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Medullary thyroid carcinoma (MTC) is a rare malignancy that originates from parafollicular (C cells) of the thyroid and accounts for 2-4% of all thyroid malignancies. MTC may be sporadic or inherited, the latter as part of the MEN 2 syndromes. Germline mutations in the RET proto-oncogene (REarranged during Transfection) are driver mutations in hereditary MTC, whereas somatic RET mutations and, less frequently, RAS mutations, have been described in tumor tissues of sporadic MTC. Genetic screening for germline mutations in RET proto-oncogene identifies gene carriers of germline mutations. That enables primary prevention (the avoidance of disease onset by total prophylactic thyroidectomy), or at least secondary prevention (early detection) of the disease. Radical surgery with complete tumor resection is still pivotal in attaining cure for MTC. Despite recent advances, the treatment of advanced, metastatic, and progressive MTC remains challenging. Metastatic MTC can have an indolent clinical course; therefore, it is necessary to assess which patient to cure and when to initiate the treatment. Multidisciplinary boards of various specialists involved in the diagnostics and therapy of the patients with MTC in highly specialized centers with a high volume of patients provide optimal patient management. Multikinase inhibitors (MKI) vandetanib and cabozantinib were approved for the treatment of progressive or symptomatic metastatic/unresectable MTC. Although these treatments have been shown to improve progression-free survival (PFS) with higher overall response rates (ORR) compared with placebo, no MKI has been shown to increase the overall survival (OS) yet, except in the subgroup of patients with RETM918T-mutations on cabozantinib therapy. As these drugs are nonselective, significant off-target toxicities may occur. Recently, next-generation small-molecule tyrosine kinase inhibitors (TKIs) have been developed. These highly selective RET-inhibitors are specifically designed, Medularni karcinomi štitnjače (MKŠ) rijetke su zloćudne bolesti podrijetla parafolikularnih (C-stanica) štitnjače i čine oko 2-4% svih zloćudnih tumora štitnjače. MKŠ može biti sporadičan ili nasljedan, potonji kao dio MEN 2 sindroma. N asljedne mutacije protoonkogena RET (od engl. REarranged during Transfection) pokretačke su mutacije kod nasljednih MKŠ, dok su somatske RET mutacije, ili, rjeđe, RAS mutacije, opisane u tumorskom tkivu kod sporadičnih MKŠ. Genetski probir na nasljedne mutacije protoonkogena RET identificira nosioce nasljednih genetskih mutacija. To omogućuje primarnu (sprječavanje razvoja bolesti provođenjem profilaktičke totalne tireoidektomije) ili barem sekundarnu prevenciju bolesti (rano otkrivanje MKŠ-a). Radikalna operacija s kompletnom resekcijom tumora još je uvijek ključna u postizanju izlječenja kod MKŠ. Naime, unatoč nedavnim dostignućima, liječenje uznapredovalog, metastatskog i progresivnog MKŠ-a i dalje predstavlja izazov. Metastatski MKŠ može biti indolentnog kliničkog tijeka, stoga je potrebno procijeniti kojeg bolesnika liječiti i kada liječenje započeti. Multidisciplinarni timovi različitih specijalista uključenih u dijagnostiku i liječenje bolesnika s MKŠ-om u visoko specijaliziranim centrima s velikim brojem bolesnika omogućuju njihovo optimalno zbrinjavanje. Multikinazni inhibitori (MKI) vandetanib i kabozantinib, odobreni su za liječenje progresivnog ili simptomatskog metastatskog/ neresektabilnog MKŠ. Premda je ovo liječenje pokazalo dobit u preživljenju bez progresije bolesti (PFS, od engl. Progression Free Survival) uz veću ukupnu stopu odgovora (ORR, od engl. Overall Response Rate) naspram placeba, MKI nisu polučili dobit u ukupnom preživljenju (OS, od engl. Overall Survival), osim kod podskupine bolesnika s RETM918T-mutacijama na terapiji kabozantinibom. Multikinazni inhibitori su neselektivni, stoga je moguća značajna toksičnost terapije. Nedavno su razvijene nove generacije tirozin-kinaznih inhibitora (TKI). Ovi visoko s

