Prognostic factors for incomplete response in thyroid microcarcinoma: an analysis of initial response to therapy in 517 patients

ABSTRACT Objective: Although thyroid microcarcinoma (TMC) usually has a favorable prognosis, some patients present a higher risk of disease recurrence or persistence. Thus, we aimed at identifying possible risk factors associated with an incomplete response to therapy in TMC. Subjects and methods: This was a retrospective study of 517 patients with TMC treated with total thyroidectomy, with or without radioactive iodine (RAI) therapy, reclassified after 1.1 ± 0.4 years according to the response to treatment into "favorable" (excellent/indeterminate) or "unfavorable" (biochemical/structural incomplete) responses. We evaluated participants' age, sex, tumor size, histological variants, multifocality, presence of vascular/lymphatic/perineural invasion, extrathyroidal extension, metastatic lymph nodes (LN), and distant metastasis. The effect of RAI therapy on the response range was analyzed in a given subgroup. Results: The mean age observed was 46.4 ± 12.0 years, and 89.7% were female. We noted 97.5% with papillary carcinoma, 27.8% with multifocality and 11.2% with LN metastasis. Although the majority of patients had a low risk of recurrence/persistence (78%), 75% were submitted to RAI therapy. Incomplete response (20.7%) was associated with multifocality (p=0.041; OR=1.619) and metastatic LN (p=0.041; OR=1.868). These variables were strongly correlated (p=0.000; OR=3.283). No cut-off of tumor size was identified as a predictor of incomplete response by the receiver operating curve analysis. RAI treatment did not influence the response of patients with multifocality or LN metastasis. Conclusion: Multifocality and LN metastasis are independent risk factors for incomplete response in TMC patients and are strongly correlated. Additional RAI therapy was not associated with a more favorable response in these subgroups.

The impact of minimal extrathyroidal extension in the recurrence of papillary thyroid cancer patients

ABSTRACT Objective We aimed to evaluate the impact of minimal extrathyroidal extension (mETE) alone on the risk of recurrence of papillary thyroid carcinoma (PTC). The impact of other factors, including multifocality, age, tumor size, and stimulated thyroglobulin (sTg) values was also assessed. Subjects and methods We retrospectively analyzed 1,108 PTC patients from a medical institution, who presented tumors ≤ 4 cm without any adverse characteristics other than mETE. Patients were classified according to their response to initial treatment 12 to 24 months after surgery as proposed by the 2015 American Thyroid Association (ATA) guideline. Statistical analysis was performed using multivariate logistic regression and receiver operating characteristic (ROC) curve. Results In the multivariate logistic regression analysis, mETE did not have an impact on the response to initial treatment (p = 0.44), similar to multifocality, age, and tumor size. Initial Tg value was the only variable associated with a poor response (p < 0.01, odds ratio = 1.303, 95% confidence interval 1.25-1.36). The ROC analysis revealed that Tg was significant (area under curve = 0.8750); the cutoff value of sTg as a predictor of poor response was 10 ng/mL (sensitivity = 72.2%, specificity = 98.5%). Conclusion For low-risk PTC presenting mETE as the only aggressive feature, the initial sTg value is essential to identify patients who may have a poor response after initial treatment and benefit from further treatment. Arch Endocrinol Metab. 2020;64(3):251-6

Thyroglobulin levels before radioactive iodine therapy and dynamic risk stratification after 1 year in patients with differentiated thyroid cancer

