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Introduction: The aim of the study was to estimate the influence of a thyroid remnants' volume, postsurgical concentration of thyroglobulin and radioiodine dose on the early treatment efficacy of well differentiated thyroid cancer., Material and Methods: We retrospectively analyzed 91 patients (76 females, 15 men) with well differentiated thyroid cancer., Results: Histological classification revealed 68.1% (62/91) papillary thyroid cancers, 25.3% (23/91) follicular thyroid cancers, and 6.6% (6/91) oxyphilic thyroid cancers. Among the group, 74 (81.3%) patients reached the remission criteria and the remaining 17 patients (18.7%) showed biochemical and morphological evidence of metastatic disease. The remission was obtained in 100% of patients in stage I of the disease, 68.4% - in stage II, 78.6% - in stage III and 33.3% in stage IV. The total radioiodine dose used in patients with remission, did not differ from the dose used in patients without remission. We did not observe the influence of remnant's volume on treatment efficacy, however larger remants required higher dose of radioiodine to obtain the remission. Patients with remission had lower postsurgical thyroglobulin concentration than patients without remission. (22.2 vs. 103.3 ng/ml; p = 0.00025)., Conclusions: Early treatment results of well differentiated thyroid cancer depend on the clinical stage, and postoperative serum thyroglobulin level measured after endogenous TSH stimulation. Early treatment results are not dependent on age, sex, histological type of thyroid cancer, the dose of radioiodine used in brackets of 60-150 mCi and additional diseases. Total thyroidectomy is equally efficient as near total.

Unlabelled: Thyroid cancer consists 1% of all malignant neoplasms. It is not known interrelationship between concentration of TSH in blood serum and condition of thyroid cancer. Thyroid cancer is difficult for diagnosis and differentiation. Therefore it is necessary to search for biochemical markers helpful in diagnostics of thyroid cancer. Significant increase in activity of N-acetyl-beta-D-hexosaminidase and its isoenzymes A and B in serum of patients with neoplasms of kidney and pancreas suggest approporiateness of evaluation of HEX and its isoenzymes in diagnostics of thyroid cancer., The Aim: of the study--evaluation of TSH concentration and activity of HEX and its isoenzymes A and B, in serum of patients with thyroid cancer., Materials and Methods: Blood was taken from 7 patients with thyroid cancer (6 men and 1 woman). Control consisted of 7 healthy men. In blood serum concentration of TSH was determined with immunoenzymatic method on analyzer Axsym of Abbott and expressed in microU/mL. The activity of HEX and its isoenzymes A and B was determined by method of Chatterjee et al., as modified by Zwierz et.al. Determination of HEX was performed on microplate reader ELX800 BIO-TEK. Activity of HEX, HEX A and B was expressed in pKat/mL, and specific activity in pKat/mg protein). Protein was determined by biuret method and results were expressed in mg/mL., Results: Concentration of HEX A activity in serum of thyroid cancer patients is significantly higherin comparison to healthymen (p = 0.0191). Also specific activity of HEX A in serum of thyroid cancer patients is significantly higher in comparison to healthy men (p = 0.0393)., Conclusions: 1. Determination of TSH concentration in serum of thyroid cancer before the operation may confirm euthyreosis. 2. Determination of HEX A activity in serum may be helpful in diagnostics of thyroid cancer.

Introduction: Apoptosis (programmed cell death) is the best described mode of physiological cell death. During embryonal development and morphogenesis, apoptosis may be induced by two pathways. The first is external protein signal originating from other cell--also named as "death signal". Another one is specific cell reaction for external stress factors. Blood concentration of proteins regulating both pathways of apoptosis may be useful in early diagnosis and staging of thyroid tumors. The aim of study was evaluation of p53 and sFasL blood concentration in patients with benign follicular adenoma and follicular thyroid cancer., Materials and Methods: The study population was composed of 28 patients: 14 with thyroid carcinoma and 14 patients with follicular neoplasm (NF). All patients underwent surgical treatment. P53 and sFasL levels were evaluated before surgery and related to the histopathological diagnosis obtained post-surgery., Results: The analysis revealed high sFasL blood concentration in patients with follicular thyroid cancer in comparison with the group with follicular adenoma. There was no statistically significant difference between levels of p53 in both groups., Conclusions: Evaluation of sFasL serum level concentration may be useful in preoperative diagnosis of follicular thyroid tumors.

