Management Of Thyroid Cancer Research Articles

Disparities Research in Thyroid Cancer: Challenges and Strategies for Improvement.

Until recently, thyroid cancer was one of the most rapidly increasing cancers in the United States. Disparities exist in many aspects of thyroid cancer care as a result of the multifactorial interplay of systemic, patient, and physician factors. To better understand the management of thyroid cancer in populations at risk for health disparities and subsequently implement changes that will lead to health equity for all patients with thyroid cancer, health services research with innovative approaches is necessary.

MON-092 Clinical Characteristics and Management of Thyroid Cancer in Pediatrics: Results from the Mexican Population Registry Between 2010-2019

METHODSStudy: Analytical and retrospectivePatients files diagnosed with Thyroid Cancer treated during January 2010 to May 2019, who underwent surgical intervention and histopathological study were reviewed. Chi Square test were used as statistical analysis. A level of significance p <0.001 was established. INTRODUCTION: Cancer thyroid in pediatrics is characterized by advanced presentation, coupled with frequent lymph nodal metastases and often pulmonary metastases. There are few reports on the rate of cancer and hypoparathyroidism in children. OBJECTIVE: Describe of pediatric thyroid cancer with particular emphasis on the clinical characteristics, risk factors associated and with treatment outcomesRESULTS43 patients were included in the study 69.8% were female. Average age of 12 years (range 5 to 17 years). Association of cancer and thyroiditis 25% and Cancer with Graves Disease 2.3%.Histopathological diagnoses of thyroid cancer: 86% papillary, 2.3% follicular, 11.6% medullary, 69.8% patients presented with metastases, most often lymph node (46.5%), pulmonary (2.3%) and pulmonary plus lymph node (23.3%), 11.6% patients do not present metastasis and 16.3% without data.Surgical interventions: only thyroidectomy 16.3%, Hemitiroidectomy 4.7%, total thyroidectomy with lymph node emptying 74% and modified radical neck dissection 5%.In 16% of the patients, second surgery was required after the histopathological report. Post-surgical hypoparathyroidism was recorded in 27 patients (62%): transitory in 11 (25%) and 16 (37%) permanent.Biochemical variables: (N /%/ Hypoparathyroidism /NO hypoparathyroidism) of 18 patients with post-surgical PTH <10 pg/ml (18/42%/17/1) 17 of them presented post-surgical hypoparathyroidism (P <0.001), PTH >10 pg/ml (13/30%/9/4), and without post-surgical measurement of PTH (12/28% / 6/6). Post-surgical ionized calcium <4mg/dl in 29 patients of which 22 had hypoparathyroidism (P <0.001) (29 / 67.4% / 22/7), with calcium >4 mg/dL (14 / 32.6% / 9/5). 21 patients with seric calcium <8mg/dl 20 with hypoparathyroidism. (21/48%/ 20/1) (P <0.001). Seric calcium >8 (16/37%/9/7) without measurement data. Serial calcium in 6 patients (6/15% / 3/3). Postoperative positive thyroglobulin parameter was presented as an risk factor for complication and metastases OR 1.42 (1-1.6)Regarding iodine treatment, 29 patients received an average dose of 200 (range 100- 720 milicuries mCi).CONCLUSIONSPapillary cancer is the most common type in pediatric patients, evidence of metastases find in 69.8% most frequent lymph node, postoperative thyroglobulin OR 1.42. They should always be considered in the management of these patients. As a post-surgical complication, there is an increased risk to present hypoparathyroidism when PTH less < 10 pg / ml, post-surgical ionized calcium < 4 mg/dl and serum calcium <8 mg/dl.

Role of laser ablation in multimodal treatment of radioiodine- refractory bone metastases of thyroid cancer: a retrospective study.

