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1.
Rev. méd. Chile ; 145(8): 1028-1037, ago. 2017. tab, graf
Article Dans Espagnol | LILACS | ID: biblio-902581

Résumé

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.


Sujets)
Humains , Glande thyroide/anatomopathologie , Glande thyroide/imagerie diagnostique , Nodule thyroïdien/diagnostic , Consensus , Chili , Facteurs de risque , Appréciation des risques , Cytoponction
2.
Rev. méd. Chile ; 141(12): 1506-1511, dic. 2013. graf, tab
Article Dans Espagnol | LILACS | ID: lil-705568

Résumé

Background: Serum thyroglobulin (sTg) is an excellent marker of persistence or recurrence of disease in differentiated thyroid cancer (DTC), however its role as prognostic factor has not been fully established. Aim: To assess the value of the preablative thyroglobulin (pTg) as predictor of disease-free survival in DTC. Patients and Methods: Retrospective study of 104 patients with low and intermediate risk DTC subjected to total thyroidectomy and 131iodine ablation. TSH, pTg and thyroglobulin antibodies (AbTg) were determined by chemiluminescence. Patients with distant metastases or presence of AbTg were excluded. Results were analyzed using receiving operating characteristic (ROC) curves. Results: During the 40 ± 29 months of follow-up (range 6-132), 14 of 104 (13%) patients had recurrence of disease. pTg was an independent indicator to predict disease-free survival. Using a pTg cutoff of < 10 ng/ml the negative predictive value was 99%, sensitivity 93%, specificity 82%, positive likelihood ratio (LR) 5.2 and negative LR 0,087. Conclusions: pTg value is useful as a prognostic marker in predicting disease-free survival in DTC patients with low or intermediate risk of recurrence.


Sujets)
Adulte , Sujet âgé , Femelle , Humains , Mâle , Adulte d'âge moyen , Jeune adulte , Carcinomes/thérapie , Récidive tumorale locale/sang , Thyroglobuline/sang , Tumeurs de la thyroïde/thérapie , Marqueurs biologiques tumoraux/sang , Carcinomes/sang , Chili , Survie sans rechute , Études de suivi , Radio-isotopes de l'iode/usage thérapeutique , Valeur prédictive des tests , Pronostic , Courbe ROC , Études rétrospectives , Tumeurs de la thyroïde/sang , Thyroïdectomie/méthodes
3.
Rev. méd. Chile ; 139(11): 1475-1480, nov. 2011. ilus
Article Dans Espagnol | LILACS | ID: lil-627579

Résumé

Paragangliomas are tumors arising from sympathetic and parasympathetic tissues. The classic associated syndromes are neurofibromatosis type 1, multiple endocrine neoplasia type 2 and von Hippel-Lindau. Germline mutations of succinate dehydroge-nase subunits genes, are associated with familial paraganglioma syndromes 1,2,3 and 4. We report a 29-year-old woman with a family background of pheochromocytoma and history of paroxysmal headache, nausea, sweating, palpitations, associated with severe hypertension. The patient had elevated plasma noradrenalin and urinary normetanephrines. Imaging studies revealed three retroperitoneal extra-adrenal masses. The clinical and laboratory study of classic syndromes associated with para-ganglioma was negative. The patient was operated and the pathological study of the surgical specimen was consistent with paragangliomas. The genetic study showed a mutation in the SDHB succinate dehydrogenase gen, Exon 2 of CCTCA c.300_304 (p.P56delYfsX5).


Sujets)
Adulte , Femelle , Humains , Tumeurs de la surrénale/génétique , Mutation/génétique , Paragangliome/génétique , Succinate Dehydrogenase/génétique , Pedigree
4.
Rev. méd. Chile ; 139(9): 1196-1200, set. 2011. ilus, tab
Article Dans Espagnol | LILACS | ID: lil-612245

Résumé

Addisonian crisis as a first manifestation of metastatic disease secondary to cancer is uncommon. We report a 63-year-old man with a history of one year of fatigue, weakness, weight loss and repeated symptomatic hypoglycemia. The cortisol stimulation test with ACTH confirmed primary adrenal insufficiency. While receiving adequate treatment with oral hydrocortisone, he presented an adrenal crisis that was treated properly. A CT scan of the lung demonstrated a nodule in the upper right lobe and bilateral adrenal tumors. The biopsy of the lesion revealed a lung adenocarcinoma. The staging with positron emission tomography using 18 fluoroglucose (PET/CT18F- FDG) showed hypermetabolic uptake in the primary lung tumor and in both adrenal glands, suggesting metastatic implants.


