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Background: Detection of circulating malignant thyroid cells may provide a method to identify postoperative patients at risk for metastatic thyroid cancer., Methods: On the basis of tissue specificity of thyroglobulin gene expression and the sensitivity of the reverse transcriptase-polymerase chain reaction (RT-PCR) analysis, we performed RT-PCR using primers for thyroglobulin on blood samples from patients with thyroid disease to detect thyroglobulin RNA transcripts. Postoperative peripheral blood samples from 100 patients, including patients with known metastatic thyroid cancer (six papillary and three follicular), thyroid cancer and no evidence of current metastases (63 papillary, 10 follicular, and five patients with both papillary and follicular), benign thyroid disease (six nontoxic nodular goiters), and normal volunteers (seven)., Results: Thyroglobulin transcripts were detected in nine of nine patients with metastatic thyroid cancer, seven of 78 patients with thyroid cancer and no current metastases (although of these seven patients, five had a history of metastatic disease that had been previously treated by surgery, one had a coexisting parathyroid cancer, and one had both papillary and follicular thyroid cancers), zero of six patients with benign thyroid disease, and zero of seven normal volunteers. Identity of amplicons was confirmed by restriction enzyme digestion and by cloning and sequencing of RT-PCR amplified thyroglobulin fragment (the latter in a limited number of cases)., Conclusions: These data indicate that RT-PCR can be used to detect thyroglobulin mRNA in peripheral blood. The presence of these transcripts correlates with the existence of extrathyroidal disease.

The purpose of this study was to compare the results of fine-needle biopsy (FNB) and coarse-needle biopsy (CNB) in evaluating patients with dominant thyroid nodules. Five hundred twenty-six patients were seen because of solitary thyroid nodules. Three hundred of these underwent satisfactory CNB and FNB. Using the incidence of cancer found at operation as a guide to the specificity of the biopsy, CNB was better than FNB in determining underlying pathologic condition. The main difference between the two techniques was the inability of FNB to distinguish adenomatous hyperplasia from true adenoma. FNB, however, was as good as most older techniques in selecting patients for surgery. The main limitation of CNB was that it could only be applied on 69% of solid lesions.

Two patients with sporadic primary hyperparathyroidism were found to harbor tiny medullary thyroid carcinomas. In addition, parafollicular-cell hyperplasia was recognized in one of these thyroids by the use of immunoperoxidase stain to localize calcitonin. The possible relationships between these lesions are discussed.