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Gac. méd. Méx ; 157(1): 19-24, ene.-feb. 2021. tab, graf
Article in Spanish | LILACS | ID: biblio-1279068


Resumen Introducción: La elastografía por ondas de corte (SWE) ha demostrado ser predictiva de malignidad en nódulos tiroideos. Objetivo: Determinar mediante SWE, el punto de corte de la rigidez con mayor especificidad y sensibilidad para detectar nódulos tiroideos que requieren cirugía. Métodos: Estudio transversal de pacientes con nódulos tiroideos evaluados ultrasonográficamente en un periodo de tres años; se empleó la clasificación TI-RADS y mediante SWE se determinó la rigidez de los nódulos. Con el sistema Bethesda se clasificaron las muestras histopatológicas y mediante curva ROC se obtuvo el punto de corte de la rigidez con mayor especificidad y sensibilidad. Resultados: 41 % de los nódulos fue TI-RADS 5 y 59 %, TI-RADS 1-4. En los TI-RADS 5, la mediana de rigidez de los nódulos con categoría IV-VI del sistema Bethesda fue de 35.9 kPa y en los nódulos con TI-RADS 1-4, 21.6 kPa. En los nódulos TI-RADS 5, la rigidez > 32.5 kPa tuvo especificidad de 75 % y sensibilidad de 57 % para detectar los que requieren cirugía; en los TI-RADS 1-4, el valor de corte de 21.5 kPa tuvo especificidad de 63 % y sensibilidad de 51 %. Conclusión: La rigidez determinada por SWE es útil para detectar nódulos que requerirán exploración quirúrgica.

Abstract Introduction: Shear-wave elastography (SWE) has been shown to be predictive of malignancy in thyroid nodules. Objective: To determine, by SWE, the stiffness cutoff point with the highest specificity and sensitivity to detect thyroid nodules that require surgery. Methods: Cross-sectional study of ultrasonographically-evaluated patients for thyroid nodules over a period of three years; the TI-RADS classification system was used, and nodule stiffness was determined by SWE. Histopathological specimens were classified using the Bethesda system, and the stiffness cutoff point with the highest specificity and sensitivity was obtained using ROC curves. Results: Forty-one percent of the nodules were classified as TI-RADS 5, and 59 %, as TI-RADS 1-4. In TI-RADS 5 nodules, median stiffness of those in Bethesda system IV-VI categories was 35.9 kPa; in nodules with TI-RADS 1-4, 21.6 kPa. In TI-RADS 5 nodules, a cutoff point > 32.5 kPa had a specificity of 75 % and sensitivity of 57 % to detect those requiring surgery; in TI-RADS 1 to 4 nodules, a cutoff point of 21.5 kPa had a specificity of 63 % and sensitivity of 51 %. Conclusion: SWE-determined stiffness is useful to detect nodules that require surgical evaluation.

Humans , Male , Female , Middle Aged , Aged , Thyroid Nodule/diagnostic imaging , Elasticity Imaging Techniques/methods , Thyroid Gland/pathology , Thyroid Gland/diagnostic imaging , Cross-Sectional Studies , Sensitivity and Specificity , Thyroid Nodule/pathology , Biopsy, Fine-Needle/methods
Arch. endocrinol. metab. (Online) ; 64(3): 269-275, May-June 2020. tab, graf
Article in English | LILACS | ID: biblio-1131093


ABSTRACT Objective Acromegaly is characterized by high neoplastic morbidity as a side effect of growth hormone (GH) hypersecretion. Increased incidence of goiter, thyroid carcinoma, and thyroid dysfunction is also reported. The aim of the present study was to find the prevalence of thyroid dysfunction and goiter in patients with acromegaly and determine its relationship to disease activity, disease duration, and the presence of secondary hypothyroidism. Subjects and methods In a cross-sectional study of the period 2008-2012 were included 146 patients with acromegaly (56 men, 90 women) of mean age 50.3 ± 12.4 years. Acromegaly disease activity and thyroid function were evaluated in all patients. Thyroid ultrasonography was performed to calculate thyroid volume and detect the presence of nodular goiter. Results Ninety-one patients were determined to have an active disease, and 55, a controlled disease. The mean thyroid volume in patients without previous thyroid surgery was 37.6 ± 38.8 mL. According to disease activity, thyroid volume was significantly higher in patients with active disease (38.5 ± 45.4 mL vs. 27.2 ± 18.4 mL, p = 0.036). A weak positive correlation was found between thyroid volume and insulin-like growth factor 1 (IGF-1) in the whole group and in females (R = 0.218; p = 0.013, and R = 0.238; p = 0.037, respectively). There was no significant correlation of thyroid volume with disease duration and GH level in the whole group and in both sexes. The patients with secondary hypothyroidism had twofold smaller thyroid volume, relative to the rest of the group. The prevalence of thyroid dysfunction was 39%, with a female to male percentage ratio of 1.73. Goiter was diagnosed in 87% of patients, including diffuse goiter (17.1%) and nodular (69.9%), with no significant difference between patients with active and controlled disease or the presence of secondary hypothyroidism. Conclusions Thyroid volume in patients with acromegaly depends on disease activity and the presence of secondary hypothyroidism as a complication. The increased prevalence of nodular goiter determines the need of regular ultrasound thyroid evaluation in the follow-up of patients with acromegaly. Arch Endocrinol Metab. 2020;64(3):269-75

Humans , Male , Female , Adult , Thyroid Gland/physiopathology , Acromegaly/complications , Goiter, Nodular/physiopathology , Hypothyroidism/physiopathology , Thyroid Function Tests , Thyroid Gland/diagnostic imaging , Thyroid Hormones/blood , Acromegaly/physiopathology , Cross-Sectional Studies , Ultrasonography , Goiter, Nodular/diagnosis , Hypothyroidism/etiology , Hypothyroidism/diagnostic imaging , Middle Aged
Clinics ; 75: e1594, 2020. tab, graf
Article in English | LILACS | ID: biblio-1133448


