Anaplastic thyroid carcinoma developed after treatment of "hot" thyroid nodule with radioiodine]

A case of 55 years old woman with "hot" right lobe toxic thyroid nodule, presenting with paroxysmal atrial fibrillation, and therefore treated with 131I 666MBq (18 mCi) is described. After six years she became pyrexic and suffered of severe cough proxyisms. The fine needle biopsy of the above nodule showed the presence of anaplastic thyroid carcinoma. Strumectomy followed by local radiotherapy resulted in complete disappearence of all symptoms. The microscopic of the removed thyroid tissue confirmed the above diagnosis. After 22 months' observation the patient remained in good general condition. The possible reasons for the development of the thyroid carcinoma in this case are discussed.     

Role of the hypophysis in thyroid regeneration after partial thyroidectomy.

The role of the hypophysis in thyroid regeneration was investigated by measuring the mitotic activity of the thyroid remnant in hemithyroidectomized rats as well as the blood levels of thyroid hormone at various time-intervals after hemithyroidectomy. Mitotic activity underwent a significant increase to reach a peak (a 5- to 8- fold increase) 2 days after hemithyroidectomy. The thyroid hormone level in blood was lower than in controls. Histologically, the thyroid gland showed signs of an elevated rate of functional activity, as indicated by losses of colloid and cell hypertrophy. In a second approach, the mitotic activity of the thyroid remnant was estimated in hypophysectomized and in thyroxine treated rats. Both hypophysectomy and thyroxine injection prevented occurrence of the mitotic peak at 2 days. The regeneration of the thyroid after hemithyroidectomy, as it occurred in the present work, may be explained by a release of thyroid stimulating hormone from the pituitary, brought about by the low level of circulating thyroid hormone, itself resulting from a loss of thyroid tissue.     

Fine needle aspiration of the hot thyroid nodule

The use of fine needle aspiration (FNA) cytology in the evaluation of solitary hot thyroid nodules was examined in 24 patients. Satisfactory FNA specimens were obtained from 22 patients. None of the cytologic samples was considered malignant or suspicious for malignancy. The cytologic findings were indeterminate in one instance--a smear with follicular features. The smears from the other 21 patients were judged to be benign. If FNA had been used as the initial diagnostic step, the need for a thyroid scan would thus perhaps have been avoided in 21 of the 24 patients. These results support the idea that FNA is the most effective procedure in the evaluation of the solitary thyroid nodule, whether functional or not.     

Ultrasonographic and scintigraphic studies of "hot" autonomic thyroid nodules

Scintigraphic and gammagraphic (gamma-camera) techniques have been applied in diagnosing "hot" non-TSH dependent thyroid nodules. On the basis of frequent uneven accumulation of isotopic tracer observed in scintigraphic studies it was concluded that the structure of these nodules is heterogeneous. In some cases paradoxical patterns have been obtained following the dynamic tests of suppression and stimulation of the thyroid: after the administration of thyroid preparations paranodular thyroid tissue appears, while TSH administration causes an increase in the iodine uptake by the nodule. Ultrasonographic and gamma-camera studies have been carried out in 50 cases of "hot" autonomic thyroid nodules previously diagnosed by scintigraphy. Ultrasonographic studies revealed a weaker echogenicity in some cases and an intensified echo in the other. Sometimes by using this technique it was possible to demonstrate the occurrence of heterogeneous structures suggesting a cystic degeneration of the nodule. Paranodular thyroid tissue, invisible in scintigraphic scanning, could usually be observed by applying gamma-camera. It was concluded that both gamma camera and ultrasonographic studies confirm heterogeneous structure of intranodular tissue producing paradoxical patterns in scintigraphic scanning, with the latter technique usually aiding the detection of paranodular thyroid tissue without the necessity of application of the TSH test.     

Influence of the endogene TSH stimulation of thyroid volume increase in the patients after total thyroidectomy due to differentiated thyroid cancer

INTRODUCTION: The treatment-of-choice for differentiated thyroid carcinoma (DTC) is a total thyroidectomy with subsequent radioiodine therapy. In order to increase an iodine uptake in thyroid tissue remnants, the L-thyroxine withdrawal is required. It is recommended to achieve TSH levels higher than 25 mU/ml. As TSH is a known key factor in thyroid cell proliferation regulation, prolonged stimulation of the cells during L-thyroxine withdrawal can be a causative factor for a re-growth. Our aim was to assess the degree of thyroid re-growth in the patients after total thyroidectomy due to DTC and its possible clinical implications. MATERIAL AND METHODS: 23 patients operated due to papillary and follicular thyroid cancer were included into the study. Biochemical determinations and ultrasound thyroid imaging were performed (TSH, Tg) during suppressive L-thyroxine therapy as well as 4-5 weeks after the withdrawal. RESULTS: The mean volume of thyroid tissue remnants increased after withdrawal for substantial 30.1%. The difference was extremely significant. CONCLUSIONS: L-Thyroxine withdrawal in the patients after total thyroidectomy due to DTC can cause re-growth of the tissue remnants. The phenomenon may be of a clinical significance in the selected cases influencing therapeutic decisions.     

The relationship between the structure and activity of rat skeletal muscle mitochondria after thyroidectomy and thyroid hormone treatment

The fine structure of rat gastrocnemius muscle fibers has been studied after changes were induced in the basal metabolic rate (BMR) by thyroidectomy and L-thyroxine administration under anabolic conditions. Biochemical analysis of skeletal muscle mitochondrial respiration and phosphorylation from the same tissue preparations has been summarized, details having been published earlier (3). As estimated from electron micrographs, the total amount of mitochondria from thyroidectomized animals was enlarged 1.5 times over that from normal controls. The total amount of mitochondria from thyroidectomized or normal animals made hypermetabolic with thyroxine was increased 2.5 to 3.5 times over that from their corresponding controls. In all cases, there was an increase in the mitochondrial population and the profile ratio of cristae to matrix was also considerably increased, thus indicating both relative and absolute enlargements of the entire surface of the cristae per unit fiber. The major structural changes persisted for at least 3 weeks after the cessation of thyroxine treatment, by which time the elevated mitochondrial respiratory and phosphorylative activity had declined to normal values. The hypertrophy and increase in mitochondrial population was more prominent in the perinuclear and subsacrolemmic regions near blood vessels than in the interstices of the fibrils. The very long interfibrillar mitochondria found in both the hypo- and hypermetabolic tissues are more likely to be derived from outgrowths of the original mitochondria rather than from a fusion of smaller ones. These findings are compatible with the ideas expressed elsewhere (see 1, 3, 10) that, under conditions close to the physiological, thyroid hormones control mitochondrial metabolic activity by a subtle alteration in mitochondrial composition with respect to their respiratory and phosphorylative constituents. The possible application of using thyroid hormones in the study of biogenesis of mitochondria and the synthesis of mitochondrial constituents are discussed.