Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0027627 (metastases)
 103,950 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Long-acting somatostatin analogues such as SMS 201-995 (Sandoz) are being evaluated in a wide range of clinical indications, including gut neuroendocrine tumours and acrogemaly. Long-term continuous SMS 201-995 treatment has achieved useful symptomatic improvement in diarrhoea in 4 patients with metastatic VIPomas who had relapsed following previous treatment. Clinical improvement has outlasted suppression of VIP secretion (suggesting an additional direct antisecretory action of SMS 201-995) and has occurred despite expansion of hepatic metastases. In 6 patients with tumours secreting gastrin and/or glucagon, secretion of these peptides was acutely inhibited by SMS 201-995. However, endocrine and clinical responses to chronic treatment have been less consistent. SMS 201-995 is active orally at doses of 4-8 mg and when given thrice-daily to 6 patients with active acromegaly, suppressed mean 24-h growth hormone levels by 51-88%. Despite significantly reduced plasma insulin concentrations, glucose tolerance did not deteriorate. SMS 201-995 was also effective in suppressing thyroid-stimulating hormone (TSH) and thyroid hormone secretion in a patient with mild thyrotoxicosis due to non-tumoural inappropriate TSH hypersecretion. In all cases SMS 201-995 treatment has been well tolerated and has few side-effects.
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PMID:Clinical evaluation of SMS 201-995. Long-term treatment in gut neuroendocrine tumours, efficacy of oral administration, and possible use in non-tumoural inappropriate TSH hypersecretion. 289 35

Fluid and electrolyte homeostasis is impaired in patients suffering from hypothyroidism and myxedema because myxedema induces retention of salt and water. We have measured plasma levels of human atrial natriuretic peptide (hANP) in 8 female patients who had been totally thyroidectomized because of thyroid carcinoma. Estimations of the hormone were done 4 weeks after diagnostic withdrawal (searching for iodine retaining metastases) and after 2 weeks and 4 weeks of reinitiation of thyroid suppressive therapy by L-thyroxine. hANP levels, although within the normal range (10-80 ng/l) throughout the study, were positively linked to the amount of pericardial effusion (determined by echocardiography), which was highest initially and decreased or vanished with duration of L-thyroxine therapy. Additionally, a positive correlation between thyroid hormone levels and hANP was obtained when the counteracting effect of pericardial effusion was allowed for by partial correlation analysis. Our findings might facilitate explanation of mild polyuria in hyperthyroidism and impaired water excretion in hypothyroidism.
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PMID:Thyroid hormones and pericardial effusion may influence plasma levels of atrial natriuretic peptide (ANP) in humans. 294 72

The effect of hypothyroidism on left ventricular function at rest and during exercise was studied in nine patients without demonstrable cardiovascular disease who had had total thyroidectomy and ablative radioiodine treatment for thyroid cancer. Radionuclide ventriculography and simultaneous right heart catheterisation were performed while the patients were hypothyroid two weeks after stopping triiodothyronine treatment (to permit routine screening for metastases) and while they were euthyroid on thyroxine replacement treatment. When the patients were hypothyroid, cardiac output, stroke volume, and end diastolic volume at rest were all lower and peripheral resistance was higher than when they were euthyroid. Pulmonary capillary wedge pressure, right atrial pressure, heart rate, left ventricular ejection fraction, and the systolic pressure:volume relation of the left ventricle, which was used as an estimate of the contractile state, were not significantly different when the patients were hypothyroid or euthyroid. During exercise, heart rate, cardiac output, end diastolic volume, and stroke volume were higher when the patients were euthyroid than when they were hypothyroid. Again, pulmonary capillary wedge pressure, ejection fraction, and the systolic pressure:volume relation were similar in both thyroid states. The data suggest that the alterations in cardiac performance seen in short term hypothyroidism are primarily related to changes in loading conditions and exercise heart rate; they do not suggest that acute thyroid hormone deficiency has a major effect on the contractile properties of the myocardium.
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PMID:Left ventricular function at rest and during exercise in acute hypothyroidism. 317 36

Patients with thyroid cancer benefit from treatment with exogenous thyroid hormone for two reasons: it provides adequate levels of thyroid hormone to peripheral tissues, and it reduces the level of thyrotropin, which may be an important growth factor in patients with differentiated malignant neoplasms. The use of radioactive iodine for thyroid cancer is highly controversial. Its most appropriate applications are in follicular cancers, in older patients, and in distant functioning metastases. Its value in papillary cancer is questionable, particularly in young patients. There is a great need for effective basic and clinical research on the natural course of differentiated thyroid cancer and the effects of specific therapies.
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PMID:Thyroid suppression and medical ablation for differentiated thyroid cancer. 375 95

Patients between the ages of 6 and 45 years with distant metastases from papillary carcinoma of the thyroid can be treated as effectively by subtotal thyroidectomy and suppressive doses of thyroid hormone as by total thyroidectomy followed by treatment with iodine 131 (131I). Moreover, distant metastases can be treated by either 131I or suppression as effectively after they are apparent on x-ray as they can be when treated in a subclinical stage. Therefore, in patients younger than 45 years old it is rarely necessary to perform a total thyroidectomy or to do frequent postoperative scans. In patients older than 44 or younger than 7 who have distant metastases or extensive involvement of both lobes, total or almost total thyroidectomy is justified if it can be done with minimal morbidity. In patients of this age group whose tumors fail to respond to suppressive doses of thyroid, 131I should be used. In view of the importance of diagnostic related groups (DRG) to the economy of hospitals, we note that the cost of total thyroidectomy, ablation by 131I, and intermittent body scans is at least three times that of less radical procedures which, in conjunction with suppression by thyroid feeding, give the same survival with less morbidity.
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PMID:The advantages of subtotal thyroidectomy and suppression of TSH in the primary treatment of papillary carcinoma of the thyroid. 392 11

