Clinical Features of Early and Late Postoperative Hypothyroidism After Lobectomy.

Context: Lobectomy is preferred in thyroid cancer to decrease surgical complications and avoid lifelong thyroid-hormone replacement. However, postoperative hypothyroidism, requiring thyroid-hormone replacement, may occur. Objective: We aimed to identify the incidence and risk factors of postoperative hypothyroidism to develop a surveillance strategy after lobectomy for papillary thyroid microcarcinoma (PTMC). Methods: This historical cohort study involved 335 patients with PTMC treated by lobectomy. Postoperative thyroid functions were measured regularly, and patients were prescribed levothyroxine according to specific criteria. Patients not satisfying hormone-replacement criteria were closely followed up. Results: Postoperative hypothyroidism occurred in 215 patients (64.2%) including 5 (1.5%) with overt hypothyroidism and 210 (62.7%) with subclinical hypothyroidism. Forty patients (11.9%) were required thyroid hormone replacement. One hundred nineteen patients (33.5%) experienced temporary hypothyroidism and spontaneously recovered to euthyroid state. High preoperative thyroid-stimulating hormone (TSH) was the most important factor predicting postoperative hypothyroidism and failure of recover from hypothyroidism (odds ratio [OR], 2.82 and 1.77; 95% confidence interval [CI], 2.07 to 3.95 and 1.22 to 2.63; P < 0.001 and 0.002, respectively). Of the 215 patients eventually developing postoperative hypothyroidism, 70 (32.6%) developed hypothyroidism after the first postoperative year. Postoperative 1-year TSH levels were able to differentiate patients developing late hypothyroidism or euthyroidism (OR, 2.29; 95% CI, 1.68 to 3.26; P < 0.001). Conclusions: Preoperative and postoperative TSH levels might be predictive for patients who develop postlobectomy hypothyroidism and identify those requiring long-term surveillance for hypothyroidism. Additionally, mild postoperative hypothyroidism cases should be followed up without immediate levothyroxine replacement with the expectation of spontaneous recovery.

Quality-of-Life Priorities in Patients with Thyroid Cancer: A Multinational European Organisation for Research and Treatment of Cancer Phase I Study.

BACKGROUND: The objectives of this study were to determine quality of life (QoL) issues that are relevant to thyroid cancer patients cross-culturally, and to identify those with highest relevance to them in addition to the more general issues covered by the core European Organisation for Research and Treatment of Cancer QoL questionnaire (EORTC QLQ-C30). METHODS: A systematic literature search provided a list of potentially relevant QoL issues to supplement the core questionnaire EORTC QLQ-C30, which is widely used in research and in care and addresses QoL issues relevant to all groups of cancer patients. A panel of experts revised this list, and thyroid cancer patients rated the issues regarding their relevance for QoL by selecting the 25 issues that they would include in a thyroid cancer-specific QoL module. RESULTS: The literature search and expert discussion provided a list of 71 QoL issues that was rated by thyroid cancer patients (n = 110) from seven countries. All issues were of high priority to at least some of the patients. The most frequently selected issues were sudden attacks of tiredness, exhaustion, quality of sleep, employment, social support, fear of cancer progression, fear of second operation, difficulties swallowing, and globus sensation. CONCLUSIONS: Thyroid cancer patients cross-culturally rate fatigue-related issues as highly important for their QoL, calling for increased efforts to find successful treatments for this problem. Vocational rehabilitation is also highly relevant for them and should therefore be an important aim of multidisciplinary care. The third important area of concern is psychological issues, especially fear of progression and of additional treatments.

Quality of life, body mass index, and physical activity among uterine cancer patients.

OBJECTIVE: The purpose of this study was to assess the independent and joint effects of body mass index (BMI) and physical activity (PA) on overall quality of life (QoL) in survivors of uterine cancer. METHODS: We conducted a survey among uterine cancer patients who received curative therapy at the University of Pennsylvania between 2006 and 2010. Surveys assessed the weight, height, PA (college alumnus survey), and QoL (Functional Assessment of Cancer Therapy-Gynecologic Oncology Group). RESULTS: The response rate to the survey was 43%. Among 213 patients, the mean (SD) BMI was 31.1 (8.9) kg/m, and 48% reported greater than or equal to 150 min·wk of PA. Higher BMI was independently associated with poorer overall QoL (P = 0.050), including physical (P = 0.002) and functional well-being (P = 0.008). Higher min·wk of PA was not independently associated with any QoL outcome. However, among patients who engaged in greater than or equal to 150 min·wk of PA, the negative association between BMI and overall QoL was attenuated (P = 0.558), whereas among patients who engaged in less than 150 min·wk of PA, the negative association between BMI and overall QoL persisted (P = 0.025). Among patients who engaged in greater than or equal to 150 min·wk of PA, the negative association between BMI and physical and functional well-being was attenuated (P = 0.765 and P = 0.284), whereas among patients who engaged in less than 150 min·wk of PA, the negative association between BMI and physical and functional well-being persisted (P < 0.001 and P = 0.010), respectively. CONCLUSIONS: Body mass index is associated with poorer QoL among uterine cancer patients. The findings from this cross-sectional study are consistent with the hypothesis that endometrial cancer survivors who are able to perform 150 min/wk of PA may be protected from the negative effects of BMI on QoL.

The 'fixed' removable partial denture: report of case.

Careful monitoring of tissue that had been the site of three previous surgical procedures was necessary, but the patient needed a functional, esthetically acceptable prosthesis. The Andrews bridge was selected because it combines the stabilizing qualities of a fixed prosthesis with the accessibility to the tissues of a removable prosthesis. The recurring nature of the verrucous carcinoma along with extensive tissue loss were additional factors in selecting this appliance. The final results satisfied all the criteria. The patient has been seen at regular follow-up visits for 2 years since the last surgical procedure and there has been no clinical change in the previously involved tissue. The patient has tolerated the prosthesis well and is satisfied with her appearance.