Sujets)
Humains , Mâle , Adulte d'âge moyen , Maladie d'Addison/étiologie , Adénocarcinome/secondaire , Tumeurs de la surrénale/secondaire , Tumeurs du poumon , Maladie d'Addison , Adénocarcinome/diagnostic , Tumeurs de la surrénale , Tumeurs du poumon/diagnostic , Radiopharmaceutiques
5.
Rev. chil. endocrinol. diabetes ; 4(1): 18-22, ene. 2011. tab, ilus
Article Dans Espagnol | LILACS | ID: lil-640624

Résumé

Carcinoid syndrome is observed in one third of carcinoid tumors and usually appears when there are liver metastases. One of the main complications of this syndrome is the appearance of tricuspid or pulmonary valvular disease. We report a 56 years old male presenting with malaise and a weight loss of 10 kg. On physical examination, a heart murmur suspicious of a double tricuspid lesion was found. The echocardiogram was suggestive of a carcinoid valvular disease. The abdominal CAT scan showed a small bowel tumor. Urinary 5-hydroxy-indol- acetic acid values were highly elevated. The patient was subjected to excision of the distal ileum, liver metastasectomy and hemicolectomy. The pathological study of the surgical piece confirmed the diagnosis of carcinoid tumor. Two years after surgery, the patient is in stable conditions.


Sujets)
Humains , Mâle , Adulte d'âge moyen , Cardiopathie carcinoïde/diagnostic , Syndrome carcinoïde malin/diagnostic , Composés organométalliques , Acide 5-hydroxy-indole-3-acétique , Tumeurs du foie/secondaire , Tumeurs de l'intestin/secondaire , Tomographie par émission de positons , Syndrome carcinoïde malin/anatomopathologie , Tomodensitométrie
6.
Rev. méd. Chile ; 136(9): 1107-1112, sept. 2008. tab
Article Dans Espagnol | LILACS | ID: lil-497024

Résumé

Background: During the detection ofneck recurrence in patients with Papillary Thyroid Carcinoma (PTC), sometimes it is difficult to distinguish metastatic from inflammatory neck lymph nodes. The measurement of serum thyroglobulin (sTg) under thyroid hormone suppression therapy the presence of serum thyroglobulin antibodies (sAbTg), the diagnostic whole body sean and cytology can give false negative results. Measurement of thyroglobulin in the washout fluid from fine-needle aspiration biopsy (FNAB) of suspicious neck lymph nodes could improve the diagnostic aecuracy Aim: To evaluate the usefulness of detecting Tg in lymph nodes (LTg) suspicious by ultrasonography (US) and compare it to cytology. Patients and Methods: Between the years 2004 and 2007 we prospectively studied 30 patients with PTC and cervical US findings of suspicious recurrence. LTg was assayed in US guided FNAB used for cytology. Results: Sixteen out of 30 patients underwent surgery using as selective criteria an LTg higher than sTg or a positive cytology. Surgery confirmed the presence of metástasis in all 15 patients with positive LTg (8 with positive cytology) and in 1 patient with negative LTg and positive cytology (a case with undifferentiated thyroid cancer). The sensitivity was 93.7 percent for LTg and 56.2 percent for cytology. We identified byLTg 3 of 6 patients with undetectable sTg and positive sAbTg. Conclusions: The presence of LTg showed a higher sensitivity than cytology for the detection of cervical lymph node metástasis. This method is useful even in the presence ofsAbTg.


Sujets)
Adolescent , Adulte , Sujet âgé , Sujet âgé de 80 ans ou plus , Femelle , Humains , Mâle , Adulte d'âge moyen , Jeune adulte , Carcinome papillaire/anatomopathologie , Thyroglobuline/analyse , Tumeurs de la thyroïde/anatomopathologie , Marqueurs biologiques tumoraux/analyse , Cytoponction , Carcinome papillaire/composition chimique , Carcinome papillaire/secondaire , Faux négatifs , Études de suivi , Noeuds lymphatiques/anatomopathologie , Métastase lymphatique/anatomopathologie , Cou/anatomopathologie , Études prospectives , Sensibilité et spécificité , Thyroglobuline/sang , Tumeurs de la thyroïde/composition chimique , Marqueurs biologiques tumoraux/sang , Jeune adulte
7.
In. Dedivitis, Rogério Aparecido; Guimarães, André V. Patologia cirúrgica da glândula tireóide. São Paulo, Frontis Editorial, 1 ed; junho 1999. p.111-115.
Monographie Dans Espagnol | LILACS | ID: lil-509654
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