Thyroid Diseases: Kusić Z

Kusić Z, Jukić T, Dabelić N, Franceschi M, Anonymous00045. · Hrvatsko drustvo za stitnjacu, Klinika za onkologiju i nuklearnu medicinu, Klinicka bolnica, Sestre milosrdnice, Zagreb. · Lijec Vjesn. · Pubmed #19062757 No free full text.

Abstract: With the introduction of ultrasound and fine-needle aspiration biopsy at the beginning of 1980s, dramatic changes in the clinical perception of thyroid diseases happened, especially thyroid nodules and thyroid cancer. The prevalence of thyroid nodules in the population according to ultrasound findings ranges from 20-50%, while around 5% of thyroid nodules harbour cancer. During the past decades significant increase in the incidence of thyroid cancer was recorded worldwide, mainly due to increase in the incidence of papillary thyroid cancer, probably due to improved diagnostics. Many thyroid societies developed guidelines for the management of patients with differentiated thyroid cancer. An interdisciplinary team of experts of the Croatian Thyroid Society studied guidelines of other thyroid societies and international publications, and according to our tradition and clinical practice developed the Guidelines for the Management of Patients with Differentiated Thyroid Cancer. The guidelines were published at Croatian Thyroid Society web page--www.stitnjaca.org, for open discussion and recommendations. Finally, the guidelines were accepted.

Murgić J, Salopek D, Prpić M, Jukić T, Kusić Z. · Department of Oncology and Nuclear Medicine, University Hospital "Sestre milosrdnice", Zagreb, Croatia. · Coll Antropol. · Pubmed #19149242 No free full text.

Abstract: Clinical guidelines have been increasingly used in medicine. They represent a system of recommendations for the conduction of specific procedures used in fields from public health to different diagnostic and therapeutic procedures in clinical medicine. Guidelines are designed to facilitate to medical practitioners the adoption, evaluation and application of an increasing body of evidence and arising number of expert opinions regarding the presently best treatment and to help in delivering proper decision for the management of a patient or condition. Clinical guidelines represent a part of complementary activity by which research is implemented into praxis, standards are defined and clinical excellence is promoted in all health care fields. There are specific conditions which quality guidelines should meet. First of all, they need to be founded on comprehensive literature review, apart from clinical studies and trials in the target field. Also, there are more systems for analyzing and grading the strength of clinical evidence and the level of recommendation emerging from it. Algorithms are used to organize and summarize guidelines. The algorithm itself has a form of an informatic record and a logical flow. Algorithms, especially in case of clinical uncertainty, must be used for the improvement of health care, increasing it's availability and integration of the newest scientific knowledge. They should have an important role in the health care rationalisation, fight against non-rational diagnostics manifested as diagnostic procedures with no clinical indications, it's unnecessary repetition and wrong sequence. Several diagnostic algorithms used in the field of thyroid diseases are presented, since they have been proved to be of great use.

Lechpammer M, Lukac J, Lechpammer S, Kusić Z. · Department of Oncology and Nuclear Medicine, Sestre Milosrdnice University Hospital, Vinogradska 29, HR-10000 Zagreb, Croatia. · Acta Med Croatica. · Pubmed #12455450 No free full text.

Abstract: The study was so designed as to determine the effect of low to medium daily doses of methimazole (10-20 mg per day) on the number and function of different types of immunocompetent cells in peripheral blood of patients with Graves' disease administered methimazole for the treatment of hyperthyroidism. The study included 127 patients with Graves' disease divided into three groups: group I of 29 thyrotoxic patients before the beginning of treatment; group II of 73 euthyroid patients under antithyroid treatment; and group III of 25 patients who remained euthyroid 8 weeks after therapy discontinuation. In group I, the proportion of CD4+ cells, proportion and number of granulocytes, and their ingestion and microbicidity as well as monocyte phagocytic activity and ingestion were decreased. The mentioned alterations were concluded to most likely be the consequence of the underlying autoimmune process. In group II, the proportion and number of CD8+ cells were increased, while the natural killer cell activity was impaired. Granulocyte microbicidity was suppressed as compared to group I, while the granulocyte phagocytic activity was impaired as compared to normal values. Compared to normal, monocyte microbicidity and phagocytic activity were also suppressed. Monocyte ingestion was suppressed as compared to groups I and III, regardless of the patients' thyroid hormone status. Study results strongly support the hypothesis of a direct immunosuppressive effect of methimazole in patients with Graves' disease rather than the theory favoring concomitant immunomodulation due to thyroid hormone decrease.