To assess the efficacy, safety, and pain benefits of imaging-guided laser ablation (IGLA) in patients with radioiodine-refractory (RR) bone metastases from differentiated thyroid carcinoma (DTC). The institutional medical records of patients with bone metastases from DTC treated with laser ablation (LA) were reviewed retrospectively. Local response, complications, and effects on pain relief were investigated. Six osteolytic lesions in five patients (one male, four females; mean age 65.4 ± 5.1 years, range 58-72) were treated with IGLA. All lesions were osteolytic and all have had previous treatments with high-dose radioiodine therapy followed by external radiotherapy (EBRT). All patients assumed opioid analgesics for severe pain. Overall, the lesions (mean size 5.8 ± 3.2 cm; median 5.0 cm, range 3.0-12.0 cm) underwent nine IGLA sessions (mean 1.8 ± 0.4 sessions; median 2.0 sessions, range 1-2). In four (80%) out five lesions, cross-sectional imaging showed a nearly complete response (CR) while the largest lesion was ablated by 80%. Pain changes were assessed with the Brief Pain Inventory-Short Form, that was administered before IGLA and during a 6-month follow-up. Patients experienced significant reduction in worst pain, average pain, and pain interference. Following IGLA, the average daily opioid requirement rapidly and progressively decreased. Treatments were well-tolerated and no major complications occurred. IGLA is an effective and safe debulking procedure and provides significant pain relief in patients suffering from DTC bone metastases that are not responsive to standard treatments. So, IGLA could be considered as part of a multimodality management of advanced thyroid cancer with RR metastatic skeletal involvement.

Radiation-Associated Thyroid Cancer Surveillance and Management in a Cohort of Late Effects Patients.

Compared to the general population, the incidence of thyroid cancer in childhood and adolescent and young adult malignancy survivors is increased 14.0-18.0 times (CI 11.7-23.8). The cumulative incidence is variably reported as 0.5% by age 45 with 30-year incidence of 1.3% in women and 0.6% in men. This study aims to evaluate the incidence of radiation-associated thyroid cancer amongst patients treated with prior radiation to the thyroid followed up in a late effects service. A secondary aim was to assess screening compliance in this cohort. The medical records of all patients attending the late effects service from 1 January 2000 to 20 February 2013 were interrogated to identify patients exposed to thyroid irradiation. The screening compliance and incidence of thyroid cancer were assessed for the duration whilst under the guidance of the late effect service. Mode of diagnosis, all imaging and cytology were retrieved from the institutional electronic record. Cytology was categorized according to Bethesda. Four hundred and sixty-five patients were exposed to direct or scatter neck irradiation. Compliance with thyroid surveillance was observed in 76.9%. Ultrasound features of microcalcification and increased internal vascularity had a low sensitivity (62.5%) for predicting a malignant nodule, which improved when used in conjunction with a Bethesda IV-VI result (91.7%). However, cytological assessment was not performed in 45.6% of operative cases. Thirty-three patients had thyroid carcinoma of which 45.4% (n = 15) were incidental. The majority were papillary thyroid cancers (88.9%); of which 12.5% were node positive and 34.4% were multifocal. The incidence of thyroid cancer was elevated 57.6 times compared to the Australian general population (p < 0.001). Due to the high incidence of thyroid cancer, this study supports screening in this cohort. However, due to the risk of overtreatment, we endorse further investigation of thyroid nodules with ultrasound-guided fine-needle aspiration cytology based on sonographic criteria as for the general population and American Thyroid Association guidelines.

Patient Preferences Around Extent of Surgery in Low-Risk Thyroid Cancer: A Discrete Choice Experiment.

