MyMedR

Fulltext The minimum amount of fluids needed to achieve the fastest time to reach permissible level for release in well-differentiated thyroid patients undergoing high-dose I-131 therapy

Cheen Hoe AK, Fong LY, Halim FNA, Fatt QK, Hamzah F

World J Nucl Med, 2018 7 24;17(3):182-187.

PMID: 30034283 DOI: 10.4103/wjnm.WJNM_59_17

Radioiodine (131I) therapy is the mainstay of treatment for patients who had undergone total thyroidectomy for well differentiated thyroid carcinoma. Increased fluid intake has always been encouraged to minimize the risk of non-target organ exposure to I-131radiation. This study aimed to determine the minimum amount of fluids needed for patients to have the fastest time to achieve permissible level for release after high dose I-131therapy.

METHODOLOGY: All the patients who were treated with high dose I-131from 18th January 2016 till 31st December 2016 in Hospital Pulau Pinang, Malaysia were recruited. The data from 126 patients on thyroxine hormone withdrawal (THW) group and 18 patients on recombinant human thyroid stimulating hormone (rhTSH) group were analysed. There is no change in patient management in terms of preparation, dose or post therapy whole-body scan. Fluid intake of patients were monitored strictly and whole-body retention of I-131are measured using ionizing chamber meter immediately after ingestion of I-131then at 1 hour, 24 hours, 48 hours, 72 hours and 96 hours.

RESULTS: The median time to achieve permissible release limit (50 μSV/hr at 1 meter) was 21.6 hours and 22.1 hours post-ingestion of I-131in the THW and rhTSH group respectively. The minimum amount of fluid needed to reach permissible release limit in the fastest time was 2,103 ml and 2,148ml for the THW and TSH respectively.

CONCLUSION: Clinicians would be able to evidently advise their patient on the amount of fluid to consume and utilize their isolation wards faster to treat more patients.

Matched MeSH terms: Thyroid Neoplasms

A rare case of minimally invasive follicular thyroid cancer with intraluminal superior vena cava and right atrium metastases

Khoo ACH, Chen SL

World J Nucl Med, 2019 9 14;18(3):301-303.

PMID: 31516376 DOI: 10.4103/wjnm.WJNM_43_18

Follicular thyroid cancers are known to spread hematogenously to the bones and lungs and rarely presenting with massive angioinvasion. We report a case of a middle-aged female who had undergone total thyroidectomy for minimally invasive follicular thyroid cancer with angioinvasion in 2014. She was noted to have a large tumor thrombus extending from the superior vena cava to the right atrium on whole body scan post-Iodine-131 (131I) remnant ablation therapy. We discuss the various imaging modalities, treatment options, and difficulties in managing such massive angioinvasion in patients with well-differentiated thyroid cancers.

Matched MeSH terms: Thyroid Neoplasms

The findings of 18F-fluorodeoxyglucose positron emission tomography-computed tomography scan in patients with hidradenitis suppurativa in Malaysia: A multicenter study

Loo CH, Khoo ACH, Tan WC, Khor YH, Tang JJ, Tang MM, et al.

World J Nucl Med, 2020 08 22;20(1):32-37.

PMID: 33850487 DOI: 10.4103/wjnm.WJNM_33_20

Hidradenitis suppurativa (HS) is known to have association with systemic diseases with chronic inflammation such as psoriasis. We aim to describe the concomitant systemic inflammation in patients with HS using 18F-fluorodeoxyglucose positron emission tomography-computed tomography (18F-FDG PET/CT) scan. This was a case-control study conducted in three tertiary hospitals in Northern Malaysia from January to December 2017, involving HS patients aged 18 years and above. Thirty-two HS patients with age- and sex-matched controls were recruited with a mean age of 31.4 years (range: 18-56). Numerous cutaneous inflammatory foci were detected on FDG-PET/CT scan in clinically unapparent sites (27/32, 84.4%). Approximately 90.6%, 93.8%, and 50.0% of the patients had significantly higher cutaneous uptake over nasal, mandibular, and scalp regions, respectively (P < 0.0001). PET/CT scan did not detect any systemic inflammation unlike those found in psoriasis. Three (9.4%) patients had thyroid nodules with high uptake (maximum standard uptake values ranging from 2.9 to 11.3). Two of them were confirmed to have papillary thyroid carcinoma, while the third patient has inconclusive finding. 18F-FDG PET/CT scan may be useful to map disease burden of HS. Nonlesional inflammatory foci on the skin of the nose, mandibular, and scalp are probably significant. The association of thyroid carcinoma in HS warrants further evaluation.

