growth per se seems not to be a stand-alone marker for malignancy. Kim et al. reported that nodules showing more than 50 % growth during sonographic follow-up were unlikely to result in a diagnosis of malignancy, whereas malignancy was more often present when sus- picious US features were found . However, the re- vised American Thyroid Association guidelines from 2015 suggested that a 50 % threshold for nodule vol- ume increase at follow-up is a criterion for further diag- nostic work-up and repeat FNA to rule out malignancy (weak recommendation based on low quality evidence) . Moreover, in commonplace practice, thyroid nodules with growth are often surgically treated to rule out cancer . The results of this study show that relevant thyroid nodule growth over time defined as a volume increase of more than 50 % is present in three fourths of the patients followed. Moreover, rapid nodule growth within 24 months was seen in 30 % of all patients. Nevertheless, nodule growth was rarely associated with well-differentiatedthyroidcancer, and a rapid thyroid nodule growth pattern occurred only in benign lesions, metastatic cancers and lymphoma. All data were obtained from a surgical database, meaning that data from patients still under follow-up without surgery were not included in this analysis. These results are thus not comparable to the results of plain observational studies reporting much lower thyroid nodule growth rates [18, 21]. In matters of nodule growth and well-differentiatedthyroidcancer, this might even further increase the ratio of patients with rele- vant nodule growth and without thyroid malignancy.
Introduction: Age is an important prognostic factor in differentiatedthyroidcancer (DTC). Our aim was to evaluate differences in clinicopathological features and treatment outcomes among children and adult patients with DTC. Materials and methods: We studied 27 children (below 18 years) with DTC treated during the period 2000 – 2012 and were compared with (a) 78 adults aged 19 – 25 years and (b) 52 adults aged 26 – 30 years treated during the same period in terms of their clinicopathological features and long term treatment outcomes. Locoregional recurrence (LRR), locoregional control (LRC), distant metastasis (DM), distant metastasis control (DMC), disease free survival (DFS) and overall survival (OS) rates were evaluated.
Extrathyroidal extension (ETE), which is defined as tumor spread outside of the thyroid gland and into the surrounding tissues, occurs in up to 30% of patients with differentiatedthyroidcancer (DTC)[1, 2]. Minimal ETE (mETE), detectable only on histological examination, was not regarded as a negative predictor for either survival or disease recurrence[3-5]. Accordingly, mETE was removed from the T3 definition in the 8th edition of the American Joint Committee on Cancer (AJCC) classification, as it would not affect either T category or overall stage. In contrast, gross ETE is believed to be an important risk factor for recurrence and mortality[7, 8]. Thus, DTC patients with gross ETE are classified as T3b or T4 in the AJCC system. Moreover, the 2015 American Thyroid Association (ATA) guidelines grouped tumors with gross ETE in the high risk of recurrence category, with a nearly 20% risk of structural
Background: Lateral neck dissection is risky and should be performed only as a therapeutic intervention for known disease. Aim of the Study: This study aims at finding predictors which help in selecting patients who have high risk of lymph node metastasis. Methods: All the patients with well differentiatedthyroidcancer underwent thyroidectomy with lateral lymph nodes (LNs) dis- section with available pathology report and sufficient data have been included in the study. Results: Sixty nine patients have been included in this study. In multivariate analysis, the most reliable and significant factors for detecting L.N. involvement were the clinical picture and the U/S appearance of the Neck with P value of (0.008) and (0.001) respectively. Conclusion: Clinical and U/S examinations are the most independent and reliable factors to detect lateral neck lymph nodes involvement.