Background: Patient preferences pertaining to surgical options for thyroid cancer management are not well studied. Our aim was to conduct a discrete choice experiment (DCE) to characterize participants' views on the relative importance of various risks and benefits associated with lobectomy versus total thyroidectomy for low-risk thyroid cancer. Methods: Adult participants with low-risk thyroid cancer or a thyroid nodule requiring surgery were asked to choose between experimentally designed surgical options with varying levels of risk of nerve damage (1%, 9%, 14%), hypocalcemia (0%, 3%, 8%), risk of needing a second surgery (0%, 40%), cancer recurrence (1%, 3%, 5%), and need for daily thyroid hormone supplementation (yes, no). Their choices were analyzed using random-parameters logit regression. Results: One hundred fifty participants completed an online DCE survey. Median age was 58 years; 82% were female. Twenty-four participants (16%) had a diagnosis of thyroid cancer at the time of completing the survey, and 126 (84%) had a thyroid nodule necessitating surgery. On average, 35% of participants' choices were explained by differences in the risk of cancer recurrence; 28% by the chance of needing a second surgery; 19% by the risk of nerve damage; and 9% by differences in risks of hypocalcemia and the need for thyroid hormone supplementation. When accounting for differences in postoperative risks, the average patient favored lobectomy over total thyroidectomy as long as the chance of needing a second (i.e., completion) surgery after initial lobectomy remained below 30%. Participants would accept a 4.1% risk of cancer recurrence if the risk of a second surgery could be reduced from 40% to 10%. Conclusions: While patients with thyroid cancer may have clear preferences for extent of surgery, common themes moderating preferences for surgical interventions were identified in the DCE. Adequate preoperative evaluation to decrease the chance of a second surgery and providing patients with a good understanding of risks and benefits associated with extent of surgery can lead to better treatment decision-making.

Management of pediatric differentiated thyroid cancer: An overview for the pediatric oncologist.

Differentiated thyroid cancer (DTC) is the most common childhood thyroid malignancy. The standard of care for pediatric DTC is total thyroidectomy followed by radioactive iodine (RAI) treatment when indicated. Molecular changes and potential therapeutic targets have been recently described in pediatric thyroid cancer. Pediatric oncologists are increasingly involved in the evaluation of thyroid nodules in childhood cancer survivors and in the management of advanced thyroid cancer. In 2015, the American Thyroid Association published management guidelines for children with DTC. We provide an overview of the current standard of care and highlight available targeted therapies for progressive or RAI refractory DTC.

Thyroid cancer histological subtypes based on tumor size: National perspective.

Thyroid tumor size is an important prognostic factor. The aim of this study is to examine the histological subtypes and management of thyroid cancer based on tumor size (≤4 cm vs >4 cm). Retrospective cohort study utilizing the National Cancer Database, 2004-2014. A total of 152 387 patients were included, 13 614 (8.9%) of whom had a tumor size >4 cm. Histological subtypes of tumors >4 cm were: 69.6% papillary thyroid carcinoma, 17.5% FTC, 7.9% HCC, and 2.8% medullary thyroid carcinoma (MTC). High-volume hospitals for thyroid surgery were less likely to perform two-stage thyroidectomy, particularly for tumors ≤4 cm. Low-volume hospitals had a higher risk of staged thyroidectomy for MTC ≤4 cm (19.8%) compared with high-volume hospitals (8.7%) (P < .001). This study describes the prevalence of thyroid cancer subtypes. In the era of a conservative approach to differentiated thyroid carcinoma, there could be a potential increase in the risk of staged thyroidectomy.

What is the appropriate nodular size of differentiated thyroid cancer management by Transoral Endoscopic Thyroidectomy Vestibular Approach?

