancer were more likely to think the lesion was a skin cancer on initial impression (28% vs 8%) (p < .001). CONCLUSIONS Understanding how patients perceive their skin cancers may aid in targeting educational strategies and increase awareness of skin cancer risk. Our data suggest that there are important subtleties in self‐identification that may need to be taken into consideration in any educational campaign targeting NMSC.