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O carcinoma papilífero de tireoide (CPT) é a neoplasia maligna mais comum na glândula tireoide. Embora essas lesões geralmente tenham um excelente prognóstico, há casos que apresentam características clínico-patológicas agressivas, com alto índice de metástase linfonodal e recorrência. Diante disso, novos biomarcadores moleculares têm sido pesquisados com a finalidade de esclarecer melhor os processos biológicos e moleculares envolvidos no desenvolvimento e progressão desta neoplasia. Dentre eles destaca-se as proteínas YAP, LATS2 e TEAD, constituintes da Via Hippo (VH), a qual é essencial em diversos processos biológicos, além de participar no processo da carcinogênese quando a via está desregulada. Dessa forma, esta pesquisa teve como objetivo avaliar as proteínas relacionadas YAP, LATS2 e TEAD, nos CPTs, com o intuito de verificar se estas moléculas podem influenciar o comportamento biológico destas lesões. A amostra foi composta por 31 casos de CPTs e 5 de adenomas foliculares (grupo controle). As informações clínico-patológicas foram coletadas e correlacionadas à imunoexpressão das proteínas YAP1, LATS-2 e TEAD nestas lesões. A avaliação da marcação foi realizada no núcleo e citoplasma, onde foram considerados como positivos os casos com mais de 20% dos núcleos marcados para cada um das moléculas. Quanto ao citoplasma, foi avaliado a intensidade para YAP1 e LATS2. Nesse compartimento os casos foram classificados em negativo (sem coloração), fraco (coloração marrom claro) e forte (cor marrom escuro). Os dados foram submetidos à análise estatística por meio dos testes Qui-quadrado de Pearson e Exato de Fisher, com o nível de significância estabelecido em 5% (p < 0,05). Na análise da imunoexpressão, observou-se que, para YAP, todos os casos (n=31;100%) de CPTs apresentaram positividade nuclear. Houve também, uma associação significativa da forte expressão da YAP no citoplasma com casos de CPTs, quando comparado ao grupo controle (p=0,001). Para a LATS2 houve uma baixa expressão citoplasmática na maioria dos casos dos CPTs (58,1%). Já para o TEAD, houve uma maior positividade nuclear para TEAD (p=0,029) nos CPTs. Em relação às associações com os dados clínico-patológicos não houve dados estatisticamente significativos relevantes. A menor expressão citoplasmática de LATS2 nos CPTs sugere que essa proteína pode não estar regulando a YAP, o que resulta em sua translocação para o núcleo. Já a elevada expressão nuclear de YAP e TEAD sugere que essas moléculas podem estar interagindo no núcleo. Com base nisso, propõe-se que a subregulação citoplasmática da LATS 2 e a interação nuclear YAPTEAD podem influenciar o processo de tumorigênese dos CPTs (AU).

Papillary thyroid carcinoma (PTC) is the most common malignant neoplasm of the thyroid gland. Although these lesions generally have an excellent prognosis, there are cases that present aggressive clinicopathological characteristics, with a high rate of lymph node metastasis and recurrence. Given this, new molecular biomarkers have been researched with the aim of better clarifying the biological and molecular processes involved in the development and progression of this neoplasm. Among them, the YAP, LATS2, and TEAD proteins, components of the Hippo Pathway (HP), stand out, which is essential in various biological processes and also participates in the carcinogenesis process when the pathway is deregulated. Therefore, this research aimed to evaluate the related proteins YAP, LATS2, and TEAD in PTCs, to verify whether these molecules can influence the biological behavior of these lesions. The sample consisted of 31 cases of PTCs and 5 follicular adenomas (control group). Clinicopathological information was collected and correlated with the immunoexpression of the YAP, LATS2, and TEAD proteins in these lesions. The evaluation of the staining was performed in the nucleus and cytoplasm, where cases with more than 20% of the nuclei stained for each of the molecules were considered positive. Regarding the cytoplasm, the intensity for YAP1 and LATS2 was evaluated. In this compartment, cases were classified as negative (no staining), weak (light brown staining), and strong (dark brown staining). Data were subjected to statistical analysis using Pearson's Chi-square and Fisher's Exact tests, with a significance level set at 5% (p < 0.05). The immunoexpression analysis showed that all PTC cases (100%) exhibited nuclear positivity for YAP. A significant association was also found between strong cytoplasmic YAP expression and PTC cases compared to the control group (p = 0.001). For LATS2, low cytoplasmic expression was observed in most PTC cases (58.1%). TEAD showed higher nuclear positivity (p = 0.029) in PTC cases. No statistically significant associations with clinicopathological data were found. The lower cytoplasmic expression of LATS2 in PTCs suggests that this protein may not regulate YAP, leading to its nuclear translocation. The elevated nuclear expression of YAP and TEAD indicates possible nuclear interaction. Therefore, the cytoplasmic subregulation of LATS2 and the nuclear YAP-TEAD interaction may influence PTC tumorigenesis (AU).

