Thyroid Diseases

Nitrini R, Caramelli P, Bottino CM, Damasceno BP, Brucki SM, Anghinah R, Anonymous00264. · Departamento Científico de Neurologia Cognitiva e do Envelhecimento, Academia Brasileira de Neurologia, Brazil. · Arq Neuropsiquiatr. · Pubmed #16172732 links to  free full text

Abstract: This panel had the objective of recommending evidence-based guidelines for the clinical diagnosis of Alzheimer's disease (AD) in Brazil. Guidelines from other countries and papers on the diagnosis of AD in Brazil were systematically evaluated in a thorough research of PUBMED and LILACS databases. The panel concluded that dementia diagnosis should be based on the DSM criteria and AD diagnosis, on the McKhann et al. criteria (NINCDS-ADRDA). The recommended auxiliary tests are: blood cell count, blood urea nitrogen, serum levels of creatinine, free-thyroxine, thyroid-stimulant hormone, albumin, hepatic enzymes, vitamin B12 and calcium, serological tests for syphilis and, for those aged less than 60 years, serological tests for HIV. Cerebrospinal fluid examination is recommended in special situations. Computed tomography (or preferentially magnetic resonance imaging, when available) is mandatory and has the main objective of excluding other diseases. SPECT and EEG are optional diagnostic methods.

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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Sherman SI, Angelos P, Ball DW, Beenken SW, Byrd D, Clark OH, Daniels GH, Dilawari RA, Ehya H, Farrar WB, Gagel RF, Kandeel F, Kloos RT, Kopp P, Lamonica DM, Loree TR, Lydiatt WM, McCaffrey J, Olson JA, Ridge JA, Robbins R, Shah JP, Sisson JC, Thompson NW, Anonymous00251. · University of Texas M.D. Anderson Cancer Center, USA. · J Natl Compr Canc Netw. · Pubmed #16002006 No free full text.

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Edwards FH, Ferraris VA, Shahian DM, Peterson E, Furnary AP, Haan CK, Bridges CR, Anonymous00128. · Division of Cardiothoracic Surgery, University of Florida, Jacksonville, Florida 32209, USA. · Ann Thorac Surg. · Pubmed #15919346 No free full text.

Abstract: Gender differences in coronary bypass surgery have been the focus of numerous publications in recent years. Unfortunately these publications have contradictions that leave surgeons with conflicting recommendations for care. To help resolve these inconsistencies, The Society of Thoracic Surgeons (STS) Workforce on Evidence-Based Surgery has carried out an objective review of published information in this field. The STS Workforce recognizes that there are important gender issues associated with referral bias, the impact of body size, psychosocial factors, and postoperative support, but the intent of this guideline is to focus specifically on perioperative management. As with all practice guidelines, our goal is to gather the most important information, analyze the information in a logical and unbiased fashion, and make recommendations based solely on the available evidence.

Mori Y, Kusakabe K, Ikekubo K, Ishikawa N, Nakada K, Kanaya S, Misaki T, Yokoyama K, Kubo A, Higashi T, Itou K, Noguchi Y, Tsuchimochi S, Togawa T, Anonymous00394. · Department of Radiology, The Jikei University School of Medicine. · Kaku Igaku. · Pubmed #15794118 No free full text.

Abstract: Radio-iodine (131I) therapy has been using in Graves' disease and well differentiated thyroid cancer. The rules of control in the discharge from radio-isotope hospital were notified in 1999 in Japan. Guideline of the 131I therapy in Graves' disease and thyroid cancer were prepared by sub-group of Japanese Society of Nuclear Medicine.

Anonymous00195, Anonymous00196. · No affiliation provided · J Feline Med Surg. · Pubmed #15742502 No free full text.

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Anonymous00110. · No affiliation provided · Thyroid. · Pubmed #15687827 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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Watkinson JC, Anonymous00039. · Queen Elizabeth Hospital, University at Birmingham NHS Trust, Edgbaston, Birmingham, UK. · Nucl Med Commun. · Pubmed #15319594 No free full text.

