Evaluación de la agudeza diagnóstica de la Ecografía Translaríngea Transcutánea (ETLTC) en la valoración de la movilidad de las cuerdas vocales en cirugía de tiroides y paratiroides / Evaluation of the diagnostic acuity of the Transcutaneous Translaryngeal Ultrasound (TCTLUS) in the assessment of the vocal cords mobility in thyroid and parathyroid surgery

Introducción. La evaluación de la movilidad de las cuerdas vocales en cirugía de tiroides y paratiroides hace parte de la adecuada valoración integral. Aunque la laringoscopia directa es prueba de referencia, su uso real no es rutinario por lo que se propone la ecografía translaríngea como alternativa de evaluación. Métodos. Estudio prospectivo de evaluación de una prueba diagnóstica de la movilidad de las cuerdas vocales pre y posoperatoria, comparando la ecografía translaríngea con la video laringoscopia, en pacientes con cirugía de tiroides y paratiroides, de febrero 1° a noviembre 30 de 2022. Se describieron las variables usando frecuencias absolutas y relativas. En el análisis univariado se calcularon Chi cuadrado y T de Student y en el bivariado, regresión logística binaria. La agudeza diagnóstica se determinó con sensibilidad, especificidad y valores predictivos; se consideró la significancia estadística con p < 0,05. Resultados. Se incluyeron 267 pacientes, 219 mujeres y 48 hombres; 196 pacientes (73,4%) tenían malignidad. Se encontró en el preoperatorio, sensibilidad 100 %, especificidad 99,6 %, VPP 83,3 %, VPN 100 %, odds de probabilidad positiva 83 % y Odds de probabilidad negativa 0,004 %. En el posoperatorio, sensibilidad 82,8 %, especificidad 99,2 %, VPP 92,3 % VPN 97,9 %, odds de probabilidad positiva 92 % y odds de probabilidad negativa 0,2 %. Conclusiones. La ecografía translaríngea en nuestro medio tiene alta agudeza diagnóstica. Podría ser usada en el abordaje inicial de la evaluación de la movilidad de las cuerdas vocales y reemplazar la laringoscopia directa, dejando ésta para cuando la visualización ecográfica no sea adecuada, o en casos de afectación o sospecha de invasión, para su confirmación.

Introduction. The evaluation of the mobility of the vocal cords in thyroid and parathyroid surgery is part of the adequate comprehensive assessment. Altough, direct laryngoscopy is the gold standard, its real use is not routine, so translaryngeal ultrasound approach is proposed as an alternative. Methods. A prospective diagnostic test study was carried out to evaluate the translaryngeal ultrasound compared with video laryngoscopy in visualizing vocal mobility in patients with thyroid and parathyroid surgery from February 1 to November 30, 2022. Patients were described using absolute and relative frequencies. Univariate statistical analysis with Chi-square and Student's t tests. T. Bivariate analysis using binary logistic regression. Diagnostic acuity was calculated with sensitivity, specificity, PPV, NPV. Statistical significance with p< 0.05, 95% confidence interval. Results. 267 patients undergoing thyroid or parathyroid surgery were included, 219 women and 48 men. Malignant: thyroid neoplasm 196 patients (73.4%). The findings were for the preoperative period, 100% sensitivity, 99.6% specificity, PPV 83.33%, NPV 100%, 83% positive probability odds, and 0.004% negative probability odds. For the postoperative period, 82.8% sensitivity, 99.2% specificity, 92.3% PPV, 97.9% NPV, 92% positive probability odds, and 0.2% negative probability odds were found.Conclusions. Translaryngeal ultrasound in our series has high diagnostic acuity. It could be used as the initial approach to evaluate vocal mobility and might replace direct laryngoscopy, leaving it when its visualization is not adequate or in cases of involvement or suspected invasion for confirmation.

Manejo del paciente con Hipertiroidismo en consulta externa de la Unidad Técnica de Endocrinología del Hospital Carlos Andrade Marín / Management of the patient with hyperthyroidism in the outpatient clinic of the Technical Unit of Endocrinology of the Endocrinology Technical Unit of the Carlos Andrade Marín Hospital

El hipertiroidismo es un trastorno caracterizado por el exceso de hormonas tiroideas. El déficit de yodo es un factor clave en dicha patología y en lugares con suficiencia del mismo se asocian a au-toinmunidad tiroidea. La prevalencia de hipertiroidismo mani-fiesto varía del 0,2% al 1,3% en áreas con suficiencia de yodo, sin embargo, esto puede variar en cada país por diferencias en umbrales de diagnóstico, sensibilidad de ensayo y población se-leccionada. Un reporte de The Third National Health and Nutri-tion Examination Survey (NHANES III) mostró que el hiperti-roidismo manifiesto se presenta en 0,7% de la población general e hipertiroidismo subclínico en el 1,7%1,2.En incidencia, la patología se asocia con la suplementación de yodo, con la mayor frecuencia en áreas de deficiencias, por au-mento de nódulos tiroideos en la población anciana, teniendo a regiones de áreas montañosas como América del Sur, África Central y suroeste de Asia dentro de este grupo. Un meta aná-lisis de estudios europeos mostró una incidencia general de 50 casos por 100000 personas/años1. En Ecuador, según los datos del Instituto Nacional de Estadísticas y Censos (INEC) del 2017, se reportaron 157 casos de hipertiroidismo, de los cuales la En-fermedad de Graves (EG) fue la causa más común, seguida por el bocio multinodular tóxico (BMNT) y finalmente el adenoma tóxico (AT) con una incidencia de 61 %, 24 % y 14 % respecti-vamente3.Los pacientes con esta patología tienen aumento de riesgo com-plicaciones cardiovasculares y mortalidad por todas las causas, siendo falla cardíaca uno de sus principales desenlaces, así el diagnóstico precoz evita estos eventos, principalmente en pobla-ción de edad avanzada.El presente protocolo se ha realizado para un correcto trata-miento de esta patología en el Hospital de Especialidades Carlos Andrade Marín (HECAM).

