engleski

Papillary thyroid carcinoma in dialysed patients

Endocrine disturbances are often seen in dialysis patients. One of the most important is secondary hyperparathyroidismus. The enlarged parathyroid gland (PTG) can be detected with ultrasound. A thyroid abnormality can be seen in some patients during the ultrasound examination. In our previous work the echographic changes of the thyroid gland were found in 33 of 144 (22, 9%) dialysed patient. For ultrasound examination of the neck a standard ultrasound equipment was used with a high resolution 7.5-13 MHz linear probes. The echographic changes suspected on papillary thyroid carcinoma were confirmed by fine needle aspiration biopsy. In the last ten years among 700 dialysed patients examined by neck sonography in seven of them (1%) a thyroid papillary carcinoma was incidentally detected. There were 4 women and 3 men, aged 30-65 years at the time of diagnosis, treated with hemodialysis for 0-12 years. Occult papillary carcinoma up to 0, 5 cm were found in three patients, in one of them lymph node metastases were detected. In all others, the size of thyroid carcinoma was 0, 9-1, 5 cm. In one of these thyroid carcinoma was multicentric and in another had lymph node metastases. In the patient with multicentric papillary carcinoma, parathyroid carcinoma was diagnosed at the same time. After diagnosis of malignancy, surgical treatment was performed in 6 patients. One women died before surgery due to severe calciphylaxis. In the others was performed total thyreoidectomy, with lateral neck dissection in two patients, and parathyreodectomy in four patients. After surgery, the patients received thyroxine therapy. Two patients received reduced radioiodine theraphy (4-5 fold decreased dose). The patients are now in good conditions, except one with parathyroid carcinoma, who died from brain metastases after 3 years. Papillary carcinoma in dialysed patients is rare. It is not in correlation with dialysis treatment, and is relatively small (up to 1, 5 cm). But in 43% (3/7) of the patients, the carcinoma was more aggressive. Therapy with radioiodine requires individual treatment i.e. precise measurement of radioiodine kinetic and calculation of the dose.

Thyroid carcinoma; dialysis

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