The incidence of differentiated thyroid cancer (DTC) is rising, but controversy exists in many aspects of its treatment. This study described the change in incidence of DTC in Ontario, variations in management including extent of thyroidectomy and the influence of provider volume, and the impact of these parameters on recurrence and thyroid cancer-specific death (TCSD). A population-based study identified all new cases of DTC between 1992-2007. The incidence of DTC increased dramatically (annual percentage change 7.6%). Linkage to administrative databases revealed that extent of thyroidectomy is influenced by various factors including patient gender, age, year of diagnosis, surgeon specialty, and hospital setting, but not provider volume. Total thyroidectomy is associated with a lower recurrence rate. There is a significant association between provider volume and recurrence, with lower volume surgeons having a higher recurrence risk. Extent of thyroidectomy and provider volume did not influence TCSD. Such variations in management may lead to disparities in health outcomes.

Orientador: Euclides Timótio da Rocha / Banca: Sonia Marta Moriguchi / Banca: José Humberto Tavares Guerreira Fregnani / Resumo: O câncer de tireóide responde por cerca de 1% das neoplasias em adultos, sendo a doença maligna mais comum do sistema endócrino. No entanto, na infância e na adolescência o carcinoma de tireóide é uma condição menos freqüente, variando de 0,5 a 3% das neoplasias malignas. O tratamento deve ser cirúrgico e seguido de ablação com Iodo-131.avaliar o impacto da terapia com Iodo-131 e correlacionar com a qualidade de vida.Foram estudados 19 pacientes com idade média de 19 anos - variando de 15 a 28 anos no momento do estudo, que tiveram câncer bem diferenciado da tireóide (CDT) na infância e adolescência, e que realizaram tireoidectomia complementada com terapia com Iodo-131. Foi recrutado um grupo controle de indivíduos saudáveis com os mesmos parâmetros demográficos. Todos os sujeitos foram submetidos à cintilografia das glândulas salivares, e, foram solicitados a responder a um questionário para avaliação da qualidade de vida de pacientes oncológicos, o instrumento de escolha foi o questionário QLQ-C30 e H&N35 específico para pacientes com câncer de cabeça e pescoço da EORTC.Análises qualitativa e quantitativa das glândulas salivares mostraram déficit funcional com maior acometimento das parótidas quanto ao volume, concentração e excreção; enquanto que as submandibulares apresentaram significância quanto ao volume à direita. Através dos questionários foi possível observar que surgiram diferenças entre os dois grupos relacionadas aos domínios saliva espessa, boca seca e problemas na fala, além dos domínios de saúde funcional e saúde global que avaliam a saúde geral de pacientes oncológicos.O estudo demonstrou que apesar da terapia ser efetiva e segura, os danos advindos do tratamento conduzem a uma piora da qualidade de vida. No entanto, outros estudos nesta direção e com um número maior de pacientes serão bem vindos... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Thyroid cancer accounts for about 1% of all cancers in adults, being the most common malignant disease of the endocrine system. However, in infancy and adolescent population thyroid carcinoma is a less common condition, ranging from 0.5 to 3% of the malignancies. The treatment have to be surgery and followed by ablation with iodine-131.To evaluate the impact of therapy with Iodine-131 and correlate with the quality of life.We studied 19 patients with mean age 20 years - ranging from 15 and 28 years during the study, who had well-differentiated thyroid cancer (DTC) in infancy and adolescence, and who underwent thyroidectomy supplemented with iodine-131 therapy. We also recruited a control group of healthy subjects with the same demographics. All patients underwent salivary gland scintigraphy as well as they were requested to answer a questionnaire for avaliation of quality of life in cancer patients, the instrument of choice was the questionnaire QLQ - C30 and H&N35 specific for head and neck cancer patients of EORTC.Qualitative and quantitative analysis of the salivary glands revealed functional deficits with bigger involvement of the parotids on the volume, concentration and excretion; right submandibular gland had significance for volume. Through the questionnaires it was possible to observe significant differences between the two groups related to the domains thick saliva, dry mouth and problems with speech, moreover the domain of functional health and overall health that evaluate the overall health of cancer patients.The study has demonstrated that in spite of the therapy be very effective and safe, the damage arising from the treatment leads to a poorer quality of life. Nevertheless, other studies in this direction and with a larger number of patients are welcome / Mestre