ABSTRACT Objectives: We sought to assess the relationship between stimulated thyroglobulin (sTg) before radioactive iodine therapy (RIT), and the dynamic risk stratification 1 year after treatment, and to establish the utility of the sTg as a predictor of response to therapy in these patients. A retrospective chart review of patients with differentiated thyroid cancer (DTC) who underwent RIT after surgery and were followed for at least 1 year, was carried out. Subjects and methods: Patients were classified according to the dynamic risk stratification 1 year after initial treatment. The sTg values before RIT were compared among the groups. ROC curve analysis was performed. Results: Fifty-six patients were enrolled (mean age 44.7 ± 14.4 years, 80.7% had papillary carcinoma). Patients with excellent response had sTg = 2.1 ± 3.3 ng/mL, those with indeterminate response had sTg = 8.2 ± 9.2 ng/mL and those with incomplete response had sTg = 22.4 ± 28.3 ng/mL before RIT (p = 0.01). There was a difference in sTg between excellent and incomplete response groups (p = 0.009) while no difference was found between indeterminate and either excellent or incomplete groups. The ROC curve showed an area under the curve of 0.779 assuming a sTg value of 3.75 ng/mL. Conclusion: Our study results suggest that the higher the sTg before RIT, the greater the likelihood of an incomplete response to initial treatment. A sTg cut-off of 3.75 ng/mL was found to be a good predictor of response to initial treatment in patients with DTC.

Regression of orbital brown tumor after surgical removal of parathyroid adenoma

Brown tumors are rare skeletal manifestations that occur in less than 2% of primary hyperparathyroidism (PHPT) cases. Even rarer is the occurrence of brown tumor of the orbit, and few cases have been reported around the world. The rare instance of this benign tumor has prompted us to report the case and treatment of an orbital brown tumor in a patient with PHPT caused by parathyroid adenoma. We present the case of a patient undergoing follow-up at a referral center. The 60-year-old female patient, presented herself with progressive swelling in the nasal region, epistaxis and proptosis, she had noticed seven months prior to our examination. Multiple imaging and laboratory findings revealed parathyroid hormone (PTH)-dependent hypercalcemia (total calcium = 14.3 mg/dL and PTH = 1,573 pg/mL), a nodular lesion in the upper pole of the left thyroid lobe and increased uptake in left upper cervical region. The patient underwent left superior parathyroidectomy in September 2011, which led to the normalization of hypercalcemia and regression of the orbital tumor, as seen on control CT scan. This case highlights the spontaneous regression of the brown tumor after surgical management of the parathyroid adenoma.

Critérios semiquantitativos de análise da linfocintilografia em linfedema dos membros inferiores / Criteria for semi-quantitative analysis of lymphoscintigraphy in lower limb lymphedema

OBJETIVO: Avaliar se diferentes parâmetros de análise da linfocintilografia permitem a distinção entre membros com e sem linfedema em pacientes com quadro clínico de edema unilateral. MÉTODOS: Levantamento retrospectivo dos exames de 20 pacientes submetidos a linfocintilografia para investigação de edema unilateral de membros inferiores, divididos em pacientes com linfedema primário (grupo 1, n = 7) ou secundário pós-traumático (grupo 2, n = 13). Foi realizada linfocintilografia após injeção subdérmica de soroalbumina humana marcada com tecnécio-99m nos pés, com imagens da região inguinal durante 15 min e imagens dos membros inferiores após 15 min e 1 h. Os parâmetros analisados foram: tempo de aparecimento da cadeia inguinal, índice semiquantitativo (fluxo linfático, difusão intersticial, aspecto dos vasos, tempo de aparecimento e aspecto dos linfonodos inguinais) e inclinação da curva de atividade em função do tempo da região inguinal. As medidas nos membros clinicamente acometidos foram comparadas aos membros sem linfedema em ambos os grupos. RESULTADO: O tempo médio de aparecimento da cadeia inguinal e o índice semiquantitativo foram significativamente maiores nos membros com linfedema que nos membros sem linfedema quando considerados todos os pacientes, com maior retardo e índice semiquantitativo nos membros com linfedema do grupo 1 em relação aos do grupo 2. CONCLUSÃO: A análise do tempo de aparecimento da cadeia inguinal e o índice semiquantitativo fornecem parâmetros objetivos de avaliação do linfedema que podem auxiliar na detecção e seguimento dos pacientes com linfedema.

