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News Article | February 15, 2017
Site: www.prweb.com

University of Pittsburgh School of Medicine scientists and doctors are embarking on the first-ever clinical trial to determine if a genetic test they pioneered could successfully spare patients with nonaggressive thyroid cancer from complete removal of their thyroid, a butterfly-shaped gland in the neck that is important to hormone regulation and development. Such thyroid-preserving surgery minimizes surgical complications, and many patients also may avoid taking medication every day to keep thyroid hormone levels in check. The two-year trial, which is entirely philanthropically funded by individual donors affected by thyroid cancer, will investigate whether the UPMC-developed molecular genetic test ThyroSeq can correctly differentiate between thyroid cancers most likely to spread and need complete removal of the thyroid gland, and those likely to be far less invasive, warranting a thyroid-preserving surgical approach. “We’re looking at potentially saving patients from unnecessary surgery,” said Linwah Yip, M.D., principal investigator of the trial. “Today we use the most recent developments in cancer genetics to guide treatment for many types of cancers such as breast and colon; we are hoping to safely apply the same approach to thyroid cancer. It’s really exciting to be on the verge of tailoring the extent of thyroid surgery precisely to the aggressiveness of the cancer,” added Yip, an associate professor of surgery in Pitt’s Clinical and Translational Science Institute. About 56,870 cases of thyroid cancer are diagnosed in the U.S. every year, and about 2,010 people die of the disease, according to the American Cancer Society. Under current guidelines of the American Thyroid Association, when patients are diagnosed preoperatively with thyroid cancer, which means a small sample of their thyroid has cancerous cells, they can start by having just half of their thyroid removed. Often, this allows the remaining part of the thyroid to continue functioning naturally without long-term medication. However, a second thyroid operation can then be required if the removed cancer is an aggressive type. Alternatively, under the current guidelines, patients can skip the initial removal of half the thyroid and proceed straight to full removal, but they will definitely need medication for the rest of their lives. “When we get a biopsy result that is positive for cancer before surgery, there are not a lot of tools that we can use to decide with patients which surgery is best,” said Sally E. Carty, M.D., professor of surgery and co-director of the UPMC/University of Pittsburgh Cancer Institute Multidisciplinary Thyroid Center (MTC). “It becomes an educated guess that also is informed by the patient’s preference to either perform a partial removal of the gland and accept a potential repeat surgery if the cancer is found to be aggressive, or to remove the entire thyroid in the initial surgery.” ThyroSeq is a genetic test developed by a scientific team lead by Yuri Nikiforov, M.D., Ph.D., director of UPMC’s Division of Molecular and Genomic Pathology and co-director of the MTC. UPMC’s latest version allows pathologists to simultaneously test 14 genes for 42 markers of thyroid cancer using just a few cells collected during the initial biopsy. The test has performed well at differentiating between cancerous and noncancerous thyroid nodules, already sparing patients from unnecessary surgeries. Over the next two years, Yip and her colleagues plan to enroll about 100 patients who are newly diagnosed with thyroid cancer. Each participant’s biopsy sample will be tested with ThyroSeq to determine whether the cancer has an aggressive or nonaggressive genetic signature. The patients and their doctors can then use that knowledge to decide whether to remove half or the entire thyroid. In addition, the clinical trial also will evaluate the quality-of-life parameters associated with complete removal of the thyroid gland. “I’m particularly passionate about this part of the trial because it will help us to know whether all of our efforts to preserve the thyroid are worth it,” said Yip. “We all want to make sure that patients’ quality of life is considered to truly provide personalized surgical and cancer treatment recommendations.” This trial can be found on ClinicalTrials.gov with the identifier NCT02947035.