The aim is to present data on the treatment and follow-up in a cohort of patients with pediatric thyroid cancer who underwent total thyroidectomy and received postoperative radioactive iodine (I-131) therapy. The study was conducted in a tertiary high-volume thyroid center, in pediatric patients with differentiated thyroid cancer who were consecutively treated during the 1965-2015 period. A total of 45 patients aged ≤18 years having undergone total thyroidectomy with or without selective neck dissection were included in the study. Decision on postoperative I-131 ablation was based on tumor characteristics, postoperative thyroglobulin level, preablative whole body scintigraphy, and/or neck ultrasound. Median age at diagnosis was 15 years. The presence of cervical lymph node metastases was significantly associated with papillary thyroid cancer, larger tumor size, involvement of two thyroid lobes, and multifocal disease. The presence of distant metastases was significantly associated with larger tumor size. None of the patients died during follow-up period, and the 5-year and 10-year overall survival rates were 100%. The 5-year and 10-year progression-free survival (PFS) rates were 87% and 73%, respectively. Male gender (p=0.046), age ≤15 years (p=0.029) and tumor size >15 mm (p=0.042) were significantly associated with inferior PFS. A significant positive trend of increase in the number of newly diagnosed patients was observed over time (p=0.011). Clinical management of pediatric thyroid cancer is challenging, especially in the light of increasing incidence in this population. Male patients younger than 15 years and with tumors of more than 15 mm in size require additional caution due to lower PFS observed., Cilj je prikazati podatke o liječenju i praćenju kohorte bolesnika s pedijatrijskim rakom štitnjače, kod kojih je učinjena totalna tireoidektomija te provedena poslijeoperacijska terapija radioaktivnim jodom (I-131). Studija je provedena u tercijarnom centru za štitnjaču visokog volumena, u bolesnika s pedijatrijskim diferenciranim karcinomom štitnjače koji su liječeni konsekutivno u razdoblju od 1965. do 2015. godine. U studiju je bilo uključeno 45 bolesnika (18 godina i mlađi) kod kojih je učinjena totalna tireoidektomija sa selektivnom disekcijom vrata ili bez nje. Odluka o indikaciji za provođenje poslijeoperacijske ablacije pomoću I-131 je donesena na temelju karakteristika tumora, poslijeoperacijske razine tireoglobulina, predablacijske scintigrafije cijelog tijela i/ili ultrazvuka vrata. Medijan dobi pri postavljanju dijagnoze je iznosio 15 godina. Prisutnost metastaza u limfne čvorove vrata je bila značajno povezana s papilarnim rakom štitnjače, većom veličinom tumora, zahvaćenosti dvaju režnjeva štitnjače te multifokalnom bolešću. Prisutnost udaljenih metastaza je bila značajno povezana s većom veličinom tumora. Tijekom razdoblja praćenja nijedan bolesnik nije preminuo, a 5-godišnje i 10-godišnje stope ukupnog preživljenja su iznosile 100%. Petogodišnje i 10-godišnje preživljenje bez progresije bolesti (PPB) je iznosilo 87% odnosno 73%. Muški spol (p=0,046), dob ≤15 godina (p=0,029) i veličina tumora >15 mm (p=0,042) su bili značajno povezani s nižim PPB. Zamijećen je značajan trend porasta broja novodijagnosticiranih bolesnika tijekom vremena (p=0,011). Klinički postupak u populaciji dece s diferenciranim karcinomom štitnjače je izazovan, osobito u svjetlu porasta incidencije u ovoj populaciji. Osobitu pozornost treba posvetiti muškim bolesnicima mlađim od 15 godina s tumorima većim od 15 mm zbog opaženog nižeg PPB.

