New perspectives, management and problems associated with thyroid cancer treatment

n the first part of this Phd thesis we investigated the role of Raman spectroscopy (RS) in thyroid cancer diagnosis; in the second part we report the results of PTH (1-34) treatment to prevent hypocalcemia in subjects at high risk of post-surgical hypocalcemia after thyroidectomy. Raman spectroscopy (RS) is a non-invasive optical label-free tool increasingly used to get molecular fingerprints of biological tissues. It is able to provide bioanalytical information on any biomolecule with high specificity. Technological advances over the last decade have created a new and faster Raman imaging microscope instrument, providing morphological tissue investigation of large areas coupled with point-by-point spectral analysis of biochemical composition. This option is important not only for discrimination between healthy and pathological tissues. The reported results have demonstrated the feasibility and reproducibility of RS to discriminate normal thyroid tissue from PTC, and between classical and follicular variants of PTC, on the basis of their biochemical fingerprints. Based on the experimental results obtained in this work, we can attest the significant carotenoids presence in the PTC tissues with respect to the healthy tissue, in which their absence or minimal and localized presence was detected. To our knowledge, this is the first experimental evidence of carotenoids presence in the neoplastic thyroid tissue. Several future perspectives can derive from these preliminary results: 1. the development of a RS optical biopsy system to investigate thyroid tissue alterations. 2. The development of intraoperative technology which may able to classify cell populations in real time, making it an ideal guide for surgical resection and decision making. In the second section of this Phd thesis we report the results of Monocentric Prospective Phase II Randomized Open Label Trial (Teriparatide for HYpocalcemia in POst-surgical Subjects: Thypos Trial). The objective of this trial was to evaluate whether teriparatide can prevent postsurgical hypocalcemia and shorten the hospitalization in subjects at high risk of hypocalcemia following thyroid surgery. Twenty-six subjects (six males, 20 females) with intact PTH lower than10 pg/ml 4 hours after thyroidectomy were included and then they randomized (1:1) to receive SC administration of 20 mcg of teriparatide every 12 hours until the discharge (treatment group) or to follow standard clinical care (control group). The obtained results allow us to conclude that Teriparatide may prevent postsurgical hypocalcemia and shorten the duration of hospitalization.