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Query: UMLS:C0027627 (metastases)
 103,950 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Greater precision has developed in recent decades in the selection of patients for operation for thyroid nodules suspicious for malignancy and in adapting operative procedures to the extent and pathologic variety of the individual thyroid carcinoma, when present. A thyroid lobectomy is considered to be the minimal operative procedure usually indicated for a suspicious thyroid nodule or carcinoma involving one lobe of the thyroid gland. Factors determining the extent of operation for thyroid carcinoma include the pathologic variety, gross distribution of the malignancy, and health status of the individual patient. Total or near total thyroidectomy should be considered for all patients with thyroid carcinoma except for single occult carcinomas and unilateral low grade angio-invasive carcinomas. Removal of lymph nodes in regions adjacent to the thyroid carcinoma is advisable, lateral neck dissections being reserved for patients with palpable lymphadenopathy, demonstrated metastases to lateral cervical lymph nodes, or a poorly differentiated carcinoma likely to metastasize to these lymph nodes. A modified radical lymph node dissection is satisfactory except for those carcinomas invading muscles in the neck. Anatomic neck dissections provide a better prognosis than incomplete lymph node procedures for patients with regional lymph node metastases. Following operation, patients should receive thyroid hormone therapy, be evaluated for possible treatment with radioactive iodine or other therapeutic measures, and be followed for evidence of recurrent disease as well as thyroid and parathyroid function. Adequate early operation is preferred to late ultraradical procedures, from standpoints of morbidity and prognosis. Unfavorable prognostic factors include extensive gross disease, poorly differentiated carcinoma present as the entire lesion or as foci in a differentiated carcinoma, and age over 40. With adequate surgical treatment, the prognosis for operable thyroid carcinoma is good.
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PMID:Management of carcinoma of the thyroid. 31 68

The duration of thyroid hormone deprivation necessary on the one hand to achieve a sufficiently high endogenous TSH level for the identification of 131I-storing metastases or local relapses, and on the other hand to keep the consequences of thyroid hormone deprivation as low as possible, was determined in 111 athyrotic patients with thyroid carcinoma by means of the basal TSH level or a TRH stimulation test. From the first follow-up examination, a T3 deprivation of 8 days is to be recommended. Low basal TSH levels and marked stimulation in the TRH test should be sufficient cause to prolong the T3 deprivation to 10 days with further examinations. After a longterm suppression of athyrotic patients with thyroid hormone, a decrease in the TSH rise was observed in the course of 2 years, after appropriate interruption of the substitution.
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PMID:[TSH state after thyroid hormone deprivation in athyrotic thyroid cancer patients (author's transl)]. 40 53

Thyroid function was assessed at the time of initial diagnosis in 204 patients with lung cancer and compared with that of age and sex-matched patients with non-malignant lung disease. Abnormalities in thyroid function were found in 67 patients (33%). The most prevalent abnormality was a low T3 concentration; this was not associated with other clinical or biochemical evidence of hypothyroidism, but the short-term prognosis of these patients was worse than that of matched patients with lung cancer having normal T3 concentrations. Primary hypothyroidism occurred in three patients, low T4 concentrations and free thyroxine index (FTI) with normal thyrotrophin (TSH) concentrations in four patients, and moderately raised TSH with normal thyroid hormone concentrations in six patients; nine patients had a raised FTI with or without raised T4 concentration as the sole abnormality.Overall, the pattern of thyroid hormone metabolism in lung cancer was a tendency towards reduced T3 concentrations with significantly increased T4/T3 ratios and modestly increased 3,3',5'-triiodothyronine (rT3) concentrations. The altered T4/T3 ratio was particularly noticeable in patients with anaplastic tumours of small ("oat cell") and large cell types, but was not apparently related to detectable extrathoracic metastases.These data suggest that thyroid hormone metabolism is altered in patients with lung cancer by decreased 5'-monodeiodination of T4. The resulting low T3 concentrations and altered T4/T3 ratio may be partly responsible for the reduced ratio of androsterone to aetiocholanolone observed in lung cancer, which is known to be a poor prognostic sign.
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PMID:Thyroid function in lung cancer. 62 Feb 66

The inadequacy of the standard pathologic criteria for identifying certain well-differentiated thyroid follicular carcinomas from follicular adenomas in rare instances is illustrated by four cases. The excised thyroid nodule in these patients appeared to be adenoma, but subsequent local spread in the neck or distant metastases disclosed the actual malignant nature of the lesions. This observation is not intended as a basis for more extensive operations for adenoma, but rather as an indication for close, long-term observation. Postoperative, lifelong suppressive therapy with thyroid hormone is suggested for all patients with a diagnosis of follicular adenoma.
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PMID:Clinical implications of the rare thyroid carcinoma which is indistinguishable from a follicular adenoma. 72 20

A 57-year old woman with thyroid carcinoma manifesting overt thyrotoxicosis is presented. After the patient had been made euthyroid with propylthiouracil, right lobectomy and lymph node dissection were performed. Permanent paraffin sections revealed follicular adenocarcinoma with capsular and vascular invasion. Metastases to the right humerus, both femurs, the skull and pleural cavity became prominent with the recurrence of thyrotoxicosis and the patient died 2 years and 3 months after operation. The clinical evidence indicates that thyrotoxicosis in the present case is caused by the excessive secretion of thyroid hormone by both the original carcinoma and the secondary deposits. Twenty three similar cases reported in the English and Japanese literatures are summarized.
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PMID:Report on a case of functioning thyroid carcinoma provoking thyrotoxicosis with review of literature. 75 8