Thyroid nodular disease is a common problem in clinical practice. Incidental thyroid nodules are more frequently diagnosed because of the increased access to radiologic investigations [1]. Though thyroid nodules are common, malignant cases (4.0% to 6.5% of all thyroid nodules) are clinically significant and must be precisely diagnosed. Improvements in surgical techniques have reduced perioperative morbidities. The rates of permanent recurrent laryngeal nerve (RLN) dysfunction and hypoparathyroidism are &lt;1% in experienced hands [2]. Recently, Anuwong reported that transoral endoscopic thyroidectomy vestibular approach (TOETVA) done for 60 selected cases has a low complication rate comparable to that of the conventional open thyroidectomy [3]. In this technique, endoscopic trocars were placed through a central incision in the oral vestibule and bilateral incisions in both sides of the oral commissure. The plane under the superficial fascia is entered away from the lower margin of mandibular bone to avoid damage of the marginal branch of the facial nerve as well as the facial Vessels. However, retrieval of large thyroid specimens through the central incision of the TOETVA necessitated breaking it down into smaller fragments to avoid damage of the mental nerve. This can be problematic for a suspicious or malignant differentiated thyroid cancer (DTC), whose capsule should remain intact for a precise histopathologic examination [4,5]. Imprecise pathologic diagnosis negatively impacts further treatment, follow up and prognosis. However, in this technique of TOETVA, the thyroid specimen was all put and fragmented in the retrieval bag. Supposedly, the cancer should not be spilt out during the procedure of pull out. Thyroglobulin (TG) level 3-4 weeks post-surgery can be used to assess the size of the residual thyroid mass either locally or distally, and guide remnant I-131 ablation therapy [6]. Hence, we presume the prognosis of DTC would be affected by the procedure of fragmentation of TOETVA. In this issue, we would like to establish the critical largest diameter for DTC to be removed safely (with mental nerve preservation) and completely by the TOETVA technique. In our experience, we believe that the ideal nodular size should be &lt;2.5cm to achieve safety and carcinologic goals.

African Head and Neck Society Clinical Practice guidelines for thyroid nodules and cancer in developing countries and limited resource settings.

International thyroid nodule and cancer management guidelines generally fail to take into account potential limitations in diagnostic and treatment resources. Thyroid cancer specialists from the African Head and Neck Society and American Head & Neck Society Endocrine Section developed guidelines for diagnosis and management of thyroid nodules and cancer in low resource settings. Recommendations were based on literature review and expert opinion, with level of evidence defined. Using the ADAPTE process, diagnostic and treatment algorithms were adapted from the National Comprehensive Cancer Network (NCCN). Low resource settings were simulated by systematically removing elements such as availability of laboratory testing, hormone replacement, imaging, and cytopathology from NCCN guidelines. Successful management of thyroid nodules and cancer in low resource settings requires adaptation of treatment methodologies. These guidelines define specific scenarios where either more or less aggressive intervention for thyroid pathology may be advisable based on limited available resources.

Time trend analysis of thyroid cancer surgery in China: single institutional database analysis of 15,000 patients

PurposeThe institutional database of the Thyroid Surgery Division in China–Japan Union Hospital of Jilin University was queried to audit time trend patterns in thyroid cancer (TC) management between 2008 and 2017.MethodsRetrospective longitudinal analysis. Clinicopathological features and treatment strategies were analyzed. Frequencies and multivariate tests were used to detect correlations.ResultsClinical data were obtained from 15,000 TC patients (i.e., 71.3% of 21,044 operations). Papillary was the most common histological subtype (n = 14,916, 99%), and 76% were microcarcinomas. Stage I (95%) and low-risk patients (58%) were prevalent throughout the 10-year period. The trend for total thyroidectomy increased from 29.1% (2008–2012) to 67.9% (2013–2015), and then dropped to 48.6% (2016–2017). A total of 8827 (52%) patients received central lymph node dissection (CLND). The tendency for CLND increased from 15.7 to 86.4% during the 10-year period. While the trend of lateral lymph node dissection decreased from 71.3 to 13.3%. Radioactive iodine therapy was offered to 10% of patients (2008–2012), except for a low value (5.4%) in 2009, and then increased from 12.3% (2012) to 41.3% (2015), while decreased to 32.4% (2017).ConclusionThe surgical management of TC patients has undergone continuous changes over the past 10 years. The evolution from aggressive treatment to a more conservative approach has been constant. Our results suggest that the current surgical management approach for TC is adequate and in support of the published guidelines. Our findings warrant further investigation to determine the clinical implications of decision making for TC.

