Le traitement du carcinome différencié de la thyroïde est chirurgical. Il est souvent complété par l’administration d’iode radioactif. À ce jour, les conséquences de ce traitement sur la fonction testiculaire sont mal connues.

Purpose: The purpose of the study was to assess prospectively the impact of recombinant human TSH (rhTSH) administration on positron emission tomography (PET)/computed tomography (CT) imaging in differentiated thyroid cancer patients who, after primary treatment, had a suppressed or stimulated serum thyroglobulin greater than 10 ng/ml and no radioactive iodine uptake consistent with thyroid cancer on a whole body scan.Patients and Methods: PET/CT was performed before (basal PET) and 24-48 h after rhTSH administration (rhTSH-PET) in 63 patients (52 papillary and 11 follicular thyroid cancers). Images were blindly analyzed by two readers. The proposed treatment plan was prospectively assessed before basal PET, after basal PET, and again after rhTSH-PET.Results: A total of 108 lesions were detected in 48 organs in 30 patients. rhTSH-PET was significantly more sensitive than basal PET for the detection of lesions (95 vs. 81%; P = 0.001) and tended to be more sensitive for the detection of involved organs (94 vs. 79%; P = 0.054). However, basal PET and rhTSH-PET did not have significantly different sensitivity for detecting patients with any lesions (49 vs. 54%; P = 0.42). Changes in treatment management plan occurred in 19% of the patients after basal PET. Lesions found only by rhTSH-PET contributed to an altered therapeutic plan in eight patients, among whom only four were true-positive on pathology (6%).Conclusion: The use of rhTSH for 2-[18F]-fluoro-2-deoxy-D-glucose-PET/CT significantly increased the number of lesions detected, but the numbers of patients in whom any lesion was detected were no different between basal and rhTSH-stimulated PET/CT scans. Treatment changes due to true positive lesions occurred in 6% of cases. (J Clin Endocrinol Metab 94: 1310-1316, 2009)

Multinodular goiter is a common disorder, found in 5% of the general population. If only one thyroid lobe is affected, hemithyroidectomy may be preferred to total thyroidectomy, to limit the risk of complications and avoid hormone replacement therapy, but incurs a risk of subsequent completion thyroidectomy. The aim of the present study is to determine whether the arguments in favor of hemithyroidectomy are justified and whether it still provides real benefit.A retrospective observational study based on prospective data included all patients who underwent surgery for goiter or nodule in our center between September 2010 and September 2014. Rates of hormone replacement 6 months after hemithyroidectomy, postoperative complications and completion thyroidectomy during the postoperative year due to the discovery of carcinoma were analyzed.Four hundred and ninety-three patients were studied: 335 with total thyroidectomy and158 with hemithyroidey. The rate of hormone replacement 6 months after hemithyroidectomy was 84.4%. The rate of definitive hypocalcemia was 6.3% in total thyroidectomy and zero in hemithyroidectomy (P < 0.05). There was no significant difference between groups in terms of recurrent laryngeal nerve palsy (1.8% versus 1.9%; P = 1) or hematoma (1.2% versus 3.5%; P = 0.15). A total of 11.3% of hemithyroidectomies required completion due to discovery of carcinoma (mean interval between surgeries 3.58 ± 2.5 months).This study suggests that hemithyroidectomy does not in fact avoid the risk of hormone replacement and places the patient at risk of completion thyroidectomy. However, it does avoid a 6% rate of hypocalcemia. We would recommend hemithyroidectomy only in case of single toxic or euthyroid nodule with healthy contralateral lobe and/or refusal of hormone replacement by the patient.Le goitre multinodulaire est une pathologie fréquente, de l’ordre de 5 % de la population générale. Si un seul lobe thyroïdien est atteint, l’isthmolobectomie peut être préférée à une thyroïdectomie totale pour diminuer les risques de complications et éviter la supplémentation hormonale, mais expose le patient à un risque de totalisation. Le but de cette étude est de savoir si ces arguments sont justifiés et s’il reste vraiment un intérêt à l’isthmolobectomie.Nous avons réalisé une étude observationnelle rétrospective basée sur des données recueillies de façon prospective. Nous avons étudié tous les patients opérés d’un goitre ou nodule thyroïdien dans notre centre entre septembre 2010 et septembre 2014. Nous avons analysé le taux de supplémentation hormonale à 6 mois après isthmolobectomie, les complications postopératoires et le taux de totalisation dans l’année du fait de la découverte d’un carcinome thyroïdien.Nous avons étudié 493 patients (335 thyroïdectomies totales et 158 isthmolobectomies). Le taux de supplémentation hormonale était de 84,4 % à 6 mois de l’isthmolobectomie. Nous avons trouvé un taux d’hypocalcémie définitive de 6,3 % parmi les cas de thyroïdectomies totales et aucun parmi les isthmolobectomies (p < 0,05). Il n’y avait pas de différence significative en terme de paralysie récurrentielle (1,8 % versus 1,9 %; p = 1) ou d’hématome (1,2 % contre 3,5 %; p = 0,15). Au total, 11,3 % des isthmolobectomies ont été totalisées en raison de la découverte d’un carcinome, avec un intervalle moyen de 3,58 ± 2,5 mois après la première opération.Cette étude suggère que l’isthmolobectomie ne réduit pas le risque de supplémentation hormonale et expose le patient au risque d’une totalisation secondaire. Néanmoins, l'isthmolobectomie prévient le risque de 6 % d’hypocalcémie associée à la thyroïdectomie totale. Nous recommandons une isthmolobectomie en cas de nodule unique (toxique ou euthyroïdien) avec un lobe controlatéral sain et/ou en cas de refus de supplémentation hormonale du patient après chirurgie.

