1,721,135 research outputs found
Clinically silent thyroid cancers: drop those needles and scalpels!
No full textThere’s no doubt about it: the steady, worldwide increases in the incidence of differentiated thyroid cancers (DTCs)arelargely the result of theincreasing diagnosisof small [papillary]malignancies less than 1 cm in diameter—the so-called microcarcinoma
Into the wardrobe of Narnia: beyond HIV infection a world of cardiovascular risk.
No full textA 38-years-old HIV-hepatitis C virus (HCV) coinfected woman presented to us for dyslipidemia. Clinical, familial and laboratory data were consistent with the diagnosis of familial heterozygous hypercholesterolaemia. History, clinical examination and laboratory findings also supported suspected acromegaly. A pituitary MRI showed a sellar macroadenoma that was removed by transphenoidal surgery without complications. MRI carried out 6 months after surgery showed almost complete removal of the adenoma. This case report describes an uncommon association of diseases, very different for aetiology--genetic for FH, infectious for HIV and HCV, caused by excessive hormone secretion for acromegaly--clinical features and therapy, but all sharing a significant impact on cardiovascular risk as a common feature
A genetic based disease management in inherited cancer syndromes: the multiple endrocrine neoplasia model
No full textDifferentiated thyroid carcinoma: defining new paradigms for the post-operative management
No full textThe demography of differentiated thyroid cancers (DTCs) has changed considerably since the 1990s, when the vast majority of these tumors were clinically evident at the time of diagnosis, and many were associated with regional lymph-node involvement. Today's DTCs are more likely to be small, localized, asymptomatic papillary forms that have been discovered incidentally, during neck imaging procedure performed for other reasons or during postoperative assessment of a gland removed for benign nodular goiter. The tools available for diagnosing, treating, and monitoring DTCs have also changed and their diagnostic capacities have increased. For these reasons, DTC treatment and follow-up paradigms are being revised to ensure more appropriate, cost-effective management of the current generation of DTCs. This review will examine some of the key issues in this area, including the assessment of risks for disease recurrence and thyroid cancer-related death, indications for postoperative ablation of the thyroid remnant with radioactive iodine and TSH-suppressive doses of levothyroxine, the pros, cons, and rationales for use of various follow-up tools (serum thyroglobulin assays, neck ultrasound, 18FDG-positron emission tomography, whole-body 131I scintigraphy), and temporal strategies for maximizing their efficacy. An algorithm will be presented for individualized, risk-tailored management of DTC patient
Editorial: Radiofrequency Ablation as an Alternative to Conventional Treatment
No full textUltrasound (US)-guided radiofrequency ablation (RFA) is a minimally invasive treatment modality that may be an alternative to surgery in patients with benign thyroid nodules. In addition, it may serve as an alternative treatment for carefully selected papillary microcarcinomas (PMC) and recurrent thyroid cancers
HABP2 Mutation and Nonmedullary Thyroid Cancer
No full textOn the basis of a study involving a single large kindred with seemingly nonsyn- dromic familial nonmedullary thyroid cancer, Gara and coworkers provide various lines of evi- dence that the G534E variant of HABP2 confers susceptibility to familial papillary thyroid can- cer. The filtering criteria they used to identify this variant required an allele frequency of 1% or less in public databases for variant prioritization, the rationale being that common variants are un- likely causes of rare diseases.1 However, several sources currently show allele frequencies for HABP2 G534E that approach 4% among Euro- peans and European Americans (Table 1). These frequencies resemble the reported frequency among patients with papillary thyroid cancer in the TCGA database (4.7%).
Moreover, as the authors note, HABP2 G534E has been clinically associated with an increased risk of venous thrombosis2 and carotid-artery stenosis,3 as well as protection against liver fibrosis.4 These associations are also reported in the Human Gene Mutation Database (www.hgmd .cf.ac.uk/ac/index.php) and ClinVar (www.ncbi .nlm.nih.gov/clinvar/). Have Gara et al. tested their kindred members to rule out the presence of these conditions as well as other conditions that are potentially related to HABP2 G534E
Management of Papillary Thyroid Cancer Patients in Absence of Postoperative Radioiodine Remnant Ablation: Tailoring Follow-Up by Neck Sonography
No full text[No abstract available
Nonsurgical approaches to the management of thyroid nodules
No full textEpidemiologic studies have documented substantial increases in the frequency of nodular thyroid disease. This trend is largely due to the increasing detection of nodules by the routine use of sonography in clinical practice. Only a small percentage of the nodules currently being detected will prove to be malignant. The probability of malignancy is similar in nonpalpable and palpable nodules. Fine-needle aspiration cytology has a central role in identifying malignant nodules, which are generally treated with surgery. Most thyroid nodules are cytologically benign and can be managed nonsurgically. Nodules that are completely asymptomatic require follow-up without treatment. Cosmetic problems and/or compression-related symptoms may be indications for surgery. When surgery is contraindicated or refused, several nonsurgical approaches are available. These include levothyroxine therapy, radioiodine treatment, percutaneous ethanol injections, and the new technique of laser photocoagulation. Levothyroxine therapy is the most widely used approach, but its clinical efficacy and safety are controversial. Levothyroxine might, nonetheless, be appropriate in selected cases characterized by low risk for adverse effects and nodule characteristics associated with response to this type of therapy. Radioiodine is the therapy of choice for toxic nodules or for symptomatic nodular goiters when surgery is not possible. Percutaneous ethanol injection should be used, in our opinion, as the first-line therapy only for recurrent symptomatic cystic nodules. Laser therapy should be reserved for selected patients treated in experienced centers only. With these options, clinicians can personalize the management of nodular thyroid disease according to a careful cost-benefit analysis
Clinical implications of BRAF mutation in thyroid carcinoma
No full textSignificant progress has recently been made in the clinical management of papillary thyroid carcinoma. The accuracy of diagnosis and prognostic stratification of this type of carcinoma are high but still fall below 100%. Lack of effective treatments for advanced stage papillary thyroid carcinoma leads to death in some patients. Approximately half of all such carcinomas harbor mutations in the gene encoding the serine/threonine-kinase B-type Raf kinase (BRAF), resulting in constitutive activation of the mitogen-activated protein kinase-extracellular-signal-regulated kinases signal transduction pathway. There is intriguing evidence that BRAF mutation testing of papillary thyroid carcinoma might improve the diagnosis, prognostic stratification and treatment of these tumors but large, prospective trials are needed to define the actual clinical impact of these approaches
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