Redifferentiation of radioiodine-refractory thyroid cancers.

The management of radioiodine refractory thyroid cancers (RAIR TC) is challenging for the clinician. Tyrosine kinase inhibitors classically prescribed in this setting can fail due to primary or acquired resistance or the necessity of drug withdrawal because of serious or moderate but chronic and deleterious adverse effects. Thus, the concept of redifferentiation strategy, which involves treating patients with one or more drugs capable of restoring radioiodine sensitivity for RAIR TC, has emerged. The area of redifferentiation strategy leads to the creation of new definitions of RAIR TC including persistent non radioiodine-avid patients and 'true' RAIR TC patients. The latter group presents a restored or increased radioiodine uptake in metastatic lesions but with no radiological response on conventional imaging, that is, progression of a metastatic disease, thus proving that they are 'truly' resistant to the radiation delivered by radioiodine. Unlike these patients, metastatic TC patients with restored radioiodine uptake offer the hope of prolonged remission or even cure of the disease as for radioiodine-avid metastatic TC. Here, we review the different redifferentiation strategies based on the underlying molecular mechanism leading to the sodium iodide symporter (NIS) and radioiodine uptake reinduction, that is, by modulating signaling pathways, NIS transcription, NIS trafficking to the plasma membrane, NIS post-transcriptional regulation, by gene therapy and other potential strategies. We discuss clinical trials and promising preclinical data of potential future targets.

Updates on the Management of Thyroid Cancer.

The diagnostic modalities, stratification tools, and treatment options for patients with thyroid cancer have rapidly evolved since the development of the American Thyroid Association (ATA) guidelines in 2015. This review compiles newer concepts in diagnosis, stratification tools and treatment options for patients with differentiated thyroid cancer (DTC), medullary thyroid carcinoma (MTC) and anaplastic thyroid cancer (ATC). Newer developments apply precision medicine in thyroid cancer patients to avoid over-treatment in low risk disease and under-treatment in high risk disease. Among novel patient-tailored therapies are selective RET inhibitors that have shown efficacy in the treatment of MTC with limited systemic toxicity compared with non-specific tyrosine kinase inhibitors. The combination of BRAF and MEK inhibitors have revolutionized management of BRAF V600E mutant ATC. Several immunotherapeutic agents are being actively investigated in the treatment of all forms of thyroid cancer. In this review, we describe the recent advances in the diagnosis and management of DTC, MTC, and ATC, with an emphasis on novel treatment modalities.