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El carcinoma papilar tiroideo es el tipo de cáncer más común de esta glándula, y su tratamiento de elección es la tiroidectomía. Entre las complicaciones asociadas resalta la parálisis de las cuerdas vocales, la cual ocurre por una lesión directa del nervio laríngeo recurrente durante la cirugía. Se presenta una paciente de 22 años de edad con este diagnóstico, a la cual se le realizó una tiroidectomía total; en el postoperatorio inmediato la paciente comenzó con estridor laríngeo intenso que requirió una traqueotomía de urgencia. En el examen físico se constató una parálisis bilateral de las cuerdas vocales y se decidió comenzar un tratamiento de rehabilitación del nervio recurrente laríngeo con laserterapia y HIVAMAT-200 como modalidades combinadas. Los resultados alcanzados con la fisioterapia fueron satisfactorios y la paciente se reintegró rápidamente a su ámbito familiar, escolar y social.

Papillary thyroid carcinoma is the most common type of cancer of this gland, and its treatment of choice is thyroidectomy. Vocal cord paralysis stands out among the associated complications, in which a direct injury to the recurrent laryngeal nerve occurs during surgery. We present a 22-year-old female patient with this diagnosis, who underwent a total thyroidectomy; in the immediate postoperative period the patient began with intense laryngeal stridor requiring an emergency tracheotomy. Physical examination revealed bilateral vocal cord paralysis and it was decided to begin rehabilitation treatment of the recurrent laryngeal nerve with laser therapy and HIVAMAT-200 as combined modalities. The results achieved with physiotherapy were satisfactory and the patient was quickly reintegrated into her family, school and social environment.

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Objective To investigate the role and mechanism of circ_0092315 in the proliferation and invasion of papillary thyroid carcinoma cells. Methods The expression of circ_0092315 in papillary thyroid carcinoma cells was examined by real-time fluorescence quantitative PCR.The proliferation and invasion of TPC-1 cells was assessed by CCK-8 and Transwell assays.The protein level of high mobility group A2 (HMGA2) was determined by Western blotting.The regulatory relationship of circ_0092315,microRNA-1256 (miR-1256),and HMGA2 was explored by bioinformatics tools,dual-luciferase reporter assay,real-time fluorescence quantitative PCR,and Western blotting. ++++Results circ_0092315 was overexpressed in papillary thyroid carcinoma cells (all P<0.001).circ_0092315 promoted the proliferation and invasion of TPC-1 cells (all P<0.001).The transfection of si-circ_0092315 up-regulated the expression of miR-1256 (P<0.001),and miR-1256 inhibitor up-regulated the protein level of HMGA2 (P<0.001). ++++Conclusion circ_0092315 is overexpressed in TPC-1 cells and it promotes the proliferation and invasion of TPC-1 cells by regulating the miR-1256/HMGA2 axis.

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Objective: To compare the efficacies between open surgery and axillary non-inflatable endoscopic surgery in papillary thyroid carcinoma (PTC). Methods: A retrospective analysis was performed on 343 patients with unilateral PTC treated by traditional open surgery (201 cases) and transaxillary non-inflating endoscopic surgery (142 cases) from May 2019 to December 2021 in the Head and Neck Surgery of Sichuan Cancer Hospital. Among them, 97 were males and 246 were females, aged 20-69 years. 1∶1 propensity score matching (PSM) was performed on the enrolled patients, and the basic characteristics, perioperative clinical outcomes, postoperative complications, postoperative quality of life (Thyroid Cancer-Specific Quality of Life), aesthetic satisfaction and other aspects of the two groups were compared after successful matching. SPSS 26.0 software was used for statistical analysis. Results: A total of 190 patients were enrolled after PSM, with 95 cases in open group and 95 cases in endoscopic group. Intraoperative blood losses for endoscopic and open groups were [20 (20) ml vs. 20 (10) ml, M (IQR), Z=-2.22], postoperative drainage volumes [170 (70)ml vs. 101 (55)ml, Z=-7.91], operative time [135 (35)min vs. 95 (35)min, Z=-7.34], hospitalization cost [(28 188.7±2 765.1)yuan vs. (25 643.5±2 610.7)yuan, x¯±s, t=0.73], postoperative hospitalization time [(3.1±0.9)days vs. (2.6±0.9)days, t=-3.24], and drainage tube placement time [(2.5±0.8) days vs. (2.0±1.0)days, t=-4.16], with statistically significant differrences (all P<0.05). There was no significant difference in surgical complications (P>0.05). There were significant diffferences between two groups in the postoperative quality of life scores in neuromuscular, psychological, scar and cold sensation (all P<0.05), while there were no statistically significant differences in other quality of life scores (all P>0.05). In terms of aesthetic satisfaction 6 months after surgery, the endoscopic group was better than the open group, with statistically significant difference (χ2=41.47, P<0.05). Conclusion: Endoscopic thyroidectomy by a gasless unilateral axillary approach is a safe and reliable surgical method, which has remarkable cosmetic effect and can improve the postoperative quality of life of patients compared with the traditional thyroidectomy.

