Murakami T. Noguchi S. Murakami N. Tajiri J. Ohta Y. Destructive thyrotoxicosis in a patient with anaplastic thyroid cancer. Endocrinologia Japonica. 36(6):905-7, 1989 Dec.
A 55-year-old man was admitted to our hospital with an anterior neck tumor, hoarseness, and dysphagia that had continued for a few weeks. He was diagnosed as anaplastic thyroid cancer by fine-needle aspiration cytology. He was treated by external radiation and chemotherapy, but left hemothorax developed and he died of respiratory failure on the 76th day in hospital. On admission, the levels of serum free triiodothyronine (FT3), free thyroxine (FT4), and TSH were 12.8 pg/ml, 4.2 ng/dl, and 0 microU/ml, respectively. The simultaneous thyroidal I-131 uptake rate was 1.2% at 24 hours. The levels of free thyroid hormones fell gradually without antithyroid drugs to result in hypothyroidism (FT3 0.8 pg/ml, FT4 0 ng/dl, and TSH 36 microU/ml). The rapid growth of anaplastic thyroid cancer seemed to be responsible for destructive thyrotoxicosis followed by hypothyroidism in this patient.
Murakami T. Noguchi S. Murakami N. Kato r. Ohta Y. [The mechanism of postoperative tetany in Graves’ disease]. [Japanese] Nippon Naibunpi Gakkai Zasshi – Folia Endocrinologica Japonica. 65(8):771-80, 1989 Aug 20.
The levels of serum calcium (Ca), inorganic phosphate (P) and mid-molecular parathyroid hormone (PTH) were measured in 37 patients with Graves’ disease (12 in hyperthyroid state, 25 in euthyroid state followed by subtotal thyroidectomy), 6 with papillary carcinoma of the thyroid, 8 with benign nodular goiter and 19 healthy control subjects in order to investigate the change in these levels before and after thyroidectomy. The levels of serum Ca and P of the hyperthyroid patients with Graves’ disease were 9.73 +/- 0.30 mg/dl and 4.47 +/- 0.44 mg/dl, respectively, which were significantly higher than those of healthy control subjects. No significant difference in the levels of serum PTH was observed between hyperthyroid patients with Graves’ disease and healthy control subjects. The levels of serum Ca, P and PTH of euthyroid patients with Graves’ disease were not significantly different from those of healthy control subjects. In the patients with Graves’ disease who had undergone subtotal thyroidectomy followed by postoperative tetany, serum Ca and serum PTH decreased significantly from 9.39 +/- 0.45 mg/dl to 7.90 +/- 0.33 mg/dl and from 406.6 +/- 164.4 pg/ml to 229.9 +/- 136.0 pg/ml, respectively, after surgery, but there was no change in serum P. In the patients without postoperative tetany, serum Ca and serum P decreased significantly after surgery from 9.65 +/- 0.36 mg/dl to 9.15 +/- 0.33 mg/dl and from 4.03 +/- 0.46 mg/dl to 3.47 +/- 0.54 mg/dl, respectively, without any change in the levels of serum PTH. In the patients with papillary carcinoma or benign nodular goiter without postoperative tetany, the levels of serum Ca, P and PTH did not change after surgery. In the patients with papillary carcinoma followed by postoperative tetany, serum Ca decreased significantly after surgery with concomitant decrease of serum PTH. It was concluded that excessive thyroid hormones influenced Ca metabolism, and the transient tetany following subtotal thyroidectomy for Graves’ disease seemed to be due to both the absorption of Ca by hungry bone and parathyroid hypofunction.
Kunihiro K. Noguchi S. Murakami N. Kato R. Oribe Y. Takaki R. [Studies on serum ketone bodies in patients with hyperthyroidism]. [Japanese] Nippon Naibunpi Gakkai Zasshi – Folia Endocrinologica Japonica. 64(7):531-8, 1988 Jul 20.
In order to investigate effects of thyroid hormone on ketone bodies metabolism, fasting levels of serum ketone bodies, serum free fatty acids (FFA), serum insulin (IRI), plasma glucagon (IRG) and plasma glucose were examined in 29 untreated patients with hyperthyroidism and 20 healthy subjects. In 21 patients the levels of serum ketone bodies were re-examined when euthyroidism was achieved after treatment. In all of healthy subjects and 17 patients changes in the levels of serum ketone bodies after oral glucose load were examined. The results were as follows: 1). Fasting levels of serum FFA and total ketone bodies (TK), acetoacetate (AcAc), 3-hydroxy-beta-butylate (3OHBA), ratio of 3OHBA to AcAc in the patients were significantly higher than those in healthy subjects. The levels of IRI, IRG or ratio of IRG to IRI in the patients were not different from those in healthy subjects. In the patients, the fasting level of TK was significantly correlated with the level of FFA. 2). After oral glucose load the levels of TK and FFA in the patients decreased gradually. 3). The fasting levels of TK and FFA in the patients decreased when euthyroidism was achieved after treatment. It was suggested that the fasting levels of serum ketone bodies in patients with hyperthyroidism elevated probably due to activated lipolysis.