Greetings From the Editor of Clinical Thyroidology

Clinical ThyroidologyVol. 32, No. 2 Greetings from the EditorFree AccessGreetings From the Editor of Clinical ThyroidologyAngela M. LeungAngela M. LeungSearch for more papers by this authorPublished Online:6 Feb 2020https://doi.org/10.1089/ct.2020;32.49-50AboutSectionsPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail DEAR COLLEAGUES,Welcome to another issue of Clinical Thyroidology. This month's issue contains a wide variety of important material, including the first of a new series of guest editorials that will be published throughout the year. We start this issue with a guest opinion/editorial on the topic of thyroid ultrasound certification in the United States by Dr. J. Woody Sistrunk, who has been a thought leader in this field alongside other experts and multiple key societies. It is a great look at the history of thyroid ultrasound use from the perspective of an endocrinologist, the evolution of certification for this procedure, and reimbursement considerations in the United States. As Woody outlines, it is also pertinent to mention that the American Thyroid Association (ATA) is planning what is sure to be a stimulating thyroid ultrasound course, specifically related to the active surveillance of biopsy-proven low-risk thyroid cancer, that will be held on May 28, 2020 (the first day of this year's ATA spring meeting), in New York City.We also present expert reviews on what we think are some of the most impactful and/or novel papers that have been published recently. On the topic of thyroid dysfunction, Dr. Daniel Toft reviews an interesting study examining the associations between major depressive disorder and thyroid surgery using a population-level database from South Korea. The controversial topic of cancer risk following radioactive iodine therapy for patients with hyperthyroidism is further examined in a study reviewed by Dr. Tim Korevaar. Drs. Marius Stan and George Kahaly then discuss a study regarding the role of prophylactic glucocorticoids for Graves’ orbitopathy in relation to the duration of Graves’ disease. As immunotherapy is being used more and more for the treatment of various malignancies, the endocrine-related adverse events will become increasingly pertinent to the practicing thyroidologist. Thus, Dr. Trevor Angell reviews an interesting study that shows a mortality benefit among patients in whom thyroiditis develops after the use of PD-L1 inhibitor therapy for nonthyroid cancers.Incidental thyroid nodules are a common part of an endocrine practice. Dr. Lisa Orloff discusses an intriguing study related to this, which reports that machine-assisted learning may outperform humans in predicting malignancy of a thyroid nodule. Dr. Benjamin Gigliotti is new to our editorial board and shares his first review on the implications of isolated extrathyroidal extension of papillary thyroid cancer into neck strap muscles. Finally, as the management of thyroid cancer continues to improve, it is important to consider the long-term quality of life and socioeconomic effects of this disease. Dr. Tracy Wang reviews a Canadian study examining quality of life-related measures among patients who undergo hemithyroidectomy, as compared with those who undergo a total thyroidectomy. Similarly, Dr. Maria Papaleontiou discusses a primarily U.S.-based study reporting quality-of-life outcomes and financial burden implications in patients with thyroid cancer.Finally, our monthly highlight of a first-author trainee case report presented at the 2019 American Thyroid Association Annual Meeting is by Dr. Aashka Shah and colleagues from Saint Michael's Medical Center in Newark, New Jersey, U.S.A. I invite everyone to read their interesting case report titled “A Choking ‘Wooden’ Goiter Resistant to Levothyroxine.”Our editorial team is proud to bring you these editorials, reviews, and case reports, and I hope that our material is directly helpful to your clinical thyroid practice. Thank you to our global friends and readers who are connecting with us through our social media channels. I invite you to come join these chats:Twitter:https://twitter.com/clinicalthyroid(@clinicalthyroid)Facebook:https://www.facebook.com/ThyroidAssociationLinkedIn:https://www.linkedin.com/company/american-thyroid-associationYoutube:https://www.youtube.com/user/thyroidorgOur reviews covered in Clinical Thyroidology are also translated into shorter lay summaries in our sister journal, Clinical Thyroidology for the Public (https://www.thyroid.org/patient-thyroid-information/ct-for-patients), that is edited by Dr. Alan Farwell and his team each month. The summaries in CTFP may be of use to patients and the public who have questions regarding recently published studies in the clinical thyroid literature.As always, thank you to both our new and faithful readers of Clinical Thyroidology. Please feel free to send me any questions or comments at clinicalthyroidology@thyroid.org.Warmest regards,Angela M. Leung, MD, MScEditor-in-Chief, Clinical ThyroidologyFiguresReferencesRelatedDetails Volume 32Issue 2Feb 2020 InformationCopyright 2020 American Thyroid Association, Inc.To cite this article:Angela M. Leung.Greetings From the Editor of Clinical Thyroidology.Clinical Thyroidology.Feb 2020.49-50.http://doi.org/10.1089/ct.2020;32.49-50Published in Volume: 32 Issue 2: February 6, 2020PDF download

SEOM clinical guideline thyroid cancer (2019)

Thyroid carcinoma is the most frequent endocrine malignancy and accounts for around 3% of global cancer incidence. Different histologies and clinical scenarios make necessary a multidisciplinary approach that includes new diagnostic methods and surgical, radiopharmaceutical and systemic therapies. This guideline updates several aspects of management of thyroid cancer.