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Dietlein M, Dressler J, Farahati J, Grünwald F, Leisner B, Moser E, Reiners C, Schicha H, Schober O, Anonymous00006. · Klinik und Poliklinik für Nuklearmedizin, Universität zu Köln 50924 Köln. · Nuklearmedizin. · Pubmed #15316577 No free full text.

Abstract: The procedure guidelines for radioiodine therapy (RIT) of differentiated thyroid cancer (version 2) are the counter-part to the procedure guidelines for (131)I whole-body scintigraphy (version 2) and specify the interdisciplinary guidelines for thyroid cancer of the Deutsche Krebsgesellschaft and the Deutsche Gesellschaft für Chirurgie concerning the nuclear medicine part. Compared with version 1 facultative options for RIT can be chosen in special cases: ablative RIT for papillary microcarcinoma </=1 cm, ablative RIT for mixed forms of anaplastic and differentiated thyroid cancer, and RIT in patients with a measurable or increasing thyroglobulin concentration but without detectable metastases by imaging. The description of the pretherapeutic dosimetry now includes the isotopes (123)I and (124)I as well as a broader range of the activity of (131)I. Activities of 2-5 GBq (131)I are recommended for the first ablative RIT. If high accumulative activities of (131)I are expected, men who have not yet finished their family planning should be advised to the option of sperm cryoconservation. An interdisciplinary consensus is necessary whether the new TNM-classification (UICC, 6(th) edition, 2002) will lead to modified recommendations for surgical or nuclear medicine therapy, especially for the surgical completeness and for the ablative RIT of pT1 papillary cancer.

Dietlein M, Schober O, Schicha H. · Klinik und Poliklinik für Nuklearmedizin, Universität zu Köln 50924 Köln, · Nuklearmedizin. · Pubmed #15316576 No free full text.

Abstract: Papillary thyroid microcarcinomas </=1 cm have an excellent prognosis both in terms of overall and relapse-free survival. Their high prevalence in autopsy series suggests that most papillary microcarcinomas do not progress to clinically relevant cancer. The extent of surgery is still controversial. Lobectomy or subtotal resection are standard procedures, but multifocal microcarcinomas or lymph node metastases might be overlooked. The pros and cons of completion thyroidectomy and ablative radioiodine therapy are based on limited evidence due to heterogenous inclusion criteria in published series. The retrospective data analyses included subgroups with infiltration of the thyroid capsule, lymph node metastases or multifocal microcarcinomas at the primary staging. The local relapse rate reached approximately 7% after different therapeutic regimes. Radioiodine ablation decreased the recurrence rate in some retrospective studies, but data are inconsistent. Successful radioiodine ablation is possible also after less radical surgery without complete thyroidectomy with postoperative (131)I uptake of 10 to 20% or remnants of 3-8 ml. This concept was evaluated successfully in a monocentric series of patients with multifocal microcarcinomas. The therapeutic consideration should include the diameter of the carcinoma, neighbourhood to the thyroid capsule, histopathologic sub-groups, age, familiar occurrence, patient's informed consent and in future moleculargenetic tests, too. There-fore, limited surgical procedures for small papillary carcinomas as therapeutic standard, respectively thyroidectomy, lymph node dissection in the central compartment of the neck and ablative radioiodine therapy for individual cases are options for experienced surgeons and specialized tumour centers.

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.

Razvi S, Basu A, McIntyre EA, Wahid ST, Bartholomew PH, Weaver JU, Anonymous00365. · Department of Diabetes and Endocrinology, Queen Elizabeth Hospital, Gateshead, Tyne and Wear, UK. · Nucl Med Commun. · Pubmed #15208494 No free full text.

