Metastatic lymph node characteristics as predictors of recurrence/persistence in the neck and distant metastases in differentiated thyroid cancer

ABSTRACT Objective: The aim of this study was to evaluate the association between this characteristic and outcomes in patients with lymph node metastasis in a Brazilian cohort. Subjects and methods: This study examined a retrospective cohort of adult patients diagnosed with differentiated thyroid cancer and lymph node metastases from 1998 to 2015 in two referral centers. Number, location, size and extranodal extension (ENE) of metastatic lymph nodes were assessed and correlated with response to initial therapy. Results: A greater number of metastatic nodes, larger size, presence of lateral neck disease and ENE were all associated with a lower probability of achieving an excellent response to initial therapy (p ≤ 0.05 for all these parameters). Local recurrent disease had a significant association with lymph node number (6 in the recurrence/persistence group versus 4 in the non-recurrent group; p = 0.02) and ENE (19.2 versus 75%, p = 0.03). Lateral neck disease was the only characteristic associated with distant metastasis and was present in 52.1% of the group without metastasis and 70.4% of the group with metastasis (p = 0.001). Conclusion: The lymph node characteristics were associated with response to initial therapy and neck recurrence/persistence, confirming the importance of the analysis of these factors in risk stratification in a Brazilian population and its possible use to tailor initial staging and long term follow-up.

Diagnóstico de hipertireoidismo após hipotireoidismo primário. Relato de caso / Diagnosis of hyperthyroidism after hypothyroidism. Case report

JUSTIFICATIVA E OBJETIVOS: Poucos são os casos des­critos na literatura em que o hipotireoidismo precede o hipertireoidismo. O objetivo deste estudo foi relatar um caso de evolução atípica de hipotireoidismo para hipertireoidismo. RELATO DO CASO: Paciente do sexo feminino, 41 anos, com diagnóstico de hipotireoidismo primário, que após de oito meses de tratamento com levotiroxina apresentou níveis de TSH inferiores a 0,005 miuUI/mL, mesmo após a suspensão da medicação. Nessa ocasião, as dosagens de anticorpos anti-TPO eram 337 IU/mL e TRAb igual 14%. A cin­tilografia da tireóide mostrou bócio difuso hipercaptante e a ultra-sonografia da tireóide (US) glândula heterogênea de ecogenicidade grosseira. CONCLUSÃO: Diversos fatores podem estar envolvidos na gênese do problema, mas a não padronização dos mé­todos diagnósticos dificulta a definição dos mecanismos etiopatogênicos.