High-throughput metabolomic method based on liquid chromatography: high resolution mass spectrometry with chemometrics for metabolic biomarkers and pathway analysis to reveal the protective effects of baicalin on thyroid cancer.

Cell metabonomics focuses on discovering metabolic biomarkers and pathway changes in cells from biological systems to obtain the cell properties and functional information under different conditions. Baicalin possesses various pharmacological activities, and plays a vital role in the oncology research field. However, the detailed mechanism of its action is still unclear. In this work, we employed ultra-high performance liquid chromatography-mass spectrometry (UPLC-MS) based non-targeted metabolomics method associated with chemometrics analysis to explore metabolic pathways and biomarkers for investigating the efficacy and pharmacological targets of baicalin against thyroid cancer cells. In addition, morphological observation, parameter calculation of cell proliferation and apoptosis were carried out, which assisted in elucidation of pharmacological activity of baicalin on the human thyroid cancer cells. The results showed that baicalin possesses an intense stimulative apoptosis and inhibits proliferation activity on SW579 human thyroid cancer cells, and partially reversed the cell metabolite abnormalities. A total of nineteen differentiated metabolites in SW579 cells were identified and deemed as potential biomarkers after the baicalin treatment, involving nine metabolic pathways, such as taurine and hypotaurine metabolism, pyrimidine metabolism, fructose and mannose metabolism, steroid hormone biosynthesis and sphingolipid metabolism. High-throughput non-targeted metabolomics provide an insight into specialized mechanism of baicalin against thyroid cancer and contributes to novel drug discovery and thyroid cancer management in clinical practice.

A Case Report of Water Intoxication During Radioactive Iodine Treatment: Why Physicians Should Communicate Clearly With Patients

Radioactive iodine (RAI) treatment is an effective method for the treatment of thyroid remnant ablation and metastasis in patients with differentiated thyroid cancer. The current guidelines recommend patients to drink lots of water to reduce the amount of iodine in the body during RAI treatment; however, water intoxication is a life-threatening condition resulting from hyponatremia. This case report describes water intoxication during RAI treatment in a 55-year-old patient who was evaluated for the management of angio-invasive follicular thyroid cancer following a total thyroidectomy. Hyponatremia is an electrolyte imbalance commonly encountered in oncology practice and is usually defined as a serum sodium level of less than 135 mEq/L. Water intoxication is a rare phenomenon that occurs due to an excessive intake of water, especially when the volume of water intake exceeds the excretory capacity of the kidney. This case report has revealed that all relevant information and instructions including the consumption of water should be clearly and accurately communicated to patients. J Endocrinol Metab. 2020;10(3-4):101-105 doi: https://doi.org/10.14740/jem646

The revised clinical practice guidelines on the management of thyroid tumors by the Japan Associations of Endocrine Surgeons: Core questions and recommendations for treatments of thyroid cancer.

The Japan Associations of Endocrine Surgeons has developed the revised version of the Clinical Practice Guidelines for Thyroid Tumors. This article describes the guidelines translated into English for the 35 clinical questions relevant to the therapeutic management of thyroid cancers. The objective of the guidelines is to improve health-related outcomes in patients with thyroid tumors by enabling users to make their practice evidence-based and by minimizing any variations in clinical practice due to gaps in evidential knowledge among physicians. The guidelines give representative flow-charts on the management of papillary, follicular, medullary, and anaplastic thyroid carcinoma, along with recommendations for clinical questions by presenting evidence on the relevant outcomes including benefits, risks, and health conditions from patients' perspective. Therapeutic actions were recommended or not recommended either strongly (◎◎◎ or XXX) based on good evidence (😊)/good expert consensus (+++), or weakly (◎, ◎◎ or X, XX) based on poor evidence (😣)/poor expert consensus (+ or ++). Only 10 of the 51 recommendations given in the guidelines were supported by good evidence, whereas 35 were supported by good expert consensus. While implementing the current guidelines would be of help to achieve the objective, we need further clinical research to make our shared decision making to be more evidence-based.