Abstract: BACKGROUND: Thyrotoxicosis is associated with significant morbidity, therefore adequate control of the disease is paramount. The outcome of treatment of thyrotoxicosis using radioiodine shows variable failure rates depending, amongst other things, on the administered activity of radioiodine and the use of anti-thyroid drugs. Thus, management should follow an evidence based protocol, which has a low failure rate. METHOD: We prospectively analysed the outcome of treatment using our Gateshead protocol of a fixed administered activity of radioiodine therapy (400 MBq) given to 201 patients (including 140 with Graves' disease, 48 with toxic multinodular goitre (TMNG) and 13 with toxic nodule) followed up for a median period of 12 months (range, 6-77 months). Carbimazole was discontinued in patients rendered euthyroid 16 days prior to radioiodine. No routine anti-thyroid drugs or thyroxine were given following radioiodine unless hypothyroidism or thyrotoxicosis occurred. RESULTS: Following the Gateshead protocol led to a failure rate of 6.5% (eight females with Graves' disease, four females with TMNG and one female with toxic nodule), 29% euthyroidism and 64% hypothyroidism. The rates of hypothyroidism for women and for men were: in Graves' disease 77% and 79%, in TMNG 29% and 75%, in toxic nodule 42% and 0%, respectively. CONCLUSIONS: Our observations show that withholding an antithyroid drug in excess of just over 2 weeks prior to administering a fixed administered activity of radioiodine in patients with thyrotoxicosis leads to the lowest reported failure rate, irrespective of the underlying cause. One possible mechanism for this could be the avoidance of drug induced radio-resistance.

Anonymous00266. · No affiliation provided · Am Fam Physician. · Pubmed #15168962 links to  free full text

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van der Molen AJ, Thomsen HS, Morcos SK, Anonymous00275. · Department of Radiology, Leiden University Medical Center, P.O. Box 9600, 2300 RC Leiden, The Netherlands. · Eur Radiol. · Pubmed #14997334 No free full text.

Abstract: Excess free iodide in the blood (ingested or injected) may cause thyrotoxicosis in patients at risk. Iodinated contrast medium solutions contain small amounts of free iodide and may be of significance for patients at risk. The free iodide may also interfere with nuclear medicine diagnostic studies and treatment. Therefore the Contrast Media Safety Committee of the European Society of Urogenital Radiology reviewed the literature on this subject in order to prepare guidelines. A report and guidelines were prepared based on an extensive Medline search. The report was discussed with the participants attending the Tenth European Symposium on Urogenital Radiology, Uppsala, Sweden, September 2003. Contrast medium induced thyrotoxicosis is rare. Contrast medium injection does not affect thyroid function tests (e.g., T3, T4, TSH) in patients with a normal thyroid. Routine monitoring of thyroid function tests before contrast medium injection in patients with a normal thyroid is not indicated even in areas where there is dietary iodine deficiency. Patients at risk of developing thyrotoxicosis after contrast medium injection are patients with Graves' disease and patients with multinodular goiter with thyroid autonomy, especially elderly patients and patients living in areas of iodine deficiency. Patients at high-risk should be carefully monitored by endocrinologists after contrast medium examinations. Prophylaxis in these groups is not generally recommended, although it may offer some protection in selected high-risk individuals. The free iodide load of contrast media injections interferes with iodide uptake in the thyroid and therefore compromises diagnostic thyroid scintigraphy and radio-iodine treatment of thyroid malignancies for 2 months after administration of contrast media. Simple guidelines on the subject are proposed.

Anonymous00159. · No affiliation provided · Ann Intern Med. · Pubmed #14734336 links to  free full text

Abstract: This statement summarizes the current U.S. Preventive Services Task Force (USPSTF) recommendations on screening for thyroid disease and updates the 1996 recommendations on this topic. The complete USPSTF recommendation statement on this topic, which includes a brief review of the supporting evidence, is available through the USPSTF Web site (http://www.preventiveservices.ahrq.gov), the National Guideline Clearinghouse (http://www.guideline.gov), and in print through the Agency for Healthcare Research and Quality Publications Clearinghouse (telephone, 800-358-9295; e-mail, ahrqpubs.gov). The complete information on which this statement is based, including evidence tables and references, is available in the accompanying article in this issue and in the summary of the evidence and systematic evidence review on the Web sites already mentioned. The recommendation statement and article are also available in print through the Agency for Healthcare Research and Quality Publications Clearinghouse.