Matched MeSH terms: Thyroid Neoplasms

Fusion of spatial gray level dependency and fractal texture features for the characterization of thyroid lesions

Raghavendra U, Rajendra Acharya U, Gudigar A, Hong Tan J, Fujita H, Hagiwara Y, et al.

Ultrasonics, 2017 05;77:110-120.

PMID: 28219805 DOI: 10.1016/j.ultras.2017.02.003

Thyroid is a small gland situated at the anterior side of the neck and one of the largest glands of the endocrine system. The abrupt cell growth or malignancy in the thyroid gland may cause thyroid cancer. Ultrasound images distinctly represent benign and malignant lesions, but accuracy may be poor due to subjective interpretation. Computer Aided Diagnosis (CAD) can minimize the errors created due to subjective interpretation and assists to make fast accurate diagnosis. In this work, fusion of Spatial Gray Level Dependence Features (SGLDF) and fractal textures are used to decipher the intrinsic structure of benign and malignant thyroid lesions. These features are subjected to graph based Marginal Fisher Analysis (MFA) to reduce the number of features. The reduced features are subjected to various ranking methods and classifiers. We have achieved an average accuracy, sensitivity and specificity of 97.52%, 90.32% and 98.57% respectively using Support Vector Machine (SVM) classifier. The achieved maximum Area Under Curve (AUC) is 0.9445. Finally, Thyroid Clinical Risk Index (TCRI) a single number is developed using two MFA features to discriminate the two classes. This prototype system is ready to be tested with huge diverse database.

Matched MeSH terms: Thyroid Neoplasms/pathology*

Fulltext Airway emergency from spontaneous haemorrhagic thyroid cancer

Vijendren A, Ladha N, Hilger AW

Med J Malaysia, 2014 Aug;69(4):187-8.

PMID: 25500848

Spontaneous thyroid haemorrhages are rare. There are reported cases occurring in thyroid nodules and cysts but none in thyroid malignancies. We describe a 48 year old who presented to the on-call ENT team with a rapidly progressing neck swelling that was interfering with his airway. After resuscitation, the patient underwent a right lobectomy to stop the bleeding. Histology showed a thyroid follicular carcinoma. As per the regional multidisciplinary team discussion, he underwent a completion thyroidectomy followed by radioactive iodine treatment. We conclude that spontaneous haemorrhages of the thyroid gland can occur in malignancies and stress the importance of early histological diagnosis.

Matched MeSH terms: Thyroid Neoplasms

Fulltext Patterns of differentiated thyroid cancer in Baluchistan Province of Pakistan: some initial observations

Iftikhar A, Naseeb AK, Khwaja A, Mati H, Karim K, Hameeda N

Med J Malaysia, 2011 Oct;66(4):322-5.

PMID: 22299551

The incidence of thyroid cancer is increasing in several countries. The main objective of this retrospective study was to find and describe province-specific estimates of incidence in males and females by age groups for differentiated thyroid cancer (DTC). This study reports on 87 cases of DTC from Baluchistan province of Pakistan treated with post operative radioiodine at the Center for Nuclear Medicine and Radiotherapy (CENAR) Quetta from January 2003 to December 2009. The patient data has been collected from CENAR Quetta. Patients with DTC were confirmed by clinical examination, thyroid scintigraphy (Thyroid scan), blood tests (T3, T4, TSH) and histopathalogy tests and then treated with radioiodine. The Median age of the patients was 35.5 years (Range 12-70 years). The final histological diagnosis was papillary carcinoma in 71 (81.6 %) cases, follicular carcinoma in 6 (6.9%) cases while 10 (11.5%) cases presented with mixed papillary and follicular carcinoma. About 53 % cases were found in females with age 21-40 years. No strike predominance was observed in any age group for males. Four patients presented with recurrence while six patients showed metastasis in cervical lymph nodes. The small annual incidence did not follow any definite pattern. DTC has a small incidence in Baluchistan due to lack of education and health care facilities. The incidence of DTC is higher in females when compared with males as per this study. This preliminary study will provide an insight to incidence of DTC, its treatment facilities and future planning strategies in Baluchistan, Pakistan.

