[Show abstract][Hide abstract] ABSTRACT: Context: It is normally recognised that the preferred treatment in large toxic thyroid nodules should be thyroidectomy Objective: To assess the efficacy of combined laser ablation treatment (LAT) and radioiodine-131 (131I) treatment of large thyroid toxic nodules with respect to rapidity of control of local symptoms, of hyperthyroidism and of reduction of 131I administered activity in patients at refusal or with contraindications to surgery. Design and Setting: Pilot study at a single centre specialised in thyroid care. Patients: Fifteen patients were treated with LAT followed by 131I (Group A); a series of matched consecutive patients were treated by 131I only (group B). Intervention(s). Laser energy was delivered with an output power of 3W (1800 J per fiber per treatment) through two 75mm, 21-gauge spinal needles. Radioiodine activity was calculated to deliver 200 Gy to the hyperfunctioning nodule. Main Outcome Measure(s): Thyroid function, TPOAb and TgAb, US and local symptoms were measured at baseline and up to 24 months. Results: Nodule volume reduction at 24 months was: 71.3±13.4 vs 47.4±5.5 %; Group A (LAT+131I) vs Group B (131I) respectively, p<0.001). In Group A (LAT+131I) a reduction in radioiodine administered activity was obtained (-21.1% ± 8.1 %). Local symptom score demonstrated a more rapid reduction in Group A (LAT+131I). In three cases no 131I treatment was needed after LAT. Conclusions: In this pilot study combined LAT/131I treatment induced faster and greater improvement of local and systemic symptoms compared to 131I only. This approach seems a possible alternative to thyroidectomy in patients at refusal of surgery.
The Journal of Clinical Endocrinology and Metabolism 03/2014; 99(7):jc20132967. DOI:10.1210/jc.2013-2967 · 6.21 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The aim of this study was to define, retrospectively, the utility to perform (99m)Tc-EDDA/HYNIC-Tyr3-octreotide ((99m)Tc-EDDA/HYNIC-TOC) scan in patients with NET. We studied 50 consecutive patients affected by different types of NET and divided in two groups. Group 1: 34 patients with known lesions in which (99m)Tc-EDDA/HYNIC-TOC was performed for staging, characterisation or to choose the appropriate treatment. Group 2: 16 patients suspected of having NET or in follow up after surgery. Patients were injected with 370 MBq of (99m)Tc-EDDA/HYNIC-Tyr3-octreotide and whole-body and SPET images acquired 2-3 hours after injection. Overall, 29 patients (58%) had a positive scan, with a sensitivity, specificity and accuracy of 70.3%, 76.9% and 72%, respectively (78.1%, 50% and 76.5%, in group 1 and 20%, 81.2%, 62.5% in group 2). In patients from group 1 (99m)Tc-HYNIC-TOC scintigraphy showed a concordance of 68% with another imaging procedure and in 9 patients revealed a greater number of lesions. In the second group, false negative results were especially found in patients with medullary thyroid cancer with negative radiological findings and elevated calcitonin. In conclusion, (99m)Tc-EDDA/HYNIC-TOC is highly indicated for in vivo histological characterization of known NET lesions, previously identified by other imaging modalities or biopsy, to plan appropriate therapy especially for patients with inoperable disease. In patients with only biochemical suspicion of NET and in those with negative markers, this scintigraphy does not significantly modify the clinical management.
The quarterly journal of nuclear medicine and molecular imaging: official publication of the Italian Association of Nuclear Medicine (AIMN) [and] the International Association of Radiopharmacology (IAR), [and] Section of the Society of.. 11/2010; 56(1):90-8. · 2.03 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: (a) To compare the efficacy of low-activity (2 GBq; 54 mCi) (131)I ablation using l-thyroxine withdrawal or rhTSH stimulation, and (b) to assess the influence of thyroid remnants volume on the ablation rate.
Patients underwent neck ultrasound, (131)I neck scintigraphy and radioiodine uptake. Post-therapy whole body scan (WBS) was acquired after 4-6 days. Ablation was assessed after 6-12 months by WBS, Tg and TgAb following l-thyroxine withdrawal.
Group A: preparation by L-T(4) withdrawal (37 days); 21 patients received (131)I (2.02+/-0.22 GBq; 54.6+/-5.9 mCi) and on the day of treatment, TSH, Tg, TgAb were measured; Group B: stimulation by rhTSH; 21 patients received (131)I (1.97+/-0.18 GBq; 53.2+/-4.9 mCi) 24 h after the second injection of rhTSH (0.9 mg) and TSH, Tg and TgAb were measured after 2 days.