INTRODUCTION:The clinical benefits of recombinant human thyroid-stimulating hormone (rhTSH; Thyrogen) are well established as an alternative stimulation procedure to thyroid hormone withdrawal in the diagnostic follow-up of thyroid cancer patients. By avoiding periods of hypothyroidism, patients do not suffer from a decreased quality of life and keep their ability to work. This study compared the frequency, the duration and the cost of sick leave for follow-up control between rhTSH and withdrawal.METHODS:The study population consisted of patients with thyroid carcinoma first treated by thyroidectomy and radioiodine ablation. Patients were recruited at their control visit between October 2004 and May 2006 in three hospitals, both prospectively and retrospectively. Collection data consisted of patient information, job characteristics and duration of sick leave during the month before and the month after control. The valuation of sick leave used the friction cost method.RESULTS:Among the 306 patients included, 292 (95%) completed the entire questionnaire. The mean age was 46.7 years. Among the 194 active patients, patients treated with rhTSH, when compared with patients treated by withdrawal, were less likely to require sick leave (11 vs 33%; P=0.001). The mean duration of sick leave was shorter (3.1 vs 11.2 days; P=0.002) and indirect costs due to absenteeism accounted for 454 Euro +/- 1673 vs 1537 Euro +/- 2899 for withdrawal stimulation.CONCLUSION:For active patients, rhTSH treatment reduced the length and the cost of sick leave by 8.1 days and 1083 Euro per control respectively, when compared with withdrawal treatment.

BACKGROUND Serum thyroglobulin (Tg) is the marker of differentiated thyroid cancer after initial treatment and TSH stimulation increases its sensitivity for the diagnosis of recurrent disease. AIM The goal of the study is to compare the diagnostic values of seven methods for serum Tg measurement for detecting recurrent disease both during L-T4 treatment and after TSH stimulation. METHODS Thyroid cancer patients who had no evidence of persistent disease after initial treatment (total thyroidectomy and radioiodine ablation) were studied at 3 months on L-T4 treatment (Tg1) and then at 9-12 months after withdrawal or recombinant human TSH stimulation (Tg2). Sera with anti-Tg antibodies or with an abnormal recovery test result were excluded from Tg analysis with the corresponding assay. The results of serum Tg determination were compared to the clinical status of the patient at the end of follow-up. RESULTS Thirty recurrences were detected among 944 patients. A control 131I total body scan had a low sensitivity, a low specificity, and a low clinical impact. Assuming a common cutoff for all Tg assays at 0.9 ng/ml, sensitivity ranged from 19-40% and 68-76% and specificity ranged from 92-97% and 81-91% for Tg 1 and Tg2, respectively. Using assays with a functional sensitivity at 0.2-0.3 ng/ml, sensitivity was 54-63% and specificity was 89% for Tg1. Using the two methods with a lowest functional sensitivity at 0.02 and 0.11 ng/ml resulted in a higher sensitivity for Tg1 (81% and 78%), but at the expense of a loss of specificity (42% and 63%); finally, for these two methods, using an optimized functional sensitivity according to receiver operating characteristic curves at 0.22 and 0.27 ng/ml resulted in a sensitivity at 65% and specificity at 85-87% for Tg1. CONCLUSION Using an assay with a lower functional sensitivity may give an earlier indication of the presence of Tg in the serum on L-T4 treatment and may be used to study the trend in serum Tg without performing any TSH stimulation. Serum Tg determination obtained after TSH stimulation still permits a more reliable assessment of cure and patient's reassurance.