News Article | February 15, 2017
Site: www.prweb.com

San Francisco Magazine recently queried area doctors to nominate their choice of best physicians in eight Bay Area counties for 2017. Almost 1,000 nominations were submitted and a little over 500 physicians were selected by the healthcare research company managing the award process. Results were announced in the magazine’s most recent issue. Under the category of Otolaryngology Northern California Medical Associate’s Otolaryngologist Dr. Mark Homicz has been selected for this honor by San Francisco Magazine for two years. This year’s award notes these specialties performed by Dr. Homicz: Dr. Mark Homicz graduated from the prestigious Yale Medical School in 1998 and conducted his internship training in general surgery at Stanford University. He completed a residency in Otolaryngology/Head & Neck Surgery at the University of California, San Diego. Dr. Homicz’s training included an intensive focus on head and neck cancer and thyroid/parathyroid surgery. He has received national awards from the American Academy of Otolaryngology/Head & Neck Surgery, American Academy of Facial Plastic Surgery, and the Triologic Society for academic achievement and research during training. Dr. Homicz joined NCMA and the Santa Rosa Head & Neck Surgical Group in 2004. He is board certified in his field and practices all areas of ENT – Ear, Nose, Throat and Head & Neck Surgery. Particular areas of interest and expertise include thyroid/parathyroid surgery, head and neck cancer, facial plastic/reconstructive surgery, and nasal/sinus surgery. Dr. Homicz also serves as Director of the NCMA Thyroid Center. Santa Rosa Head and Neck Surgical Group (SRHN) offers expertise in the medical and surgical treatment of patients with a wide variety of disorders of the head and neck including; hearing and balance problems, nasal/sinus disease, snoring, voice disorders, and swallowing problems. All SRHN physicians are recognized for their expertise in the management of cancers of the nose, mouth, throat, neck, facial skin, and thyroid. They have also been extensively trained in cosmetic and reconstructive procedures of the face and neck. Listed below is more information on the services offered: NCMA Santa Rosa Health & Neck Surgery is located at 1701 Fourth St. Suite 120 in Santa Rosa, CA. For more information about Dr. Homicz and SRHN surgery, visit our website. Call (707) 523-7025 to make an appointment.


News Article | February 15, 2017
Site: www.prweb.com

Northern California Medical Associates (NCMA) is proud to announce that Redwood Family Dermatology has recently joined their multi-specialty medical group. The dermatology practice provides general dermatologic treatment, outpatient surgery, clinical trials and a full range of cosmetic services. “We’re excited to add this excellent dermatology practice to our group’s medical services,” explains NCMA CEO, Ruth Skidmore. “Our patients benefit with easier referrals, shared health record access and continuity of care. NCMA is well known in Northern California for attracting top level physicians to join it’s elite medical team and NCMA patients recognize and appreciate the premium level of care.” Started in 2002, Redwood Family Dermatology has offices in Sonoma and Mendocino counties. Their four physicians and two certified physician assistants are recognized local leaders in the management of skin health and skin disease by providing the highest level of care and offering outstanding service. These providers offer a full line of dermatology care for patients including adult dermatology, skin cancer screening and treatment, Mohs surgery, cosmetic dermatology, esthetic services, laser hair removal, intense pulsed light treatment, V-Beam laser treatment, excimer laser for psoriasis, BLU-U light treatment and sclerotherapy and clinical research. Redwood Family Dermatology also uses injectables such as Botox® and Dysport® for fine facial lines along with Restylane® and Juvederm® for deep skin folds, facial lines and lip lines. NCMA CEO Ruth Skidmore notes, “In our changing health care landscape, adding this top-level dermatology practice to our existing medical group is very exciting. Local patients will benefit with increased access and providers benefit via our centralized administration and professional practice management model. NCMA handles physician recruitment, billing, contracting, purchasing, collections, human resources, accounting and reporting functions leaving the physicians with more quality time for their patients.” Northern California Medical Associates (NCMA) is the premier provider of medical and surgical care north of the Golden Gate since 1975. NCMA has successfully created a model featuring an independent, multi-specialist group practice that allows their patients access to a sweeping range of medical and surgical services, diagnostic testing and preventive programs. NCMA is owned by the most highly respected primary care physicians and specialists. NCMA’s clinical specialties include centers of excellence in cardiology (comprehensive care, interventional and the HeartWorks rehabilitation program), cardiovascular testing/services, cardiovascular/thoracic surgery, dermatology, endocrinology (incorporating the NCMA Diabetes Center, thyroid disease and osteoporosis treatment), endovascular care (NCMA Vein Center), ENT/otolaryngology (Santa Rosa Head & Neck Surgery, NCMA Allergy Center, NCMA Hearing Center and the NCMA Thyroid Center), family medicine, internal medicine, obstetrics & gynecology (Women’s OB/Gyn Medical Group), orthopedics, podiatry, pulmonary medicine, rheumatology and urology (including Northern California’s only HIFU treatment for prostate cancer). The group serves patients in Sonoma, Lake and Mendocino counties. Redwood Family Dermatology (RFD) was started by Dr. Jeffrey Sugarman as a solo physician. He was later joined by Albert Peng MD, Judith Hong, MD, Ligaya Park, DO, Angela Wyble PA-C and Heather Lowe PA-C. The practice also offers the services of an esthetician, Dionne Ferronato and Tatiana Longoria, RN who provides cosmetics as well as laser services for psoriasis and RFD providers are committed to clinical, professional, ethical, and academic excellence through active engagement in ongoing medical research and education, sensitivity to patients' needs, and community service. In August 2006, RFD opened a satellite office in Ukiah, which provides convenience for coastal area patients. The practice serves patients in Sonoma and Mendocino Counties with office locations in Santa Rosa and Ukiah. For more information about the full range of services offered by Northern California Medical Associates, including dermatology, visit the NCMA website. To make an appointment with Redwood Family Dermatology call: (707) 545-4537 or for more information on NCMA or RFD go to: ncmahealth.com or redwoodfamilyderm.com