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@#A 23-year-old woman underwent left thyroid lobectomy and isthmusectomy for a 2 cm diameter firm mass on the left side of the neck that was also visualized on ultrasonography. The specimen consisted of a 22-gram thyroid gland composed of the left lobe, isthmus and a pyramidal lobe. Cut section of the left lobe showed a 3.5 cm diameter solitary, discrete and encapsulated mass with a tan lobulated and solid cut surface. The rest of the thyroid tissues had red-brown meaty cut surfaces. Microscopic section shows a follicular-patterned proliferation enclosed by a thin fibrous capsule with frequent Sanderson polster-like papillary excrescences. (Figures 1 and 2) Both the follicular and the papillary structures are lined by cuboidal to columnar follicular epithelial cells that had ample eosinophilic to pale cytoplasm and uniformly sized, minimally enlarged, generally round, and monolayered nuclei without nuclear grooving, folds, pseudoinclusions, and chromatin clearing. There are no mitotic figures seen. Some of the papillary structures have delicate vascular cores. (Figure 3) There are no psammoma bodies noted. The follicles contain variable amounts of pale eosinophilic colloid ranging from colloid-poor crowded follicles to those with ample colloid that have frequent peripheral scalloping. (Figure 4) Exhaustive sections failed to disclose capsular or vascular invasion. Based on the microscopic features, a diagnosis of follicular adenoma with papillary architecture was rendered.

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This case report has described a case of papillary carcinoma of thyroglossal duct in a young male. This patient was admitted with a mass in the anterior neck for 2 years. Preoperative Bultrasonography, CT and MR showed a subcutaneous cystic mass with irregular calcification shadow in the central region of the neck without obvious enhancement. Initial diagnosis was thyroglossal duct cyst, and was excised by Sistrunk under general anesthesia. The postoperative pathological examination showed thyroglossal duct cyst combined with thyroid papillary carcinoma, which was confirmed by immunohistochemistry as thyroglossal duct papillary carcinoma.

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Background@#The majority of thyroid malignancies are differentiated thyroid carcinomas (DTCs). We examined the incidence, disease extent, recurrence and disease-specific mortality (DSM) of DTC among Filipinos residing in the Philippines and Filipino immigrants.@*Methodology@# In accordance with the 2020 PRISMA statement, we performed a systematic literature search in MEDLINE, Google Scholar, EBSCO, Cochrane and Clinicaltrials.gov for the period January 1, 1980 until January 27, 2022. Pooled incidence rate ratio and pooled proportions of disease extent, recurrence and DSM were determined.@*Results@#Literature search yielded 1,852 studies. Out of 26 articles retrieved, nine retrospective case controls and cohorts were included. Incidence of DTC was significantly higher in female Filipino immigrants compared with non-Hispanic whites (NHW). Distant metastases and recurrence were more common among Filipinos and Filipino immigrants compared with NHW. Limited data showed higher DSM in Filipino immigrants and NHW than Filipinos, which may be influenced by reporting bias.@*Conclusion@#This review supports the trend of increased incidence and recurrence of DTC among Filipinos, although case registries are essential to confirm these findings. In the setting of the newly released Philippine guidelines for DTC, prospective studies with active long-term follow-up will help detect any changes in the outcomes of DTC among Filipinos.

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Active surveillance, as a first-line treatment strategy for low-risk papillary thyroid microcarcinoma, has been recommended by guidelines worldwide. However, active surveillance has not been widely accepted by doctors and patients in China. In view of the huge challenges faced by active surveillance, doctors should improve their understanding of the "low risk" of papillary thyroid micropapillary cancer, identify some intermediate or high-risk cases, be familiar with the criteria and methods of diagnosis for disease progression, and timely turn patients with disease progression into more active treatment strategies. By analyzing the long-term cost-effectiveness of active surveillance, it is clear that medical expense is only one cost form of medical activities, and the health cost (thyroid removal and surgical complications) paid by patients due to"over-diagnosis and over-treatment" is the most important. Moreover, the weakening of the patients' social function caused by surgical procedures is a more hidden and far-reaching cost. The formulation of health economic policies (including medical insurance) should promote the adjustment of diagnosis and treatment behavior to the direction which is conducive to the long-term life and treatment of patients, improving the overall health level of society and reducing the overall cost. At the same time, doctors should stimulate the subjective initiative of patients, help them fully understand the impact of various treatment methods on their psychological and physical status, support patients psychologically, and strengthen their confidence in implementing active surveillance. By strengthening multi-disciplinary treatment team and system support, doctors can achieve risk stratification of papillary thyroid microcarcinoma, accurate judgment of disease progress, timely counseling for psychological problems, and long-term adherence to active surveillance. Improving the treatment level of advanced thyroid cancer is the key point of improve the prognosis. It is important to promote the development of active surveillance for low-risk papillary thyroid microcarcinoma. In the future, it is necessary to carry out multi-center prospective research and accumulate research evidence for promoting the standardization process of active surveillance. Standardized active surveillance will certainly benefit specific papillary thyroid microcarcinoma patients.

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@#Papillary thyroid carcinoma is the most common well-differentiated thyroid malignancy accounting for more than 80 to 90% of all thyroid tumors. It has an overall excellent prognosis owing to advances in screening via imaging and ultrasound-guided fine-needle aspiration biopsy, which have facilitated early detection, diagnosis, and surgical treatment followed by adjuvant radioactive iodine therapy. Exceptionally rare cases of papillary thyroid tumors may present with enormous growth due to delayed consultation and, thus, late diagnosis, posing a challenge to definitive management, quality of life, overall survival, and prognosis. We report a case of a 35-year-old woman who presented with a 4-year history of a bleeding exophytic and fungating anterior neck mass. Computed tomography showed a fungating mass arising from the left thyroid lobe that measured 14.1 x 14.0 x 11.1 cm with areas of necrosis and hemorrhage, left internal jugular vein thrombus formation, and compression of the left internal carotid artery. The mass causes a displacement of the trachea to the right side and multiple bilateral cervical lymphadenopathies. The patient was fully aware, and she consented to undergo wide excision, total thyroidectomy, neck dissection, and pectoralis major muscle flap reconstruction. However, she went into arrest intraoperatively attributed to massive pulmonary embolism. Papillary thyroid cancer is well known for its excellent prognosis. However, outcomes may not be favorable and can even be fatal in advanced and extensive cases. Although fungating papillary cancers are rare, they remain more common in the developing countries, where early detection and access to healthcare remains limited. They also represent a big challenge to surgeons. Even if the outcome was not good, we opted to report this case as there were many learning points. If only patients with good and excellent outcomes are reported in the literature, it will overestimate the treatment success of these complex cases.

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Background and Objective@#Epidemiological studies have shown that Filipinos have a higher prevalence of welldifferentiated thyroid cancer and a higher rate of recurrence. The BRAF V600E mutation has been proposed as a potential prognostic marker in aggressive papillary thyroid cancers. In this study, we determined whether this mutation is a risk factor for tumor recurrence in papillary thyroid cancer among Filipinos.@*Methods@#We conducted an age and sex-matched case-control study of patients with papillary thyroid cancer; we had two groups – with and without tumor recurrence – of 14 patients each, with at least a 5-year follow-up. We extracted the DNA samples from the patients’ (paraffin-embedded) tumor biopsy tissue blocks from thyroidectomy specimens, then detected the BRAF V600E mutation using polymerase chain reaction. The McNemar’s test for difference of proportions in paired data was used to determine the association of BRAF V600E mutation with recurrence. @*Results@#The BRAF V600E mutation was found in 57.14% of all cases. We found a prevalence of 64.29% among those with recurrence and 50.00% among those without recurrence, with no significant difference between the two groups (p = 0.688).@*Conclusion@#Our study showed the BRAF V600E mutation was not associated with recurrence. We encountered several limitations: we had limited data regarding molecular methodologies in the Philippine setting, we had a small sample size, and therefore we could not study other parameters (e.g., tumor characteristics, lymph node metastasis, stage of disease). We hope that this paves the way for future studies and collaborations to establish the role of BRAF V600E in Filipinos with papillary thyroid tumor recurrence.

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Objective:To investigate the relationship between parathyroid hormone（PTH） level and permanent hypoparathyroidism（PHPP） on the first day after radical papillary thyroidectomy, and its predictive value. Methods:A total of 80 patients with papillary thyroid cancer who underwent total thyroid resection and central lymph node dissection were collected and analyzed from January 2021 to January 2022. According to whether PHPP occurred after surgery, the patients were divided into hypoparathyroidism group and normal parathyroid function group, and univariate and binary logistics regression were used to analyze the correlation between PTH and serum calcium levels and PHPP on the first day after surgery in two groups. The dynamic changes of PTH at different time points after operation were analyzed. The area under the receiver operating characteristic was used to evaluate the predictive power of PTH on the development of PHPP after surgery. Results:Among the 80 patients with papillary thyroid cancer, 10 cases developed PHPP, with an incidence rate of 12.5%. Binary logistics regression analysis showed that PTH on the first postoperative day（OR=14.534, 95%CI: 2.377-88.858, P=0.004） was an independent predictive risk factor for postoperative PHPP. Taking PTH=8.75 ng/L on the first postoperative day as the cut-off value, the AUC of the area under the curve was 0.874（95%CI: 0.790-0.958, P<0.001）, the sensitivity was 71.4%, the specificity was 100%, and the Yoden index was 0.714. Conclusion:PTH level on the first day after total thyroid papillary carcinoma surgery is closely related to PHPP, and is an independent predictor of PHPP.