Hyperthyroidism is a disorder characterized by an excess of thyroid hormones. Iodine deficiency is a key factor in this pa-thology and in places with iodine deficiency it is associated with thyroid autoimmunity. The prevalence of overt hyperthyroidism varies from 0,2% to 1,3% in iodine-sufficient areas; however, this may vary from country to country due to differences in diag-nostic thresholds, assay sensitivity, and selected population. A report from The Third National Health and Nutrition Examina-tion Survey (NHANES III) showed that overt hyperthyroidism occurs in 0,7% of the general population and subclinical hyper-thyroidism in 1,7%1,2.In incidence, the pathology is associated with iodine supplemen-tation, with the highest frequency in areas of deficiencies, due to increased thyroid nodules in the elderly population, having regions of mountainous areas such as South America, Central Africa and Southwest Asia within this group. A meta-analysis of European studies showed an overall incidence of 50 cases per 100000 person/years1. In Ecuador, according to data from the National Institute of Statistics and Census (INEC) in 2017, 157 cases of hyperthyroidism were reported, of which, Graves' di-sease (GD) was the most common cause, followed by toxic mul-tinodular goiter (BMNT) and finally toxic adenoma (TA) with an incidence of 61 %, 24 % and 14 % respectively3.Patients with this pathology have an increased risk of cardiovas-cular complications and all-cause mortality, with heart failure being one of the main outcomes, so early diagnosis avoids these events, mainly in the elderly population.The present protocol has been carried out for the correct treat-ment of this pathology at the Carlos Andrade Marín Specialties Hospital (HECAM).

Thyroid Volume in Pregnancy is Associated with Parity, Gestational Age, and Body Mass Index in an Iodine-sufficient Area / O volume tireoidiano em gestantes está associado à paridade, idade gestacional e índice de massa corporal em uma área suficiente em iodo

Abstract Objective We compared thyroid volume (TV) and presence of nodular goiter (NG) in pregnant vs. non-pregnant women in an iodine-sufficient area. We also evaluated the relationship between gestational age, parity, and TV in the pregnant women group, and determined the 2.5th and 97.5th percentiles of normal TV in pregnancy. Methods This cross-sectional study included 299 healthy women (216 pregnant) without previous thyroid diseases. Thyroid ultrasounds were performed and compared between pregnant and non-pregnant women. The range of normal distribution of TV (2.5th and 97.5th percentiles) in pregnancy was determined after excluding individuals with positive thyroid antibodies, NG, and/or abnormal serum thyrotropin (TSH) or free thyroxine (FT4). Results Thyroid volume was larger among pregnant compared to non-pregnant women (8.6 vs 6.1 cm3; p< 0.001) and was positively correlated with gestational age (rs = 0.221; p= 0.001), body mass index (BMI, rs 0.165; p= 0.002), and FT4 levels (rs 0.118 p= 0.021). Nodular goiter frequency did not differ between the two groups. There was a negative correlation between TV and TSH (rs -0.13; p= 0.014). Thyroid volume was lower among primiparous compared to multiparous patients (7.8 vs 8.9; p< 0.001) and was positively correlated with parity (rs 0.161; p= 0.016). The 2.5th and 97.5th percentiles of TV were 4.23 and 16.47 cm3, respectively. Conclusion Thyroid volume was higher in pregnant compared to non-pregnant women and was positively related to parity, BMI, and gestational age in a normal iodine status population. Pregnancy did not interfere with the development of NG.

Resumo Objetivo Comparamos o volume tireoidiano (VT) e a presença de bócio nodular (BN) em mulheres grávidas e não grávidas em uma área suficiente em iodo. Também avaliamos a relação entre idade gestacional, paridade e VT no grupo de gestantes e determinamos os percentis 2,5 e 97,5 de VT normal na gestação. Métodos Este estudo transversal incluiu 299 mulheres saudáveis (216 grávidas) sem doenças tireoidianas prévias. Ultrassonografias de tireoide foram realizadas e comparadas entre mulheres grávidas e não grávidas. A faixa de distribuição normal de VT (percentis 2,5 e 97,5) na gestação foi determinada após a exclusão de indivíduos com anticorpos tireoidianos positivos, BN e/ou tireotropina sérica (TSH) ou tiroxina livre (T4L) anormais. Resultados O VT foi maior entre as gestantes em comparação com as mulheres não grávidas (8,6 vs 6,1 cm3; p< 0,001) e foi positivamente correlacionado com a idade gestacional (rs = 0,221; p= 0,001), índice de massa corporal (IMC, rs 0,165; p= 0,002) e níveis de T4L (rs 0,118 p= 0,021). A frequência de BN não diferiu entre os dois grupos. Houve correlação negativa entre VT e TSH (rs -0,13; p= 0,014). O VT foi menor entre as primíparas em comparação com as multíparas (7,8 vs 8,9; p< 0,001) e foi positivamente correlacionado com a paridade (rs 0,161; p= 0,016). Os percentis 2,5 e 97,5 de VT foram 4,23 e 16,47 cm3, respectivamente. Conclusão O VT foi maior em gestantes em comparação com mulheres não grávidas e foi positivamente relacionado à paridade, IMC e idade gestacional em uma população com status iódico normal. A gravidez não interferiu no desenvolvimento de BN.

