Korean J Endocr Surg.  2002 Jun;2(1):5-9. 10.16956/kjes.2002.2.1.5.

Carcinoma Thyroid-Have Turned Around the Corner?

Affiliations
  • 1Post Graduates in General Surgery, Madras Medical College and Research Institute, Chennai-600 003, India.
  • 2Professor of Surgery, Madras Medical College and Research Institute, Chennai-600 003, India. ndr@dr.com

Abstract

Thyroid surgery was revolutionized by Theodre Kocher and his work earned him the Nobel Prize in 1909. The techniques laid down by him hold good even today, even in thyroid cancer surgery. William Halstead, Charles Mayo, George Crile, Frank Lahey and Thomas Dunhill also made significant contributions in vastly improving the outcome of surgery of Thyroid disease. FNAC, a technique first performed by Greig and Gray in 1904 to aspirate trypanosomes from the lymph nodes of patients with sleeping sickness, is the best modality for work up of thyroid nodules and has eclipsed Radio Active Iodine Uptake study. After the widespread use of FNAC in thyroid disease since 1970s a pre operative tissue diagnosis was possible in most thyroid nodules. The role of FNAC is further enhanced by combining Immuno Histo chemistry and nuclear DNA analysis (Petra Werga et al, Karolinska hospital, Sweden, 2000). Yield is highest when done by persons well versed with this technique. The only distinct failure of FNAC is its inability to distinguish between follicular adenoma and carcinoma. But even this has been overcome with the advent of techniques like the following. Two dimensional proton Magnetic Resonance Spectroscopic analysis has now enabled one to effectively identify malignancy as well as to differentiate between Follicular adenoma and carcinoma and is based increased cell surface fucosylation (Wanda. B Mackinnon et al, NSW, Australia). Molecular genetics in relation to thyroid disease especially in carcinoma thyroid had exploded many myths and realities. The relationship between RET-PTC oncogene and MTC is established beyond doubt and signaled the induction of "prophylactic thyroidectomy" in the realm of surgeons. Prophylactic thyroidectomy is ideally done in RET-PTC positive individuals at six years of age. Central compartment lymph node dissection is added if there is a raised serum calcium or if the patient is older than 10 years. Bilateral lymph node dissection is done in patents older than 15 with elevated serum calcitonin (Henning Dralle et al, Germany 1998). An Association between TSHR and Gs mutation with toxic adenosis has also been proven. P 53 mutation plays a dominant role in the development of anaplastic carcinoma (Diana Learoyd et al, NSW, Australia, 2000). Familial Papillary Thyroid Carcinoma [FPTC] and MNG has also been recognized as a distinct entity apart from other familial syndromes like Gardener's syndrome and Cowden's disease. Primary criteria for susceptibility to FPTC include PTC in two first degree relatives, MNG in three first or second degree relatives , patients younger than 33 years with multi focal, bilateral or metastatic PTC (Thomas.Musholt et al, Hannover, Germany 2000). Surgical techniques are opted based on various scoring systems like AMES, MACIS, AGES. These systems help prognosticate thyroid cancer based on age, size of tumor, extra thyroidal spread, metastasis and completeness of thyroidectomy. Sentinel lymph node mapping was first with isosulfan blue dye is safe and sentinel nodes even if present in the lateral cervical compartments and mediastinum are detected (Elijah Dixon et al, Alberta, Canada 2000). Microdissection with central compartment lymph nodal clearance has been shown to positively influence survival and decrease local recurrence in patients with PTC (Lars-Erik Tissel et al, Goteberg, Sweden 1996). Complications of surgery like permanent Recurrent laryngeal nerve palsy [1%] and hypo parathyroidism [2%] have been reduced and recurrence scaled down significantly because of well established endocrine centers and training of young surgeons (Tom Reeve, NSW Australia, 2000). Complications are higher in re operative thyroid surgeries with RLN palsy as high as 2% and hypoparathyroidism seen in almost 5% of the cases (Puzzolo et al, Italy 1997).

Keyword

Thyroid cancer
Full Text Links
  • KJES
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr