Prevalencia de hipertirotropinemia neonatal comoindicador de deficiencia de yodo en la provincia de La Pampa: un análisis epidemiológico / Prevalence of high neonatal thyroid stimulating hormone levels as an indicator of iodine deficiency in the province of La Pampa: An epidemiological analysis

Introducción. El yodo desempeña un rol fundamental en el metabolismo, el crecimiento y el desarrollo humano. Durante el embarazo y la infancia, la demanda de este micronutriente aumenta considerablemente. La tirotropinemia neonatal (TSHn) aumentada, definida como TSHn ≥5 mUI/l, es un marcador que señala la deficiencia de yodo en una población cuando su prevalencia supera el 3 %. Objetivo. Determinar la prevalencia de TSHn ≥ 5 en La Pampa durante el período 2021-2022, analizar su correlación con diferentes variables y compararla con datos de una cohorte histórica. Población y métodos. Estudio transversal, de diseño descriptivo-analítico, sobre una población de neonatos nacidos en las cinco zonas sanitarias de la provincia de La Pampa durante los años 2021 y 2022. Resultados. De los 5778 neonatos evaluados, el 9,6 % presentó niveles de TSHn ≥5 mUI/l. El 70,4 % de estas mediciones fueron realizadas después del tercer día de vida. No se observaron diferencias significativas en la frecuencia de niveles elevados de TSHn según el año de nacimiento, peso al nacer o días hasta la extracción. Se registró una mayor prevalencia en el sexo masculino (10,6 % versus 8,5 %; p = 0,007) y entre los neonatos nacidos a término (9,8 % versus 6,6 %; p = 0,02). La prevalencia de hipertirotropinemia fue superior a la observada en una cohorte de 2001-2002. Conclusiones. La prevalencia de hipertirotropinemia neonatal en La Pampa durante los años 2021 y 2022 fue del 9,6 %, lo que indica un estado de deficiencia leve de yodo en la provincia, superior al reportado hace dos décadas.

Introduction. Iodine plays a key role in human metabolism, growth, and development. During pregnancy and childhood, the demand for this micronutrient increases notably. Increased neonatal thyroid stimulating hormone (nTSH) levels, defined as nTSH ≥ 5 mIUL, are a marker of iodine deficiency in a population if its prevalence is higher than 3%.Objective. To establish the prevalence of nTSH ≥ 5 in La Pampa in the 2021­2022 period, analyze its correlation with different variables, and compare it with data from a historical cohort.Population and methods. Cross-sectional, descriptive-analytical study in a population of newborn infants born in the 5 health regions of the province of La Pampa in 2021 and 2022. Results. Of  the  5778  assessed  newborn  infants,  9.6%  had  nTSH  levels  ≥  5  mIU/L. It was reported that 70.4% of these measurements were done after the third day of life. No significant differences were observed in the frequency of high nTSH levels by year of birth, birth weight, or days until samplecollection.A higher prevalence was observed among male infants (10.6% versus 8.5%; p = 0.007) and term infants (9.8% versus 6.6%; p = 0.02). The prevalence of high TSH levels was superior to that observed in the 2001­2002 cohort. Conclusions. The  prevalence of high nTSH levels in La Pampa during 2021 and 2022 was 9.6%, suggesting the presence of mild iodine deficiency in the population of this province, higher that what  had been reported 2 decades ago.

Características y supervivencia de adultos con cáncer diferenciado de tiroides en un hospital de Perú / Characteristics and survival of adults with differentiated thyroid cancer in a Peruvian hospital

RESUMEN El propósito del estudio fue describir las características clínicas, anatomopatológicas, tratamiento y supervivencia de los pacientes con cáncer de tiroides diferenciado. Se realizó un estudio de cohorte retrospectiva con datos de 150 pacientes de un hospital peruano entre los años 2010 al 2020. Se describieron las características y supervivencia (método de Kaplan-Meier). La media de edad fue 48,3 años, 130 (86,7%) fueron mujeres y el tipo histológico más frecuente fue el papilar 94,6%. El 74,2% tenían estadio TNM I, 70,7% tiroidectomía total y 68,7% recibió yodo radiactivo. La supervivencia global a los 5 años fue 89,3%, siendo menor en aquellos con estadio TNM IV y mayor en los que usaron yodo radiactivo. En conclusión, en un hospital de Cusco, el cáncer diferenciado de tiroides fue más frecuente en mujeres y la supervivencia fue menor en comparación con reportes de otros países.

ABSTRACT This study aimed at studying the clinical and anatomopathological characteristics, treatment and survival of patients with differentiated thyroid cancer. A retrospective cohort study was conducted with data from 150 patients from a Peruvian hospital between the years 2010 to 2020. Characteristics and survival (Kaplan-Meier method) were described. The mean age was 48.3 years, 130 participants (86.7%) were women and the most frequent histologic type was papillary 94.6%. Of the participants, 74.2% had TNM stage I, 70.7% had total thyroidectomy and 68.7% received radioactive iodine. Overall survival at 5 years was 89.3%, being lower in those with TNM stage IV and higher in those who used radioactive iodine. In conclusion, in a hospital in Cusco, differentiated thyroid cancer was more frequent in women and survival was lower compared to reports from other countries.