Aspects épidémiologiques, cliniques, thérapeutiques et évolutifs des maladies thyroïdiennes à Bouaké (Côte d'Ivoire) / Epidemiological, clinical, therapeutic and evolutionary aspects of thyroid deseases in Bouake (Ivory Coast)

Contexte : la maladie thyroïdienne représente la plus fréquente endocrinopathie dans le monde après le diabète sucré. En Afrique, elle constitue un véritable problème de santé publique et sa prise en charge est souvent entravée par les moyens d'investigations. Le but était d'étudier le profil des affections thyroïdiennes à Bouaké. Méthodes : il s'agissait d'une étude rétrospective, descriptive, menée dans le service de consultation de Médecine Interne du Centre Hospitalier Universitaire de Bouaké du 1er janvier 2020 au 31 décembre 2021. Elle a porté sur les dossiers de 104 patients suivis pour une pathologie thyroïdienne. Résultats : Sur 2560 patients reçus, la pathologie thyroïdienne concernait 104 patients ; soit une fréquence de 4,1%. Il s'agissait de 93 femmes et 11 hommes avec un sex-ratio (H/F) de 0,12 L'âge moyen était de 42,03 ans ±15 ans. Dans plus de la moitié des cas (55,8%), le délai de consultation était supérieur à 06 mois. Sur le plan fonctionnel, 58 patients (55,8%) présentaient une hyperthyroïdie avec comme principales étiologies la maladie de Basedow (60,3%, n=35) et le goitre multinodulaire toxique (24,1%, n=14). L'hypothyroïdie était retrouvée chez 10 patients (9,6%), le plus souvent post thyroïdectomie (60%). Les goitres et nodules euthyroïdiens étaient retrouvés chez 36 patients (34,6%) dominés par le goitre multinodulaire euthyroïdien (36,1%, n=13) et le goitre simple (27,8%, n=10). Le traitement des hyperthyroïdies reposait essentiellement sur les antithyroïdiens de synthèse dans 96,7%. Seulement 1 patient hyperthyroïdien avait subi une thyroïdectomie. La majorité des patients (82,2%) étaient perdus de vue. Conclusion : La pathologie thyroïdienne au CHU de Bouaké est une maladie fréquente de la femme jeune. Les hyperthyroïdies dominent le tableau des thyréopathies avec comme principale étiologie la maladie de Basedow. On note un taux élevé de perdu de vue, d'où l'intérêt d'une éducation de nos patients.

Context: Thyroid disease is the most common endocrinopathy observed in the world. In Africa, thyroid diseases remain a real public health problem and their care is often hampered by the means of investigation. The purpose of this work was to study the profile of thyroid affections in Bouake. Methods: This was a descriptive study with retrospective data collection, carried out over the period from 1 January 2020 to 31 December 2021 at the Internal Medicine consultation at the University Hospital of Bouake. All epidemiological, clinical and therapeutic and evolutionary data from patients followed for thyroid pathology were collected. It focused on the records of 104 patients followed for thyroid disease. Results: Out of a total of 2560 consultations, 104 patients were involved in thyroid pathology, prevalence of 4.1%. They were 93 women and 11 men with a sex ratio of 0.12. The average age was 42.03±15.64 years. In more than half of the patients (55.8%) the evolution of the clinical symptomatology was more than six months. A total of 58 patients (55.8%) had hyperthyroidism. The etiologies of hyperthyroidism were dominated by Grave's disease and toxic multinodular goiter, with 60.3% and 24.1% of hyperthyroidism respectively. Hypothyroidism was confirmed in 10 patients (9.6%), among then 6 (60%) had undergone total thyroidectomy. The multinodular goiter was found in 36 patients and was dominated by multinodular goiter (36.1%) and single goiter (27.8%). The treatment of hyperthyroidism was exclusively with synthetic antithyroid drugs. Hypothyroidism was treated with hormone replacement therapy. The majority of patients (82.2%) were lost in view. Conclusion: The thyroid pathology at the University Hospital Center of Bouake is a frequent illness of the young woman. Hyperthyroidism were frequently found with as main etiology Grave's disease The majority of patients (82.2%) were lost in view hence the interest of patient's education.

Profil échographique des nodules thyroïdiens au centre hospitalouniversitaire de Bouaké (Cote d'ivoire) / Ultrasound Profile of thyroid spheres at the University Hospital of Bouaké (Côte d'Ivoire)

Introduction : l'échographie est l'examen de première intention dans l'exploration morphologique de la thyroïde. Elle constitue un excellent outil diagnostique et pronostique dans les thyropathies nodulaires. Objectif : déterminer le profil des nodules thyroïdiens à l'échographie selon la classification EU-TIRADS. Matériel et méthodes : étude transversale descriptive réalisée dans le service de radiologie du CHU de Bouaké durant une année. Nous avons inclus tous les comptes rendus d'échographie thyroïdienne des patients ayant des nodules thyroïdiens. Les données ont été analysées à l'aide du logiciel Epi Info 7. Résultats : Au total, 60 patients présentaient des nodules sur 97 reçus pour thyropathies soit 60,8%. L'âge moyen était de 45,6 ans [13-82 ans]. Legenre féminin prédominait avec 82,7%. La tuméfaction cervicale antérieure était la principale indication dans 72%. Le volume thyroïdien était augmenté chez 63%des patients avec un volume moyen de 71 cm3. Il s'agissait de nodule solitaire dans 46,55%. Les nodules spongiformes prédominaient dans 32%. Les nodules étaient solides dans 29,8% et mixtes dans 16,5.%. L'hypo-échogénicité était retrouvée dans 44,8% des cas de nodules solides. Les lésions étaient classées EU-TIRADS 2 dans 58,8%, EU-TIRADS 3 dans 23,5%, EU-TIRADS 4 dans 14,7% et EU-TIRADS 5 dans 2,9%. Conclusion : la caractérisation et la classification des nodules thyroïdiens constituent une étape importante pour la prise en charge des patients. Ces nodules dans notre étude sont essentiellement d'allure bénigne (EU-TIRADS 2 et 3) avec une prédominance féminine. Un arbre décisionnel tenant compte des éléments cliniques et cytopathologiques servirait davantage pour d'éventuelles chirurgies.