Journal Article European consensus for the management of patients with differentiated thyroid carcinoma of the follicular epithelium Get access Furio Pacini, Furio Pacini Section of Endocrinology and Metabolism, University of Siena, Via Bracci, 53100 Siena, Italy (Correspondence should be addressed to F Pacini; Email: pacini8@unisi.it) Search for other works by this author on: Oxford Academic Google Scholar Martin Schlumberger, Martin Schlumberger Service de Médicine Nucléaire, Institut Gustave Roussy, Villejuif, France Search for other works by this author on: Oxford Academic Google Scholar Henning Dralle, Henning Dralle Department of General, Visceral and Vascular Surgery, University of Halle, Germany Search for other works by this author on: Oxford Academic Google Scholar Rossella Elisei, Rossella Elisei Department of Endocrinology, University of Pisa, Italy Search for other works by this author on: Oxford Academic Google Scholar Johannes W A Smit, Johannes W A Smit Department of Endocrinology and Metabolic Disease, Leiden University Medical Center, The Netherlands Search for other works by this author on: Oxford Academic Google Scholar Wilmar Wiersinga, Wilmar Wiersinga Department of Endocrinology and Metabolism, University of Amsterdam, The Netherlands Search for other works by this author on: Oxford Academic Google Scholar the European Thyroid Cancer Taskforce the European Thyroid Cancer Taskforce Search for other works by this author on: Oxford Academic Google Scholar European Journal of Endocrinology, Volume 154, Issue 6, Jun 2006, Pages 787–803, https://doi.org/10.1530/eje.1.02158 Published: 01 June 2006 Article history Received: 10 February 2006 Accepted: 03 March 2006 Published: 01 June 2006

L'elevation isolee d'un marqueur serique est un signal d'alerte pour la reprise evolutive d'un cancer traite. L'identification precise et precoce du site tumoral permet d'entreprendre un traitement adapte et d'esperer une efficacite therapeutique meilleure. La TEP- 18 FDG constitue une avancee significative en cancerologie et a ete utilisee dans la recherche de ces localisations chez des patients traites pour un cancer presentant une elevation isolee d'un marqueur tumoral serique. METHODE : 815 patients, ages de 31 a 82 ans, traites pour un cancer du sein (n= 318), un cancer colorectal (n=246), un cancer de l'ovaire (n=164) ou un carcinome epidermoide (n=87) ont ete etudies. La TEP- 18 FDG a ete realisee avec une camera TEP couplee a un scanner (TDM) et correlee avec l'evolution clinique, les methodes d'imagerie conventionnelle focalisee et les resultats pathologiques. RESULTATS : La TEP-TDM 18 FDG a ete positive pour 647 patients. Avec une sensibilite de 95,8% et une valeur predictive positive de 95,3%, une maladie evolutive a ete identifiee pour 92% des patients avec une precession sur les signes cliniques de 4-11 mois. CONCLUSION : Ces resultats justifient une modification des thesaurus de surveillance et la mise en route de nouveaux protocoles comparant l'attitude therapeutique classique a un traitement precoce avec comme cible le taux des marqueurs seriques et la lesion detectee avec la TEP-TDM 18 FDG avec comme but une amelioration de la survie.

