Recombinant human thyrotropin (rhTSH) in the management of differentiated thyroid cancer.

Recombinant human thyrotropin (rhTSH) has been evaluated in 38 patients with differentiated thyroid cancer. The patients had all been treated previously by operation and 31 had received radioiodine 131I. The patients continued to take thyroid hormone and changed to a low iodine diet for 14 days before and throughout the week of testing. The rhTSH was injected intramuscularly on two consecutive days, 74 MBq 131I was administered on the next day and scintigraphy completed 48 h after that. TSH was measured before administration of 131I, and thyroglobulin after the scan. All patients preferred this method to withdrawal of thyroid hormone, but 45% had mild symptoms including headache and nausea. The average TSH was 127 mU x l(-1), and was inversely related to the weight of the patients. Thirty-four had negative scans with a mean uptake of 0.06%. Thyroglobulin values above 10 ng x ml(-1) were found in seven patients, of whom four had similar findings when scanned after withdrawal of thyroid hormone. Of four with positive scans, two had undetectable thyroglobulin. The rate of clearance of 131I was compared in patients studied at 72 h who were hypothyroid and at 48 h in euthyroid patients given rhTSH and was found to be longer in the latter. We conclude that rhTSH can be used to stimulate thyroid tissue to trap 131I and secrete thyroglobulin. Both scan and thyroglobulin should be obtained. The method is well tolerated.

Imaging of locally recurrent and metastatic thyroid cancer with positron emission tomography.

Serum thyroglobulin and imaging have been routinely used in the evaluation of thyroid cancer patients suspected of having metastatic or recurrent disease. A more sensitive technique capable of identifying the sites of disease not detected by current imaging methods might improve overall management. The objective in this study was to demonstrate the feasibility of using positron emission tomography (PET) for the detection of recurrent thyroid cancer. Thirty patients with a history of either papillary/follicular or medullary thyroid cancer suspected of having locally recurrent or metastatic cancer on the basis of elevated or rising blood markers were evaluated with PET. Imaging studies were performed with the radiotracer [F-18] fluorodeoxyglucose (FDG). A retrospective review of other imaging results was performed and compared to the PET results. PET was able to identify locally recurrent or metastatic papillary/follicular disease in all 24 patients studied with elevated or rising thyroglobulin. Similar results were obtained in 6 patients with medullary cancer recurrences in the presence of elevated calcitonin. In cases where follow-up data was obtainable (17/24 papillary/follicular cancers and 4/6 medullary cancers), disease was confirmed either directly by surgery and/or indirectly through changes or persistence of laboratory findings. The results support the hypothesis that in the presence of elevated blood markers indicative of recurrent thyroid cancer, PET may prove valuable as an adjunctive imaging test for identifying disease and influencing management in cases where conventional imaging fails to detect suspected disease.

Breast cancer screening and associated factors for low-income African-American women.

BACKGROUND: Recent reports suggest that much of the difference in breast cancer survival between African-Americans and whites could be reduced through greater access to and use of screening by African-American women. Few community-based studies have addressed screening-related issues among low-income African-American women. METHODS: A simple random sample of households was drawn; a total of 585 women of age 40 or older were interviewed in their homes (response rate = 75%). Women were grouped into four stages of adoption of screening: participated regularly, participated nonregularly, heard of but never participated in screening, or never heard of it. Bivariate analyses were used to describe relations between screening (mammography, clinical breast examination, and breast self-examination) and mediating variables. RESULTS: Ninety percent of the women were not getting regular mammography screening, 36% had heard of but had never had mammography, and 33% had never heard of mammography. Strong associations were noted with predisposing, enabling, and reinforcing factors inhibiting screening at each stage of adoption. CONCLUSIONS: For women who had heard of, but who were not getting, regular screening, recommendations were made for improving screening procedures in primary care practices. For women who had never heard of screening, coordinated community and primary care interventions were recommended for moving them toward regular screening.