OBJECTIVE: Fine-needle aspiration cytology is the risk stratification tool for thyroid nodules, and ultrasound elastography is not routinely used for the differential diagnosis of thyroid cancer. The current study aimed to compare the diagnostic parameters of ultrasound elastography and fine-needle aspiration cytology, using surgical pathology as the reference standard. METHODS: In total, 205 patients with abnormal thyroid function test results underwent ultrasound-guided fine-needle aspiration cytology on the basis of the American College of Radiology Thyroid Imaging-Reporting and Data System classification and strain ultrasound elastography according to the ASTERIA criteria. Histopathological examination of the surgical specimens was performed according to the 2017 World Health Organization classification system. Moreover, a beneficial score analysis for each modality was conducted. RESULTS: Of 265 nodules, 212 measured ≥1 cm. The strain index value increased from benign to malignant nodules, and the presence of autoimmune thyroid diseases did not affect the results (p>0.05 for all categories). The sensitivities of histopathological examination, ultrasound elastography, and fine-needle aspiration cytology for detection of nodules measuring ≥1 cm were 1, 1, and 0.97, respectively. The working area for detecting nodule(s) in a single image was similar between strain ultrasound elastography and fine-needle aspiration cytology for highly and moderately suspicious nodules. However, for mildly suspicious, unsuspicious, and benign nodules, the working area for detecting nodule(s) in a single image was higher in strain ultrasound elastography than in fine-needle aspiration cytology. CONCLUSION: Strain ultrasound elastography for highly and moderately suspicious nodules facilitated the detection of mildly suspicious, unsuspicious, and benign nodules.

Humans , Male , Female , Adult , Middle Aged , Thyroid Gland/diagnostic imaging , Thyroid Neoplasms/diagnosis , Thyroid Nodule/diagnostic imaging , Biopsy, Fine-Needle/methods , Elasticity Imaging Techniques/methods , Thyroid Gland/pathology , Thyroid Neoplasms/pathology , Thyrotropin/blood , Predictive Value of Tests , Retrospective Studies , Sensitivity and Specificity , Thyroid Nodule/pathology , Diagnosis, Differential
Pesqui. vet. bras ; 39(11): 923-931, Nov. 2019. tab, graf, ilus
Article in English | LILACS, VETINDEX | ID: biblio-1056913


Few reports have been published regarding the use of ultrasonography as a method of evaluating the normal thyroid gland in horses. For these reasons, this study aimed at determining reliably of the thyroid measurements from the comparison between the left and right thyroid lobes, as well as assessing the contour, format, echotexture and echogenicity of the healthy thyroid by mode-B ultrasonography. Additionally, the equine thyroid vascularization was quali-quantitatively characterized the by Doppler. The sample size initially was determined by the animal selection with advanced age and without volume increase in the neck proximal region. Finally, eleven horses were selected by laboratory test, search of thyroid neoformations by ultrasonography and cytology thyroid. Next, these animals were submitted to thyroid lobes ultrasonographic evaluation. Excellent reproducibility was observed for all measurements obtained. Among the comparisons made between the quantitative parameters of the left and right lobes, it was observed that there was only difference between their respective lengths. Qualitatively, there was a significant variation between the lobes elliptical format in the longitudinal plane of some glands, which oscillated between a rounded and flattened conformation. Thus, we can conclude that the difference between the lobes format of some thyroids can be explained by the significant difference observed between the length of the left and right lobes. Additionally, it was verified that there was no difference between the Doppler quantitative parameters. Therefore, we may suggest that unilateral analysis of the cranial thyroid artery by spectral Doppler can be used to evaluate equine thyroid diffuse disorders.(AU)

Poucas análises foram publicadas com relação ao uso da ultrassonografia como método de avaliação da glândula tireoide hígida em equinos. Alguns trabalhos incluem a determinação das dimensões e características do parênquima. Por essas razões, este estudo teve como objetivo determinar com segurança as medidas tireoidianas a partir da comparação entre o lobo tireoidiano esquerdo e direito, bem como avaliar os contornos, formato, ecotextura e ecogenicidade das glândulas tireoides hígidas pela ultrassonografia em modo B. Além disso, a vascularização da tireoide equina foi caracterizada quali-quantitativamente pela ferramenta Doppler. O tamanho da amostra inicialmente foi determinado pela seleção dos animais com idade avançada e sem aumento de volume na região proximal do pescoço. Por fim, onze equinos foram selecionados por meio de exame laboratorial, pesquisa de neoformações tireoidianas por ultrassonografia e citologia da tireoide. Em seguida, estes animais foram submetidos à avaliação de lobos tireoidianos por ultrassonografia. Observou-se excelente reprodutibilidade em relação a todas as medidas deste estudo. Foram observadas diferenças qualitativas entre os lobos tireoidianos direito e esquerdo. Assim, podemos concluir que tais diferenças entre o formato dos lobos tireoidianos podem ser explicadas pela diferença significativa e/ou tendência observada no parâmetro comprimento entre os respectivos lobos. Além disso, não foi encontrada diferença significativa entre os valores da artéria tireoidiana cranial esquerda em relação aos obtidos na artéria tireoidiana cranial direita, sugerindo que a análise dos valores espectrais do Doppler de uma das artérias tireoidianas craniais possa ser utilizada como método de avaliação de distúrbios difusos da tireoide equina.(AU)

Animals , Thyroid Gland/anatomy & histology , Thyroid Gland/diagnostic imaging , Horses , Ultrasonography/veterinary , Reference Parameters
Arch. endocrinol. metab. (Online) ; 63(5): 495-500, Sept.-Oct. 2019. tab
Article in English | LILACS | ID: biblio-1038504


ABSTRACT Objectives The differentiation between the various etiologies of thyrotoxicosis, including those with hyperthyroidism (especially Graves' disease [GD], the most common cause of hyperthyroidism) and without hyperthyroidism (like thyroiditis), is an important step in planning specific therapy. Technetium-99m (99mTc) pertechnetate thyroid scanning is the gold standard in differentiating GD from thyroiditis. However, this technique has limited availability, is contraindicated in pregnancy and lactation, and is not helpful in cases with history of recent exposure to excess iodine. The aim of this study was to identify the diagnostic value of the peak systolic velocity of the inferior thyroid artery (PSV-ITA) assessed by color-flow Doppler ultrasound (CFDU) and compare the sensitivity and specificity of this method versus 99mTc pertechnetate thyroid uptake. Subjects and methods We prospectively analyzed 65 patients (46 with GD and 19 with thyroiditis). All patients were evaluated with clinical history and physical examination and underwent 99mTc pertechnetate scanning and measurement of TRAb levels and PSV-ITA values by CFDU. The diagnosis was based on findings from signs and symptoms, physical examination, and 99mTc pertechnetate uptake. Results Patients with GD had significantly higher mean PSV-ITA values than those with thyroiditis. At a mean PSV-ITA cutoff value of 30 cm/sec, PSV-ITA discriminated GD from thyroiditis with a sensitivity of 91% and specificity of 89%. Conclusion Measurement of PSV-ITA by CFDU is a good diagnostic approach to discriminate between GD and thyroiditis, with sensitivity and specificity values comparable to those of 99mTc pertechnetate thyroid uptake.