The study aims to review the literature regarding extent of lateral neck dissection for differentiatedthyroidcancer by way of a systematic review. Though there is abundant data available on outcomes of lateral neck dissection in relation to differentiatedthyroidcancer, including some international guidelines, there is no clear consensus which is accepted throughout the world. Apart from this, the findings of some new studies cast serious doubt on the current treatment practices, which necessitates a thorough review of all available evidence to bring out latest inferences. Purpose: To review the literature regarding extent of lateral neck dissection for differentiatedthyroidcancer by way of a systematic review. Though there is abundant data available on outcomes of lateral neck dissection in relation to differentiatedthyroidcancer, including some international guidelines, there is no clear consensus which is accepted throughout the world. Apart from this, the findings of some new studies cast serious doubt on the current treatment practices, which necessitates a thorough review of all available evidence to bring out latest inferences. Materials and Methods: An electronic search was conducted using the terms ―PTC or thyroid neoplasms or papillary carcinoma‖, ―neck dissection‖, ―lateral or cervical lymphadenopathy‖ and ―differentiatedthyroidcancer‖ in combination with the following search strategy : Search block Thyroid Neoplasms - "Thyroid Neoplasms"[Mesh] OR thyroid neoplasm*[tiab] OR thyroidcancer*[tiab] OR thyroid tumor*[tiab] OR thyroid tumour*[tiab] OR thyroid carcinoma*[tiab] OR thyroid malignancy*[tiab] OR thyroid oncology*[tiab] OR dtc[tiab] OR ptc[tiab]; Search block Neck Dissection - "Neck Dissection"[Mesh] OR neck dissection*[tiab] OR cervical lymphadenectomy*[tiab] OR lateral lymphadenopathy*[tiab] OR cervical
 Webb, R.C., Howard, R.S., Stojadinovic, A., et al . (2012) The Utility of Serum Thy- roglobulin Measurement at the Time of Remenant Ablation for Predicting Dis- ease-Free Status in Patients with DifferentiatedThyroidCancer: A Mata-Analysis In- volving 3947. The Journal of Clinical Endocrinology & Metabolism , 97, 2754-2763. https://doi.org/10.1210/jc.2012-1533
Abstract: Thyroidcancer is the most common endocrine malignancy. Incidence of thyroidcancer, particularly dif- ferentiated thyroidcancer, has substantially increased worldwide. Therefore, appropriate diagnosis and treatment methods for differentiatedthyroidcancer are critically important. The current review aimed to explore studies con- cerning the etiology, epidemiology, diagnosis, and treatment of differentiatedthyroidcancer, referring to recent American Thyroid Association and British Thyroid Association guidelines. The current study discusses overdiagnosis and overtreatment of differentiatedthyroid carcinomas. Future direction for studies investigating differentiatedthyroidcancer, aiming to achieve precise diagnosis and treatment, was also discussed. Accuracy levels of diagno- sis and treatment methods of differentiatedthyroidcancer have not been high enough. They must be refined by additional studies. Therefore, diagnosis and treatment of differentiatedthyroidcancer requires multidisciplinary collaboration, as well as individual management. Careful preoperative evaluations should be performed, selecting reasonable surgical methods and proper adjuvant therapies to achieve accurate diagnoses. These measures will provide optimal treatment for differentiatedthyroidcancer patients, helping them to achieve better outcomes.
Differentiatedthyroidcancer (DTC) is the most com- mon endocrine malignancy. It affects any age group and sex, and its incidence has been increasing for the last 20 years [1, 2]. Treatment of DTC includes thyroidec- tomy, followed by nuclear medicine therapy with radio- iodine 131 I for eradication of persistent disease and ablation of residual thyroid remnant, to facilitate post- treatment radiological and clinical follow-up of the pa- tient . 131 I treatment can damage radiation-sensitive tissues, and it has been shown that some radiation is de- livered to the testes after administration of radioiodine . Some studies have reported impairment in sper- matogenic functions such as elevated serum FSH levels, reduced sperm count resulting in some cases in oligo- zoospermia [5–8]. These effects were usually not per- manent and were reversed within 18 months, although permanent damage has been reported in patients receiv- ing repeated or high cumulative doses . Radiations are known to induce double strand breaks in DNA, and it has been shown that treatment with 131 I induces a rise in γH2AX and 53BP1 DNA repair foci in blood cells . There are no reports on potential effects on sperm- atozoa DNA, although it has been shown that higher levels of DNA strand breaks are associated with infertil- ity and miscarriages .
Differentiatedthyroidcancer ( DTC ) is usually not very common ( incidence is about 1 % of all cancers and women are more often affected than men ). However, higher incidences has been reported in many parts of South East Asia particularly in iodine deficient areas. Unlike other solid tumors , DTC is potentially curable with documented survival rate of > 90 %. Even if the disease is not totally cured, through repeated high dose radio iodine therapy the progress of the disease can be controlled with significant improvement in quality of life for many years. This is possible if a proper and state of the art therapeutic approach is made. Since the incidence is relatively low, individual experience of treating physicians or centers is mostly inadequate leading to improper management with subsequent increase in morbidity and mortality. The purpose of this review is to evolve a rational management protocol for the treatment of thyroidcancer. Centers which do not have all facilities like high dose radio iodine therapy etc. may still follow the protocol by referring the patient for a particular step to another centre. What is needed is the awareness of the treating physician about the appropriate management of DTC. In recent years, there have been some important developments in the management of differentiatedthyroidcancer like use of recombinant human thyrotropin (rhTSH), use of retinoic acid for redifferentiation etc. Some of these developments having practical relevance have been briefly mentioned.
