Cáncer de tiroides: estudio descriptivo retrospectivo / Thyroid carcinoma: a descriptive retrospective study

Entre todos los tumores, el carcinoma tiroideo (CT) es poco frecuente, se caracteriza por su lenta evolución y elevado porcentaje de curación. Nuestro objetivo es estudiar las características de los pacientes con CT. Analizamos retrospectivamente a 171 pacientes, edad media al diagnóstico 41.1( ± 14.6 años), que consultaron entre los años 2000-04 por CT. Se evaluaron datos de anamnesis, métodos de diagnóstico, anatomía patológica y evolución. Agrupamos a los tumores por el tamaño y según TNM (tumor-adenopatía-metástasis) en estadios (E). La presencia de tiroglobulina estimulada (Tg) > 2 ng/ml e imagen positiva (con 131I u otro radiotrazador) fueron consideradas como positivas para CT residual. De la población total el 88% fue sexo femenino, el 62% menores de 45 años, y el 77.1% tuvo función tiroidea normal. La punción con aguja fina (PAAF) fue diagnóstica en 78%. El 96% fue carcinoma papilar (CTP), 63% presentaban E I; 14% E II; 19% E III y 4% E IV. Se detectó CT residual en el 90% de los pacientes con Tg entre 2 y 10, y en el 100% con Tg > 10 ng/ml, mientras que con Tg < 2 el 18% mostró imagen positiva. No encontramos correlación significativa con antecedentes patológicos ni con ningún signo relevante en imágenes. En conclusión, en nuestra población el CTP fue predominante. Más frecuente en mujeres, en menores de 45 años y en eutiroideos. El nivel de Tg estimulada es un buen indicador de CT residual, pero no es una prueba suficiente para seleccionar pacientes libres de enfermedad

The thyroid carcinoma (TC) is not very frequent among all cancers. Its course is slow and is high potentially curable. Our aim was to analyse the characteristics in patients with TC. A retrospective analysis on 171 patients, with an average age of 41.1 (±14,6), who asked for TC to our service between the years 2000-04, was performed. From case histories it was evaluated: anamnesis, diagnostic image, histopathology and evolution. Tumours were grouped for size and TNM (tumour-nodule-metastasis) in stages (S). A stimulated serum thyroglobulin level > 2 ng/ml and positive image with 131I or another nuclear marker were considered as positive for residual TC. In the totality of the analyzed patients 88% were female, 62% below 45 years old, and in 77% the thyroid function was normal. The fine needle aspiration (FNA) was diagnostic in 78%. Papillary thyroid carcinoma (PTC) in 96%. The 63% was SI; 14% SII; 19% SIII and 4% SIV. During follow-up, we observed that 90% of patients with Tg between 2 and 10 had evidence of residual TC, and 100% with Tg > 10 ng/ml, whereas 18% of those whose stimulated Tg < 2 presented positive image. There was not found significative correlation with pathologic antecedents or relevant image signs. In conclusion: TCP was the most frequent carcinoma in women, in patients younger than 45 years and in those who have euthyroid function. A stimulated serum thyroglobulin level was a good indicator for residual TC, but failed to select those patients who were disease free

Multinodular goiter management in Western Saudi Arabia

The aim of this study was to provide epidemiological data and summarize the different modalities of management of multinodular goiters [MNG] in the Western Province of Saudi Arabia [KSA]. A total of 135 patients had MNG, which were diagnosed by ultrasonography at King Abdul-Aziz University Hospital in Jeddah, KSA between January 2003 and June 2004. The data collected includes the age, gender, physical examination of the thyroid gland [trifluorothymidine, free thyroxine, free triiodothyronine, thyroid stimulating hormone], ultrasonographic findings and Tc99 radioiodine nuclear scan of the thyroid gland, fine needle aspiration [FNA] of the gland and antithyroid antibodies. The study group was divided according to the thyroid status: nontoxic euthyroid MNG, hypothyroid MNG and toxic hyperthyroid MNG. The management of MNGs according to the patients' clinical presentations and thyroid status was reviewed. The mean age was 39 +/- 12.66 years with a range of 10-79 years. Forty-two patients [31%], with no history of thyroid cancer, had ultrasoundguided FNA; 41 [97.6%] of the FNAs were benign. One FNA [2.3%] was positive for papillary carcinoma in a 56-year-old female patient. Thyroid antibodies [anti-microsomal antibodies and anti-thymoglobulin antibodies] were measured in 50 patients [37%]. Thirty-one [62%] were positive, 11 [35%] of which were positive in patients with documented hypothyroidism. All patients with hypothyroidism were treated with levothyroxine; however, only 25.6% with euthyroid MNG were treated with suppressive doses of levothyroxine. Twelve patients [44.4%] with toxic MNG were treated with antithyroid medications. Radioiodine therapy was not given to any patient with nontoxic MNG; however, 48% of those with hyperthyroid MNG received radioactive iodine treatment. Surgery was carried out in 25.6% of patients with euthyroid nontoxic MNG, and in 11 patients with toxic MNG. Nearly half of those with nontoxic MNG [46.5%] and 14.8% of those with a subclinical hyperthyroid MNG refrained from any therapy. They were followed-up by their clinician in the outpatient clinic. Serum thyroid stimulating hormone levels, ultrasound and fine needle biopsy were the cornerstones of the diagnostic evaluation of patients with MNG. Review of the management of these patients was comparable to that found in the literature. The treatment strategy was similar to the recommendations by the American Thyroid Society; however, radioactive iodine treatment was not used as a treatment for patients with nontoxic goiters

