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Ito Y.,Kuma Hospital | Miyauchi A.,Kuma Hospital
Journal of Thyroid Research | Year: 2012

There are some important prognostic factors for papillary thyroid carcinoma (PTC) and follicular thyroid carcinoma (FTC). In this paper, clinicopathological features significantly affecting patient prognosis are described based on our data as well as others. Distant metastasis at diagnosis is the most important prognostic factor for both PTC and FTC. Other than that, preoperative and intraoperative findings are important to evaluate the biological behavior of PTC. Extrathyroid extension, large lymph-node metastasis, and extranodal tumor extension that can be evaluated preoperatively or intraoperatively are significant prognostic factors for PTC patients. In contrast, pathological findings are important not only for diagnosis of FTC, but also for the evaluation of its biological character. Grade of invasiveness (minimally or widely invasive) and degree of differentiation (well differentiated or including a poorly differentiated component) greatly affect the prognosis of FTC patients. © 2012 Yasuhiro Ito and Akira Miyauchi.


Nakamura H.,Kuma Hospital
Nihon rinsho. Japanese journal of clinical medicine | Year: 2012

Thyroid nodules are very common. Several articles suggest that thyroid nodules are detected by ultrasonography (US) in one of six males and one of 3.5 females in Japan. Thyroid cancer exists among these nodules and distinction between benign and malignant nodules is not always easy. Japan Thyroid Association (JTA) is currently preparing for guidelines for management of thyroid nodules. This article describes how to treat thyroid nodules according to the guidelines in progress. Ultrasonography and fine needle aspiration cytology (FNA) are critical to evaluate nodules. Every nodule should be examined by US, since it is safe, relatively cheap in Japan and can provide a lot of information about characteristics of nodules. Several findings suggesting benign and malignancy have been known. Regarding a FNA classification, the Bethesda system for reporting thyroid cytopathology published a few years ago is expected to become prevailing in the world. Currently the WHO classification of sixth version is used in Japan and the JTA guidelines will adopt a modified WHO classification: "Indeterminate" is divided into two categories; "Indeterminate A, considering follicular tumor" and "Indeterminate B, considering other than follicular tumor". Re-FNA is not recommended for the former subgroup, while re-FNA has a possibility to lead to a correct FNA diagnosis for the latter subgroup. This article discusses several issues regarding papillary thyroid cancer and follicular thyroid cancer also in brief.


Li Y.,Wakayama Medical University | Nishihara E.,Kuma Hospital | Hirokawa M.,Kuma Hospital | Taniguchi E.,Wakayama Medical University | And 2 more authors.
Journal of Clinical Endocrinology and Metabolism | Year: 2010

Context: IgG4-related sclerosing disease is anewsyndrome characterized by high serum IgG4 levels and increased IgG4-positive plasma cells in the involved organs. Recently the first description was made by our group of a subsection of Hashimoto's autoimmune thyroiditis (HT) patients showing indistinguishable histopathological features with IgG4-related sclerosing disease, which was termed as IgG4 thyroiditis. Objective: The objective of the study was analysis of the immunophenotypic features of IgG4 in 70 cases of HT patients and to clarify the histopathological and clinical characteristics of the patients with IgG4 thyroiditis. Design: Thyroid tissue samples were obtained from 70 patients with HT who were treated surgically. Quantitative analyses of the expression of IgG4 and IgG were performed. Statistical analyses of clinical and histopathological parameters were also conducted. Results: On the basis of immunohistochemistry of IgG4 and IgG4/IgG ratio, the 70 patients with HT were divided into two groups: IgG4 thyroiditis (19 cases) and non-IgG4 thyroiditis (51 cases). Histopathologically, IgG4 thyroiditis showed higher grade of stromal fibrosis, lymphoplasmacytic infiltration, and follicular cell degeneration than non-IgG4 thyroiditis. Moreover, thesetwogroups were also demonstrated to be related with different clinical features, with IgG4 thyroiditis associated more with male gender, rapid progress, subclinical hypothyroidism, more diffuse low echogenicity, and higher level of circulating antibodies. Conclusions: From both clinical and histopathological aspects, IgG4 thyroiditis and non-IgG4 thyroiditis were demonstrated to be distinct entities. Measuring serum IgG4 concentration provides a useful method of distinguishing IgG4 thyroiditis from non-IgG4 thyroiditis. Copyright © 2010 by The Endocrine Society.


