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International audience; Importance: Because inadvertent damage of parathyroid glands can lead to postoperative hypocalcemia, their identification and preservation, which can be challenging, are pivotal during total thyroidectomy.Objective: To determine if intraoperative imaging systems using near-infrared autofluorescence (NIRAF) light to identify parathyroid glands could improve parathyroid preservation and reduce postoperative hypocalcemia.Design, setting, and participants: This randomized clinical trial was conducted from September 2016 to October 2018, with a 6-month follow-up at 3 referral hospitals in France. Adult patients who met eligibility criteria and underwent total thyroidectomy were randomized. The exclusion criteria were preexisting parathyroid diseases.Interventions: Use of intraoperative NIRAF imaging system during total thyroidectomy.Main outcomes and measures: The primary outcome was the rate of postoperative hypocalcemia (a corrected calcium

Introduction : les cicatrices visibles, dont la cicatrice de thyroïdectomie, peuvent avoir un impact sur la qualité de vie. L’objectif principal de l'étude est de déterminer si l’impact de la cicatrice de thyroïdectomie estimé par le médecin généraliste est bien corrélé au vécu du patient. L’objectif secondaire est d’identifier les groupes de patients à risque de mauvais vécu de la cicatrice de thyroïdectomie. Méthode : la qualité de vie selon les patients adultes opérés d’une thyroïdectomie (DLQI) était comparée aux estimations de leurs médecins généralistes par une analyse de concordance. Le DLQI était aussi analysé selon l’âge, le sexe et la pathologie thyroïdienne. L'étude était rétrospective et observationnelle. Résultats : 50 sujets ont été inclus, dont 41 femmes et 9 hommes, âgés, en moyenne, de 52,4 ans. La majorité avaient été opérés pour un goitre ou un cancer de la thyroïde. La concordance entre DLQI du patient et estimation du médecin généraliste était faible, (k pondéré = 0,29, p = 0,0053). L’âge de moins de 60 ans était associé a un moins bon vécu de la cicatrice. Le sexe et la pathologie thyroïdienne n’avaient pas d’influence sur le vécu de la cicatrice. Le DLQI moyen était de 1,84. L'impact sur la qualité de vie était supérieur chez les patients aux antécédents psychiatriques (DLQI moyen = 3,8). Conclusion : l’impact de la cicatrice de thyroïdectomie sur la qualité de vie est sous-estimé en médecine générale. Cet impact existe surtout chez des sujets jeunes, ou ayant un terrain psychiatrique. La discordance entre le vécu du patient et l’estimation du médecin généraliste souligne l’importance de l’évaluation du vécu de toute cicatrice visible en médecine générale.

Medullary thyroid carcinomas (MTCs) complicated by ectopic Cushing's syndrome (CS) have a poor prognosis, partially due to the difficulty in controlling hypercortisolism by adrenal blocking drugs. Recent reports (including the initial follow-up of this patient) have suggested that tyrosine kinase inhibitors (TKIs) may be a therapeutic option due to an anti-secretory action on ACTH. However, there is a lack of long-term follow-up studies.The case is reported of a 58-year-old man with MTC-related CS resistant to a combination of several anti-cortisolic drugs. Vandetanib, an oral multi-TKI that targets RET in particular, was initiated, and a rapid reversal of the hypercortisolism was observed without any change in tumor size. Vandetanib was briefly interrupted twice, once for 45 days because of side effects and a second time for 10 days to schedule surgical debulking. Each time, plasma cortisol and calcitonin levels increased after TKI withdrawal and were rapidly lowered by vandetanib reintroduction. As described in other cases of CS caused by MTC, a marked ACTH increase after desmopressin stimulation was observed before vandetanib therapy. In contrast, a blunted ACTH response to desmopressin was documented throughout the course of vandetanib treatment. This modulation of the tumoral ACTH production is a strong argument in favor of a TKI anti-secretory action. A left thyroid lobectomy and a modified neck dissection were performed one year after the initiation of vandetanib in order to reduce the tumor mass. An activating M918T RET (c.2753TC) somatic mutation was identified in a lymph node metastasis.Three years and eight months after vandetanib initiation, there was no sign of recurrence of hypercortisolism. This case illustrates the long-term effectiveness of vandetanib in maintaining the control of hypercortisolism in MTC-related CS.

International audience; Hypocalcaemia is a rare cause of reversible heart failure. We reported a 76-year-old woman who had a severe systolic heart failure. She had severe hypocalcaemia due to hypoparathyroidism after thyroidectomy. Echocardiography showed a dilated left ventricle with a depressed left ventricular ejection fraction. Serum calcium level was low without other biological abnormalities. After calcium supplementation, heart failure improved rapidly. At 2 months, the calcium level was in a normal range and biventricular systolic and diastolic functions returned to normal.

International audience; PURPOSE: This prospective study evaluated the recurrence rate in 715 patients with differentiated thyroid cancer who had no evidence of persistent disease after total thyroidectomy and lymph node dissection in 94% of them followed up by radioiodine ablation (30-100 mCi) and assessed the predictive value of the initial thyroglobulin (Tg) levels for detecting recurrence, both during levothyroxine (LT4) treatment and after TSH stimulation. PATIENTS AND METHODS: Patients had Tg determinations performed at 3 months on LT4 treatment (Tg1) and at 9-12 months after stimulation by either thyroid hormone withdrawal or recombinant human TSH (Tg2); the Access kit was used (functional sensitivity of 0.11 ng/ml); they had undetectable anti-Tg antibodies. Patients were followed up annually. Predictive values were calculated by comparing Tg levels (Tg1 and Tg2) and the outcome in terms of recurrence. RESULTS: During the median follow-up of 6.2 yr, 32 patients had a recurrence. Assuming a cutoff level for Tg1 at 0.27 ng/ml, Tg1 sensitivity and specificity reached 72 and 86%, respectively, whereas predictive positive and negative values were 20 and 99%, respectively. With a cutoff level for Tg2 at 1.4 ng/ml, sensitivity and specificity reached 78 and 90%, respectively, whereas positive and negative predictive values were 26 and 99%, respectively. CONCLUSION: This large prospective cohort of patients presented a low rate of recurrence. Initial Tg measurements allow to predict long-term recurrence with an excellent specificity. Stimulated Tg determination presented a slightly higher sensitivity than Tg determination on LT4. TSH stimulation may be avoided when Tg measured 3 months after ablation is less than 0.27 ng/ml during LT4 treatment.