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Objective:To investigate the risk factors of recurrence after surgical resection of differentiated thyroid carcinoma combined with iodine-131 and TSH（Thyroid stimulating hormone） inhibition therapy. Methods:From January 2015 to April 2020, the clinical data of patients with structural recurrence and without recurrence were retrospectively collected after surgical treatment combined with iodine-131 and TSH inhibition therapy in the First Medical Center of PLA General Hospital. The general conditions of the two groups of patients were analyzed and the measurement data in line with the normal distribution was used for comparison between groups. For measurement data with non-normal distribution, the rank sum test was used for inter-group comparison. The Chi-square test was used for comparison between the counting data groups. Univariate and multivariate regression analyses were used to determine the risk factors associated with relapse. Results:The median follow-up period was 43 months（range 18-81 months） and 100 patients（10.5%） relapsed among the 955 patients. Univariate analysis showed that tumor size, tumor multiple, the number of lymph node metastases>5 in the central region of the neck, and the number of lymph node metastases>5 in the lateral region were significantly correlated with post-treatment recurrence（P<0.001, P=0.018, P<0.001, P<0.001）. Multivariate analysis showed that tumor size（adjusted odds ratio OR: 1.496, 95%CI: 1.226-1.826, P<0.001）, tumor frequency（adjusted odds ratio OR: 1.927, 95%CI: 1.003-3.701, P=0.049）, the number of lymph node metastases in the central neck region>5（adjusted odds ratio OR: 2.630, 95%CI: 1.509-4.584, P=0.001） and the number of lymph node metastases in the lateral neck region>5（adjusted odds ratio OR: 3.074, 95%CI: 1.649-5.730, P=0.001） was associated with tumor recurrence. Conclusion:The study showed that tumor size, tumor multiple, the number of lymph node metastases in the central region of the neck>5 and the number of lymph node metastases in the side of the neck >5 are independent risk factors for recurrence of differentiated thyroid cancer after surgical resection combined with iodine-131 and TSH inhibition therapy.

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Objective:To analyze the clinical significance of multigene assay in papillary thyroid carcinoma（PTC）. Methods:Patients who underwent thyroidectomy in a tertiary hospital from August 2021 to May 2022 were enrolled. The eight-gene panel was used to detect the tumor tissue of patients, and the correlation between gene mutations and clinical features was analyzed. Results:Among 161 patients, mutation rate of BRAF V600E, RET/PTC1 and TERT promotor were 82.0%, 6.8% and 4.3%, respectively. BRAF V600E mutation was more common in male patients（P=0.023）. TERT promotor-mutated tumors had a large diameter（P=0.019）, a high proportion of multifocal lesions（P=0.050）, and a large number of lymph node metastases（P=0.031）. Among 89 patients who completed preoperative BRAF detection, there was a strong consistency between the preoperative aspiration test and postoperative panel（Cohen κ=0.694, 95%CI: 0.482-0.906, P<0.01）. In the hematoxylin-eosin sections obtained from 80 patients, BRAF V600E was still the main type of gene mutation, and the classical/follicular type was more distributed. TERT promotor and RET/PTC1 mutation were the main genetic events for tall-cell/columnar/hobnail type and diffuse sclerosing type, respectively. One-way ANOVA showed that there were differences in diagnosis age（P=0.029） and tumor size（P<0.01） among different pathological types. Conclusion:As a simple and feasible clinical detection method for PTC, the multigene assay can supplement the identification of important genetic events other than BRAF V600E, and provide more prognostic information and follow-up hints for postoperative patients.

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Papillary thyroid carcinoma (PTC) is the most common pathological type of thyroid cancer,accounting for 90%.Most cases of PTC are inert tumors,while a few are invasive.Cervical lymph node metastasis is one of the major manifestations of invasive PTC.Preoperative accurate prediction of cervical lymph node metastasis is of great significance for the selection of therapeutic regimen and the evaluation of prognosis.New ultrasound technology is a non-invasive,convenient,and radiation-free examination method,playing a key role in predicting the cervical lymph node metastasis of PTC.This paper reviews the research status and makes an outlook on new ultrasound technology in predicting cervical lymph node metastasis of PTC.

