Reach further, in an Open Access Journal Endocrinology, Diabetes & Metabolism Case Reports

ISSN 1470-3947 (print)
ISSN 1479-6848 (online)

Searchable abstracts of presentations at key conferences in endocrinology

Published by BioScientifica
Endocrine Abstracts (2010) 22 P821 

Long term results of Isthmus preserving total bilobectomy (IPTB) as the optimized treatment for C-cell hyperplasia

Carlo Dietl, Babette Koch, Christian Vorländer & Robert A Wahl

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Background: The thyroid isthmus contains no C-cells, thus we established IPTB for cases with nodular goiter and moderate hypercalcitonemia (stimulated up to 350 pg/ml). In these cases C-Cell-Hyperplasia is the primary pathologic correlate. Exclusion criteria were pre- or intraoperative signs of malignancy.

We furthermore established IPTB as a prophylactic operation for patients with hereditary medullary thyroid carcinoma, excluding high-risk mutations.

(WJS 30 (2006): 860). Now, we report on ongoing follow-up over 7 years.

Patients and methods: From 2001 to 2007, IPTB was the definite procedure in 78 out of 107 patients with intended IPTB. Seventy with sporadic hypercalcitoninemia in nodular goiter (preop Calcitonin x¯: 19.84 pg/ml basal, 129.72 pg/ml stimulated), 8 with hereditary MTC. The remaining 29 patients were converted to Total Thyroidectomy (TTX).

Patients were prospectively evaluated for long-term postoperative outcome, regarding recurrence of nodular goiter and C-Cell disease.

Results: No permanent RLN-palsy, 1.9% permanent Hypocalcemia occurred.

Follow-up (6–84 months, median 42 months) showed Calcitonin always under the measurable limit in 69 out of the 78 patients (88%) and intermittently measurable basal in the lower normal range (<10 pg/ml) in 9 patients. Those 9 patients showed no response to pentagastrin stimulation. Sonographic examinations of the isthmic remnants showed early postoperative volumes of 2 ml (median; range 1 to 5) and 2 ml (median; range 0.5 to 6) in follow-up.

One hypoechoic lesion of 0.1 ml was found after 42 months.

Substitution with L-thyroxine was lower (121±22 μg) after IPTB than after TTX (147±21 μg) (P<0.001), without a significant correlation between functional data and morphologic development of isthmic volumes.

Conclusions: By IPTB C-Cells are removed completely and permanently. The risk of recurrence of goiter (nodular, hyperplastic) or c-cell disease is low.

The basic production and regulatory function of tissue-remnants might well be of importance for many patients.

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