Matched MeSH terms: Thyroid Neoplasms/etiology; Thyroid Neoplasms/epidemiology*

Fulltext Triple primary cancers of the larynx, lung and thyroid presenting in one patient

Iqbal FR, Sani A, Gendeh BS, Aireen I

Med J Malaysia, 2008 Dec;63(5):417-8.

PMID: 19803306 MyJurnal

Patients with multiple malignant primary tumours are often described, based on their chronology of presentation, as simultaneous, synchronous or metachronous tumours. Lung malignancies presenting in association with head and neck tumours are well documented while there have been small series of thyroid synchronous cancers presenting with laryngeal lesions in literature. No cases, to our knowledge, have been reported in literature of a single patient with all three laryngeal, lung and thyroid malignancies. We report one such case of a 71-year-old Chinese man who had undergone a total laryngectomy for a recurrent cancer of the larynx only to be found to have tumours of the lung and thyroid in the post-operative period and he eventually died of post-operative complications. We also discuss screening for lung and thyroid malignancies in patients with head and neck squamous cell carcinoma (SCC).

Matched MeSH terms: Thyroid Neoplasms/diagnosis*; Thyroid Neoplasms/surgery

Fulltext Germline RET mutations in exons 10 and 11: an Iranian survey of 57 medullary thyroid carcinoma cases

Hedayati M, Nabipour I, Rezaei-Ghaleh N, Azizi F

Med J Malaysia, 2006 Dec;61(5):564-9.

PMID: 17623957

The susceptibility gene for hereditary Medullary Thyroid Carcinoma (MTC) is the RET proto-oncogene. The aim of this study was to evaluate the prevalence of common germline RET mutations in exons 10 and 11 among Iranian MTC patients. Fifty-seven non-related MTC patients were examined in this study (Females: Males =1.2:1.0, Mean age = 40.0 +/- 11.5 years) and the existence of mutations was assessed through the PCR-RFLP technique. The only Multiple Endocrine Neoplasia type 2A (MEN2A) patient displayed a C634W mutation in exon 11. Among 53 apparently sporadic MTC patients, one patient showed a C620R mutation in exon 10 and two other patients displayed C624Y mutations in exon 11 of RET proto-oncogene. Neither the only Multiple Endocrine Neoplasia type 2B (MEN2B) patient nor two Familial MTC patients was found to carry germline mutations in exons 10 and 11. This study reports, for the first time, the prevalence of common RET mutations among Iranian, apparently sporadic MTC patients, underlining the critical importance of screening for RET mutations in such patients.

Matched MeSH terms: Thyroid Neoplasms/genetics*

Fulltext The use of SPECT-CT improves accuracy of post-radioiodine therapy imaging and changes the management strategy in a case of advanced follicular thyroid carcinoma

Wong TH, Amir Hassan SZ

Med J Malaysia, 2015 Dec;70(6):356-7.

PMID: 26988209

This is a case of follicular thyroid carcinoma with extensive lung, bone and brain metastases. Multi-modality treatments including total thyroidectomy, modified radical neck dissection, cranial radiotherapy and Iodine-131 (RAI) therapy were instituted. Post RAI therapy planar whole body scan showed RAI avid metastases in the skull, cervical spine, bilateral lungs and abdomen. With the use of SPECTCT imaging, rare adrenal metastasis and additional rib metastasis were identified. Besides, management strategy was altered due to detection of non-RAI avid brain and lung metastatic lesions.

Matched MeSH terms: Thyroid Neoplasms

Fulltext Metastatic disease of the proximal femur

Faisham WI, Zulmi W, Biswal BM

Med J Malaysia, 2003 Mar;58(1):120-4.

