The Approach to the Irradiated Thyroid

Witt, Thomas R.; Meng, Ronald L.; Economou, Steven G.; Southwick, Harry W.

doi:10.1016/s0039-6109(16)41732-9

Cited by 24 publications

(24 citation statements)

References 34 publications

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“…61 The majority of radiation-induced thyroid carcinomas are small (< 1.5 cm) papillary lesions, implying a relatively benign course, yet a number of authors recommend total thyroidectomy for their treatment. 1317320358, 60 The basis for this recommendation is the high incidence of multicentricity displayed. Indeed, in the current study, radiation-induced lesions had a multicentnc incidence of 64%, with bilobal involvement in 30%.…”

Section: Discussionmentioning

confidence: 99%

Operative strategy for thyroid cancer. Is total thyroidectomy worth the price?

Schröder

Chambors

1986

Cancer

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The authors conducted a retrospective analysis with 5-to 30-year follow-up on 109 patients in order to determine the optimum management of nonmedullary thyroid cancer. Results of total thyroidectomy were compared to partial thyroidectomy, among patients well matched for prognostic indicators. No differences in cancer mortality or recurrence rates were evident. However, there were significantly more complications when total thyroidectomy was employed. In view of these results, partial thyroidectomy is recommended as the treatment of choice for nonmedullary thyroid cancer.Cancer 58:2320-2328, 1986.ONTROVERSY CONCERNING the treatment of non-C medullary thyroid cancer still exists, despite critical analysis of operative results for many years. Surgeons are divided into three camps: those advocating routine total thyroide~tomy,'-~ those advocating routine partial thyroidectomy (consisting of at least removal of one entirelobe and isthmus, to include a portion of the contralateral lobe when required for the resection of all gross tumor),6-' and those advocating total thyroidectomy selectively in patients displaying adverse prognostic fact o r~. '~-'~ The current study identifies the factors which influence prognosis and evaluates their implications on operative strategy. The advantages and complications of partial vcrsus total thyroidectomy are retrospectively evaluated. 1955 and 1979, 117 patients underwent thyroid surgery for nonmedullary primary thyroid carcinoma at Saint John Hospital in Detroit, Michigan. Follow-up with a minimum of 5 to 30 years (mean, 12.7 years) was possible in 109 patients by hospital and office records and by direct correspondence. Patients and Methods BetweenNomenclature devised by the American Thyroid Association was used for tumor clas~ification.~~ Papillary tumors were subdivided into pure papillary and mixed pap-

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Section: Discussionmentioning

confidence: 99%

Operative strategy for thyroid cancer. Is total thyroidectomy worth the price?

Schröder

Chambors

1986

Cancer

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“…There is agreement that exposure to radiation provides a legitimate risk factor for the induction of both benign and malignant thyroid nodular disease (13,3). Rosen et al (31) considered near-total thyroidectomy safe for patients with postradiation thyroid disease and FNA unreliable.…”

Section: Discussionmentioning

confidence: 99%

“…To determine the accuracy of FNA, we analyzed the results of FNA in 27 patients who had one or more other family members with differentiated thyroid cancer of follicular origin. We hypothesized that these patients tend to be similar to patients with thyroid nodules who have previously been exposed to low dose therapeutic radiation, and also frequently have thyroid cancer and both benign and malignant thyroid neoplasms (13).…”

mentioning

confidence: 99%

Reliability of Fine-Needle Aspiration in Patients with Familial Nonmedullary Thyroid Cancer