At follow-up, 90.0% of patients from group A and 85.0% of patients from group B had Tg levels <1 ng/ml; no uptake was observed in 95.2% and in 90.5% of patients from group A or B respectively, with no statistical differences for both ablation criteria. Before (131)I treatment, small thyroid remnants (<1 ml) were detected by US in <25% of all patients.
The use of rhTSH for the preparation of low-risk patients to ablation therapy with low activities of (131)I (2 GBq; 54 mCi) is safe and effective and avoids hypothyroidism. The presence of thyroid remnants smaller than 1 ml at US evaluation had no effect on the ablation rate.
European Journal of Endocrinology 12/2008; 160(3):431-6. DOI:10.1530/EJE-08-0669 · 4.07 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Apraxia of speech (AOS) is a rare disorder of motor speech programming, and few case reports have included sufficient description of both clinical findings and lesion localization. We report a case with an isolated progressive speech articulation deficit and brain involvement restricted to the left superior frontal gyrus. This case suggests that slowly progressive AOS may be a clinical disorder distinct from primary progressive aphasia, and that it can occur without language disorders or bucco-facial apraxia. Our findings highlight the importance of the left hemisphere in speech articulatory deficits and suggest that the left superior frontal gyrus plays a crucial role in specific articulatory processes.
[Show abstract][Hide abstract] ABSTRACT: We report the case of a 59 years old woman affected by lung and joint sarcoidosis, secondary Sjogren's syndrome refractory to common disease-modifying antirheumatic drugs (DMARDs) that regressed with infliximab and methotrexate. 99mTc-HYNIC-TOC scintigraphy was useful in diagnosis, choice of treatment and follow-up.
European review for medical and pharmacological sciences 11/2007; 12(2):127-30. · 1.21 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Inversion of gated myocardial perfusion imaging has been proposed for the evaluation of left ventricular function. This study compared the results of inversion technique of gated left anterior oblique 45 degrees images (G-LAO 45 degrees) with those provided by equilibrium radionuclide angiography in the assessment of global left ventricular function in the same patients with suspected or known coronary artery disease.
A total of 107 patients (85 men and 22 women, mean age 59 +/- 9 years) with suspected or documented coronary artery disease were studied. Eighty-seven underwent a 2-day stress/rest technetium-99m sestamibi single photon emission computed tomography with acquisition of G-LAO 45 degrees images on the day of rest, and 20 underwent thallium-201 stress/redistribution single photon emission computed tomography with G-LAO 45 degrees image acquisition immediately after redistribution imaging. An excellent correlation (P < .001) with no significant differences was found between left ventricular ejection fraction values provided by inversion G-LAO 45 degree and radionuclide angiography in 87 patients studied with Tc-99m sestamibi and 20 patients studied with TI-201. The Bland-Altman analysis demonstrated the difference in absolute ejection fraction values obtained by inversion G-LAO 45 degree images and radionuclide angiography as <8%. The inversion G-LAO 45 degrees left ventricular ejection fraction distinguishes the patients with myocardial infarction (ejection fraction = 43% +/- 13%) and without myocardial infarction (ejection fraction = 60% +/- 5%) (P < .001). In patients with left ventricular ejection fraction <40%, inversion G-LAO 45 degree images provide evaluation of left ventricular function comparable with that obtained by RNA.
Semiautomated myocardial perfusion gated inversion technique analyzed with a count-based method is useful in the evaluation of left ventricular function and provides similar results to those of radionuclide angiography.
[Show abstract][Hide abstract] ABSTRACT: Liver metastases from differentiated thyroid tumors are unusual clinical findings, and are only rarely hyperfunctioning. We report a case of thyrotoxicosis caused by a huge and surgically unresectable liver metastasis from follicular thyroid cancer, unresponsive to treatment with large doses of thionamides. To avoid the hazardous side effects of (131)I treatment in a severely thyrotoxic patient, a preliminary debulking of the liver mass was performed by means of percutaneous interstitial laser photocoagulation. Three treatments (total energy delivery: 7200 J) were performed under ultrasound guidance, with no serious complications, during a 2-week period. One month later, serum thyroid hormones had decreased, general condition was improved, and magnetic resonance evaluation revealed large and well-defined areas of necrosis of metastatic tissue. During the following 10 months, the patient underwent 3 radioiodine treatments. Eighteen months after diagnosis, thyroid hormones were within normal levels, liver mass decreased, and the clinical condition markedly improved. The combination of percutaneous interstitial laser photocoagulation treatment and radioiodine therapy made possible the effective management of a hyperfunctioning and surgically untreatable liver metastasis from thyroid follicular carcinoma, avoiding the side effects of (131)I therapy in a thyrotoxic patient and increasing the effectiveness of radioiodine-induced neoplastic tissue ablation.