Thyroid cancer in patients undergoing thyroidectomy total in the Otorhinolaryngology Department of the Hospital de Clínicas during the period 2018-2022

Introduction: Thyroid cancer, considered one of the most frequent malignant tumors of the endocrine system, accounts for 80%-90% of cases. The most common histological type observed in most studies is papillary cancer. Objective: To determine the frequency of thyroid cancer in patients undergoing total thyroidectomy at the Otorhinolaryngology Department of the Hospital de Clínicas between the period 2018-2022. Methodology: This retrospective study included 260 patients treated during the study period. Data were obtained from the patients' medical records, and sociodemographic and clinical variables related to thyroid cancer were analyzed. Data were analyzed with the SPSS v25 program, using descriptive statistics. Results: The frequency of thyroid cancer was 48.1%. The mean age of the cancer patients was 42.10±13.10 years. A higher frequency was observed in females 34.2%, n=89) and among those aged 25-44 years 20.0%, n=52). The most frequent were papillary (36.9%), follicular (2.7%), medullary (1.5%), and anaplastic (1.2%) types. Discussion: The frequency of thyroid cancer is high; it is more common in women and as age increases.

Introducción: El cáncer de tiroides, considerado uno de los tumores malignos más frecuentes del sistema endocrino, representa entre el 80% y el 90% de los casos. El tipo histológico más común observado en la mayoría de los estudios es el cáncer papilar. Objetivo: Determinar la frecuencia de cáncer de tiroides en pacientes sometidos a tiroidectomía total en la Cátedra y Servicio de Otorrinolaringología del Hospital de Clínicas durante el período 2018-2022. Metodología: se realizó un estudio retrospectivo con un total de 260 pacientes atendidos en el período de estudio. Los datos fueron tomados de las historias clínicas de los pacientes, en el cual se analizan variables sociodemográficas y clínicas relacionadas con el cáncer de tiroides. Los datos se analizaron con el programa SPSS v25, mediante estadística descriptiva. Resultados: La frecuencia del cáncer de tiroides fue del 48.1%. El promedio de edad de los pacientes con cáncer fue de 42.10±13.10 años. se observó una mayor frecuencia en las personas del sexo femenino 34.2% (n=89) y entre quienes tuvieron de 25-44 años 20.0% (n=52). El más frecuente fue el tipo papilar 36.9%, el folicular 2.7%, el medular 1.5% y el anaplásico 1.2%. Discusión: la frecuencia de cáncer de tiroides es alta, es más frecuente en las mujeres y a medida que aumenta la edad.

Metastasis of breast cancer to the thyroid gland / Metástasis de cáncer de mama en glándula tiroides

Abstract Metastases to the thyroid gland from nonthyroidal malignant tumors are rare but significant. They are often asymptomatic, indicating advanced-stage primary tumors and poor prognosis. Although infrequently, breast cancer (BC) can metastasize to the thyroid gland. We present the case of a 56-year-old woman with a history of BC who pre sented with a nodular goiter. Physical examination and im aging revealed a thyroid nodule and cervical lymph nodes with suspicious features. Fine-needle aspiration biopsy (FNAB) confirmed the presence of atypical epithelial cells in the thyroid nodule and lymph nodes. Further evaluation, including positron emission tomography, histological biop sy, and immunohistochemistry, supported the diagnosis of metastatic BC to the thyroid gland. Due to the local extent of the disease, total thyroidectomy was not feasible. The treatment with ribociclib and letrozole was initiated, but unfortunately, the patient had an unfavorable progression with the development of metastasis in the nervous system. Metastatic carcinoma to the thyroid gland is rare but has increased due to improved diagnostic techniques. BC can metastasize to the thyroid. Diagnosis involves imaging, FNAB, and immunohistochemistry. Treatment options include surgery, radiotherapy, and chemotherapy, but the prognosis is generally poor.

Resumen Las metástasis en la glándula tiroides a partir de tu mores malignos no tiroideos son raras pero significativas. A menudo son asintomáticas, lo que indica tumores primarios en etapas avanzadas y un mal pronóstico. Aunque infrecuentemente, el cáncer de mama puede metastatizar en la glándula tiroides. Presentamos el caso de una mujer de 56 años con antecedente de cáncer de mama que consultó por bocio nodular. El examen físico y las imágenes revelaron un nódulo tiroideo y ganglios linfáticos cervicales con características sospechosas. La punción aspiración con aguja fina confirmó la presencia de células epiteliales atípicas en el nódulo tiroideo y los ganglios linfáticos. Una evaluación adicional, que incluyó tomografía por emisión de positrones, biopsia histológica e inmunohistoquímica, respaldó el diagnóstico de cáncer de mama metastásico en la glándula tiroides. Debido a la extensión local de la enfermedad, no fue factible realizar una tiroidectomía total. Se inició el tratamiento con ri bociclib y letrozol, pero desafortunadamente la paciente tuvo una progresión desfavorable con el desarrollo de metástasis en el sistema nervioso. El carcinoma metas tásico en la glándula tiroides es raro, pero ha aumentado debido a las técnicas de diagnóstico mejoradas. El cáncer de mama puede metastatizar en la tiroides. El diagnóstico implica imágenes, punción aspiración con aguja fina e in munohistoquímica. Las opciones de tratamiento incluyen cirugía, radioterapia y quimioterapia, pero el pronóstico generalmente es desfavorable.

Chronic urticaria with thyroid auto-antibodies linked to urticarial vasculitis

Chronic urticaria is a common disorder of unknown origin, which is often associated with normal routine laboratory values and no evidence of systemic disease. Cutaneous vasculitis is one of the rare presentation of chronic urticaria. We reported a 13-year-old female child, who presented to us with tender urticarial wheals all over the body, who on further evaluation was found to have positive anti-thyroid peroxidase antibodies and was diagnosed to have urticarial vasculitis.