PubMed | Thyroid Center and Sungkyunkwan University
Type: Journal Article | Journal: European thyroid journal | Year: 2016

The incidence of childhood thyroid cancer is increasing in several populations; however, contributing factors have not been adequately discussed.Our aim was to identify trends of childhood thyroid cancer based on the Korea Central Cancer Registry (KCCR) database and to elucidate changes in detection methods of cancers using a single-center database.Data from the KCCR and Statistics Korea between 1999 and 2012 were used to calculate the crude incidence of thyroid cancer in children. To analyze detection methods for cancers, pediatric patients (aged 0-19 years, n = 126) who underwent thyroid surgery for thyroid cancers at our institution were identified. Subjects were divided into two groups by detection method: (1) palpation group and (2) screening group.The crude incidence of childhood thyroid cancer increased from 0.5 per 100,000 in 1999 to 1.7 in 2012. The proportion of thyroid cancer among total cancers also increased from 4.4% in 1999 to 10.6% in 2012. Among 126 children from our institution, 91 cases (72%) were identified as palpable neck masses, and the remainder were discovered during imaging studies. The numbers in both groups gradually increased during the study period.The incidence of childhood thyroid cancer has steadily increased in Korea. Regarding the detection methods of cancers, most tumors are detected by palpation rather than screening, although the rate of masses identified during screening has increased.


PubMed | Thyroid Center, Laboratory, V Zilioli and Oncology Institute of Southern Switzerland
Type: | Journal: European journal of endocrinology | Year: 2017

High sensitive thyroglobulin assays (hsTg) has decreased the need for stimulated Tg measurements in patients with differentiated thyroid carcinoma (DTC). However, multiple assays analyzing the same samples may report different values. Accordingly, appropriate assay-specific cut-off levels should be selected in representative patients series. Here we evaluate the role of a new hsTg assay in low to intermediate risk DTC patients and select appropriate assay-specific clinical cut-off limits.This was a retrospective study. The response to treatment was assessed according to ATA.Patients with low to intermediate risk DTC treated and regularly followed-up in our Thyroid Center. Tg was measured on the Kryptor compact Plus instrument (BRAHMS Thermo Fisher Scientific, Henningsdorf, Germany).The study series comprised 201 and excellent response (ER) was demonstrated in 184 (91.5%). Optimized threshold of basal Tg (onT4-Tg) measured 6-12 months after initial treatment was set by ROC curves analysis at 0.28 ng/mL. Having onT4-Tg <0.28 ng/mL at 6-12 months after treatment was associated with longer disease-free survival of Kaplan-Meier (p<0.001), ER at early follow-up [Odds Ratio 165, p<0.001] and absence of relapse during follow-up [Odds Ratio 328, p=0.0001].Patients with low and intermediate risk DTC could be considered cured when they have onT4-Tg levels <0.28 ng/mL coupled with negative imaging at their first post-ablation visit.


