PET/CT in the management of differentiated thyroid cancer

The standard treatment of differentiated thyroid cancer (DTC) consists of surgery followed by iodine-131 (¹³¹I) administration. Although the majority of DTC has a very good prognosis, more aggressive histologic subtypes convey a worse prognosis. Follow-up consists of periodically measurements of serum thyroglobulin, thyroglobulin antibodies and neck ultrasound and ¹²³I/¹³¹I whole-body scan. However, undifferentiated thyroid tumors have a lower avidity for radioiodine and the ability of DTC to concentrate ¹³¹I may be lost in metastatic disease. Positron emission tomography (PET)/computed tomography (CT) has been introduced in the evaluation of patients with thyroid tumors and the 2-[18F]-fluoro-2-deoxyd-glucose (¹⁸F-FDG) has been largely validated as marker of cell's metabolism. According to the 2015 American Thyroid Association guidelines, ¹⁸F-FDG PET/CT is recommended in the follow-up of high-risk patients with elevated serum thyroglobulin and negative ¹³¹I imaging, in the assessment of metastatic patients, for lesion detection and risk stratification and in predicting the response to therapy. It should be considered that well-differentiated iodine avid lesions could not concentrate ¹⁸F-FDG, and a reciprocal pattern of iodine and ¹⁸F-FDG uptake has been observed. Beyond ¹⁸F-FDG, other tracers are available for PET imaging of thyroid tumors, such as Iodine-124 (¹²⁴I), ¹⁸F-tetrafluoroborate and Gallium-68 prostate-specific membrane antigen. Moreover, the recent introduction of PET/MRI, offers now several opportunities in the field of patients with DTC. This review summarizes the evidences on the role of PET/CT in management of patients with DTC, focusing on potential applications and on elucidating some still debating points.     

不同分期白癜风患者TPOAb、TGAb、TRAb表达分析

目的分析不同分期白癜风患者血清甲状腺过氧化物酶抗体(TPOAb)、甲状腺球蛋白抗体(TGAb)、促甲状腺素受体抗体(TRAb)的表达。方法 161例白癜风患者依据病情分为进展期组(n=84)和稳定期组(n=77),并选择健康者60例为对照组。检测3组血清TPOAb、TGAb、TRAb水平,并比较以上指标在3组中的表达水平及阳性率差异。结果3组TPOAb、TGAb、TRAb水平比较,差异有统计学意义(H=14.371、6.335、8.284,P0.05)。两两比较,进展期组TPOAb、TGAb、TRAb水平高于稳定期组和对照组(U_(与稳定期组)=9.380、7.923、8.381,P0.05;U_(与对照组)=23.244、19.026、25.873,P0.05);稳定期组TPOAb、TGAb、TRAb水平高于对照组(U=11.356、12.450、16.351,P0.05)。3组TPOAb、TGAb、TRAb表达水平由高到低依次为:进展期组、稳定期组、对照组。3组TPOAb、TGAb、TRAb阳性率比较,差异有统计学意义(χ~2=18.676、23.618、23.857,P0.05)。两两比较显示,进展期组TPOAb、TGAb、TRAb阳性率高于稳定期组、对照组(χ_(与稳定期组)~2=5.273、6.484、6.305,P0.017;χ_(与对照组)~2=14.997、18.352、17.829,P0.017),稳定期组TPOAb、TGAb、TRAb高于对照组(χ~2=5.233、5.036、6.719,P0.017)。3组TPOAb、TGAb、TRAb阳性率由高到低依次为:进展期组、稳定期组、对照组。结论白癜风患者存在甲状腺自身抗体(TPOAb、TGAb、TRAb)表达异常,病情进展与否也与此类抗体表达水平有关。     

A multi-analyte immunoassay for thyroid related analytes

We describe the development and validation of multianalyte immunoassays (MAIA) for three analytes, viz., thyroxine (T4), thyroid stimulating hormone (TSH), and thyroglobulin (Tg) essential for assessment of thyroid function but having widely varying molecular weights. Using polycarbonate (PC) track-etched membranes (TEM) as an immobilization support and ¹²⁵I as the tracer, both competitive assay for T4 and non-competitive assay for TSH and Tg were performed on the same TEM. MAIA was found to be highly sensitive and precise with clinically useful working range and correlated very well with individual analyte immunoassays. While we have demonstrated this assay format with radiotracer, it can be used with non-isotopic tracers equally well.     

