Tiroiditis crónica de Hashimoto: Serie clínica / Hashimoto chronic thyroiditis: Retrospective analysis of 228 patients

Background: Chronic Hashimoto Thyroiditis (CHT) is the main cause of hypothyroidism. Aim: To report a series of patients with CHT. Material and Methods: Retrospective analysis of a series of 27 men aged 38 ± 14 years and 201 women aged 37 ± 16 years, evaluated in the private offces of two of the authors. Results: Fifty six percent of patients only had unspecifc symptoms at the moment of consultation, 50 percent had a family history of thyroid diseases and only 21 percent of women had a previous history of goiter. Eighty one percent of patients had clinical or subclinical hypothyroidism, 62 percent had both antithyroglobulin and antithyroid peroxidase positive antibodies and 13 percent had both antibodies negative. Only 1.4 percent of patients had a normal thyroid ultrasound examination. Patients were treated with levothyroxine at a mean dosage of 75 µg/day and 53 percent achieved an adequate TSH level. Six of ten patients operated due to nodules had a papillary carcinoma. Conclusions: CHT should be sought in the general population, especially those with a family history of thyroid disease. Thyroid ultrasound is seldom normal in patients with CHT. Thyroid substitution should be monitored periodically to achieve adequate TSH levels.

Cáncer tiroideo: comunicación de 85 casos / Thyroid cancer: report of 85 cases

Background: Thyroid cancer is the most frequent endocrine cancer with important implications in terms of diagnosis and treatment. Aim: to report a population of patients with thyroid cancer diagnosed by pathological studies of the surgical piece. Patients and methods: Eighty five patients (68 female) with the definitive diagnosis of thyroid cancer were studied. Clinical, imaginological, cytological and pathological findings were analyzed. Results: The age range of patients was 10 to 77 years old. Sixty nine patients had ultrasonographic studies which showed a solid nodule in 84 percent, mixed solid-cystic area in 14.5 percent and a purely cystic nodule in 1.5 percent of the cases. Nineteen patients had non specific calcifications. Fine needle aspiration cytology was negative for malignancy in eight patients (false negative rate of 9.9 percent). The average size of the nodules was of 2.8 ñ 1.6 cm). Six nodules measured less than one cm (microcarcinoma). In the initial surgical procedure, 13 patients had lymph node metastases, 2 of them had a primary tumor of 1 cm and 5 patients had Graves's Disease. Frozen biopsies during operation had 9 false negative results for cancer (10.6 percent). Pathology showed 64 cases of papillary cancer (75 percent), 14 of follicular (16.5 percent), two were Hurthle cell cancer (2.4 percent), three were medullary (3.5 percent), and two anaplastic (2.4 percent). Conclusions: in our experience, thyroid cancer is more common in women, solid lesions predominate in the ultrasonography and calcifications are frequently found. The tumor size is variable and the most frequent pathological type corresponds to differentiated cancers. Using the definitive pathological study as the standard, the diagnostic sensitivity of fine needle cytology was 90.1 percent, and of frozen section 89.4 percent

Actualización en el manejo del cáncer diferenciado de tiroides / Update in the management of differentiated thyroid cancer

Esta revisión describe los avances más recientes en el diagnóstico y tratamiento del carcinoma diferenciado de tiroides. Esta neoplasia tiene una morbilidad relativamente elevada. Se presentan los principales procedimientos diagnósticos, haciendo énfasis en los estudios morfológicos y citológicos disponibles. Las diferentes modalidades terapéuticas, médicas y quirúrgicas son expuestas. Se discuten las ventajas y desventajas de los procedimientos quirúrgicos más utilizados. Se incluyen temas controversiales como la indicación de tiroidectomía subtotal en tumores de "buen iagnóstico", el uso del yodo 131 para terapia ablativa y las complicaciones asociadas a la terapia supresora con hormona tiroidea

Nódulo tiroídeo en enfermedad de Basedow Graves y cáncer tiroídeo: experiencia en 6 pacientes / Thyroid nodules in Basedow Graves disease and thyroid cancer: experience in 6 patients

Traditionally, Basedow graves disease was considered a protection against cancer. However, recent reports suggest that cancer occurs with a higher frequency than expected and is more aggressive in this disease. We report six patients with hyperthyroidism due to a Basedow Graves disease that presented a palpable thyroid nodule, which was cold in the scintiscan and solid in the ultrasound examination. Fine needle cytology disclosed cancer in 5 cases (2 with cytological features of greater aggressiveness) and a nodular hyperplasia in one. The diagnosis was confirmed in the surgical piece in all patients. We conclude that Basedow Graves disease and thyroid cancer, which can have an increased aggressiveness, may coexist