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1.
Rev. colomb. cir ; 39(1): 70-84, 20240102. tab, fig
Article in Spanish | LILACS | ID: biblio-1526809

ABSTRACT

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.


Subject(s)
Humans , Thyroid Diseases , Vocal Cords , Diagnostic Imaging , Thyroid Gland , Ultrasonography , Larynx
2.
Cambios rev. méd ; 22 (2), 2023;22(2): 927, 16 octubre 2023. ilus, tabs
Article in Spanish | LILACS | ID: biblio-1516527

ABSTRACT

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).


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Antithyroid Agents , Thyroid Hormones , Graves Disease , Endocrinology , Graves Ophthalmopathy , Hyperthyroidism , Thyroid Diseases , Thyroid Gland , Iodine Deficiency , Thyroid Crisis , Adenoma , Ecuador , Goiter, Nodular
3.
Chinese Journal of Pathology ; (12): 820-826, 2023.
Article in Chinese | WPRIM | ID: wpr-1012314

ABSTRACT

Objective: To investigate the clinicopathological features, immunophenotype and gene alterations of thyroid-like low-grade nasopharyngeal papillary adenocarcinoma (TL-LGNPPA). Methods: Fifteen case of TL-LGNPPA diagnosed at Zhejiang Cancer Hospital (5 cases) and the First Affiliated Hospital, Zhejiang University School of Medicine (10 cases) from November 2011 to August 2020 were collected. Clinical and pathological examinations, immunohistochemical staining and next-generation sequencing were performed. The clinicopathological and molecular characteristics were summarized, and relevant literature was reviewed. Results: Fifteen patients were identified and included. Their median age was 36 years (range, 20-60 years). The male-female ratio was 1.0∶1.1. The most common symptoms were epistaxis and nasal obstruction. The neoplasms were located on the roof of the nasopharynx or the posterior margin of the nasal septum. The pathological features included complex papillary and glandular structures mainly composed of single or pseudostratified cubic and columnar cells, with mild to moderate cytological atypia. In some cases, spindle cell features, nuclear grooves, ground glass nuclei, squamous metaplasia, or scattered psammoma bodies were identified. In addition, nuclear polar reversal cells, hobnail cells and micropapillary structures were found, but have not been reported in previous literature. Immunohistochemistry showed that the tumor cells were diffusely positive for TTF1, CK7, vimentin and CKpan; focally positive for p40, CK5/6 and p16; and negative for Tg, NapsinA, CK20, CDX2, S-100 and PAX8. The Ki-67 positive rates ranged from 1% to 20% and were≤10% in thirteen cases (13/15). EBER in situ hybridization was negative in all cases. DNA sequencing of 6 specimens was performed and all specimens were found harboring gene mutations (EWSR1, SMAD2, ROS1, JAK3, GRIN2A, ERRCC5, STAT3, and TET2), but no hot spot gene alterations were found. No MSI-H and MMR related gene changes were detected. All tumors showed low tumor mutation burden. All 15 patients underwent endoscopic surgery, and only 1 of them underwent radiotherapy postoperatively. All patients were recurrence free and alive at the end of follow-up periods (range: 23 to 129 months). Conclusions: TL-LGNPPA is a rare indolent tumor of the nasopharynx and exhibits a unique morphology and immunophenotype. Endoscopic resection is an effective treatment for TL-LGNPPA with excellent overall prognosis.


Subject(s)
Humans , Male , Female , Adult , Thyroid Gland/pathology , Adenocarcinoma, Papillary/pathology , Nasopharyngeal Neoplasms/pathology , Protein-Tyrosine Kinases , Proto-Oncogene Proteins , Nasopharynx/pathology , Biomarkers, Tumor
4.
Journal of Clinical Otorhinolaryngology Head and Neck Surgery ; (12): 832-836, 2023.
Article in Chinese | WPRIM | ID: wpr-1011053