放射免疫分析法相关参数对甲状腺球蛋白检测结果的影响

目的评价放射免疫分析法曲线拟合方式一定时,不同试剂盒、结合率方式(B/T与B/B0)对甲状腺球蛋白(TG)检测结果的影响。方法选用国内具有代表性的3家放射免疫试剂盒(A、B、C组),分别对78例临床确诊的甲状腺疾病患者血清TG进行检测。曲线拟合方式一定前提下,分别用B/T与B/B0 2种结合率方式进行检测,分析3家放射免疫试剂盒的不同结合率方式对检查结果的影响。结果 A、B、C组试剂盒检测TG值差异有统计学意义(z=6.11,P0.05);A组与B组检测TG值差异无统计学意义(z=0.894,P0.05);A组与C组检测TG值差异有统计学意义(z=2.01,P0.05);B组和C组检测TG值差异也有统计学意义(z=1.963,P0.05)。在B/T与B/B0 2种结合率方式下,A组和B组检测TG值差异均无统计学意义(P0.05),C组检测TG值差异有统计学意义(z=-1.68,P0.05)。结论曲线拟合方式一定,选择不同的放射免疫试剂盒必须选择其试剂盒所对应的结合率方式,才能得出较准确的TG检测结果。     

Malignant struma ovarii: The west of Scotland experience and review of literature with focus on postoperative management

Introduction: Malignant struma ovarii is an extremely rare ovarian tumour containing malignant thyroid carcinoma within differentiated thyroid tissue, as the predominant tissue type. Surgery for suspected ovarian tumour and incidental pathological diagnosis is the most common presentation. Evidence supporting any particular approach to the clinical management of this condition is limited, mainly consisting of case reports, small series or pathological case series. There is no randomised evidence for postoperative management in view of the rarity of this condition. The opinion is divided between conservative management versus total thyroidectomy and radio‐iodine ablation. Methods: We carried out a retrospective review of our series with focus on postoperative management of this rare condition. A review of existing literature was also carried out. Results: Six patients with a median age of 52 years presented with various symptoms of abdominal pain, pressure or menstrual problems. After the initial gynaecological resection and specialised pathology review, they were subsequently treated with total thyroidectomy and administration of radioactive iodine. All of these six patients are in remission at a median follow up of 60 months. Conclusion: We favour aggressive postoperative management with total thyroidectomy and radioactive iodine, and long‐term follow up of these patients.     

牛甲状腺球蛋白制备大鼠Graves病模型

目的：通过给大鼠注射牛甲状腺球蛋白,制备Graves病动物模型。方法：Wistar大鼠20只,分为对照组和模型组。模型组腹腔注射牛甲状腺球蛋白,每两周注射1次。对照组使用生理盐水代替。分别在第4周和第8周测定摄碘率、血清游离三碘甲状腺原氨酸（FT3）、血清游离甲状腺素（FT4）和促甲状腺素受体抗体（TRAB）。结果：第4周两组无明显差异。第8周两组出现明显差异,同时模型组中有6只大鼠达到甲状腺功能亢进（简称甲亢）标准。结论：使用牛甲状腺球蛋白制备大鼠Graves病模型是可行的。     

分化型甲状腺癌血液标志物的研究现状及进展

目的阐述近年来有关分化型甲状腺癌的血液标志物的研究现状及进展,以提高分化型甲状腺癌的临床诊治水平。方法对近年来国内外有关分化型甲状腺癌的血液标志物、液体活检等文献进行检索,对不同标志物进行归纳总结与分析。结果甲状腺球蛋白和甲状腺球蛋白抗体是分化型甲状腺癌目前最常用的血清学标志物,微小RNA、长链非编码RNA等血液标志物在分化型甲状腺癌的诊断、治疗和随访中的应用价值也不断被发现。结论因血液标志物具有特异度高、敏感度强且无创等优点,是未来协助提高甲状腺癌患者的诊断准确率、监测患者疾病进展及复发的有用指标。     

Genes and Environment as Predisposing Factors in Autoimmunity: Acceleration of Spontaneous Thyroiditis by Dietary Iodide in NOD.H2h4 Mice

In the field of autoimmune thyroiditis, NOD.H2^h4 mice have attracted significant and increasing attention since they not only develop spontaneous disease but they present thyroiditis with accelerated incidence and severity if they ingest iodide through their drinking water. This animal model highlights the interplay between genetic and dietary factors in the triggering of autoimmune disease and offers new opportunities to study immunoregulatory parameters influenced by both genes and environment. Here, we review experimental findings with this mouse model of thyroiditis.