Clinical Thyroidology for Patients

Clinical Thyroidology for Patients is a collection of summaries of recently published articles from the medical literature that covers the broad spectrum of thyroid disorders.

Starting with the May 2009 issue, Clinical Thyroidology for Patients will be published on a monthly basis and include summaries of research studies that were discussed in the previous month’s issue of Clinical Thyroidology, a publication of the American Thyroid Association for physicians. Dr. Mazzaferri is the Editor-in-Chief of Clinical

Current Issue – August 2009 Volume 2 Issue 4

Now available in pdf format for saving and printing and Web page format for viewing online

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Clinical Thyroidology for Patients August 2009 Volume 2 Issue 4 (PDF file, 371 KB)


Editor’s Comments

THYROID CANCER While most patients with thyroid cancer do well and do not die from their cancer, a small number of patients are not cured with the usual regimen of surgery and radioactive iodine and have cancers that spread and continue to grow. In the past, there was little to offer these unfortunate patients as there had been no effective chemotherapy drugs. Sorafanib is a new drug that has been shown to have some effect on metastatic thyroid cancer that does not respond to radioactive iodine. This study reports the results of a Phase II clinical trial of Sorafenib in patients with metastatic thyroid cancer.
Kloos RT, Ringel MD, Knopp MV, Hall NC, King M, Stevens R, Liang J, Wakely PE Jr, Vasko VV, Saji M, Rittenberry J, Wei L, Arbogast D, Collamore M, Wright JJ, Grever M, Shah MH. Phase II trial of sorafenib in metastatic thyroid cancer. J Clin Oncol 2009;27:1675–84.
(PDF File for saving and printing, 101 KB)

ANTI-THYROID MEDICATION Methimazole is an antithyroid medication that is frequently used to treat hyperthyroidism due to Graves’ disease. Methimazole is usually a well-tolerated and safe drug, but on rare occasions, serious side effects can occur. The most serious side effect is called agranulocytosis, which may occur in 1 in 500 – 1000 patients. This is when the number of infection-fighting white blood cells in the blood decreases and cause the patient to be more likely to get an infection. This study attempts to see if agranulocytosis is more common in patients on 30 mg of Methimazole as compared to 15 mg of the drug.
Takata, K., Kubota S, Fukata S., Kudo T, Nishihara E, Ito M, Amino N, Miyauchi A. Methimazole-induced agranulocytosis in patients with Graves’ disease is more frequent with an initial dose of 30 mg daily than with 15 mg daily. Thyroid 2009; 19: 559–63.
(PDF File for saving and printing, 97 KB)

THYROID NODULES Thyroid nodules are extremely common in adults, occurring in about half of the population according to some studies. Since about 5% of thyroid nodules are cancer, it is important to determine which nodules should undergo a fine needle aspiration biopsy. Guidelines developed by the American Thyroid Association indicate that the best way to initially evaluate thyroid nodules is to perform an ultrasound examination of the thyroid. This study examines what ultrasound features are most helpful in selecting which nodules should be biopsied and which nodules are more likely to be benign (non-cancerous).
Popowicz B, Klencki M, Lewinski A, Slowinska-Kiencka D. The usefulness of sonographic features in selection of thyroid nodules for biopsy in relation to the nodule’s size. Eur J Endocrinol 2009;161:103–11.
(PDF File for saving and printing, 99 KB)

THYROID CANCER Papillary microcarcinoma is a form of thyroid cancer where the cancer is very small (<1 cm). Since very few patients with Papillary microcarcinoma will die from their cancer, it is not clear how aggressive treatment should be for these patients. In larger thyroid cancers, there are features of the cancer that are known risk factors for recurrence of the cancer. This study looked at how common one or more of these findings were found in papillary microcarcinomas and whether these risk factors were associated with cancer recurrence in these smaller cancers.
Arora N, Turbendian HK, Kato MA, Moo TA, Zarnegar R, Fahet TJ. Papillary thyroid carcinoma and microcarcinoma: is there a need to distinguish the two? Thyroid 2009;19:473–77 .
(PDF File for saving and printing, 99 KB)

THYROID NODULES Thyroid nodules occur in about 1–2% of children and adolescents. Fine needle aspiration biopsy (FNAB) is a procedure commonly used to evaluate patients with thyroid nodules to determine if these nodules are cancerous. Some studies in adults have shown that when FNAB is done with the help of an ultrasound machine (US-FNAB), the accuracy is better than if the sample is obtained guided only by palpation of the nodule. No information is available regarding the usefulness of this method in children. This study looks at the value of US-FNAB in the evaluation and treatment of children with thyroid nodules.
Izquierdo R, Shankar R, Kort K, Khurana K. Ultrasound-guided fine-needle aspiration in the management of thyroid nodules in children and adolescents. Thyroid 2009;19:703–5.
(PDF File for saving and printing, 118 KB)