ABSTRACT

Objective:To investigate the application value of near-infrared autofluorescence imaging in identifying and protecting parathyroid glands in endoscopic thyroid surgery. Methods:From May 2022 to February 2023, 158 patients who underwent endoscopic thyroid surgery in the Department of Thyroid and Breast Vascular Surgery of Guilin People's Hospital were selected. The endoscopic fluorescence camera system was used to monitor the parathyroid glands under autofluorescence during endoscopic thyroid surgery. A total of 214 pieces were collected, among which the first 15 cases that could not be preserved in situ during the operation needed to be autotransplanted or the tissue clamped parts that could not be clearly identified as parathyroid glands were sent to fast-frozen pathology to determine whether they were parathyroid glands. Results:Among the first 15 patients who could not be preserved in situ during the operation or whose anatomy could not be clearly defined, 23 parathyroid glands were detected by autofluorescence imaging, 21 parathyroid glands were confirmed by pathology, and 2 were adipose tissue, with an accuracy rate of 91.30%; 158 patients underwent surgery Blood calcium decreased 2 hours after operation compared with preoperative blood calcium(P<0.05), decreased blood calcium 5 days after operation compared with preoperative blood calcium(P<0.01), and increased slightly 5 days after the operation compared to blood calcium 2 hours after the operation, but the difference was not statistically significant(P>0.05); while comparing parathyroid hormone(PTH), PTH at 2 hours after operation decreased significantly compared with PTH before operation(P<0.01), and PTH at 5 days after operation compared with PTH before operation PTH also decreased(P<0.01), but increased compared with PTH 2 hours after operation(P=0.001). Conclusion:In laparoscopic thyroid surgery, the application of near-infrared autofluorescence imaging technology can help surgeons quickly identify and protect parathyroid glands, and reduce the incidence of permanent hypoparathyroidism. Combining autofluorescence imaging, visual anatomy recognition under magnification of laparoscope, and intraoperative frozen pathological examination "trinity" method can improve the success rate of parathyroid gland recognition.


Subject(s)
Humans , Parathyroid Glands/transplantation , Thyroid Gland/surgery , Calcium , Parathyroid Hormone , Optical Imaging/methods , Laparoscopy , Thyroidectomy/methods
5.
Philippine Journal of Surgical Specialties ; : 9-19, 2023.
Article in English | WPRIM | ID: wpr-984296

ABSTRACT

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.


Subject(s)
Thyroid Gland
6.
Chinese Journal of Lung Cancer ; (12): 369-376, 2023.
Article in Chinese | WPRIM | ID: wpr-982168

ABSTRACT

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.


Subject(s)
Humans , Carcinoma, Non-Small-Cell Lung/therapy , Retrospective Studies , Thyroid Gland , Lung Neoplasms/therapy , Immunotherapy/adverse effects , Pleural Effusion
7.
Journal of the ASEAN Federation of Endocrine Societies ; : 120-124, 2023.
Article in English | WPRIM | ID: wpr-984401

ABSTRACT

@#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.


Subject(s)
Thyroid Gland , Fibroma , Immunohistochemistry , Thyroid Nodule
8.
Chinese Journal of Medical Genetics ; (6): 1191-1196, 2023.
Article in Chinese | WPRIM | ID: wpr-1009274

ABSTRACT

OBJECTIVE@#To assess the influence of thyroid function on the fetal fraction (FF) during the second trimester of pregnancy.@*METHODS@#A total of 1 861 pregnant women undergoing non-invasive prenatal testing (NIPT) and thyroxine function testing at 12 ~ 26 gestational weeks at the Affiliated Suzhou Hospital of Nanjing Medical University/Suzhou Municipal Hospital from January 2016 to December 2020 were selected as the study subjects. Univariate analysis and multivariate regression models were used to assess the correlation between free thyroxine 4 (FT4) levels and FF.@*RESULTS@#Univariate linear regression analysis indicated that the FF is correlated to the level of FT4 (b = 0.035, P < 0.001). The median fetal FF was 10.78% (IQR: 8.2%, 13.82%), and this has increased along with the level of FT4 from 10.58% at <= 12.0 pmol/L to 11.77% at > 16.0 pmol/L. After further adjustment of gestational age and body mass index (BMI), the FF showed an increase trend along with the increase of FT4 levels, and a trend test also showed a statistical significance (Ptrend < 0.001).@*CONCLUSION@#Maternal FF can be affected by the level of free thyroxine during the second trimester of pregnancy.


Subject(s)
Pregnancy , Female , Humans , Pregnancy Trimester, Second , Thyroid Gland , Thyroxine , Fetus , Gestational Age
9.
Journal of Clinical Otorhinolaryngology Head and Neck Surgery ; (12): 389-392, 2023.
Article in Chinese | WPRIM | ID: wpr-982755

ABSTRACT

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.


