Thyroid Diseases: Cohen JI

Cohen JI, Salter KD, Anonymous00013, Anonymous00014, Anonymous00015. · Department of Otolaryngology/Head and Neck Surgery, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, PV-01, Portland, OR 97239-3098, USA. · Oral Maxillofac Surg Clin North Am. · Pubmed #18603201 No free full text.

Abstract: Although thyroid nodules are a common clinical entity, few (5% to 10%) are malignant and require surgical treatment. Most nodules are discovered incidentally in patients undergoing surveillance for medical reasons unrelated to thyroid disorders. Therefore, a systematic approach to their evaluation is important to avoid unnecessary surgery. High-resolution ultrasonography and fine-needle aspiration have resulted in substantial improvements in diagnostic accuracy, cost reductions, and higher malignancy yield at the time of surgery. In this article, the authors present practical guidelines and a suggested management strategy for the effective diagnosis and management of incidentally discovered thyroid nodules.

Soler ZM, Hamilton BE, Schuff KG, Samuels MH, Cohen JI. · Department of Otolaryngology/Head and Neck Surgery, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Campus Box PV-01, Portland, OR 97239-3098, USA. · Arch Otolaryngol Head Neck Surg. · Pubmed #18794443 No free full text.

Abstract: OBJECTIVE: To characterize the ability of computed tomography (CT) to identify subclinical cervical metastatic disease in papillary thyroid carcinoma (PTC). DESIGN: Retrospective review. SETTING: Tertiary academic center. PATIENTS: Consecutive patients undergoing neck dissection for PTC between July 1, 2004, and July 1, 2006. INTERVENTION: Preoperative CT scans were reevaluated in a blinded fashion by a single head and neck radiologist. Positive criteria included node with size larger than 10 mm, round shape, calcification, cystic character, or abnormal enhancement. MAIN OUTCOME MEASURE: Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated separately for central compartment (level VI) and lateral compartment (levels III and IV) dissections. RESULTS: One hundred four patients underwent selective neck dissection for PTC during the study period. Forty-three patients had disease that involved primary lymphadenectomy at the time of thyroidectomy, and 61 had persistent or recurrent disease. There were 111 lateral compartment dissections and 145 central compartment dissections. The overall sensitivity was 59% for both the central and lateral compartments, and the specificity was 76% and 71%, respectively. The PPV and NPV were 84% and 47% for the central compartment and 73% and 57% for the lateral compartment, respectively. CONCLUSIONS: Computed tomography has a limited capability to identify subclinical metastatic cervical disease in PTC, with a sensitivity near 60% and an NPV near 50%. Sole reliance on CT findings will miss a significant portion of disease likely because of the high incidence of microscopic foci. However, using strict criteria, a positive finding on a CT scan provides useful information because it predicts with a fairly high assurance that disease will in fact be found in a specific compartment during surgical dissection.

Schuff KG, Weber SM, Givi B, Samuels MH, Andersen PE, Cohen JI. · Division of Endocrinology, Diabetes and Clinical Nutrition, Oregon Health and Science University, Portland, Oregon 97239, USA. · Laryngoscope. · Pubmed #18197134 No free full text.

Abstract: CONTEXT: Although commonly performed, data are lacking regarding efficacy and safety of lymph node dissection (LND) for recurrent/persistent papillary thyroid cancer (PTC). OBJECTIVE: Evaluate the efficacy and morbidity of LND in recurrent/persistent PTC. DESIGN: Retrospective review of central or lateral LND performed for persistent/recurrent PTC between January 2004 and March 2006. SETTING: Multidisciplinary thyroid cancer clinic with a single surgeon at an academic medical center. PARTICIPANTS: Seventy-five patients who underwent 79 LND for persistent/residual PTC. Safety analysis included all 79 resections. Exclusion criteria for the efficacy analysis were factors prohibiting evaluation of thyroglobulin (Tg) response. Forty-one resections were included in the efficacy analysis. INTERVENTION: Selective LND per standard of care. MAIN OUTCOME MEASURE: Primary outcome was the Tg response to LND. Secondary outcomes were surgical complications. RESULTS: Thirty-nine of the 41 evaluable resections also had Tg data allowing classification of Tg response. Of 39 classifiable resections, 16 (41%) resulted in undetectable postoperative stimulated Tg levels. An additional 12 resections resulted in significant (> or =50%) reductions in suppressed or stimulated Tg levels for an overall improvement rate of 72%. Of all 79 resections, 25 (32%) resulted in minor and 7 (9%) resulted in major complications. CONCLUSIONS: LND for persistent/recurrent PTC is a relatively safe procedure in experienced hands. It can lead to an undetectable Tg in 41% of cases and produce a major Tg reduction in an additional 31%. Its efficacy in short-term follow-up is comparable with that reported for I-131, and it should be considered in the management of persistent/recurrent PTC.

Grosz AH, Sauer DA, Bliziotes MM, Cohen JI, Gross ND. · Head and Neck Surgery, Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon 97239, USA. · Thyroid. · Pubmed #17725440 No free full text.

This publication has no abstract.

Le TD, Cohen JI. · Department of Otolaryngology/Head and Neck Surgery and Multidisciplinary Thyroid and Parathyroid Clinic, Oregon Health and Science University, Portland, Oregon 97239-3098, USA. · Laryngoscope. · Pubmed #17603313 No free full text.

This publication has no abstract.