Serum immunoglobulin G and haematological parameters in goitrous thyroid disease treated by radioiodine and surgery

They were aimed at determining the serum immunoglobulin G [IgG] and hematological parameters in goitrous patients treated by radioiodine and thyroid surgery. This prospective clinicopathologic study was conducted in Postgraduate Medical Institute, Lahore. Blood samples of 20 patients with toxic diffuse goiter [TDG] and 30 with non-toxic nodular goiter were analyzed for serum IgG, hemoglobin [Hb], total and differential white cell counts [TLC and DLC] at 0, 10d and 6-8 weeks of radioiodine or surgical treatment. Twenty age-and.sex-mulched healthy individuals were included as reference population. Goitrous patients had significantly higher IgG that was detected after sub total thyroidectomy in cases of nodular goitre. Patients with TDG showed significantly increased IgG after radioiodine therapy [p<0.01]. Hb level in patients was lower as compared to control group [p<0.05], Hb showed a significant increase after 6-8 weeks of therapy [p<0.05]. Changes in TLC and DLC were not significant. Serum IgG in goitrous patients was significantly higher than healthy controls. Patients with TDG showed an increase in IgG after radioiodine therapy. Changes in Hb, TLC, DLC were mostly insignificant after treatment with radioiodine as well as surgery

Prevalence of thyroid microsomal and thyroglobulin autoantibodies in goitrous lesions

This prospective study was done to evaluate the serum levels of Microsomal and Thyroglobulin autoantibodies in patients with toxic diffuse goiter and nodular goitre [non-toxic] undergoing radio-iodine therapy and thyroidectomy respectively. Forty eight patients suffering from thyroid disorders, 29 with nodular goiter and 19 with toxic diffuse goitre [TDG] and 15 age and sex-matched normal controls were studied. Thyroid microsomal [MSAb] and thyroglobulin autoantibodies [TGAb] were estimated in the sera of all the subjects using the commercially available kits based on tanned red cell hemaglutination technique. MSAb seropositivity in TDG and nodular goitre was found to be 78.9% and 51.7% respectively. On the other hand, TGAb seropositivity was 57.9% and 27.6% in cases of TDG and nodular goitre. 13.3% and 6.7% of the normal controls were positive for MSAb and TGAb respectively. These findings indicate that autoimmunity is implicated in the genesis of commonly occurring thyroid disorders