Thyroid hormone status in children with transfusion-dependent thalassemia

Background: Thalassemia, a prevalent genetic disorder, necessitates recurrent blood transfusions for life, precipitating iron overload and premature death. In ?-thalassemia major (BTM), hypothyroidism prevalence fluctuates (6-30%) globally, influenced by diverse chelation regimens. The objective of this study is to evaluate the thyroid hormone levels in pediatric patients diagnosed with transfusion-dependent thalassemia (TDT).Methods: A hospital-based cross-sectional study was conducted at the paediatrics department of Sir Salimullah medical college Mitford hospital, Dhaka, focusing on TDT patients aged 4 to 18 years. Exclusions comprised known cases of hypothyroidism, children receiving hormonal therapy, those with a family history of hypothyroidism, and individuals with fewer than 10 blood transfusions. Serum separation involved centrifugation at 3000 rpm for 5 minutes, with subsequent aliquoting into two screw-capped dry clean vials: 1 ml each for FT4/TSH and serum ferritin estimation. Data were analyzed using SPSS version 24.0.Results: Eighty-seven transfusion dependent thalassemia children aged between 4 to 18 years were chosen in this study. The hypothyroidism was seen in 7 (8%) patients. Of these, 4 (4.6%) participants were compensated hypothyroid and 3 (3.4%) participants were uncompensated hypothyroid. Most of the participants were hypothyroidism with Hb E-? thalassemia. The mean serum ferritin level was 2578.49�85.06 ng/ml. Positive correlation of TSH with duration of disease (in years), total number of blood transfusion times and serum ferritin were statistically significant (p<0.05).Conclusions: The present study demonstrates that 8% of the children with TDT have hypothyroidism. Hypothyroidism is more frequent among Hb E ?-thalassemic children as compared to ?-thalassemic children.

Metachronous multiple primary malignancies: a case report of colon and thyroid cancer

Cancer remains a challenging disease for our profession despite the medical and technological advances achieved in recent years. This challenge increases when we encounter multiple primary tumors that significantly modify the prognosis of our patients.

Assessing the prevalence of hypocalcemia after total thyroidectomy at a tertiary care hospital

Background: Thyroidectomy is a common surgical procedure for various thyroid disorders, but it often leads to complications such as hypocalcemia. Understanding the prevalence and predictors of hypocalcemia post-total thyroidectomy is crucial for improving patient outcomes. Methods: This prospective cross-sectional study was conducted at a tertiary care hospital with 100 patients undergoing thyroid surgery, including total thyroidectomy, completion thyroidectomy, and thyroidectomy with neck dissection. We analyzed the incidence of transient and permanent hypocalcemia, examining correlations with surgery type, demographic variables, and postoperative day of onset. Data were collected through patient records and postoperative follow-ups. Results: The study revealed that 30% of patients experienced hypocalcemia postoperatively. Hypocalcemia was most prevalent among patients undergoing thyroidectomy with neck dissection (58.33%), compared to those undergoing total thyroidectomy (18.18%) and completion thyroidectomy (40.00%). The majority of hypocalcemia cases (66.67%) occurred on the second postoperative day. Most hypocalcemia instances were transient (86.67%), with a smaller fraction being permanent (13.33%). Conclusions: Hypocalcemia remains a significant complication following thyroid surgery, particularly in surgeries involving neck dissection. Early identification and management of at-risk patients could mitigate the severity of this complication. Our findings underscore the importance of vigilant monitoring and tailored postoperative care to minimize the impact of hypocalcemia on patient recovery and quality of life.

Sonographic evaluation of thyroid nodule based on thyroid imaging reporting and data system classification and its correlation with fine needle aspiration cytology findings

Background: Thyroid nodules, common clinical occurrences, often require diagnostic assessment. Ultrasonography (USG) is primary non-invasive method for detection, with advancing technology enhancing detection capabilities. Fine needle aspiration cytology (FNAC) remains standard but poses risks and expenses. American college of radiology-thyroid image reporting and data system (ACR-TIRADS), introduced in 2017, offers a systematic scoring system based on ultrasound features. This study aims to evaluate USG guided by ACR-TIRADS for accurate nodule classification. Methods: A 1.5-year study at department of radio-diagnosis of BSMCH evaluated thyroid nodules using high-resolution USG based on ACR-TIRADS criteria, followed by FNAC for selected cases, comparing results for concordance. Results: Out of 47 thyroid nodules evaluated, 19.1% were malignant and 80% benign. ACR-TIRADS demonstrated sensitivity, specificity, and accuracy of 66.7%, 87.8%, and 82.9%, respectively. Higher ACR-TIRADS categories correlated with an increased risk of malignancy. Suspicious USG features such as hypo-echogenicity, taller-than-wide shape, lobulated margin, and punctate echogenic foci exhibited significant predictive value for malignancy, with varying levels of sensitivity and specificity. Overall, USG parameters demonstrated notable accuracy in identifying malignant nodules. Conclusions: ACR-TIRADS 2017 reliably predicts thyroid nodule malignancy, reducing unnecessary FNAC procedures, minimizing patient discomfort, and optimizing healthcare resources.