PMID: 14556337

Since January 1999, ten patients had undergone surgical treatment for metastatic bony lesions of proximal femur at this centre. Seven of these patients were treated for complete pathological fractures, one for impending fracture and one for revision of internal fixation and loosening of hemiarthroplasty. Primary malignancies were located in breast in four cases, prostate in three and one in lung, thyroid and neurofibrosarcoma. Two patients had died within six months after surgery, four after 1 year while the remaining four were still alive. The mean duration of survival was eleven months. Nine patients had been ambulating pain free and there were no failure of reconstruction.

Matched MeSH terms: Thyroid Neoplasms/diagnosis; Thyroid Neoplasms/pathology*; Thyroid Neoplasms/surgery

Fulltext Preliminary report on somatostatin receptor imaging in rare endocrine tumours

Abdullah BJJ, Paramsothy M, Khir ASM, Chan SP

Med J Malaysia, 2000 Jun;55(2):169-73.

PMID: 19839144

Our preliminary experience of Somatostatin Receptor Positive Tumour Scintigraphy (SRPTS) in the management of some rare neuroendocrine tumours is highlighted. Six patients were evaluated using SRPTS. A single patient each with Zollinger-Ellison syndrome, recurrent medullary carcinoma of thyroid and Stage IV neuroblastoma. Two patients with phaeochromocytoma, and one patient with suspected insulinoma were evaluated. SRPTS was useful in three of the six patients studied i.e. patient with gastrinoma, recurrent medullary carcinoma of thyroid and metastatic neuroblastoma. SRPTS although expensive is a useful and cost-effective approach of rare endocrine tumours and it role as a first line tool in the diagnosis is discussed.

Matched MeSH terms: Thyroid Neoplasms

Fulltext Radiation doses to patient's relatives following radioiodine therapy

Sulaiman BT, Clarke SE

Med J Malaysia, 1996 Mar;51(1):131-3.

PMID: 10967992

A total of 10 volunteers were monitored for radiation doses, whose spouses were given radio-iodine (131I) orally. Nine of the spouses were given radio-iodine for Graves' disease and one for thyroid carcinoma. It was found that the highest radiation dose received by the volunteer was only 13.5% of the annual dose limit for individual members of the public. Hence, patients treated with radio-iodine do not pose a significant radiation hazard to the public.

Matched MeSH terms: Thyroid Neoplasms/radiotherapy*

Fulltext Solitary thyroid nodule--experience in a district hospital

Thambi Dorai CR

Med J Malaysia, 1988 Mar;43(1):55-8.

PMID: 3244321

Matched MeSH terms: Thyroid Neoplasms/diagnosis

Fulltext Ultrasound of the cold thyroid nodule

Alif AK, Meah F

Med J Malaysia, 1984 Jun;39(2):123-6.

PMID: 6392839

Matched MeSH terms: Thyroid Neoplasms/diagnosis*

Fulltext Carcinoma of thyroid--clinical presentation and outcome

Sothy K, Mafauzy M, Mohamad WB, Mustaffa BE

Med J Malaysia, 1991 Sep;46(3):212-7.

PMID: 1839914

The clinical, biochemical and pathological features of 31 patients with thyroid carcinoma managed at Hospital Universiti Sains Málaysia, Kubang Kerian from 1985 to 1989 were analyzed. There were 25 females and 6 males. The types of carcinoma were: papillary-17 cases; follicular-10 cases; medullary-2 cases and anaplastic-2 cases. For papillary carcinoma the mean age of the patients was 52.9 years. For follicular carcinoma the mean age was 48.3 years, for medullary carcinoma, 48.5 years and for anaplastic, 74.5 years. All patients had pre-existing goitre except for 2 and most presented with advanced disease. The mean duration of symptoms for papillary carcinoma was 3.7 years, follicular carcinoma 1.6 years, medullary carcinoma 13.5 years and anaplastic carcinoma 6 months. 12 patients presented with goitre of increasing size; 9 had compression symptoms; 4 presented with cervical lymph node enlargement and 6 presented with bony pains of whom 2 had paraplegia. None of the patients were ever thyrotoxic or hypothyroid. Treatment in general was unsatisfactory because of patients' non-acceptance of surgery and/or radioactive iodine.