Serum cytokines in autoimmune and toxic multinodular thyroid diseases

Measuring serum cytokine levels in patients with Grave's disease, Hashimoto's thyroiditis, toxic multinodular goiter and compared them to a normal control group, to see if there is any correlation between the level of the serum cytokines and the pathophysiology of autoimmune and toxic multinodular thyroid diseases. Serum INF gamma [Th1], IL-10 and IL-4 [Th2] and IL-6 cytokine levels were studied in 26 patients with Graves thyrotoxicosis, 27 patients with goitrous Hashimoto's thyroiditis, 18 patients with toxic multinodular goiter and 40 normal controls. INF-GAMMA was detected in all Graves' and Hashimoto's patients with mean values of 142.11 +/- 29.53 unit/ml and 85.70 +/- 25.86 unit/ml. The mean levels of INF-gamma in Graves was significantly higher compared to Hashimoto's [P<0.001]. IL-10 was detected in all Graves' patients with a mean value of 583.85 +/- 253.35 pg/ml and 19 out of 27 Hashimoto's patients with a mean value of 332.63 +/- 213.20 pg/ml. The level of IL-10 was significantly higher in Graves' than in Hashimoto's [P<0.001]. Both INF gamma and IL-10 were not detected in toxic multinodular goiter or normal individual. IL-4 was significantly elevated in Graves' with a mean value of 132.4 +/- 44.52 but not in any of the other study groups. IL- 6 was detected in the serum of 25 Graves' with a mean value of 496.80 +/- 180.43 pg/ml, 10 Hashimoto's with a mean value of 293.50 +/- 196.61 pg/ml and 10 toxic multinodular goiter patients with a mean value of 228.75 +/- 73.96 pg/ml but not in the serum of normal individuals. The levels of IL-6 was significantly elevated in autoimmune thyroid disease [Graves and Hashimoto's] compared to toxic multinodular goiter [P<0.001]; also IL-6 level was significantly higher in Graves' than Hashimoto's [P <0.001]. The immunopathology seen in both the Grave's disease and goitrous Hashimoto's thyroiditis groups that we studied are related in part to the presence and interplay of mixed Th1 and Th2 cytokines in which there is a down regulation of cytotoxic effect and production of high levels of autoantibodies. The raised level of IL-6 that we observed in autoimmune [Grave's disease and Hashimoto's thyroiditis] and toxic multinodular goiter could be an indication of a long standing inflammatory and destructive process of the diseases

Evaluation of long-term results of two schedules of treatment for toxic multinodular goitre with radioiodine therapy (I 131).

Results of the long term effects of two schedules of radioine therapy (I131) in 130 toxic multinodular goitre patients were evaluated. Seventy five patients (group I) were treated with low doses and 55 patients (group II) with calculated high doses adjusted for thyroid weight (0.5-1 mu ci/g) and radioiodine uptake. Follow up (mean +/- SEM) was 4.5 +/- 0.4 years and 4.8 +/- 0.6 years respectively (p > 0.1). At the end of followup hyperthyroidism was successfully reversed in 87% (Group I) and 82% (Group II). In group I hypothyroidism was present in 5% of patients while it was 12.5% in group II patients. The total dose per gram of thyroid tissue was not significantly different in both the groups (0.058 mu ci +/- 0.0054 VS 0.073 +/- 0.0054 ci/g.) However in group II the number of I131 administration was significantly lower (1.5 +/- 0.2) than in group I (3.2 +/- 0.4) and the percentage of patients who were adequately treated in Group II with single dose was more as compared in group I (62% in group II versus 49% in group I) Hypothyroidism was reached in a shorter time after treatment in group II (median time 0.8 year in group II Vs 1.1 yrs in group I). Patients with positive thyroid antibodies showed a significant earlier development of hypothyroidism within six months. It is concluded that radioiodine is an effective treatment for toxic multinodular goitre with a significant low incidence of post therapy hypothyroidism in patients treated with low doses as compared to higher doses of radioiodine therapy.

Bócio multinodular atóxico: avaliaçäo da taxa de recidiva e funçäo após tiroidectomia parcial: análise retrospectiva de 39 casos / Nontoxic multinodular goiter: evaluation of recurrence rate and function after thyroidectomy partial: retrospective analysis of 39 cases

Realizou-se um estudo retrospectivo sobre a taxa de recidiva e funçäo hipofíseo-tiróidea em 39 pacientes com bócio multinodular atóxico, submetidos a tiroidectomia parcial, no período de 1970 a 1983, visando avaliar possíveis correlaçöes entre alteraçöes da funçäo tiróidea, extensäo da cirurgia e recidiva do bócio. A incidência da recidiva do bócio foi de aproximadamente 15%, sendo a maioria identificada dez ou mais anos após a cirurgia. Operaçöes mais radicais diminuíram a taxa de recidiva, às custas de um aumento do risco de hipotiroidismo subclínico. Näo foram encontradas diferenças estatisticamente significativas nos níveis plasmáticos de T3, T4, T4 livre e TSH (basal e após TRH) entre os pacientes com ou sem recidiva. Em uma paciente o tratamento pós-operatório com tiroxina näo evitou o aparecimento do bócio recidivante. Isto sugere que o aumento do TSH näo parece ser necessário para a manutençäo do bócio atóxico recidivante. Uma vez que a maioria dos pacientes submetidos a tiroidectomia permanece eutiróidea e apenas uma pequena proporçäo desenvolve recidiva, parece-nos questionável o uso pós-operaçäo rotineiro de hormônios tiróideos visando à profilaxia da recidiva do bócio multinodular