Completion Total Thyroidectomy in Children With Thyroid Cancer Secondary to the Chernobyl Accident

Miccoli, Paolo; Antonelli, Alessandro; Spinelli, Claudio; Ferdeghini, M; Fallahi, Poupak; Baschieri, L

doi:10.1001/archsurg.133.1.89

Cited by 79 publications

(51 citation statements)

References 15 publications

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“…This also applies to children and young adults, because 60-80% have regional lymph node involvement and 10-20% have distant metastases (Mazzaferri 1991, Hay et al 1998, Miccoli et al 1998, Newman et al 1998www.endocrinology.org 233 berger 1998, La Quaglia et al 2000). Of 50 children aged 15 or younger in our study, 28% developed distant metastases, usually to lung.…”

Section: Consensus Recommendationsmentioning

confidence: 51%

“…Cancer is found in the contralateral lobe in about 50% of cases (Pasieka et al 1992, Mazzaferri 2000. Lung and lymph node metastases in more than 60% of a group of irradiated children from Chernobyl could only be identified after completion thyroidectomy had been done (Miccoli et al 1998). In another important study, multivariate analysis found that patients who underwent completion thyroidectomy within 6 months of their initial operation developed significantly fewer lymph node and hematogenous recurrences and survived significantly longer than those in whom the second operation was delayed for longer than 6 months (Scheumann et al 1996).…”

Section: Completion Thyroidectomymentioning

confidence: 99%

“…Although a few debate this practice (Hay 1990), there are compelling reasons for it (Mazzaferri 1997). Firstly, a large remnant can obscure 131 I uptake in cervical or lung metastases (Vassilopoulou-Sellin et al 1993, Miccoli et al 1998. Secondly, the high TSH concentrations necessary to enhance tumor 131 I uptake cannot be achieved with a large thyroid remnant (which should be surgically excised) (Goldman et al 1980).…”

Section: Radioiodine Ablation Of Residual Normal Thyroid Tissuementioning

confidence: 99%

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Management of papillary and follicular (differentiated) thyroid cancer: new paradigms using recombinant human thyrotropin.

Mazzaferri¹,

Massoll²

2002

Endocrine-Related Cancer

161

113

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The incidence of differentiated thyroid cancer (DTC) has increased in many places around the world over the past three decades, yet this has been associated with a significant decrease in DTC mortality rates in some countries. While the best 10-year DTC survival rates are about 90%, long-term relapse rates remain high, in the order of 20-40%, depending upon the patient's age and tumor stage at the time of initial treatment. About 80% of patients appear to be rendered disease-free by initial treatment, but the others have persistent tumor, sometimes found decades later. Optimal treatment for tumors that are likely to relapse or cause death is total thyroidectomy and ablation by iodine-131 ( 131 I), followed by long-term levothyroxine suppression of thyrotropin (TSH). On the basis of regression modeling of 1510 patients without distant metastases at the time of initial treatment and including surgical and 131 I treatment, the likelihood of death from DTC is increased by several factors, including age > 45 years, tumor size > 1.0 cm, local tumor invasion or regional lymph-node metastases, follicular histology, and delay of treatment > 12 months. Cancer mortality is favorably and independently affected by female sex, total or near-total thyroidectomy, 131 I treatment and levothyroxine suppression of TSH. Treatments with 131 I to ablate thyroid remnants and residual disease are independent prognostic variables favorably influencing distant tumor relapse and cancer death rates. Delay in treatment of persistent disease has a profound impact on outcome.Optimal long-term follow-up using serum thyroglobulin (Tg) measurements and diagnostic whole-body scans (DxWBS) require high concentrations of TSH, which until recently were possible to achieve only by withdrawing levothyroxine treatment, producing symptomatic hypothyroidism. New paradigms, however, provide alternative pathways to prepare patients for 131 I treatment and to optimize follow-up. Patients with undetectable or low Tg concentrations and persistent occult disease can now be identified within the first year after initial treatment by recombinant human (rh)TSH-stimulated serum Tg concentrations greater than 2 µg/l, without performing DxWBS. These new follow-up paradigms promptly identify patients with lung metastases that are not evident on routine imaging, but which respond to 131 I treatment. In addition, rhTSH can be given to prepare patients for 131 I remnant ablation or 131 I treatment for metastases, especially those who are unable to withstand hypothyroidism because of concurrent illness or advanced age, or whose hypothyroid TSH fails to increase.

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Section: Consensus Recommendationsmentioning

confidence: 51%

Section: Completion Thyroidectomymentioning

confidence: 99%

Section: Radioiodine Ablation Of Residual Normal Thyroid Tissuementioning

confidence: 99%

See 1 more Smart Citation

Management of papillary and follicular (differentiated) thyroid cancer: new paradigms using recombinant human thyrotropin.