Jukić T, Dabelić N, Rogan SA, Nõthig-Hus D, Lukinac L, Ljubicić M, Kusić Z. · Department of Oncology and Nuclear Medicine, University Hospital "Sestre milosrdnice", Zagreb, Croatia. · Coll Antropol. · Pubmed #19149235 No free full text.

Abstract: The village of Rude is situated near Zagreb, the capital of Croatia in the last Alpine valley on Balkan. In the past, the village was well-known area of severe iodine deficiency disorders (IDD). In 1952', distinguished Croatian endocrinologist Professor Josip Matovinović carried out detailed village survey. Goiter prevalence in school-age children was 85.0% (with 2.3% of cretins in the village). In 1953, the first regulation on compulsory salt iodination with 10 mg of KI/kg of salt was established in former Yugoslavia. Ten years later a dramatic decrease in goiter prevalence was recorded in all endangered areas of the country and no new cretins appeared. However, at the beginning of 1990' mild to moderate iodine deficiency still persisted in Croatia. In 1991, the village of Rude survey demonstrated goiter prevalence in school-age children of 35.0% and median of urinary iodine excretion (UIE) of 7.4 microg/dL. In 1996, the new obligatory regulation with 25 mg of KI/kg of salt was established in Croatia. The study aim was to monitor IDD status in the village after the new law on compulsory salt iodination. Measurements of UIE and thyroid volumes (Tvol) by ultrasound were performed in 7-11-y-old schoolchildren living in the village of Rude. Medians of UIE and body surface area (BSA)-adjusted Tvol in boys and girls were calculated. The study included 84 children in 1997, 132 in 2000, 72 in 2002, 85 in 2003 and 46 in 2004 for UIE measurement. Thyroid volumes were measured in 1999 (43 boys and 26 girls) and in 2005 (22 boys and 26 girls). Data were compared with the new WHO/ICCIDD reference values. Medians of UIE in schoolchildren from the village of Rude demonstrated rising values in microg/dL: 11.4 in 1997, 14.3 in 2000, 17.3 in 2002, 15.4 in 2003 and 19.0 in 2004. Significant decrease in BSA-adjusted Tvol was recorded from 1999-2005 in boys and girls from the village of Rude and in 2005 Tvol were within the normal range according to the new international reference values for Tvol in iodine-sufficient schoolchildren. As a result of increased iodine prophylaxis, IDD no longer exist in Croatia. Monitoring of IDD status in the village of Rude after new law on compulsory salt iodination in Croatia demonstrated rising medians of UIE together with significant reduction of Tvol. In 2005, Tvol in schoolchildren from the village of Rude were within the normal range according to the new international reference values for Tvol in iodine-sufficient schoolchildren.

Matesa N, Samija I, Kusić Z. · Department of Oncology and Nuclear Medicine, Sisters of Mercy University Hospital, Zagreb, Croatia. · Cytopathology. · Pubmed #17397496 No free full text.

