ITCO, Italian thyroid cancer observatory foundation presents the results of its work
One year after its inception, the Italian Thyroid Cancer Observatory (ITCO), Italy’s first observatory on thyroid nodules and tumors, presents the results of its work with a study, carried out through analysis from data collected since 2013 in patients with thyroid cancer undergoing surgery. “A stark picture emerges,” he explains Sebastiano Filetti, internist and dean of the Faculty of Medicine, Sapienza University of Rome, that 98 percent of patients undergo total thyroid removal and only 2 percent of subjects have only the part affected by the tumor removed, confirming that the choice of radical surgery is still widely preferred regardless of the patient’s risk category.”.
The number of interventions calls for reflection. “While the trend is to reduce the number of thyroid surgeries, says Rocco Bellantone, endocrine surgeon, ITCO president and director of the Complex Operating Unit of Endocrine and Metabolic Surgery at the University Polyclinic “A. Gemini” of Rome, more than 40 are performed each year in Italy.000 surgeries, which in 80% of cases involves the female gender. In recent years, however, new scientific knowledge and the need for greater respect for anatomical structures have led to the emergence of less invasive surgery tailored to the individual patient. As was the case for breast cancers with quadrectomy, there is now a need for less invasive surgery for the thyroid as well. In fact, total thyroidectomy, i.e., total removal of the thyroid gland, is recommended in cases of differentiated thyroid tumors, while in the presence of papilliferous microcarcinomas, tumors less than 10 mm in size, and in cases of favorable prognosis, a less extensive intervention may be possible through removal of only the affected part, which reduces the need for replacement therapy and is associated with a lower occurrence of metabolic and anatomical complications. Today, therefore, interventions are increasingly tailored almost like a tailor’s surgery, concludes the specialist”.
Analyzing the Italian reality, disseminating research news and new guidelines, and promoting multidisciplinary confrontation among the different specialists involved in the management of thyroid oncologic pathology are the goals of the ITCO Foundation, which aims at a greater “personalization” of therapies by working to improve surveillance protocols for individuals with thyroid disease and with the aim of optimizing the use of economic resources of our health system.
Personalizing thyroid cancer therapy means knowing the evolution, natural history of thyroid nodules. “In the field of endocrinology, thyroid nodules represent one of the most frequent problems,” clarifies Ezio Ghigo, endocrinologist and director of the University of Turin School of Medicine. On palpation, thyroid nodules are evident in 4-7% of the general population, while ultrasound detection of non-palpable nodules is found in 20 to 67% of cases, according to autopsy data. The majority of nodules are small, give no discomfort, and are classified as benign after an ultrasound study or needle aspiration cytologic examination. Most importantly, as documented by data from a recent study 1 in which some ITCO afferent centers participated, the vast majority of thyroid nodules do not grow in size over time (about 85%) and remain benign (about 99%). In recent years there has been an increase in the incidence of thyroid nodules followed by a parallel increase in thyroid carcinomas, albeit not associated with an increase in the mortality rate. This increase was seen mainly in less aggressive tumor forms (papillary histotype) and in tumors less than 1 centimeter in size. “One of the scenarios to consider, which may give at least a partial explanation for this phenomenon, is the improved sensitivity and easy access to modern diagnostic means that has certainly influenced “bringing to light” those small tumors that would probably never have grown to become clinically evident.”.
“In cases of total or partial thyroid removal, replacement therapy with levothyroxine, the synthetic thyroid hormone (T4), is the standard treatment. Thyroid, states Domenico Salvatore, endocrinologist and Associate Professor of Endocrinology, Department of Clinical Medicine and Surgery, Federico II University of Naples, Italy, when present and functioning, it actually produces two different forms of hormone: T4, which is converted in the thyroid and peripheral tissues to the active form T3. However, a good number of thyroid-free patients, as well as 10 percent of hypothyroid patients treated with levothyroxine, complain of symptoms such as memory loss, weight gain, fatigue, depression, and reduced quality of life typical of hypothyroidism despite normal thyroid-stimulating hormone (TSH) blood values. It is noted that in 20% of cases of patients who have undergone total thyroid removal, treatment with levothyroxine does not guarantee that optimal thyroid hormone levels are obtained. This is precisely why a combination therapy of T3 and T4 is under observation, which seems in some patients to be able to improve the symptoms of hypothyroidism by improving the sense of well-being. Combination treatment with the two hormones T3 and T4 is still being evaluated by the scientific community. Pharmacological treatment of hypothyroidism has seen substantial advances in recent years due to new formulations that promote patient adherence to therapy by ensuring faster and more stable absorption of T4 .
A recent Italian study, conducted by Prof. Ghigo’s team, found that the increase in TSH is not significant. Bellantone, and recently published in Endocrine 2 , showed that the liquid formulation of levothyroxine is also preferred in cases of hypothyroidism resulting from total thyroidectomy. In fact, the study highlights the greater efficacy of the liquid formulation compared to tablets in terms of both TSH and thyroid hormone (T3 and T4) blood parameter values and the patient‘s state of mental and physical well-being.”.
“The next ITCO study will focus on assessing the quality of life of patients affected and treated for thyroid cancer,” concludes Prof. Threads: a multicenter, Italian study is about to begin, aimed at evaluating whether it changes, and how it changes, the quality of life of subjects undergoing total thyroid gland removal and on hormone replacement therapy, with the goal of understanding which therapeutic intervention is able to restore the patient’s pre-operative state”.
For more information ITCO Foundation: http://www.itcofoundation.org/
TAG: ITCO, Italian Thyroid Cancer Observatory Foundation, Filetti, Bellantone, Ghigo, Salvatore, Lombardi, Thyroid, Nodules, levothyroxine