Humans , Male , Female , Adult , Middle Aged , Thyroid Gland/diagnostic imaging , Thyroiditis/diagnostic imaging , Graves Disease/diagnostic imaging , Thyroid Gland/blood supply , Blood Flow Velocity , Sensitivity and Specificity , Sodium Pertechnetate Tc 99m , Diagnosis, Differential
Arch. endocrinol. metab. (Online) ; 63(3): 300-305, May-June 2019. tab, graf
Article in English | LILACS | ID: biblio-1011171


ABSTRACT Objective Hürthle cell carcinomas (HCCs) of the thyroid have been recently reclassified as a separate entity due to their distinct clinical and molecular profiles. Few studies have assessed the ability of preoperative characteristics in differentiating HCCs from Hürthle cell adenomas (HCAs) due to the low prevalence of both lesions. This study aimed to compare the preoperative features of HCCs and HCAs and evaluate the diagnostic performance of ultrasound in distinguishing between both. Subjetcs and methods Retrospective study including 101 patients (52 HCCs and 49 HCAs) who underwent thyroid surgery from 2000 to 2016. Clinical, ultrasonographic, and histological data were reviewed. Diagnostic performance of suspicious sonographic features was analyzed in 51 cases (24 HCCs and 27 HCAs). Results Hürthle cell neoplasms were predominant in females. Subjects ≥ 55 years represented 58% of the cases of HCCs and 53% of those of HCAs. Carcinomas were significantly larger (p < 0.001), and a tumor size ≥ 4 cm significantly increased the risk of malignancy (odds ratio 3.67). Other clinical, cytologic, and sonographic data were similar between HCCs and HCAs. Among the HCCs, the lesions were purely solid in 54.2%, hypoechoic in 37.5%, and had coarse calcifications in 12.5%, microcalcifications in 8.3%, irregular contours in 4.2%, and a taller-than-wide shape in 16.7%. Predominantly/exclusive intranodular vascularization was observed in 52.6%. Overall, 58% of the HCCs were classified as TI-RADS 4 or 5 compared with 48% of the HCAs. TI-RADS 4 or 5 had a specificity of only 51.8% and a positive likelihood ratio of 1.21. Conclusions Apart from the lesion size, no other preoperative feature adequately distinguished HCCs from HCAs. Sonographic characteristics raising suspicion for malignancy, which are mostly present in papillary carcinomas, were infrequent in HCCs. New tools must be developed to improve preoperative diagnosis and deferral of surgery in cases of adenomas.

Humans , Male , Female , Adult , Middle Aged , Aged , Thyroid Gland/diagnostic imaging , Thyroid Neoplasms/diagnostic imaging , Adenoma/diagnostic imaging , Carcinoma, Papillary, Follicular/diagnostic imaging , Ultrasonography, Doppler/methods , Thyroid Gland/surgery , Thyroid Gland/pathology , Thyroid Neoplasms/surgery , Thyroid Neoplasms/pathology , Adenoma/surgery , Adenoma/pathology , Retrospective Studies , Carcinoma, Papillary, Follicular/surgery , Carcinoma, Papillary, Follicular/pathology , Diagnosis, Differential
Acta bioquím. clín. latinoam ; 53(2): 175-182, jun. 2019. ilus, graf, tab
Article in Spanish | LILACS | ID: biblio-1019251


La injuria renal aguda es una entidad clínica compleja, caracterizada por la disminución abrupta de la función renal. La hipercalcemia como etiología de la misma es poco frecuente. Los mecanismos involucrados en su desarrollo son múltiples y poco estudiados. Se presenta el caso de un paciente varón de 59 años que desarrolló un cuadro severo de falla renal aguda como complicación de crisis hipercalcémica por un adenoma de paratiroides. Se observó alteración en los marcadores de daño y función renal. La bioquímica urinaria mostró una necrosis tubular aguda. Los niveles de calcio, parathormona y calciuria se asociaron a endocrinopatía. La ecografía, el centellograma y la biopsia paratiroidea mostraron la presencia de un adenoma. Se presentaron otras complicaciones sistémicas concomitantes como pancreatitis y complicaciones cardíacas. El tratamiento paliativo fue la hemodiálisis y el definitivo la paratiroidectomía. El síndrome de hueso hambriento se presentó como una complicación postquirúrgica. Tras el alta, la recuperación de la función renal nunca fue total. El daño renal agudo asociado a disfunción sistémica por hipercalcemia puede llevar a una recuperación parcial de la función renal. Se debe considerar el desarrollo de enfermedad renal crónica posterior a la falla renal aguda por hipercalcemia como complicación de la misma.

Acute renal injury is a complex clinical entity, characterized by the abrupt worsening in renal function. Hypercalcemia as its etiology is rare. The mechanisms involved in its development are multiple and rarely studied. The case of a 59-year-old male patient who developed a severe acute renal failure as a complication of an hypercalcemic crisis due to a parathyroid adenoma is presented here. Alterations in markers of damage and renal function were observed. Urinary biochemistry showed acute tubular necrosis. Calcium, parathormone and urine calcium levels were associated with endocrinopathy. The ultrasound, the scintigraphy and the parathyroid biopsy showed the presence of an adenoma. There were other concomitant systemic complications such as pancreatitis and cardiac complications. Hemodialysis was the palliative treatment, while the definitive treatment was parathyroidectomy. The hungry bone syndrome occurred as a postoperative complication. After discharge, recovery of renal function was never complete. Acute renal damage associated with systemic dysfunction due to hypercalcemia can lead to a partial recovery of renal function. The development of chronic kidney disease after acute renal failure due to hypercalcemia should be considered one of its complications.