Due to progressive dyspnea, a male patient aged 59 underwent medical examination in 2003 in a local hospital. Neck ultrasound and fine-needle aspiration biopsy (FNAB) of a suspect lesion in the thyroid gland revealed the presence of a malignant neoplasm, i.e. mesenchymal tumor. Immunocytochemistry for epithelial membrane antigen, chromogranin A and leukocyte common antigen (CD45) was negative, while vimentin and S-100 were positive. The patient was referred to a university hospital center, where further oncologic work-up was done. Neck ultrasound revealed a tumor in the left lobe of the thyroid, with extension to the aortic arch. After repeated FNAB, cytologic diagnosis of primary thyroid fibrosarcoma was established. Due to the locally advanced and consequently inoperable disease, primary radiotherapy to the neck region (64 Gy in 32 fractions) was applied, followed by 6 cycles of chemotherapy with doxorubicin. After completion of therapy, computed tomography scan demonstrated significant regression of primary disease, but it was still not amenable to surgical treatment. Thus, the decision of the oncology board was active surveillance of the patient. During 9-year follow up, no signs of progression or activity of the disease were found., Bolesnik u dobi od 59 godina pregledan je zbog progresivne dispneje u lokalnoj bolnici. Ultrazvukom vrata te citološkom punkcijom suspektne lezije u štitnjači registrirana je maligna neoplazma, tj. mezenhimni tumor. Imunohistokemija je bila negativna na antigen epitelnih membrana, kromogranin A i CD45 te pozitivna na vimentin i S-100. Bolesnik je upućen u klinički bolnički centar, gdje je provedena daljnja onkološka obrada. Ultrazvukom vrata nađen je tumorski proces lijevoga režnja štitnjače sa širenjem na luk aorte. Nakon ponovljene citološke punkcije postavljena je dijagnoza primarnog fibrosarkoma štitnjače. Zbog lokalno uznapredovale i posljedično inoperabilne bolesti provedena je primarna radioterapija regije vrata (64 Gy u 32 frakcije), nakon čega je bolesnik primio 6 ciklusa kemoterapije doksorubicinom. Nakon završetka liječenja kontrolni CT pokazao je značajnu regresiju primarne bolesti koja je, međutim, i dalje bila inoperabilna. S obzirom na navedeno, odluka onkološkog konzilija bila je daljnje aktivno praćenje bolesnika. Tijekom 9 godina praćenja u bolesnika nisu nađeni znakovi progresije niti aktivnosti bolesti.

In 1996, due to persistence of mild to moderate iodine deficiency, new law on obligatory salt iodination with 25 mg of potassium iodide (KI) per kg of salt was implemented in Croatia. Along with a new law, a new program formonitoring of iodine prophylaxis was implemented. Investigations of goiter and iodine intake performed in 2002, demonstrated sufficient iodine intake in Croatia with overall median of urinary iodine concentration (UIC) for schoolchildren in Croatia of 140 mg/L. In 2002, thyroid volumes (TV) measured by ultrasound in schoolchildren from all four geographic regions of Croatia were for the first time within the normal range according to ICCIDD reference values. Nowadays, Croatia is internationally recognized as iodine sufficient country. The aim of the present study was to assess current status of iodine intake in Croatia. The investigation was carried out in 2009. A total of 386 schoolchildren aged 7–10 years from all four major geographic regions of Croatia, 103 euthyroid pregnant women and 36 women of child-bearing age from Zagreb, the capital, were included in the survey. Urinary iodine concentration (UIC) was measured in all participants. Thyroid volumes were measured by ultrasound in schoolchildren from the capital of Zagreb (N=101) and the village of Rude (N=56). In the time period 2002–2009, the content of KI was analyzed in 384 salt samples from Croatian salt plants and samples of imported salt. An overall median UIC for schoolchildren in Croatia was 248 mg/L. Median UIC in pregnant women was 159 mg/L, with 50% of samples below and under 150 mg/L. Median UIC in women of child-bearing age was 136 mg/L. Thyroid volumes in schoolchildren were within the normal range according to the new reference values. Mean value of KI/kg of salt in samples from Croatian salt plants was 25.5 mg/kg and 24.9 mg/kg in samples of imported salt. A total of 72/384 (18.8%) of salt samples didn’t corresponded to the Croatian law on obligatory salt iodination. Present

Fibrodysplasia ossificans progressiva (FOP) is an extremely rare genetic disorder with diffuse extra-skeletal bone formation. The genetic mutation responsible for FOP has recently been discovered and is connected with excessive activation of bone morphogenetic protein receptor. This disease usually begins with typical ossification pattern in early childhood, causing increasing disability and making patients totally disabled by the age of 30. Ectopic ossification develops spontaneously and can be triggered by any trauma and even intramuscular injections. The symptoms of FOP are often misdiagnosed as cancer, causing unnecessary biopsies, which can precipitate further progressive heterotopic ossification. There is no effective treatment for this severe condition. Radiotherapy can be helpful in impeding ossification, although the strict evidence for that is lacking. There are only two reports in the literature referring to the use of radiotherapy in treatment of FOP. Herein, we present a 35-year-old patient successfully treated with small doses of fractionated radiotherapy in several courses. This case indicates that radiotherapy can be useful in treating patients with FOP