Introduction: Ultrasound is the first-line examination in the morphological exploration of the thyroid. It is an excellent diagnostic and prognostic tool in nodular thyropathy. Objective: to determine the profile of thyroid nodules on ultrasound according to the EU-TIRADS classification. Material and methods: descriptive cross-sectional study carried out in the radiology department of the University Hospital of Bouaké during one year. We included all thyroid ultrasound reports of patients with thyroid nodules. Data were analysed using Epi Info 7 software. Results: A total of 60 patients had nodules out of 97 referred for thyropathy (60.8%). The mean age was 45.6 years [13-82 years]. Females predominated with 82.7%. Anterior cervical swelling was the main indication in 72%. Thyroid volume was increased in 63% of patients with a mean volume of 71 cm3. Solitary nodules were present in 46.55%. Spongiform nodules were predominant in 32%. The nodules were solid in 29.8% and mixed in 16.5%. Hypoechogenicity was found in 44.8% of solid nodules. Lesions were classified as EU-TIRADS 2 in 58.8%, EU-TIRADS 3 in 23.5%, EU-TIRADS 4 in 14.7% and EU-TIRADS 5 in 2.9%. Conclusion: The characterisation and classification of thyroid nodules is an important step in the management of patients. In our study, these nodules are essentially benign (EU-TIRADS 2 and 3) with a female predominance. A decision tree taking into account the clinical and cytopathological elements would be more useful for possible surgery.

Recurrent desmoid fibromatosis of the thyroid gland: A diagnostic challenge / Journal of the ASEAN Federation of Endocrine Societies

@#A 31-year-old Indian female with a history of near-total thyroidectomy 2.5-years prior presented with recurrent neck swelling. Magnetic resonance imaging (MRI) of the neck revealed an infiltrating mass involving the thyroid bed. Biopsy from the mass and review of slides from the previous thyroidectomy revealed a spindle cell tumour with interspersed areas of fibrosis and infiltrative edges entrapping thyroid follicles. Beta-catenin immunopositivity and CTNNB1 mutation confirmed the diagnosis of fibromatosis. The case is being reported for its rarity and the discussion of its differential diagnoses.

Knowledge, attitude and practice of Filipino surgeons regarding clinical practice guidelines on Thyroid Nodules and Malignancy: A PCS-PSGS -PAHNSI collaborative study

RATIONALE@#In 2008, the Philippine College of Surgeons in collaboration with the Philippine Society of General Surgeons and the Philippine Academy of Head and Neck Surgeons, Inc. had published Evidence-based Clinical Practice Guidelines (CPG) on the Diagnosis and Management of Thyroid Nodules. This was followed by an update in 2013 with a focus on important diagnostic and therapeutic management issues concerning thyroid malignancy. The objective of this study was to assess knowledge gaps and behavioral patterns among users with respect to these CPGs. @*METHODS@#A validated 30 item survey assessing knowledge of, attitudes towards, and adherence to the recommendations of different Evidence based Clinical Practice Guidelines was administered to general surgery residents, PSGS fellows, and otorhinolaryngology residents and consultants performing thyroidectomies.@*RESULTS@#There were 343 assessable forms. Of the respondents, 276 (80.47%) were general surgeons, 33 (9.62%) were otorhinolaryngologists. There were 66 (19.24%) consultants, and 277 (80.76%) residents. Otorhinolaryngologists were less aware of the local CPGs than their GS counterparts. GS Residents, compared to their consultants, were more aware of the American Thyroid Association guidelines than the local guidelines. Among all respondents, the local guidelines had about equal preference for usage as the American Thyroid Association guidelines. There were no statistically significant differences on the level of knowledge and attitudes among the respondents. @*CONCLUSION@#The level of awareness about the PCS Thyroid Guidelines needs to be improved. The dissemination process needs to be reviewed and ensure that all stakeholders will be reached.

Langerhans cell histiocytosis presenting as anterior neck mass in a child: A case report / Journal of the ASEAN Federation of Endocrine Societies

@#Thyroid involvement in Langerhans Cell Histiocytosis (LCH) is rare. We report a 10-year-old Filipino male who presented with a rapidly enlarging goiter. Computed tomography scan showed thyroid and bilateral submandibular masses with malignant features, pulmonary blebs and hepatic cysts. Ultrasound-guided core needle biopsy findings were consistent with LCH and chemotherapy was initiated. This case demonstrates that LCH should be considered in patients with goiter. Multidisciplinary management is warranted to achieve proper diagnosis and institute timely treatment.

Surgical management of goiter with intrathoracic extension at the Philippine General Hospital Department of Otolaryngology Head and Neck Surgery

Objective@#To describe the demographic and clinical characteristics of patients diagnosed with intrathoracic thyroid masses managed surgically in our institution, determine associated factors affecting eventual operative approaches for these patients, and assess postoperative outcomes and complications associated with surgical intervention.@*Methods@#Design: Retrospective descriptive case series. Setting:Tertiary National University Hospital. Participants: 24 patients.@*Results@#The mean age of patients diagnosed with intrathoracic goiters was 55.71 years old, with a 1:1.4 male to female ratio; with most having an intrathoracic extent of Huins Grade 1 (67%) compared to others having Huins Grade 2-3. Majority of patients pre-operatively had a Fine Needle Aspiration (FNA) Bethesda Thyroid Nodule Classification of Category II (benign); 79% of total patients underwent excision of thyroid mass utilizing a transcervical approach alone. As Intrathoracic Extension (ITE) grade increased, additional transthoracic approaches were performed; duration of operation, average estimated blood loss, length of hospital stay was also noted to increase. Majority of post operative surgical histopathology results revealed malignant thyroid masses, in contrast to pre-operative FNA. Post-operative transient hypocalcemia was the most reported immediate complication. @*Conclusions@#Management of intrathoracic goiter is often multidisciplinary. Referral to the thoracic vascular service is warranted for access to the thoracic inlet. Classification by grade of intrathoracic goiters is helpful to determine the most appropriate operative approach and may be predictive of intraoperative and postoperative outcomes. Postoperative histopathology across all ITE grades mostly yield malignant results; hence, preoperative FNA results should be used with caution.

