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P&S Journal

P&S Journal: Fall 1996, Vol.16, No.3
Clinical Advances
Making Headway Against Thyroid Disease

Anew, highly sensitive test to detect thyroid cells in the bloodstream can help determine whether thyroid cancer has spread. The test was developed by surgery faculty Drs. Beth Ann Ditkoff, John Chabot, Carl Feind, and Paul LoGerfo. It should help bring peace of mind to the 14,000 people per year who suffer from thyroid cancer.

In many cases, thyroid cancer is completely curable by surgery. The new test can identify people who need additional therapy because of metastatic thyroid cancer.

The test uses reverse transcriptase polymerase chain reaction (PCR) analysis to find thyroglobulin RNA, which is produced only by thyroid cells. The test's detection of thyroglobulin RNA after removal of the thyroid gland indicates thyroid cells are circulating in the bloodstream.

"This is the first time we've documented that thyroid cells circulate in the bloodstream of people with metastatic thyroid cancer," says Dr. Ditkoff. "We had suspected it before but were never able to prove it because previous assays were too insensitive."

Researchers have tried the test on approximately 100 patients: All patients with metastatic thyroid disease tested positive, and patients with benign tumors and patients without thyroid disease tested negative.

The new PCR test is only one of several advances that fall under the auspices of CPMC's new Thyroid Center. The new center solidifies a once-informal connection among specialists from various disciplines, making it easier to coordinate clinical care, says Dr. Robert McConnell, co-director and associate professor of clinical medicine. Staff for the center includes endocrinologists, surgeons, radiologists, pathologists, and ophthal- mologists with a major interest in diseases of the thyroid. Dr. Paul LoGerfo, professor of surgery, also is co-director.

Thyroid diseases affect an estimated 20 million Americans; approximately 25 percent of all women will have a thyroid disorder during their lifetimes.

CPMC's leadership in the study and treatment of thyroid disorders dates back to the 1930s, when physicians here first began investigating thyroid disease. In that era, Virginia Kneeland Frantz'22 founded a multidisciplinary thyroid clinic, which today is formally structured as the Thyroid Center. Throughout the years, the thyroid clinic contributed much to the understanding and treatment of thyroid diseases. Among CPMC's "firsts" were the first use of radioactive iodine to treat thyroid disease and one of the first uses of fine needle aspiration biopsy for diagnosis of thyroid disease.

Today, CPMC's leadership in thyroid research continues. Current projects include the use of naturally formed antibodies to treat thyroid disease, the development of animal models, research on the use of antibodies to treat thyroid cancer, and the use of local anesthesia in some thyroid operations. In fact, CPMC is one of the few centers in the country to use local anesthesia in some thyroid surgery.

In addition, CPMC is among the few centers using coarse needle biopsies to make preoperative diagnoses, says Dr. Ditkoff. Unlike a fine needle biopsy, which withdraws only a few cells, a coarse needle biopsy collects a larger portion of thyroid tissue, improving the diagnosis and reducing the need for surgery.

"In the United States, we spend an absolutely incredible amount of money on the treatment of thyroid disorders," says Dr. LoGerfo. "Basic and clinical science at the Thyroid Center will help change these statistics by finding better ways to prevent thyroid disease."


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