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Antonio Matrone, Carla Gambale, Margherita Biagini, Alessandro Prete, Paolo Vitti, and Rossella Elisei

Objective: Recently, several scientific societies designed ultrasound (US) risk stratification systems (RSS) to guide the work-up of thyroid nodules and decide which nodules should undergo fine needle aspiration cytology (FNAC). However, these systems have been developed against papillary thyroid carcinoma, and scanty data on their role in identifying medullary thyroid carcinoma (MTC) are available. The aims of this study are to describe the US features of MTC and evaluate the performance of RSS in identifying MTC.

Methods: We evaluated data of 152 consecutive patients with MTC. We collected the results of the pre-operative neck US of all patients. Ultrasound features of each MTC were evaluated and classified according to the 5 main RSS available.

Results: Median MTC dimension was 1.3 cm. Most of the nodules showed solid composition, hypoechoic pattern, and regular margins. About half of them showed the presence of calcifications, but only a subgroup had microcalcifications. A minority of the nodules showed a “taller than wide” shape. Only 7.9% of all MTC showed the simultaneous presence of at least 4 US features suggestive for malignancy. Ultrasonographic high-risk of malignancy of the MTC included in the 5 RSS, varied from 45.4 to 47.4%, and performing FNAC was suggested in only 48.7-63.8% of all MTC.

Conclusions: In our series neither single nor association of US features are specific for MTC. The 5 main RSS correctly identify less than 50% of MTC and do not suggest of performing FNAC in about half of them with potentially missed or delayed diagnosis.

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Maria Cristina Campopiano, Debora Podestà, Francesca Bianchi, Carlotta Giani, Laura Agate, Valeria Bottici, Virginia Cappagli, Loredana Lorusso, Antonio Matrone, Luciana Puleo, Laura Valerio, David Viola, Paolo Piaggi, Rossella Elisei, and Eleonora Molinaro


At present, recombinant TSH cannot be used for the treatment of metastatic differentiated thyroid cancer patients. The aim of this study was to evaluate if the type of TSH stimulation, recombinant or endogenous, had an impact on the outcome of these patients.

Design and methods:

We compared the outcome of two propensity score-matched groups of metastatic patients, stimulated by either only recombinant TSH (n = 43) or only endogenous TSH (n = 34).


As expected from the matching procedure, the clinical–pathological features and the cumulative 131-I activities administered to the two groups were very similar. After 4 years of follow-up, 4% of patients were cured, 3% had biochemical disease and 93% had structural disease. However, 91% of patients obtained a clinical benefit from this therapy in terms of stabilization of the disease or complete remission or partial response. When considering the two groups separately, we did not find any difference in their outcome. When considering the response to 131-I therapy of the single type of metastases, 8% of lymph node metastases and 8% of lung metastases disappeared but none of the bone metastases. The response to 131-I therapy of the single type of metastases was similar when we looked at the two groups separately.


This study shows (i) an overall clinical benefit of the 131-I therapy, since the majority of patients remained affected but with a stable disease, and (ii) that the preparation with either recombinant or endogenous TSH has no impact on the 131-I therapy efficacy and the outcome of our two groups of patients.