Hypercalcium crisis and postoperative hungry bone syndrome caused by primary hyperparathyroidism: a case report / 临床耳鼻咽喉头颈外科杂志

To review the diagnosis and treatment of a case of hypercalcium crisis caused by primary hyperparathyroidism（PHPT） and prophylactic treatment of hungry bone syndrome. In a 32-year-old male with hypercalcemia, the main manifestations were loss of appetite, nausea, polyuria, polydipsia, fatigue, lethargy, etc. parathyroid hormone, serum calcium increased, thyroid function was normal, thyroid color ultrasound and MRI showed space-occupying behind the right thyroid, radionuclide examination showed abnormal imaging agent concentration in the right parathyroid area, there was a history of pathological fracture. Clinically diagnosed as hypercalcemia crisis secondary to PHPT.

Correlation Analysis between Thyroid Function Abnormality and Efficacy in Patients with Advanced Non-small Cell Lung Cancer after Immunotherapy / 中国肺癌杂志

BACKGROUND@#Thyroid function abnormality (TFA) is one of the common adverse reactions in patients with advanced non-small cell lung cancer (NSCLC) treated with immunotherapy, but the risk factors of TFA and its relationship with efficacy are not completely clear. The purpose of this study was to explore the risk factors of TFA and its relationship with efficacy in patients with advanced NSCLC after immunotherapy.@*METHODS@#The general clinical data of 200 patients with advanced NSCLC in The First Affiliated Hospital of Zhengzhou University from July 1, 2019 to June 31, 2021 were collected and analyzed retrospectively. χ² test and multivariate Logistic regression were used to explore the risk factors of TFA. Kaplan-Meier curve was drawn and Log-rank test was used for comparison between groups. Univariate and multivariate Cox analysis was used to explore the efficacy factors.@*RESULTS@#A total of 86 (43.0%) patients developed TFA. Logistic regression analysis showed that Eastern Cooperative Oncology Group Performance Status (ECOG PS), pleural effusion and lactic dehydrogenase (LDH) were factors influencing TFA (P<0.05). Compared with normal thyroid function group, the median progression-free survival (PFS) of patients in the TFA group was significantly longer (19.0 months vs 6.3 months, P<0.001), and the objective response rate (ORR) (65.1% vs 28.9%, P=0.020) and disease control rate (DCR) (100.0% vs 92.1%, P=0.020) of the TFA group were better than those of the normal thyroid function group. Cox regression analysis showed that ECOG PS, LDH, cytokeratin 19 fragment (CYFRA21-1) and TFA were factors influencing prognosis (P<0.05).@*CONCLUSIONS@#ECOG PS, pleural effusion and LDH may be risk factors affecting the occurrence of TFA and TFA may be a predictor of the efficacy of immunotherapy. Patients with advanced NSCLC who have TFA after immunotherapy may obtain better efficacy.

Carcinoma de tiroides: Descripción de 634 pacientes atendidos en el Hospital Universitario San Ignacio, Bogotá, D. C., Colombia / Thyroid carcinoma: Description of 634 patients treated at the Hospital Universitario San Ignacio, Bogotá, D. C., Colombia

Introducción. La incidencia del carcinoma de tiroides ha aumentado a nivel mundial, probablemente relacionado con el sobre diagnóstico de nódulos tiroideos asintomáticos. La alta sobrevida del carcinoma diferenciado de tiroides ha permitido posibilidades de manejo quirúrgico menos radicales, o inclusive, la vigilancia activa de tumores seleccionados. Existen reportes de características clínico-patológicas del carcinoma de tiroides de nuestro país distintas a las reportadas en la literatura internacional. Métodos. Estudio observacional descriptivo de una cohorte retrospectiva de pacientes con carcinoma de tiroides atendidos en un hospital universitario entre 2015 y 2020. Resultados. Se identificaron 634 pacientes, el 83,4 % de sexo femenino. La tiroidectomía total con vaciamiento central fue el procedimiento más realizado (86,7 %). De 613 carcinomas diferenciados de tiroides, el 94,2 % corresponden al tipo papilar, seguido por el carcinoma de células de Hürtle (1,6 %); el 26,2 % presentaron subtipos histológicos agresivos y el 28,4 % compromiso tumoral bilateral. En los vaciamientos centrales se encontró 58,7 % de enfermedad metastásica; que fue de 49 % en los pacientes con microcarcinomas papilares (19 %). De las 68 lesiones del nervio laríngeo recurrente, 47 % fueron por secciones oncológicas. Discusión. En nuestra serie, la proporción de pacientes con carcinoma papilar de tiroides y de sus variantes histológicas agresivas, así como el compromiso tumoral bilateral es mayor a lo reportado en la literatura científica. Conclusión. El comportamiento biológico del carcinoma de tiroides es variable y puede tener características diferentes entre regiones; el manejo en nuestro medio debería considerar las características propias de nuestra población.

Introduction. The incidence of thyroid carcinoma has increased worldwide, probably related to the overdiagnosis of asymptomatic thyroid nodules. The high survival of differentiated thyroid carcinoma has allowed less radical surgical resection or even active surveillance for selected tumors. There are reports of clinicopathological features of thyroid carcinoma in our country that are different from those reported in the international literature. Methods. Retrospective observational study of a cohort of patients with thyroid carcinoma treated at a university hospital between 2015 and 2020. Results. 634 patients were identified; 83.4% were female. Total thyroidectomy with central dissection was the most performed procedure (86.7%). Of the 613 differentiated thyroid carcinomas, 94.2% were papillary type, followed by Hürtle cell carcinoma with 1.6%; 26.2% presented aggressive histological subtypes and 28.4% had bilateral tumor involvement. Metastatic disease was found in 58.7% of the central dissections performed, which was 49% in patients with papillary microcarcinomas (19%). Of the 68 recurrent laryngeal nerve injuries, 47% were due to oncological involvement. Discussion. In our series, the rate of patients with papillary thyroid carcinoma and its aggressive histological subtypes as well as bilateral tumor involvement is higher than that reported in the scientific literature. Conclusion: The biological behavior of thyroid carcinoma is variable and may have different characteristics between regions; the management in our country should consider our population's characteristics.

