ABSTRACT
Several guidelines on diagnosis and treatment of thyroid nodules and cancer have recently been published. However, recommended practices are not always appropriate to different settings or countries. The aim of this consensus was to develop Clinical Guidelines for evaluation and management of patients with thyroid nodules applicable to Latin American countries. The panel was composed by 13 members of the Latin American Thyroid Society involved with research and management of thyroid nodules and cancer from different medical centers in Latin America. The consensus was produced based on the expert opinion of the panel with use of principles of evidence-based medicine. Following a group meeting, a first draft based on the expert opinion of the panel was elaborated and later circulated among panel members for further revision. After revision, this document was submitted to all LATS members for commentaries and considerations and finally revised and refined by the authors. The final recommendations represent state of the art on management of thyroid nodules applied to all Latin American countries.
Vários consensos têm sido publicados acerca do diagnóstico e do tratamento de nódulos e câncer da tireoide. Entretanto, as recentes recomendações nem sempre são apropriadas para diferentes regiões ou países. O objetivo deste trabalho foi oferecer uma série de recomendações para a avaliação e conduta de pacientes portadores de nódulos tireoideos aplicáveis a todos os países da América Latina. O trabalho foi realizado por um comitê composto por 13 membros da Sociedade Latino-Americana de Tireoide envolvidos com pesquisa e manejo de pacientes portadores de nódulos e carcinoma diferenciado da tireoide, de diferentes centros médicos da América Latina. As recomendações foram estabelecidas, após consenso, utilizando as opiniões especializadas de cada membro e os princípios da medicina baseada em evidência. Após a primeira reunião do grupo, um primeiro documento foi elaborado e encaminhado a todos os membros para revisão. Posteriormente, o documento foi enviado aos membros da Sociedade Latino-Americana de Tireoide para avaliação, sugestões e comentários. A versão final, elaborada após refinada revisão de todos os autores, representa o estado da arte no diagnóstico e na conduta de nódulos tireoideos, aplicáveis a todos os países da América Latina.
Subject(s)
Humans , Thyroid Nodule , Latin America , Societies, Medical , Thyroid Nodule/diagnosis , Thyroid Nodule/therapyABSTRACT
The aims of these recommendations were to develop clinical guidelines for evaluation and management of patients with differentiated thyroid cancer applicable to Latin American countries. The panel was composed by 13 members of the Latin American Thyroid Society (LATS) involved with research and management of thyroid cancer from different medical centers in Latin America. The recommendations were produced on the basis of the expert opinion of the panel with use of principles of Evidence-Based Medicine. Following a group meeting, a first draft based on evidences and the expert opinions of the panel was elaborated and, later, circulated among panel members, for further revision. After, this document was submitted to the LATS members, for commentaries and considerations, and, finally, revised and refined by the authors. The final recommendations presented in this paper represent the state of the art on management of differentiated thyroid cancer applied to all Latin American countries.
Estas recomendações tiveram por objetivo o desenvolvimento de diretrizes para avaliação e manejo de pacientes com câncer diferenciado da tiroide em países latino-americanos. Um painel composto por 13 membros da Sociedade Latino-Americana de Tireoide (SLAT) - que estavam envolvidos em pesquisas, e eram peritos no cuidado do paciente com câncer da tiroide e provenientes de diferentes centros médicos latino-americanos - utilizou os princípios da Medicina Baseada em Evidências para produzir esse consenso. Após uma primeira reunião, um texto inicial foi elaborado, baseado em evidências e opiniões dos especialistas do painel e, posteriormente, circulado entre os membros do painel, para revisão. Após a revisão, o documento foi enviado aos membros da SLAT para comentários e considerações e, finalmente, revisado e refinado pelos autores. As recomendações finais aqui apresentadas demonstram o estado da arte no manejo do câncer diferenciado da tireoide aplicadas aos países latino-americanos.
