Bernet, Victor

Abstract Amiodarone is known to cause thyroid dysfunction, due to both direct cytotoxicity and high iodine content. Due to its lipophilic properties, amiodarone gets stored in the adipose tissue and may induce delayed amiodarone-induced thyrotoxicosis (AIT), months after discontinuation. We present the case of a 60-year-old man admitted with new-onset atrial fibrillation. He had a history of ventricular tachycardia, treated with amiodarone that was discontinued 14 months earlier. On admission, thyrotropin was undetectable, with markedly elevated free thyroxine and total triiodothyronine. He had no previous history of thyroid dysfunction or recent exposure to iodinated contrast. Additional history revealed that the patient had been taking tirzepatide 10 mg weekly resulting in a 54-kg weight loss over the previous 12 months. With this information, a spot urine iodine/creatinine (Cr) was measured and found to be significantly increased at 2323 µg/g Cr (SI: 2075 µmol/mol Cr) (normal reference range <584 µg/g Cr, [SI: <521 µmol/mol Cr]). He was treated with prednisone and methimazole with eventual resolution of hyperthyroidism. Delayed AIT should be considered in the differential diagnosis of new-onset thyrotoxicosis in patients previously treated with amiodarone who experience significant weight loss.

The NCCN Guidelines for Thyroid Carcinoma address the management of different types of thyroid carcinoma, including papillary, follicular, oncocytic, medullary, and anaplastic carcinoma. The NCCN Thyroid Carcinoma Panel meets at least annually to review comments from reviewers within their institutions, examine relevant new data from publications and abstracts, and reevaluate and update their recommendations. These NCCN Guidelines Insights focus on the panel’s most recent recommendations regarding systemic therapies for thyroid carcinoma as well as the supporting clinical data.

Abstract Disclosure: P.L. castellanos: None. A.M. Chindris: None. S. Rao: None. J. Janus: None. R. Paz-Fumagalli: None. V.J. Bernet: None. Introduction: Limited information exists regarding the relationship between outcomes and decision-making based on results from Ultrasound-guided fine needle aspiration (USG-FNA) of cervical nodes/nodules suspicious for thyroid cancer metastases. Management options for positive findings include surgery, percutaneous ethanol ablation, radioactive iodine therapy, external beam radiation systemic therapy, or observation. This retrospective review is aimed at describing the management and associated outcomes of a cohort of thyroid cancer patients who underwent USG FNA for cervically metastases. Methods: Following our Clinic IRB review and approval, we performed a chart review and identified 163 patients with thyroid cancer patients who had undergone USG FNA of apparent cervical metastases at the Florida campus between 2012 and 2018. Cytology results and corresponding tumor marker washout from each sampled focus were recorded. The records review included recording anatomical and biochemical outcomes related to management decisions based on USG FNA results. Appropriate statistical plots were used to help visualize the data pattern. ResultsThe median age was 59 years 69.9% were female and 91.3% were Caucasian. Initial presentation typically consisted of the appearance of a neck nodule and thyroidectomy was the first line of therapy in 155 of 163 cases. Imaging post-thyroidectomy demonstrated evidence of cervical lymphadenopathy in 75.5% of cases with localization in the lateral neck in 65.2% and central in 19.2% respectively. Regarding USG-FNA outcomes, 46.2% yielded malignancy while 26% were benign. The most prevalent cytology was papillary thyroid cancer detected in 87.1%.Thyroglobulin washout was performed on all patients with a history of papillary variant thyroid carcinoma, with positive results reported in 8.3%. Ethanol ablation was the most used treatment for lymph node recurrence followed by neck surgery in 56.2%. During the follow-up, 14% of the patients who were TGAB+ remained so.Outcome trends were as follows: The combined anatomical and biochemical negative was 82.3%, while the combined anatomical and biochemical positive was 2.5%. The combined anatomical negative and biochemical positive was 7.6%, alongside the combined anatomical positive and biochemical negative was 7.6%. Conclusion: Of 163 thyroid cancer cases with cervical lymphadenopathy, 46% had cytology-proven presence of malignancy. These patients underwent either observation, PEA, or surgery.At follow up the majority of the patients were without anatomical and biochemical evidence of disease while about 7-8% were positive by one of the parameters and much fewer were positive for disease by both parameters. Presentation: 6/3/2024