Encefalopatía asociada a enfermedad tiroidea autoinmune: reporte de caso y revisión de la literatura / Encephalopathy associated with autoimmune thyroid disease: Case report and literature review

RESUMEN INTRODUCCIÓN: La encefalopatía asociada a enfermedad tiroidea autoinmune se caracteriza por un inicio insidioso de síntomas neuropsiquiátricos que incluyen alteración de la función cognoscitiva, cambios del comportamiento, crisis convulsivas y trastornos del movimiento. REPORTE DE CASO: Hombre de 69 años con antecedente de hipotiroidismo primario que consultó por dos semanas de alteración de la memoria, confusión y trastorno del lenguaje, asociados a hiperreflexia y temblor generalizado. Los estudios mostraron nivel de hormona tiroidea y títulos de anticuerpos antitiroideos elevados, líquido cefalorraquídeo con aumento de proteínas y anticuerpos antineuronales negativos, neuroimagen normal y electroencefalograma con alteraciónes inespecíficas. Posterior a descartar otras etiologías, se hizo el diagnóstico de encefalopatía asociada a enfermedad tiroidea autoinmune y se inició manejo con esteroides, con los que presentó una mejoría clínica significativa. DISCUSIÓN: La encefalopatía asociada a enfermedad tiroidea autoinmune es un trastorno complejo que requiere un diagnóstico oportuno y rápido. En todos los pacientes con síntomas neuropsiquiátricos agudos o subagudos, y sin causa clara, es pertinente solicitar un perfil de anticuerpos antitiroideos independiente de la función tiroidea basal.

ABSTRACT INTRODUCTION: Thyroid autoimmune disease-associated encephalopathy is characterized by an insidious onset of neuropsychiatric symptoms which may include impaired cognitive function, behavioral changes, seizures, and movement disorders. CASE REPORT: A 69-year-old man with a history of primary hypothyroidism who consulted for two weeks of memory impairment, confusion, and language disorder, associated with hyperreflexia and generalized tremor. Studies showed elevated thyroid hormone levels and antithyroid antibody titers, cerebrospinal fluid with increased protein and negative antineuronal antibodies, normal neuroimaging, and electroencephalogram with nonspecific abnormalities. After ruling out other etiologies, a diagnosis of encephalopathy associated with autoimmune thyroid disease was made and management with steroids was started, with which he presented significant clinical improvement. DISCUSSION: Encephalopathy associated with autoimmune thyroid disease is a complex disorder that requires timely and rapid diagnosis. In all patients with acute or subacute neuropsychiatric symptoms, and without a clear cause, it is pertinent to request an antithyroid antibody profile independent of baseline thyroid function

Utilidad de la neuromonitorización vagal continua en cirugía tiroidea: experiencia y resultados en un hospital de tercer nivel / The role of continuous vagal intraoperative nerve monitoring in thyroid surgery: experience and results in a third-level hospital

Resumen Objetivo: La lesión del nervio laríngeo recurrente es una grave complicación en cirugía tiroidea. El propósito del presente estudio es analizar la utilidad de la neuromonitorización vagal continua intraoperatoria en un hospital terciario. Materiales y Método: Estudio observacional, analítico y retrospectivo que recoge pacientes intervenidos de cirugía tiroidea con neuromonitorización en un período de 14 meses. La pérdida de señal se define como amplitud final nerviosa < 100 ^V, realizándose laringoscopia postquirúrgica ante la sospecha de lesión nerviosa. El análisis estadístico se realizó con el programa SPSS® V25,0, con p < 0,05. Resultados: Se incluyeron 120 pacientes intervenidos, registrándose en el 24,2% pérdida de señal. Factores de riesgo para lesión fueron bocio intratorácico (OR 5,31; IC 95% 1,56-17,99; p = 0,007), cirugía cervical previa (OR 5,76; IC 95% 0,64-51,97; p = 0,119) y patología maligna (OR 1,44; IC 95% 0,16-12,79; p = 0,743). Fue posible el cambio de estrategia quirúrgica en 7 casos. En el seguimiento posterior se cuantificó parálisis recurrencial transitoria en 27 pacientes y permanente en 4. Discusión: La neuromonitorización parece reducir la incidencia de parálisis laríngea porque aumenta la seguridad en la identificación del nervio recurrente y reduce su manipulación durante la cirugía. Conclusiones: La neuromonitorización intraoperatoria es útil para identificar el nervio laríngeo recurrente y advierte del riesgo potencial de lesión, permitiendo cambiar la estrategia quirúrgica para evitar la parálisis bilateral de cuerdas vocales.

Aim: Recurrent laryngeal nerve injury is a serious complication in thyroid surgery. The purpose of the present study is to analyze the use of intraoperative continuous vagal neuromonitoring in a tertiary hospital. Materials and Method: Observational, analytical and retrospective study that includes patients who underwent thyroid surgery with neuromonitoring in a period of 14 months. Loss of signal is defined as final nerve amplitude < 100 ^V, and postsurgical laryngoscopy is performed due to suspicion of nerve injury. Statistical analysis was performed with the SPSS® V25.0 program, with p < 0.05. Results: 120 operated patients were included, registering loss of signal in 24.2%. Risk factors for injury were intrathoracic goiter (OR 5.31; 95% CI 1.56-17.99; p = 0.007), previous cervical surgery (OR 5.76; 95% CI 0.64-51.97; p = 0.119) and malignant pathology (OR 1.44; 95% CI 0.16-12.79; p = 0.743). A change in surgical strategy was possible in 7 cases. In the subsequent follow-up, transient recurrent paralysis was quantified in 27 patients and permanent in 4. Discussion: Neuromonitoring seems to reduce the incidence of laryngeal paralysis because it increases the security in the identification of the recurrent nerve and reduces its manipulation during surgery. Conclusions: Intraoperative neuromonitoring is useful to identify the recurrent laryngeal nerve and warns of the potential risk of injury, allowing to change the surgical strategy to avoid bilateral vocal cord paralysis.