Following operation or/and radioiodine therapy in 69 patients with malignant tumors of the thyroid gland the plasma level of TSH was increased independently of the level of thyroid hormone and of a clinical finding of hypothyroidism. In all cases it was possible to stimulate the secretion of TSH with TRH (p less than 0,0005). Therefore, application of TRH may be helpful to increase the uptake of iodine by metastases. On the other hand substitution of thyroid hormones--thyroxine or triiodothyronine or both combined--resulted in normal levels of TSH and normal response to TRH.
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PMID:[Behavior of the TSH level in thyroidectomized patients after thyrotropin releasing hormone (TRH)]. 81 89

Between 1960 and 1972, 305 patients with malignomas of the thyroid gland were surgically treated, irradiated (megavoltage therapy and/or iodine-131), and treated with thyroid hormone according to principles formerly stated. Differentiated adenocarcinomas (34.4% of all the patients) were observed more frequently in women and younger patients, whereas dedifferentiated carcinomas (33.8%) are found relatively more often in men and in an advanced age. Only in 12% of the cases the tumor was discovered in an early stage; thus, an early diagnosis is much too rare so far. In almost two thirds of the patients a spread of metastases occurred. Of these, 11% grew manifest later than five years following the therapy. Distant metastases from differentiated adenocarcinomas accumulated I-131 in sixty per cent, those from undifferentiated carcinomas still in twenty per cent. Treatment results are influenced decisively by histology, tumor spread, age and sex, women less than forty years old with differentiated adenocarcinomas and a circumscribed extension of the tumor having the best prognosis. More prognostic importance is due to the extension of the primary tumor than to the presence of metastases to regionary lymph nodes. Patients with metastases accumulating I-131 have a better chance of survival than those whose metastases do not accumulate. By means of standardized therapeutic rules, utilizing modern therapeutic techniques and based on interdepartmental cooperation, it was possible to improve the results partly by the two- or threefold as compared to a previously treated group of patients.
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PMID:[Thyroid malignant neoplasms. Therapeutic results in 305 patients]. 96 Jan 30

At the University of Chicago Hospitals, 40 per cent of patients with a history of irradiation to the neck and a palpable thyroid abnormality have been found recently to have carcinoma of the thyroid at operation. In a study of 100 unselected patients with a history of neck irradiation, 26 had palpatory abnormalities and seven of 15 who were operated upon had carcinoma of the thyroid. Five of these lesions demonstrated evidence of local invasion or lymph node metastases. This prevalence rate of carcinoma of at least 7 per cent in irradiated patients is the highest yet reported. These facts have led us to take a very aggressive position in the treatment of these patients. All patients must be examined carefully. When any palpatory abnormality is present which cannot be explained convincingly by thyroiditis, the patient should be operated upon. Total or near-total thyroidectomy should be performed in each patient by a qualified neck surgeon. In cases of proved carcinoma, a modified radical neck dissection should be added if cervical lymph nodes are clinically involved with tumor. Postoperative thyroid hormone suppression is mandatory and ablation of any residual iodine uptake in the neck or elsewhere by radioactive iodine is advocated. If treatment is aggressive, an excellent prognosis can be expected. However, deaths do occur from this disease. It is imperative that each of us be aware of this disease entity and that we treat these irradiated patients appropriately.
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PMID:Recent developments in radiation-induced carcinoma of the thyroid. 125 1

The role of thyroid ablation following thyroidectomy for invasive follicular cancer remains controversial. The use of iodine 131 (131I) ablation as adjuvant therapy may facilitate follow-up of patients in whom serum thyroglobulin levels and 131I total body scans are used to detect metastatic disease. It is uncertain if 131I ablation improves survival of patients with follicular thyroid cancer. Thus, the purpose of this study was to determine if survival is enhanced following ablation, with particular reference to those patients with minimally invasive cancer. Between the years 1955 to 1988, 142 patients with invasive thyroid follicular cancer were treated at the British Columbia Cancer Agency, of whom 71 had minimal invasion and no extrathyroidal extension of tumor. In this group of patients, 46 underwent hormone suppression only, 17 had ablation, and 8 had neither. The average follow-up was 9 years and extended beyond 15 years in many patients. Data were entered in a mainframe computer, and Kaplan-Meier survival analysis was used, comparing crude survival, disease-specific survival, and disease-free survival. There was no significant difference between groups. In patients with follicular thyroid cancer and capsular invasion only, 131I ablation does not improve survival compared with patients treated with thyroid hormone suppression only.
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PMID:Efficacy of 131I ablation following thyroidectomy in patients with invasive follicular thyroid cancer. 157 1

In the last ten years, 47 patients with distant metastases of differentiated thyroid carcinoma have been treated with 131I following total thyroidectomy. Post-therapy whole body 131I scans revealed detectable uptake in the metastatic lesions in 23 (62%) of 37 patients with lung metastases, 10 (67%) of 15 patients with bone metastases five (71%) of seven patients with mediastinal metastases, and neither of two patients with brain metastases. The concentration of 131I in the metastases was significantly correlated with serum T3 and T4 concentrations, and inversely correlated with serum TSH concentrations. Most of the patients with a strong positive scan were euthyroid, suggesting that thyroid hormones produced by the tumor compensated for hypothyroidism following total thyroidectomy. There was no significant relationship between serum thyroglobulin concentration during T4 replacement therapy and 131I uptake or the efficacy of therapy. Twenty patients with lung (54%), five with bone (33%), two with mediastinal (29%), and none with brain metastases showed tumor regression after treatment. Significantly increased 131I uptake in lung metastases, better therapeutic results and better prognosis were demonstrated in young patients. In conclusion, age, 131I whole body scanning and serum thyroid hormone concentrations are considered to be useful in predicting the efficacy of 131I treatment for distant metastases, especially in the lung.
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PMID:[Results of radioiodine therapy in 47 patients with distant metastases of differentiated thyroid carcinoma]. 189 47


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