A Lesão renal aguda é uma entidade clínica complexa, caracterizada pela diminuição abrupta da função renal. A hipercalcemia como etiologia da mesma não é muito frequente. Os mecanismos que participam no seu desenvolvimento são múltiplos e pouco estudados. Apresenta-se o caso de um paciente, homem, de 59 anos, que desenvolveu um quadro severo de insuficiência renal aguda como complicação de crise hipercalcêmica por um adenoma da paratireóide. Foi observada alteração nos marcadores de dano e função renal. A bioquímica urinária mostrou uma necrose tubular aguda. Os níveis de cálcio, paratormona e calciúria foram associados a endocrinopatia. A ultra-sonografia, a cintilografia, e a biópsia da paratireóide mostraram a presença de um adenoma. Apresentaram-se outras complicações sistêmicas concomitantes como pancreatite e cardíacas. O tratamento paliativo foi hemodiálise e o definitivo, a paratireoidectomia. A síndrome do osso faminto apresentou-se como uma complicação pós-operatória. Após a alta, a recuperação da função renal nunca foi total. O dano renal agudo associado à disfunção sistêmica por hipercalcemia pode levar para uma recuperação parcial da função renal. Deve ser considerado o desenvolvimento da doença renal crônica posterior à insuficiência renal aguda por hipercalcemia como complicação da mesma.

Humans , Male , Middle Aged , Acute Kidney Injury/diagnosis , Hypercalcemia/complications , Thyroid Gland/diagnostic imaging , Abdomen/diagnostic imaging , Hypercalcemia/urine , Kidney Tubular Necrosis, Acute/urine
Rev. argent. radiol ; 83(1): 3-11, mar. 2019. ilus, tab
Article in Spanish | LILACS | ID: biblio-1003284


Objetivo Determinar la frecuencia y el tipo de tumor maligno/premaligno insospechado como hallazgo en estudios 18 F-FDG PET/TC en pacientes oncológicos. Material y Métodos Se revisaron retrospectivamente (de enero de 2014 a marzo de 2017), informes de estudios 18 F-FDG PET/TC de pacientes oncológicos, identificando aquellos pacientes con hallazgo de lesión sospechosa de otro tumor maligno como hallazgo incidental. La información fue obtenida a partir de determinadas "palabras clave" en la base de datos del Centro. Los hallazgos se confirmaron mediante histopatología y/o seguimiento clínico y paraclínico de como mínimo seis meses. Resultados De 4.086 pacientes oncológicos estudiados con 18 F-FDG PET/TC, se encontró lesión sospechosa de otro tumor maligno en 130 (3,2%), de los cuales 72 eran mujeres y 58 hombres, con edad media de 61 años. Los tumores primarios más frecuentes (aquellos que motivaron el pedido del examen PET/CT inicialmente), fueron de mama (n = 27), pulmón (n = 27) y colo-recto (n = 20). Se confirmaron por histopatología 49 (1,2%) nuevos tumores malignos/premalignos y dos lesiones metastásicas. La localización del segundo tumor primario correspondió a: colon (n = 18), pulmón (n = 6), mama (n = 6), linfoma (n = 3), ovario (n = 2), endometrio/cuello uterino (n = 2), tiroides (n = 2) y otros (n = 10). Resultaron 28 hallazgos falsos positivos, 31 pacientes no se estudiaron por progresión lesional y 20 pacientes se perdieron de seguimiento. Discusión La prevalencia de neoplasia primaria maligna múltiple (NPMM) es variable entre 0,7 y 11,7%. En nuestra serie, se encontró lesión sospechosa de segundo tumor en 130 casos (3,2%), de los cuales se confirmaron 49 segundos tumores (1,2%), similar a Conclusiones La tasa de detección de tumor maligno insospechado confirmado histológicamente fue de 1,2%. Todo hallazgo incidental sospechoso de malignidad en 18 F-FDG PET/TC debe ser estudiado, ya que puede corresponder a un segundo tumor maligno no sospechado con posibilidad de tratamiento curativo.

Purpose To determine the frequency and type of unexpected malignant/ premalignant tumor as a finding in 18 F-FDG PET/CT studies in oncological patients. Material and Methods Reports of 18 F-FDG PET/CT studies of oncological patients were reviewed retrospectively (from January 2014 to March 2017), with the finding of suspicious lesion of another malignant tumor. The information was obtained from certain "keywords" in the Center's database. The findings were confirmed by histopathology when possible and with clinical and paraclinical follow-up for at least six months. Results Of 4086 oncological patients, studied with 18 F-FDG PET/CT, a suspicious lesion of another malignant tumor was found in 130 (3.2%), 72 female and 58 male sex, average age 61 years. The most frequent primary tumors were: breast (n = 27), lung (n = 27) and colo-rectum (n = 20). 49 (1.2%) new malignant/premalignant tumors and two metastatic lesions were confirmed by histopathology. The location of the second primary tumor was: colon (n = 18), lung (n = 6), breast (n = 6), lymphoma (n = 3), ovary (n = 2), endometrium/cervix (n = 2), thyroid (n = 2) and others (n = 10). There were 28 false positive findings, 31 patients were not studied for progression and 20 patients were lost to follow-up. Discussion The prevalence of multiple malignant primary neoplasia (MMPN) is variable between 0.7 and 11.7%. In our series, a suspicious second tumor lesion was found in 130 cases (3.2%), of which 49 second tumors (1.2%) were confirmed, similar to that reported by other authors. Conclusions The detection rate of unsuspected malignant tumor was 1.2%, coincident with the literature. Any incidental finding suspicious of malignancy in 18 F-FDG PET/CT should be studied since in most cases it corresponds to early diagnosis with the possibility of curative treatment.

