Thyroid nodule and thyroid cancer management pre- and post-cardiac transplantation

Tilluckdharry, Nicole V.; Krishnamani, Rajan; DeNofrio, David; Burman, Kenneth D.; Kim, Caroline S.

doi:10.1016/j.healun.2010.04.003

Cited by 2 publications

(2 citation statements)

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“…Such decisions are often made on a case-by-case basis. 19,20 Several large published transplantation series found that hematological neoplasms and melanoma, lung, and breast cancer have the greatest risk of transmission. [21][22][23] To the best of our knowledge, only 1 case was reported in which metastatic follicular thyroid carcinoma was transmitted with a transplanted kidney.…”

Section: Discussionmentioning

confidence: 99%

“…An important issue is the limited time available to complete donor evaluation, in order not to delay organ recovery. As a general rule, 19,20 potential donors typically undergo US-guided examination of their thyroid gland, while blood tests (thyroid stimulating hormone and calcitonin) are ordered upon request. When a newly discovered thyroid nodule needs further investigation, there are no clear protocols to follow.…”

Section: Discussionmentioning

confidence: 99%

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Management of Thyroid Nodules in Deceased Donors With Comparison Between Fine Needle Aspiration and Intraoperative Frozen Section in the Setting of Transplantation

Eccher¹,

Girolami²,

d’Errico

et al. 2019

Prog Transpl

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Introduction: Newly discovered thyroid nodules in deceased donors are investigated to rule out cancer that can be transmitted, but there are no established protocols. The aim of the study was to compare fine needle aspiration versus intraoperative frozen section in the donor management with limited time. Methods: Data were extracted only from the records of Italian second opinion consultation service in the years 2016 to 2017 and included donor details, pathology diagnoses, complications, transmission risk profile, and impact on transplantation. Results: Among 31 deceased donors with thyroid nodules, we documented 4 with a clinical history of cancer and 27 with a newly discovered nodule. The latter was evaluated by thyroidectomy with frozen section in 22 and fine needle aspiration in 5. Among all donors, 7 had papillary thyroid carcinoma with negligible transmission risk, whereas 8 with unacceptable risk. Two donors presented major bleeding after thyroidectomy, with organ discard in 1 case. Transplantation was delayed in 4 cases that were evaluated with frozen section. Discussion: There was no uniform approach for the investigation of thyroid nodules. Our results showed that fine needle aspiration was more accurate and useful than frozen section. Fine needle aspiration had minor economic impact and a far less rate of bleeding/hemodynamic complications, potentially delaying and compromising organ recovery. Our results suggested considering fine needle aspiration as a first step in the evaluation of thyroid nodules in donors.

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