An observational study of association of thyroid dysfunction and heart failure in a tertiary care centre

Background: Heart failure (HF) is becoming leading problem in world now a days. Thyroid hormone has been proven to influence physiologic functions of cardiovascular system in many ways. HF presents a clinical challenge, with thyroid dysfunction emerging as a significant comorbidity, affecting prognosis and management. Approximately 22% of patients with HF have been demonstrated to have thyroid dysfunction. Clinical studies were confirmed that the patients with sub-clinical hypothyroidism had high risk of cardiovascular disease due to increased low density lipoprotein, elevated homocystein, hypercoagulative blood. In this study, we aim to evaluate association between sub-clinical hypothyroidism and HF to know its clinical significance. Methods: An observational study conducted over three months on 70 diagnosed HF patients admitted in tertiary care hospital, evaluating history, clinical profile and demographics, HF types, comorbidity, and screened for thyroid function. Results: Thyroid dysfunction prevalence among HF patients was 27.14%, with subclinical hypothyroidism being most common. Treatment led to significant improvements in symptoms and cardiac function. Conclusions: There is significant correlation between thyroid dysfunction and HF with Subclinical hypothyroidism can be independent risk factor for HF. Timely and early recognition and management of thyroid dysfunction in HF patients are crucial for prognosis enhancement. Early intervention holds promise for improved outcomes in HF management.

Nuevas perspectivas en el tratamiento del cáncer de tiroides de bajo riesgo. Experiencia con la lobectomía tiroidea en una cohorte de 114 pacientes / New perspectives in the management of low-risk thyroid cancer. Experience with thyroid lobectomy in a cohort of 114 patients

RESUMEN Antecedentes: el tratamiento del carcinoma diferenciado de tiroides (CDT) de bajo riesgo es aún motivo de discusión. En las últimas décadas se observó una migración hacia tratamientos personalizados acordes con las características de cada paciente y de cada tumor. Las guías de práctica vigentes habilitan la lobectomía en pacientes seleccionados, con bajo riesgo de recurrencia. Objetivo: describir los resultados en una cohorte de pacientes con CDT de bajo riesgo de recurrencia tratados con lobectomía tiroidea. Material y métodos: estudio observacional descriptivo de una revisión retrospectiva de historias clínicas de 114 pacientes con CDT tratados con lobectomía tiroidea entre enero de 2015 y abril de 2023. Resultados: fueron operados 114 pacientes, con media de edad de 44 años ± 12; 90 (79%) fueron mujeres. La mediana del tamaño tumoral fue de 9,4 mm, RIC (rango intercuartílico 25-75% 7-13 mm), y 103 de los nódulos (90%) fueron ecográficamente sólidos. Solo 2 pacientes con invasión vascular mayor de 4 vasos requirieron completar la tiroidectomía total. No se registraron complicaciones de importancia, salvo una parálisis recurrencial transitoria. Con un seguimiento promedio de 33,4 meses, no se observaron recurrencias locorregionales ni a distancia en la población analizada. Conclusión: la lobectomía tiroidea en el tratamiento del CDT de bajo riesgo tuvo una baja morbilidad sin recurrencias en la serie presentada. La selección rigurosa de los pacientes y la interacción de un equipo multidisciplinario se consideran esenciales para la implementación exitosa de esta metodología terapéutica.

ABSTRACT Background: The treatment of low-risk differentiated thyroid cancer (DTC) is still a matter of debate. Over the past few decades, there has been a shift towards a more personalized approach, tailored to the individual risks of each patient and tumor. The current practice guidelines recommend lobectomy in selected patients, with low risk of recurrence. Objective: To describe the results of thyroid lobectomy in a cohort of patients with DTC with low risk of recurrence. Material and methods: We conducted a descriptive and observational study. The medical records of patients with DTC who underwent thyroid lobectomy between January 2015 and April 2023 were retrospectively reviewed. Results: A total of 114 patients were operated on; mean age was 44 ± 12 years and 90 (79%) were women. The median tumor size was 9.4 mm (IQR 25-75% 7-13 mm), and 103 nodules (90%) were solid on ultrasound. Only 2 patients with vascular invasion involving > 4 vessels required completion thyroidectomy. There were no major complications and only one patient developed temporary recurrent laryngeal palsy. There were no locoregional or distant recurrences during mean follow-up of 33.4 months. Conclusion: Thyroid lobectomy for low-risk DTC had low morbidity and no recurrences in the series presented. The rigorous selection of patients and the interaction of a multidisciplinary team are considered essential for the successful implementation of this therapeutic approach.

Marcadores de cáncer stem cells y transición epitelio mesenquimal como factores de agresividad y progresión en pacientes jóvenes con cáncer de tiroides

El cáncer de tiroides (CT) es el primer tumor maligno en glándulas endocrinas, y se estima que al 2030 estará en el top cinco de cáncer a nivel mundial. En Chile, el CT fue incluido, recientemente, como la patología N° 82 con Garantías Explícitas de Salud, lo que implica destinar importantes recursos públicos y privados al tratamiento de pacientes con un cáncer que va en aumento en el mundo. Existen grupos de pacientes jóvenes con tumores pequeños que presentan un comportamiento clínico más agresivo desde el inicio, donde se podría adelantar la toma de decisiones. Específicamente, destaca un grupo de pacientes menores de 55 años con tumores pequeños menores de 2 cm, pero con metástasis regionales, que quedan fuera de la indicación de radioyodoterapia y podrían requerir tratamiento complementario o presentar peor evolución. Las herramientas clínicas y moleculares para guiar el tratamiento adecuado en pacientes con metástasis linfonodales son limitadas y no han sido actualizadas hasta el momento. Existen factores de tumorigenicidad y pronóstico, tales como los marcadores de Transición Epitelio-Mesenquimal (TEM) y Cáncer Stem Cells (CSC) que se han incorporado al estudio de otros tumores y recientemente en cáncer de tiroides. Actualmente estudios que relacionan TEM y CSC con CT apuntan a la descripción molecular y genética, con escasos reportes que correlacionen, clínicamente, estos hallazgos, (particularmente en subgrupos con características particulares de agresividad) y que los propongan como marcadores de tumorigenicidad y pronóstico. La descripción de estos biomarcadores en la población descrita podría facilitar la toma de decisiones en cuanto a seguimiento, terapia quirúrgica y radioyodoterapia.

