Thyroid Diseases

Rosato L, Miccoli P, Pinchera A, Lombardi G, Romano M, Avenia N, Bastagli A, Bellantone R, De Palma M, De Toma G, Gasparri G, Lampugnani R, Marini PL, Nasi PG, Pellizzo MR, Pezzullo L, Piccoli M, Testini M. · Dipartimento di Chirurgia - ASL TO/4, Ospedale di Ivrea, Italy. · G Chir. · Pubmed #19351456 No free full text.

Abstract: AIM: To review and to update the management protocols in thyroid surgery proposed two years ago by 1st Consensus Conference called on the topic by the Italian Association of Endocrine Surgery Units (UEC Club). METHOD: The 2nd Consensus Conference took place November 30, 2008 in Pisa within the framework of the 7th National Congress of the UEC Club. A selected board of endocrinologists and endocrine surgeons (chairmans: Paolo Miccoli and Aldo Pinchera; speaker: Lodovico Rosato) examined the individual chapters and submitted the consensus text for the approval of several experts. This plain and concise text provides the rationale of the thyroid patient management and wants to be the most complete possible tool for the physicians and other professionals in the field. CONCLUSIONS: The diagnostic, therapeutic and healthcare management protocols in thyroid surgery approved by the 2nd Consensus Conference are officially those proposed by the Italian Association of Endocrine Surgery Units (UEC Club) and are subject to review by two years.

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.

Bieglmayer C, Buchinger W, Födinger M, Müller MM, Sinha P, Vogl M, Weissel M, Zechmann W. · Osterreichische Gesellschaft für Laboratoriumsmedizin und Klinische Chemie, Wien, Austria. · Wien Klin Wochenschr. · Pubmed #18709526 No free full text.

This publication has no abstract.

Luster M, Clarke SE, Dietlein M, Lassmann M, Lind P, Oyen WJ, Tennvall J, Bombardieri E, Anonymous00011. · Department of Nuclear Medicine, University of Würzburg, Josef-Schneider-Strasse 2, 97080 Würzburg, Germany. · Eur J Nucl Med Mol Imaging. · Pubmed #18670773 No free full text.

Abstract: INTRODUCTION: The purpose of the present guidelines on the radioiodine therapy (RAIT) of differentiated thyroid cancer (DTC) formulated by the European Association of Nuclear Medicine (EANM) Therapy Committee is to provide advice to nuclear medicine clinicians and other members of the DTC-treating community on how to ablate thyroid remnant or treat inoperable advanced DTC or both employing large 131-iodine ((131)I) activities. DISCUSSION: For this purpose, recommendations have been formulated based on recent literature and expert opinion regarding the rationale, indications and contraindications for these procedures, as well as the radioiodine activities and the administration and patient preparation techniques to be used. Recommendations also are provided on pre-RAIT history and examinations, patient counselling and precautions that should be associated with (131)I iodine ablation and treatment. Furthermore, potential side effects of radioiodine therapy and alternate or additional treatments to this modality are reviewed. Appendices furnish information on dosimetry and post-therapy scintigraphy.

Anonymous122956. · No affiliation provided · Vestn Khir Im I I Grek. · Pubmed #18652216 No free full text.

Abstract: The presented recommendations unify the opinions of the conciliatory commission members on the most debatable problems of diagnostics and treatment of differentiated cancer of the thyroid gland. The recommendations elucidate the problems of diagnostics, including ultrasonic diagnostics, fine needle puncture biopsy, scintigraphy of the thyroid gland. The approaches to the volume of surgery on the thyroid and lymph nodes of the neck, the parameters of staging the tumor process are shown. Indications for radio-iodotherapy, suppressive hormonotherapy are emphasized. The work has determined the strategy of postoperative management of the patients.

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.

Lassmann M, Hänscheid H, Chiesa C, Hindorf C, Flux G, Luster M, Anonymous00045. · Department of Nuclear Medicine, University Hospital Würzburg, Würzburg, Germany. · Eur J Nucl Med Mol Imaging. · Pubmed #18491092 No free full text.

Abstract: INTRODUCTION: The purpose of the EANM Dosimetry Committee Series on "Standard Operational Procedures for Pre-therapeutic Dosimetry" (SOP) is to provide advice to scientists and clinicians on how to perform pre-therapeutic and/or therapeutic patient-specific absorbed dose assessments. MATERIAL AND METHODS: This particular SOP gives advice on how to tailor the therapeutic activity to be administered for systemic treatment of differentiated thyroid cancer (DTC) such that the absorbed dose to the blood does not exceed 2 Gy (a widely accepted limit for bone marrow toxicity). The methodology of blood-based dosimetry has been developed in the 1960s and refined in a series of international multi-centre trials in the framework of the introduction of new diagnostic and therapeutic tools, e.g. recombinant human thyroid-stimulating hormone in the management of DTC. CONCLUSION: The intention is to guide the user through a series of measurements and calculations which the authors consider to be the best and most reproducible way at present.