Neoangiogenesis is a significant event in a cascade of growth and progression of solid tumors. Assessment of the tissue expression and measurement of the concentrations of angiogenic and antiangiogenic factors, contributing to this process, in body fluids, can be used not only for an early diagnosis of tumors and their staging but also as an important parameter of treatment efficiency evaluation. The aim of this study is to evaluate the concentrations of crucial angiogenic cytokine VEGF and its soluble receptors in peripheral blood of patients with benign and malignant thyroid tumors. The study comprised 35 patients with thyroid cancer and 10 patients with follicular neoplasm, both diagnosed by means of ultrasound-guided fine-needle aspiration biopsy. For these patients surgical treatment was instituted. The examined angiogenic factors were determined preoperatively and 4 weeks after the surgical procedures. The results were compared with the control group which comprised 10 healthy individuals. Analysing obtained results, we demonstrated high VEGF concentrations and low soluble VEGF receptor concentrations in patients with benign and malignant thyroid tumors. This fact confirms a vital role of VEGF in angiogenesis of thyroid tumors and a hypothetical antiangiogenic activity of its soluble receptors. Disequilibrium of the above-mentioned angiogenic factor concentrations is probably essential for the growth and progression of benign and malignant thyroid tumors.

The medullary thyroid carcinoma (MTC) occurs in the two major forms, the sporadic medullary carcinoma (SMTC) and hereditary medullary carcinoma, to which belong familial form (FMTC) and the element of Multiple Endocrine Neoplasia Syndrome MEN 2A and 2B. The method-of-choice of treatment is total thyroidectomy with following radiotherapy in selected cases. Among the follow-up methods, there are two used the most frequently: the pentagastrin and omeprazole stimulation test of calcitonin (CT), and CEA antigen assay. The aim of this study is to evaluate usefulness of plasma CT, CEA and AFP assay in the early detection of relapse or metastasis of MTC. 18 patients (14 females and 4 males) were investigated. The following procedures were performed in all the patients: plasma CT assays in the basal conditions and after stimulation tests, CEA and AFP. The results were analysed according to TNM staging and neck USG results. Our conclusion is that calcitonin stimulation tests, and CEA assays are useful methods to estimate the presence of relapse or metastases in the patients after surgical treatment due to MTC. Assays of plasma AFP concentration are not useful in a follow-up of patients operated on MTC.

Monitoring patients with differentiated thyroid carcinoma (DTC) by thyroglobulin (Tg) measurements requires selecting optimal methods used for detection of this marker. An increase the thyroglobulin concentration in serum is a predictor of tumor recurrence. All serum thyroglobulin assays can be falsified by presence of Tg autoantibodies, which are present in approximately 20% of DTC patients. The aim of this study was a comparison of the clinical utility of two different methods for determining serum Tg concentration in monitoring patients with DTC during thyroxine treatment. Tg concentration was measured in serum samples of 1530 patients with DTC during replacement thyroid hormone using two methods: fluoroimmunometric assay (IFMA) Wallac Delfia Thyroglobulin and immunoradiometric assay (IRMA) Brahms DYNOtest Tg-S. 1847 values of Tg concentration and recovery test detected between 1992 and 1995 years using IFMA methods and 1187 values of Tg and thyroglobulin autoantibodies concentration measured in 2000 year using IRMA methods were also included. The correlation between Tg values in all patients group wasn't good (r = 0.83; p < 0.05), but when we excluded patients with incorrect recovery test determined by IRMA, the correlation factor was higher (r = 0.94; p < 0.05). The estimation of Tg recovery test obtained in IRMA assay eliminated from monitoring only 3% patients with DTC, when IFMA assay excluded nearly 1/5 patients, whereas the estimation Tg autoantibodies 7% from all patients. The IRMA method is the most resistant to interference and allows to monitor a reliably greater group of patients with DTC during thyroxine treatment.