Thyroid cancer (TC) is the first malignant tumor in endocrine glands, and it is estimated that by 2030 it will be in the top five cancers worldwide. In Chile, TC was recently included as pathology No. 82 with Explicit Health Guarantees, which implies allocating significant public and private resources to the treatment of patients with a cancer that is on the rise. There are groups of young patients with small tumors that present a more aggressive clinical behavior, where decision-making could be advanced. Specifically, a group of patients under 55 years of age with tumors less than 2 cm in size but with regional metastases, that lack indication for radioiodine therapy and could require complementary treatment or present a worse evolution. Clinical and molecular tools to guide appropriate treatment in patients with lymph node metastases are limited and have not been updated. There are tumorigenicity and prognostic factors, such as EpithelialMesenchymal Transition (EMT) and Cancer Stem Cells (CSC) markers that have been incorporated into the study of other tumors and recently in thyroid cancer. Studies linking EMT and CSC with TC currently point to molecular and genetic description, with few reports clinically correlating these findings (particularly in subgroups with particular characteristics of aggressiveness) and proposing them as tumorigenicity and prognosis markers. The description of these biomarkers in the described population could facilitate decision-making regarding follow-up, surgical therapy, and radioiodine therapy.

Coexistence of microfilaria and chronic lymphocytic thyroiditis: a rare case report

Filariasis is a common health problem in tropical countries of Southeast Asia. The commonest site of involvement is the lymphatic system where the adult worms can remain viable for long periods. Though the patients can remain asymptomatic, the clinical presentation with hydrocele, fever, localised swelling and/or lymphedema are commonly seen. Localization of the parasite at various other sites like breast, lungs, and thyroid have been uncommonly described. We report a case of an elderly female who presented with a large anterior neck mass associated with a recent history of change in voice. Radiological investigations revealed a soft tissue mass in the neck along with multiple lesions in the thyroid which were suspicious of malignancy. Fine needle aspiration cytology, however, revealed microfilariae coexisting with chronic lymphocytic thyroiditis. This case highlights the importance of critical screening of cytology smears to identify the parasites at unusual locations. A correct diagnosis on a simple and inexpensive investigation like fine needle aspiration cytology can help in administering appropriate therapy at the earliest and avoiding unnecessary interventions.

Role of thyroid abnormality in perimenopausal abnormal uterine bleeding

Background: Diagnosing and treating abnormal uterine bleeding (AUB) presents special problems during the perimenopausal era, which often need for a thorough study of contributory variables. Comprehending the relationship between perimenopausal AUB and thyroid function has important therapeutic ramifications that might influence customized treatment plans and enhance patient outcomes.Methods: This prospective research sought to determine the significance of thyroid anomalies in perimenopausal AUB. It was carried out at the Department of Obstetrics and Gynecology, Rajashri Chatrapati Shahu Government Medical College, and Chatrapati Pramila Raje hospital. Data was carefully collected over a 6-month period, from April to September 2018, and placed into excel spreadsheets for statistical analysis. The goal of the research is to clarify the connection between perimenopausal AUB and thyroid dysfunction by using the proper statistical tests.Results: Out of 120 individuals with severe menstrual bleeding, 80 had hypothyroidism. Hyperthyroidism affected 45 hypomenorrhea and irregular menstrual cycle individuals. Thyroid issues are commonly ignored, and patients are given estrogen progesterone tablets without thyroid function testing.Conclusions: By providing insights into its complex etiology and opening the door for more focused therapy approaches in this patient population, this study aims to further our understanding of AUB.

Multivariate analysis of histopathological features as prognostic factors in fifty cases of thyroid neoplasm: a retrospective study done at tertiary care centre

Background: Number of prognostic factors for thyroid carcinoma have been identified including age, gender and tumor characteristics, such as histology and stage. The importance of these factors as independent predictors of survival for patients with differentiated thyroid carcinoma has been extensively studied but remains uncertain. Methods: A retrospective analysis of 50 thyroid carcinomas was made to assess prognostic factors including histological variants from September 2019 to February 2022 at our centre. The surgical and histopathological data were studied. Results: 72% patients had papillary thyroid cancer. Multivariate analysis was done and factors showing prognostic significance were tumour size, extrathyroid extension, extranodal extension, lymphovascular, perineural invasion, histological type, necrosis, focality, capsular invasion were found to have poor prognosis. Conclusions: There are histopathological factors which can modify the course and influence the line of treatment of thyroid neoplasms.

Clinical Effect Observation of Apatinib Combined with 131I for Radioiodine-Refractory Differentiated Thyroid Cancer and Prognostic Significance Analysis of Macrophage Inflammatory Protein-1alpha After Treatment: A Cell Regulation Study / Observación del Efecto Clínico de Apatinib Combinado con 131I para el Cáncer de Tiroides Diferenciado Resistente al Yodo Radiactivo y Análisis de Importancia Pronóstica de la Proteína Inflamatoria 1alfa de Macrófagos Después del Tratamiento: Un Estudio de Regulación Celular