Thesis (M.A.)--Boston University, 2011. / OBJECTIVE: Thyroid cancer is the most common endocrine malignancy and patients presenting with thyroid nodules often undergo surgery solely for diagnostic purposes. The goal of our study was to examine the accuracy of Elastic Scattering Spectroscopy (ESS) in distinguishing between benign and malignant thyroid nodules in fresh ex vivo specimens and to design an in vivo ESS probe and device, manufacture it and conduct a clinical trial. METHODS: Patients already undergoing thyroidectomy surgery were consented for the ex vivo study. ESS data was obtained from ex vivo specimens by recording 5 readings per nodule with five repetitive readings per each site. Final pathology reports were used to confirm the diagnosis. The spectra were analyzed using principal component analysis, linear discriminant analysis and leave one out technique. The in vivo ESS study was conceptually designed and IRB approval from Boston Medical Campus was obtained. RESULTS: The ex vivo study showed that ESS could predict the difference between benign and malignant tumors with a sensitivity of 74%, specificity of 90%, positive predictive value of 82% and negative predictive value of 85%. 193 spectra were analyzed from 64 patients, 120 spectra were from benign nodules and 73 from malignant nodules. Subanalysis examined only indeterminate nodules showed sensitivity of 65%, specificity of 79%, PPV 77% and NPV 67%. The in vivo ESS probe was designed and 12 identical instruments were manufactured. Initial experimental readings were taken and parameters were adjusted for the in vivo tissue environment. The clinical trial is underway. CONCLUSIONS: ESS is a practical tool that can accurately identify malignancy in ex vivo thyroid specimens with high specificity and sensitivity. Initial in vivo experimental trials have been conducted and show promise for similar results.

Made available in DSpace on 2014-06-11T19:23:07Z (GMT). No. of bitstreams: 0 Previous issue date: 2011-03-23Bitstream added on 2014-06-13T18:09:23Z : No. of bitstreams: 1 correa_lg_me_botfm.pdf: 4676842 bytes, checksum: 992b218c8377f04a14e8d89035c082b5 (MD5) / Fundação Pio Xii - Barretos / O câncer de tireóide responde por cerca de 1% das neoplasias em adultos, sendo a doença maligna mais comum do sistema endócrino. No entanto, na infância e na adolescência o carcinoma de tireóide é uma condição menos freqüente, variando de 0,5 a 3% das neoplasias malignas. O tratamento deve ser cirúrgico e seguido de ablação com Iodo-131.avaliar o impacto da terapia com Iodo-131 e correlacionar com a qualidade de vida.Foram estudados 19 pacientes com idade média de 19 anos - variando de 15 a 28 anos no momento do estudo, que tiveram câncer bem diferenciado da tireóide (CDT) na infância e adolescência, e que realizaram tireoidectomia complementada com terapia com Iodo-131. Foi recrutado um grupo controle de indivíduos saudáveis com os mesmos parâmetros demográficos. Todos os sujeitos foram submetidos à cintilografia das glândulas salivares, e, foram solicitados a responder a um questionário para avaliação da qualidade de vida de pacientes oncológicos, o instrumento de escolha foi o questionário QLQ–C30 e H&N35 específico para pacientes com câncer de cabeça e pescoço da EORTC.Análises qualitativa e quantitativa das glândulas salivares mostraram déficit funcional com maior acometimento das parótidas quanto ao volume, concentração e excreção; enquanto que as submandibulares apresentaram significância quanto ao volume à direita. Através dos questionários foi possível observar que surgiram diferenças entre os dois grupos relacionadas aos domínios saliva espessa, boca seca e problemas na fala, além dos domínios de saúde funcional e saúde global que avaliam a saúde geral de pacientes oncológicos.O estudo demonstrou que apesar da terapia ser efetiva e segura, os danos