Abstract: OBJECTIVE: To investigate whether the presence of macrophages and Hürthle cells (HC) in benign thyroid lesions could explain the false-positive expression of galectin-3 and CD44v6 detected by reverse transcriptase-polymerase chain reaction (RT-PCR). METHODS: For galectin-3 and CD44v6, RT-PCR was performed on RNA isolated from aspirates obtained by ultrasound guided fine needle aspiration cytology (FNAC) from 123 patients with benign thyroid lesions. The results of RT-PCR analysis were evaluated against the definitive FNAC diagnosis. RESULTS: Galectin-3 expression was found in 29% follicular adenoma (FA), 26% Hashimoto thyroiditis (HT), and in 24% nodular goitre (NG). We found a statistically significant relationship between the presence of macrophages and galectin-3 positivity in NG and HT samples (P < 0.0001 and P = 0.0087 respectively). We found a statistically significant (P = 0.0219) relationship between the presence of HC and galectin-3 positivity in HT and a tendency of such a relationship (P = 0.0838) in NG. CD44v6 expression was found in 29% FA, 33% HT and in 18% NG. We found a statistically significant relationship between the presence of HC and positive expression of CD44v6 in NG (P = 0.0003) and a strong tendency of such a relationship in HT (P = 0.0571). We did not find a statistically significant relationship between the presence of macrophages and CD44v6 positivity. In FA, we did not find a statistically significant relationship between the presence of macrophages or HC and galectin-3 or CD44v6 positivity. CONCLUSION: Our results suggest that the presence of macrophages and/or HC may explain the positive expression of galectin-3 and CD44v6 detected by RT-PCR in HT and NG cytological samples.

Balenović A, Vlasić M, Sonicki Z, Bodor D, Kusić Z. · Department of Oncology and Nuclear Medicine, University Hospital Sestre Milosrdnice, Zagreb, Croatia. · Coll Antropol. · Pubmed #17243543 No free full text.

Abstract: The aim of the study was to investigate the influence of radioiodine (RAI) therapy on pregnancies and the health status of children born to mothers who had received therapeutic doses of I-131 for differentiated thyroid carcinoma (DTC). Gestational histories of 76 women treated for DTC from 1971-2005 were retrospectively analyzed. The outcome of 49 pregnancies after RAI was: 35 children (72%), 5 (10%) miscarriages and 9 (18%) induced abortions. RAI did not adversely affect the rate of successful delivery and live birth demographics. Congenital malformation and first year mortality were not observed. The children's ages range from 1 month to 29 years (chi+/-SD=8.0+/-8.4). A higher therapeutic dose (>100 mCi) did not significantly alter the pregnancy outcome. There is no reason to discourage females treated with 1-131 from becoming pregnant. Patients should avoid pregnancy after RAI administration for 1 year.

Pavelić K, Dedivitis RA, Kapitanović S, Cacev T, Guirado CR, Danić D, Radosević S, Brkić K, Pegan B, Krizanac S, Kusić Z, Spaventi S, Bura M. · Division of Molecular Medicine, Ruder Bosković Institute, Zagreb, Croatia. · Mutat Res. · Pubmed #16698048 No free full text.

Abstract: Several oncogenes and tumor-suppressor genes are involved either as early or late event in thyroid gland carcinogenesis. Human FHIT (fragile histidine triad) gene is highly conserved gene whose loss of function may be important in the development and/or progression of various types of cancer. We undertook this study to analyze FHIT and p53 gene status in different benignant and malignant thyroid tumors. Status of these genes as well as intensity of apoptosis was analyzed in tumor tissues by molecular genetic methods, immunohistochemistry, and FACS-scan analysis. The majority of the malignant thyroid cancers displayed aberrant expression of FHIT gene, concominant with p53 gene inactivation. This is followed by low rate of apoptosis, which may be important in the development and/or progression of thyroid cancer. We found higher incidence of p53 mutation and aberrant processing of FHIT mRNA in malignant tumors (papillary, follicular, medullary and anaplastic carcinomas) and in those tumors with distant metastasis. The growth of p53(-)/FHIT(-) follicular carcinoma of human origin was much faster in nude mice than p53(+)/FHIT(+) follicular carcinoma, and mice had shorter survival rate. Our results show a correlation between aberrant FHIT and p53 expression, low rate of apoptosis, and malignancy. Concomitant aberration of FHIT gene and p53 could be responsible for development of highly malignant types of thyroid cancer and may be considered as a prognostic marker for these tumors.