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Objective To investigate the effect of calcification on the ultrasound-guided radiofrequency ablation(RFA)of papillary thyroid carcinoma(PTC).Methods We retrospectively analyzed the preoperative and follow-up data of 164 patients(182 nodules)with PTC treated by percutaneous ultrasound-guided RFA in the First Medical Center of Chinese PLA General Hospital from January 1,2018 to December 31,2021.The tumor status 12 months after RFA was taken as the endpoint event.The univariate Logistic regression analysis was employed to predict the influencing factors of incomplete ablation.The factors were then included in the multivariate Logistic regression analysis for prediction of the independent risk factors of incomplete ablation.Results The maximum nodule diameter(OR=1.16,95%CI=1.04-1.29,P=0.009)and calcification ratio >2/3(OR=19.27,95%CI=4.02-92.28,P<0.001)were the factors influencing the disappearance of lesion 12 months after RFA.Conclusions PTC with calcification can be treated with ultrasound-guided RFA.In the case of calcification ratio ≤ 2/3,this therapy demonstrates the effect equivalent to that of no calcification.

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Introducción: El cáncer de tiroides se posiciona como una de las neoplasias más prevalentes en Ecuador, manifestándose típicamente en la cuarta década de vida, con una mayor inciden-cia en mujeres. El subtipo histológico predominante es el papilar (CPT), y diversos estudios han evidenciado que hasta un 80% de los casos de CPT presentan la mutación BRAF. Esta mutación se ha asociado con factores de pronóstico desfavorable, como la presencia de me-tástasis ganglionares, estadíos tumorales avanzados, extensión extratiroidea y característi-cas histológicas agresivas. Además, se ha observado una relación con una mayor tasa de recurrencia y una respuesta reducida al tratamiento con yodo. Ante este contexto, esta inves-tigación se propone analizar la distribución de la mutación BRAF según características epide-miológicas e histopatológicas en pacientes con diagnóstico de cáncer papilar de tiroides en Ecuador. Materiales y métodos: Este estudio se llevó a cabo de manera descriptiva y retrospectiva, abarcando a pacientes con diagnóstico de cáncer papilar de tiroides a quienes se les practicó el análisis genético para la detección de la mutación BRAF. La muestra incluyó 106 historias clínicas que cumplían con los criterios de selección establecidos Resultados: La evaluación de las historias clínicas reveló la presencia de la mutación BRAF en el 75% de los casos. Este porcentaje fue más elevado en mujeres, individuos mayores de 45 años y residentes en áreas urbanas. Respecto a la ocupación, la mayoría de los pacientes se dedicaba a labores de limpieza y no presentaban antecedentes personales de exposición a radiación ionizante ni antecedentes oncológicos familiares. El 84% se encontraba en la etapa clínica I, y en su mayoría, la neoplasia estaba localizada en el lóbulo tiroideo derecho.Conclusión:Este análisis subraya la imperiosa necesidad de identificar los factores de riesgo vinculados con la aparición del carcinoma papilar de tiroides en la población ecuatoriana. Los resultados indican una prevalencia significativa de la mutación BRAF, lo que subraya su rele-vancia comomarcador pronóstico en esta enfermedad. Estos hallazgos pueden contribuir a una mejor comprensión de la epidemiología y la patogenia del cáncer de tiroides, así como a la mejora de las estrategias de prevención y tratamiento en el ámbito local.

Introduction: Thyroid cancer is positioned as one of the most prevalent neoplasms in Ecuador, typically manifesting in the fourth decade of life, with a higher incidence in women. The pre-dominant histological subtype is papillary carcinoma (PTC), and various studies presentshown that up to 80% of PTC cases present the BRAF mutation. This mutation has been as-sociated with unfavorable prognostic factors, such as the presence of lymph node metasta-ses, advanced tumor stages, extrathyroidal extension, and aggressive histologicalfeatures. Additionally, a correlationhas been observed with a higher recurrence rate and a reduced re-sponse toiodine treatment. Given this context, this research aims to analyze the distribution of the BRAF mutation according to epidemiological and histopathological characteristics in patients diagnosed with papillary thyroid cancer in Ecuador. Materials and methods: This retrospective descriptive study involved the analysis of genetic data from 106 medical records of patients diagnosed with papillary thyroid cancer who under-went BRAF mutation detection. The sample was selected based on established criteria. Results: Evaluation of medical records revealed the presence of the BRAF mutation in 75% of cases. This percentage was higher in women, individuals over 45 years of age, and residents in urban areas. Regarding occupation, most patients were dedicated to cleaning work and had no personal history of exposure to ionizing radiation orafamily history of cancer.Additionally, 84% of the patients were in clinical stage I and the neoplasmswerelocated in the right thyroid lobe.Conclusion: This analysis highlights the urgent need to identify risk factors linked to the ap-pearance of papillary thyroid carcinoma in the Ecuadorian population. The results indicate a significant prevalence of the BRAF mutation, underlining its relevance as a prognostic marker in this disease. These findings may contribute to a better understanding of the epidemiology and pathogenesis of thyroid cancerleadingtoimprovementsinprevention and treatment strategies at the local level.

