ABSTRACT
PURPOSE OF THE REPORT: The evaluation of patients with differentiated thyroid cancer is commonly based on serum thyroglobulin (Tg) measurement and 131I whole-body scan (WBS). The first follow-up (6-12 months after initial treatment) shows the response to therapy, a prognostic factor.The aims of the study were to describe the clinical outcome during a long-term follow-up of patients with negative 131I WBS in the first evaluation, and to assess clinical and histological characteristics related to the outcome in this patient population. PATIENTS AND METHODS: This retrospective study reviewed data from 209 patients followed at 2 Brazilian hospitals. A minimum of 10 years of follow-up was required. RESULTS: During mean follow-up of 13.7 ± 4.2 years, 20% of patients developed recurrence. At the end of follow-up, 21% of patients had persistent disease. The clinical and histological characteristics related to adverse outcomes (recurrence or persistent disease) were lymph node metastases at diagnosis, high risk according to American Thyroid Association (ATA) classification, and incomplete response to treatment. Stimulated Tg levels (under thyroid hormone withdrawal) and basal Tg levels (with thyroid hormone) greater than 10 ng/mL at first evaluation were associated with an adverse outcome. CONCLUSION: Negative WBS at first evaluation should not be used as an isolated prognostic factor. This must be considered together with histopathological (ATA classification, lymph node metastases) and clinical/laboratory characteristics (stimulated and basal Tg; response to therapy).
Subject(s)
Cell Differentiation , Thyroid Neoplasms/diagnostic imaging , Thyroid Neoplasms/therapy , Whole Body Imaging , Adolescent , Adult , Aged , Aged, 80 and over , Female , Follow-Up Studies , Humans , Iodine Radioisotopes , Male , Middle Aged , Radionuclide Imaging , Thyroglobulin/metabolism , Thyroid Neoplasms/pathology , Time Factors , Treatment Outcome , Young AdultABSTRACT
The objective of this study is to report and discuss a rare and inflammatory cause of exophthalmos. This report describes a patient with exophthalmos, who was initially diagnosed with euthyroid Graves' with good response to therapy. After 8 years of follow-up, she had recurrence of symptoms and a new evaluation revealed the final diagnosis of orbital pseudotumor. Orbital pseudotumor is an uncommon disorder that both radiologically and clinically mimics a malignant process or other inflammatory disease, such as Graves' ophthalmopathy.
Subject(s)
Graves Ophthalmopathy/diagnosis , Orbital Pseudotumor/pathology , Adult , Diagnosis, Differential , Female , Graves Ophthalmopathy/drug therapy , Humans , RecurrenceABSTRACT
The objective of this study is to report and discuss a rare and inflammatory cause of exophthalmos. This report describes a patient with exophthalmos, who was initially diagnosed with euthyroid Graves' with good response to therapy. After 8 years of follow-up, she had recurrence of symptoms and a new evaluation revealed the final diagnosis of orbital pseudotumor. Orbital pseudotumor is an uncommon disorder that both radiologically and clinically mimics a malignant process or other inflammatory disease, such as Graves' ophthalmopathy.
O objetivo deste estudo é relatar e discutir uma causa de exoftalmia rara e inflamatória. Este artigo relata uma paciente com exoftalmia que recebeu diagnóstico inicial de oftalmopatia de Graves eutireoideana com boa resposta à terapia. Após oito anos de seguimento, houve recorrência dos sintomas e uma nova avaliação revelou o diagnóstico final de pseudotumor orbitário. Pseudotumor orbitário é uma condição incomum que mimetiza clínica e radiologicamente uma doença maligna ou inflamatória, como a oftalmopatia de Graves.
