Thyroid Diseases: Brilli L

Pacini F, Castagna MG, Brilli L, Jost L, Anonymous00151. · Department of Internal Medicine, University of Siena, Siena, Italy. · Ann Oncol. · Pubmed #18456786 links to  free full text

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Capezzone M, Marchisotta S, Cantara S, Busonero G, Brilli L, Pazaitou-Panayiotou K, Carli AF, Caruso G, Toti P, Capitani S, Pammolli A, Pacini F. · Section of Endocrinology and Metabolism, Department of Internal Medicine, Endocrinology and Metabolism and Biochemistry, University of Siena, Policlinico Santa Maria alle Scotte, Viale Bracci 1, 53100 Siena, Italy. · Endocr Relat Cancer. · Pubmed #18832444 No free full text.

Abstract: Non-medullary thyroid carcinoma (NMTC) is mostly sporadic, but familial clustering is described. We aimed to compare the features of patients with sporadic and familial NMTC (FNMTC) patients and to assess whether FNMTC patients with parent-child relationship exhibit the 'anticipation' phenomenon (earlier age at disease onset and increased severity in successive generations). Among 300 NMTCs followed in the Section of Endocrinology (University of Siena, Italy), 34 (11.3%) patients, all with the papillary histotype, (16 kindred), met the criteria of FNMTC. Twenty-seven of them (79.4%) exhibited a parent-child relationship and seven (20.6%) a sibling relationship. These patients were compared with 235 patients with sporadic papillary thyroid cancer (PTCs). To analyze the features of FNMTC of the first and second generations, we cumulated the series of Siena with 32 additional FNMTC patients (15 kindred) from the Department of Endocrinology-Endocrine Oncology, Thessaloniki, Greece. Significant difference between sporadic PTC and FNMTC patients included more frequent tumor multifocality (P=0.001) and worse final outcome in FNMTC patients (P=0.001). Among 47 FNMTC with parent-child relationship, we found an earlier age at disease presentation (P<0.0001), diagnosis (P<0.0001), and disease onset (P=0.04) in the second generation when compared with the first generation. Patients in the second generation were more frequently males (P=0.02); their tumors were more frequently multifocal (P=0.003) and bilateral (P=0.01), had higher rate of lymph node metastases at surgery (P=0.02) and worse outcome (P=0.04) when compared with the first generation. In conclusion, FNMTC displays the features of clinical 'anticipation' with the second generation acquiring the disease at an earlier age and having more advanced disease at presentation.

Castagna MG, Brilli L, Pilli T, Montanaro A, Cipri C, Fioravanti C, Sestini F, Capezzone M, Pacini F. · Department of Internal Medicine, Endocrinology and Metabolism and Biochemistry, University of Siena, Policlinico Santa Maria alle Scotte, Viale Bracci 1, 53100 Siena, Italy. · J Clin Endocrinol Metab. · Pubmed #17971424 links to  free full text

Abstract: CONTEXT: One year after initial treatment, low-risk differentiated thyroid cancer (DTC) patients undergo recombinant human (rh)TSH-stimulated serum thyroglobulin (Tg) (rhTSH-Tg) and neck ultrasound (US). OBJECTIVE: The need for more rhTSH-Tg in these patients is controversial. We evaluated the utility of a second rhTSH-Tg in DTC patients 2-3 yr after their first evaluation. RESULTS: At the first rhTSH-Tg, basal and stimulated serum Tg was undetectable in 68 of 85 patients. Neck US was unremarkable in all but one, who had evidence of lymph node disease. Seventeen of 85 patients had undetectable serum Tg that became positive after rhTSH, with negative imaging in 10 and evidence of disease in seven. Patients with no evidence of disease were reevaluated 2-3 yr later (second rhTSH-Tg). In patients in which the first stimulated Tg was undetectable, all had undetectable basal serum Tg, which remained undetectable after rhTSH in 66 of 67 patients (98.5%) and became detectable in one (1.5%) (positive neck US). In the 10 patients with detectable stimulated Tg in the first test, basal serum Tg and US were negative at the second test, but rhTSH-Tg became detectable in six. Compared with the first rhTSH-Tg, the second stimulated Tg in these six patients decreased in one, increased in three, and stabilized in two patients. CONCLUSIONS: The second rhTSH-Tg was informative in patients who had first stimulated Tg detectable but not in those who had undetectable Tg at the first test, in which the only patient with recurrence was diagnosed by neck US. Thus, rhTSH-Tg should be repeated only in patients who have had a positive first rhTSH-Tg and negative imaging.

Brilli L, Guarino E, Ghezzi M, Carli AF, Occhini R, Pacini F. · Department of Internal Medicine, Endocrine-Metabolic Sciences and Biochemistry, Section of Endocrinology, University of Siena, Siena, Italy. · Thyroid. · Pubmed #17696844 No free full text.

This publication has no abstract.

Guarino E, Tarantini B, Pilli T, Checchi S, Brilli L, Ciuoli C, Di Cairano G, Mazzucato P, Pacini F. · Department of Internal Medicine, Endocrinology and Metabolism, Section of Endocrinology and Metabolism, University of Siena, Italy. · Thyroid. · Pubmed #16187912 No free full text.

Abstract: We investigated whether serum thyroglobulin determination before surgery for differentiated thyroid carcinoma may have any prognostic value with regard to tumour extension and disease outcome in a retrospective series of 71 patients with papillary thyroid cancer. Presurgical serum thyroglobulin levels were correlated with the size of the primary tumoral nodule (p = 0.006) and of the whole thyroid (p = 0.02). The same correlation was found in a control group of patients with benign thyroid nodules, confirming that presurgical serum thyroglobulin cannot be used for the differential diagnosis of thyroid carcinoma. Presurgical serum thyroglobulin levels did not differ among patients with tumor limited to thyroid gland or extending to cervical lymph nodes or invading outside the thyroid capsule or metastasising to distant size. In addition presurgical serum thyroglobulin levels were not correlated with the disease outcome after a mean follow-up of 9 years: no difference was found among patients in complete remission or with persistent disease or dead from thyroid cancer. In conclusion, this study failed to show any prognostic value of presurgical serum thyroglobulin determination that consequently should not be measured.