Considerations on some anatomo-clinical phenomena of thyroid cancer. Treatment and prognosis. Personal experience with 1515 operated cases.

The authors present a retrospective study on 1515 histologically confirmed cases of thyroid cancer encountered along a period of 30 years of activity. These cases were found among 15,200 patients operated on for thyroid disorders. Of these 1515 cases, 1310 were differentiated carcinomas of the follicular, papillary or trabecular type, 156 nondifferentiated carcinomas and 49 medullary carcinomas. The treatment for all these forms of cancer was a complex one, depending on the clinical stage and the anatomo-pathologic form. The authors advocate total or quasi-total thyroidectomy in all the forms of differentiated cancer, followed by administration of radioactive iodine and hormones. Under these conditions, the prognosis is extremely favourable. For nondifferentiated and medullary cancer the authors propose a wide resection followed by application of X-ray or cobalt and hormonal substitution therapy. The prognosis of these cases is poor.

Surgical indications in endemic goiter. Pre- and postoperative care.

The authors express their opinion with respect to anatomo-clinical forms of endemic goiter. First they suggest preoperative thyroid re-equilibration to avoid postoperative complications such as hypothyroidism or recurrence. Then operative indications for endocrine goiter, especially in an endemic area are discussed. Opinions are also expressed with respect to diffuse parenchymatous (endemic) goiter, nodular and polynodular goiter together with the various forms that may have a nodular or polynodular aspect both anatomically and as localization. Extemporaneous examination is viewed by the authors as compulsory in all such goiters, whereas preoperative thyroid puncture is counterindicated. Surgical care of mixed endemic goiter (diffuse hyperplasia with nodules imbedded in the hyperplasia) is also reviewed. It is recommended that each operation be preceded by an adequate preoperative treatment, for which therapeutic schemes are indicated as well as postoperative care directions taking into account the anatomo-clinical form. The surgical approach recommended is subtotal thyroidectomy. The paper also provides some statistical figures concerning surgery in the Institute of Endocrinology in Bucharest.

The thyroglobulin variations during the thyroid surgery for polynodular goiter, hyperthyroidism and cancer.

A radioimmunoassay (RIA) double antibody system for human thyroglobulin (Tgl) was developed with a sensitivity of 2.5 ng/ml T3 and T4 did not interfere in the antibody Tgl binding. The blood was collected pre-, intra- and 24 hrs post-thyroidectomy from 50 females and 4 males diagnosed as polynodular goiter, hyperthyroidism, chronic thyroiditis and thyroid cancer. The ratios of the intra- and post-operatory values versus pre-operatory values were calculated. The basal values in the patients having thyroid troubles varied within very large limits (two orders of magnitude) and these values could not be clearly correlated to the thyroid pathology, However, in untreated hyperthyroid patients the basal values exceeded 100 ng/ml, while in medullary carcinoma they were near the sensitivity limit of the technique. The intra-operatory values varied within the percentual area (thyroid carcinoma), multiplicative area (polynodular goiter and some cases of hyperthyroidism) and the order of magnitude area (hyperthyroid patients and some of the polynodular goiters). The value of the RIA measurement of the Tgl in the serum as an adjuvant in the post-treatment follow up of thyroid patients is discussed.