Kusić Z, Jukić T. · Department of Nuclear Medicine and Oncology, Sestre Milosrdnice University Hospital, Zagreb, Croatia. · Coll Antropol. · Pubmed #16117293 No free full text.

Abstract: At the time after the Second World War, endemic goiter was present in most parts of Croatia with a prevalence of more than 50% and presence of cretinism. In the village of Rude near Zagreb, goiter was detected in 85% of school children with 2.3% of cretins in the village population. In 1953 the first regulation on obligatory salt iodination, requiring 10 mg of potassium iodide (KI) per kg of salt was established in former Yugoslavia. A three-fold reduction of goiter prevalence, together with disappearance of cretinism was recorded ten years later In 1992, the National Committee for Eradication of Goiter was founded. The survey performed during 1991-1993 exhibited prevalence of goiter among school children between 8% and 35% and urinary iodine excretion under 10 microg/dL in most of the children from continental parts of the country. The new obligatory regulation, requiring 25 mg of KI/kg of salt, was proposed by the National Comittee and finally established in 1996. In 2002 thyroid volumes and medians of urinary iodine excretion were normal according to the ICCIDD criteria. Overall median of urinary iodine excretion for schoolchildren in Croatia was 14 ug/dL. Croatia crossed a path from severe iodine deficiency detected in the 1950's to the period of mild to moderate iodine deficiency during the 1990's, and finally, nowadays, iodine sufficiency has been achieved.

Toromanović A, Tahirović H, Kusić Z. · Klinika za djecije bolesti, Univerzitetski klinicki centar Tuzla. · Med Arh. · Pubmed #12822378 No free full text.

Abstract: Goiter frequency and urinary iodine excretion levels were assessed in schoolchildren, aged 7-15 years, living in Tuzla Canton. Goiter frequency was evaluated by clinical examination and ultrasound of the thyroid gland. Goiter by inspection and palpation was found in 19.1% of all subjects, in 19.8% of girls and 18.4% of boys. With regard to updated reference values for thyroid volume reported by WHO and ICCIDD, goiter by ultrasonography was found in 12.9% (n = 62) of all subjects (n = 480). Median urinary iodine was 71.0 micrograms/L. Mild iodine deficiency is observed in Tuzla Canton, based on goiter frequency and urinary iodine excretion. Neonatal TSH results, obtained in the programme of the neonatal thyroid screening, were also analyzed. The frequency of neonatal TSH above 5 mU/L was 12.0% indicating, as two other indicators, mild degree of iodine deficiency in this region. The results underline the inefficacy of iodine prophylaxis with 10 mg K1 per kg of salt in correcting iodine deficiency. On the basis of the study, carried out in the rest of the Federation of Bosnia and Herzegovina, the new regulation was proclaimed in 2001 requiring 20-30 mg of iodine per kg of salt.

Matesa N, Tabain I, Dabelić N, Petric V, Kusić Z. · Department of Oncology and Nuclear Medicine, Sisters of Mercy University Hospital, Vinogradska 29, 10000 Zagreb, Croatia. · Croat Med J. · Pubmed #12402405 links to  free full text

Abstract: AIM: To determine diagnostic relevance of cytologic subclassification of follicular lesions of the thyroid and its role in the therapeutic approach. METHODS: We performed a retrospective analysis of the data of patients who underwent thyroid surgery at the Sisters of Mercy University Hospital, Zagreb, between March 1995 and February 2001, and had a report of preoperative fine needle aspiration (FNA) biopsy of thyroid follicular lesion, which comprises cellular follicular lesion, suspicious for follicular neoplasm, or follicular neoplasm. RESULTS: Out of 110 patients with preoperative FNA biopsy diagnosis of follicular lesion, 86 (78%) had a lesion corresponding histologically to a neoplasm. However, a malignant tumor was found in only 6% of the patients. In the diagnostic categories of cellular follicular lesion and lesion suspicious for follicular neoplasm, the rate of malignancy was even lower, 3% and 4%, respectively. We found significant difference between FNA and histologic findings in distinguishing non-neoplastic from neoplastic thyroid lesions in the category of cellular follicular lesion and follicular neoplasm. CONCLUSION: Due to the low malignancy rate in patients with FNA biopsy diagnoses of cellular follicular lesion or lesion suspicious for follicular neoplasm of the thyroid, we suggest close clinical follow-up of such patients, rather than immediate surgical intervention.

