SOME DESCRIPTIVE AND EPIDEMIOLOGICAL CHARACTERISTICS OF MALIGNANT TUMOURS OF THE THYROID GLAND

SURVIVAL OF THE PATIENTS AFTER THERAPY AT WELLDIFFERENTIATED THYROID CARCINOMA

SURGICAL TECHNIONE OF TOTAL THYROIDEOTOMY

Summary: Thyroid cancer ranges from well- differentiate lesions with excellent prognosis to anaplastic carcinoma which is almost uniformly fatal. Thus, methods to assess the behavior of thyroid malignancis are necessary to arrive at appropriate treatment decisions. We discus the factors (TNM staging system; Staging of the disease; AGES,AMES and MACIS scoring system) that affect the prognosis of patients with thyroid cancer.

Although little doubt exists about the pivotal role of fine-needle aspiration (FNA) biopsy in the preoperative diagnosis of thyroid cancer, each step in the subsequent management gives rise to controversy. Fine needle aspiration cytology has three limita. tions. Firstly, about 20% of samples are initially unsatis. factory, although repeat sampling increases the likelihood of obtaining adequate samples. Partly cystic or cystic lesions account for 20% of thyroid nodules and often yield insufficient cells for diagnosis.

The paper reviews briefly the role of various radiopharmaceuticals for scintigraphic diagnosis and follow-up of thyroid malignancies. The emphasis is given to thyroglobuline quantification and 131-I whole-body scintigraphy as specific and accurate methods in the follow up of differentiated thyroid cancer. Recombinant human TSH is introduced as a promising, safe and effective method to stimulate 131-I uptake and Tg secretion without the disadvantages of induced hypothyroidism.

Fine-needle aspiration is a low-cost diagnostic tool with principal value in determining which patients with thyroid nodules should undergo surgery. Team work and close cooperation among endocrinologists, surgeons, and pathologists are essential for success. Cytologic criteria for diagnosis of the most frequent malignancies found in thyroid aspirates have been provided. The unsolved problem of the so-called »follicular or oxyphilic lesion or neoplasia« will be investigated by immunocytochemistry.

Numerous pathohistologic criteria, difficultes and pitfalls in the process of diagnosing of thyroid carcinoma are discussed. Benign hyperplastic papillae may be present in colloidal cystic goiter and hyperplastic goiter. These structures are lined by cells with normochromatic nuclei and do not disturb the thyroid tissue architecture. Papillae in papillary thyroid carcinoma have cells with ground –glass, hypochromatic nuclei.

HYPOKALEMIA

ENTERAL AND PARENTERAL NUTRITION IN ACUTE PANCREATITIS