Institutional experience of PTH evaluation on fine-needle washing after aspiration biopsy to locate hyperfunctioning parathyroid tissue

Assaying parathyroid hormone(PTH) in the washing liquid after fine-needle aspiration biopsy(FNAB) seems to be a valid approach to locate parathyroid tissue.PTH-FNAB was evaluated in 47 patients with a clinical picture of primary hyper-parathyroidism(PHP) and ultrasonography(US) suggestive of parathyroid lesion.The patients were subdivided into two groups on the basis of the absence or presence of US thyroid alterations.The result of PTH-FNAB was compared with those of cytology,scintigraphy and,in 24 patients,surgical outcome.PTH-FNAB samples with a value higher than that recorded in the serum and higher than our institutional cut-off were deemed to be probable samples of parathyroid tissue.Cytology proved diagnostic for benign thyroid lesions,non-diagnostic for thyroid lesions,hyperplastic parathyroid tissue,undetermined or malignant thyroid lesions and other lesions in 45%,30%,17%,4%,and 4% of cases,respectively.In 47% of cases,PTH-FNAB indicated that the sample had been taken in parathyroid tissue.In patients without US alterations,the diagnostic accuracy of PTH-FNAB was greater than that of scintigraphy.After surgery,comparison between the results of PTH-FNAB and scintigraphy,in terms of positive predictive value(PPV),revealed the superiority of PTH-FNAB;PPV was 94% for FNAB and 71% for scintigraphy,while sensitivity was 83% and 69%,respectively.PTH-FNAB evaluation after FNAB appears to be more diagnostic than cytology and scintigraphy.Of all the procedures used,PTH-FNAB appears to be the method of choice when the target is US suggestive and reachable.PTH-FNAB appears to be a useful method of guiding surgical intervention.

Five-year longitudinal evaluation of quality of life in a cohort of patients with differentiated thyroid carcinoma

Differentiated thyroid carcinoma(DTC) generally has a favorable outcome.Thyroid disease,treatments,stress,and comorbidity can compromise health-related quality of life(QoL) and indirectly weigh upon the outcome. From 2004 to 2008,we evaluated QoL longitudinally in 128 DTC subjects.During scheduled examinations,subjects were asked to undergo a semi-structured psychiatric interview and five rated inventories.The same examination was conducted in 219 subjects after surgery for benign thyroid pathology.Low scores represent a better QoL.DTC and control subjects were similar in terms of age,male/female ratio,concomitant psychopharmacological treatments,and frequency of psychiatric diseases.In DTC subjects,Billewicz scale(BS) scores showed an increasing trend over time,especially among females.The ad hoc thyroid questionnaire(TQ) scores were similar in both groups and did not change over time,but at the end of the study ad hoc TQ and BS were significantly related.Ad hoc TQ scores were also related to age on entry to the study.In both male and female DTC subjects,Hamilton's tests for anxiety(HAM-A) ,but not for depression(HAM-D),showed an improving trend.At the end of the study,HAM-A and HAM-D scores were comparable to those of the control group.HAM-A and HAM-D were both positively correlated with the stage of cancer and the time between diagnosis and treatment.Only HAM-D correlated with age on entry to the study.Kellner symptom questionnaire(KSQ) item scores were higher in DTC subjects than in controls.The change over time in the items including anxiety,somatization,depression,and hostility was significant.Somatization and hostility were more significantly reduced in DTC females than in DTC males.Hostility scores were significantly lower in DTC subjects than in controls at the end of the study.Somatization and depression were significantly related to staging on diagnosis and age on entry to the study.Our study confirms a wide variation of illness perception in DTC subjects,which is generally unrelated to the favorable clinical follow-up of the disease.Psychological evaluation during long-term follow-up im-proved QoL scores,which reached the same levels noted in subjects with a history of thyroid surgery for benign thyroid pathology.Our data indicate that special attention should be paid to QoL in older DTC subjects and those with more severe staging on diagnosis.