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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. Source

De Groot L.,University of Rhode Island | Abalovich M.,Favaloro University | Alexander E.K.,Harvard University | Amino N.,Kuma Hospital. | And 9 more authors.
Journal of Clinical Endocrinology and Metabolism | Year: 2012

Objective: The aim was to update the guidelines for the management of thyroid dysfunction during pregnancy and postpartum published previously in 2007. A summary of changes between the 2007 and 2012 version is identified in the Supplemental Data (published on The Endocrine Society's Journals Online web site at http://jcem.endojournals.org). Evidence:This evidence-based guideline was developed according to the U.S. Preventive Service Task Force, grading items level A, B, C, D, or I, on the basis of the strength of evidence and magnitude of net benefit (benefits minus harms) as well as the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system to describe both the strength of recommendations and the quality of evidence. Consensus Process: The guideline was developed through a series of e-mails, conference calls, and one face-to-facemeeting. An initial draft was prepared by the Task Force, with the help of a medical writer, and reviewed and commented on by members of The Endocrine Society, Asiaand Oceania Thyroid Association, and the Latin American Thyroid Society. A second draft was reviewed and approved by The Endocrine Society Council. At each stage of review, the Task Force received written comments and incorporated substantive changes. Conclusions: Practice guidelinesarepresentedfordiagnosisandtreatmentofpatientswiththyroid-related medical issues just before and during pregnancy and in the postpartum interval. These include evidence-ased approaches to assessing the cause of the condition, treating it, and managing hypothyroidism, hyperthyroidism, gestational hyperthyroidism, thyroid autoimmunity, thyroid tumors, iodine nutrition, postpartumthyroiditis,andscreening for thyroid disease. Indicationsandside effects of therapeutic agents used in treatment are also presented. Copyright © 2012 by The Endocrine Society. Source

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. Source

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. Source

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. Source

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