Local infiltration of adjacent anatomic structures and soft tissues of the neck from well-differentiated carcinoma of the thyroid gland is a relatively infrequent occurrence. We report our experience with 21 such cases seen in our department over the past 20 years. All patients were treated by total thyroidectomy and total or partial excision of the infiltrated adjacent structures. Papillary carcinoma was the most frequent type of primary tumor seen. Following the definitive surgery, all patients were scanned with radioactive iodine (131I). In case of isotope entrapment, a curative dose 131I was given. All patients in our series were required to receive thyroid hormone replacement. Four patients died as a result of their disease. Uncontrolled local disease and distant metastases were present at the time of death. Three patients died of unrelated causes. Two-thirds of the patients are still alive (from 1 to 19 years after the treatment).
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PMID:Locally aggressive differentiated thyroid carcinoma. 407 92

While few solitary thyroid nodules are carcinomatous, it is essential to identify and preferentially select those that are for surgery. Clinical, biochemical, serologic, radiographic, scintigraphic, sonographic, biopsy, and even therapeutic evaluation may be necessary to choose those patients with the greatest probability of malignancy. The benefits and limitations of each diagnostic modality are discussed, and the importance of fine-needle aspiration is stressed. After the operative confirmation of malignancy, the prognosis in any given case depends on 1) the histologic type of the neoplasm, 2) its size and extent, 3) the presence of angioinvasiveness, 4) the tendency toward multicentricity of the lesion, 5) the age and sex of the patient, and 6) whether distant metastases are present. These factors influence the extent of surgery required for well-differentiated carcinomas. Meticulous dissection and preservation of the recurrent laryngeal nerves and the parathyroid glands along with their blood supply are important if total thyroidectomy for papillary carcinoma is to be employed with an acceptable operative morbidity to optimize survival. The value of the adjunctive use of thyroid hormone and radioactive iodine is also discussed. Finally, the clinical behaviors and treatments of undifferentiated carcinomas, sarcomas, lymphomas, and neoplasms metastatic to the thyroid gland are reviewed.
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PMID:The solitary thyroid nodule: diagnosis and management of malignant disease. 637 9

Thyroglobulin has been evaluated among 30 control subjects and 81 thyroidectomized patients with differentiated thyroid carcinoma (50 papillary, 15 follicular, 16 mixed). 40 presented without residual thyroid tissue in the neck, 27 with residual tissue, 14 with metastases. Tg evaluation was performed on (78 dosages) and off thyroid hormone therapy (74 dosages), before and after withdrawal of thyroid medication in 25 patients. Tg was measured at different periods after surgical or radioiodine therapy of metastases (7 cases). The sera containing anti-Tg antibodies are rejected. The mean Tg levels was 11.9 +/- 8.5 ng/ml in the control group. In the group of patients with thyroid cancer, Tg levels were dependent on several factors: presence or not of residual thyroid tissue, presence or absence of a replacement therapy. All the patients on or off thyroid medication with metastases except one, presented with plasma Tg levels alone 5 ng/ml. In conclusion, plasma Tg appears as a good index for the research of metastases but only in patients without anti-Tg antibodies and residual thyroid tissue in the neck. Despite the existence of false negative results, a Tg undetectable in treated patients presenting a normal roentgen chest leads to avoid total body radioiodine scan and other usual radiologic investigations. On a opposite hand a plasma Tg greater than 50 ng/ml is highly suggestive of the presence of metastases.
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PMID:[Value of the assay of thyroglobulin for postoperative surveillance of differentiated thyroid cancers]. 648 15

Plasma triiodothyronine (T3), reverse T3 (rT3), thyroxine (T4), total thyroid hormone-binding globulin (TBG) capacity, and serum albumin were assayed in patients with early and advanced breast and colonic cancer and in healthy women. Plasma T3 levels were reduced in both breast cancer group, but were reduced only in colonic cancer patients with systemic metastases. Plasma rT3 was normal in early cancer, but increased in nine of 38 (24%) with advanced breast cancer and four of 17 (24%) with metastatic colonic cancer; in consequence their rT3/T3 ratios were elevated. Plasma T4 concentrations were normal in all patient groups. Plasma TBG capacity was reduced in breast cancer patients with systemic metastases and a similar tendency occurred in metastatic colonic cancer. Levels of TBG were positively correlated with the serum albumin values. These changes were associated particularly with liver metastases.
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PMID:Plasma thyronine levels in carcinoma of the breast and colon. 678 87

Two groups of patients were studied to compare the efficacy of serum thyroglobulin (Tg) levels to 131I total body scans in the follow-up of patients with thyroid cancer. All of the group of 30 patients without recurrence had undetectable Tg levels on and off thyroid hormone replacement, and all had negative total body scan results although eight patients showed uptake in remnant thyroid tissue. In the second group of 37 patients with documented recurrent or metastatic disease, 34 (92%) had positive serum Tg levels, although the levels in five of these patients were undetectable while on thyroid replacement, and 31 (84%) had positive total body scan results. The false negative results of the two tests were not overlapping, and of those with positive Tg levels, 29 showed a significant increase once thyroid hormone therapy had been withdrawn. We conclude that although the percentages of positive Tg levels and body scan results in patients with recurrent disease are similar, both tests are required to minimize the number of patients with undiagnosed metastases. Second, thyroid-stimulating hormone suppression has a definite although unpredictable effect on serum Tg levels in patients with thyroid cancer, and thyroid hormone should be withdrawn prior to measurement of serum Tg to minimize the number of false negative results.
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PMID:Radioiodine total body scan versus serum thyroglobulin levels in follow-up of patients with thyroid cancer. 703 59


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