Ruggieri M

Analysis of clinical, ultrasound and colour flow‐Doppler characteristics in predicting malignancy in follicular thyroid neoplasms

Fine-needle aspiration cytology (FNAC) represents the main diagnostic tool in the evaluation of thyroid nodules because of its high sensitivity, specificity and accuracy. However, while FNAC is very reliable in detecting papillary thyroid carcinomas (PTC) and anaplastic thyroid carcinomas, follicular neoplasms (FN) represent the grey zone in which cytology cannot discriminate malignant from benign tumours. 1 Consequently, in presence of nodules cytologically classified as FN, thyroidectomy is usually required and the histological evaluation reveals that about 80% are benign lesions. Thus, identification of parameters associated with malignancy is needed. In this context, several studies have focused on clinical, ultrasonographic and cytological aspects, with controversial results. 2,3

Is Minimally Invasive Surgery Appropriate for Small Differentiated Thyroid Carcinomas

PurposeTo retrospectively evaluate the surgical completeness of minimally invasive total thyroidectomy for small (<20 mm) differentiated thyroid carcinoma (DTC).MethodsThe subjects of this study were 30 patients who underwent minimally invasive total thyroidectomy as a single procedure. We registered the following postoperative measurements in the LT4 withdrawal period: serum thyroglobulin level, 6-h radioiodine uptake diagnostic test results, and neck ultrasound (US) findings.ResultsThe mean serum thyroglobulin level was 4.99 ± 4.67 ng/ml, the mean radioiodine uptake diagnostic test after 6 h was 3.11% ± 2.90%, and US showed no thyroid remnant.ConclusionsThe short-term outcome measures showed adequate resection of thyroid tissue, comparable with that reported after conventional surgery. Our findings suggest that small nodules with suspicious or malignant cytology are one of the best indications for minimally invasive surgery.

Diagnostic accuracy of rhTSH test with neck ultrasonography in differentiated thyroid cancer follow-up.

Serum thyroglobulin levels measurement after injection of recombinant human thyrotropin (rh-TSH) represents the most important advance in the follow-up of patients with differentiated thyroid cancer, obtaining TSH elevation without L-thyroxine withdrawal, avoiding marked hypothyroidism symptoms. During a 4-yr period (2004-2008), 66 consecutive patients with DTC (59 papillary and 7 follicular carcinomas) were examined after rh-TSH Tg test and neck ultrasonography. In all patients basal Tg was <0.25 ng/ml. In twelve (18.5%) examined patients rh-TSH Tg was >0.25 ng/ml, and in seven (58.3%) of these was demonstrated persistent or recurrent disease. These data indicate that rhTSH-Tg>0.25 ng/ml should be considered diagnostic for persistent or recurrent disease and suggests further exams (neck ultrasonography, whole body scan or cytology) to localize the disease. Furthermore, neck ultrasonography has demonstrated high accuracy in detecting lymph nodal metastases and should be always combined with rh-TSH test.

Medullary Thyroid Carcinoma and Tuberous Sclerosis

Medullary thyroid carcinoma (MTC) is a rare tumor and accounts for 5–10% of thyroid cancers. Tuberous sclerosis (TS) is a complex autosomal dominant neurocutaneous syndrome. In literature, a few endocrine neoplasias have been reported in association with TS, but never a case of TS associated with sporadic MTC. We describe a unique case, which has never been reported previously, of MTC associated with TS. The MTC up to today has been associated with other endocrine neoplasia, and TS increases risk of neoplasia in various organs. The case reported shows one more circumstance and suggests thyroid screening in patients with diagnosis of TS.