Incidence, diagnosis and treatment of adrenal metastases from differentiated thyroid carcinoma: personal experience and review of literature

Aim of the present work is to evaluate incidence, diagnosis and treatment of adrenal metastasis (AM) from a differentiated thyroid carcinoma (DTC) through a comparison of a case report with the review of literature. Our experience is based upon a case of isolated adrenal metastasis discovered during the follow up of a 71-year-old woman previously submitted to total thyroidectomy for a papillary carcinoma. In spite of repeated cycles of radioiodine therapy, 10 years after surgery she was discovered with high values of thyroglobulin (TG) associated with a left adrenal mass that showed high uptake at FDG PET/CT scan. Laparoscopic adrenalectomy (LA) was successfully performed and after 24 months, serum TG levels and 131 I whole body scan are normal and the patient free of disease. Incidence of AM from DTC is a very rare occurrence: its discovery usually comes through the follow up of patients submitted to total thyroidectomy The most useful tools to diagnose such metastases are serum levels of TG, 131I uptake and FDG PET/CT scan. Therapy depends if the AM is isolated or with synchronous recurrences in other organs. In the first case LA is the best option, while radioiodine should be the treatment of choice in the cases not fit for surgery Return to normal values of TG and lack of 131I uptake are the best way to confirm recovery from disease. AM from a DTC is nearly exceptional but should be suspected in case of increasing values of TG and high 131I uptake during post-thyroidectomy follow up; CT and PET scan are frequently necessary to confirm diagnosis. Surgical therapy is usually possible through LA

Differentiated Thyroid Cancer: Indications and Extent of Central Neck Dissection—Our Experience

The aim of this retrospective study was to determine the rate of metastases in the central neck compartment and examine the morbidity and rate of recurrence in patients with differentiated thyroid cancer treated with or without a central neck dissection. Two hundred and fifteen patients undergoing total thyroidectomy with preoperative diagnosis of differentiated thyroid cancer, in the absence of suspicious nodes, were divided in two groups: those who underwent a thyroidectomy only (group A; ) and those who also received a central neck dissection (group B; ). Five cases (2.32%) of nodal recurrence were observed: 3 in group A and 2 in group B. Tumor histology was associated with a risk of recurrence: Hürthle cell-variant and tall cell-variant carcinomas were associated with a high risk of recurrence. Multifocality and extrathyroidal invasion also presented a higher risk, while smaller tumors were at lower risk. The results of this study suggest that prophylactic central neck dissection should be reserved for high-risk patients only. A wider use of immunocytochemical and genetic markers to improve preoperative diagnosis and the development of methods for the intraoperative identification of metastatic lymph nodes will be useful in the future for the improved selection of patients for central neck dissections

HYPOTHYROIDISM AND THYROID AUTOIMMUNITY AS A PROGNOSTIC BIOMARKER OF BETTER RESPONSE IN METASTATIC CANCER LONG SURVIVORS TREATED WITH SUNITINIB

The development of thyroid dysfunction is a frequent side effect associated to sunitinib therapy but scanty data are available on thyroid function on long-term sunitinib-treated patients