Thyroid Diseases: Baskin HJ

Gharib H, Papini E, Valcavi R, Baskin HJ, Crescenzi A, Dottorini ME, Duick DS, Guglielmi R, Hamilton CR, Zeiger MA, Zini M, Anonymous00012. · No affiliation provided · Endocr Pract. · Pubmed #16596732 No free full text.

Abstract: Thyroid nodules are common and are frequently benign. Current data suggest that the prevalence of palpable thyroid nodules is 3% to 7% in North America; the prevalence is as high as 50% based on ultrasonography (US) or autopsy data. The introduction of sensitive thyrotropin (thyroid-stimulating hormone or TSH) assays, the widespread application of fine-needle aspiration (FNA) biopsy, and the availability of high-resolution US have substantially improved the management of thyroid nodules. This document was prepared as a collaborative effort between the American Association of Clinical Endocrinologists (AACE) and the Associazione Medici Endocrinologi (AME). Most Task Force members are members of AACE. We have used the AACE protocol for clinical practice guidelines, with rating of available evidence, linking the guidelines to the strength of recommendations. Key observations include the following. Although most patients with thyroid nodules are asymptomatic, occasionally patients complain of dysphagia, dysphonia, pressure, pain, or symptoms of hyperthyroidism or hypothyroidism. Absence of symptoms does not rule out a malignant lesion; thus, it is important to review risk factors for malignant disease. Thyroid US should not be performed as a screening test. All patients with a palpable thyroid nodule, however, should undergo US examination. US-guided FNA (US-FNA) is recommended for nodules > or = 10 mm; US-FNA is suggested for nodules < 10 mm only if clinical information or US features are suspicious. Thyroid FNA is reliable and safe, and smears should be interpreted by an experienced pathologist. Patients with benign thyroid nodules should undergo follow-up, and malignant or suspicious nodules should be treated surgically. A radioisotope scan of the thyroid is useful if the TSH level is low or suppressed. Measurement of serum TSH is the best initial laboratory test of thyroid function and should be followed by measurement of free thyroxine if the TSH value is low and of thyroid peroxidase antibody if the TSH value is high. Percutaneous ethanol injection is useful in the treatment of cystic thyroid lesions; large,symptomatic goiters may be treated surgically or with radioiodine. Routine measurement of serum calcitonin is not recommended. Suggestions for thyroid nodule management during pregnancy are presented. We believe that these guidelines will be useful to clinical endocrinologists, endocrine surgeons, pediatricians, and internists whose practices include management of patients with thyroid disorders. These guidelines are thorough and practical, and they offer reasoned and balanced recommendations based on the best available evidence.

Gharib H, Tuttle RM, Baskin HJ, Fish LH, Singer PA, McDermott MT, Anonymous00181. · Division of Endocrinology, Diabetes, Metabolism, Nutrition, and Internal Medicine, Mayo Clinic College of Medicine, Rochester, MN 55905, USA. · Endocr Pract. · Pubmed #16033723 No free full text.

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Gharib H, Tuttle RM, Baskin HJ, Fish LH, Singer PA, McDermott MT, Anonymous00249, Anonymous00250, Anonymous00251. · Mayo Clinic College of Medicine, Rochester, MN 55905, USA. · Thyroid. · Pubmed #15687817 No free full text.

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Baskin HJ, Cobin RH, Duick DS, Gharib H, Guttler RB, Kaplan MM, Segal RL, Anonymous00009. · No affiliation provided · Endocr Pract. · Pubmed #15260011 No free full text.

Abstract: These clinical practice guidelines summarize the recommendations of the American Association of Clinical Endocrinologists for the diagnostic evaluation of hyperthyroidism and hypothyroidism and for treatment strategies in patients with these disorders. The sensitive thyroid-stimulating hormone (TSH or thyrotropin) assay has become the single best screening test for hyperthyroidism and hypothyroidism, and in most outpatient clinical situations, the serum TSH is the most sensitive test for detecting mild thyroid hormone excess or deficiency. Therapeutic options for patients with Graves' disease include thyroidectomy (rarely used now in the United States), antithyroid drugs (frequently associated with relapses), and radioactive iodine (currently the treatment of choice). In clinical hypothyroidism, the standard treatment is levothyroxine replacement, which must be tailored to the individual patient. Awareness of subclinical thyroid disease, which often remains undiagnosed, is emphasized, as is a system of care that incorporates regular follow-up surveillance by one physician as well as education and involvement of the patient.

Baskin HJ, Duick DS. · No affiliation provided · Thyroid. · Pubmed #16571080 No free full text.

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Baskin HJ. · No affiliation provided · Thyroid. · Pubmed #15068622 No free full text.