Objectif Le but de ce travail était d'évaluer les corrélations entre les résultats des dosages d'anticorps antithyroglobuline par différentes techniques et les tests de récupération. Matériels et Méthodes Nous avons mesuré la concentration d'anticorps antithyroglobuline par trois méthodes immunoradiométriques différentes (TGAB IRMA Pasteur, Thyrak assay Behring et Anti-Tgn DYNOtest Brahms) dans 724 sérums provenant de 301 patients sous surveillances clinique et biologique après traitement initial d'un cancer thyroïdien folliculopapillaire. La thyroglobuline a été mesurée par une technique immunoradiométrique utilisant cinq anticorps monoclonaux (Thyroglobuline IRMA Pasteur). Des tests de récupération ont été faits en parallèle avec les dosages d'anticorps antithyroglobuline et leurs résultats comparés aux concentrations d'anticorps antithyroglobuline. Résultats Une absence de relation entre les deux méthodes visant à identifier la probabilité d'interférences dans le dosage de la thyroglobuline est montrée. Ces résultats confirment ceux antérieurement obtenus et sont en accord avec le fait qu'il ne s'agit pas d'un problème lié à une technique particulière de dosage des anticorps antithyroglobuline. Conclusion Aucune corrélation significative n'a pu être mise en évidence entre les pourcentages de récupération de la thyroglobuline et les concentrations d'anticorps antithyroglobuline, quelle que soit la méthode employée.

CONTEXT:After surgery for differentiated thyroid carcinoma, many patients are treated with radioiodine to ablate remnant thyroid tissue. This procedure has been performed with the patient in the hypothyroid state to promote endogenous TSH stimulation and is often associated with hypothyroid symptoms and impaired quality of life. OBJECTIVE AND INTERVENTION: This international, randomized, controlled, multicenter trial aimed to compare the efficacy and safety of recombinant human TSH (rhTSH) to prepare euthyroid patients on L-thyroxine therapy (euthyroid group) to ablate remnant thyroid tissue with 3.7 GBq (100 mCi) 131I, compared with that with conventional remnant ablation performed in the hypothyroid state (hypothyroid group). Quality of life was determined at the time of randomization and ablation. After the administration of the 131-I dose, the rate of radiation clearance from blood, thyroid remnant, and whole body was measured.RESULTS:The predefined primary criterion for successful ablation was "no visible uptake in the thyroid bed, or if visible, fractional uptake less than 0.1%" on neck scans performed 8 months after therapy and was satisfied in 100% of patients in both groups. A secondary criterion for ablation, an rhTSH-stimulated serum thyroglobulin concentration less than 2 ng/ml, was fulfilled by 23 of 24 (96%) euthyroid patients and 18 of 21 (86%) hypothyroid patients (P = 0.2341). Quality of life was well preserved in the euthyroid group, compared with the hypothyroid group, as demonstrated by their lower pretreatment scores on the Billewicz scale for hypothyroid signs and symptoms, 27 +/- 7 vs. 18 +/- 4 (P < 0.0001) and their significantly higher Short Form-36 Health Assessment Scale scores in five of eight categories. Euthyroid patients had a statistically significant one third lower radiation dose to the blood, compared with patients in the hypothyroid group.CONCLUSIONS:This study demonstrates comparable remnant ablation rates in patients prepared for 131I remnant ablation with 3.7 GBq by either administering rhTSH or withholding thyroid hormone. rhTSH-prepared patients maintained a higher quality of life and received less radiation exposure to the blood.