Matched MeSH terms: Thyroid Neoplasms/radiotherapy; Thyroid Neoplasms/surgery; Thyroid Neoplasms/therapy*

Fulltext Immunohistochemical localization of RET rearrangements in a Malaysian papillary thyroid carcinoma population

Omar E, Othman NH

Med J Malaysia, 2003 Aug;58(3):461-2.

PMID: 14750392

Matched MeSH terms: Thyroid Neoplasms/metabolism*

Features of post-radioiodine whole body scan in non-invasive Follicular Thyroid Neoplasm with papillary-like nuclear features (NIFTP)

Wong TH, Tan TH, Chin SC, Lee BN

Med J Malaysia, 2018 06;73(3):181-182.

PMID: 29962506

Recently, encapsulated follicular variant of papillary thyroid carcinoma has been reclassified as non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) to emphasize the benign nature of this entity. In our institution, we have assessed 455 patients treated with radioiodine ablation for differentiated thyroid carcinoma and 20 of them were retrospectively found to fulfill the new NIFTP criteria. There was no evidence of metastasis on post radioiodine whole body scans for NIFTP cases and these patients were in remission subsequently. The benign features of these patients' whole body scans and good clinical outcome following treatment further support NIFTP as a low risk thyroid neoplasm.

Matched MeSH terms: Thyroid Neoplasms/pathology

Follicular thyroid cancer with sternal metastasis - challenges and outcomes

Syazni MA, Gendeh HS, Kosai NR, Ramzisham AR, Gendeh BS, Basiron NH, et al.

Med J Malaysia, 2017 02;72(1):80-82.

PMID: 28255152 MyJurnal

Sternal metastasis from differentiated thyroid carcinoma (DTC) is rare and presents a conundrum for surgeons. We present a lady diagnosed with follicular thyroid carcinoma and sternal metastasis who underwent thyroidectomy, sternectomy and sternoplasty with titanium mesh and acrylic plate. She developed a surgical site infection, of which multiple conservative approaches were attempted. She eventually required removal of the implant. Closure of sternal defect was completed with bilateral pectoralis major advancement flaps. This article highlights a series of complications faced during the course of treatment and how they were managed in a tertiary healthcare centre.

Matched MeSH terms: Thyroid Neoplasms

Reliability of the ultrasound classification system of thyroid nodules in predicting malignancy

Farihah AG, Nurismah MI, Husyairi H, Shahrun Niza AS, Radhika S

Med J Malaysia, 2018 02;73(1):9-15.

PMID: 29531197 MyJurnal

AIM: This study aims to evaluate the reliability of the Ultrasound (U) Classification system in predicting thyroid malignancy by using pathology diagnosis as the reference standard.

METHODS: It was a cross-sectional study carried out at Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Malaysia. Records of patients with focal thyroid nodules on ultrasound (US) for which US-guided fine needle aspiration cytology (FNAC) was performed and pathology results were available, from January 2014 to May 2016 were selected for review. Correlation of the U Classification with pathology results was assessed. Sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, predictive value, negative predictive value and accuracy were calculated in a conservative and non-conservative method. The threshold for statistical performance was set at 0.05. Each sonographic feature was also compared with its pathology results.

RESULTS: A total of 91 patients with 104 nodules were eligible. 12 nodules out of 104 (11.5%) were malignant. The sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, positive predictive value, negative predictive value and accuracy were 100%, 91.3%, 11.5, 0.0, 60%, 100% and 92.3%, and 100%, 91.4%, 11.7%, 0.0, 78.6%, 100% and 93.5%, for the non-conservative and conservative method of calculations respectively.

CONCLUSION: The U Classification is reliable in predicting thyroid malignancy. More evidence is nevertheless necessary for widespread adaptation and use.

Matched MeSH terms: Thyroid Neoplasms

Follicular carcinoma thyroid

Dharmalingam SK, Narasimha K

Med J Malaya, 1972 Sep;27(1):73-6.

PMID: 4264829

Matched MeSH terms: Thyroid Neoplasms/diagnosis*

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