Our aim was to assess malignancy risk in adenomatoid nodules and suspicious follicular lesions of the thyroid obtained by fine needle aspiration (FNA) cytology. Retrospective research was performed of 276 patients who underwent thyroid surgery after preoperative ultrasound-guided FNA diagnosis of either adenomatoid nodule, cellular follicular lesion, »suspicious for follicular neoplasm» or follicular neoplasm. Out of 276 patients, FNA reports showed 15 diagnoses (5%) of adenomatoid nodules, 73 (26%) cellular follicular lesions, 76 (28%) »suspicious for follicular neoplasm«, and 112 diagnoses (41%) of follicular neoplasm. FNA reports were compared with pathohistological findings. In FNA reports of adenomatoid nodule (N=15), there were seven (47%) pathohistological diagnoses (PHDs) of nodular goiter, and eight (53%) PHDs of follicular adenoma. In FNA reports of cellular follicular lesion (N=73), there were 2 (3%) PHDs of thyroiditis, 32 (44%) PHDs of nodular goiter, 38 (52%) PHDs of follicular adenoma, and one (1%) PHD of papillary carcinoma. In FNA reports of »suspicious for follicular neoplasm« (N=76), there was one (1%) PHD of thyroiditis, 24 (32%) PHDs of nodular goiter, 47 (62%) PHDs of follicular adenoma and four (5%) diagnoses of papillary carcinoma. In FNA reports of follicular neoplasm (N=112), there were 25 (22%) PHDs of nodular goiter, 72 (64%) PHDs of follicular adenoma, and 15 (14%) PHDs of thyroid carcinoma. We found significant difference (p<0.01) between investigated FNA report groups according to malignancy risk. Stratification of cytologic diagnoses of follicular thyroid lesions into different subcategories with various probabilities of malignancy allows more accurate estimation of malignancy risk and individualized patient treatment, when deciding between immediate operation and close follow-ups with repeat FNA.

People of all ages can be affected by iodine deficiency; however, pregnant women and children are especially at a high risk. Because of changes that occur in maternal thyroid hormone economy during pregnancy and the potential unfavorable effects of iodine deficiency on the offspring, an adequate dietary iodine intake throughout the pregnancy is highly important. Therefore, the World Health Organization, United Nations Children's Fund and International Council for the Control of Iodine Deficiency Disorders have proposed that dietary intake of iodine during pregnancy should be 200-300 µg/day to compensate for the augmented T4 requirements in pregnant women. It has been shown that in countries with a longstanding and well-established universal salt iodination program where iodine sufficiency has been reached, there is a fraction of pregnant women that still have low median urinary iodine concentration, which indicates insufficient dietary iodine. Studies performed in such countries emphasize that pregnant women should use multivitamin and/ or mineral tablets specifically prepared for the needs of pregnancy and containing iodine supplements. Only the United States of America and Canada have official recommendations concerning iodine supplementation. In other countries, no such firm decisions have yet been made by medical community and public health authorities. In Croatia, an iodine sufficient country, the situation is the same. There is a need to collect adequate data on iodine supplementation and urinary iodine during pregnancy, along with the universal salt iodination program, so that definitive conclusions can be made., Nedostatak joda može zahvatiti bilo koju dobnu skupinu, ali je ta opasnost osobito visoka kod trudnica i djece. Dostatan unos joda u prehrani kroz cijelo razdoblje trudnoće je veoma važan zbog promjena koje nastaju u kretanju majčinih hormona štitnjače tijekom trudnoće i mogućih negativnih učinaka nedostatka joda na dijete. Stoga su Svjetska zdravstvena organizacija, Fundacija za djecu Ujedinjenih naroda i Međunarodni savjet za kontrolu bolesti uzrokovanih nedostatkom joda predložili unos joda prehranom tijekom trudnoće od 200-300 µg/dan kako bi se nadoknadile povećane potrebe za T4 kod trudnica. Pokazalo se da u zemljama s dugotrajnim i dobro uspostavljenim sveopćim program om za jodiranje soli u kojima je postignut dostatan unos joda uvijek postoji skupina trudnica koje ipak imaju nizak medijan koncentracije joda u mokraći, što pak ukazuje na nedostatak joda u prehrani. U istraživanjima provedenim u takvim zemljama naglašava se kako bi trudnice trebale uzimati tablete multivitamina ili minerala koje sadrže dodatak joda i namijenjene su upravo za primjenu u trudnoći. Sjedinjene Američke Države i Kanada su jedine zemlje koje imaju službene preporuke za dodavanje joda, dok u drugim zemljama takve čvrste odluke medicinske struke i javnozdravstvenih vlasti još nisu donešene. Takva je situacija i u Hrvatskoj, zemlji s dostatnim unosom joda. Uz programe općeg jodiranja soli potrebno je prikupiti dovoljno podataka o dodavanju joda i koncentraciji joda u mokraći za vrijeme trudnoće kako bi se mogli donijeti valjani zaključci.