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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Anonymous120180. · No affiliation provided · Ann Endocrinol (Paris). · Pubmed #18342281 No free full text.

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Muller AF, Berghout A, Wiersinga WM, Kooy A, Smits JW, Hermus AR, Anonymous00181. · Diakonessenhuis Utrecht, Utrecht, the Netherlands. · Neth J Med. · Pubmed #18349473 links to  free full text

Abstract: Thyroid function disorders are common with a female to male ratio of 4 to 1. In adult women primary hypothyroidism and thyrotoxicosis have a prevalence of 3.5/1000 and 0.8/1000, respectively. This guideline is aimed at secondary care providers especially internists, but also contains relevant information for interested general practitioners and gynaecologists. A multidisciplinary working group, containing delegates of professional and patient organisations, prepared the guideline. According to principles of 'evidence-based medicine' available literature was studied and discussed. Considering the availability and quality of published studies a practical advice was formulated. For a full overview of the literature and considerations the reader is referred to the original version of the guideline (accessible through NIV-net). In this manuscript we have aimed to provide the practicing internist with practical and 'as evidence-based as possible' treatment guidelines with respect to thyroid function disorders.

Bartalena L, Baldeschi L, Dickinson AJ, Eckstein A, Kendall-Taylor P, Marcocci C, Mourits MP, Perros P, Boboridis K, Boschi A, Currò N, Daumerie C, Kahaly GJ, Krassas G, Lane CM, Lazarus JH, Marinò M, Nardi M, Neoh C, Orgiazzi J, Pearce S, Pinchera A, Pitz S, Salvi M, Sivelli P, Stahl M, von Arx G, Wiersinga WM. · Department of Clinical Medicine, University of Insubria, Varese, Italy. · Thyroid. · Pubmed #18341379 No free full text.

This publication has no abstract.

Anonymous00337. · No affiliation provided · Ann Fam Med. · Pubmed #18332410 links to  free full text

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Anonymous00393, Andersson M, de Benoist B, Delange F, Zupan J. · Department of Nutrition for Health and Development, World Health Organization, 8803 Rüschlikon, ZH, Switzerland. · Public Health Nutr. · Pubmed #18053287 No free full text.

This publication has no abstract.

Cibas ES, Sanchez MA. · Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115, USA. · Cancer. · Pubmed #18300233 links to  free full text

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van Lieshout J, Wessels P, van Rijswijk E, Boer AM, Wiersma A, Goudswaard AN, Anonymous00358. · Nederlands Huisartsen Genootschap, afd. Richtlijnontwikkeling en Wetenschap, Utrecht. · Ned Tijdschr Geneeskd. · Pubmed #18237051 No free full text.

Abstract: --The practice guideline 'Thyroid disorders' developed by the Dutch College of General Practitioners replaces the practice guideline 'Functional thyroid disorders' from 1996. Recommendations for palpable thyroid disorders have been added. --Hypothyroidism can often be treated by the general practitioner. The guideline offers specific recommendations for substitution therapy based on the 'start low, go slow'-principle. --Pharmacological treatment of hyperthyroidism is described as an optional activity for general practitioners. --A conservative approach is taken to the treatment of subclinical thyroid dysfunction. The development of symptoms may justify treatment initiation. --Cooperation has improved harmonisation of this practice guideline with the Netherlands Association for Internal Medicine's practice guideline 'Functional thyroid disorders' and the Dutch Institute for Healthcare Improvement's practice guideline 'Thyroid carcinomas'.