OBJECTIVE: To evaluate whether different parameters could be used in the analysis of lymphoscintigraphy to distinguish affected from unaffected limbs in patients with unilateral edema. METHODS: Twenty patients who underwent lymphoscintigraphy for screening of unilateral lower limb edema were retrospectively assessed and divided into patients with primary lymphedema (group 1, n = 7) or secondary post-traumatic edema (group 2, n = 13). Technetium 99m-labeled human serum albumin was subdermally administered in the feet, followed by a dynamic lymphoscintigraphy of the pelvis during 15 min and static images of the lower limbs after 15 min and 1 h. Analyzed parameters were detection time of groin activity, semi-quantitative index (lymph flow, interstitial diffusion, aspect of vessels, detection time and aspect of inguinal lymph nodes) and slope of groin time-activity curve. The parameters of clinically affected limbs were compared to those of the contralateral limbs in both groups. RESULTS: Detection time of groin activity and semi-quantitative index were significantly higher in affected limbs considering all patients, with a more severe delay and a higher semi-quantitative index in group 1 compared to group 2. CONCLUSION: Analysis of detection time of groin activity and semi-quantitative index can add objective parameters that can be used in the diagnosis and follow-up of patients with lymphedema.

Linfocintilografia dinâmica em pacientes com linfedema unilateral: avaliação quantitativa e semiquantitativa / Dynamixlymphoscintigraphy in patients with unilateral lymphedema: quantitative and semiquantitative evaluation

A linfocintilografia fornece informações funcionais do sistema linfático de forma pouco invasiva.Objetivo: Comparar parâmetros quantitativos e semi-quantitativos da linfocintilografia em pacientes com linfedema unilateral.METODO: Foram estudados os membros inferiores de 22 pacientes, com edema unilateral e sem sinais de comprometimento venoso. Administrou-se soro albumina humana - Tc99m via intradérmica nos pés,seguido de cintilogradia dinâmica da região inguinal durante 15 minutos e imagens estáticas dos membros inferiores após 15 e minutos. Construíram-se curvas de atividade inguinal, calculando-se sua inclinação por regreessão linear. Obteve-se também índices semiquantitatuivo (ISQ) baseado na análise visual. RESULTADO: Observou-se menor inclinação da curva no lado afetado (p= 0,017), com sensibilidade de 91 por cento, e especificidade de 64 por cento para linfedema. O ISQ foi maior no lado edemaciado (p= 0,0001), com sensibilidade de 86 por cento e especificidade 82 por cento para o nível de corte = 10. CONCLUSÃO: A análise quantitativa e semiquantitativa acrescenta parâmetros objetivos que podem auxiliar no seguimento dos pacientes com linfedema...

Avaliação radiográfica e densiométrica das próteses totais não cimentadas do quadril / Radiographic and densitometric evaluation of cementless total hip arthrplasty

Foram avaliados retrospectivamente 12 pacientes (13 quadris) submetidos à artroplastia total do quadril não cimentada do tipo Osteonics (Stryker), com tempo médio de seguimento de cinco anos e dois meses. O estudo foi baseado na avaliação clínica, radiográfica e densitométrica, com o objetivo de avaliar o stress shielding. O exame densitométrico foi realizado no período pós-operatório precoce e atual. Foi observada a ocorrência de aumento da densidade óssea, tanto real quanto percentual.

Influence of body composition on the bone mass of postmenopausal women

Aims: To investigate the influence of body weight (BW), fat mass (FM) and lean mass (LM) on the bone mineral density (BMD) of several areas of the skeleton. Participants: Sixty one white postmenopausal women (50.1 + 4.8 years). Measurements: Measurement of BMD by dual energy x-ray absorptiometry. The results were analyzed by linear regression and the slopes of each curve were compared. Results: The results showed that the correlations between BW, FM and LM to BMD were positive, whilst the correlations between age and years since menopause to BMD were negative. LM was the main factor that influence BMD in almost all areas. Conclusions: FM and LM present a positive effect on BMD, although LM is the main determinant of bone mass. Moreover, higher values of LM and FM present a protective effect against the reduction of BMD combined with menopause. Therefore postmenopausal women with low BM, especially low LM, present serious risk for developing osteoporosis.