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Sacral zoster may be associated with bladder and bowel dysfunction Persistent neuralgia, anesthesia or scarring of the affected area, facial or other nerve paralysis, and encephalitis may occur Postherpetic neuralgia is most common after involvement of the trigeminal region, and in patients over the age of 55 Early (within 72 hours after onset) and aggressive antiviral treatment of herpes zoster reduces the severity and duration of postherpetic neuralgia Zoster ophthalmicus (V1) can result in visual impairment

The most effective treatment is prevention with early and aggressive antiviral therapy Once established, postherpetic neuralgia may be treated with capsaicin ointment, 0025 0075%, or lidocaine (Lidoderm) topical patches Chronic postherpetic neuralgia may be relieved by regional blocks (stellate ganglion, epidural, local infiltration, or peripheral nerve), with or without corticosteroids added to the injections Amitriptyline, 25 75 mg as a single nightly dose, is the first-line oral therapy beyond simple analgesics Gabapentin, up to 3600 mg daily (starting at 300 mg three times daily), may be added for additional pain relief

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External radiation may be delivered to bone metastases Brain metastases do not usually respond to 131I and are best resected or treated with gamma knife radiosurgery

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Patients with differentiated thyroid carcinoma must be observed long-term for recurrent or metastatic disease Follow-up must include physical examinations and laboratory testing to ensure that patients remain clinically euthyroid with a suppressed TSH To achieve suppression of serum TSH, the required dose of thyroxine may be such that serum FT4 levels may be slightly elevated; in that case, measurement of serum T3 or free T3 (women who are pregnant or receiving oral estrogens) can be useful to ensure the patient is not frankly hyperthyroid Thyrotoxicosis can be caused by overreplacement with thyroxine or by the growth of functioning metastases Neck palpation has a sensitivity of only 16% for detecting cervical lymph node metastases Therefore, a combination of surveillance techniques must be used to detect recurrent or metastatic thyroid cancer For surveillance, neck ultrasound and serum thyroglobulin determinations (baseline and rhTSH-stimulated) have largely repeated whole-body radioiodine scanning, which has a false-negative rate of about 80% Follow-up intervals of 4 6 months are usually satisfactory 1 Neck ultrasound Neck ultrasound should be used in all patients with thyroid carcinoma to supplement neck palpation It is prudent to perform a thyroid/neck ultrasound in all patients with thyroid cancer preoperatively, 3 months postoperatively, and regularly thereafter Ultrasound is more sensitive for lymph node metastases than either CT or MRI

Patients with anaplastic thyroid carcinoma are treated with local resection and radiation Lovastatin, an HMG-CoA inhibitor, has been demonstrated to cause differentiation and apoptosis of anaplastic thyroid carcinoma cells in vitro; however, clinical studies have not been performed Anaplastic

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