Vriens¹,

Sabancı²,

Epstein³

et al. 1999

Thyroid

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In this case-control study we describe how often thyroid cancers and occult cancers are diagnosed or not diagnosed by fine-needle aspiration (FNA) in patients with thyroid nodules and a family history of nonmedullary thyroid cancers (FNMTC). Our hypothesis is that patients with thyroid nodules and a family history of FNMTC seem to be similar to patients with thyroid nodules and a history of exposure to low-dose therapeutic radiation. Both have been reported to have multifocal thyroid neoplasms and malignant tumors are common. Cytological examination may therefore be less accurate. From 1979 to 1996, 27 patients from 24 families with FNMTC were examined histologically after a preoperative cytological examination in all of them. A positive cytology examination was defined when biopsy documented thyroid cancer. It was interpreted as a false-negative study when a benign diagnosis was made and thyroid cancer was present anywhere within the thyroid, including in areas sampled or not sampled by FNA and not palpable preoperatively. A randomized control group, matched for age and gender, contained 27 patients with papillary thyroid cancer without familial disease. In our study group, 25 patients were treated with total thyroidectomy, including 7 with neck dissection, and 2 by thyroid lobectomy. At final histological examination 17 of 27 patients (63%) in this study group had multiple nodules and 25 of 27 (92.6%) had thyroid cancer. Thyroid cancer was diagnosed by FNA in 22 of 25 patients (88%), with 3 (12%) false-negative biopsies due to sampling errors (thyroid cancer not in the index nodule), versus 1 (3.7%) false-negative biopsy in the control group. Two patients in the study group with benign nodules were accurately diagnosed. In patients with false-negative biopsies and a history of FNMTC, the cancer was situated in one or more small nodules. Only one cancer was occult (< 1.0 cm). One-third of the patients in our study group (33%) had a history of radiation; 44% of the irradiated group had a single nodule; 56% had multiple nodules. In the control group, 9 of 27 patients (33%) also had a history of radiation; 33% of the irradiated group had a single nodule, 67% had multiple nodules. In conclusion, the reliability of FNA in patients with FNMTC appears to be less accurate than it is for other patients because of the high incidence of multifocal thyroid cancer and coexistence of benign nodules. Patients with thyroid nodules and a family history of thyroid cancer are more likely to have thyroid cancer and because they also have more coexistent benign nodules, they must be followed closely or treated with total or near-total thyroidectomy.

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“…At first, very few total thyroidectomies were done at Evanston Hospital because of the potential risks to the recurrent laryngeal nerves and parathyroid glands. However, total or near-total thyroidectomy is now done based on the rationale reviewed by K a~l a n , 2~ Paloyan,"6 Witt et al, 27 and Perzik.2M The procedure is performed with minimal morbidity in patients with a higher incidence of multicentric and bilateral carcinoma and of occult pathology in the lobe contralateral to that with palpable abnormalities. These morbidity figures are comparable to those of Paloyan,26 who had a 2.8% incidence of permanent hypoparathyroidism and a 1.4% incidence of permanent recurrent nerve palsy in 70 patients after total thyroidectomy.…”

Section: Choice Of Procedures For Irradiated Thyroid Diseasementioning

confidence: 99%

Head and neck neoplasia following irradiation for benign conditions

Scanlon

Sener

1981

Head Neck

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A retrospective review of 143 patients with head or neck tumors who had received radiation therapy in the head and neck area for benign conditions during childhood or adolescence was conducted. This included an analysis of 1,080 patients from the Evanston Hospital Irradiated Thyroid Evaluation Clinic, which was established to define the relationship between irradiation and the subsequent development of thyroid neoplasia. The data support the following concepts of irradiation-induced neoplasia: (1) The thyroid, parathyroid, and salivary glands can develop benign and malignant changes after irradiation for benign conditions, with latent periods averaging about 30 years; (2) Once a glandular abnormality within the irradiated field appears, the risk of other glands in the field developing neoplastic changes is significantly increased.

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The Approach to the Irradiated Thyroid

Cited by 24 publications

References 34 publications

Operative strategy for thyroid cancer. Is total thyroidectomy worth the price?

Operative strategy for thyroid cancer. Is total thyroidectomy worth the price?

Reliability of Fine-Needle Aspiration in Patients with Familial Nonmedullary Thyroid Cancer

Head and neck neoplasia following irradiation for benign conditions

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