Subject(s)
Humans , Societies, Medical , Thyroid Neoplasms/diagnosis , Thyroid Neoplasms/therapy , Evidence-Based Medicine , Latin AmericaABSTRACT
La resistencia a la insulina (RI) es una alteración que ha sido relacionada al sindrome plurimetabólico y conlleva mayor riesgo de enfermedad coronaria. La respuesta de insulina durante el test de tolerancia oral a la glucosa (TTOG), puede indirectamente valorar la RI en un paciente. Con el objeto de determinar en nuestro medio los valores de insulina sérica basal y a los 120 minutos después del TTOG con 75 gramos y los factores condicionantes de esta respuesta, se han estudiado 92 sujetos (65 mujeres) normotensos, con un TTGO normal (OMS 1997) de 42.1 ±13.9 años de edad, con índice de masa corporal (IMC) de 31.8 ± 7.6 kg/m². La mediana de la insulina basal y los valores del cuartil inferior (CI) y superior (CS) fueron 11.85 uUI/ml (6.92-18.51) y a los 120 minutos 41.7 (26.3-93.3). Al agrupar a los sujetos de acuerdo al IMS (OMS 1997), en normales, con sobrepeso y obesos, las medianas de insulina basal y los valores del CS y CI fueron: 6.6 (5.6-8.7), 11.5 (7.4-13.5) y 16.3 (9.4-27.4), respectivamente (p<0.00001) y a los 120 minutos: 31.5 (19.2-34.4), 76.5 (30.1-76.8) y 96.9 (35.8-138) (p<0.00001). No hubo diferencia en la respuesta entre sexos ni con el antecedente familiar de diabetes. La insulina basal correlacionó significativamente con el peso (r=0.52), IMC (r=0.57), perímetro de la cintura (r=0.48) y triglicéridos (r=0.469). En el análisis de regresión múltiple, el IMC fue la única variable asociada independientemente a la insulina basal (p<0.0212). La insulina a los 120 minutos correlacionó en forma significativa con el valor de insulina basal (r=0.77), la relación insulina/glucosa (r=0.77), el índice de HOMA (r=0.75), el IMC (r=0.44), el perímetro de la cintura (r=0.339) y los triglicéridos (r=0.36). En el análisis de regresión múltiple la única variable asociada independientemente fue la insulina basal (p<0.00001).
Insulin resistance (IR) has been associated to the plurimatabolic syndrome, a known risk factor for coronary heart disease. Fasting plasma insulin and the 120 minutes insulin response to an oral glucose tolerance test (OGTT), are both widely used in clinical practice and indirectly estimate IR. The aim of this study is to determine insulin levels in our population, both fasting and a 2 hours after 75 g oral glucose load, and the factors conditioning them. 92 normotensives subjects (65 females), aged 42.1 ±13.9 years, with a mean body mass index (BMI) of 31.8 ± 7.6 kg/m² and with a normal OGTT (WHO 1997) were studied. Median of serum fasting insulin and the values of the upper (UQ) and lower quartiles (LQ) were; 11.85 uU/ml (26.3-93.3). Grouping subjects by the BMI, as normal, overweight and o base (WHO 1997), the median of the basal insulin and the UQ and LQ values were 6.6 (5.6-8.7), 11.5 (7.4-34.5) and 16.3 (9.4-27.4), respectively (p<0.00001) and after 120 minutes post glucose oral load were: 31.5 (19.2-34.4), 76.5 (30.1-76.8) and 96.9 (35.8-138) (p<0.00001). There was no difference in basal or 120 minutes insulin, nor by sex, neither by diabetic antecedent in relatives. Basal insulin correlated significantly with weight (r=0.52), BMI (r=0.57)waist circumference (WC) and triglycerides (r=0.469). Multiple regression analysis disclosed BMI as the only variable related to basal insulin (p<0.0212). Insulin after 120 minutes glucose load correlated significantly with basal insulin (r=0.339) and triglycerides (r=0.36). Multiple regresion analysis and showed basal independently related to it (p<0.0001).