Modelo ambulatorial de atendimento de nódulo de tireoide / Ambulatory care model thyroid nodule

A prevalência de detecção de nódulos na tireoide através da palpação é de aproximadamente 5%. Essa prevalência sobe para 19 a 67% quando utilizada a avaliação ecográfica. A importância da avaliação clínica dessa entidade está na necessidade de diagnosticar o câncer de tireoide que ocorre em 5 a 10% dos casos. O relato descreve o perfil dos atendimentos realizados no ambulatório de nódulos de tireoide do Hospital Municipal Dr. Mário Gatti no período de 01/05/17 a 27/07/18 de pacientes que tiveram diagnóstico ultrassonográfico de nódulo de tireoide e realizaram punção aspirativa por agulha fina, a fim de inferir a respeito da capacidade de resolutividade do ambulatório interdisciplinar (endocrinologia e cirurgia de cabeça e pescoço) no diagnóstico e tratamento do câncer de tireoide. A organização do ambulatório com atendimento integral e por equipe multidisciplinar, possibilita uma melhora na qualidade assistencial além de ser elemento facilitador para o ensino, aprendizado e pesquisa. (AU)

The rate of thyroid node detection by touch is approximately 5%. This rate goes up to a range between 19 and 67% when a sonographic evaluation is used. The importance of the clinical evaluation of those thyroid nodes is within the need of diagnosing the cancer that occurs in 5 to 10% of the cases. This paper describes the profile of consultations performed at the Outpatient Clinic Thyroid Node Unit of the Municipal Hospital Dr. Mário Gatti (HMMG) from 01/05/17 to 07/27/18, of patients who had ultrasonographic diagnostics of thyroid node and underwent fine-needle aspiration, in order to draw conclusions about the capacity of the interdisciplinary clinic (Endocrinology and Head and Neck surgery) to diagnose and treat thyroid cancer effectively. The organization of the outpatient clinic, with comprehensive care and multidisciplinary team, enables an improvement in medical assistance as well as facilitating teaching, learning and research. (AU)

Avaliação de nódulos tireoidianos / Thyroid nodes assessment

Os autores objetivam realizar uma sucinta revisão a respeito da avaliação de nódulo tireoidiano, com o intuito de orientar o clínico frente a tal achado. Também estão inclusas informações sobre o manejo desses casos. Todas as orientações estão de acordo com as diretrizes da Associação Americana de Tireoide e com as diretrizes brasileiras no manejo dos nódulos tireoidianos e do câncer diferenciado da tireoide.

The authors aim to conduct a brief review about the evaluation of thyroid nodules, in order to guide the clinician. Also is included information about management of these cases, in agreement with the guidelines of the American Thyroid Association and The Thyroid Nodules and Differentiated Thyroid Cancer: Brazilian Consensus.

Cirugía mínimamente invasiva de la glándula tiroides: Estudio experimental en el perro / Minimally invasive surgery of the thyroid gland: Experimental study in the dog

El objetivo de este estudio fue determinar  si la lobectomía tiroidea video-asistida, realizada en el modelo canino, reduce el tiempo operatorio, el sangramiento, lesiones de las estructuras nerviosas, y mejora los resultados cosméticos de la cicatriz cervical, en comparación con la lobectomía convencional. Se intervinieron 36 perros adultos mestizos sanos, desparasitados, de ambos sexos, procedentes del bioterio del Instituto de Cirugía Experimental de la Universidad Central de Venezuela. Los animales fueron  asignados al azar simple, a dos grupos de estudio: lobectomía tiroidea convencional (LTC) y lobectomía video - asistida (LTVA), sin insuflación de gas. Los resultados estéticos fueron evaluados por los cirujanos de acuerdo a una escala (excelentes, buenos, regulares y malos), observándose los mejores resultados (P<0,05) en el grupo LTVA (promedio ± DE; 9,2 ± 0,5), que en el grupo LTC (promedio ± DE, 5,8±0,7; P<0,001). En el grupo LTVA  el promedio  de tiempo fue 81±3  min mejor que en el LTC 62±4. El sangramiento fue mayor en el LTC (34±5 mL) que en el LTVA (23±5 mL). No se observaron diferencias significativas en cuanto a la paresia o parálisis de los pliegues vocales, o infección de la herida operatoria.  La lobectomía tiroidea video-asistida es una alternativa válida a la cirugía convencional, resultando en un modelo experimental factible y seguro. Se deberían realizar en Medicina humana estudios comparativos y multicéntricos, para determinar la seguridad y eficacia  de estas técnicas.

A study was conducted to determine if the video-assisted lobectomy performed on a canine model, reduces surgical time, bleeding volume, nerve structures injuries; and improves the cosmetic results of the cervical scar, when compared to conventional lobectomy. Thirty-six adult crossbred dogs of either sex from the animal facility of the Institute of Experimental Surgery, Universidad Central de Venezuela were used. The animals were randomly allocated into two experimental groups: Group A: Eighteen dogs who underwent conventional thyroid lobectomy (CTL); Group B: Eighteen dogs who underwent video-assisted thyroid lobectomy (VATL) without gas insulation. Cosmetic results were assessed by surgeons according to a scale, as follows: excellent, good, average, and bad. The results of the experiment show that dogs operated with the VATL technique exhibited significantly (P<0.05) the highest improvements (9.2±0.5), when compared to the CTL technique (5.8±0.7).  Surgical time lasted longer (P<0.001) in dogs under VATL (81±3 min) than in dogs subjected to CTL (62±4 min). Bleeding volume was significantly higher in CTL (34±5 mL) than in VATL (23±5 mL). No statistically significant differences were found regarding paralysis of vocal cords or surgical wound infections. The VATL is a valid alternative in conventional surgery, becoming a feasible and safe experimental model. Comparative and multicentric studies should be carried out in human subjects to determine both safety and efficacy of these techniques.