advindos do tratamento conduzem a uma piora da qualidade de vida. No entanto, outros estudos nesta direção e com um número maior de pacientes serão bem vindos... / Thyroid cancer accounts for about 1% of all cancers in adults, being the most common malignant disease of the endocrine system. However, in infancy and adolescent population thyroid carcinoma is a less common condition, ranging from 0.5 to 3% of the malignancies. The treatment have to be surgery and followed by ablation with iodine-131.To evaluate the impact of therapy with Iodine-131 and correlate with the quality of life.We studied 19 patients with mean age 20 years - ranging from 15 and 28 years during the study, who had well-differentiated thyroid cancer (DTC) in infancy and adolescence, and who underwent thyroidectomy supplemented with iodine-131 therapy. We also recruited a control group of healthy subjects with the same demographics. All patients underwent salivary gland scintigraphy as well as they were requested to answer a questionnaire for avaliation of quality of life in cancer patients, the instrument of choice was the questionnaire QLQ - C30 and H&N35 specific for head and neck cancer patients of EORTC.Qualitative and quantitative analysis of the salivary glands revealed functional deficits with bigger involvement of the parotids on the volume, concentration and excretion; right submandibular gland had significance for volume. Through the questionnaires it was possible to observe significant differences between the two groups related to the domains thick saliva, dry mouth and problems with speech, moreover the domain of functional health and overall health that evaluate the overall health of cancer patients.The study has demonstrated that in spite of the therapy be very effective and safe, the damage arising from the treatment leads to a poorer quality of life. Nevertheless, other studies in this direction and with a larger number of patients are welcome

Orientador: Laura Sterian Ward / Dissertação (mestrado) - Universidade Estadual de Campinas. Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-15T07:53:42Z (GMT). No. of bitstreams: 1 Santos_AnaPaulaCarneiroDos_M.pdf: 2998875 bytes, checksum: 9fd6ce397ec8eae4d85db8afcd041e9e (MD5) Previous issue date: 2010 / Resumo: Fragmentos de anticorpos recombinantes têm se tornado ferramentas importantes em diversas áreas, tais como: Biologia Molecular, Farmacêutica e pesquisa Médica. Avanços recentes estão relacionados à aplicação desses anticorpos na oncologia, com estratégias diagnósticas e terapêuticas para diferentes carcinomas. Neste estudo, uma biblioteca de fragmentos de anticorpos monoclonais scFv foi construída utilizando RNA total de sangue periférico de 25 pacientes com Carcinoma Diferenciado da Tireóide. Essa biblioteca scFv foi selecionada utilizando os métodos Bioppaning and Rapid Analysis of Selective Interactive Ligands (BRASIL) e Phage display contra células tumorais de tireóide, com o objetivo de encontrar ligantes específicos a superfície celular tumoral. Os clones selecionados foram identificados por Dot blotting, e a reatividade contra proteínas de tumor, adenoma e bócio foi analisada por Elisa. O clone scFv-C1 apresentou melhor reatividade pelas proteínas tumorais e foi escolhido para a imunoistoquímica. Esta foi realizada com lâmina de Micro-arranjo de tecido (TMA) com duzentos e vinte nove casos de tireóide, sendo 110 Carcinomas, 52 Adenomas Foliculares, 49 Bócios e 18 tecidos normais de tireóide. O anticorpo scFv-C1 reagiu especificamente aos tecidos de câncer, com reatividade ao citoplasma das células tumorais, foi capaz de distinguir o Grupo Câncer do Controle (Bócio, Adenoma e tireóide normal) com significância estatística (p<0,0001) e entre os carcinomas reagiu melhor com os tumores pequenos (TNM 1 e 2) e com pouca agressividade (p=0,050). O fragmento de anticorpo scFv-C1 pode ser um potencial candidato a biomarcador para o diagnóstico do Câncer de tireóide / Abstract: Recombinant antibody fragments have become important tools in several fields, including molecular biology, pharmaceutical and medical research. In this study, a human single-chain variable fragment (scFv) antibody library was constructed using total RNA of leukocyte cells obtained from blood of patients with well differentiated thyroid carcinoma. This scFv antibody library was selected using the Biopanning and