Thyroidcancer is the most common endocrine malignancy. More than 90% of primary thyroid cancers are differentiated papillary or follicular types. The treatment of thyroid carcinoma consists of total thyroidectomy and radioactive iodine ablation therapy, followed by L-thyroxine therapy . Follicular and papillary thyroidcancer (frequently called differentiatedthyroidcancer (DTC)) have good prognosis. Iodine scintigraphy and thyroglobulin (Tg) are the best tools for monitoring DTC after total thyroidectomy. A detectable Tg associated with a negative scintigraphy is not a rare situation.
Objective: Among more than 40 mutations identified in the BRAF gene, the BRAF T1799A (V600E) point mutation is the most common and accounts for more than 90% of all the mutations found in the BRAF gene. It has been found to occur frequently in thyroidcancer. While some reports suggest the BRAF V600E mutation is associated with poor prognosis and recurrence or iodine uptake resistance, this remains a controversial issue. The aim of study was to: 1) determine the status of BRAF mutation in differentiatedthyroidcancer in Bach Mai hospital; 2) evaluate the association of the BRAF mutation with clinicopathological parameters.
in detecting osseous lesions, as in the patient described here. Because 131 I-WBS can detect some, but not all, bone metastases, further testing is needed . For example, FDG-PET shows preferential tracer uptake by malignant cells with a high turnover rate due to increased glucose metabolism. FDG-PET is useful in patients with metastatic poorly differentiatedthyroidcancer, in those with high thyroglobulin levels and in pa- tients negative on 131 I-WBS . X-rays and CT scans in the patient described here showed femoral head col- lapse, whereas MRI showed that the focal lesion of the femoral head had the shape of a band, with low intensity
For patients with low-risk and intermediate-risk differentiatedthyroid carcinoma, two large non-inferiority randomised trials (HiLo and ESTIMABL1) published in 2012 showed that a low administered radioactive iodine (¹³¹I) dose (1·1 GBq) had a similar ablation success rate after 6–9 months as the standard high dose (3·7 GBq) for thyroid remnant ablation. The effect of radioactive iodine dose on the risk of recurrence was only reported in observational studies. Most studies comprised low-risk patients, comparing those treated with or without radioactive iodine ablation. Three literature reviews, covering studies published until 2014, concluded that there is little or no difference between radioactive iodine and no radioactive iodine in thyroidcancer recurrence or mortality risk in low-risk patients. We searched PubMed for studies published in English between January, 2008, and December, 2017, comparing low-dose and high-dose radioactive iodine in low-risk and intermediate-risk patients. We used the keywords “differential thyroidcancer/carcinoma”, “radioiodine ablation”, and “low/high dose”. We identified five studies, with sample sizes ranging between 176 and 970 and median follow-up of at least 5 years, suggesting that there is no increased recurrence risk in patients treated with low-dose radioactive iodine compared with high-dose radioactive iodine. There had been no data on recurrences from randomised trials until the follow-up study
One limitation of this survey was the inability to calcu- late the response rate due to significant overlaps be- tween institutions contacted. The significance of bias due to non-response is therefore unclear. The potential impact of non-responders cannot be ignored as they may not have perceived treatment related morbidity in DTC to be a significant clinical problem. The survey only targeted surgeons and physicians who are members of specific organisations (TCF, BAETS and BTA), the findings may not be applicable to the entire population of thyroid surgeons and physicians.