[Show abstract][Hide abstract] ABSTRACT: This study compared serum thyroglobulin measurement and whole-body scans in the post-surgical follow-up of patients with differentiated thyroid carcinoma. Thyroglobulin levels were measured in 61 patients receiving L-thyroxine therapy after thyroidectomy, and again after suspension of therapy, before performing a whole-body scan with iodine-131. The sensitivity, specificity, and accuracy of thyroglobulin levels, measured during L-thyroxine therapy, for diagnosis of tumor residue or metastases were then calculated and compared with results obtained by diagnostic whole-body scanning. Our data show that neither thyroglobulin levels nor whole-body scans alone can discriminate between patients with or without metastases. Sensitivity reached 95.7%, specificity 100%, and accuracy 96.7% if results of both procedures were also taken into consideration. We conclude that in the management and follow-up of patients with differentiated thyroid carcinoma both parameters need to be evaluated.
Journal of Nuclear Medicine 12/1990; 31(11):1766-71. · 6.16 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: In 1037 patients undergoing total (827 cases) or partial thyroidectomy (52 cases of subtotal thyroidectomy, 108 of hemithyroidectomy, 50 of enucleation and resection) for each study group the incidence of hypoparathyroidism, its possible causes and technical factors favouring the onset, were examined. In this series postoperative prevalence of hypoparathyroidism was 16.6%. It seems to be directly proportional to the extent of surgery thus confirming the necessity to locate and preserve the parathyroid glands during surgery. This should be as conservative as possible according to the prognosis of the thyroid disease.
The Italian journal of surgical sciences / sponsored by Società italiana di chirurgia 02/1988; 18(2):151-4.
[Show abstract][Hide abstract] ABSTRACT: In 233 patients with differentiated thyroid carcinoma previously treated by total thyroidectomy supplemented, when necessary, with a therapeutic dose of 131I, serum thyroglobulin determinations and whole body scans were simultaneously performed. 82 of the 233 showed local or distant metastases: they were detected by both tests only in 36 cases. In 43 patients thyroglobulin was positive but without pathological concentrations of 131I at whole body scan were observed. The remaining 3 cases were detected on the basis of the positive whole body scan only, without increase in the circulating thyroglobulin. These results suggest that caution should be taken when considering thyroglobulin determination as possible substitutive test of whole body scan in the follow-up of differentiated thyroid carcinoma. However, for optimal sensitivity and reliability the complementary role of the two tests is stressed.
The Italian journal of surgical sciences / sponsored by Società italiana di chirurgia 02/1986; 16(1):11-5.
[Show abstract][Hide abstract] ABSTRACT: The study was carried out on 46 patients operated for simple goiter. The statistical analysis of data of TRH test on a sample of 57 healthy volunteers has permitted an evaluation of the upper limits of the normal thyrotropin response; the secretory area (As) was shown to be more discriminating. The patients were divided on the basis of response to TRH (evaluated by As) and incidence of recurrence in the group of patients with an abnormal curve with respect to patients with a normal curve was shown to be highly significant (77% v.s. 33%; p less than 0.01). The study underlines the limits of conventional methods of follow-up which should avoid the appearance of recurrence and suggests the validity of TRH test in the screening of subjects to be treated by opotherapy for prevention of recurrence.
The Italian journal of surgical sciences / sponsored by Società italiana di chirurgia 02/1983; 13(2):95-9.
[Show abstract][Hide abstract] ABSTRACT: SUMMARY BACKGROUND Thyroid remnant ablation after total thyroidectomy has traditionally been performed after thyroid hormone withdrawal (THW). However, the subsequent hypothyroidism frequently causes fatigue, depression, difficulties with concentration, and myriad other debilitating symptoms. Thus, the development of recombinant human TSH (rhTSH) was well received by patients with thyroid cancer and their clinicians, as it offered the opportunity to perform diagnostic whole-body 131 I scans without the associated morbidity of hypothyroidism. A randomized, prospective trial using 100 mCi of 131 I found comparable ablation rates with THW and rhTSH. The Food and Drug Administration consequently approved the use of rhTSH to stimulate thyrotropin (TSH) levels prior to remnant ablation with 100 mCi. Whether smaller amounts of 131 I will be associated with equivalent ablation rates with THW and rhTSH continues to spark research. The present study examines whether remnant ablation with 54 mCi (2 GBq) is comparable with THW and rhTSH. METHODS All patients had papillary thyroid carcinoma (PTC) or minimally invasive follicular thyroid carcinoma (FTC), all of which were American Joint Committee on Cancer (AJCC; 5th edition) tumor-node-metastasis (TNM) stage