Background Anaplastic thyroid carcinoma (ATC) is among the most aggressive human malignancies. It is associated with a high rate of local recurrence and with poor prognosis. Methods We retrospectively reviewed 44 consecutive patients treated between 1996 and 2010 at Leon Berard Cancer Centre, Lyon, France. The combined treatment strategy derived from the one developed at the Institut Gustave Roussy included total thyroidectomy and cervical lymph-node dissection, when feasible, combined with 2 cycles of doxorubicin (60 mg/m2) and cisplatin (100 mg/m2) Q3W, hyperfractionated (1.2 Gy twice daily) radiation to the neck and upper mediastinum (46-50 Gy), and then four cycles of doxorubicin-cisplatin. Results Thirty-five patients received the three-phase combined treatment. Complete response after treatment was achieved in 14/44 patients (31.8%). Eight patients had a partial response (18.2%). Twenty-two (50%) had progressive disease. All patients with metastases at diagnosis died shortly afterwards. Thirteen patients are still alive. The median survival of the entire population was 8 months. Conclusion Despite the ultimately dismal prognosis of ATC, multimodality treatment significantly improves local control and appears to afford long-term survival in some patients. There is active ongoing research, and results obtained with new targeted systemic treatment appear encouraging.

BACKGROUND: The best surgical treatment for hyperthyroidism caused by Graves' disease remains a controversial subject. METHODS: Seven hundred fourteen consecutive patients underwent total or near-total thyroidectomy for Graves' disease in a 13-year period. In a first analysis, postoperative rates of suffocating hematoma, wound infection, recurrent laryngeal nerve (RLN) palsy, hypoparathyroidism, and persistence or recurrence of hyperthyroidism, were studied and compared with the same parameters in 4,426 patients who underwent bilateral thyroid gland resection for other conditions. A second analysis identified factors associated with postoperative complications among Graves' disease patients. RESULTS: Comparing Graves' disease patients with patients who had bilateral thyroid resection for other conditions, the transient morbidity rate was 13.3% versus 8.2% (p < 0.0001), with 10.2% versus 5.0% (p < 0.0001) hypoparathyroidism, 2.2% versus 1.7% (p = 0.35) RLN palsy, 1.7% versus 0.9% (p < 0.05) suffocating hematoma, and 0.3% versus 0.4% (p = 0.67) wound infection, respectively. Permanent morbidity rate was 2% versus 2.2% (p = 0.72), including 0.4% versus 0.6% RLN palsy and 1.5% versus 1.7% hypoparathyroidism. Among the Graves' disease patients, univariate analysis revealed that those who experienced postoperative complications had a higher weight resected thyroid gland (odds ratio = 1.5; 95% CI, 1.0-2.3) and a higher rate of total thyroidectomy (24.4% versus 19.5%, odds ratio = 2.2; 95% CI, 1.4-3.4) than patients without complications. In the multivariable model, these two factors remained independent. There was no recurrence of hyperthyroidism with a median followup of 6.7 years (interquartile range 4.1 to 10.1 years). Persistent hyperthyroidism developed in three patients. CONCLUSIONS: Total or near-total thyroidectomy is an effective and safe treatment for Graves' disease when performed by an experienced surgeon.

International audience; The extraction by cervicotomy of substernal goitres may be impossible and sometimes requires the enlargement of the thoracic inlet with at least a sternal-split. We present the extraction of a posterior mediastinal substernal goitre with the application of an innovative vacuum-based suction device, previously used for the control of bleeding from the heart and great vessels in clinical and experimental conditions.

International audience; In order to examine the role of thyroid hormones on pituitary gonadotropin synthesis and release, normal, thyroidectomized and orchidectomized male rats were treated in parallel by daily injections of thyroxine (10 micrograms/10 g). Pituitary levels of alpha, LH beta, FSH beta and TSH beta mRNA were determined using two complementary approaches: 1) cell-free translation of pituitary mRNA and quantitative immunoprecipitation of labeled subunit precursors, and 2) hybridization with [32P]-labeled cDNA probes. In intact and thyroidectomized rats, injection of thyroxine (T4) resulted in the depletion of all mRNAs encoding the glycoprotein hormone subunits. In contrast, when rats received T4 three weeks after orchidectomy, levels of alpha, LH beta- and FSH beta-mRNA, but not TSH beta-mRNA increased, by 2, 1.5 and 1.2 times, respectively, compared to castrated, sham-injected rats. LH was assayed in serum and pituitary. In intact rats, T4 decreased pituitary content and release of LH by about 25%. In castrated rats, T4 antagonized the gonadectomy-induced increase in serum LH and increased the pituitary content in LH to levels consistent with an increased synthesis. In conclusion, T4 treatment increases or decreases levels of translatable mRNA encoding all 3 gonadotropin subunits depending on whether rats were castrated or not, respectively. Thus, T4 appears to exert a modulatory role in the regulation of gonadotropin gene expression by steroids. This effect of T4 on the synthesis is discordant with the effects of T4 on the release of LH and probably involves complex, multimodal control mechanisms.