In order to clarify the molecular mechanism involved in thyroid carcinogenesis and to identify candidate molecular targets for diagnosis and treatment, we analyzed genome-wide gene expression profiles of 18 papillary thyroid carcinomas with a microarray representing 38,500 genes in combination with laser microbeam microdissection. We identified 243 transcripts that were commonly up-regulated and 138 transcripts that were down-regulated in thyroid carcinoma. Among these 243 transcripts identified, only 71 transcripts were reported as up-regulated genes in previous microarray studies, in which bulk cancer tissues and normal thyroid tissues were used for the analysis. We further selected genes that were overexpressed very commonly in thyroid carcinoma, though were not expressed in the normal human tissues examined. Among them, we focused on the regulator of G-protein signaling 4 (RGS4) and knocked-down its expression in thyroid cancer cells by small-interfering RNA. The effective down-regulation of its expression levels in thyroid cancer cells significantly attenuated viability of thyroid cancer cells, indicating the significant role of RGS4 in thyroid carcinogenesis. Our data should be helpful for a better understanding of the tumorigenesis of thyroid cancer and could contribute to the development of diagnostic tumor markers and molecular-targeting therapy for patients with thyroid cancer.

1415I N A 60-YEAR-OLD male with a 14-year history of viral hepatitis and liver cirrhosis, an ultrasound examination of the thyroid gland (2002) revealed a 10/8 cm hypoechoic lesion in the left thyroid lobe with partially retrosternal location, unclear outlines and microcalcifications. Fine-needle aspiration biopsy (FNAB) cytology result was follicular adenoma but follicular type of papillary thyroid carcinoma could not be ruled out. The patient was admitted for surgery in our institution in October 2002. Intraoperative examination revealed left thyroid lobe, 12/10 cm in size, with hard consistency; the strap muscles as well as the lymph nodes in the central cervical compartment of the neck and the inferior thyroid artery were also invaded. There were no macroscopic changes in the right thyroid lobe. Thyroidectomy with selective cervical node dissection was performed. On macroscopic examination of the specimen, some green-yellowish areas (1) with extratumoral location (2) were found (Fig. 1). Hystologic result was follicular type of papillary thyroid carcinoma in the left thyroid lobe (1), metastases from hepatocellular carcinoma in the same lobe (2) (Fig. 2A); tumor emboli from papillary (1) and hepatocellular (2) carcinoma in the vessels (Fig. 2B); adenoma of the left inferior parathyroid gland (Fig. 3); focci of papillary thyroid carcinoma and focci of hepatocellular carcinoma in the ipsilateral lymph nodes from the central cervical compartment (Fig. 4).

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Objective:The purpose of this prospective study was to evaluate the efficacy and safety in the application of ultrasonic scalpel compared to conventional operative technique in open surgery of the thyroid gland. Methods:The study included 100 patients operated between May 2013 and August 2013. Patients were divided into two groups -50 patients were operated using So-noSurg® and 50 patients were operated using classic "clamp and Tie" technique. We evaluated and compared the outcome between the two groups.Results: Both groups had a similar distribution in the demographic features such as gender, age, functional activity and malignant diseases of the thyroid gland. When comparing the results, we found a significant reduction in the duration of surgery in patients operated with So-noSurg® (SST group) (72 ± 20 min vs 100 ± 32 min, p = 0.01). There was no difference for fluid in the vacuum drainage during the first 24 hrs. Hospital stay of patients in both groups was similar -an average of 3 days stay into the clinic. Conclusion:Our results showed that "ultrasonic scalpel" is an effective, easy to use and completely reliable method for achieving hemostasis with visible advantages over classical operational technique. J Clin Exp Invest 2015; 6 (3): [209][210][211][212][213]

Benign bilateral thyroid disease is the most common indication for surgery in endemic iodine-deficiency regions. Total thyroidectomy is currently the preferred treatment for thyroid cancer, multinodular goiter and Graves disease; however, many surgeons and endocrinologists choose not to perform or recommend total thyroidectomy to treat benign thyroid diseases. We sought to assess whether the results support the hypothesis that total thyroidectomy is safe and can be considered as the optimal surgical approach for treating BTD in endemic region such as Bulgaria.A total of 500 patients underwent thyroid operation between 2007 and 2009. We excluded patients with thyroid cancer or suspicion of thyroid malignancy. We evaluated indications for total thyroidectomy, complication rates, local recurrence rate and long-term outcome after total thyroidectomy. Diagnoses before surgery were multinodular goiter (n = 300), Graves disease (n = 100) and Toxic multinodular goiter (n = 100). The incidence of permanent bilateral recurrent laryngeal nerve palsy was 0% and that of permanent unilateral recurrent laryngeal nerve palsy and permanent hypocalcaemia was 1.8-5%. Haemorrhage requiring repeated surgery occurred in 4.5-13% of patients. There was no wound infection, and postoperative mortality was 0%.Total thyroidectomy is safe and is associated with a low incidence of disabilities. Furthermore, our study showed that total thyroidectomy is the optimal procedure, when surgery is indicated, for Graves disease and toxic multinodular goiter, as total thyroidectomy has the advantages of immediate and permanent cure and no recurrences.