Treatment and diagnostics with 131I play an important role in patients with differentiated thyroid cancer (DTC) after thyreoidectomy. The aim of the study was to assess the influence of some factors on ablative therapy results. Fifty seven patients with DTC were investigated (44 females--mean age 46.6 yrs, 13 males--mean age 55.6 yrs.). Papillary thyroid cancer was diagnosed in forty five patients (79%) however, follicular thyroid cancer in the others (21%). We performed post-therapeutic whole-body scan (WBS) after high fixed doses of 131I (median = 75 mCi) and six months later diagnostic WBS (mean 4.3 mCi) in every patient. Postoperative radioiodine uptake, levels of TSH and thyroglobulin (Tg) serum concentrations were assessed after thyroid hormones withdrawal before imaging. The absence of radioiodine uptake in the thyroid bed (effective ablation) was observed in 64.9% of patients. In other cases scans showed significantly diminished uptake of the tracer in the remnants. Statistically significant difference in TSH levels before and after radioiodine therapy (75.6 vs. 106.7 microIU/ml, p < 0.001) was found in all patients. However, effectiveness of the ablative therapy did not depend on radioiodine uptake, TSH and Tg levels before radioiodine treatment.

The aim of this study was the assessment of diagnostic value of thyroglobulin serum measurement in patients with DTC during endogenous TSH stimulation. Thyroglobulin was measured by immunofluorometric method (Delfia-Wallac) in patients after combined surgery and I131 ablation. Predictive values for two threshold levels 10 and 30 ng/ml were compared. At 5 years follow up it has been demonstrated, that Tg values higher than 10 ng/ml were the true signals of DTC relapse only in 46% patients. Tg values higher than 30 ng/ml were associated with disease progression in 65% of patients. Thus, we accept Tg concentration of 30 ng/ml measured during endogenous TSH stimulation as a good cut-off limit for the detection of DTC progression. Reduction of this threshold up to 10 ng/ml is associated with the increased risk of false positive results.

Unlabelled: In patients with a suspicion of recurrence of differentiated thyroid cancer with metastases to lymph nodes, detection of thyroglobulin (Tg) mRNA in fine needle biopsy material may support the interpretation of classic cytological examination in cases where it fails to detect lymph node involvement early enough., Aim: Prospective study of thyroglobulin mRNA detection in neck lymph nodes in patients with suspected differentiated thyroid cancer (DTC) metastases., Material: 70 nodes from 60 patients with suspected DTC recurrence were investigated. Patients with suspicion of lymph node metastases of other types of cancer were included as a control group. Thyroglobulin RT-PCR was conducted in residual material left after preparation of cytological smears from fine needle biopsy specimens. Primers spanning exons 3-5 were used with 39 cycles of PCR. RNA isolation control and cDNA amplification were carried out using GADPH starters., Results: Classical cytology confirmed nodal involvement in 22 of DTC patients, RT-PCR Tg was positive in 20 of them (91%). Among 48 patients with a suspicion of DTC recurrence and negative cytology, Tg mRNA was found twice. One positive RT-PCR result was confirmed by repeated cytology conducted 4-6 months later and followed by surgery. No positive result of RT-PCR was obtained with other head and neck malignancies. The overall specificity was estimated with 98%., Conclusions: RT-PCR Tg shows sufficient specificity to be applied in further studies estimating its usefulness in fine needle biopsy for early detection of lymph node metastases in differentiated thyroid cancer.

Unlabelled: The aim of the study was to estimate the dose of thyroxine required by pregnant women who had undergone total thyreoidectomy and radioiodine treatment for thyroid cancer. Material consisted of 4 pregnant women, aged mean 30.8 years. One of patients was studied during 2 consecutive pregnancies. The daily mean dose of thyroxine was 175 micrograms. The control group consisted of 7 women with primary hypothyroidism aged mean 33.5 years, who were treated with replacement doses of thyroxine. One of them was pregnant twice. The mean daily dose of thyroxine was 106.3 micrograms. The estimation of TSH, fT4 were repeated every 4 weeks., Results: In all cases natural deliveries took place. All infants were alive and had no congenital malformations and no clinical or biochemical thyroid dysfunction was found. Pregnant women treated for thyroid cancer needed to have optimized their suppressive therapy by increasing the dose of thyroxine by 26% at the first trimester, 27% at the second and 38% at the last one. Statistically significant increase was found at the 1st trimester of pregnancy and it remained at the same level till the delivery. Pregnant hypothyroid women needed to have optimized their replacement thyroxine therapy by increasing of the dose by 53% at the first trimester, by 49% at the second and by 53% at the last one. Similarly to the 1st group of patients, we noticed statistically significant increase at the 1st trimester of pregnancy., Conclusion: In pregnant women who have been previously treated for thyroid cancer the suppressive dose of thyroxine needs to be increased by 26-38% which is slightly less than the increase of the replacement dose in hypothyroid pregnant women.