Sonicki Z, Morin A, Plasaj T, Sonicki D, Kusić Z. · Andrija Stampar School of Public Health, Medical School, University of Zagreb, HR-10000 Zagreb, Rockefellerova 4, Croatia. · Stud Health Technol Inform. · Pubmed #11187673 No free full text.

Abstract: In this paper, we introduced an idea of using redundant thyroid laboratory diagnostic modules integrated in laboratory information system. The first module was based on decision tree which was the result of Assistant algorithm applied to thyroid laboratory test results. Instead of improving decision rules, the "second opinion" module was designed based on Spad-S software. Diagnosis obtained with both modules were compared with results before introducing the "second opinion" module. From the first results it was clear that introducing the "second opinion" module decreased the number of misclassified records from the first module. With three or more modules, the final diagnosis could be obtained by voting or more complex procedures.

Mesaros-Kanjski E, Kontosić I, Kusić Z, Kaić-Rak A, Daković N, Kuser J, Antonić K. · Public Health Institute of Primorsko-Goranska County, Rijeka, Croatia. · Coll Antropol. · Pubmed #10646250 No free full text.

Abstract: A total of 1975 school-children on the island of Krk aged 7-19 years of life were included in this study. The purpose was to establish the goitre status and plasmatic level of vitamins A and E in the examined children with the enlarged thyroid gland. The goitre prevalence was 29.8%. The average plasmatic values of vitamins A and E in the children with enlarged thyroids were statistically significantly lower from the reference values. Mentioned goitre prevalence at the level of moderate and heavier endemic goitre speaks on behalf of alimentary iodine deficiency. But the goiter examinations suggested the idoine deficiency not to be the only etiological factor of goitre on the island of Krk. Lower average plasmatic values of vitamins A and E in the examined with the enlarged thyroids referred to this fact to a certain degree.

Kusić Z, Lechpammer S, Lukinac L, Petrović I, Nöthig-Hus D. · University Hospital "Sestre Milosrdnice", Department of Nuclear Medicine and Oncology, Zagreb, Croatia. · J Endocrinol Invest. · Pubmed #10614523 No free full text.

Abstract: Presented pilot-study on urinary iodine excretion among schoolchildren in main geographic regions of Croatia indicates a significant improvement in iodine excretion only 12 months after introduction of a new mandatory salt iodination with 25 mg KI/kg of salt. Measurements of urine iodine excretion in 663 schoolchildren of both sexes, aged 9-16 years, from Zagreb, Rude, Bednja, Osijek, Dakovo, Rijeka, Pazin and Dubrovnik showed that from 77.9% to 94.8% of subjects have had urinary iodine above 5 microg/dl. Also from 41.2% to 70.8% of children have had urinary iodine excretion above 10 microg/dl. Before introduction of a new law mostly borderline values of urinary iodine excretion were recorded; therefore recent values present significant positive shift and actually they are the best signs of almost adequate iodine intake in Croatian youth. Nevertheless, further measures for improvement of iodine intake are recommendable because still 31% of controlled table-salt samples from households and 15.7% of imported salt samples have had KI level below 20 mg/kg of NaCl. Salt produced in Croatia was (Pag and Nin salt plants) completely in accordance with iodination regulations. On the other hand, as recent increase in urinary iodine excretion could not be simultaneously followed by reduction in goiter prevalence, in the following years further epidemiological surveys of iodine deficiency disorders shall be warranted.

Lukinac L, Kalafatić D, Nöthig-Hus D, Lechpammer S, Solter M, Franceschi D, Kusić Z. · No affiliation provided · J Endocrinol Invest. · Pubmed #10698055 No free full text.

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