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The commonly used tumour-node-metastasis (TNM) staging system is designed to predict death and not recurrence. Based on this, patients with thyroid cancer are grouped into risk categories at the time of initial treatment. However, recent guidelines proposed a novel staging system focusing on microscopic invasion into the perithyroidal tissues, neck lymph node involvement and 131I uptake outside the thyroid bed following treatment. This risk re-assessment improves the prediction of recurrent/persistent disease. The cornerstone in the follow-up is measurement of plasma-thyroglobulin concentration and ultrasound of the neck focusing on the thyroid bed and classification of lymph nodes according to their location and high risk signs.

The commonly used tumour-node-metastasis (TNM) staging system is designed to predict death and not recurrence. Based on this, patients with thyroid cancer are grouped into risk categories at the time of initial treatment. However, recent guidelines proposed a novel staging system focusing on microscopic invasion into the perithyroidal tissues, neck lymph node involvement and ¹³¹I uptake outside the thyroid bed following treatment. This risk re-assessment improves the prediction of recurrent/persistent disease. The cornerstone in the follow-up is measurement of plasma-thyroglobulin concentration and ultrasound of the neck focusing on the thyroid bed and classification of lymph nodes according to their location and high risk signs.

Graves' disease (GD) is caused by autoantibodies to the thyrotropin receptor (TRAb). In a controlled study using the B-lymphocyte depleting agent rituximab (RTX), an RTX-specific effect was found on long-term remission following methimazole (MMI) therapy. However, benefits were limited to patients with low baseline TRAb levels, and the decrease in TRAb levels observed after treatment with RTX in combination with MMI was no greater than that observed after treatment with MMI alone. Considering its price and adverse effect profile, RTX therapy does not seem to be a relevant treatment option in uncomplicated GD. The potential use of other immunomodulatory agents in GD is discussed.

The current medical treatment options for Graves' ophthalmopathy (GO) are unsatisfactory. Recent treatment of GO patients with the B-lymphocyte depleting monoclonal antibody rituximab or with the anti-tumor necrosis factor-alpha agents etanercept and infliximab has shown promising results. We discuss the use of these and other biological agents targeting B lymphocytes, T-lymphocyte interaction with antigen-presenting cells, or cytokines in the future treatment of GO.

In a randomized, double-blind, placebo-controlled trial, 57 patients with nontoxic nodular goiter were stimulated with either 0.3 mg recombinant human thyrotropin (rhTSH) or placebo before radioactive iodine 131I therapy. After one year the goiter reduction had improved by 35% compared to conventional 131I therapy. The difference was most pronounced in patients with a large goiter. Adverse effects, including development of permanent hypothyroidism, were significantly more frequent in the rhTSH group. Patient satisfaction was high and uninfluenced by the use of rhTSH.

Introduction: Thyroid-associated ophthalmopathy is most often seen in patients with Graves' disease. Surgical decompression is rarely used in Denmark. We report the results of neurosurgical two-wall orbital decompression in a consecutive group of patients., Material and Methods: From 1997 to 2000 we used a uniform technique and a standardised follow-up of 52 orbital decompressions in 27 patients. All the patients were assessed preoperatively, and at one month and one year postoperatively. Visual acuity, proptosis (Hertel ophthalmometry), soft tissue involvement, and eye motility were recorded and graded according to a modified NOSPECS scale., Results: As reduced visual acuity was present in only a few patients, it was not significantly changed during follow-up. No case with worsening was seen. Proptosis had decreased by a mean of 3.4 mm (0-9 mm) in the first month and by 3.9 mm (0-9 mm) at one year. Twenty-three patients had reduced eye motility before and 15 one month after operation. Eye motility improved in all 15 patients. Soft tissue involvement was present in 21 patients (40 eyes) before and in 10 patients (19 eyes) one month after operation and improved in all ten patients. Soft tissue involvement was further reduced one year after operation. A total of ten patients received glucocorticoid treatment before and during the operation. The corresponding figures were six at one month and four at one year. One patient had a lesion of one frontal branch of the facial nerve. No other side effects were encountered., Discussion: Transcranial two-wall orbital decompression is effective in patients with thyroid-associated ophthalmopathy and complications seem rare. This surgical method is superior to other surgical approaches as regards the effect on eye motility.