Also of potential interest is the relatively low valued HRQL impact of alopecia (mean observed utility for stable disease with alopecia grades I/II of 0.75, compared with 0.80 for stable disease without). Given thyroidcancer is more prevalent in women than in men, it is possible that the impact of alopecia as an AE associated with treatment may be valued differently by a RR-DTC patient population than the general public in which the sexes are more equally represented. An exploratory analysis was conducted to examine the impact of sex on preferences around alopecia in this study. The findings were consistent with the hypothesis that women were more concerned with alopecia than men; however, the results were not conclusive. While for many regions societal valuation is required for health utilities for use in economic evaluation of treatments, the potential relevance of alopecia to female DTC patients should not be overlooked, as a patient may consider alopecia to be of higher significance than observed during this study.
the p-ERK expression in BRAF wild-type (WT) BHP27 cells (Fig.1A) . However, Vemurafenib was unable to induce apoptosis of K1 cells as supported by the unchanged levels of caspase-3, PARP1, and its cleaved fragments. We investigated the redifferentiation effect of Vemurafenib and found that it suppressed GLUT1 in a dose-dependent manner without reducing HK2 or increasing TSHR (Fig.1B). Using Memorial Sloan Kettering Cancer Center cBioPortal (http://www. cbioportal.org/public-portal/study.do?cancer_study _id=thca_tcga), we performed a comprehensive evaluation of The Cancer Genome Atlas (TCGA) thyroidcancer data where tumor and normal tissues from 496 PTCs were profiled for gene expression using multi-platforms . Our analysis revealed that Bcl-2 mRNA was overexpressed more than two-fold in 7% of DTC tissues when compared with adjacent normal thyroid tissue (Fig.1C). A previous study had shown that anti-apoptotic Bcl-2 governed outcome of the targeted therapy and addition of ABT-737 to Vemurafenib sensitized melanoma cells to the mitochondrial pathway of apoptosis .
time corresponding to the CY. At this level of geog- raphy, it was not feasible to disaggregate counts further by age and sex. In the regression analysis, controls were included for the age and sex composition of the adult population of each DA. The exposure variable was the adult population in the DA at the CY multiplied by the number of years in the corresponding time interval for that census (2, 4, or 5 years). Negative binomial regres- sion models were estimated where neighborhood socio- economic status, as measured by the InQ of the DA, was captured by a binary variable for each InQ, with the highest InQ specified as the baseline. To capture the changes in incidence over time, we defined indicator variables for each CY from 1996 to 2006 with 1991 as the reference year. In our first specification, differences in rural or urban status were captured by a binary vari- able for each type of region defined above. In our second specification, we interacted the InQ variables with indi- cators for residence in cities, towns and rural areas to allow the relationship between socioeconomic status and incidence of thyroidcancer to vary by urban–rural resi- dence. Both regressions included detailed controls for the age and sex composition of the DA. Since healthcare in Canada is administered at the provincial level, both regressions also included indicator variables for each province or territory of residence in order to capture re- gional unobserved effects important to the incidence and diagnosis of thyroidcancer.
Thyroid tumours are usually classified into multiple subtypes according to their histopathological character- istics, and treatments are selected depending on the sub- type and stage of thyroidcancer. The main subtypes include papillary thyroidcancer (PTC), follicular thyroidcancer (FTC), anaplastic thyroidcancer (ATC) and medullary thyroidcancer (MTC) . PTC and FTC are also sometimes collectively referred to as differentiatedthyroidcancer (DTC) or well-differentiatedthyroid can- cer (WDTC), while ATC can also be referred to as undifferentiated thyroidcancer. In addition, a number of rare subtypes have been described. Cellular origins and some of the known molecular mechanisms differ for each subtype , which may include subtype-specific alterations in DNA methylation patterns  and have led to new therapeutic approaches based on the molecu- lar signature of the tumours.
Thyroidcancer is the rare and aggressive endocrine malignant cancer. Thyroid tumors are rare in children and increase in frequency in each decade. There are about 2-3 times more frequent as in women than in men. There are many variants of thyroidcancer but over 90% are of Differentiatedthyroidcancer which arises from follicular (papillary, follicular, Hurthle cell cancer) and parafollicular variants (medullary thyroidcancer, MTC). The most common symptom noticed by the patient is Lump present in the neck during a clinical exam but there are many other symptoms like hoarseness in voice, difficulty in breathing, pain in neck and size of lymph nodes increases etc. There are many causes of thyroidcancer, it may be due to a history of some other thyroid disease, in hereditary abnormal genes, overweight, and radiation especially exposure during childhood, gender etc. FNA is the main tool for the diagnosis of differentiated type of cancer. The treatment of cancer are done different ways like Radiation exposure with 131 I , surgery, chemotherapy and hormone replacement etc and the survival rate of this cancer is better than other cancers after the treatment.