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Baskin HJ. · Florida Thyroid and Endocrine Clinic, Orlando, FL 32804, USA. · Minerva Endocrinol. · Pubmed #15765029 links to  free full text

Abstract: In the past decade ultrasound has become an essential part of the examination of the thyroid patient. Sonography of the thyroid has been integrated with the history and physical exam and other thyroid tests (especially needle biopsy) to provide valuable information that has improved patient care. Advances in technology and engineering including high-resolution phased-array transducers, color flow and power Doppler have provided much more detail and information regarding thyroid and neck morphology making diagnosis more accurate. This has expanded the use of ultrasound and resulted in development of new ultrasound applications for both the diagnosis and therapy of thyroid and parathyroid disorders. Ultrasound guidance for needle biopsy of thyroid nodules has become routine. It is now being used to confirm the ultrasound diagnosis of parathyroid adenoma by measuring parathyroid hormone obtained with the needle placed in the lesion under ultrasound guidance. Likewise, non-palpable lymph nodes in the neck discovered by ultrasound and suspected of having metastatic carcinoma can be easily biopsied using ultrasound. The material can be submitted for both cytology and peptide analysis to confirm the diagnosis replacing more expensive imaging. Using these same ultrasound guidance techniques, several groups of investigators have developed methods of therapeutic ablation of tissue by chemical or physical means. This may result in an alternative to surgery for certain thyroid, parathyroid, and lymph node lesions.

Baskin HJ. · Florida Thyroid and Endocrine Clinic, Orlando, Florida 32804, USA. · Endocr Pract. · Pubmed #15310533 No free full text.

Abstract: OBJECTIVE: To describe various techniques for performing ultrasound-guided fine-needle aspiration (FNA) biopsy of thyroid nodules, with the intent of shortening the learning curve for physicians with interest in this new procedure. METHODS: General principles and details of biopsy techniques and equipment are reviewed, and personal experience and preferences are described. RESULTS: Real-time ultrasound guidance has technically refined the FNA biopsy technique by decreasing the number of inadequate biopsy specimens and increasing both the specificity and the sensitivity of this procedure. In addition to being cost-effective, well tolerated, and expedient, ultrasound-guided FNA biopsy has emerged as the most accurate method for evaluation of thyroid nodules. The success of the procedure depends on the experience of the person using these techniques. CONCLUSION: For provision of optimal evaluation and management of thyroid nodules, endocrinologists should develop expertise in ultrasound-guided FNA biopsy and understand its advantages over conventional FNA biopsy.

Duick DS, Baskin HJ. · Endocrine Associates, PA, Phoenix, Arizona 85013, USA. · Endocr Pract. · Pubmed #15310544 No free full text.

Abstract: OBJECTIVE: To report the effects of pretreatment with recombinant human thyrotropin (rhTSH) on radioiodine uptake (RAIU) and subsequent radioiodine therapy in 30 patients with symptomatic nontoxic or toxic multinodular goiter. METHODS: Patients received a single injection of rhTSH (0.1 mg in 21 and 0.3 mg in 9 patients). Thyroid function tests were performed before and 72 hours after rhTSH administration. Both 4-hour and 24-hour RAIU studies were done after rhTSH administration and repeated at 48 to 52 hours and at 72 hours, respectively. Then all patients were treated with 30 mCi of 131 I. RESULTS: All study patients experienced symptomatic relief by 1 to 2 months. In addition to the previously reported twofold increase over the baseline RAIU at 24 hours, we found that a second 24-hour RAIU showed a further twofold increase (quadrupling of the RAIU over baseline) at 72 hours after administration of 0.1 mg of rhTSH (from 22% to 43%; P<0.001) and 0.3 mg of rhTSH (from 16% to 37%; P = 0.002), with no significant difference between doses on the RAIU at 24 hours or at 72 hours. Additionally, the RAIU value at 4 hours and 52 hours after administration of 0.1 mg and 0.3 mg of rhTSH revealed a fourfold increase for each dose--from 7% to 28% (P<0.001) and from 5% to 21% (P = 0.002), respectively. CONCLUSION: In patients with symptomatic toxic or nontoxic multinodular goiter, 0.1 mg and 0.3 mg of rhTSH were equally efficacious at inducing a quadrupling of the low or low-normal baseline RAIU values at 72 hours after injection. Subsequent radioiodine therapy alleviated compressive and thyrotoxic symptoms in all 30 treated patients. Future studies should help determine doses of rhTSH and radioiodine therapy that are optimal in iodine-sufficient and insufficient regions of the world.

Baskin HJ. · Florida Thyroid and Endocrine Clinic, Orlando, Florida 32804, USA. · Thyroid. · Pubmed #15671775 No free full text.