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The incidence of complications during thyroidectomy is approximately 0-5-4% and tracheal injury associated with thyroidectomy occurs in 0.06%. A 48-year-old woman diagnosed with papillary carcinoma of the thyroid, right cervical nodule compatible with metastasis. Total thyroidectomy was performed, modified radical bilateral cervical resection, with a combined approach by sterenotomy and post surgical mediastinitis, where tracheal injury was produced and later there was infection at the surgery site that required re-intervention due to sternotomy dehiscence. The purpose of this article is to demónstrate the importance of diagnosing in a timely manner and establishing an adequate treatment to avoid complications.

La incidencia de complicaciones durante tiroidectomía es aproximadamente 0-5-4% y la lesión traqueal asociada a tiroidectomía se presenta en el 0,06%. Mujer de 48 años de edad diagnosticada de carcinoma papilar de tiroides, nódulo cervical derecho compatible con metástasis. Se realizó tiroidectomía total, resección cervical bilateral radical modificada, con abordaje combinado por esternotomía, donde se produce lesión traqueal y posteriormente presenta infección en el sitio de la cirugía que amerito reintervención quirúrgica por dehiscencia de esternotomía y mediastinitis posquirúrgica. Esté artículo tiene como finalidad recalcar la importancia del diagnóstico de forma oportuna y establecer un plan de tratamiento multidisciplinario para evitar complicaciones.

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Introdução: A presença de nódulos tireoidianos e câncer de tireoide pode ser resultado de uma complexa interação de fatores. O status iódico é um dos fatores mais importantes a ser estudado. Objetivos: Avaliar em um grupo de mulheres atendidas em um hospital terciário na cidade do Rio de Janeiro a associação entre o status de iodo, a presença de nódulos tireoidianos e o risco de malignidade tireoidiana - carcinoma papilífero da tireoide (CPT). Métodos: Neste estudo transversal, foram avaliadas 133 mulheres, com base na história clínica, dados antropométricos, ultrassom de tireoide, coleta de amostra única de urina para determinação da concentração urinária de iodo (CUI) pelo "Inductively Coupled Plasma Mass Spectrometry" (ICP-MS). CPT foi definido com base no laudo histopatológico pós-cirúrgico. Resultados: A mediana da CUI da população geral de mulheres foi 173,0 µg/L, considerada adequada. A prevalência de ioduria mais que adequada ou excessiva foi de 44,0% enquanto deficiência iódica foi encontrada em 20,3% das participantes. A mediana da CUI nas mulheres sem nódulos foi de 158,0µg/L vs. 207,1µg/L naquelas com nódulos, com diferença estatisticamente significativa entre os grupos (p=0,022). CUI > 200µg/L foi um fator de risco independente para nódulos tireoidianos (RR= 2,90, IC 95%=1,06- 7,95; p=0,038). O risco de CPT foi maior entre as pacientes com excesso de iodo quando comparado ao grupo com status de iodo adequado. CUI > 300µg/L foi independente e positivamente associado à presença de CPT (RR=4,67, IC 95%= 1,26- 17,34 p=0,021). A frequência do status excessivo de iodo foi maior em mulheres com CPT em relação às mulheres sem CPT (40,0 vs 17,0%; p= 0,032). Entretanto, a CUI não diferiu estatisticamente entre pacientes com CPT e naqueles sem câncer de tireoide (249,4µg/L vs 171,5 µg /L p=0,820). Conclusão: Nossos dados demonstram que os níveis aumentados da CUI estão associados a um maior risco de nódulos tireoidianos e CPT e indicam a necessidade de mais estudos envolvendo pacientes em áreas suficientes em iodo , para uma análise conclusiva entre o status de iodo e o câncer de tireoide.(AU)