Stack Jr. B.C.,University of Arkansas for Medical Sciences | Stack Jr. B.C.,Thyroid Center | Moore E.,University of Arkansas for Medical Sciences | Spencer H.,UAMS | And 2 more authors.
Otolaryngology - Head and Neck Surgery (United States) | Year: 2013

Objective. Describe data from patients undergoing outpatient thyroid surgeries for benign and malignant disease at academic medical centers in the United States. Study Design. Retrospective database search. Setting. The University Health System Consortium (UHC), Oak Brook, Illinois, data compiled from discharge summaries. Subjects and Methods. Discharge data were collected from the first quarter of 2005 through the fourth quarter of 2010. Searching strategy was based on diagnosis of thyroid disease and patients undergoing thyroid surgery across all UHC facilities. Demographic information was collected as well as charges. Complications were also evaluated in this analysis. Results. During the study period, 38,362 outpatient thyroidectomies were performed from our sample, 32% for thyroid cancer. More total thyroidectomies (43%) and fewer hemithyroidectomies (36%) were being performed overall; 64.1% of patients stayed 23 hours. Conclusion. This is one of the largest series reporting outcomes for outpatient thyroid surgery. Since these surgeries appear to be shifting to an outpatient setting, this report reflects the experience with the majority of endocrine surgeries from the UHC database being performed presently. These results are derived from teaching hospitals and their affiliates and may not reflect the entirety of thyroid surgery in the United States. © 2013 American Academy of Otolaryngology-Head and Neck Surgery Foundation.


Stack Jr. B.C.,University of Arkansas for Medical Sciences | Stack Jr. B.C.,Thyroid Center | Spencer H.,UAMS | Moore E.,University of Arkansas for Medical Sciences | And 2 more authors.
Otolaryngology - Head and Neck Surgery (United States) | Year: 2012

Objective. To determine demographics and cost for outpatients undergoing parathyroid surgery at hospitals belonging to the University Health System Consortium (UHC). Study Design. UHC data were accessed in 2011 and reflected data collected from 2005 through 2010 (24 quarters). Searching strategy was based on diagnoses of parathyroid disease and patients undergoing parathyroidectomy across all UHC member facilities. Complications evaluated in this analysis included: hypocalcemia, hypoparathyroidism, aspiration pneumonia, hematoma, wound infection, stroke, myocardial infarction, deep venous thrombosis/pulmonary embolism (PE), and death. Setting. The University Health System Consortium, Oak Brook, Illinois, was formed in 1984 and consists of 112 academic medical centers and 250 of their affiliated hospitals. This represents 90% of the nonprofit academic medical centers in the United States (www.uhc.edu). Subjects and Methods. Patients enrolled in the UHC database were studied retrospectively. Data were compiled from discharge summaries into a secure, interactive, Web-based database. The outpatient data collection set has been a recent addition to the originally established UHC inpatient discharge database. Results. There were 21,057 patients who had outpatient parathyroid surgery. The average age was 59.0 (0.8-96.2) yrs. Seventy-six percent of patients were female. Outpatient parathyroidectomy had lower charges than inpatient surgery ($12,738 and $14,657, respectively; P = 0.004, Wilcoxon signed-rank test). Complications were low but were likely underreported. Conclusion. Parathyroid surgery is increasingly being done in the outpatient setting in the United States. By virtue of omitting inpatient hospitalization, the outpatient approach becomes a more economical way to manage parathyroid disease. This is the largest known series reporting experience with outpatient parathyroid surgery. © 2012 American Academy of Otolaryngology-Head and Neck Surgery Foundation.


Rutledge J.,University of Arkansas for Medical Sciences | Siegel E.,University of Arkansas for Medical Sciences | Belcher R.,Emory University | Bodenner D.,University of Arkansas for Medical Sciences | And 3 more authors.
Otolaryngology - Head and Neck Surgery (United States) | Year: 2014

