Thyroid Carcinoma: Criteria in Selection of Patients for Total and Subtotal Thyroidectomy

Surgical management of patients with thyroid carcinoma continues to be a controversial subject among surgeons throughout the nation. The authors have recently treated patients with differentiated thyroid carcinoma using a selective surgical approach based on criteria classifying patients into high- and low-risk subgroups. Categorization is based on patient age, size and invasiveness of the tumor, and the presence or absence of distant metastatic disease. Women older than 50 and men over the age of 40 were classified as “high-risk” patients. Other criteria qualifying patients for high-risk categorization included lesion size greater than 3 cm and/or the presence of distant metastases. For patients with follicular tumors, histologic evidence of significant vascular invasion also constituted a high-risk criterion. Patients with high-risk criteria are associated with a significantly poorer prognosis. The records of 136 patients treated from 1958 to 1978 were reviewed. The findings and research from the literature suggest that these high-risk patients, when treated by total thyroidectomy, have an overall increased rate of survival when compared with those under-going lesser surgical procedures.     

Development of Thyroid-Associated Ophthalmopathy in Patients Who Underwent Total Thyroidectomy

Purpose

To report clinical characteristics of thyroid-associated ophthalmopathy (TAO) in patients who previously underwent total thyroidectomy for thyroid cancer or a benign mass of the thyroid.

Materials and Methods

Of the patients who were diagnosed with TAO from March 2008 to March 2012, we performed a retrospective chart review on those who had undergone total thyroidectomy for thyroid cancer or a benign mass of the thyroid before the occurrence of ophthalmopathy.

Results

Of the 206 patients diagnosed with TAO, seven (3.4%) met the inclusion criteria. The mean age of the subjects was 47.4 years, and all were female. Six patients were diagnosed with papillary thyroid cancer, and one was diagnosed with a benign mass. The duration between total thyroidectomy and onset of TAO ranged from 3-120 months (median 48 months). Ophthalmic manifestations varied among cases. Except for the patient who was diagnosed with a benign mass, all patients showed hyperthyroid status and were under Synthroid hormone treatment at the time of TAO development. Five of these six patients had positive levels of thyroid-stimulating hormone (TSH) receptor autoantibodies.

Conclusion

TAO rarely develops after total thyroidectomy, and the mechanism of TAO occurrence is unclear. However, most patients showed abnormalities in thyroid function and TSH receptor autoantibodies.     

Primary Myxedema Heart Disease

A case of primary myxedema heart disease in an 84-year-old man is presented. His history and physical examination were typical of myxedema. Electrocardiographic changes showing generalized low voltage, nonspecific S-T segment and T-wave changes, and nodal rhythm are characteristic of the disease. The patient showed remarkable improvement after oral liothyronine (Cytomel) therapy.     

Exercise and Heart Disease

The role of exercise (particularly distance running) in the prevention of coronary heart disease is discussed. Evidence is presented that the ability to perform an activity requiring the most extreme degree of physical stamina is no guarantee of a healthy heart or protection from a fatal myocardial infarct. A plea is made for correction or elimination of all coronary risk factors rather than focusing on one or a few which some regard as more important than the others.