Abalovich M, Amino N, Barbour LA, Cobin RH, De Groot LJ, Glinoer D, Mandel SJ, Stagnaro-Green A. · Endocrinology Division, Durand Hospital, Buenos Aires, Argentina. · J Clin Endocrinol Metab. · Pubmed #17948378 links to  free full text

Abstract: OBJECTIVE: The objective is to provide clinical guidelines for the management of thyroid problems present during pregnancy and in the postpartum. PARTICIPANTS: The Chair was selected by the Clinical Guidelines Subcommittee (CGS) of The Endocrine Society. The Chair requested participation by the Latin American Thyroid Society, the Asia and Oceania Thyroid Society, the American Thyroid Association, the European Thyroid Association, and the American Association of Clinical Endocrinologists, and each organization appointed a member to the task force. Two members of The Endocrine Society were also asked to participate. The group worked on the guidelines for 2 yr and held two meetings. There was no corporate funding, and no members received remuneration. EVIDENCE: Applicable published and peer-reviewed literature of the last two decades was reviewed, with a concentration on original investigations. The grading of evidence was done using the United States Preventive Services Task Force system and, where possible, the GRADE system. CONSENSUS PROCESS: Consensus was achieved through conference calls, two group meetings, and exchange of many drafts by E-mail. The manuscript was reviewed concurrently by the Society's CGS, Clinical Affairs Committee, members of The Endocrine Society, and members of each of the collaborating societies. Many valuable suggestions were received and incorporated into the final document. Each of the societies endorsed the guidelines. CONCLUSIONS: Management of thyroid diseases during pregnancy requires special considerations because pregnancy induces major changes in thyroid function, and maternal thyroid disease can have adverse effects on the pregnancy and the fetus. Care requires coordination among several healthcare professionals. Avoiding maternal (and fetal) hypothyroidism is of major importance because of potential damage to fetal neural development, an increased incidence of miscarriage, and preterm delivery. Maternal hyperthyroidism and its treatment may be accompanied by coincident problems in fetal thyroid function. Autoimmune thyroid disease is associated with both increased rates of miscarriage, for which the appropriate medical response is uncertain at this time, and postpartum thyroiditis. Fine-needle aspiration cytology should be performed for dominant thyroid nodules discovered in pregnancy. Radioactive isotopes must be avoided during pregnancy and lactation. Universal screening of pregnant women for thyroid disease is not yet supported by adequate studies, but case finding targeted to specific groups of patients who are at increased risk is strongly supported.

Maia AL, Ward LS, Carvalho GA, Graf H, Maciel RM, Maciel LM, Rosário PW, Vaisman M. · Departamento de Tireóide, Sociedade Brasileira de Endocrinologia e Metabologia, Serviço de Endocrinologia, Hospital de Clínicas de Porto Alegre, Universidad Federal do Rio Grande do Sul, RS, Brazil. · Arq Bras Endocrinol Metabol. · Pubmed #17891253 links to  free full text

Abstract: Thyroid nodules are a common manifestation of thyroid diseases. It is estimated that approximately 10% of adults have palpable thyroid nodules with the frequency increasing throughout life. The major concern on nodule evaluation is the risk of malignancy (5-10%). Differentiated thyroid carcinoma accounts for 90% of all thyroid malignant neoplasias. Although most patients with cancer have a favorable outcome, some individuals present an aggressive form of the disease and poor prognostic despite recent advances in diagnosis and treatment. Here, a set of clinical guidelines for the evaluation and management of patients with thyroid nodules or differentiated thyroid cancer was developed through consensus by 8 member of the Department of Thyroid, Sociedade Brasileira de Endocrinologia e Metabologia. The participants are from different reference medical centers within Brazil, to reflect different practice patterns. Each committee participant was initially assigned to write a section of the document and to submit it to the chairperson, who revised and assembled the sections into a complete draft document, which was then circulated among all committee members for further revision. All committee members further revised and refined the document. The guidelines were developed based on the expert opinion of the committee participants, as well as on previously published information.

Goldschlager N, Epstein AE, Naccarelli GV, Olshansky B, Singh B, Collard HR, Murphy E, Anonymous00418. · University of California, San Francisco, California, USA. · Heart Rhythm. · Pubmed #17765636 No free full text.

Abstract: Amiodarone is commonly used to treat supraventricular and ventricular arrhythmias in various inpatient and outpatient settings. Over- and under-use of amiodarone is common, and data regarding patterns of use are sparse and largely anecdotal. Because of adverse drug reactions, proper use is essential to deriving optimal benefits from the drug with the least risk. This guide updates an earlier version published in 2000, reviews indications for use of amiodarone and recommends strategies to minimize adverse effects. The recommendations included herein are based on the best available data and the collective experience of the member of the writing committee.

Sherman SI, Angelos P, Ball DW, 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, Shah JP, Sisson JC, Tuttle RM, Urist MM, Anonymous00403. · The University of Texas M.D. Anderson Cancer Center, USA. · J Natl Compr Canc Netw. · Pubmed #17623612 No free full text.

This publication has no abstract.

Weetman AP. · The Medical School, Beech Hill Road, Sheffield, UK. · Clin Endocrinol (Oxf). · Pubmed #17466000 No free full text.

