Objective: We made a prospective study evaluating the prevalence of thyroid nodular disease in acromegalic patients. Subjects and methods: Thyroid ultrasound and ultrasound-guided fine needle aspiration biopsy were performed when nodules were detected. Nodules were characterized by cytology and histopathology. Results: We found high prevalence of nodular thyroid disorder, 23/34 (67%) in acromegalic patients. High risk and malignant cytology were significantly higher in acromegalic patients than in our non-acromegalic population (25% vs. 9%). Differentiated thyroid carcinoma was present in 11% of the acromegalic patients. Conclusions: We strongly recommend periodic thyroid evaluation by ultrasound in patients with acromegaly. Fine needle aspiration biopsy should be performed in nodules larger than 10 mm, and in all suspicious nodules, regardless of the size. Arq Bras Endocrinol Metab. 2012;56(5):300-4 Keywords Acromegaly; thyroid nodules; thyroid ultrasonography; fine needle aspiration biopsy; thyroid carcinoma RESUMO Objetivo: Realizamos um estudo prospectivo avaliando a prevalência de patologia nodular tireói dea em 34 pacientes acromegálicos. Sujeitos e métodos: Avaliamos os pacientes com ecografia tireóidea e punção biópsia com agulha fina quando se detectavam nódulos. Resultados: Encontramos uma alta prevalência de patologia nodular tireóidea 23/34 (67%) em acromegálicos. A citologia tireóidea de alto risco e maligna foi significativamente mais elevada em pacientes acromegálicos que em uma população não acromegálica (25% vs. 9%). O grupo acromegálico apresentou carcinoma diferenciado de tireoides em 11%. Conclusões: Recomendamos fortemente a ecografia periódica tireóidea em pacientes acromegálicos. Uma punção biópsia aspirativa com agulha fina deve ser realizada em presença de nódulos tireóideos maiores que 10 mm e daqueles com critérios ecográficos suspeitos de malignidade, independentemente do tamanho deles. Arq Bras Endocrinol Metab. 2012;56(5):300-4

Objective Bone metastases (BM) from differentiated thyroid cancer (DTC) are associated with poor survival rates. Due to the low frequency of this entity, we performed a multicentric retrospective study that aimed to evaluate the presentation, outcome and causes of death in this population. Subjects and methods We reviewed file records from 10 databases. BM were diagnosed by: i) biopsy and/or ii) radioiodine (RAI) bone uptake + elevated thyroglobulin (Tg) levels and/or c) bone uptake of 18-FDG in the PET-CT scan + elevated Tg levels. Results Fifty-two patients with DTC were included (44% male, mean age 54 years); 58% had papillary histology. BM were synchronous with DTC diagnosis in 46% of the participating cases. BM were symptomatic in 65% of the cases. Multiple BM were present in 65% of patients, while simultaneous metastatic disease in additional sites was found in 69%. Ninety-eight percent of patients received treatment for the BM, which included RAI therapy in 42 patients; 30 of them received cumulative RAI doses that were larger than 600 mCi 131I. The mean follow-up after a BM diagnosis was 34 months. The 2- and 5-year survival rates after diagnosis of the first BM were 64% and 38%, respectively. The status on the last evaluation was DTC-related death in 52% of the patients; 26% of them died from direct complications of BM or their treatments. Conclusion BM are usually radioiodine-refractory and are associated with a short overall survival, although most of the patients died of causes not directly related to the BM.

Aim: To determine the frequency of visually asymptomatic choroidal metastases in patients with disseminated breast and lung carcinomas in order to establish optimal patient management policies. Methods: All patients with confirmed metastatic disease treated in our institution between January 2002 and December 2003 were invited to undergo a funduscopic examination and a B-scan ultrasound evaluation. Results: Of the 169 study participants, 77 had breast cancer (64 with metastases in one organ and 13 with multiple-organ involvement) and 92 had lung cancer (85 with metastases in one organ and 7 with multipleorgan involvement). No patient with metastatic breast cancer and two patients with metastatic lung disease (each with multiple-organ involvement) were found to have choroidal metastases. The choroidal metastases were detected by both the funduscopic and ultrasound examinations. Conclusions: The 2.17% incidence of choroidal metastasis in disseminated lung cancer and the 0% incidence in disseminated breast cancer speaks against the practicality of screening for early detection of choroidal metastasis among these patients, even though it would lead to early implementation of appropriate, often vision saving, therapeutic management. Its low incidence probably testifies to progress achieved by enhanced systemic oncological treatment policies that have been introduced into routine patient management over the past few years. B reast and lung carcinomas are the most common primary sites for choroidal metastases.1 The incidence of choroidal metastasis from metastatic breast cancer was 0-9.7% in clinical trials 2-5 and up to 30% in histopathological trials. 6 The incidence of choroidal metastases from metastatic lung cancer was reported to be 2-6.7% in clinical trials.2 7 The need for screening for asymptomatic choroidal metastasis among patients with disseminated disease continues to be a matter of controversy.8 Although a metastasis causes considerable visual disability and presents a very difficult therapeutic challenge, the cost of conducting numerous examinations on unaffected individuals is obviously high. As such, there must be compelling evidence of clinical benefits for operating an early detection programme in asymptomatic patients. We designed this study to determine the frequency of choroidal metastases in patients seen in our medical centre, who had disseminated breast and lung cancer, in order to determine whether such a clinical screening programme was justified. Our goal was to identify a subgroup of patients with early choroidal involvement who would profit from early implementation of appropriate changes in treatment. METHODSThe local institutional review board approved the study. The participants were consenting patients with proved disseminated lung or breast cancer to at least one site. Between January 2002 and December 2003, 169 unselected patients were screened for choroidal metastases in the Department of Ophthalmology, Tel Aviv Sourasky Medical Center, a large urban university-affiliated tertiary c...

The results suggest that the reliability of thyroglobulin measurements in washout of fine needle aspirates could be preserved by immediate measure of thyroglobulin or the use of stabilizing diluents to perform washout.