SUMMARY: The objective of this study was to observe the clinical efficacy of apatinib (AP) combined with 131I in the treatment of radioiodine-refractory differentiated thyroid cancer (RAIR-DTC) and the prognostic significance of MIP-1α after treatment, and to provide reference and guidance for future treatment and disease assessment of RAIR-DTC. One hundred and six patients with RAIR- DTC admitted to our hospital from January 2019 to October 2020 were selected for the study. All the patients were treated with TC surgery with 131I at our hospital, and 58 of them were subsequently transferred to AP treatment, which was considered as the research group; the other 48 patients were transferred to thyroid stimulating hormone (TSH) suppression treatment, which was considered as the control group. The clinical efficacy of the research group was better than that of the control group (P 0.05). After treatment, Tg, TL, maximum diameter of C/B lymph nodes, number of lymph nodes and number of calcified spots were lower in the research group than in the control group (P < 0.05). ROC analysis revealed that the predictive sensitivity of MIP-1α for prognosis of 3-year RAIR-DTC death in the research group of patients was 84.63 % and the specificity was 72.16 %. AP combined with 131I is effective in the treatment of RAIR-DTC and is worth using in the clinical practice. In addition, elevated levels of MIP-1α predicted a poor prognosis for patients with RAIR-DTC.

El objetivo de este estudio fue observar la eficacia clínica de apatinib (AP) combinado con 131I en el tratamiento del cáncer de tiroides diferenciado refractario al yodo radiactivo (RAIR-DTC) y la importancia pronóstica de MIP-1α después del tratamiento, y proporcionar referencia y orientación para futuros tratamientos y enfermedades. Evaluación de RAIR- DTC. Se seleccionaron para el estudio 106 pacientes con RAIR- DTC ingresados en nuestro hospital desde enero de 2019 hasta octubre de 2020. Todos los pacientes fueron tratados con cirugía CT con 131I, y 58 de ellos fueron trasladados posteriormente a tratamiento AP, los que fueron considerados como grupo de investigación; los otros 48 pacientes fueron transferidos a tratamiento de supresión de la hormona estimulante de la tiroides (TSH), que se consideró como grupo de control. La eficacia clínica del grupo de investigación fue mejor que la del grupo de control (P 0,05). Después del tratamiento, Tg, TL, diámetro máximo de los linfonodos C/B, número linfonodos y número de manchas calcificadas fueron menores en el grupo de investigación que en el grupo de control (P <0,05). El análisis ROC reveló que la sensibilidad predictiva de MIP-1α para el pronóstico de muerte por RAIR-DTC a 3 años en el grupo de pacientes de investigación fue del 84,63 % y la especificidad fue del 72,16 %. AP combinado con 131I es eficaz en el tratamiento del RAIR-DTC y vale la pena utilizarlo en la práctica clínica. Además, los niveles elevados de MIP-1α predijeron un mal pronóstico para los pacientes con RAIR- DTC.

Resposta Vascular da Triiodotironina sobre Anéis de Aortas Isoladas: Contribuição de Mecanismos Redox / Vascular Response of Triiodothyronine on Isolated Aortic Rings: Contribution of Redox Mechanisms

Resumo Fundamento A disfunção vascular constitui a etiologia de diversas doenças, incluindo infarto do miocárdio e hipertensão, diante da ruptura da homeostase oxi-redutiva ("redox"), desempenhando um papel no desequilíbrio do mecanismo de controle vasomotor. Nosso grupo demonstrou anteriormente que os hormônios tireoidianos melhoram a sinalização da angiogênese, exercendo efeitos protetores sobre o tecido aórtico de ratos infartados. Objetivos Investigar o papel da triiodotironina (T3) na resposta vascular, explorando seus efeitos em aortas isoladas e a presença de mecanismos redox vasculares. Métodos Anéis aórticos isolados (endotélio intacto e desnudado) pré-contraídos com fenilefrina foram incubados com T3 (10-8, 10-7, 10-6, 10-5 e 10-4 M) e a tensão foi registrada usando um transdutor de deslocamento de força acoplado a um sistema de coleta. Para avaliar o envolvimento do estresse oxidativo, os anéis aórticos foram pré-incubados com T3 e posteriormente submetidos a um sistema de geração de espécies reativas de oxigênio (ROS) in vitro. O nível de significância adotado na análise estatística foi de 5%. Resultados A T3 (10-4 M) promoveu o vasorrelaxamento dos anéis aórticos pré-contraídos com fenilefrina em endotélio intacto e desnudado. Os anéis aórticos pré-incubados na presença de T3 (10-4 M) também mostraram diminuição da vasoconstrição provocada pela fenilefrina (1 µM) em preparações de endotélio intacto. Além disso, o efeito vasorrelaxante da T3 (10-4 M) persistiu em anéis aórticos pré-incubados com éster metílico de NG-nitro-L-arginina (L-NAME, 10 µM), um inibidor inespecífico da NO sintase (NOS). Por fim, a T3 (10-4 M) exibiu, in vitro, um papel antioxidante ao reduzir a atividade da NADPH oxidase e aumentar a atividade da SOD nos homogenatos aórticos. Conclusão A T3 exerce efeitos dependentes e independentes de endotélio, o que pode estar relacionado ao seu papel na manutenção da homeostase redox.