Abstract: Radioiodine has been in use for over 60 years as a treatment for hyperthyroidism. Major changes in clinical practice have occurred with the realization that accurate dosimetry is incapable of avoiding the risks of hypothyroidism, while more accurate assessment of the risks of other adverse effects of radioiodine such as ophthalmopathy and carcinogenesis have become available. More is also known of the potential for pretreatment with an antithyroid drug to affect the outcome of radioiodine treatment. However, we are still uncertain of the benefits of radioiodine treatment in subclinical hyperthyroidism. During the last two decades there has been wider acceptance of radioiodine as a safe and effective therapy for benign, nontoxic goitre, coupled with waning enthusiasm for the use of levothyroxine, as the risks and benefits of this option have become more apparent. The use of recombinant TSH offers the prospect that radioiodine treatment of nontoxic goitre can be simplified and improved, although more studies of this strategy are urgently required.

Anonymous00109. · No affiliation provided · Rev Assoc Med Bras. · Pubmed #17120329 No free full text.

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Bondy CA, Anonymous00170. · Developmental Endocrinology Branch, National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland 20892, USA. · J Clin Endocrinol Metab. · Pubmed #17047017 links to  free full text

Abstract: OBJECTIVES: The objective of this work is to provide updated guidelines for the evaluation and treatment of girls and women with Turner syndrome (TS). PARTICIPANTS: The Turner Syndrome Consensus Study Group is a multidisciplinary panel of experts with relevant clinical and research experience with TS that met in Bethesda, Maryland, April 2006. The meeting was supported by the National Institute of Child Health and unrestricted educational grants from pharmaceutical companies. EVIDENCE: The study group used peer-reviewed published information to form its principal recommendations. Expert opinion was used where good evidence was lacking. CONSENSUS: The study group met for 3 d to discuss key issues. Breakout groups focused on genetic, cardiological, auxological, psychological, gynecological, and general medical concerns and drafted recommendations for presentation to the whole group. Draft reports were available for additional comment on the meeting web site. Synthesis of the section reports and final revisions were reviewed by e-mail and approved by whole-group consensus. CONCLUSIONS: We suggest that parents receiving a prenatal diagnosis of TS be advised of the broad phenotypic spectrum and the good quality of life observed in TS in recent years. We recommend that magnetic resonance angiography be used in addition to echocardiography to evaluate the cardiovascular system and suggest that patients with defined cardiovascular defects be cautioned in regard to pregnancy and certain types of exercise. We recommend that puberty should not be delayed to promote statural growth. We suggest a comprehensive educational evaluation in early childhood to identify potential attention-deficit or nonverbal learning disorders. We suggest that caregivers address the prospect of premature ovarian failure in an open and sensitive manner and emphasize the critical importance of estrogen treatment for feminization and for bone health during the adult years. All individuals with TS require continued monitoring of hearing and thyroid function throughout the lifespan. We suggest that adults with TS be monitored for aortic enlargement, hypertension, diabetes, and dyslipidemia.

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.

Dillehay GL, Ellerbroek NA, Balon H, Brill DR, Grigsby PW, Macklis RM, Mauch PM, Mian TA, Potters L, Silberstein EB, Williams TR, Wong JC, Gaspar LE, Anonymous00250. · American College of Radiology, Reston, VA, USA. · Int J Radiat Oncol Biol Phys. · Pubmed #16472933 No free full text.

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Rodrigues F, Limbert E, Marques AP, Santos AP, Lopes C, Rodrigues E, Borges F, Carrilho F, Castro JJ, Neto J, Salgado L, Oliveira MJ, Anonymous00295. · No affiliation provided · Acta Med Port. · Pubmed #16202330 links to  free full text

Abstract: Differentiated thyroid carcinoma of follicular origin (DTCFO), although not very frequent, has registered a raising incidence in the last decades. In the majority of the cases, DTCFO is a curable disease when treated and monitored by experienced, multidisciplinary teams. These factors contribute to an increasing number of DTCFO survivors requiring life-long monitoring, due to the possibility of occurrence of recurrences many years after the initial treatment. Several aspects of the treatment and management of these patients are still controversial. The present protocol represents the consensus of the members of the Grupo de Estudo da Tiróide of the Sociedade Portuguesa de Endocrinologia, Diabetes e Metabolismo. It aims to define guidelines, in agreement with the current state of the art and contemplating the necessary adaptations to local constrains, that ensure decreased mortality and protection of patients' quality of life, avoiding unnecessarily aggressive or ineffective treatments, optimizing the use of the available resources.