Dietlein M, Dressler J, Eschner W, Leisner B, Reiners C, Schicha H, Anonymous00372, Anonymous00373. · Klinik und Poliklinik für Nuklearmedizin der Universität zu Köln, 50924 Köln. · Nuklearmedizin. · Pubmed #12802477 No free full text.

Abstract: The version 2 of the procedure guideline for iodine-131 whole-body scintigraphy for differentiated thyroid cancer is an update of the procedure guideline published in 1999. The following statements are added or modified: The two alternatives of an endogenous TSH-stimulation by the withdrawal of the thyroidal hormone medication and of an exogenous TSH-stimulation by the injection of the recombinant human TSH (rhTSH) have an equal sensitivity for the diagnostic use of radioiodine and for the measurement of thyroglobulin. Image acquisition under rhTSH is obtained approximately 48 h after the radioiodine administration, while an interval of about 72 h is preferred under endogenous TSH-stimulation. If iodine-negative metastases are expected, the feasibility of scintigraphy using (99m)Tc sestamibi or preferably positron emission tomography using (18)F-fluorodeoxyglucose should be considered. The sensitivity of FDG-PET is increased by TSH-stimulation. Before planning the iodine-131 scintigraphy the patient has to avoid iodine-containing medication and the possibility of additives of iodine in vitamin- and electrolyte-supplementation has to be considered.

Dietlein M, Dressler J, Eschner W, Leisner B, Reiners C, Schicha H, Anonymous00370, Anonymous00371. · Klinik und Poliklinik für Nuklearmedizin der Universität zu Köln, 50924 Cologne. · Nuklearmedizin. · Pubmed #12802476 No free full text.

Abstract: The version 2 of the procedure guideline for thyroid scintigraphy is an update of the procedure guideline published in 1999. The procedure guideline considers the current amendment of legislative rules (Richtlinie Strahlenschutz in der Medizin 2002). Indication and use of radiopharmaceuticals have to be confirmed by the specialist in nuclear medicine. Activities of 75 MBq technetium-99m, respectively of 10 MBq iodine-123 should not be exceeded without an individual justification. The interpretation of the scintigraphy requires the knowledge of the patients' history, the palpation of the neck, the laboratory parameters, and of the sonography. The interpretation of the technetium-99m uptake requires the knowledge of TSH concentration.

Dietlein M, Dressler J, Eschner W, Lassmann M, Leisner B, Reiners C, Schicha H, Anonymous00368, Anonymous00369. · Klinik und Poliklinik für Nuklearmedizin der Universität zu Köln, 50924 Cologne. · Nuklearmedizin. · Pubmed #12802475 No free full text.

Abstract: The version 2 of the procedure guideline for radioiodine test is an update of the guideline published in 1999. The following statements were added or modified: The procedure guideline discusses the pros and cons of a single measurement or of repeated measurements of the iodine-131 uptake and their optimal timing. Different formulas are described when one, two or three values of the radioiodine kinetic are available. The probe with a sodium iodide crystal, alternative or additionally the gamma-camera using the ROI-technique are instrumentations for the measurement of iodine-131 uptake. A possible source of error is an inappropriate measurement (sonography) of the target volume. The patients' preparation includes the withdrawal of antithyroid drugs 2-3 days before radioiodine administration. The patient has to avoid iodine-containing medication and the possibility of additives of iodide in vitamin- or electrolyte-supplementation has to be considered.

Dietlein M, Dressler J, Grünwald F, Joseph K, Leisner B, Moser E, Reiners C, Rendl J, Schicha H, Schneider P, Schober O, Anonymous00367. · No affiliation provided · Nuklearmedizin. · Pubmed #12802474 No free full text.