Abstract Background Vascular dysfunction constitutes the etiology of many diseases, such as myocardial infarction and hypertension, with the disruption of redox homeostasis playing a role in the imbalance of the vasomotor control mechanism. Our group previously has shown that thyroid hormones exert protective effects on the aortic tissue of infarcted rats by improving angiogenesis signaling. Objective Investigate the role of triiodothyronine (T3) on vascular response, exploring its effects on isolated aortas and whether there is an involvement of vascular redox mechanisms. Methods Isolated aortic rings (intact- and denuded-endothelium) precontracted with phenylephrine were incubated with T3 (10-8, 10-7, 10-6, 10-5, and 10-4 M), and tension was recorded using a force-displacement transducer coupled with an acquisition system. To assess the involvement of oxidative stress, aortic rings were preincubated with T3 and subsequently submitted to an in vitro reactive oxygen species (ROS) generation system. The level of significance adopted in the statistical analysis was 5%. Results T3 (10-4 M) promoted vasorelaxation of phenylephrine precontracted aortic rings in both intact- and denuded-endothelium conditions. Aortic rings preincubated in the presence of T3 (10-4 M) also showed decreased vasoconstriction elicited by phenylephrine (1 µM) in intact-endothelium preparations. Moreover, T3 (10-4 M) vasorelaxation effect persisted in aortic rings preincubated with NG-nitro-L-arginine methylester (L-NAME, 10 µM), a nonspecific NO synthase (NOS) inhibitor. Finally, T3 (10-4 M) exhibited, in vitro, an antioxidant role by reducing NADPH oxidase activity and increasing SOD activity in the aorta's homogenates. Conclusion T3 exerts dependent- and independent-endothelium vasodilation effects, which may be related to its role in maintaining redox homeostasis.

Gasto energético en reposo y concentración sérica de lipoproteínas de baja densidad en adultos con hipotiroidismo subclínico leve

La alta prevalencia de hipotiroidismo subclínico en Chile puede deberse a que el límite superior normal de la hormona estimulante del tiroides (TSH) sérica es bajo. Personas con TSH levemente mayor al límite superior pueden ser metabólicamente similares a personas sanas. Se compararon marcadores de acción tiroidea (gasto energético en reposo [GER] y lipoproteína de baja densidad [LDL]) en adultos con hipotiroidismo subclínico leve y con función tiroidea normal con o sin tratamiento con levotiroxina. Se midió GER, perfil lipídico y tiroideo en personas sanas con función tiroidea normal (TSH ≥0,4-<4,5 µUI/ml; n=91); con hipotiroidismo subclínico leve (TSH ≥4,5-≤6,5 µUI/ml; n=5); y con hipotiroidismo clínico tratado con levotiroxina y TSH normal (n=13). Se analizó la LDL en 838 personas sanas con función tiroidea normal y 89 con hipotiroidismo subclínico leve de la Encuesta Nacional de Salud 2016/17 (ENS). El GER, ajustado por peso, sexo y edad, fue similar entre grupos (p=0,71). La LDL fue similar entre personas con función tiroidea normal e hipotiroidismo subclínico leve (91±24 vs. 101±17 mg/dl; p=0,67), y menor en hipotiroidismo tratado (64±22 mg/dl; p<0,01). La LDL no se asoció con TSH pero si inversamente con T4L en mujeres (r=-0,33; p=0,02; n=53). En la ENS, ambos grupos tuvieron similar LDL (p=0,34), la que se asoció inversamente con T4L en mujeres (r=-0,12; p=0,01; n=569) pero no con TSH. Personas sanas con función tiroidea normal y con hipotiroidismo subclínico leve tienen similar GER y LDL. Esto apoya la idea de redefinir el límite superior normal de TSH.

The high prevalence of subclinical hypothyroidism in Chile may be due to the low normal upper limit of serum thyroid-stimulating hormone (TSH). People with TSH slightly higher than the upper limit may be metabolically similar to healthy people. Thyroid action markers (resting energy expenditure [REE] and low-density lipoprotein [LDL]) were compared in adults with mild subclinical hypothyroidism and with normal thyroid function with or without levothyroxine treatment. REE, lipid and thyroid profile were measured in healthy people with normal thyroid function (TSH ≥0,4-<4,5 µUI/ml (n=91); with mild subclinical hypothyroidism (TSH ≥4,5-≤6 µUI/ml; n=5); and with clinical hypothyroidism treated with levothyroxine and normal TSH (n=13). LDL was analyzed in 838 healthy people with normal thyroid function and 89 with mild subclinical hypothyroidism from the 2016/17 National Health Survey (NHS). REE, adjusted for weight, sex and age, was similar between the groups (p=0,71). LDL was similar between people with normal thyroid function and mild subclinical hypothyroidism (91±24 vs. 101±17 mg/dl; p=0,67), and lower in treated hypothyroidism (64±22 mg/dl; p<0,01). LDL was not associated with TSH but was inversely with FT4 in women (r=-0,33; p=0,02; n=53). In the NHS, both groups had similar serum LDL (p=0,34), which was inversely associated with FT4 in women (r=-0,12; p=0,01; n=569), but not with TSH. Healthy people with normal thyroid function and mild subclinical hypothyroidism have similar REE and LDL. These results support the idea of redefining the normal upper limit of TSH.

Guía de práctica clínica para el tratamiento y seguimiento de personas con cáncer diferenciado de tiroides. Parte I: Vigilancia activa

