Faculty Bibliography

The inadequacy of the standard pathologic criteria for identifying certain well-differentiated thyroid follicular carcinomas from follicular adenomas in rare instances is illustrated by four cases. The excised thyroid nodule in these patients appeared to be adenoma, but subsequent local spread in the neck or distant metastases disclosed the actual malignant nature of the lesions. This observation is not intended as a basis for more extensive operations for adenoma, but rather as an indication for close, long-term observation. Postoperative, lifelong suppressive therapy with thyroid hormone is suggested for all patients with a diagnosis of follicular adenoma.

Reversible hypertension occurred in a patient during episodes of hypercalcemia caused by hyperparathyroidism, vitamin D toxicity, and an infusion of calcium during an 11-year period of observation. It is suggested that normal renal function may be required for the hypertension of hyperparathyroidism to be reversible and that the hypertension may be directly related to the hypercalcemia in some patients. Early surgery is suggested for otherwise asymptomatic, mildly hypercalcemia hyperparathyroidism that is accompanied by hypertension.

The scan of the thyroid gland in oblique projections has enabled us to visualize 11 "cold" thyroid nodules which were not delineated on a traditional anterior view among 825 patients studied in a 2-yr period. Accurate localization of the nodule in the oblique projection facilitated accurate placement of the transducer for echography. The combination of the isotope imaging studies and ultrasound then permitted one to differentiate solid and cystic "cold" nodules. Diagnosis and choice of therapy are therefore enhanced by the addition of oblique views, when needed, and echography.