Objective. Describe barriers to same-day surgery for patients undergoing total and completion thyroidectomy. Study Design. Case series with chart review. Setting. Academic health sciences center. Subjects and Methods. The subjects were patients who underwent total thyroidectomy or completion thyroidectomy and remained in hospital overnight or longer. A review was performed on patients who were operated on by a single surgeon from July 2005 through June 2013. Results. Two hundred and sixty-eight cases were planned for same-day surgery. One hundred patients were not discharged on the same day (37%). Patients observed overnight or admitted to hospital had significantly lower postoperative calcium levels, 8.4 mg/dL (P < .0001), and lower intraoperative parathyroid hormone (PTH), mean 6.0 pg/mL (P <.0001). Those significantly more likely to require overnight observation were male patients (P = .0117), black patients (P = .0045), those with completion thyroidectomy (P = .0039), and those with a complication of surgery (P = .003). Conclusion. Intraoperative PTH less than 10 pg/mL was the most frequent factor (25.7%) precluding same-day discharge, followed by admission for social/financial/transportation reasons (22.6%), large dead space from goiter (15.5%), multiple comorbidities (13.4%), multiple surgical reasons (5.2%), airway observation (5.2%), pain management (3.1%), and intractable nausea due to general anesthetic (2.1%). Hypocalcemia and postoperative bleeding still remain obstacles to outpatient thyroid surgery; however, the use of rapid PTH testing, modern hemostatic techniques, appropriate calcium prophylaxis, and experienced clinical decision making can effectively stratify which patients require overnight observation. © American Academy of Otolaryngology-Head and Neck Surgery Foundation 2014.


Marino M.,University of Arkansas for Medical Sciences | Spencer H.,UAMS | Hohmann S.,University of Chicago | Bodenner D.,Thyroid Center | And 2 more authors.
Otolaryngology - Head and Neck Surgery (United States) | Year: 2014

Objective. To compare the cost of same-day vs 23-hour observation outpatient thyroidectomy at US academic medical centers. Study Design. Cross-sectional analysis of a national database. Setting. The University HealthSystem Consortium (UHC) data collected from discharge summaries. Subjects and Methods. Discharge data were collected from the first quarter of 2009 through the second quarter of 2013. The UHC database, compiled from more than 200 affiliated hospitals, was searched based on diagnosis codes for outpatient thyroid procedures. Cost data, calculated based on reported charges, were collected in addition to demographics. Comparisons were made between same-day vs 23-hour observation based on cost. Additional stratification was performed based on the extent of thyroidectomy. Results. During the study period, 49,936 outpatient thyroidectomies were performed. Overnight observation (63%) was more common than same-day discharge (37%). The overall mean cost of outpatient thyroidectomy was $5617, with a mean cost of same-day surgery of $4642 compared with $6101 for overnight observation (P <.0001). When stratifying by extent of thyroidectomy, the cost of same-day surgery was consistently lower than that for overnight observation. Conclusion. Outpatient thyroidectomy is commonly performed in the United States. It is most commonly performed on a 23-hour overnight observation basis. Overnight stay and complications were chief among other factors associated with higher cost, independent of the type of thyroid procedure performed. In appropriately selected patients, same-day thyroidectomy is a safe and cost-effective alternative to overnight observation or inpatient thyroid procedures. © American Academy of Otolaryngology-Head and Neck Surgery Foundation 2014.


Rothman I.N.,University of Arkansas for Medical Sciences | Middleton L.,University of Arkansas for Medical Sciences | Stack Jr. B.C.,University of Arkansas for Medical Sciences | Stack Jr. B.C.,Thyroid Center | And 5 more authors.
European Archives of Oto-Rhino-Laryngology | Year: 2011

Positron emission tomography (PET) positive lesions are common in the thyroid. The uptake can be focal or diffuse. Diffuse thyroid uptake is thought to be indicative of autoimmune thyroiditis and not for lesions of malignant potential. Hashimoto's thyroiditis as a cause for diffusely positive thyroid glands has been demonstrated. We determine the incidence of diffuse thyroid PET positivity in hypothyroid patients, presumed to have Hashimoto's thyroiditis. The study design was retrospective database and electronic medical record review. The study setting includes tertiary care and academic health sciences center. The subjects were patients at our medical center who underwent positron emission tomography. Hypothyroid patients were identified who had total body PET imaging performed for any reason. Patients were excluded if they were not taking levothyroxine, had a history of neck surgery, neck irradiation, Graves' disease, taking lithium, thalidomide, amiodarone or interleukin. Patients remaining after the application of these exclusion criteria were presumed to be hypothyroid from Hashimoto's thyroiditis. Only 9.5% of PET scans of hypothyroid patients display diffuse thyroid activity. Only a small minority of presumed Hashimoto's thyroiditis patients will display diffuse thyroid activity after PET imaging. The etiology of this effect is unknown. Diffuse thyroid activity rarely requires surgical intervention. Level of evidence: IV. © 2011 Springer-Verlag.

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