Noguchi S. Murakami N. The value of lymph-node dissection in patients with differentiated thyroid cancer. [Review] Surgical Clinics of North America. 67(2):251-61, 1987 Apr.
The perithyroidal and ipsilateral cervical lymphatic system not only is commonly involved by thyroid cancer but also is a common site of recurrence. Modified radical neck dissection, with preservation of the sternocleidomastoid muscle and spinal accessory nerve, is the treatment of choice for patients with clinically evident lymph node metastases due to differentiated thyroid cancer. It is also recommended, by us, for patients over 40 years of age who have primary thyroid tumors greater than 1.5 cm in size whether or not nodes are clinically palpable. This is because at least 75 per cent of these patients have metastases, and their discernment at operation is unreliable. With more aggressive surgery, the recurrence-free survival rate can be improved substantially without cosmetic deformity or postoperative dysfunction. [References: 30]
Noguchi S. [Immunoreactive thyroglobulin in thyroid cancer]. [Japanese] Horumon to Rinsho – Clinical Endocrinology. 31(8):725-9, 1983 Aug.
Noguchi S. Murakami N. Noguchi A. Surgical treatment for Graves’ disease: a long term follow-up of 325 patients. British Journal of Surgery. 68(2):105-8, 1981 Feb.
Postoperative thyroid status was classified into 6 categories on the basis of serum free thyroxine index (FTI), serum triiodothyronine (T-3) and serum TSH concentration. Review of 325 patients who underwent thyroidectomy for Graves’ disease more than 4 years previously showed that 25 patients (7.7 per cent) had recurrent hyperthyroidism. Six patients (1.8 per cent) were classified as equivocal hyperthyroid since either FTI or T-3 was above the normal range. Two hundred and twenty-two patients (68.3 per cent) were unequivocally euthyroid and 33 patients (10.3 per cent) were euthyroid with elevated TSH levels. Twenty patients (6.2 per cent) were equivocal hypothyroid since either their FTI or T-3 values were below the normal range and TSH were increased. Hypothyroidism was present in 19 patients (5.8 per cent), of whom 11 had no clinical manifestation of thyroid dysfunction. The incidence of hypothyroidism did not correlate with the intervals between operation and review. The second review, performed in 189 patients 18 months after the first, showed that there was a change in thyroid functional status in 46 patients, of whom 32 had an increased level of function, including one hypothyroid and 7 equivocal hypothyroid patients who became euthyroid spontaneously. Thus postoperative hypothyroidism in some patients can recover without medication. Also thyroid function in some postoperative patients is not maintained at a fixed level but may fluctuate.
Noguchi S. Noguchi A. [Myxoedema coma, thyroid storm, exophthalmos (author’s transl)]. [Japanese] Nippon Rinsho – Japanese Journal of Clinical Medicine. 38(3):1698-703, 1980.
Ito J. Noguchi S. Murakami N. Noguchi A. Factors affecting the prognosis of patients with carcinoma of the thyroid. Surgery, Gynecology & Obstetrics. 150(4):539-44, 1980 Apr.
Of 763 patients with carcinoma of the thyroid who had undergone a primary operation between 1948 and 1970, 705 were observed for more than five years. Included were 545 patients with papillary carcinoma. 123 with follicular carcinoma, 59 with microcancer, 30 with undifferentiated carcinoma and six with medullary carcinoma. The relative survival rate for patients with pure undifferentiated carcinoma one year after operation was 27 per cent and that for those with mixed undifferentiated carcinoma was 24 per cent. For patients with differentiated carcinomas, the most important factors affecting the prognosis were age and sex. The 15 year survival rates for women less than 40 years of age with papillary or follicular carcinoma were 102 and 100 per cent, respectively, while for women more than 40 years with papillary or follicular carcinoma, they were 90 and 84 per cent, respectively. For men more than 40 years of age with papillary carcinoma, the relative survival rate was 67 per cent. The size of the tumor and the types of operation did not affect the prognosis in patients less than 40 years. The presence of chronic thyroiditis also had no effect upon the prognosis. The relative survival rate with tumors up to 99 grams in weight, after 20 years, was almost 100 per cent in women less than 40 years of age, while for women more than 40 years of age the survival rates were 95 per cent with tumors weighing less than 20 grams and 72 per cent with those weighing 20 to 99 grams, an indication that tumor size may affect prognosis in older patients.