Application of extracorporeal membrane oxygenation in surgical management of thyroid cancer invading the trachea: A report of two cases

Application of extracorporeal membrane oxygenation in surgical management of thyroid cancer invading the trachea: A report of two cases

Surgical management of papillary thyroid cancer: review of current evidence and consensus

The optimal surgical management of papillary thyroid carcinoma has been an ongoing debate. Most recommendations in clinical practice guidelines are based on large retrospective studies and expert opinion. The objective of the article is to summarize the recent evidence and main arguments related to the surgical management of papillary thyroid carcinoma. A definitive correlation between loco-regional recurrence and long-term survival and the extent of thyroid resection or lymph node dissection have not been established through randomized controlled clinical trials. Due to the low rates of recurrence and mortality associated with papillary thyroid cancer, large scale prospective randomized controlled trials that will help identify the optimal surgical management are unlikely to be available in the future as well. According to current consensus, hemithyroidectomy is sufficient for low-risk disease whereas total thyroidectomy should be performed in those with high-risk features. The place of therapeutic and prophylactic central compartment and lateral neck dissection is discussed based on evidence on short-term and long term outcomes. Furthermore, post-operative staging and dynamic risk stratification are important in determining adjuvant therapy and a follow-up plan.

Targeted high-throughput sequencing for somatic mutations identification in thyroid cancer management

Abstract Background Main challenges in thyroid cancer management are low sensitivity of preoperative differential diagnostics and absence of sufficient prognostic markers for choosing of therapeutic strategy, including decision regarding radioiodine therapy. The study aims evaluation of clinical utility of analyses of comprehensive set of driver and secondary mutations with targeted high-throughput sequencing. Methods Point mutations in 52 genes, CNVs at 1q, 9q, 17q, 22q, and fusions of 66 genes were analyzed with targeted high-throughput sequencing. The analyzed mutations included well known driving and putatively driving mutations selected from TCGA project and literature, and secondary mutations with known or putative prognostic significance. Enrichment of regions of interest was performed with AmpliSeq technology. Fusions were detected by the presence of chimeric transcripts. Sequencing was performed on Illumina NextSeq (for point mutations and CNVs) or MiSeq (for fusions). Samples included 64 confirmed cancer samples (41 samples with Bethesda IV-V cytology, and 23 samples - Bethesda VI cytology), 16 confirmed benign samples, 12 normal tissue samples. Results Mutations detected in carcinomas included, in addition to BRAF and RASs: CDKN2B, ZFHX3, PDGFRA, KIT, NTRK3, ECM2, TERT, KDR, KMT2A, TP53, RNF213, APC, CHEK2, PTEN, PPM1D, ATR, CDKN2A, CTNNB1, ARID1B, KMT2C, ALK, DICER1, fusions of NTRK3, NTRK1, PPARG and RET, and CNVs 22q-del и 9q-del. The detected mutations allow to characterize all studied cancer cases. In benign nodules mutations in NRAS, TSC2, KDR, EIF1AX, ARID1B, TSHR, ZFHX3, GRIN3A, DICER1, HRAS, CHEK2 were found. Conclusions Tests limited to BRAF, K/N/HRAS, RET-PTC1/3, PAX-PPARG mutations have low diagnostic value. The developed panel allows analyzing an expanded range of mutations, including recently described rearrangements and CNV. Design of the panel, initial validation and sequencing of cancer samples were funded by Foundation for Assistance to Small Innovative Enterprises in Science and Technology (№ 442ГС2/9119 - С3-40846); sequencing of benign samples was supported by the grant of the Russian Science Foundation (Agreement 19-75-00053). Legal entity responsible for the study The authors. Funding Foundation for Assistance to Small Innovative Enterprises in Science and Technology (442ГC2/9119 - C3-40846); Russian Science Foundation (Agreement 19-75-00053). Disclosure All authors have declared no conflicts of interest.