Subject(s)
Male , Humans , Adult , Hypercalcemia/diagnosis , Hyperparathyroidism, Primary/surgery , Parathyroid Hormone , Hypocalcemia/complications , Thyroid Gland , Calcium
10.
Biomedical and Environmental Sciences ; (12): 917-929, 2023.
Article in English | WPRIM | ID: wpr-1007866

ABSTRACT

OBJECTIVE@#This study explored whether thyroglobulin and thyroid disease prevalence rates were higher in pregnant Chinese women with a median urinary iodine concentration of 100-149 µg/L, compared with those with a median urinary iodine concentration of 150-249 μg/L maintained through sustainable universal salt iodization.@*METHODS@#This was a cross-sectional study in which 812 healthy pregnant women were enrolled to collect samples of their household edible salt, urine, and blood during their routine antenatal care in the 18 counties in Fujian Province, China. The levels of salt iodine concentration, urinary iodine concentration (UIC), free triiodothyronine (FT3), free thyroid hormone (FT4), thyroid-stimulating hormone (TSH), thyroglobulin (Tg), thyroid peroxidase antibody and thyroglobulin antibody were assessed during the routine antenatal care visits.@*RESULTS@#The median UIC (mUIC) in pregnant women was 130.8 μg/L (interquartile range = 91.5-198.1 μg/L) in the counties with an mUIC of 100-149 μg/L (Group I), and 172.0 μg/L (interquartile range = 123.5-244.4 μg/L) in the counties with an mUIC of 150-249 μg/L (Group II). Goiter prevalence and thyroid nodule detection rates showed no difference between Group I and Group II ( P > 0.05). Except for FT4 values, the TSH, FT4, FT3, Tg and Tg values > 40 (μg/L) and the thyroid diseases prevalence rate (TDR) showed no significant differences between Group I and Group II ( P > 0.05), whether or not iodine supplementation measures were taken.@*CONCLUSION@#Compared with an mUIC of 150-249 μg/L, not only there was no difference in thyroid morphology, but also the Tg value, rate of Tg values > 40 µg/L, and TDR were not higher in pregnant women in the counties with an mUIC of 100-149 μg/L achieved through sustainable universal salt iodization in Fujian Province, China.


Subject(s)
Female , Humans , Pregnancy , Cross-Sectional Studies , Iodine/urine , Pregnant Women , Sodium Chloride, Dietary , Thyroglobulin , Thyroid Gland , Thyrotropin , East Asian People
11.
Journal of the ASEAN Federation of Endocrine Societies ; : 149-153, 2023.
Article in English | WPRIM | ID: wpr-1003695

ABSTRACT

@#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.


Subject(s)
Histiocytosis, Langerhans-Cell , Thyroid Gland
12.
Philippine Journal of Otolaryngology Head and Neck Surgery ; : 35-41, 2023.
Article in English | WPRIM | ID: wpr-1003647

ABSTRACT

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.


Subject(s)
Thyroid Diseases , Thyroid Neoplasms , Goiter , Thyroid Gland , General Surgery , Thyroidectomy , Sternum , Manubrium
13.
Rev. venez. cir ; 76(1): 10-14, 2023. tab
Article in Spanish | LILACS, LIVECS | ID: biblio-1552933

ABSTRACT

La comunidad científica se ha preocupado por cuantificar el volumen tiroideo según variables como sexo, edad y deficiencias de yodo asociadas, sin embargo, pese al uso globalizado de TI-RADS para estimación de riesgo de malignidad en la patología tiroidea, no existe suficiente información en relación a si el tamaño de la glándula guarda o no relación con esta escala. Objetivo: comparar el Volumen Tiroideo con TI-RADS en pacientes atendidos en la unidad de ecografía diagnóstica del Centro Clínico Naguanagua en el período enero 2022 - enero 2023. Métodos: estudio observacional-descriptivo de nivel comparativo, con diseño transversal y prospectivo. Muestra no probabilística censal, abarcando la totalidad de los pacientes a los cuales se les efectuó ecografía tiroidea en el período establecido. Se efectuó un registro en cuanto a la cuantificación del volumen de: lóbulo tiroideo derecho, lóbulo tiroideo izquierdo y total de tiroides, TI-RADS, edad y sexo del paciente. Se utilizó el estadístico ANOVA y se empleó el programa Statistical® de licencia libre. Resultados: muestra de 126 pacientes, con edad promedio de 51,71 años ± 1,44, mediana de 53 años. Cuando se comparó el Volumen Total de Tiroides con TI-RADS, se constató que el mayor promedio lo registraron aquellos pacientes clasificados como 4B (p <0,05). Conclusión: aun cuando se registran mayores promedios de volumen total glandular en pacientes con hallazgos nodulares, llama la atención que entre los datos registrados existan pacientes con valores muy similares a lo reportado en la literatura como volúmenes normales en presencia de patología nodular tiroidea(AU)