Introduction: The presence of thyroid nodules and thyroid cancer may be the result of a complex interaction of factors. Iodine status is one of the most important factors to be studied. Objectives: To evaluate, in a group of women monitored at a university hospital in the city of Rio de Janeiro, the association between iodine status, the presence of thyroid nodules and the risk of thyroid malignancy - papillary thyroid carcinoma (PTC). Methods: In this cross-sectional study, 133 women were evaluated, based on clinical history and anthropometric data, thyroid ultrasound, a single sample collection for determination of urinary iodine concentration (UIC) by the "Inductively Coupled Plasma Mass Spectrometry" (ICP-MS). PTC was defined based on the post-surgical histopathological report. Results: The median UIC (mUIC) of the general population of women was 173,0 µg/L, which is considered adequate. The prevalence of more than adequate or excessive iodine was 44,0%, while iodine deficiency was present in 20,3% of the participants. The mUIC in women without nodules was 158,0µg/L vs. 207,1µg/L in those with nodules, with a statistically significant difference between groups (p=0,022). UIC > 200µg/L was an independent risk factor for thyroid nodules RR=2,90, CI=1,06-7,95; p=0,038). UIC > 300µg/L was independently and positively associated with the presence of PTC (RR=4,67, CI= 1,26-17,34; p=0,021). The frequency of excessive iodine status was higher in women with PTC compared to women without PTC (40,0 vs 17,0%; p= 0,032). However, UIC did not statistically differ between patients with PTC and those without thyroid cancer (249,4µg/L vs 171,5 µg /L; p=0,820). Conclusion: Our data demonstrate that increased UIC levels are associated with a higher risk of thyroid nodules and PTC and indicate the need for further studies involving patients in iodine-sufficient regions, for a conclusive analysis between iodine status and thyroid cancer.(AU)

ABSTRACT

Los nódulos tiroideos son una ocurrencia común. Aunque la mayoría de los nódulos son benignos y asintomáticos, un pequeño porcentaje de ellos puede ser maligno. Por esta razón, es crucial identificar los nódulos malignos y proporcionar el tratamiento apropiado

ABSTRACT

Introducción. Existen resultados inconsistentes con relación al planteamiento de la hipótesis que sugiere una mayor probabilidad de documentar un carcinoma papilar de tiroides en especímenes quirúrgicos con cambios compatibles con tiroiditis linfocítica crónica. En los metaanálisis existentes se han incluido estudios no comparables metodológicamente y no se proponen claras fuentes de sesgo, justificación para la realización del presente metaanálisis. Métodos. Se realizó una búsqueda bibliográfica en Pubmed y Embase. Fueron obtenidos estudios retrospectivos donde se comparaba la prevalencia de carcinoma papilar de tiroides en especímenes con y sin cambios por tiroiditis linfocítica crónica. La evidencia recolectada fue sintetizada estadísticamente. Resultados. Un total de 22 artículos fueron incluidos. La población estuvo conformada por 63.548 especímenes. El OR combinado fue 1,81 (IC95%: 1,51-2,21). Hubo heterogeneidad entre la distribución de las razones de oportunidad entre los estudios (I2= 91 %; p>0,00001). La forma del gráfico en embudo de los estudios incluidos en el análisis parece estar simétrica, lo que indica la ausencia del sesgo atribuible a los estudios pequeños. Conclusiones. La literatura actual sugiere que existe un mayor riesgo de documentar un carcinoma papilar de tiroides en especímenes quirúrgicos en los que se observan cambios compatibles con tiroiditis linfocítica crónica; sin embargo, existen fuentes de sesgo que no será posible controlar en estudios retrospectivos, por lo que recomendamos estudiar la hipótesis que sugiere una mayor probabilidad de diagnosticar un carcinoma papilar de tiroides en especímenes con cambios compatibles con tiroiditis linfocítica crónica mediante metodologías prospectivas

Introduction. Inconsistent results exist in the literature regarding the hypothesis statement suggesting an increased likelihood of documenting papillary thyroid carcinoma (PTC) in surgical specimens with changes compatible with chronic lymphocytic thyroiditis. Existing meta-analyses have included studies that are not methodologically comparable and do not propose clear sources of bias, thus, this is justification for the present meta-analysis. Methods. A literature search in Pubmed and Embase was performed from January 1, 1950 to December 31, 2020. Retrospective studies comparing the prevalence of papillary thyroid carcinoma in specimens with and without chronic lymphocytic thyroiditis changes were obtained. The collected evidence was statistically analyzed. Results. A total of 22 articles were included. The study population consisted of 63,548 surgical specimens. The pooled OR, based on the studies, was 1.81 (95% CI: 1.51-2.21). There was heterogeneity between the distribution of prevalence ratios and opportunity ratios across studies (I²= 91%; p>0.00001). The funnel plot shape of the studies included in the analysis appears to be symmetrical, indicating the absence of bias attributable to small studies. Conclusions. The current literature suggests that there is an increased risk of documenting papillary thyroid carcinoma in surgical specimens in which chronic lymphocytic thyroiditis-compatible changes are observed; however, there are sources of bias that will not be possible to control for in retrospective studies, so we recommend studying the hypothesis suggesting an increased likelihood of diagnosing PTC in specimens with chronic lymphocytic thyroiditis-compatible changes using prospective methodologies