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Jung, K. Y., et al. (2015).

"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
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.