Ghaheri BA, Liebler SL, Andersen PE, Schuff KG, Samuels MH, Klein RF, Cohen JI. · Department of Otolaryngology/Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon 97239, USA. · Laryngoscope. · Pubmed #16585852 No free full text.

Abstract: OBJECTIVE: Perioperative hypocalcemia from temporary parathyroid gland dysfunction is common after thyroid surgery. No reliable cutoff values for parathyroid hormone (PTH) and the subsequent possibility of developing hypocalcemia exist. The purpose of this study is to determine a criterion for predicting hypocalcemia based on different PTH levels as cutoff values. STUDY DESIGN: Retrospective chart review. METHODS: A centralized database of intraoperative PTH levels was analyzed. PTH values approximately 10 minutes after excision of the thyroid gland and in the recovery room were obtained; serial ionized calcium levels were also analyzed. PTH values were then compared using chi-square analysis with significance defined as P < .05. A receiver operator characteristic (ROC) curve was also constructed to define sensitivities and specificities of different PTH levels as potential cutoff values. RESULTS: Eighty patients were identified meeting the study criteria between January 1999 and February 2005. Fourteen of the 80 (17.5%) patients became hypocalcemic during the hospital stay; none experienced permanent hypocalcemia. Patients who became hypocalcemic during their hospitalization were more likely to have a PTH level below 15 pg/mL (P < .01). Patients with a PTH level less than 15 pg/mL were more likely to develop hypocalcemia (P < .01). Finally, an ROC curve was constructed, allowing the surgeon to determine acceptable sensitivities and specificities and various PTH cutoff values. CONCLUSION: Low perioperative PTH levels significantly correlate with the presence of postoperative hypocalcemia but cannot be used to predict it. Using the ROC curve allows different chosen cutoff values to predict hypocalcemia with varying sensitivity and specificity.

Gross ND, Weissman JL, Talbot JM, Andersen PE, Wax MK, Cohen JI. · Department of Otolaryngology-Head and Neck Surgery, Oregon Health Sciences University, Portland, Oregon 97201, USA. · Laryngoscope. · Pubmed #11801967 No free full text.

Abstract: BACKGROUND: With the advent of the use of serum thyroglobulin as a marker for the recurrence of well-differentiated thyroid cancer (WDTC) after total thyroidectomy, clinicians are increasingly faced with the diagnostic dilemma of detecting the site of recurrence in thyroglobulin-positive patients with normal clinical examinations. The high protein content of this thyroglobulin may make it specifically detectable by magnetic resonance (MR) imaging. OBJECTIVE: To determine the ability of MR imaging to detect the presence of metastatic WDTC in cervical lymph nodes. STUDY DESIGN: Retrospective cohort. METHODS: Blinded review by two independent head and neck radiologists of 34 head and neck MR scans obtained from 26 patients with thyroid cancer (12 with primary disease and 14 with recurrent disease) all of whom subsequently underwent surgical removal of the lymph nodes considered at risk by imaging. RESULTS: The average overall percent sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of MR imaging were 95%, 51%, 84%, 78%, and 83%, respectively. The concordance between the two radiologists was 69%. There was no overall difference in the ability of the MR scan to detect the presence of disease in the upper jugular, lower jugular, or paratracheal nodal stations. However, it was more useful for papillary carcinoma (PPV 86%, accuracy 85%) than for follicular carcinoma or the follicular variant of papillary carcinoma (PPV 63%, accuracy 67%). CONCLUSION: MR imaging is a sensitive and accurate technique for the detection of WDTC, particularly papillary carcinoma, metastatic to cervical lymph nodes. However, the lower specificity of this modality precludes its use as a screening tool.

Luu Q, Andersen PE, Adams J, Wax MK, Cohen JI. · Department of Otolaryngology/Head and Neck Surgery, Oregon Health Sciences University, PV-01, 3181 SW Sam Jackson Park Road, Portland, OR 97201. USA. · Head Neck. · Pubmed #11774404 No free full text.

Abstract: BACKGROUND: This work was done to determine whether the slope of change between preoperative and early postoperative (2 hr and 8 hr) ionized calcium levels (ciCa) could predict significant postoperative hypocalcemia. METHODS: We did a retrospective chart review of 79 patients undergoing thyroid (n = 56) or parathyroid surgery (n = 23) where overall parathyroid function was felt to be at risk. Results/Conclusions A positive slope between the preoperative ciCa and any postoperative ciCa or the first two postoperative ciCa's predicted normocalcemia in 100% of patients. For the thyroid group, the difference in the slope of the change from preoperative ciCa to first (<2 hours) postoperative ciCa (-15.940%/hours vs -9.375%/hours, p =.082) did not differentiate patients who developed hypocalcemia (n = 11) and those who remained normocalcemic (n = 45). By contrast the slope of change from preoperative ciCa to the second postoperative (8 hr) ciCa (-1.671%/ hour vs -0.849%/hours, p =.006) and first to second postoperative ciCa (-1.022%/hour vs -0.473%/hour, p =.001) did. For the parathyroid group, none of the differences in similar comparisons between the normocalcemic (n = 20) and hypocalcemic patients (n = 3) approached statistical significance. The relatively small number of patients who became hypocalcemic in this study precluded definition of an absolute slope of calcium level change above which normocalcemia can be assured.

Robbins KT, Atkinson JL, Byers RM, Cohen JI, Lavertu P, Pellitteri P. · Department of Otolaryngology, University of Florida, Gainesville 32610-0264, USA. · J Am Coll Surg. · Pubmed #11442259 No free full text.

This publication has no abstract.