Humans , Male , Female , Adult , Middle Aged , Aged , Young Adult , Neoplasms/diagnostic imaging , Thyroid Gland/diagnostic imaging , Breast Neoplasms/diagnostic imaging , Uterine Cervical Neoplasms/diagnostic imaging , Epidemiology, Descriptive , Prevalence , Retrospective Studies , Colonic Neoplasms/diagnostic imaging , Incidental Findings , Endometrium/diagnostic imaging
Arch. endocrinol. metab. (Online) ; 62(4): 460-465, July-Aug. 2018. tab, graf
Article in English | LILACS | ID: biblio-950088


ABSTRACT Objectives: Detection rate of thyroid nodules is increasing with the use of new imaging modalities, especially in screening for malignancies. Positron emission tomography/computed tomography (PET/ CT)-positive thyroid nodules should be differentiated for malignancy to avoid unnecessary operations and further follow-up. Most trials evaluate the role of SUVmax, but there is no definitive information about the utility of Hounsfield unit (HU) values for prediction of malignancy. This study aimed to evaluate the HU values beside SUVmax for detecting malignancy risk of PET/CT-positive thyroid nodules. Subjects and methods: Results of 98 cancer patients who had fine needle aspiration biopsy (FNAB) for thyroid nodules detected on PET/CT between January 2011 and December 2015 were assessed. The FNABs and surgical pathological results were recorded. Results: FNABs revealed benign results in 32 patients (32.7%), malignant in 18 (18.4%), non-diagnostic in 20 (20.4%), and indeterminate in 28 (28.5%). Twenty-four patients underwent thyroidectomy. The mean HU values were not significantly different in benign and malignant nodules (p = 0.73). However, the mean SUVmax was significantly higher (p < 0.001) in malignant ones. Area under curve (AUC) was 0.824 for SUVmax; the cut-off value was over 5.55 (p < 0.001), with 80% sensitivity, 84.5% specificity. Conclusions: Our current study demonstrated that HU value does not add any additional valuable information for discriminating between malignant and benign thyroid nodules. We also defined a SUV cut-off value of 5.55 for malignant potential of thyroid nodules detected on PET/CT Arch Endocrinol Metab. 2018;62(4):460-5

Humans , Male , Female , Adult , Middle Aged , Aged , Thyroid Gland/pathology , Thyroid Neoplasms/pathology , Thyroid Nodule/pathology , Positron Emission Tomography Computed Tomography/methods , Thyroid Gland/diagnostic imaging , Thyroidectomy , Thyroid Neoplasms/diagnostic imaging , Retrospective Studies , Sensitivity and Specificity , Thyroid Nodule/diagnostic imaging , Radiopharmaceuticals/administration & dosage , Fluorodeoxyglucose F18/administration & dosage , Biopsy, Fine-Needle , Diagnosis, Differential
Arch. endocrinol. metab. (Online) ; 62(4): 386-391, July-Aug. 2018. tab
Article in English | LILACS | ID: biblio-950081


ABSTRACT Objectives: American Thyroid Association (ATA)'s new guidelines recommend use of population-based trimester-specific reference range (RR) for thyrotropin (TSH) in pregnancy. The aim of this study was to determine first trimester TSH RR for a population of pregnant women in Rio de Janeiro State. Subjects and methods: Two hundred and seventy pregnant women without thyroid illness, defined by National Academy of Clinical Biochemistry, and normal iodine status were included in this sectional study. This reference group (RG) had normal median urinary iodine concentration (UIC = 219 μg/L) and negative anti-thyroperoxidase antibodies (TPOAb). Twin pregnancy, trophoblastic disease and use of drugs or supplements that influence thyroid function were excluded. In a second step, we defined a more selective reference group (SRG, n = 170) by excluding patients with thyroiditis pattern on thyroid ultrasound and positive anti-thyroglobulin antibodies. This group also had normal median UIC. At a final step, a more selective reference group (MSRG, n = 130) was defined by excluding any pregnant women with UIC < 150 μg/L. Results: In the RG, median, 2.5th and 97.5th percentiles of TSH were 1.3, 0.1, and 4.4 mIU/L, respectively. The mean age was 270 ± 5.0 and the mean body mass index was 25.6 ± 5.2 kg/m2. In the SRG and MSRG, 2.5th and 975th percentiles were 0.06 and 4.0 (SRG) and 0.1 and 3.6 mIU/L (MSRG), respectively. Conclusions: In the population studied,TSH upper limit in the first trimester of pregnancy was above 2.5 mIU/L. The value of 3.6 mIU/L, found when iodine deficiency and thyroiditis (defined by antibodies and ultrasound characteristics) were excluded, matches recent ATA guidelines.

Humans , Female , Pregnancy , Adult , Young Adult , Pregnancy Trimester, First/blood , Thyroid Gland/diagnostic imaging , Thyrotropin/blood , Practice Guidelines as Topic/standards , Reference Values , Autoantibodies/blood , Autoantigens/blood , Thyroid Function Tests/standards , Brazil , Thyrotropin/standards , Cross-Sectional Studies , Ultrasonography , Iron-Binding Proteins/blood , Iodide Peroxidase/urine , Iodide Peroxidase/blood
Clinics ; 73: e370, 2018. tab, graf
Article in English | LILACS | ID: biblio-952815


OBJECTIVES: Most thyroid diseases are nodular and have been investigated using ultrasound-guided fine needle aspiration biopsy (FNAB), the reports of which are standardized by the Bethesda System. Bethesda category III represents a heterogeneous group in terms of lesion characteristics and the malignancy rates reported in the literature. The objective of the present study was to evaluate the differences in the malignancy rates among Bethesda III subcategories. METHODS: Data from 1,479 patients who had thyroid surgery were reviewed. In total, 1,093 patients (89.6% female, mean age 52.7 (13-89) years) were included, and 386 patients were excluded. FNAB results (based on Bethesda Class) and histopathological results (benign or malignant) for coincident areas were collected. Bethesda III patients were subcategorized according to cytopathological characteristics (FLUS: follicular lesion of undetermined significance, Bethesda IIIA; AUS: atypia of undetermined significance, Bethesda IIIB). Data were correlated to obtain the malignancy rates for each Bethesda category and the newly defined subcategory. RESULTS: FNAB results for these patients were as follows: Bethesda I: 3.1%; Bethesda II: 18.6%; Bethesda III: 35.0%; Bethesda IV: 22.1%; Bethesda V: 4.1%; and Bethesda VI: 17.1%. The malignancy rates for Bethesda Class IIIB were significantly higher than those for Bethesda Class IIIA (p<0.001) and Bethesda Class IV (p<0.001). Bethesda Class IIIA showed significantly lower malignancy rates than Bethesda Class III overall (p<0.001) CONCLUSIONS: Improvements of the Bethesda System should consider this subcategorization to better reflect different malignancy rates, which may have a significant impact on the decision-making process.

Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Thyroid Gland/pathology , Thyroid Neoplasms/diagnostic imaging , Thyroid Nodule/diagnostic imaging , Thyroid Gland/diagnostic imaging , Thyroid Neoplasms/classification , Thyroid Neoplasms/pathology , Retrospective Studies , Ultrasonography , Thyroid Nodule/classification , Thyroid Nodule/pathology , Risk Assessment , Biopsy, Fine-Needle , Diagnosis, Differential , Image-Guided Biopsy
Rev. chil. endocrinol. diabetes ; 11(1): 16-19, 2018. tab, ilus
Article in Spanish | LILACS | ID: biblio-999028


INTRODUCTION: The hypercalcemia is infrequent in pediatrics, its clinical is diverse, and its etiology is determined by age. Among the dependent causes of parathormone (PHT) is the hyperthyroidism, state of hypersecretion of PHT by parathyroid glands (PG). The primary hyperparathyroidism (PHPT) is rare in children, there are 200 reported cases. In older children, the causes for PHPT correspond to parathyroid adenoma, multiglandular disease and parathyroid carcinoma. OBJECTIVE: Report a case of an 11 years old male adolescent. He presents three months symptoms of constipation, anorexia, vomiting and weight loss. Urgent consultation due to an increase of his symptoms, in exams stand out: calcemia 16.67 mg/dl (NV 8.8-10.8 mg/dl), phosphatemia 2.21 mg/dl (NV 4.5-5.5 mg/dl), parathormone (PHT) 308.7 pg/ml (NV 15-68.3 pg/ml), calciuria/creatininuria 0.56 (NV < 0.2). He was hospitalized to manage his severe hypercalcemia, it was indicated hyperhydration, monopotassium phosphate, intravenous hydrocortisone and furosemide. In his study was performed a cervical ultrasound which showed a solid node in the right parathyroid gland, hypoechogenic and scintigram parathyroid compatible with right superior parathyroid adenoma. In the waiting for surgery was necessary the administration of intravenous pamidronate. In the post-operatory, he evolved with hipocalcemia that was corrected with intravenous calcium carbonate, overlapping to oral calcium and calcitriol. CONCLUSION: The PHPT is a pathology of low prevalence in pediatrics, one hundred times less than adults. In the adolescent, the most frequent cause is the parathyroid adenoma. It should be considered as a differential diagnosis in cases of symptomatic hypercalcemia in this age group

Humans , Male , Child , Parathyroid Neoplasms/diagnosis , Adenoma/diagnosis , Hyperparathyroidism, Primary/etiology , Parathyroid Hormone/blood , Parathyroid Neoplasms/surgery , Parathyroid Neoplasms/complications , Phosphorus/blood , Thyroid Gland/diagnostic imaging , Adenoma/surgery , Adenoma/complications , Calcium/blood , Parathyroidectomy , Hyperparathyroidism, Primary/surgery , Hyperparathyroidism, Primary/diagnosis , Hypercalcemia/diagnosis , Hypercalcemia/etiology
Rev. chil. radiol ; 23(4): 143-150, dic. 2017. tab, graf, img
Article in Spanish | LILACS | ID: biblio-900121


Resumen: La presencia de microcalcificaciones en nódulos tiroideos es un signo muy específico de malignidad, al corresponder a cuerpos de Psammoma. No existen suficientes estudios que demuestren una correlación entre su presencia histológica y su aspecto ecográfico real. Materiales y Métodos: Se seleccionaron todos los nódulos con tamaño mayor a 3 cm puncionados en el Hospital Clínico Universidad Católica entre los años 2010-2015 y se clasificó el aspecto ecográfico según la presencia de 3 tipos de focos ecogénicos con una definición más estricta a lo usual. Se correlacionó lo anterior con hallazgos en biopsias. Resultados: 44 nódulos correspondieron a cáncer papilar de tiroides. Hubo relación estadísticamente significativa entre una nueva definición ecográfica de las microcalcificaciones (focos ecogénicos puntiformes) y la presencia histológica de cuerpos de psamomma. Discusión: Habría una buena correlación entre una definición más estricta y la presencia real de microcalcificaciones en histología, mejorando la alta tasa de sobrediagnóstico advertido recientemente por algunos autores.

Abstract: The presence of microcalcifications in thyroid nodules is a very specific sign of malignancy, as it corresponds to Psammoma bodies. There are not enough studies that demonstrate a correlation between their histological presence and their actual ultrasound appearance. Materials and Methods: All nodules larger than 3 cm punctured at the Universidad Católica Clinical Hospital between 2010-2015 were selected, and the sonographic appearance was classified according to the presence of 3 types of echogenic foci according to a stricter definition than usual. The above was correlated with findings in biopsies. Results: 44 nodules corresponded to papillary thyroid cancer. There was a statistically significant relationship between a new ultrasound definition of the microcalcifications (punctate echogenic foci) and the histological presence of psamomma bodies. Discussion: There would be a good correlation between a stricter definition and the actual presence of microcalcifications in histology, improving the high rate of over diagnosis recently noticed by some authors.