Mazzaferri¹,

Massoll²

2002

Endocrine-Related Cancer

161

113

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“…A varredura com radioiodo tem sua sensibilidade para metástases reduzida se a cirurgia inicial for a lobectomia, pelo seqüestro do traçador pelos remanescentes tireoideanos (26). Miccoli e cols.…”

Section: Discussionunclassified

Tratamento do microcarcinoma de tireóide

Rosário

Fagundes

Purisch

2004

Arq Bras Endocrinol Metab

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RESUMOAvaliamos, retrospectivamente, a recorrência, presença de metástases distantes e mortalidade em 78 pacientes com microcarcinoma papilífero seguidos durante 6,8 anos, em média. Dos 56 pacientes com tumor unifocal sem metástases, nenhum apresentou recorrência, independente do tratamento (22 loboistmectomia, 11 tireoidectomia total sem ablação e 23 com ablação). O mesmo ocorreu nos 15 casos de tumor multicêntrico restrito à tireóide e tratados com tireoidectomia total e radioiodo. Dos 7 casos com metástases na apresentação inicial e submetidos a cirurgia extensa e terapia ablativa, recorrência cervical ocorreu em apenas 1 paciente. A presença de anticorpos anti-tireoglobulina foi mais comum após a lobectomia (22,7% vs. 9%) e a especificidade da tireoglobulina (Tg) ficou comprometida com este procedimento, mas não nos pacientes com tireoidectomia total sem ablação. Observou-se dois casos de hipoparatireoidismo definitivo no gruposubmetido à tireoidectomia total (3,5%) e nenhum com lobectomia. O presente estudo concorda que a loboistmectomia pode ser suficiente para o tratamento do microcarcinoma papilífero único restrito à tireóide. No entanto, a especificidade da Tg no seguimento fica comprometida. Para tumores multicêntricos ou com linfonodos acometidos, recomenda-se a tireoidectomia total, mas o uso rotineiro da radioiodoterapia é controvertido. We retrospectively analyzed the recurrence, distant metastases and mortality of 78 patients with papillary microcarcinoma during a mean period of 6.8 years. None of the 56 patients with unifocal tumors without metastases relapsed, irrespective of the type of treatment (22 submitted to lobectomy, 11 to total thyroidectomy without ablation and 23 with ablation). The same occurred for the 15 cases of multicentric tumors restricted to the thyroid and treated with total thyroidectomy and radioiodine. Of the 7 patients with metastases in the initial presentation and treated with extensive surgery and ablative therapy, cervical recurrence was observed in 1 case. Detectable anti-thyroglobulin antibodies were more common after lobectomy (22.7% vs. 9%) and the specificity of thyroglobulin was compromised by this procedure, but not in patients submitted to total thyroidectomy without ablation. Two cases of definitive hypoparathyroidism were observed in the group submitted to total thyroidectomy (3.5%) and no cases with lobectomy. The present study agrees that lobectomy can be sufficient for the treatment of single microcarcinoma restricted to the thyroid. However, the Tg specificity is compromised. Total thyroidectomy is recommended for multicentric tumors or with lymph nodes metastases, but the routine use of radioiodine is a matter of controversy.

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“…However, serum calcium tests, probably much more frequent in the West, potentially conductive to detection and treatment of hyperparathyroidism [35], could have contributed to a lower prevalence of this condition among the controls in [33]. On the other hand, the risk of postsurgical hyperparathyroidism (6 % of operated pediatric TC cases [25]; 10,5 % of those undergoing completion total thyroidectomy [36]), recurrent nerve palsy etc. [20,37], are among reasons why false-positive diagnosis should be precluded.…”

Section: Introductionmentioning

confidence: 99%

Malignancies after Chernobyl Accident: What Is True and What Is Untrue

Jargin¹

2016

Diagn Pathol Open

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Several publications in the field of pathology, overestimating medical consequences of the Chernobyl nuclear accident, are reviewed here. Among the causes of high registered incidence of pediatric thyroid cancer after the accident was the screening effect with detection of advanced cases. This explains also for the relatively high prevalence of dedifferentiated histological patterns and pronounced invasiveness described as the features of Chernobyl-related thyroid cancer. Mechanisms of false-positive diagnostics of thyroid and urinary bladder lesions are analyzed here. Morphological features of renal cell carcinoma from Chernobyl and adjacent areas are discussed in relation to the averagely late detection of malignancies. In conclusion, results of some molecular-genetic and other studies based on Chernobyl material should be re-evaluated, considering that many tumors detected during the first decade after the accident by the screening or brought from non-contaminated areas were advanced tumors, some of them misinterpreted as aggressive radiogenic cancers developing after a short latency.

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Completion Total Thyroidectomy in Children With Thyroid Cancer Secondary to the Chernobyl Accident

Cited by 79 publications

References 15 publications

Management of papillary and follicular (differentiated) thyroid cancer: new paradigms using recombinant human thyrotropin.

Management of papillary and follicular (differentiated) thyroid cancer: new paradigms using recombinant human thyrotropin.

Tratamento do microcarcinoma de tireóide

Malignancies after Chernobyl Accident: What Is True and What Is Untrue

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