Factors predicting contralateral nodal spread in papillary carcinoma of thyroid

Background: Lymph node metastasis (LNM) is evident in about 20–50% of cases at presentation in papillary carcinoma thyroid (PTC). There are no clear recommendations for the need and extent of lateral and central compartment dissection in PTC. Methods: A total of 83 patients who underwent total thyroidectomy and bilateral selective neck dissection for diagnosed PTC from September 2011 to October 2017 were retrospectively analyzed. Results: Tumor site was bilobar or involving isthmus in 40 patients. Contralateral LNM was seen in 42 patients. Both radiological (median size 2.6 cm, P = 0.051) and pathological (median size 3.65 cm, P = 0.015) size of tumor, tumor involving isthmus or bilateral lobes (P = 0.006), and lymphovascular invasion (LVI) (P = 0.026) had significant correlation with contralateral LNM. Conclusion: Size and site of tumor, ipsilateral lateral compartment nodes involvement, and LVI status of tumor significantly increases the probability of contralateral LNM in patients of PTC.

Radiation?induced hypothyroidism in patients of oral squamous cell carcinoma: A retrospective analysis of 195 patients

Background: Radiation-induced hypothyroidism (RIH) is common after neck irradiation, and biochemical evaluation of thyroid function is recommended periodically for early diagnosis and treatment. This study aimed to evaluate the predictors of RIH after completion of adjuvant radiotherapy (RT) for primary oral squamous cell carcinoma (OSCC). Methods: This is a retrospective study involving 195 patients who received RT after surgery for OSCC between August 2011 and December 2016. Thyroid function tests were obtained every 6 months and patients were considered to be hypothyroid if thyroid-stimulating hormone level was >5 mIU/mL. Results: The study cohort comprised 130 men with a median age of 52 years (range 21–77 years). About 107 (54.87%) patients developed hypothyroidism, with a median of 21 months (range 2–67 months) for the development of RIH. Women [41 (63.1%) versus 66 (50.8%), p=0.035], addition of chemotherapy [36 (63.2%) versus 71 (51.4%), p= 0.019], and higher cumulative dose to the thyroid gland (median dose 4690 cGy versus 2981 cGy, P < 0.001) resulted in higher incidence of RIH on univariate analysis. On multivariate Cox regression analysis, female sex (P = 0.042), bilateral irradiation (P = 0.046), and cumulative dose to the thyroid (P = 0.001) were factors associated with increased risk of developing RIH. Conclusion: The addition of chemotherapy, high dose of radiation to the thyroid gland, bilateral irradiation, and female sex were at higher risk of developing RIH. However, more studies are required to identify the dose-volume constraints of the thyroid gland

Unusual loco-regional presentation in papillary carcinoma of thyroid: A case series

BACKGROUND: Papillary carcinoma of thyroid (PTC) is usually indolent with good prognosis and excellent long-term survival. However, PTC sometimes presents itself in unusual situations, posing diagnostic and therapeutic challenges. Owing to paucity of data, there is lack of consensus as to what treatment should be prescribed in patients with loco-regional spread other than the usual sites. MATERIALS AND METHODS: Six patients of PTC presenting with involvement of the aero-digestive tract, retropharyngeal, and para-pharyngeal lymph nodes and great vessels of the neck are included in this case series. RESULTS AND CONCLUSION: Though rare, unusual loco-regional presentation of PTC poses challenges in diagnosis and treatment. A keen clinical sense is paramount in effectively diagnosing these cases. Aggressive surgical resection and reconstruction results in good functional and aesthetic outcomes. Further studies are required for establishing specific guidelines on the approach to the treatment of these cases

Sale and Consumption on Smokeless Tobacco in Jammu and Kashmir, India: Attitude and Views of Jammu Adult Population

Background: Concerned over increasing cases of mouth cancer in the state, the Jammu and Kashmir Government hasbanned the smokeless tobacco (ST) products like gutkha and also increased the taxes in other tobacco-related products.Despite legislation, the effectiveness of this step is a matter of concern. The gutka users are able to get their regular supplyand shopkeepers are still seen selling gutka pouches.Objective: The objective of this study was to assess the attitude and views of Jammu adult population toward the sale andconsumption on ST by Jammu and Kashmir Government.Materials and Methods: A cross-sectional survey was carried out among the general adult population of Jammu city. 400respondents completed a questionnaire on tobacco use, knowledge of existence of law, health warning, cost increase, andhazards related to ST.Results: Half of the current users (51.6%) surveyed compared to the past users (61.4%) and non-users (69.7%) had knowledgeabout laws on gutka products. Significantly higher percentage of the current users (52.1%) and past users (57.9%) indicatedthat the actions against tobacco products would be slightly effective (P < 0.05). 52.5–68.4% of respondents were aware ofhealth warning signs printed on the tobacco packet. 59.1% of the current users reported easy availability of gutka. The pastusers (54.4%) reported an increase in black marketing of ST gutka.Conclusion: The sale and consumption ban and increased taxes by the government are an effective measure for the improvementof health and reduce consumption. They demonstrate that there is a need for greater public education and the policy has beenlagging behind to curb the black market sale.