Rapid Analysis of Selective Interactive Ligands method (BRASIL) and Phage display technology against tumor thyroid cells, aiming to find specific cell-surface binders. The selected clones were identified by dot blot and ELISA assays and their reactivity analyzed against tumor, goiter and adenoma proteins. One clone (scFv-C1) presented the highest reactivity ratio between cancer and the control group (goiter and adenoma) and was chosen for further analysis. Immunohistochemistry was performed by means of Tissue Microarray with two hundred and twenty-nine thyroid cases (110 carcinomas, 52 follicular adenomas, 49 goiters and 18 normal tissues) including 38 papillary, 42 follicular and 30 variant follicular in the carcinoma group. The scFv-C1 reacted specifically to cancer tissues sections, showed strong reactivity with cytoplasm and was able to distinguish cancer to control groups (goiter, adenoma and normal thyroid) with_statistically significance (p<0,0001). The scFv-C1 fragment antibody described here may be a potential biomarker candidate for diagnostics and prognostics of thyroid cancer / Mestrado / Ciencias Basicas / Mestre em Clinica Medica

Os nódulos de tireóide constituem patologia comum, com uma incidência entre 4- 7% na população brasileira. Embora a punção aspirativa por agulha fina (PAAF) seja um método com boa sensibilidade, a discriminação entre lesões benignas e neoplasias malignas não é possível em todos os casos, permitindo a incidência de diagnósticos falsos-positivos, o que conduz a tireoideotectomia pelo risco de carcinoma. O escopo deste estudo foi verificar se a espectroscopia de absorção no infravermelho por transformada de Fourier (FTIR) pode contribuir no diagnóstico diferencial entre neoplasias malignas e benignas de tecidos e aspirados. Amostras de PAAF, homogenatos e tecidos de nódulos de tireóide com o diagnóstico histopatológico foram obtidos e preparados para análise espectroscópica por FTIR. As punções e homogenatos foram medidas por -FTIR (entre 950 1750 cm-1, com resolução de 4 cm-1 e 120 varreduras). As amostras de tecido foram analisadas diretamente pela técnica de ATR-FTIR, com resolução de 2 cm-1, 60 varreduras, região entre 950 1750 cm-1.. Todos os espectros foram corrigidos pela linha base e normalizados pela área sob a banda das amidas (1550-1640 cm-1) de modo a minimizar as variações de homogeneidade das amostras. Os espectros foram então convertidos em segundas derivadas usando-se o filtro de Savitzk-Golay com 13 pontos na janela. A variância de Ward e distância euclidiana foram usadas para se processar a análise de clusters. As amostras de PAAF revelaram um complexo padrão espectral. Todas as amostras mostraram alguns aglomerados de células ou grande concentração de hormônios, tendo representação em algumas bandas em 1545 e 1655 cm-1. Foram também encontradas bandas em torno de 1409, 1412, 1414, 1578 and 1579 cm-1, indicando a possível presença de açúcares, DNA e ácido cítrico de produtos metabólitos. Neste estudo, foi obtida uma excelente separação entre bócio adenomatoso e neoplasias malignas para as amostras de tecido, com 100% de sensibilidade em determinado cluster, mas 67% no geral e 50% de especificidade. Nos homogenatos e aspirados este valor foi menor (76,2% de sensibilidade e 52,6% de especificidade) porque incluiu outros tipos de lesões. Para uma maior diferenciação das amostras de PAAF de padrão folicular, um maior número de amostras se faz necessário. Os resultados deste estudo sugerem que a espectroscopia FTIR pode ser útil na diferenciação de carcinomas da tiróide em amostras de tecidos. / Thyroid nodules are a common disorder, with 4-7% of incidence in the Brazilian population. Although the fine needle aspiration (FNA) is an accurate method for thyroid tumors diagnosis, the discrimination between benign and malignant neoplasm is currently not possible in some cases with high incidence of false negative diagnosis, leading to a surgical intervention due to the risk of carcinomas. The aim of this study was to verify if the Fourier Transform infrared spectroscopy (FTIR) can contribute to the diagnosis of thyroid carcinomas and goiters, using samples of tissue and aspirates. Samples of FNA, homogenates and tissues of thyroid nodules with histopathological diagnosis were obtained and prepared for FTIR spectroscopy analysis. The FNA and homogenates samples were measured by -FTIR (between 950 1750 cm-1), at a nominal resolution of 4 cm-1 and 120 scans). Tissue samples were analized directly by ATR-FTIR technique, at a resolution 2 cm-1, with 60 scans in the same region. All spectra were corrected by the baseline and normalized by amides area (1550-1640 cm-1) in order to minimize variations of sample homogeneity. Then, spectra were converted into second derivatives using the Savitzk-Golay algorithm with a 13 points window. The Ward\'s minimum variance algorithm and Euclidean distances among the points were used for cluster analysis. Some FNA samples showed complex spectral pattern. All samples showed some cell pellets and large amount of hormone, represented by the bands of 1545 and 1655 cm-1. Bands in 1409, 1412, 1414, 1578 and 1579 cm-1 were also found, indicating possible presence of sugar, DNA, citric acid or metabolic products. In this study, it was obtained an excellent separation between goiter and malign lesion for the samples of tissues, with 100% of specificity in specific cluster and 67% sensibility and 50 of specificity. In homogenate and FNA samples this sensibility and specificity were lower, because among these samples, it were included many types of thyroid lesions. To obtain a more precise diagnosis for FNA of follicular thyroid the sample size should be increased. The results of this study suggest that FTIR spectroscopy may be useful for discriminate thyroid carcinomas from goiters in tissue samples.

Eosinophilia is not an uncommon finding on a routine complete blood count (CBC) during a primary care visit. The differential diagnosis is varied including allergic/atopic disease, drug reaction, infection, inflammatory conditions, and malignancy. An 80-year-old male was incidentally found to have leukocytosis on routine labs. White blood cell (WBC) was 27.5 K/ul with eosinophilia 4.3 K/ul (normal range 0-0.6 Kul) and Hemoglobin/Platelet counts were normal. Patient was asymptomatic. Denied history of medication change or allergy. Chest X-Ray (CXR) followed by Computed tomography (CT) showed 5 cm pulmonary mass with mediastinal lymphadenopathy. Patient developed progressively enlarging left neck mass, hoarseness, weight loss and decreased appetite in the next 3 weeks. WBC increased steeply to 65 K/ul with eosinophil count - 18.5 K/ul. CT neck revealed a large heterogeneous mass of the thyroid extending to the trachea, esophagus, and mediastinum. Patient decided not to proceed with further diagnostic workup and management given his age and comorbidities. Eosinophilia can be asymptomatic or present with nonspecific symptoms like cough, fatigue, skin rash or neuropathy. Eosinophilia work up starts with a comprehensive history detailing travel history, exposure to well water/spring water, analysis of past medical history to include asthma, atopy and especially medication history. Physical exam with attention to atopy/eczema and skin rash is vital. Work up may include a CBC, peripheral blood smear, stool test (for ova and parasite), IgE/tryptase levels and evaluation for occult malignancy (CXR is an ideal first step). Further testing with Bone marrow biopsy and CT scans is a consideration if a clear diagnosis is not achieved. Life-threatening complications of untreated hyper-eosinophilia include thromboembolism, endomyocardial fibrosis, cognitive disturbances, and respiratory failure. Incidence of eosinophilia is 1% in malignant tumors. Malignancy encompasses hematological cancers (acute leukemia, chronic myeloid leukemia, systemic mastocytosis, lymphoid neoplasms) and solid tumors (lung, thyroid, breast and gastrointestinal tract cancers). Eosinophilia suggests advanced disease in solid tumors and portends poor prognosis. Paraneoplastic eosinophilia has been reported in thyroid cancer (sclerosing muco-epidermoid) and lung cancer (squamous and adenocarcinoma). Pathophysiology of eosinophilia in solid tumors is related to bone marrow stimulation through cytokines (interleukin-5, granulocyte-macrophage colony-stimulating factor, and interleukin-2). Primary eosinophilia responds to steroids and hydroxyurea. Treating the underlying malignancy is the cornerstone of paraneoplastic eosinophilia management. We present a case of extreme progressive eosinophilia secondary to a malignancy which would be of interest to the primary care clinician.

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