Archive for the ‘Endocrinology’ Category

Test increases odds of correct surgery for thyroid cancer patients

The test, available at the UPMC/UPCI Multidisciplinary Thyroid Center and other diagnostic testing agencies, improved the chances of patients getting the correct initial surgery by 30 percent, according to the study published this month in the Annals of Surgery.

“Before this test, about one in five potential thyroid cancer cases couldn’t be diagnosed without an operation to remove a portion of the thyroid,” said lead author Linwah Yip, M.D., assistant professor of surgery in Pitt’s School of Medicine and UPMC surgical oncologist. Previously, “if the portion removed during the first surgery came back positive for cancer, a second surgery was needed to remove the rest of the thyroid. The molecular testing panel now bypasses that initial surgery, allowing us to go right to fully removing the cancer with one initial surgery. This reduces risk and stress to the patient, as well as recovery time and costs.”

Cancer in the thyroid, which is located in the “Adam’s apple” area of the neck, is now the fifth most common cancer diagnosed in women. Thyroid cancer is one of the few cancers that continues to increase in incidence, although the five-year survival rate is 97 percent. Previously, the most accurate form of testing for thyroid cancer was a fine-needle aspiration biopsy, where a doctor guides a thin needle to the thyroid and removes a small tissue sample for testing. However, in 20 percent of these biopsies, cancer cannot be ruled out. A lobectomy, which is a surgical operation to remove half of the thyroid, is then needed to diagnose or rule-out thyroid cancer. In the case of a postoperative cancer diagnosis, a second surgery is required to remove the rest of the thyroid.

Researchers have identified certain gene mutations that are indicative of an increased likelihood of thyroid cancer, and the molecular testing panel developed at UPMC can be run using the sample collected through the initial, minimally invasive biopsy, rather than a lobectomy. When the panel shows these mutations, a total thyroidectomy is advised.

Dr. Yip and her colleagues followed 671 UPMC patients with suspicious thyroid nodes who received biopsies. Approximately half the biopsy samples were run through the panel, and the other half were not. Patients whose tissue samples were not tested with the panel had a 2.5-fold higher statistically significant likelihood of having an initial lobectomy and then requiring a second operation.

“We’re currently refining the panel by adding tests for more genetic mutations, thereby making it even more accurate,” said co-author Yuri Nikiforov, M.D., Ph.D., professor in the Department of Pathology at Pitt and director of thyroid molecular diagnostics at the UPMC/UPCI Multidisciplinary Thyroid Center. “Thyroid cancer is usually very curable, and we are getting closer to quickly and efficiently identifying and treating all cases of thyroid cancer.”

In 2009, the American Thyroid Association (ATA) revised its guidelines to add that doctors may consider the use of molecular markers when the initial biopsy is inconclusive.

“The ATA is currently revising those guidelines to take into account the latest research, including our findings,” said senior author Sally Carty, M.D., Pitt professor of surgery, co-director of the UPMC/UPCI Multidisciplinary Thyroid Center and recent president of the American Association of Endocrine Surgeons. “The molecular testing panel holds promise for streamlining and eliminating unnecessary surgery not just here but nationwide.”

A previous study led by Dr. Yip showed the panel to be cost-saving when used to help in the diagnosis of thyroid cancer. Each year, approximately half of the 25,000 patients assessed at UPMC’s Multidisciplinary Thyroid Center are found to have thyroid conditions, and more than 900 thyroid operations are performed by the center’s surgeons. The center aims to provide patients with one-stop evaluation from thyroid experts in a variety of fields, including surgery and endocrinology.

source : http://www.sciencedaily.com/releases/2014/07/140725110805.htm

Vitamin D deficiency raises risk of schizophrenia diagnosis

Vitamin D helps the body absorb calcium and is needed for bone and muscle health. The skin naturally produces this vitamin after exposure to sunlight. People also obtain smaller amounts of the vitamin through foods, such as milk fortified with vitamin D. More than 1 billion people worldwide are estimated to have deficient levels of vitamin D due to limited sunshine exposure.

Schizophrenia is a mental illness with symptoms that can include delusions and hallucinations. Since schizophrenia is more prevalent in high latitudes and cold climates, researchers have theorized vitamin D may be connected to the disorder.

“This is the first comprehensive meta-analysis to study the relationship between the two conditions,” said one of the study’s authors, Ahmad Esmaillzadeh, PhD, of the Isfahan University of Medical Sciences in Isfahan, Iran. “When we examined the findings of several observational studies on vitamin D and schizophrenia, we found people with schizophrenia have lower vitamin D levels than healthy people. Vitamin D deficiency is quite common among people with schizophrenia.”

The researchers reviewed the findings of 19 observational studies that assessed the link between vitamin D and schizophrenia. Combined, the studies looked at vitamin D levels and the mental health of 2,804 adult participants. The studies used blood tests to determine each participant’s vitamin D levels.

The meta-analysis found that people with schizophrenia had significantly lower levels of vitamin D in the blood compared to the control groups. The average difference in vitamin D levels between schizophrenic patients and control participants was -5.91 ng/ml. People with vitamin D deficiency were 2.16 times more likely to have schizophrenia than those with sufficient vitamin D in their bloodstreams. In addition, 65 percent of the participants who had schizophrenia also were vitamin D deficient.

“There is a growing trend in the nutrition science field to consider vitamin D and its relationship to conditions such as diabetes, cancer, heart disease and depression,” Esmaillzadeh said. “Our findings support the theory that vitamin D may have a significant impact on psychiatric health. More research is needed to determine how the growing problem of vitamin D deficiency may be affecting our overall health.”

source : http://www.sciencedaily.com/releases/2014/07/140722142513.htm