Background: Recently, we reported that the thyroglobulin (Tg) doubling time (DT) was the most potent prognostic factor in patients with papillary thyroid carcinoma (PTC) who underwent total thyroidectomy. Interestingly 16.2% of the study patients had a decrease in Tg levels over time, giving negative values in Tg-DT. These patients had an excellent outcome. However, most of the patients did not receive ablation with radioactive iodine. Therefore, whether the Tg in these patients was derived from persistent disease or residual thyroid tissue could not be concluded. To resolve this question, we measured serum Tg levels in patients with medullary thyroid carcinoma (MTC) who underwent total thyroidectomy using similar surgical techniques for the treatment of PTC. Methods: Twenty-seven consecutive patients with MTC who underwent total thyroidectomy were selected. Of them, five patients with antibodies to Tg were excluded from the study. In the remaining 22 patients, serum Tg levels were measured before and after surgery. None of the patients received radioactive iodine ablation. They were prescribed levothyroxine as a replacement for the lost thyroid function. Results: Serum Tg levels were detectable preoperatively, while postoperative serum Tg levels were lower than the detectable level, 0.5ng/mL, in all 22 patients. Conclusions: The results indicate that most of the patients with detectable Tg levels and negative Tg-DT values after total thyroidectomy for PTC in our previous study had persistent disease, and that their serum Tg was not from residual thyroid tissue, suggesting that up to 50% of patients with persistent PTC have a decrease in serum Tg levels in response to thyroid-stimulating hormone-suppressive therapy. © 2012 Mary Ann Liebert, Inc.


Ito Y.,Kuma Hospital | Amino N.,Kuma Hospital | Miyauchi A.,Kuma Hospital
World Journal of Surgery | Year: 2010

Background The recent prevalence of ultrasonography (US) has facilitated the early detection and qualitative evaluation of thyroid nodules. Furthermore, novel technical developments are extending the application range of US for other thyroid diseases. Methods The use of US to differentiate between thyroid carcinoma and benign nodule, between a metastatic lymph node and a reactive node, between thyroid lymphoma and chronic thyroiditis, and between destruction-induced thyrotoxicosis and Graves' disease is introduced. Results Classification systems for thyroid nodule have shown high diagnostic accuracy for thyroid carcinomas except follicular carcinoma. US diagnosis of lymph node metastasis showed high specificity but low sensitivity. Patients who were suspected of thyroid lymphoma based on US findings should undergo incisional biopsy or thyroidectomy for diagnosis of the histologic type if fineneedle aspiration biopsy findings suggest lymphoma. Patients should be carefully followed even if they were diagnosed as negative based on cytologic findings. Measurement of thyroid blood flow is helpful for diagnosing destruction-induced thyrotoxicosis, such as painless thyroiditis, by distinguishing the lesion from Graves' disease. Conclusions Ultrasonography is useful for diagnosing various thyroid diseases, including thyroid carcinoma. The remaining issue to be resolved is the diagnosis of follicular carcinoma. Trials using novel techniques to differentiate these lesions are expected. © Société Internationale de Chirurgie 2009.


Li Y.,Wakayama Medical University | Nishihara E.,Kuma Hospital | Kakudo K.,Wakayama Medical University
Current Opinion in Rheumatology | Year: 2011

Purpose of review: Hashimoto's thyroiditis is commonly considered as a well defined clinicopathological entity. Its diagnosis and treatment have changed little over the last few decades. This review examines the recent progress in understanding Hashimoto's thyroiditis, particularly with regard to its close relationship to IgG4-related systemic disease (IgG4-RSD). Recent findings: During the 1-year review period, new studies have reported that there is a unique subtype of Hashimoto's thyroiditis, termed IgG4 thyroiditis, which is histopathologically characterized by lymphoplasmacytic infiltration, fibrosis, increased numbers of IgG4-positive plasma cells, and high serum IgG4 levels, which indicate that this group of Hashimoto's thyroiditis is closely related to IgG4-RSD. Furthermore, IgG4 thyroiditis and non-IgG4 thyroiditis present different clinical features, with IgG4 thyroiditis being more closely associated with rapid progress, subclinical hypothyroidism, higher levels of circulating antibodies, and more diffuse low echogenicity. In addition, Riedel's thyroiditis was recently demonstrated to be a thyroid manifestation in patients with systemic IgG4-RSD, which calls for the definition of IgG4 thyroiditis to be expanded. Summary: New insights into Hashimoto's thyroiditis with special reference to IgG4-positive plasma cells offer a novel way of viewing this well defined disease. IgG4-RSD occurring in the thyroid gland may involve two different manifestations: the organ-specific Hashimoto's thyroiditis type and the systemic Riedel's thyroiditis type, which share similar IgG4-related sclerosing features. © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins.


