No abstract

The aim of study was to compare clinical and pathologic findings of surgically removed thyroid tumors in adults with or without history of irradiation due to the Chernobyl accident. From 1990 to 2003, 2363 adults with no evidence of radiation influence in their history (group A) have undergone operation for thyroid nodules. During the same period, 311 patients (born before 1969) with strict evidence of Chernobyl irradiation also underwent operation (group B). Both groups were similar in age, sex, and preoperative examination. Group B represented three of the four official categories of people affected by the Chernobyl accident: 1-recovery operation workers; 2-people evacuated from the restricted area; 3-inhabitants of contaminated areas. The rate of thyroid carcinoma among all cases of thyroid nodules was significantly higher in group B--32.8% (102 patients) versus 27.2% (644 patients) in group A (p < 0.05). But a more distinct difference was observed in 1 and 2 categories of group B patients (the rate of cancer was, correspondingly, 54.8% and 47.8%;p < 0.01). The percentage of the invasive form of cancer (T4) was significantly higher in irradiated patients-39% versus 23% (p < 0.05) as were regional metastases (N1a,1b)--41% versus 19% (p < 0.01) and frequency of multifocality (33% versus 24%; p < 0.05). The most distinguished features were found in 1 category of group B: T4--in 47%, N1a-1b--in 62%, multifocality--in 41%. Our results suggest the irradiation as a cause of thyroid cancer in adult victims of Chernobyl and confirm the increasing aggressiveness of such tumors.

Like children exposed to Chernobyl fallout, the workers who cleaned up after the accident, also known as liquidators, have exhibited an increased incidence of thyroid cancer. A high prevalence of ret /PTC3 rearrangement has been found in pediatric post-Chernobyl thyroid tumors, but this feature has not been investigated in liquidator thyroid tumors. In this study we analyzed the prevalence of ret /PTC1 and ret /PTC3 in thyroid tumors from 21 liquidators, 31 nonirradiated adult Ukrainian patients, and 34 nonirradiated adult French patients. ret rearrangements in carcinomas were found in 83.3% of liquidators, 64.7% of Ukrainian patients, and 42.9% of French patients. The prevalence of ret /PTC1 was statistically similar in the three groups. The prevalence of ret /PTC3 was significantly higher in liquidators than in French patients (P=0.03) but it was also high in nonirradiated Ukrainian patients who exhibited values intermediate between liquidators and French patients. In adenomas the prevalence of rearrangement was significantly higher in all Ukrainians than in French patients (P=0.004). Like children exposed to Chernobyl fallout, liquidators showed a high prevalence of ret /PTC3. This finding suggests that irradiation had the same effect regardless of age. However, given the high rate of ret /PTC3 in nonirradiated adult Ukrainians, the possibility of genetic susceptibility or low-level exposure to radiation in that group cannot be excluded.

PHEO in pregnancy is a rare condition. Maternal and fetal prognosis improved over the last decades, but still lethal consequences may be present if misdiagnosed or mistreated. A thorough multidisciplinary team approach should be tailored on an individual basis to better manage the pathology. Unilateral adrenalectomy in a pregnant patient with bilateral PHEO may be an option to avoid the risk of adrenal insufficiency after bilateral adrenalectomy.

Context. Several enlarged parathyroid glands could be found during thyroid surgery in normocalcemic patients without evidence of primary or secondary hyperparathyroidism, indicating multiglandular parathyroid gland disease (MGD). Objective. Clinical role of various levels of serum ionized calcium (Ca 2+) in patients diagnosed with incidental MGD during thyroid surgery remains controversial. The aim of the study was to evaluate the features of PHPT and the clinical role of serum Ca 2+ in normocalcemic patients diagnosed with incidental MGD. Study design. A prospective study of patients with normal preoperative Ca 2+ to be operated on for thyroid diseases in 2010-2013 and diagnosed with MGD during thyroid surgery. Methods. An analysis of clinical data from 3,561 patients to be surgically treated for thyroid diseases revealed 219 (6%) patients with MGD and normal serum Ca 2+. Further data analyses showed patients with MGD and high normal (≥1.25-1.3 mmol/L) serum Ca 2+ (n = 89) and with moderate-low (1.0-1.24 mmol/L) serum Ca 2+ (n = 130). Results. Primary hyperparathyroidism was diagnosed intra-and post-operatively in 48 (54%) patients with high-normal serum Ca 2+ and in 2 (2%) patients with moderate-low serum Ca 2+ (p<0.0001). Parathyroid hormone, serum Ca 2+ as well as urine calcium excretion were elevated in 2 (2%) patients with moderate-low serum Ca 2+ and in 18 (20%) patients with high-normal Ca 2+ at follow-up (p<0.0001). Conclusion. Serum Ca 2+ level within the normal range, but higher than 1.25 mmol/L (high-normal) is associated with primary hyperparathyroidism, which should be considered in patients with visually diagnosed MGD, but without clinical symptoms of hyperparathyroidism.