The scientific community has been concerned with quantifying thyroid volume according to variables such as sex, age, and associated iodine deficiencies; however, despite the global use of TI-RADS to estimate the risk of malignancy in thyroid pathologies, there is not enough information in regarding whether or not the size of the gland is related to this scale. Objective: to compare the Thyroid Volume with TI-RADS in patients treated in the diagnostic ultrasound unit of the Naguanagua Clinical Center in the period January 2022 - January 2023. Methods: observational-descriptive study of a comparative level, with a crosssectional and prospective design. Non-probabilistic census sample, covering all the patients who underwent thyroid ultrasound in the established period. A record was made regarding the quantification of the volume of: right thyroid lobe, left thyroid lobe and total thyroid, TI-RADS, age and sex of the patient. The ANOVA statistic was used and the free license Statistical® program was used. Results: sample of 126 patients, mean age 51.71 ± 1.44 years, median 53 years. When the Total Thyroid Volume was compared with TI-RADS, it was found that the highest mean was registered by those patients classified as 4B (p <0.05). Conclusion: even when higher total glandular volume averages are recorded in patients with nodular findings, it is noteworthy that among the recorded data there are patients with values very similar to those reported in the literature as normal volumes in the presence of thyroid nodular pathology(AU)


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Thyroid Diseases , Thyroid Gland/anatomy & histology , Diagnostic Imaging , Thyroid Nodule/diagnostic imaging
14.
Rev. venez. cir ; 76(1): 76-79, 2023. ilus
Article in Spanish | LILACS, LIVECS | ID: biblio-1552972

ABSTRACT

Introducción: Las células de Hürtle fueron descritas por Max Askanazy en 1898, aunque su denominación inapropiada ha permanecido en el léxico. Pueden observarse en una amplia variedad de lesiones tiroideas, desde afecciones no neoplásicas hasta francamente malignas. Caso clínico: Femenina de 62 años de edad, asmática e hipertensa controlada, alérgica al yodo y a la penicilina, quien inicia enfermedad actual 1 año previo al presentar aumento de volumen en región anterior del cuello. Ecografía tiroidea reportó glándula aumentada de tamaño, con nódulo tiroideo derecho, complejo de 4 cm; y nódulo tiroideo izquierdo, complejo de 2 cm, TI-RADS 4C. Tomografía computarizada reportó lesión ocupantne de espacio del lóbulo tiroideo derecho de 6 cm y nódulos tiroideos izquierdos de 3 y 2 cm. Pruebas tiroideas sin alteraciones. Se realizó tiroidectomía total. Diagnóstico histopatológico: adenoma de células de Hürtle. Conclusión: En la actualidad, el término correcto es neoplasia de células oncocíticas, bien sea para el adenoma o para el carcinoma. Este tipo de tumores se presenta con mayor frecuencia en mujeres de mediana edad y con un tamaño considerable al momento del diagnóstico. Es necesario establecer un protocolo de acción ante el diagnóstico presuntivo mediante punción por aspiración por aguja fina, debido a la dificultad para diferenciar entre patología benigna y maligna, con la finalidad de garantizar una conducta terapeútica adecuada(AU)


Introduction: Hürtle cells were described by Max Askanazy in 1898, although their inappropriate name has remained in the lexicon. They can be seen in a wide variety of thyroid lesions, from non-neoplastic to frankly malignant conditions. Clinical case: A 62-year-old female, asthmatic and controlled hypertensive, allergic to iodine and penicillin, who started the current disease 1 year before presenting volume increase in the anterior region of the neck. Thyroid ultrasound reported an enlarged gland, with a 4-cm complex right thyroid nodule; and left thyroid nodule, 2 cm complex, TI-RADS 4C. Computed tomography reported a 6 cm space-occupying lesion of the right thyroid lobe and 3 and 2 cm left thyroid nodules. Thyroid tests without alterations. Total thyroidectomy was performed. Histopatological diagnosis: Hürtle cell adenoma. Conclusion: Currently, the correct term is oncocytic cell neoplasm, either for adenoma or for carcinoma. This type of tumors occurs more frequently in middle-aged women and with a considerable size at the time of diagnosis. It is necessary to establish a protocol of action before the presumptive diagnosis by means of fine needle aspiration procedure, due to the difficulty to differentiate between benign and malignant pathology, with the purpose of guaranteeing an adequate therapeutic conduct(AU)