Unlabelled: Life-time L-thyroxine therapy is obligatory in patients treated for differentiated thyroid carcinoma (DTC) in order to suppress serum TSH. The rationale for that is the TSH stimulation of follicular cells' growth and the presence of TSH receptors on DTC cells. Nevertheless, the exact criteria for TSH suppression in DTC are not specified and are a matter of discussion, stimulated by the recent progress in the evaluation of thyroxine side effects on bone and heart. The aim of the study was the optimalization of the reference range for TSH suppression in DTC patients in order to minimalize the risk of iatrogenic thyrotoxicosis. One hundred and twenty nine patients were randomly chosen among patients treated radically for DTC (116 females and 13 males). Basal and TRH stimulated TSH level, FT4 and FT3 serum level were estimated by microimmunoenzymatic method, while SHBG was estimated by immunofluorimetry. Full suppression (basal TSH < 0.05) was obtained in 64 patients (49%), submaximal suppression (TSH between 0.1 and 0.3 mU/l) was observed in 21 patients (16%). In 29 patients (22%) no suppression was obtained by the applied dose of thyroxine. The risk of iatrogenic hyperthyreosis, as judged by the increase of FT3 or SHBG, was found to be 38% in patients with full suppression and only 5% in patients with submaximal suppression (p < 0.05)., Conclusion: 1. Suppression of TSH secretion was achieved in 80% of patients with differentiated thyroid carcinoma. The control of TSH level must be controlled every 3 months in 5 first years of therapy. 2. The optimal serum TSH level for L-thyroxine therapy in asymptomatic patients after radical treatment of differentiated thyroid carcinoma ranges between 0.1 to 0.3 mU/L. This range ensures the expected suppression of TSH with only minimal risk of iatrogenic hyperthyreosis.

Differentiated thyroid carcinoma (DTC) is one of malignant neoplasms with a very good prognosis and low mortality rate provided a proper therapy and its systematic monitoring is given. DTC treatment consists of surgery, radioiodine and L-thyroxine therapy. L-thyroxine therapy in DTC should be both substitutive and suppressive. Substitutive therapy consists in the removal of the lack of thyroid hormones symptoms so that the serum TSH is about 1 mU/l. Suppressive therapy consists in complete inhibition of TSH secretion by pituitary gland. This prevents from the regrowth and inhibition of carcinoma progress in patients with evident or residual neoplasmic disease. Although complete suppressive therapy (TSH less than 0.05 mU/l) is the most recommended one, in patients with low recurrence risk incomplete suppression can be used (TSH = 0.1-0.3 mU/l). Suppressive L-thyroxine doses may give side-effects such as: cardiac signs (arrhythmia, coronary or heart insufficiency), decrease in bone mineral density with osteopoenia or osteoporosis or subclinical hyperthyroidism. However, the side-effects of the suppressive L-thyroxine doses may be symptomatically treated (with beta-blockers, biphosphoniates).

The aim of our study was to estimate the levels of neopterin (NTP), anti thyroglobulin antibodies (ATG), anti thyroid microsomal antibodies (MAB), immunoglobulins (IgG, IgA and IgM) and creatinine in the serum of patients with thyroid diseases. The clinical material consisted of 71 patients (64 women and 7 men) with non-toxic nodular goitre (30 persons), neoplasms (33 persons: 22 with thyroid adenoma and 11 with thyroid carcinoma) and thyroiditis (8 persons). The control group consisted of 30 healthy women. In studied groups the mean serum levels of NTP and creatinine were in normal range. The highest levels of NTP were found in patients with thyroid carcinoma (7.14 +/- 5.95 nmol/l) and with non-toxic nodular goitre (5.13 +/- 3.57 nmol/l). It was statistically significant in comparison with control group (p < 0.05). Anti thyroglobulin antibodies (ATG) were detected in serum of 36 patients (50.7%) and anti thyroid microsomal antibodies (MAB) were in serum of 28 patients (39.4%). Mean levels of these autoantibodies were significantly higher than in control group (< 0.05). In patients with autoantibodies (ATG and/or MAB) mean serum level of NPT was significantly higher than in patients without these autoantibodies (p < 0.05). We did not find a significant correlation between the level of NPT and the levels of ATG and MAB.