UNLABELLED Technical aspects and results of the dosimetric assessments of postoperative radioiodine ablation in the framework of an international, prospective, controlled, randomized, comparative study of the effectiveness of ablation therapy with 3.7 GBq (131)I in differentiated thyroid cancer after stimulation with recombinant human TSH (rhTSH) or by thyroid hormone withdrawal (THW) are presented. METHODS Sixty-three patients were randomized after thyroidectomy to either the THW or the rhTSH group. Scintigraphic neck images were acquired starting 48 h after radioiodine administration to assess biokinetics in the thyroid remnant. The activity in blood samples was quantified and data from whole-body probe measurements and scintigraphic whole-body scans were combined to deduce retention curves in blood and whole body, respectively. The absorbed dose to the blood was calculated using a modified approach based on the formalism of the MIRD Committee of the Society of Nuclear Medicine. RESULTS The effective half-time in the remnant thyroid tissue was significantly longer after rhTSH than THW (67.6 +/- 48.8 vs. 48.0 +/- 52.6 h, respectively; P = 0.01), whereas the observed differences of the mean 48-h (131)I uptakes (0.5% +/- 0.7% vs. 0.9% +/- 1.0% after THW; P = 0.1) and residence times (0.9 +/- 1.3 vs. 1.4 +/- 1.5 h after THW; P = 0.1) between the rhTSH and THW groups were not statistically significant. The specific absorbed dose to the blood was significantly (P <0.0001) lower after administration of rhTSH (mean, 0.109 +/- 0.028 mGy/MBq; maximum, 0.18 mGy/MBq) than after THW (mean, 0.167 +/- 0.061 mGy/MBq; maximum, 0.35 mGy/MBq), indicating that higher activities of radioiodine might be safely administered after exogenous stimulation with rhTSH. CONCLUSION Indication of an influence of the residence time of radioiodine in the blood on the fractional uptake into thyroid remnant was found. A novel regimen is proposed in which therapeutic activities to be administered are determined from the individual specific blood dose.

Le programme Standards, Options et Recommandations (SOR) en cancerologie a ete initie par la Federation nationale des centres de lutte contre le cancer (FNCLCC) en 1993 et realise en partenariat avec la Federation hospitaliere de France (FHF), la Federation nationale de cancerologie des CHRU (FNCCHRU), la Federation francaise de cancerologie des CHG (FFCCHG) et, depuis 2005, en collaboration avec l'Institut national du cancer. Il s'agit d'un travail cooperatif national des Centres regionaux de lutte contre le cancer (CRLCC) avec la participation active d'experts des secteurs public et prive et de societes savantes. Ce programme comprend la definition de recommandations pour la pratique clinique (RPC) en cancerologie, leur actualisation, leur diffusion vers les cliniciens et l'evaluation de leur impact. L'actualisation de ces recommandations repose sur une seconde approche: une veille technologique et scientifique.

L'imagerie a un role essentiel dans la prise en charge des cancers mammaires. La mammographie et l'echographie sont utilisees a la phase initiale pour permettre un diagnostic precoce dans le cadre du depistageou pour aider a la caracterisation de lesions palpables. Les examens avec injection de produits de contraste que ce soit TDM ou IRM ont un role complementaire, lorsque la mammographie et l'echographie ne permettent pas de conclure ou sont insuffisantes pour decider de la strategie a suivre. En cas d'anomalies morphologiques sans traduction clinique, la realisation de prelevements cibles est possible avec l'ensemble de ces modalites. L'analyse cyto ou histologique permet d'indiquer la malignite et de fournir egalement des informations biologiques utiles a la decision therapeutique. L'imagerie a egalement comme objectif d'identifier une extension locoregionale potentielle, notamment ganglionnaire qui constitue un facteur pronostique essentiel, mais egalement de detecter des lesions a distance. Ces informations determinent la decision therapeutique. Les techniques d'imagerie aident a la realisation du geste chirurgical pour le reperage preoperatoire de tumeurs non palpables. Il en est de meme pour la technique du ganglion sentinelle avec la methode isotopique, largement utilisee actuellement, qui rend possible la detection per-operatoire. Lorsque le diagnostic est etabli, l'ensemble des modalites intervient pour le suivi afin de detecter une recidive locale, regionale ou a distance notamment pour les patientes a risque metastatique significatif.

OBJECTIVE The aim of this study was to assess the performance of FDG PET/CT for the detection of colonic lesions, especially advanced neoplasms (villous or >10-mm adenomas, carcinomas). Because of 18F FDG accumulation in adenomatous polyps, PET using FDG can detect early premalignant colorectal lesions. MATERIALS AND METHODS FDG PET/CT studies performed for a 1-year period in 1,716 consecutive patients with various malignant diseases, except colorectal cancer, were retrospectively reviewed. PET images obtained 1 hr after FDG injection and non-contrast CT images used for attenuation correction were fused for analysis. Of 45 patients showing intense focal colonic FDG uptake, 20 patients (with 21 foci) underwent a colonoscopic investigation, and, when necessary, polyp resection. The intensity of FDG uptake was quantified using the standardized uptake value (SUV(max)). RESULTS The FDG colonic foci were associated with 18 colonoscopic abnormalities in 15 patients, with no colonic abnormality detected in five patients (false-positive [FP] results). Histopathologic findings revealed advanced neoplasms in 13 patients (13 villous adenomas and three carcinomas) and two cases of hyperplastic polyps. A difference in the mean SUV(max) was found between FP and true-positive colonic FDG foci but was not statistically significant (p = 0.14). CONCLUSION Presence of a focal colonic FDG uptake incidental finding on a PET/CT scan justifies a colonoscopy to detect (pre-)malignant lesions. The fusion of PET and CT images allows an accurate localization of the lesions. PET/CT is a useful tool to differentiate pathologic from physiologic FDG uptake.

L'imagerie a pris une importance croissante depuis 30 ans dans la prise en charge des cancers gynecologiques lors du bilan d'extension, pour l'evaluation de la reponse therapeutique et en cas de recidive. Le diagnostic de tumeur fait appel essentiellement a des investigations simples comme l'echographie, car la chirurgie est souvent fondamentale pour obtenir une confirmation histologique, ainsi que la connaissance la plus complete possible de l'extension de la maladie. Les informations fournies par l'imagerie sur les extensions des lesions aux structures adjacentes apportent une aide au choix souvent pluridisciplinaire de la therapeutique la mieux adaptee. Pour le bilan d'extension des cancers uterins, l'IRM possede les meilleures performances, mais la TDM peut se reveler utile. La TEP au FDG a un role tres reduit lors de la prise en charge initiale, mais elle permettrait d'ameliorer la determination du statut ganglionnaire. Elle permet surtout de detecter des lesions a distance dans des territoires d'interpretation difficile par les techniques radiologiques, comme le peritoine. Toutes ces methodes peut etre utilisees pour l'evaluation de la reponse therapeutique. Pour le bilan d'extension du cancer de l'ovaire, la TDM reste l'examen de reference, notamment avec les appareils de derniere generation, car elle permet une bonne exploration de la cavite peritoneale. Dans les cas difficiles de reliquats ganglionnaires ou de carcinose, la TEP permet d'identifier des zones de viabilite tumorale.

This case illustrates the possibility of increased FDG uptake in persistent lesions resulting from asymptomatic barium aspiration, which provokes a mild acute inflammatory and edematous reaction within hours, followed by macrophage accumulation, granulomatous inflammation, and fibrosis over succeeding days and months. Barium aspiration occurred during an esophagram 6 months before PET/CT scanning in a 54-year-old man who was seen for suspicion of recurrence of head and neck cancer. In case of minor aspiration, a simple cough is generally observed, but large amounts of barium aspiration can be fatal, especially in elderly people.

Positron emission tomography (PET) is a metabolic radionuclide imaging method in which a tracer labeled with a positron emitter is detected with a dedicated system. 18F-fluorodeoxyglucose (FDG) accumulates in tumor cells because of their increased glycolytic activity, and is thus widely used as a tracer in oncology. This increased metabolic activity precedes morphologic modifications, making FDG-PET a very useful tool for detecting and staging cancer It can also be used to characterize morphologic changes, differentiating not only between benign and malignant lesions, but also between viable tumor cells and areas of necrosis and/or fibrosis induced by treatments. Being a whole-body examination, it allows malignancies to be staged in a single procedure. Systems combining PET and CT (computed tomography) offer improved performance, providing both metabolic and anatomical data. This technique appears to be useful for initial breast cancer staging, especially of locally advanced forms and suspected recurrences (increase of isolated tumor marker). Early studies of PET evaluation of responses to hormonal and/or cytotoxic therapies have also given very promising results. However, this technique does not seem sufficiently sensitive to be included in the initial screening or diagnosis of primary tumors, owing to its limited resolution (about 5 mm) and its restricted availability. This approach is poorly sensitive when used for axillary assessment, but offers good specificity.