The aim of the study was to determine the incidence of coexistence of papillary carcinoma and Hashimoto's thyroiditis in cytologic material. Cytologic findings were collected from 10508 patients that underwent ultrasound-guided fine needle aspiration cytology (FNAC) of the thyroid. Hashimoto's thyroiditis was found in 2156 (20.5%) and papillary carcinoma in 269 (2.6%) of 10508 patients with FNAC, whereas both Hashimoto's thyroiditis and papillary carcinoma were present in 42 (0.4%) patients. Among patients with FNAC diagnosis of Hashimoto's thyroiditis, the prevalence of papillary carcinoma was 1.9%. Among patients with FNAC diagnosis of papillary carcinoma, the prevalence of Hashimoto's thyroiditis was 15.6%. There was no statistically significant association between the presence of papillary carcinoma and Hashimoto's thyroiditis in patients undergoing FNAC (p=0.0522). In conclusion, in a large series of patients, the incidence of Hashimoto's thyroiditis and papillary carcinoma coexistence in cytologic material was 0.4%. There was no statistically significant relationship between Hashimoto's thyroiditis and papillary carcinoma in cytologic material., Cilj ove studije bio je utvrditi incidenciju istodobne prisutnosti papilarnog karcinoma i Hashimotova tireoiditisa u citološkim uzorcima. Prikupljeni su citološki nalazi za 10.508 bolesnika podvrgnutih ultrazvučnoj citološkoj punkciji štitnjače tankom iglom (FNAC). Hashimotov tiroiditis je utvrđen kod 2156 (20,5%), a papilarni karcinom kod 269 (2,6%) od tih 10.508 bolesnika, dok je 42 (0,4%) bolesnika imalo i papilarni karcinom i Hashimotov tiroiditis. U bolesnika s Hashimotovim tireoiditisom učestalost papilarnog karcinoma bila je 1,9%, a među bolesnicima s papilarnim karcinomom učestalost Hashimotova tireoiditsa bila je 15,6%. Kod bolesnika podvrgnutih FNAC nije bilo statistički značajne povezanosti između prisutnosti papilarnog karcinoma i Hashimotova tireoiditisa (p=0,0522). Dakle, u citološkom materijalu velikog niza bolesnika utvrđena je incidencija istodobne prisutnosti papilarnog karcinoma i Hashimotova tiroiditisa od 0,4%. U citološkim uzorcima nije utvrđena statistički značajna povezanost između Hashimotova tireoiditisa i papilarnog karcinoma.

