Penn G. Skillern

The advantages of subtotal thyroidectomy and suppression of TSH in the primary treatment of papillary carcinoma of the thyroid

Patients between the ages of 6 and 45 years with distant metastases from papillary carcinoma of the thyroid can be treated as effectively by subtotal thyroidectomy and suppressive doses of thyroid hormone as by total thyroidectomy followed by treatment with iodine 131 (131I). Moreover, distant metastases can be treated by either 131I or suppression as effectively after they are apparent on x‐ray as they can be when treated in a subclinical stage. Therefore, in patients younger than 45 years old it is rarely necessary to perform a total thyroidectomy or to do frequent postoperative scans. In patients older than 44 or younger than 7 who have distant metastases or extensive involvement of both lobes, total or almost total thyroidectomy is justified if it can be done with minimal morbidity. In patients of this age group whose tumors fail to respond to suppressive doses of thyroid, 131I should be used. In view of the importance of diagnostic related groups (DRG) to the economy of hospitals, we note that the cost of total thyroidectomy, ablation by 131I, and intermittent body scans is at least three times that of less radical procedures which, in conjunction with suppression by thyroid feeding, give the same survival with less morbidity.

Hyperinsulinism due to islet-cell tumors simulating sarcoma: a report of two cases of large tumors composed of round and spindle cells associated with hypoglycemia.

Functioning islet-cell tumors are usually composed of nests, cords, or sheets of cells, resembling beta cells and associated with varying amounts of intercellular stroma. Such tumors are usually small. In contrast, we have observed two very large neoplasms which caused hypoglycemia and were composed predominantly of spindleshaped cells with cytoplasmic processes. Associated with these spindle cells in both of the tumors were round cells without cytoplasmic processes. The purpose of this paper h to describe the clinical features and pathologic findings of these two cases in order to substantiate the thesis that these tumors are actually functioning isletcell neoplasms.