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08:54: T4:Tg Ratio as a Predictor of Thyroid Cancer Recurrence
Scientific Sessions—Monday
08:54 T4:Tg Ratio as a Predictor of Thyroid Cancer Recurrence Maggie Aron, MD (presenter); Richard J Payne, MD, BCom, MSc, FRCS; Valerie Cote, MD; Michael P Hier, MD; Martin J Black, FRCS(C); Michael Tamilia, MD, FRCP OBJECTIVES: Assess the ability of the serum free thyroxine: thyroglobulin ratio (fT4:Tg), immediately prior to I-131 ablation, to predict future thyroid cancer recurrence. METHODS: The charts of 270 patients who underwent thyroidectomy for differentiated thyroid cancer between 1996 and 2006 were reviewed. Prior to I-131 ablation, unsuppressed fT4 and Tg levels were recorded. Patients were categorized based on previous studies’ groupings of Tg levels and risk of recurrence (group 1: ⬍2ng/ml, 2: 2-10ng/ml, 3:⬎10ng/ml). The fT4:Tg ratio at the time of ablation was then analyzed in conjunction with evidence of recurrent disease. RESULTS: Of 270 patients, 158 were in group 1, 69 in group 2, and 43 in group 3 based on preablation Tg levels. Of the 112 patients in groups 2 and 3, 97 were present for follow-up; 37 of the 97 had either suspected (based on imaging and biochemical evidence) or pathologically confirmed recurrent disease; 77% (28/37) of patients with suspected or pathologically confirmed recurrent disease had a fT4:Tg ratio[⬍ or ⫽]26%. When only considering the patients meeting the preablation criteria (fT4:Tg[⬍ or ⫽]26%), 68% (28/41) had evidence or pathologically confirmed recurrent disease. CONCLUSIONS: In this study, a preablation fT4:Tg ratio [⬍ or ⫽] 26% was predictive of thyroid cancer recurrence in 77% of patients. Studies with larger numbers of patients and longer follow-up are necessary to corroborate these findings, which can prove to be very useful in assessing the risk of recurrence
and need for close monitoring using the imaging and biochemical methods currently available.
09:02 Minimally Invasive Parathyroidectomy Under Local/Sedation Maisie L Shindo, MD (presenter); Joshua M Rosenthal, MD; Thomas D Lee, MD OBJECTIVES: 1. Present the outcome of parathyroidectomy performed under local/sedation. 2. Understand the two targeted approaches to parathyroidectomy that facilitate performance of the procedure under conscious sedation. METHODS: This study prospectivly evaluates 168 patients with primary hyperparathyroidism undergoing parathyroidectomy under conscious sedation between 2002 and 2006 in a tertiary academic medical center. The following outcome measures were evaluated: number of patients who underwent midline approach vs. lateral approach; number of patients in whom the procedure had to be converted to general anesthesia; percentage who were discharged same day, and complications. RESULTS: An anterior midline approach was used in 100 patients for inferior glands that were superficially located. A lateral approach was utilized in 68 patients for glands located posteriorly or superiorly. MIP was successfully completed under conscious sedation in 159 patients. Of the 159 patients in whom parathyroidectomy was successfully completed under conscious sedation, 150 were discharged the same day. The only complications were 2 pneumomediastinum (one requiring a chest tube and one self-limited), one small hematoma which resolved, and one transient vocal cord paralysis. CONCLUSIONS: By utilizing a more targeted approach, MIP can be safely and successfully performed under conscious sedation and is much preferred by patients. Another advantage of this approach is potential cost savings. This approach, contraindications and potential pitfalls will be described.
09:10 Results in the First Auditory Midbrain Implant Patients Thomas H Lenarz, MD, PhD (presenter); Hubert Hyun-Gil Lim, PhD; Minoo Lenarz, MD; Gert Joseph, MD; Rolf-Dieter Battmer, MD; Amir Samii, MD; Madjid Samii, MD OBJECTIVES: 1. Demonstrate the efficacy of a new auditory prosthesis using midbrain stimulation in patients with neural deafness. 2. Determine the effects of different types and locations of electrical stimuli within the midbrain on auditory percepts. METHODS: The team implanted 3 NF2 patients with a penetrating auditory midbrain implant (AMI, Cochlear Ltd). The array (20 sites) was implanted into the inferior colliculus (IC)
MONDAY
METHODS: Eighteen preoperative clinical data points examined in 3,500 patients cured following surgery for primary HPT. Operative findings were analyzed. RESULTS: Multigland disease (MGD) was present in 9.1% but decreased in frequency from 13% in patents with Ca levels less than 10.6 to 3.6% when Ca was higher than 12 (p⬍0.05). Kidney stones was the only symptom that correlated with operative findings, virtually guaranteeing a single (95%) or double (5%) adenoma (p⬍0.0001). The incidence of hyperplasia decreased as PTH levels rose and was not seen when PTH was ⬎2.6 times upper normal. Multiple adenomas occur at all PTH and Ca levels. CONCLUSIONS: High Ca and PTH levels and the presence of stones are the only predictors of good candidates for unilateral exploration. As Ca and PTH levels rise, the incidence of hyperplasia decreases but multiple adenoma rates are unchanged. There are no other parameters that can help predict who is better suited for limited exploration.