Abstract: To evaluate an efficient method of surveillance of low-risk patients with thyroid cancer, ultrasound was performed on 74 postoperative patients being followed for stage I and II papillary carcinoma. All patients were clinically free of cancer 1-43 years after a total thyroidectomy, and were screened with ultrasound and thyroglobulin (Tg) measurement while taking thyroid hormone suppression. Ultrasound revealed findings suspicious of recurrent disease in the lymph nodes of the neck in 21 patients. An ultrasound-guided fine-needle aspiration (FNA) to obtain material for cytology and Tg analysis was done on these 21 patients, 7 of whom tested positive for Tg in their needle washout. Only 3 of the 7 had detectable Tg in their serum, and only 5 of the 7 had positive cytology. Ultrasound (with FNA-Tg analysis of needle washout of suspicious lymph nodes) is proposed as an effective and efficient method of surveillance in these low-risk patients. Presence of Tg in the needle washout proved to be more sensitive than cytology in diagnosing cancer in the lymph nodes and was not affected by positive anti-Tg antibodies in the serum.

Gharib H, Tuttle RM, Baskin HJ, Fish LH, Singer PA, McDermott MT. · Mayo Clinic College of Medicine, 200 First Street SW, Rochester, Minnesota 55905, USA. · J Clin Endocrinol Metab. · Pubmed #15643019 links to  free full text

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Duick DS, Baskin HJ. · Endocrinology Associates, P.A., 3522 North Third Avenue, Phoenix, AZ 85013, USA. · Endocr Pract. · Pubmed #12917062 No free full text.

Abstract: OBJECTIVE: To report our results in treating 16 patients with low radioiodine uptake (RAIU) multinodular goiter who had obstructive symptoms or suppressed thyroid-stimulating hormone (TSH or thyrotropin), indicating mild hyperthyroidism. METHODS: Six patients were treated with 0.3 mg of recombinant human thyrotropin (rhTSH) followed by 30 mCi of (131)I 72 hours later. Ten patients were treated with 0.9 mg of rhTSH followed by 30 mCi of (131)I 24 hours later. RESULTS: Of the 16 treated patients, all 10 with compressive symptoms and both patients with weight loss had remission or improvement, as did 1 of 2 patients with atrial fibrillation. All patients with suppressed TSH had a return to normal levels or became hypothyroid. During the next 3 to 7 months, estimated gland size reduction was 30 to 40%. Three of the 6 patients who received 0.3 mg of rhTSH and 6 of the 10 patients who received 0.9 mg of rhTSH, in conjunction with (131)I therapy, ultimately had TSH levels indicative of hypothyroidism. Mild radiation thyroiditis developed in only one patient, and no other side effects occurred. CONCLUSION: The 0.3-mg dose of rhTSH seemed to be as efficacious as the 0.9-mg dose. The greater than fourfold increase in RAIU at 72 hours after administration of rhTSH in our study is more than twofold higher than the 24-hour RAIU results previously reported in normal subjects and in patients with multinodular goiter. These findings have implications for future expanded studies and alternative dosing regimens in treating patients with both multinodular goiter and subclinical hyperthyroidism.

Baskin HJ, Atwood TM, Holcomb LP. · Florida Thyroid and Endocrine Clinic, 2921 North Orange Ave., Orlando, FL 32804, USA. · Endocr Pract. · Pubmed #11155213 No free full text.

Abstract: OBJECTIVE: To present an approach for follow-up of low-risk patients who have undergone treatment for differentiated thyroid carcinoma. METHODS: We review our experience with monitoring of 167 patients who had undergone near-total thyroidectomy for stage I or II thyroid carcinoma and were receiving levothyroxine and discuss the advantages and disadvantages of various tests for detection of recurrent disease in this setting. RESULTS: Almost 200,000 patients who have been treated for thyroid cancer live in the United States and require monitoring for possible recurrence of their disease. Most of these patients had stage I or II well-differentiated cancer. A cost-efficient method of follow-up for these low-risk patients is needed that relies on measurement of serum thyroglobulin (Tg) rather than expensive isotope imaging procedures. The availability of recombinant human thyrotropin (thyroid-stimulating hormone) (rhTSH) allows the evaluation of Tg dynamics and provides another method, along with ultrasonography, to monitor these patients. Among our 167 patients, 10 had Tg measurements of 2.5 to 5.0 ng/mL and were thought to be at risk for recurrent cancer. Ultrasonography of the neck revealed no suspicious lymph nodes. Tg response to rhTSH stimulation disclosed that two of these patients had an exaggerated increase in Tg level, compatible with persistent or recurrent cancer. CONCLUSION: Although rhTSH stimulation testing has not yet become established in clinical practice, the finding of an exaggerated Tg response to rhTSH in patients with previously treated thyroid cancer seems to be an early indication of recurrent disease.

Bauman A, Baskin HJ, Cooper D. · No affiliation provided · Thyroid. · Pubmed #10907997 No free full text.

This publication has no abstract.