Ito Y.,Kuma Hospital | Nikiforov Y.E.,University of Pittsburgh | Schlumberger M.,University Paris - Sud | Vigneri R.,Garibaldi Nesima Medical Center
Nature Reviews Endocrinology | Year: 2013

Thyroid cancer is the most common endocrine malignancy and its incidence has been increasing considerably in the past few decades. Many studies have been published providing evidence for this increase; however, why thyroid cancer incidence keeps rising is still debated and there are conflicting reports of factors leading to the increase in its incidence. In this article, Nature Reviews Endocrinology asks four experts their opinions on some of the controversies surrounding the changing trends in thyroid cancer incidence.© 2013 Macmillan Publishers Limited. All rights reserved.


Ito Y.,Kuma Hospital | Miyauchi A.,Kuma Hospital | Kobayashi K.,Kuma Hospital | Miya A.,Kuma Hospital
Endocrine Journal | Year: 2014

In this review, we focused on the patient age as an indicator of tumor growth and prognostic significance in both clinical papillary thyroid carcinoma (PTC) and subclinical papillary microcarcinoma (PMC: PTC ≤ 1 cm). In clinical PTC, young age (< 30 years) and old age (≥ 60 years) significantly affected the disease-free survival of patients, and old age was a strong predictor of carcinoma death. In contrast, in subclinical PMC, growth activity significantly decreased with patient age, and young age (< 40 years) was an independent predictor of carcinoma growth, indicating that old patients with subclinical PMC are the best candidates for observation without immediate surgery. Taken together, our findings indicate that the role of patients' age as an indicator of tumor growth differs significantly between clinical PTC and subclinical PMC. © The Japan Endocrine Society.


Ito Y.,Kuma Hospital | Miyauchi A.,Kuma Hospital | Kihara M.,Kuma Hospital | Higashiyama T.,Kuma Hospital | And 2 more authors.
Thyroid | Year: 2014

Background: We showed previously that subclinical low-risk papillary thyroid microcarcinoma (PTMC) could be observed without immediate surgery. Patient age is an important prognostic factor of clinical papillary thyroid carcinoma (PTC). In this study, we investigated how patient age influences the observation of low-risk PTMC. Methods: Between 1993 and 2011, 1235 patients with low-risk PTMC chose observation without immediate surgery. They were followed periodically with ultrasound examinations. These patients were enrolled in this study. We divided them into three subsets based on age at the beginning of observation: young (<40 years), middle-aged (40-59 years), and old patients (≥60 years). Observation periods ranged from 18 to 227 months (average 75 months). Results: We set three parameters for the evaluation of PTMC progression: (i) size enlargement, (ii) novel appearance of lymph-node metastasis, and (iii) progression to clinical disease (tumor size reaching 12 mm or larger, or novel appearance of nodal metastasis). The proportion of patients with PTMC progression was lowest in the old patients and highest in the young patients. On multivariate analysis, young age was an independent predictor of PTMC progression. However, none of the 1235 patients showed distant metastasis or died of PTC during observation. Although only 51 patients (4%) underwent thyrotropin (TSH) suppression based on physician preference, the PTMC of all patients enrolled in this TSH suppression study, except one, were clinically stable. To date, 191 patients underwent surgery for various reasons after observation. None showed recurrence except for one in the residual thyroid, and none died of PTC after surgery. Conclusions: Old patients with subclinical low-risk PTMC may be the best candidates for observation. Although PTMC in young patients may be more progressive than in older patients, it might not be too late to perform surgery after subclinical PTMC has progressed to clinical disease, regardless of patient age. © Mary Ann Liebert, Inc.


Ito Y.,Kuma Hospital | Miyauchi A.,Kuma Hospital
Current Opinion in Oncology | Year: 2015

Purpose of review The global incidence of small papillary thyroid carcinoma (PTC) is increasing remarkably, mostly due to the increased use of imaging studies worldwide. The issue of how to manage low-risk small PTC has become urgent. In this review, we focus on how to treat low-risk papillary thyroid microcarcinomas (PMCs; i.e., PTCs measuring ≤10 mm).Recent findings Studies of large numbers of patients with low-risk PMC clarified that most of the PMCs did not grow or grew very slowly and were harmless. Active observations of these patients discriminated rare progressive cases from the majority. Surgery performed after the detection of progression signs was not too late, and surgery immediately after the detection and diagnosis of low-risk PMC may be overtreatment for most patients. Interestingly, low-risk PMCs in elderly patients were most unlikely to progress, in sharp contrast to clinical PTC. The reason for this phenomenon remains unknown.Summary Active observation without immediate surgery can be a leading alternative to the classical surgical treatment in the majority of the patients with low-risk PMC. It is not too late to perform surgery after the detection of progression signs for these patients. © 2014 Wolters Kluwer Health.

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