P51
08:54 T4:Tg Ratio as a Predictor of Thyroid Cancer Recurrence Maggie Aron, MD (presenter); Richard J Payne, MD, BCom, MSc, FRCS; Valerie Cote, MD; Michael P Hier, MD; Martin J Black, FRCS(C); Michael Tamilia, MD, FRCP OBJECTIVES: Assess the ability of the serum free thyroxine: thyroglobulin ratio (fT4:Tg), immediately prior to I-131 ablation, to predict future thyroid cancer recurrence. METHODS: The charts of 270 patients who underwent thyroidectomy for differentiated thyroid cancer between 1996 and 2006 were reviewed. Prior to I-131 ablation, unsuppressed fT4 and Tg levels were recorded. Patients were categorized based on previous studies’ groupings of Tg levels and risk of recurrence (group 1: ⬍2ng/ml, 2: 2-10ng/ml, 3:⬎10ng/ml). The fT4:Tg ratio at the time of ablation was then analyzed in conjunction with evidence of recurrent disease. RESULTS: Of 270 patients, 158 were in group 1, 69 in group 2, and 43 in group 3 based on preablation Tg levels. Of the 112 patients in groups 2 and 3, 97 were present for follow-up; 37 of the 97 had either suspected (based on imaging and biochemical evidence) or pathologically confirmed recurrent disease; 77% (28/37) of patients with suspected or pathologically confirmed recurrent disease had a fT4:Tg ratio[⬍ or ⫽]26%. When only considering the patients meeting the preablation criteria (fT4:Tg[⬍ or ⫽]26%), 68% (28/41) had evidence or pathologically confirmed recurrent disease. CONCLUSIONS: In this study, a preablation fT4:Tg ratio [⬍ or ⫽] 26% was predictive of thyroid cancer recurrence in 77% of patients. Studies with larger numbers of patients and longer follow-up are necessary to corroborate these findings, which can prove to be very useful in assessing the risk of recurrence
and need for close monitoring using the imaging and biochemical methods currently available.
09:02 Minimally Invasive Parathyroidectomy Under Local/Sedation Maisie L Shindo, MD (presenter); Joshua M Rosenthal, MD; Thomas D Lee, MD OBJECTIVES: 1. Present the outcome of parathyroidectomy performed under local/sedation. 2. Understand the two targeted approaches to parathyroidectomy that facilitate performance of the procedure under conscious sedation. METHODS: This study prospectivly evaluates 168 patients with primary hyperparathyroidism undergoing parathyroidectomy under conscious sedation between 2002 and 2006 in a tertiary academic medical center. The following outcome measures were evaluated: number of patients who underwent midline approach vs. lateral approach; number of patients in whom the procedure had to be converted to general anesthesia; percentage who were discharged same day, and complications. RESULTS: An anterior midline approach was used in 100 patients for inferior glands that were superficially located. A lateral approach was utilized in 68 patients for glands located posteriorly or superiorly. MIP was successfully completed under conscious sedation in 159 patients. Of the 159 patients in whom parathyroidectomy was successfully completed under conscious sedation, 150 were discharged the same day. The only complications were 2 pneumomediastinum (one requiring a chest tube and one self-limited), one small hematoma which resolved, and one transient vocal cord paralysis. CONCLUSIONS: By utilizing a more targeted approach, MIP can be safely and successfully performed under conscious sedation and is much preferred by patients. Another advantage of this approach is potential cost savings. This approach, contraindications and potential pitfalls will be described.
09:10 Results in the First Auditory Midbrain Implant Patients Thomas H Lenarz, MD, PhD (presenter); Hubert Hyun-Gil Lim, PhD; Minoo Lenarz, MD; Gert Joseph, MD; Rolf-Dieter Battmer, MD; Amir Samii, MD; Madjid Samii, MD OBJECTIVES: 1. Demonstrate the efficacy of a new auditory prosthesis using midbrain stimulation in patients with neural deafness. 2. Determine the effects of different types and locations of electrical stimuli within the midbrain on auditory percepts. METHODS: The team implanted 3 NF2 patients with a penetrating auditory midbrain implant (AMI, Cochlear Ltd). The array (20 sites) was implanted into the inferior colliculus (IC)
MONDAY
METHODS: Eighteen preoperative clinical data points examined in 3,500 patients cured following surgery for primary HPT. Operative findings were analyzed. RESULTS: Multigland disease (MGD) was present in 9.1% but decreased in frequency from 13% in patents with Ca levels less than 10.6 to 3.6% when Ca was higher than 12 (p⬍0.05). Kidney stones was the only symptom that correlated with operative findings, virtually guaranteeing a single (95%) or double (5%) adenoma (p⬍0.0001). The incidence of hyperplasia decreased as PTH levels rose and was not seen when PTH was ⬎2.6 times upper normal. Multiple adenomas occur at all PTH and Ca levels. CONCLUSIONS: High Ca and PTH levels and the presence of stones are the only predictors of good candidates for unilateral exploration. As Ca and PTH levels rise, the incidence of hyperplasia decreases but multiple adenoma rates are unchanged. There are no other parameters that can help predict who is better suited for limited exploration.
P51