The village of Rude is situated near Zagreb, the capital of Croatia in the last Alpine valley on Balkan. In the past, the village was well-known area of severe iodine deficiency disorders (IDD). In 1952’, distinguished Croatian endocrinologist Professor Josip Matovinovi} carried out detailed village survey. Goiter prevalence in school-age children was 85.0% (with 2.3% of cretins in the village). In 1953, the first regulation on compulsory salt iodination with 10 mg of KI/kg of salt was established in former Yugoslavia. Ten years later a dramatic decrease in goiter prevalence was recorded in all endangered areas of the country and no new cretins appeared. However, at the beginning of 1990’ mild to moderate iodine deficiency still persisted in Croatia. In 1991, the village of Rude survey demonstrated goiter prevalence in school- -age children of 35.0% and median of urinary iodine excretion (UIE) of 7.4 mg/dL. In 1996, the new obligatory regulation with 25 mg of KI/kg of salt was established in Croatia. The study aim was to monitor IDD status in the village after the new law on compulsory salt iodination. Measurements of UIE and thyroid volumes (Tvol) by ultrasound were performed in 7–11-y-old schoolchildren living in the village of Rude. Medians of UIE and body surface area (BSA)-adjusted Tvol in boys and girls were calculated. The study included 84 children in 1997, 132 in 2000, 72 in 2002, 85 in 2003 and 46 in 2004 for UIE measurement. Thyroid volumes were measured in 1999 (43 boys and 26 girls) and in 2005 (22 boys and 26 girls). Data were compared with the new WHO/ICCIDD reference values. Medians of UIE in schoolchildren from the village of Rude demonstrated rising values in mg/dL: 11.4 in 1997, 14.3 in 2000, 17.3 in 2002, 15.4 in 2003 and 19.0 in 2004. Significant decrease in BSA-adjusted Tvol was recorded from 1999–2005 in boys and girls from the village of Rude and in 2005 Tvol were within the normal range according to the new international reference values for

Fine needle aspiration (FNA) of the thyroid has been utilized as a diagnostic method for 40 years. The main purpose of thyroid FNA is to differentiate nodules that require surgery from those that do not. The sensitivity of thyroid FNA ranges from 65% to 99%, and its specificity from 72% to 100%. Ultrasound-guided FNA of the thyroid is recommended, especially for sampling of a small, deep nodule. One to four aspirations suffice in single nodular lesions measuring less than 3 cm in diameter. Although the criteria used to establish specimen adequacy are somewhat controversial, most institutions require the presence of follicular cells. FNA diagnosis of thyroid disease is a clinicocytologic diagnosis, and correlation with clinical findings is mandatory for success. At our institution, diagnostic FNA lesions are subdivided into the following general diagnostic categories: benign, indeterminate, and malignant. Benign lesions include lesions with the diagnosis of benign thyroid nodule, nodular goiter, and thyroiditis. Indeterminate lesions include cellular follicular lesion, follicular neoplasm and Hürthle cell neoplasm. Malignant neoplasms include papillary carcinoma, high-grade follicular carcinoma, medullary carcinoma, anaplastic carcinoma, large cell lymphoma, and metastatic carcinoma. No clinical or laboratory test is sensitive and specific enough to distinguish reliably whether a follicular neoplasm identified on FNA is benign or malignant. This position may be changed with the development of molecular approaches to the diagnosis. CD44v6 and galectin-3 seem to be most promising tumor markers for thyroid malignancies of follicular epithelial cell origin., Aspiracijska citologija štitnjače tankom iglom rabi se kao dijagnostička metoda već 40 godina. Glavni cilj aspiracijske citologije štitnjače je razlučiti čvorove štitnjače koji zahtijevaju kirurško liječenje od onih čvorova kod kojih to nije potrebno.Osjetljivost aspiracijske citologije štitnjače varira između 65% i 99%, a specifičnost između 72% i 100%. Preporuča se provoditi ju uz nadzor ultrazvuka, poglavito kod malih, dublje smještenih čvorova. Kod čvorova promjera manjeg od 3 cm dovoljno je izvršiti jednu do četiri aspiracije. Premda se kriteriji za prikladnost uzorka razlikuju od ustanove do ustanove, većina ih zahtijeva prisutnost folikularnih stanica. Citološka dijagnoza bolesti štitnjače zapravo je kliničko-citološka dijagnoza, jer se temelji na korelaciji citomorfološke slike i dostupnih kliničkih podataka. U našoj ustanovi dijagnostičke citološke promjene štitnjače dijelimo u tri glavne kategorije: benigne, neodređenog značaja i maligne. Benigne promjene uključuju dijagnoze kao što su benigni čvor štitnjače, nodularna struma i tireoiditis. Promjene neodređenog značaja uključuju celularnu folikularnu promjenu, folikularni tumor i tumor Hürthleovih stanica. Maligne promjene uključuju papilarni karcinom, slabo diferencirani folikularni karcinom, medularni karcinom, anaplastični karcinom, limfom velikih stanica i metastatski karcinom. Niti jedan klinički ni laboratorijski test nije dovoljno osjetljiv ni specifičan da bi pouzdano razlučio maligne od benignih citološki dijagnosticiranih folikularnih tumora štitnjače. Ovakvo stanje moglo bi se izmijeniti primjenom molekularne dijagnostike tumora pri čem se CD44v6 i galektin-3 nameću kao obećavajući biljezi malignih stanica podrijetla folikularnih epitelnih stanica.