Abstract: The version 2 of the guideline for diagnostic standards of thyroid disorders is an update of the guideline published in 1999 and describes standards of in vitro and in vivo procedures. The following statements are modified: In vitro procedures: When measurement of the TSH-receptor antibodies is indicated, the guideline recommends the use of a second generation assay (recombinant human TSH-receptor as antigen). The functional assay sensitivity for the measurement of thyroglobulin should reach a value < or =1 ng/ml. Molecular genetic tests (RET proto-oncogene) are indicated in patients with a newly diagnosed medullary thyroid cancer and in the relatives of patients with hereditary medullary thyroid cancer. In vivo procedures: The sonographic examination should use a probe with a frequency of at least 7.5 MHz. Indications for the thyroid scintigraphy: nodule size > or =1 cm in diameter, autonomous goitre/nodule with clinical or subclinical hyperthyroidism, necessity of a differentiation between Graves' disease and chronic lymphocytic thyroiditis, therapy control after a definitive treatment and - in individual cases - the follow-up of untreated autonomous nodules.

Anonymous00268. · No affiliation provided · Eur J Nucl Med Mol Imaging. · Pubmed #12723563 No free full text.

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Baloch Z, Carayon P, Conte-Devolx B, Demers LM, Feldt-Rasmussen U, Henry JF, LiVosli VA, Niccoli-Sire P, John R, Ruf J, Smyth PP, Spencer CA, Stockigt JR, Anonymous00071. · Department of Pathology & Laboratory Medicine, University of Pennsylvania Medical Center, Philadelphia, USA. · Thyroid. · Pubmed #12625976 No free full text.

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Demers LM, Spencer CA. · Department of Pathology and Medicine, The Pennsylvania State University College of Medicine, Hershey, USA. · Clin Endocrinol (Oxf). · Pubmed #12580927 No free full text.

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Shevell M, Ashwal S, Donley D, Flint J, Gingold M, Hirtz D, Majnemer A, Noetzel M, Sheth RD, Anonymous00467, Anonymous00468. · Department of Neurology, McGill University, Montreal Children's Hospital, Canada. · Neurology. · Pubmed #12578916 No free full text.

Abstract: OBJECTIVE: To make evidence-based recommendations concerning the evaluation of the child with a nonprogressive global developmental delay. METHODS: Relevant literature was reviewed, abstracted, and classified. Recommendations were based on a four-tiered scheme of evidence classification. RESULTS: Global developmental delay is common and affects 1% to 3% of children. Given yields of about 1%, routine metabolic screening is not indicated in the initial evaluation of a child with global developmental delay. Because of the higher yield (3.5% to 10%), even in the absence of dysmorphic features or features suggestive of a specific syndrome, routine cytogenetic studies and molecular testing for the fragile X mutation are recommended. The diagnosis of Rett syndrome should be considered in girls with unexplained moderate to severe developmental delay. Additional genetic studies (e.g., subtelomeric chromosomal rearrangements) may also be considered in selected children. Evaluation of serum lead levels should be restricted to those children with identifiable risk factors for excessive lead exposure. Thyroid studies need not be undertaken (unless clinically indicated) if the child underwent newborn screening. An EEG is not recommended as part of the initial evaluation unless there are historical features suggestive of epilepsy or a specific epileptic syndrome. Routine neuroimaging, with MRI preferred to CT, is recommended particularly if abnormalities are found on physical examination. Because of the increased incidence of visual and auditory impairments, children with global developmental delay may undergo appropriate visual and audiometric assessment at the time of diagnosis. CONCLUSIONS: A specific etiology can be determined in the majority of children with global developmental delay. Certain routine screening tests are indicated and depending on history and examination findings, additional specific testing may be performed.

Anonymous00271. · No affiliation provided · Int J Gynaecol Obstet. · Pubmed #12481755 No free full text.

Abstract: Because thyroid disease is the second most common endocrine disease affecting women of reproductive age, obstetricians often care for patients who have been previously diagnosed with alterations in thyroid gland function. In addition, both hyperthyroidism and hypothyroidism may initially manifest during pregnancy. Obstetric conditions, such as gestational trophoblastic disease or hyperemesis gravidarum, may themselves affect thyroid gland function. This document will review the thyroid-related pathophysiologic changes created by pregnancy and the maternal-fetal impact of thyroid disease.