Modelización del tiempo que tarda un paciente con cáncer diferenciado de tiroides en presentar la primera recaída / Modeling of the Time it Takes for a Patient with Differentiated Thyroid Cancer to Present the First Relapse / Modelagem do tempo que um paciente com câncer diferenciado de tireoide leva para apresentar a primeira recidiva

Introducción: de todos los carcinomas de tiroides, los diferenciados son los predominantes. Según la Asociación Colombiana de Endocrinología, la tasa de recaída puede ser de hasta del 30 %, especialmente en pacientes mayores de 45 años y con características tumorales agresivas. En esta investigación se estimó el tiempo libre de enfermedad que transcurre entre la finalización del tratamiento y la ocurren-cia de la primera recaída. Materiales y métodos: se tomó un archivo de datos con los registros de 469 pacientes con cáncer diferenciado de tiroides (cdt) tratados en una clínica especializada de cuarto nivel de complejidad en Bogotá (Colombia). Los datos se recolectaron entre enero de 1997 y diciembre de 2012 y se analizaron estadísticamente usando modelos paramétricos y no paramétricos para obtener las curvas de supervivencia y riesgo. Resultados: con el método no paramétrico se evidenció que en 8.5 años el 75 % de los pacientes no habrán presentado la primera recaída en cdt; mientras que en el método paramétrico el 50 % de los pacientes que no presentaron una tiroglobulina postratamiento menor o igual a 1 ng/mL y un tamaño del tumor menor o igual a 2 cm, su tiempo estimado de la primera recaída fue 29.2 años. Conclusiones: el tiempo libre de enfermedad y el riesgo de hacer recaída para pacientes con cdt está afectado por la presencia de un tamaño de tumor mayor a 2 cm en el momento de la consulta y una cantidad de tiroglobulina mayor a 1 ng/mL, registrada al terminar el tratamiento.

Introduction: Between all thyroid carcinomas, the differentiated are predominant. According to the Colombian Association of Endocrinology, the relapse rate can be up to 30%, especially in patients older than 45 years old and with aggressive tumor characteristics. In this investigation, the time that elapses between the initial surgical treatment and the first relapse of the disease was estimated. Materials and methods: A data file was taken with the records of 469 patients with differentiated thyroid cancer (cdt) treated in a specialized clinic of fourth level of complexity iv in the city of Bogotá (Colombia). Data were collected between January 1997 and December 2012 and were statistically analyzed using para-metric and non-parametric models to obtain survival curves and risk. Results: With the non-parametric method, it is evident that in 8.5 years 75% of the patients will not have presented the first relapse in cdt. While applying the parametric method 50% of patients who do not have a postreatment thyroglobulin or one less than or equal to 1 ng/mL and a tumour size less than or equal to 2 cm, their estimated time of First relapse was 29.2 years. Conclusions: Disease-free time and the risk of relapse for patients with cdt is affected by the presence of a tumor size greater than 2 cm at the time of consultation and levels of thyroglobulin greater than 1 ng/mL, recorded at the end of the treatment.

Introdução: de todos os carcinomas da tireoide, os diferenciados são os predominantes. Segundo a Associação Colombiana de Endocrinologia, a taxa de recaída pode ser até 30%, principalmente em pacien-tes com mais de 45 anos e com características de agressividade tumoral. Nesta investigação, estimou-se o tempo decorrido entre o tratamento cirúrgico inicial e a primeira recaída. Materiais e métodos: tomou-se um arquivo de dados com os prontuários de 469 pacientes com câncer diferenciado de tireoide (cdt) atendidos em uma clínica especializada de quarto nível de complexidade na cidade de Bogotá (Colombia). Coletaram-se os dados entre janeiro de 1997 e dezembro de 2012, que depois foram analisados estatisti-camente usando modelos paramétricos e não paramétricos para encontrar curvas de sobrevida e risco. Resultados: com o método não paramétrico, evidenciou-se que, em 8,5 anos, 75% dos pacientes não terão apresentado a primeira recaída na cdt. Enquanto na aplicação do método paramétrico, 50% dos pacientes que não apresentaram tireoglobulina pós-tratamento ou valores menores ou iguais a 1 ng/mL e tamanho do tumor menor ou igual a 2 cm, seu tempo estimado de primeira recaída foi de 29,2 anos. Conclusões: o tempo livre de doença e o risco de recaída, para pacientes com cdt são afetados pela presença de tama-nho de tumor maior a 2 cm no momento da consulta e uma quantidade de tireoglobulina maior a 1 ng/mL, registrada ao terminar o tratamento.

Bocio endotorácico en un adulto / Endothoracic goiter in an adult

Se presenta el caso clínico de un paciente de 48 años de edad, quien acudió a la consulta de Patología de Tiroides del Hospital Provincial Dr. Gustavo Aldereguía Lima de Cienfuegos, por presentar aumento de volumen del cuello en la región anterior, decaimiento, ocasionalmente disfagia y ligera disnea. Al examen físico se constató un tumor en la región anteroinferior y lateral derecha del cuello, movible, que se prolongaba hacia abajo a la parte superior del tórax. Se realizó hemitiroidectomía derecha con exéresis de la prolongación endotorácica. El paciente evolucionó favorablemente.

The case report of a 48 years patient is presented. He went to the Thyroid Pathology Service of Dr. Gustavo Aldereguía Lima Provincial Hospital from Cienfuegos, due to an increase of volume in the anterior region of the neck, weakness, occasionally deglutition disorders and light dyspnea. A tumor was verified in the anteroinferior and lateral right region of the neck, movable, that was prolonged downward to the superior part of the thorax when the physical exam was carried out. A right hemithyroidectomy was carried out with exeresis of the endothoracic extension. The patient had a favorable clinical course.

