Preoperatively undiagnosed papillary thyroid carcinoma in patients thyroidectomized for benign multinodular goiter

ABSTRACT Objective Incidental thyroid cancers (ITCs) are often microcarcinomas; among them, the most frequent histotype is the papillary one. The purpose of this study was to evaluate the rate of papillary thyroid cancer (PTC) in patients thyroidectomized for benign multinodular goiter. Subject and methods We retrospectively evaluated the histological incidence of PTC in 207 consecutive patients who, in a 1-year period, underwent thyroidectomy for benign multinodular goiter. All patients came from an iodine-deficient area (Orleans, France) with three nuclear power stations located in the neighboring areas of the county town. Results Overall, 25 thyroids (12.1%) harbored 37 PTC, of which 31 were microcarcinomas. In these 25 PTC patients, mean age was 55 ± 10 years (range 30-75), female:male ratio 20:5 (4:1). In 10 patients (40% of 25 and 4.8% of 207), PTCs were bilateral, and in 7 (2 with microPTCs) the thyroid capsule was infiltrated. These 7 patients underwent central and lateral cervical lymph node dissections, which revealed lymph node metastases in one and two cases, respectively. Radioiodine treatment was performed in 7 cases. Neither mortality nor transient and permanent nerve injuries were observed. Four (16%) transient hypocalcaemias occurred as early complications. At last follow-up visit (mean length of follow-up 17.2 ± 3.4 months), all patients were doing well and free of any clinical local recurrence or distant metastases. Conclusion With a 12% risk that multinodular goiter harbors preoperatively unsuspected PTCs, which can have already infiltrated the capsule and that can be accompanied by PTC foci contralaterally, an adequate surgical approach has to be considered.

Comparison of the effect between endoscopic thyroidectomy and open thyroidectomy in treatment of benign thyroid diseases / 新乡医学院学报

Objective To compare the clinical effect of endoscopic thyroidectomy and open thyroidectomy in the treat-ment of benign thyroid diseases. Methods A total of 120 patients with benign thyroid diseases were selected from March 2015 to June 2017 in the Third Affiliated Hospital of Xinxiang Medical University. The patients were divided into endoscopic opera-tion group(n = 62)and open operation group(n = 58)according to the treatment methods. The patients in the open operation group were treated with conventional open thyroidectomy,and the patients in the endoscopic operation group were treated with endoscopic thyroidectomy. The operation time,intraoperative bleeding volume,postoperative drainage volume and hospitalization time were recorded in the two groups;and the intraoperative and postoperative complications were observed. The pain of the pa-tients in the two groups was evaluated by visual analogue scale(VAS)at the time points of 6,12 and 24 hours after operation. The cosmetic satisfaction of the patients in the two groups was evaluated by numerical scoring system(NSS)at the time points of 1 and 3 months after operation. Results The operation time and hospitalization time in the endoscopic operation group were significantly shorter than those in the open operation group(P < 0. 05),and the intraoperative bleeding volume and postopera-tive drainage volume in the endoscopic operation group were significantly lower than those in the open operation group(P <0. 05). The VAS score of pain in the endoscopic operation group was significantly lower than that in the open operation group at the time points of 6,12 and 24 hours after operation(P < 0. 05). The NSS score in the endoscopic operation group was sig-nificantly higher than that in the open operation group at the time points of 1 and 3 months after operation(P < 0. 05). The in-cidence of complications in the endoscopic operation group and the open operation group was 12. 90％(8 / 62)and 39. 66％(23 / 58)respectively,the incidence of complications in the endoscopic operation group was significantly lower than that in the open operation group(χ2 = 11. 210,P < 0. 05). Conclusion Endoscopic thyroidectomy is reliable in the treatment of benign thyroid diseases. It has the advantages of small trauma,short operation time,quick recovery,light postoperative pain,small sur-gical scar and fewer complications and so on.

Clinical Characteristics of Papillary Carcinomas with Other Benign Pathologies / 대한내분비외과학회지

PURPOSE: Thyroid papillary carcinoma is the most common endocrine tumor. There are many known factors affecting the pathophysiology of papillary carcinomas. In this study, we attempted to determine the clinical characteristics of papillary carcinomas with other benign pathologies. METHODS: From May 2007 to December 2012, a total of 994 patients underwent thyroidectomy and were diagnosed as papillary carcinomas. Retrospective study was performed using medical records. We categorized them according to five groups depending on associated benign disease, Papillary carcinoma with Graves disease (Group 1), Multinodular goiter (Group 2), Hashimoto thyroiditis (Group 3), Multinodular goiter and Hashimoto thyroiditis (Group 4), and Papillary carcinoma only (Group 5), and we performed a comparison analysis. RESULTS: T and N stage of group 2 were lower than those of group 5 and T stage of group 3 was lower than that of group 4. T and N stage of group 4 were lower than those of group 5 and extrathyroidal extension rate of group 4 was lower than that of group 5. CONCLUSION: Papillary carcinomas have variable clinical characteristics according to underlying benign thyroid disease. Conduct of advanced research regarding the mechanisms of the effect of benign thyroid disease on papillary carcinomas is needed.

Comparison of Na+/I- Symporter Expression Rate in Malignant and Benign Thyroid Diseases: Immunohistochemical Study / 핵의학분자영상

PURPOSE: Previous studies have not showed consistent results for the level of expression of sodium/iodide symporter (NIS) in thyroid diseases, especially malignant tumor. We undertook this study to evaluate the distribution of NIS expression in malignant thyroid diseases and compare with that in benign thyroid disease. MATERIALS AND METHODS: Total patients were 119 cases (Men 15, 48+/-13 yrs). Total number of samples were 205 pieces. In malignant thyroid disease, there were 153 samples: 90 in papillary carcinoma, 4 in follicular carcinoma, 2 in medullary carcinoma and 57 in metastatic lymph node. In benign thyroid disease, there were 52 samples: 36 in goiter/cyst, 11 in thyroiditis and 5 in follicular adenoma. Using immunohistochemical methods, we probed 205 samples with monoclonal anti-NIS Ab. Grading of staining was scored as 0 (negative or absent), 1 (weakly positive), 2 (moderately positive) or 3 (strongly positive). Expression rate (ER) of NIS positivity in individual disease entity was expressed as percentage of total number divided by number in 2 plus 3 grade. RESULTS: ERs of malignant thyroid diseases were 63% in papillary carcinoma, 81% in metastatic lymph node, 71% in follicular carcinoma and 100% in medullary carcinoma. ERs of benign thyroid disease were 53% in goiter/cyst, 64% in thyroiditis and 40% in follicular adenoma. ER of malignant thyroid diseases was higher than benign thyroid diseases (71% vs 54%). Grading of NIS expression in papillary carcinoma or goiter/cyst was heterogeneously distributed in considerable cases. Normal tissue also showed heterogeneous distribution of NIS expression, which was not correlated with that of primary lesion. CONCLUSION: In papillary thyroid carcinoma, distribution of NIS expression was heterogeneous and increased, and not different compared with that of benign thyroid disease.

Total Thyroidectomy for Benign Thyroid Disease / 中国普外基础与临床杂志

Objective To investigate the safety and clinical significance of total thyroidectomy performed for benign thyroid disease. Methods Eighty-eight patients with benign thyroid disease were treated with total thyroidectomy. The postoperative complications were analyzed. Results With primary total thyroidectomy, the incidences of transient hypocalcemia and transient recurrent laryngeal nerve paralysis were 2.5% and 1.2% respectively. The incidences after reoperation were 28.6%( P