"Postoperative biochemical remission of serum calcito
nin is the best predictive factor for recurrence-free survival of medullary thyr oid cancer: a large-scale retrospective analysis over 30 years." Clin Endocrinol (Oxf). CONTEXT: The increase in thyroid screening in the general population may lead to earlier detection of medullary thyroid carcinoma (MTC). OBJECTIVE: We a imed to evaluate secular trends in clinicopathological characteristics and longterm prognosis of MTC and its prognostic factors. DESIGN: This was a retrospecti ve analysis from 1982 to 2012. PATIENTS: Three hundred and thirty-one patients w ith MTC were included and grouped based on the year of diagnosis (1982-2000, 200 1-2005, 2006-2010 and 2011-2012). MEASUREMENTS: These included recurrence and mo rtality as well as biochemical remission (BCR) of serum calcitonin. RESULTS: Mea n tumour size (from 2.5 cm to 1.7 cm, P < 0.001) and percentage of extrathyroida l extension (from 52.0% to 26.0%, P = 0.026) decreased. The percentage of patien ts achieving BCR within six postoperative months (po-BCR) increased with time (f rom 39.6% to 76.1%, P < 0.001). The 5-year overall recurrence rate significantly decreased in 2006-2012 compared to 1982-2005 (10% vs 18%, respectively, P = 0.0 31), although the 5-year survival rate did not improve (92% vs 92%, P = 0.929). Failure to achieve po-BCR was the strongest predictive factor associated with re currence (hazard ratio [HR] = 58.04, 95% CI 7.14-472.11; P < 0.001). Male gender (HR = 3.18, 95% CI 1.18-8.56; P = 0.022), tumour size >2 cm (HR = 18.33, 95% CI 2.35-143.06; P = 0.006) and distant metastasis (HR = 4.00, 95% CI 1.31-12.21; P = 0.015) were significant prognostic factors for mortality. CONCLUSIONS: Clinic opathological characteristics and recurrence of MTC improved with time. Po-BCR w as the best predictive factor for recurrence-free survival. Kowalska, A., et al. (2015). "The Cut-Off Level of Recombinant Human TSH-Stimula ted Thyroglobulin in the Follow-Up of Patients with Differentiated Thyroid Cance r." PLoS One 10(7): e0133852. BACKGROUND: The treatment of differentiated thyroid cancer (DTC) ends in full recovery in 80% of cases. However, in 20% of cases local recurrences or di stant metastases are observed, for this reason DTC patients are under life-long follow-up. The most sensitive marker for recurrence is stimulated thyroglobulin (Tg) which, together with neck ultrasound (US), enables correct diagnosis in nea rly all cases of the active disease. For many years the only known stimulation w as a 4-5 week withdrawal from the L-T4 therapy (THW). For the last couple of yea rs stimulation with the use of recombinant human TSH (rhTSH) has been available. This method of stimulation may have a significant influence in obtaining the Tg level. However, it is important to determine the cut-off level for rhTSH-stimul ated Tg (rhTSH/Tg). MATERIALS AND METHODS: This is a retrospective analysis of c onsecutive patients from one facility who have qualified over a period of two ye ars for repeated radioiodine therapy (RIA). In our facility the ablation effecti veness evaluation is always carried out with the use of rhTSH, with the repeated therapy following THW. Such a procedure enables two Tg measurements in the same patient after both types of stimulation within 4-5 weeks. The obtained values w ere compared, cut-off levels in THW conditions were used (2.0 ng/ml for patients in remission and 10.0 ng/ml for patients with an active disease). In order to d etermine the cut-off level for rhTSH/Tg, regression analysis and ROC curves were used. RESULTS: In 63 patients the Tg measurement of both methods of stimulation were obtained. It was observed that there was a high correlation between rhTSH/ Tg and THW/Tg. However, the rhTSH/Tg level was significantly lower than THW/ Tg. The rhTSH/ Tg cut-off levels which corresponded to the 2.0 ng/ml and 10.0 ng/ml limits for THW/Tg were calculated and the values were 0.6 ng/ml and 2.3 ng/ml r espectively. CONCLUSIONS: The method of stimulation has a significant impact on the obtained Tg concentrations. The assumed THW/Tg cut off levels must not be tr ansferred to rhTSH/Tg. Rosa, K. M., et al. (2015). "Postoperative calcium levels as a diagnostic measur e for hypoparathyroidism after total thyroidectomy." Arch Endocrinol Metab: 0. Objective The aim of the present study was to identify a fast, efficient
and low-cost method to diagnose hypoparathyroidism after total thyroidectomy. M
aterials and methods One hundred and forty medical records, which contained pati ents' clinical and laboratory data, were retrospectively analyzed. Patient parat hyroid hormone values, which were obtained immediately following operation, were compared with their ionized calcium levels the morning after surgery. This comp arison was used to examine the correlation between the two variables in predicti ng hypoparathyroidism because measuring calcium levels is low-cost and more avai lable in the hospitals compared to measuring parathormone (PTH) levels. Results There was a positive and statistically significant correlation between PTH and i onized calcium values (Pearson correlation coefficient, r = 0.456; p < 0.0001). The values of first postoperative day ionized calcium levels (stratified by the 1.10 mmol/l cut-off value) were tested as a diagnostic measure for hypoparathyro idism, and a PTH < 15 pg/mL obtained immediately following operation served as a reference. This analysis showed that ionized calcium levels measured on the fir st postoperative day had a sensitivity of 45.6% (95% CI 30.9-61.0%), a specifici ty of 88.9% (95% CI 80.5-94.5%) and an accuracy of 76.7% (95% CI 68.7-83.5%) as a diagnostic measure for hypoparathyroidism. Conclusion In conclusion, we demons trated that patients who had high ionized calcium levels on the first postoperat ive day also had high PTH levels immediately following operation and, therefore, they had lower rates of hypoparathyroidism. Ryu, C. H., et al. (2015). "Administration of Radioactive Iodine Therapy Within 1 Year After Total Thyroidectomy Does Not Affect Vocal Function." J Nucl Med 56( 10): 1480-1486. The purpose of this study was to evaluate the impact of radioactive iodi ne therapy (RIT) on vocal function during the early follow-up period after total thyroidectomy (TT) using perceptive and objective measurements, questionnaires regarding subjective symptoms, and data on vocal function in a prospectively enr olled and serially followed thyroid cancer cohort. METHODS: Of 212 patients who underwent TT and were screened between January and December 2010 at our hospital , 160 were included in the final analysis. Patients with the following histories were excluded: lateral neck dissection, organic vocal fold disease, external ra diotherapy, and voice evaluation during thyroxine withdrawal. Patients were stra tified into 3 groups: TT, TT with low-dose RIT (1.1-2.2 GBq), and TT with high-d ose RIT (>/=3.7 GBq). Voice evaluations were performed before surgery and at 1, 6, and 12 mo after TT. RESULTS: Vocal characteristics were altered after TT, inc luding changes on the grade, roughness, and strain scale; increased amplitude pe rturbation; decreased fundamental frequency; narrowed pitch range; and global di sturbances in subjective functional parameters on the voice handicap index. Howe ver, the degree of vocal changes among the 3 groups did not significantly differ within the 1-y postoperative follow-up period. According to the results of subg roup analyses of patients who demonstrated good voice outcomes after TT, there w ere no significant functional differences among the 3 groups. CONCLUSION: RIT at any dose does not affect vocal function within 1 y of TT.