Introducción: El cáncer de tiroides es una enfermedad frecuente en el mundo, con mayor prevalencia del tipo diferenciado. El diagnóstico temprano y manejo pertinente, individualizado y adaptable puede mejorar su pronóstico. Objetivo: Generar recomendaciones basadas en evidencia sobre el tratamiento y seguimiento de personas adultas con cáncer diferenciado de tiroides (CDT). Metodología: Guía de práctica clínica (GPC) a partir de revisión sistemática de literatura (RSL) y consenso de expertos clínicos. El grupo desarrollador definió el alcance y cuatro preguntas que se resolvieron a través de revisión de evidencia de GPC existentes, RSL, estudios primarios publicadas en español o inglés en diferentes fuentes de información desde 2013. Las preguntas de investigación fueron: 1. ¿Cuáles son las indicaciones de la vigilancia activa?, ¿cómo realizarla?, ¿cuándo y con que periodicidad realizarla? 2. ¿Cuál es el tratamiento y su indicación en pacientes con nódulos tiroideos sospechosos de cáncer? 3. ¿Cómo y cuándo realizar seguimiento de pacientes con CDT de acuerdo con el riesgo dinámico? 4. ¿Cuál es el manejo actual de los pacientes iodo refractarios? Se propusieron recomendaciones basadas en la evidencia, y analizadas y discutidas por el colectivo experto en sesiones asincrónicas. Se evalúo la calidad de la evidencia y las recomendaciones fueron gradadas en fuerte o condicional y a favor o en contra a partir del análisis de la calidad de la evidencia, contexto de implementación (disponibilidad e implementación) y la experticia clínica. En el presente documento se desarrollada la primera pregunta, referente a vigilancia activa. Resultados: 86 recomendaciones fueron propuestas y acordadas por el grupo desarrollador, categorizadas en tratamiento y seguimiento para resolver las preguntas planteadas. 10 de las recomendaciones corresponden a vigilancia activa y se incluyen en el presente documento. Recomendaciones claves incluyen, brindar información completa y oportuna a pacientes, conformación de equipos multidisciplinarios, análisis individualizado del paciente para la decisión de tratamiento, estadificación rutinaria de riesgo dinámico para evaluar la respuesta al tratamiento y ajustarlo, minimización de procedimientos fútiles o que aportan poco a la supervivencia y calidad de vida de los pacientes. Conclusión: Se presentan recomendaciones que esperan incidir en la estandarización de la práctica clínica cotidiana de pacientes con CDT y mejores resultados en salud.

Introduction: Thyroid cancer is a common disease in the world, with a higher prevalence of the differentiated type. Early diagnosis individualized and adaptive management can improve prognosis. Objective: Generate evidence-based recommendations on the treatment and follow-up of adults with differentiated thyroid carcinoma (DTC). Methodology: Clinical practice guideline (CPG) based on systematic literature review (RSL) and consensus of clinical experts. The development group defined the range and four questions that were resolved through a review of evidence from existing CPGs, RSLs, primary studies published in Spanish or English in various sources of information since 2013. The research questions were: 1. What are the indications for active surveillance? How to carry it out? When and how often to carry it out? 2. What is the treatment and its indication in patients with thyroid nodules suspicious for cancer? 3. How and when to follow up patients with CDT according to dynamic risk? 4. What is the current management of iodine refractory patients? Evidence-based recommendations analyzed and discussed by the expert group in asynchronous sessions were proposed. The quality of the evidence was evaluated, and the recommendations were graded as strong or conditional and in favor or against based on the analysis of the quality of the evidence, implementation context (availability and implementation) and clinical expertise. In this document, is developed the first question, referring to active surveillance. Results: 86 recommendations were proposed and agreed upon by the development group, categorized into treatment and follow-up to solve the questions raised. 10 of the recommendations correspond to active surveillance and are included in this document. Key recommendations include providing complete and timely information to patients, develop of multidisciplinary teams, individualized patient analysis for treatment decisions, routine dynamic risk staging to evaluate response to treatment and adjust it, minimization of futile procedures or that contribute little to the survival and quality of life of patients. Conclusion: Recommendations are presented that longs to influence the standardization of the daily clinical practice of patients with DTC and better health outcomes.

Ablación por radiofrecuencia de nódulos tiroideos; a propósito de un caso exitoso en un hospital público en Perú / Radiofrequency ablation of thyroid nodules: a successful case in a public hospital in Perú

RESUMEN Se expone los resultados que sugieren la viabilidad de la ablación con radiofrecuencia (ARF) como una posible estrategia terapéutica efectiva en el caso de una mujer de 56 años con un nódulo tiroideo benigno en lugar de la cirugía tradicional en un Hospital Público del Perú. El seguimiento a los 6 meses reveló una reducción significativa en el tamaño del nódulo y reducción del 70% del volumen; además de mejorar la calidad de vida, mejora en los síntomas y función tiroidea normal. Este caso destaca la evolución en el tratamiento de nódulos tiroideos benignos, con la ARF como una posible opción mínimamente invasiva y segura, la cual se ofrece una alternativa prometedora a las intervenciones quirúrgicas convencionales para el manejo de nódulos tiroideos, marcando un cambio significativo en la práctica clínica, ya que es el primer hospital del MINSA (Ministerio de Salud) en realizar este tipo de procedimientos y que ofrece múltiples enfoques de tratamiento de nódulos tiroideos: ARF, tiroidectomía endoscópica transoral, tiroidectomía convencional y vigilancia activa.

ABSTRACT The results are presented, suggesting the viability of radiofrequency ablation (RFA) as an effective therapeutic strategy in the case of a 56-year-old woman with a benign thyroid nodule instead of traditional surgery at a Public Hospital in Peru. The 6-month follow-up revealed a significant reduction in the size of the nodule and a 70% reduction in volume; in addition to improved quality of life, symptom improvement, and normal thyroid function. This case highlights the evolution in the treatment of benign thyroid nodules, with RFA as a possible minimally invasive and safe option, offering a promising alternative to conventional surgical interventions for the management of thyroid nodules, marking a significant change in clinical practice. This is because it is the first hospital of the MINSA (Ministry of Health) to perform such procedures, offering multiple treatment approaches for thyroid nodules: RFA, transoral endoscopic thyroidectomy, conventional thyroidectomy, and active surveillance.