Subject(s)
Humans , Female , Middle Aged , Thyroid Gland/pathology , Thyroid Neoplasms , Thyroid Nodule , Epithelium , Iodine
15.
Rev. bras. ginecol. obstet ; 45(10): 557-561, 2023. tab
Article in English | LILACS | ID: biblio-1529881

ABSTRACT

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.


Subject(s)
Humans , Female , Pregnancy , Thyroid Gland , Body Mass Index , Thyroid Nodule , Iodine
16.
Revue Africaine de Médecine Interne ; 10(1-2): 26-32, 2023. tables
Article in French | AIM | ID: biblio-1511811

ABSTRACT

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.


Subject(s)
Thyroid Gland
17.
Mali méd. (En ligne) ; 38(3): 27-32, 2023. figures, tables
Article in French | AIM | ID: biblio-1516106

ABSTRACT

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.


Subject(s)
Humans , Male , Female , Thyroid Gland , Thyroid Nodule , Ultrasonic Therapy
18.
Acta méd. costarric ; 64(3)sept. 2022.
Article in Spanish | LILACS, SaludCR | ID: biblio-1447058

ABSTRACT

El linfoma folicular de tiroides es una entidad rara que representa menos del 2% de los linfomas extranodales y cuyo principal factor de riesgo es la tiroiditis de Hashimoto. Suele afectar con mayor predisposición a pacientes adultos mayores, en los que con frecuencia se presenta como una masa de crecimiento rápido con compromiso de las estructuras adyacentes en el cuello. Sin embargo, dada su rara incidencia, esta patología debe ser sospechada por el clínico para un diagnóstico temprano oportuno. Aunque en la actualidad no existen guías de manejo estandarizadas para esta entidad, acostumbra tener buena respuesta a radioterapia y quimioterapia. El presente caso describe la historia de un paciente con una recaída de linfoma no Hodgkin de tipo folicular de alto grado localizado en tiroides que se presentó a urgencias con disfonía, parálisis bilateral de cuerdas vocales, cambio en el tono de la voz y disfagia, con el antecedente de un linfoma folicular de alto grado en localización retroperitoneal y en remisión luego de 8 ciclos de quimioterapia con rituximab, ciclofosfamida, doxorubicina, vincristina y prednisona, el cual presentó citorreducción luego del tratamiento con quimioterapia con el protocolo de rituximab, dexametasona, citarabina y cisplatino.


Follicular thyroid lymphoma is a rare entity that represents less than 2% of extranodal lymphomas; and whose main risk factor is Hashimoto's thyroiditis. This tends to affect older adult patients with greater predisposition, where it usually presents as a rapidly growing mass with compromise of the adjacent structures in the neck. However, given its rare incidence, this pathology should be suspected by the clinician for an early diagnosis. Although there are currently no standardized management guidelines for this entity, it usually responds well to radiotherapy and chemotherapy. The present case describes the history of a patient with a relapse of high-grade follicular-type NHL located in the thyroid who presented to the emergency room with dysphonia, bilateral paralysis of the vocal cords, change in tone of voice and dysphagia, with the history of high-grade follicular lymphoma in retroperitoneal location in remission after 8 cycles of chemotherapy with Rituximab, Cyclophosphamide, Doxorubicin, Vincristine and Prednisone, which presented cytoreduction after treatment with chemotherapy with the protocol Rituximab, Dexamethasone, Cytarabine and Cisplatin.


Subject(s)
Humans , Male , Middle Aged , Lymphoma, Non-Hodgkin/diagnostic imaging , Lymphoma, Follicular/diagnostic imaging , Thyroid Gland , Costa Rica
19.
Rev. colomb. cir ; 37(4): 588-596, 20220906. tab
Article in Spanish | LILACS | ID: biblio-1396345

ABSTRACT

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.


Subject(s)
Humans , Thyroid Neoplasms , Thyroid Cancer, Papillary , Postoperative Complications , Prognosis , Thyroid Gland , Thyroidectomy
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