Humans , Male , Female , Thyroid Gland/diagnostic imaging , Calcinosis , Thyroid Gland/anatomy & histology , Thyroid Gland/abnormalities , Thyroid Gland/growth & development , Calcinosis/diagnostic imaging
Arch. endocrinol. metab. (Online) ; 61(5): 432-437, Sept.-Oct. 2017. tab, graf
Article in English | LILACS | ID: biblio-887585


ABSTRACT Objectives To describe the findings of thyroid ultrasonography (T-US), its contribution to diagnose congenital hypothyroidism (CH) and the best time to perform it. Subjects and methods Forty-four patients with CH were invited to undergo T-US and 41 accepted. Age ranged from 2 months to 45 years; 23 patients were females. All were treated with L-thyroxine; 16 had previously undergone scintigraphy and 30 had previous T-US, which were compared to current ones. Results At the current T-US, the thyroid gland was not visualized in its normal topography in 10 patients (24.5%); 31 T-US showed topic thyroid, 17 with normal or increased volume due to probable dyshormonogenesis, 13 cases of hypoplasia and one case of left-lobe hemiagenesis. One patient had decreased volume due to central hypothyroidism. Scintigraphy scans performed 3-4 years earlier showed 100% agreement with current results. Comparisons with previous T-US showed concordant results regarding thyroid location, but a decrease in current volume was observed in eight due to the use of L-thyroxine, calling the diagnosis of hypoplasia into question. Conclusions The role of T-US goes beyond complementing scintigraphy results. It allows inferring the etiology of CH, but it must be performed in the first months of life. An accurate diagnosis of CH will be attained with molecular study and the T-US can guide this early assessment, without therapy withdrawal.

Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , Adult , Middle Aged , Young Adult , Thyroid Gland/diagnostic imaging , Congenital Hypothyroidism/diagnostic imaging , Thyroxine/therapeutic use , Time Factors , Ultrasonography , Sensitivity and Specificity , Congenital Hypothyroidism/etiology , Congenital Hypothyroidism/drug therapy
Rev. méd. Chile ; 145(8): 1028-1037, ago. 2017. tab, graf
Article in Spanish | LILACS | ID: biblio-902581


The thyroid nodule is a frequent cause of primary care consultation. The prevalence of a palpable thyroid nodule is approximately 4-7%, increasing up to 67% by the incidental detection of nodules on ultrasound. The vast majority are benign and asymptomatic, staying stable over time. The clinical importance of studying a thyroid nodule is to exclude thyroid cancer, which occurs in 5 to 10% of the nodules. The Board of SOCHED (Chilean Society of Endocrinology and Diabetes) asked the Thyroid Study Group to develop a consensus regarding the diagnostic management of the thyroid nodule in Chile, aimed at non-specialist physicians and adapted to the national reality. To this end, a multidisciplinary group of 31 experts was established among university academics, active researchers with publications on the subject and prominent members of scientific societies of endocrinology, head and neck surgery, pathology and radiology. A total of 14 questions were developed with key aspects for the diagnosis and subsequent referral of patients with thyroid nodules, which were addressed by the participants. In those areas where the evidence was insufficient or the national reality had to be considered, the consensus opinion of the experts was used through the Delphi methodology. The consensus was approved by the SOCHED board for publication.

Humans , Thyroid Gland/pathology , Thyroid Gland/diagnostic imaging , Thyroid Nodule/diagnosis , Consensus , Chile , Risk Factors , Risk Assessment , Biopsy, Fine-Needle
Int. j. morphol ; 35(2): 452-458, June 2017. ilus
Article in English | LILACS | ID: biblio-893003


Change of the thyroid gland volume is often the symptom of most common pathological conditions some thyroid diseases. The exact calculation for the thyroid volume is very important for the assessment and management of thyroid disorders. The volume of thyroid gland, using computed tomography (CT), ultrasound (USG) and magnetic resonance imaging (MRI) has been accessed in few studies published; however a gold standard method has not yet been determined. The purpose of this study was to estimate the volume of normal thyroid gland to define an optimal correction factor therefore was to compare different techniques using the CT. We used computed tomography images obtained from 8 cadavers (2 females, 6 males) to calculate the thyroid volumes. In the present study, the actual thyroid volumes were measured using the water-displacement method as a gold standard, point-counting as a stereology, and ellipsoid methods. Mean squared errors and correction factors were calculated and modeled for each model to find an optimal correction factor and from 0.450 to 0.600 in steps of 0.001 separately for thyroid volume estimation. The average volume of the thyroid glands were 14.58 ± 9.84, 15.28 ± 9.38, and 14.97 ± 8.35 cm3 by fluid displacement, stereology and ellipsoid formula, respectively. No significant difference was found among the methods (P >0.05). The results of this study suggested that the volume of thyroid gland can be measured on CT scans stereologically for diagnosis, as will as provide reliable measure of thyroid volume, management and follow-up of thyroid diseases and for preoperative planning.

El cambio de volumen de la glándula tiroides es a menudo el síntoma de las condiciones patológicas más comunes de algunas enfermedades de dicha glándula. El cálculo exacto del volumen tiroideo es muy importante para la evaluación y el tratamiento de los trastornos tiroideos. El volumen de la glándula tiroides, utilizando la tomografía computarizada (TC), el ultrasonido (USG) y la resonancia magnética (RM) ha sido presentados en varias publicaciones. Sin embargo, aún no se ha determinado un gold standard. El propósito de este estudio fue estimar el volumen de la glándula tiroides normal para definir un factor de corrección óptimo, por lo que se compararon diferentes técnicas utilizando TC. Para calcular los volúmenes tiroideos se utilizaron imágenes de tomografía computarizada obtenidas de 8 cadáveres (dos mujeres y seis hombres). En el presente estudio, los volúmenes reales de la glándula tiroides se midieron utilizando como gold standard los métodos esterológicos de desplazamiento de agua y conteo de puntos y el método volumétrico elipsoide. Se calcularon y modelaron los errores cuadráticos medios y los factores de corrección para cada modelo con el objetivo de encontrar un factor de corrección óptimo y de 0,450 a 0,600 en pasos de 0,001 por separado para la estimación del volumen tiroideo. El volumen medio de las glándulas tiroides fue de 14,58 ± 9,84, 15,28 ± 9,38 y 14,97 ± 8,35 cm3 calculados por desplazamiento de fluido, estereología y fórmula elipsoide, respectivamente. No se encontró diferencia significativa entre los métodos (P>0,05). Los resultados de este estudio sugieren que el volumen de la glándula tiroides puede ser medido estereológicamente por TC, estableciéndose como una medida fiable del volumen tiroideo, para el diagnóstico, manejo y seguimiento de las enfermedades tiroideas y la planificación preoperatoria.