Adenoma paratiroideo mediastínico gigante. Abordaje cervical y toracoscópico. Caso clínico / Gigant Mediastinal Parathyroid Adenoma. Cervical and Thoracoscopic Approach. Case Report

El hiperparatiroidismo primario es el tercer trastorno endocrino más común, alrededor del 85% de los casos se debe a adenomas paratiroideos. El tratamiento definitivo es la paratiroidectomía, siendo la causa más común de fracaso la resección inadecuada y la localización de tejido ectópico, representando un desafío para el cirujano. En el presente trabajo se presenta el caso de un paciente con diagnóstico de adenoma paratiroideo mediastínico gigante, siendo este el de mayor longitud descrito en la literatura en los últimos 10 años. Caso clínico: Paciente masculino de 70 años de edad quien consulta por presentar convulsiones, polidipsia y poliuria. Se determinan niveles elevados de PTH, hipercalcemia e hipofosfatemia. Estudios de imagen describen lesión alargada localizada en espacio paratraqueal derecho extendiéndose hasta el polo inferior de lóbulo tiroideo derecho. Se decide resolución quirúrgica, mediante la realización de cervicotomía y toracoscopia con evolución satisfactoria del paciente. Conclusión: Los adenomas paratiroideos ectópicos constituyen una causa común de falla quirúrgica e hiperparatiroidismo persistente, su sospecha es de gran importancia. El tratamiento definitivo es la cirugía. La localización preoperatoria por pruebas de imagen es fundamental para seleccionar correctamente la técnica quirúrgica y garantizar el éxito de la cirugía. El abordaje cervical y toracoscópico es una alternativa segura y eficaz(AU)

Primary hyperparathyroidism is the third most common endocrine disorder, about 85% of cases are due to parathyroid adenomas. The definitive treatment is parathyroidectomy, being the most frequent cause of failure the inadequate resection and the location of ectopic tissue. The ectopic parathyroid adenomas represent a challenge for the surgeon. In this paper a case of a patient diagnosed with giant mediastinal parathyroid adenoma is presented, and is the largest reported in the literature in the last 10 years. Clinical case: 70-year-old male patient presented with seizures, polydipsia and polyuria, reason for which he consults. Elevated PTH levels, hypercalcemia, and hypophosphatemia are determined. Imaging studies report an elongated lesion located in the right paratracheal space that extends to the lower pole of the right thyroid lobe. Surgical resolution was decided, by performing cervicotomy and thoracoscopy with satisfactory recovery of the patient. Conclusion: Ectopic parathyroid adenomas are a common cause of surgical failure and persistent hyperparathyroidism; their suspicion is of great importance. The definitive treatment is surgery. Preoperative localization through imaging tests is essential to correctly select the surgical technique and guarantee the success of the surgery, the cervical and thoracoscopic approach is a safe and effective alternative(AU)

Periodontitis and its associated factors in patients at the faculty of southern Brazil: a cross - sectional study

To verify the presence of periodontitis, its severity, and their association with associated factors based on medical records of patients who attended the Dental Clinic of the Faculty of Southern Brazil over 4 years. This is a cross-sectional study, which included 422 medical records of patients aged ≥ 18 years. The clinically analyzed data were: plaque index (PI),bleeding on probing (BOP), probing pocket depth (PPD), and clinical attachment level (CAL). Sociodemographic data, dental hygiene, harmful habits and chronic systemic diseases were described. Statistical analysis of binary logistic regression was used to verify the relationship between the severity of periodontitis and the exposure variables. The older adults [odds ratio (OR) = 2.36; 95% confidence interval (CI): 1.23-4.54 ­41 to 55 years and OR = 3.0; 95% CI: 1.49-6.09 ­56 to 87 years], and men (OR = 1.9; 95% CI: 1.18-3.14) showed higher chances of periodontitis severity. Smokers (OR = 3.54; 95% CI: 2.05-6.12), those with hypertension (OR = 2.11; 95% CI: 1.23-3.63) and with diabetes (OR = 2.10; 95% CI: 1.08-4.12) showed higher chances of developing advanced periodontitis. Advanced or severe periodontitis occurred in one-third of the patients. The findings showed that men, older adults, with systemic arterial hypertension, diabetes mellitus, and smokers are more susceptible to severe periodontitis.

Ectopic Papillary Thyroid Carcinoma presenting as right lateral neck mass: A case report / Journal of the ASEAN Federation of Endocrine Societies

@#A lateral neck mass can be the initial presentation of a papillary thyroid carcinoma. A 24-year-old female presented with a 2.0 x 2.0 cm, non-erythematous, non-tender, right lateral neck mass. A neck ultrasound showed an enlarged right jugulodigastric (Level II) lymph node and a normal-sized thyroid gland exhibiting mild parenchymal disease with no nodules. Positron emission tomography-computed tomography scan (PET-CT) showed an enlarged intensely fluorodeoxyglucose (FDG)-avid right level III lymph node, which may be primary versus metastatic. Fine-needle aspiration biopsy (FNAB) of the lymph node showed the presence of atypical cells that are highly suspicious for metastatic carcinoma. A cervical lymph node excision biopsy was performed and histopathology showed metastatic papillary thyroid carcinoma. The patient underwent total thyroidectomy with neck dissection. The final histopathologic examination of the thyroid gland revealed chronic lymphocytic thyroiditis with the lymph nodes negative for metastasis. She eventually underwent radioactive iodine ablation (RAI) with a dose of 30mCi. Post-RAI whole-body scan showed functioning thyroid tissue remnants with no distant metastasis. This case adds to the limited data that ectopic thyroid carcinoma can be present in patients who initially present with neck masses.