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Calcitonin (CT) is a sensitive marker for medullary thyroid carcinoma. Normalization of early postoperative CT level is a favorable prognostic factor. The aim of this study was to establish the prognostic value of CT-level kinetics by preoperative tumor stage and postoperative elimination rate. Blood serum from 22 medullary thyroid carcinoma (MTC) patients without remote metastases was assayed. A commercial RIA DSL-1200 test was used to assay CT levels. Basal CT< or =42 pg/ml and stimulated CT< or =120 pg/ml were considered normal. The patients were divided into three groups according to the intensity of the postoperative CT level reduction in blood serum. Group 1 comprised patients who showed basal CT normalization within the first 2-3 days after surgery. Group 2 included those patients with slow (from 2 to 4 weeks) CT-level normalization. Group 3 included patients with CT levels that reduced within 14 days, but subsequently increased. Preoperative basal CT varies from 216 to 1654 pg/ml and depends on tumor-node-metastasis (TNM) stage. In seven patients, no basal CT decrease to normal values was observed; in five of these patients, disease recurrence was detected 2-6 months after surgery. In the group with slowly decreasing CT levels, no strong correlation between preoperative CT level and the postoperative time to normalization of basal and peak CT could be established; this may be due to the small number of patients. Our study showed that preoperative CT level depended on the disease stage. Postoperative CT elimination rate is independent of preoperative CT level. Postoperative increase in the basal or stimulated CT level is an unfavorable prognostic factor, implying disease recurrence.
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Introduction Thyroid carcinoma is the most common malignant tumor in the endocrine system with a rising incidence worldwide ( Lim et al. 2017 ). Although differentiated thyroid carcinoma (DTC) including papillary thyroid carcinoma (PTC) and
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Endocrine Genetics Unit (Laboratório de Investigação Médica/LIM-25) of Hospital das Clínicas, Nursing School, School of Public Health, Human Genome Research Center, Division of Genetics, Division of Endocrinology, Brazilian National Laboratory of Biosciences, Centro Integral Oncológico Clara Campal, Department of Genetics, Endocrinology Division, Laboratory of Epidemiology and Population Sciences, University of São Paulo School of Medicine, São Paulo, São Paulo 05403-010, Brazil
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Introduction MEN2 (MIM #164761) is a dominantly inherited multiglandular tumour syndrome that presents with a high penetrance of medullary thyroid carcinoma (MTC; observed in virtually 100% of cases), phaeochromocytoma (50%) and parathyroid adenoma
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Abstract
Despite the usual excellent prognosis of differentiated thyroid carcinoma, some patients die because of disease. It has been speculated that lethal disease may have a better prognosis if patients are treated with extensive surgery plus 131I ablative treatment. We have analyzed a group of 223 patients with differentiated thyroid carcinoma treated under a uniform therapeutic protocol of surgery and followed for 3 to 17.7 years, in order to differentiate patients with a high and a low risk of mortality and the influence of therapy on survival rate.
The therapeutic protocol was as follows. If the diagnosis was papillary carcinoma, subtotal thyroidectomy was performed and cervical nodes were removed if they were suspicious for cancer. If the diagnosis was follicular carcinoma, a total thyroidectomy was performed. 131I was given in cases of patients who were more than 60 years old or who had extrathyroid disease or metastases in papillary carcinomas and in macroangioinvasive follicular carcinomas. In survival analysis, the event used as the end-point was death due to thyroid carcinoma and summarized by the Kaplan-Meier curve and the Mantel-Cox method.
We found three independent prognostic factors which determined mortality: over 60 years of age, tumor size larger than 6 cm and metastases. On the basis of these factors we identified two risk groups: a low-risk group (A), who had no risk factors, composed of 153 patients whose survival rate at 205 months was 100% and a high-risk group (B), who had one or more risk factors, composed of 55 patients whose survival rate at 213 months was 39.6%. Seventeen patients in this second group died from thyroid carcinoma. We therefore analyzed the effect of treatment in group B. Patients who had more extensive surgery had a similar survival rate to those who had less extensive surgery and 131I administration did not modify the survival rate.
These data support the idea that the identification of low-risk groups may facilitate a more rational approach to treatment of differentiated thyroid carcinoma, avoiding aggressive therapy in cases with a good prognosis.
Endocrine-Related Cancer (1997) 4 459-464
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Introduction Medullary thyroid carcinoma (MTC) originates from parafollicular cells of the thyroid and is characterized by the secretion of calcitonin and carcinoembryonic antigen. Unlike differentiated thyroid carcinoma, endocrine suppressive
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Introduction Papillary thyroid carcinoma (PTC) is the most frequent malignancy of the thyroid, accounting for 1% of all human malignancies. In general terms, it has a good prognosis and high cure rates are achieved after initial
UETeM (Unidade de Enfermedades Tiroideas e Metabolicas), Endocrinology Division, Department of Physiology, IPATIMUP (Institute of Molecular Pathology and Immunology, Endocrinology Section, Molecular Endocrinology Group, Department of Pathology, Department of Pathology, Department of Medicine, School of Medicine, University of Santiago de Compostela, Santiago de Compostela 15705, Spain
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UETeM (Unidade de Enfermedades Tiroideas e Metabolicas), Endocrinology Division, Department of Physiology, IPATIMUP (Institute of Molecular Pathology and Immunology, Endocrinology Section, Molecular Endocrinology Group, Department of Pathology, Department of Pathology, Department of Medicine, School of Medicine, University of Santiago de Compostela, Santiago de Compostela 15705, Spain
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UETeM (Unidade de Enfermedades Tiroideas e Metabolicas), Endocrinology Division, Department of Physiology, IPATIMUP (Institute of Molecular Pathology and Immunology, Endocrinology Section, Molecular Endocrinology Group, Department of Pathology, Department of Pathology, Department of Medicine, School of Medicine, University of Santiago de Compostela, Santiago de Compostela 15705, Spain
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Introduction Well-differentiated thyroid carcinomas causing thyrotoxicosis are a rare event ( Paul & Sisson 1990 ), and mostly result from bulky metastases that produce an excess of thyroid hormone ( Paul & Sisson 1990 ). Nevertheless, some cases of
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Introduction Papillary thyroid carcinoma (PTC) is the most common type of endocrine tumor, with an annual incidence of two to four per 100 000 individuals. Among several oncogenes, RET ( Santoro et al. 1992 , Bongarzone et al
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Introduction Anaplastic thyroid carcinoma (ATC) is one of the most aggressive human malignancies, responsible for up to 40% of mortality from thyroid cancer. Although multimodality treatments are successfully applied for well-differentiated thyroid