Humans , Male , Female , Thyroid Gland/anatomy & histology , Thyroid Gland/diagnostic imaging , Cadaver , Organ Size
Arch. endocrinol. metab. (Online) ; 61(3): 269-275, May-June 2017. tab, graf
Article in English | LILACS | ID: biblio-887556


ABSTRACT Objective The aim of this study was to describe the relationship between thyroid volume and age, gender, anthropometric characteristics, and echogenicity in oldest-old subjects in an iodine-sufficient area. Subjects and methods The study included 81 independent elderly individuals aged ≥ 80 years (65 [80.2%] women). We determined these individuals' anthropometric characteristics, body mass index (BMI), and lean body mass, as well as thyroid volume and echogenicity by ultrasonography. Results We observed that octogenarians and nonagenarians had different profiles of thyroid echogenicity. The volume of the thyroid was smaller in nonagenarians than octogenarians (p = 0.012, r = 0.176), and subjects aged 80-89 years had more often hypoechoic glands than those aged ≥ 90 years (p = 0.01 versus 0.602). Conclusion The identification of ultrasonographic differences in oldest-old individuals will contribute to establishing preclinical markers, such as echogenicity, to identify individuals at risk of developing autoimmune thyroid disease. Future prospective studies should identify if 80-89-year-old individuals with hypoechoic glands progress to hypothyroidism, and if the absence of changes in echogenicity (i.e. a normal thyroid parenchyma) would have a positive impact on longevity among nonagenarians.

Humans , Male , Female , Aged, 80 and over , Thyroid Gland/anatomy & histology , Thyroid Gland/diagnostic imaging , Ultrasonography/methods , Organ Size , Reference Values , Thyroid Diseases/pathology , Thyroid Diseases/diagnostic imaging , Thyrotropin/blood , Sex Factors , Anthropometry , Cross-Sectional Studies , Analysis of Variance , Age Factors , Statistics, Nonparametric
Arch. endocrinol. metab. (Online) ; 61(3): 211-221, May-June 2017. tab, graf
Article in English | LILACS | ID: biblio-887550


ABSTRACT Objective The aim of this study was to describe the ultrasound features of benign and malignant thyroid nodules and evaluate the likelihood of malignancy associated with each feature according to the Bethesda System for Reporting Thyroid Cytopathology and histopathology. With this analysis, we propose a new TI-RADS classification system. Materials and methods The likelihood of malignancy from ultrasound features were assessed in 1413 thyroid nodules according to the Bethesda System for Reporting Thyroid Cytopathology and histopathological findings. A score was established by attributing different weights to each ultrasound feature evaluated. Results Features positively associated with malignancy in bivariate analysis received a score weight of +1. We attributed a weight of +2 to features which were independently associated with malignancy in a multivariate analysis and +3 for those associated with the highest odds ratio for malignancy (> 10.0). Hence, hypoechogenicity (graded as mild, moderate or marked, according to a comparison with the overlying strap muscle), microcalcification and irregular/microlobulated margin received the highest weights in our scoring system. Features that were negatively associated with malignancy received weights of -2 or -1. In the proposed system a cutoff score of 2 (sensitivity 97.4% and specificity 51.6%) was adopted as a transition between probably benign (TI-RADS 3) and TI-RADS 4a nodules. Overall, the frequency of malignancy in thyroid nodules according to the categories was 1.0% for TI-RADS 3, 7.8% for TI-RADS 4a, 35.3% for TI-RADS 4b, and 84.7% for TI-RADS 5. Conclusion A newly proposed TI-RADS classification adequately assessed the likelihood of malignancy in thyroid nodules.

Humans , Male , Female , Adult , Middle Aged , Thyroid Gland/pathology , Thyroid Gland/diagnostic imaging , Thyroid Nodule/pathology , Thyroid Nodule/diagnostic imaging , Reference Standards , Severity of Illness Index , Multivariate Analysis , Reproducibility of Results , Retrospective Studies , Ultrasonography/methods , Sensitivity and Specificity , Thyroid Nodule/classification , Risk Assessment , Biopsy, Fine-Needle , Tumor Burden , Neoplasm Grading
Rev. argent. cir ; 108(4): 1-10, dic. 2016. ilus
Article in Spanish | LILACS, BINACIS | ID: biblio-957887


Antecedentes: las metástasis en tiroides son infrecuentes, pocas veces diagnosticadas antes de la cirugía; sin embargo, las autopsias muestran una frecuencia que oscila entre el 1 y el 24%. Objetivo: presentar nuestra estadística de metástasis en tiroides de tumores extratiroideos y citar una metástasis a los 23 años del tumor renal primario. Material y métodos: estudio retrospectivo estadístico sobre 1000 tiroidectomías y sus hallazgos histológicos, en un Hospital General. Resultados: en 1000 tiroidectomías, hallamos 3 metástasis extratiroideas, 2 de riñón (un paciente masculino de 70 años con primario 9 años antes y una mujer de 73 años con primario 23 años antes) y uno de útero (pacientede 74 años con primario de 5 años antes). La metástasis del carcinoma renal fue la más frecuente. Conclusión: la localización de metástasis en tiroides es poco habitual pero debe ser considerada especialmente en aquellos enfermos con antecedentes de carcinomas.

Background: Although metastasis in the thyroid gland are rare and infrequently diagnosed, they can be found in 1 to 24% of all autopsies. Objective: to present our series of thyroidal metastasis, of extra thyroid primary tumors and to report one case of metastasis 23 years after a primary renal tumor. Material and methods: retrospective study of 1000 thyroidectomies and the histological findings in a General Hospital. Results: in 1000 thyroidectomies, we found 3 metastases of extrathyroid cancer, 2 renal (male 70 years old with 9 year prior primary, female 73 years old with a primary 23 years before) and a female 74 years old with a primary of uterus operated 5 years earlier. The renal metastases in thyroid were the most common. Conclusion: the localization of metastases in thyroid are unusual, but should be considered in patients with history of malignancy carcinomas.

Humans , Male , Female , Aged , Thyroid Neoplasms/surgery , Neoplasm Metastasis , Thyroid Gland/diagnostic imaging , Thyroidectomy/methods , Uterus/diagnostic imaging , Carcinoma , Retrospective Studies , Ultrasonography