Abstract Disclosure: P.L. castellanos: None. S.E. Meek: None. A.M. Chindris: None. V.J. Bernet: None. Approximately 250 cases of papillary thyroid cancer (PTC) within a thyroglossal duct cyst (TGDC) have been reported worldwide. The presence of PTC within a TGDC is rare representing less than 1 % of all TGDC cases. This report describes the case of a young male with PTC in a TGDC suspicious nodules. We present this case along with a review of the literature related to this very uncommon finding. Papillary thyroid carcinoma is a very rare disease but always should be considered when speaking of a mass at the level of the central neck. There is a considerable controversy regarding the role of thyroidectomy to treat thyroglossal duct cyst carcinoma since the treatment of choice is Sistrunk procedure and the only indications to make a thyroidectomy will be aggressive disease and more than 45 years old according to some articles but without any consensus now. With a cure rate of 95 % and recurrence rate of 3 -10 % when this cancer is treated by Sistrunk operation, it doesn’t seem necessary to do an extent surgery if there is not enough thyroid compromised. Long term follow up is necessary to exclude the development of thyroid cancer. Presentation Date: Saturday, June 17, 2023

SAGE-Journals-Accessible-Video-Player 10.1089/ve.2023.0025.M1 sj-vid-1-vde-10.1089_ve.2023.0025

Differentiated thyroid carcinomas is associated with an excellent prognosis. The treatment of choice for differentiated thyroid carcinoma is surgery, followed by radioactive iodine ablation (iodine-131) in select patients and thyroxine therapy in most patients. Surgery is also the main treatment for medullary thyroid carcinoma, and kinase inhibitors may be appropriate for select patients with recurrent or persistent disease that is not resectable. Anaplastic thyroid carcinoma is almost uniformly lethal, and iodine-131 imaging and radioactive iodine cannot be used. When systemic therapy is indicated, targeted therapy options are preferred. This article describes NCCN recommendations regarding management of medullary thyroid carcinoma and anaplastic thyroid carcinoma, and surgical management of differentiated thyroid carcinoma (papillary, follicular, Hürthle cell carcinoma).

Background: The American Thyroid Association (ATA), the European Association of Nuclear Medicine, the European Thyroid Association, and the Society of Nuclear Medicine and Molecular Imaging have established an intersocietal working group to address the current controversies and evolving concepts in thyroid cancer management and therapy. The working group annually identifies topics that may significantly impact clinical practice and publishes expert opinion articles reflecting intersocietal collaboration, consensus, and suggestions for further research to address these important management issues. Summary: In 2019, the intersocietal working group identified the following topics for review and interdisciplinary discussion: (i) perioperative risk stratification, (ii) the role of diagnostic radioactive iodine (RAI) imaging in initial staging, and (iii) indicators of response to RAI therapy. Conclusions: The intersocietal working group agreed that (i) initial patient management decisions should be guided by perioperative risk stratification that should include the eighth edition American Joint Committee on Cancer staging system to predict disease specific mortality, the modified 2009 ATA risk stratification system to estimate structural disease recurrence, with judicious incorporation of molecular theranostics to further refine management recommendations; (ii) diagnostic RAI scanning in ATA intermediate risk patients should be utilized selectively rather than being considered mandatory or not necessary for all patients in this category; and (iii) a consistent semiquantitative reporting system should be used for response evaluations after RAI therapy until a reproducible and clinically practical quantitative system is validated.

BACKGROUND Hospital hyperglycemia is common and associated with potential adverse outcomes. A Hospital-wide Mobile Phone Alert (HMA) system was built to achieve real time glucose monitoring with warnings for glucose excursions. This study investigated the status of glucose control and evaluated the impact of HMA system on inpatient glycemia management. METHODS Inpatients with hyperglycemia hospitalized between 1 January, 2017 and 31 December, 2018 were identified excluding those < 18 years of age. The HMA system was activated on 1 October, 2017. It sent real time cellphone warning messages to the patient’s designated team physician whenever glucose levels > 10 mmol/L or < 3 mmol/L were detected. A serum glucose > 7.8 mmol/L was defined as hospital hyperglycemia (HH), and > 10 mmol/L was defined as significant HH (SHH). Glucose excursions before and after the HMA system was instituted were compared. RESULTS The incidence of HH, SHH and hypoglycemia was 26.1%, 12.8% and 2.5%, respectively. With the HMA system, the monthly glucose related consultation rate for all inpatients increased 65.9%. The rate of HH glucose amount/ total glucose amount improved with the HMA system, being lower than pre HMA system activation for the surgical wards (15.8 ± 4.7% vs 21.1 ± 6.1%，p<0.05). CONCLUSIONS In this study, one third of inpatients were noted to experience hyperglycemia. Real time cellphone warning messages to the patient’s designated team physician can improve consultation utilization for blood glucose excursions. The alert system was found to reduce the incidence of hyperglycemia on surgical wards.