Armadilhas no diagnóstico do carcinoma papilífero associado à doença de graves: relato de caso / Pitfalls in papillary carcinoma diagnosis associated with graves' disease: case report

A Doença de Graves constitui a forma mais comum de hipertireoidismoem áreas suficientes em iodo (60-80%)10. Por sua vez,o carcinoma papilífero, é o tumor tireoidiano mais frequentee é responsável por 80% dos casos de câncer de tireoide nosEUA12. Carcinomas da tireoide incidentais em pacientes comDG não são incomuns, mas a maioria deles são microcarcinomapapilar de tireoide de baixo risco, sem metástases em linfonodosou invasão extratireoidiana4. Exames complementares quandorealizado por profissionais experientes tornam-se instrumentode grande valia ao diagnóstico. Relata-se o caso de uma pacientefeminina, 41 anos, em seguimento ambulatorial, com sintomastípicos de DG cujos exames iniciais mostravam-se normais ecom subsequente avaliação apresentava nódulo tireoidiano comcaracterísticas de malignidade. A punção aspirativa por agulhafina (PAAF) foi compatível com Carcinoma Papilífero e a terapêuticacirúrgica indicada, seguida de dose ablativa iodo radioativo(131I) e supressiva com levotiroxina (LT4).(AU)

The Graves Disease is one of the most common clinical formsof hyperthyroidism in iodine sufficient areas (60-80%). At the same time, papillary thyroid carcinoma is the most frequent andresponsible for 80% of thyroid cancer cases in US. Incidentalthyroid cancer is common among patients with Graves disease,with no linphonodal metastasis nor local extrathyroidal invasion.Complementary exams performed by experienced physiciansare a valuable diagnostic tool. Here we describe of a 41 yearoldfemale patient that was in outpatient care for classic Graveswith typical symptoms, but with primary exams all normal.In the follow-up examination a single nodule with malignantcharacteristics was visualized and for the patient was indicatedto Fine Needle Aspiration (FNA), which was positive forPapillary Carcinoma. Patient underwent surgical treatmentfollowed by radioactive iodine therapy and a suppressing doseof levothyroxine.(AU)

Lesão folicular: correlação entre achados da punção aspirativa por agulha fina de tireoide e exame anatomopatológico / Follicular lesion: correlation between findings of fine needle aspiration of thyroid and histological study

JUSTIFICATIVA E OBJETIVO: A punção aspirativa por agulha fina é um método de alta acurácia no diagnóstico pré-operatório de nódulos tireoidianos, porém, quando se trata de lesões de padrão folicular, ainda há limitação diagnóstica na distinção entre lesões benignas e malignas. O objetivo deste estudo foi determinar a taxa de malignidade em lesões foliculares de tireoide a partir do exame anatomopatológico de pacientes cirurgicamente tratados em centro médico quaternário. MÉTODOS: Análise observacional retrospectiva dos casos de lesão folicular de tireoide investigados em ambiente ambulatorial pela disciplina de Endocrinologia do Hospital de Base de São José do Rio Preto no período entre 1º de janeiro de 2000 e 31 de dezembro de 2012. RESULTADOS: Dentre o total de 1.150 punções aspirativa por agulha fina realizadas, 841 tiveram diagnóstico citológico de benignidade (73,13%), 117 tiveram diagnóstico de malignidade (10,17%) e 192 tiveram diagnóstico de lesão folicular de significado indeterminado (16,70%). Destes, 144 (75%) foram submetidos à tireoidectomia para diagnóstico anatomopatológico confirmatório, tendo prevalência de malignidade em 36,80%. Houve predomínio do carcinoma papilífero de tireoide (20,83%), seguido do carcinoma folicular de tireoide(15,28%) e apenas um caso de carcinoma medular de tireoide (0,69%). CONCLUSÃO: A taxa de malignidade nas citologias de padrão folicular, após correlação histológica neste serviço, foi superior à estimada na literatura, o que evidencia o valor da punção aspirativa por agulha fina como um exame de screening de nódulos tireoidianos e reforça a importância da confirmação histopatológica, para correto tratamento e seguimento desses pacientes

BACKGROUND AND OBJECTIVE: The fine needle aspiration is a method of high accuracy in preoperative diagnosis of thyroid nodules, but when it comes to follicular lesions there are still limitations in diagnostic distinction between benign and malignant lesions. The aim of this study was to determine the rate of malignancy in thyroid follicular lesions from the pathologic exam of patients surgically treated in a quaternary medical center. METHODS: Retrospective observational analysis of cases of thyroid follicular lesions investigated in an outpatient basis by the Endocrinology Department, at Hospital de Base, in the city of São José do Rio Preto, São Paulo, Brazil, in the period between January 1, 2000 and December 31, 2012. RESULTS: Among a total of 1,150 fine needle aspirations, 841 had benign cytological diagnosis (73.13%), 117 had diagnosis of malignancy (10.17%) and 192 had diagnosis of follicular lesions of undetermined significance (16.70%). Of these, 144 (75%) underwent thyroidectomy for confirmatory histological diagnosis, with prevalence of malignancy in 36.80%. There was a predominance of papillary thyroid carcinoma (20.83%), followed by follicular thyroid carcinoma (15.28%) and only one case of medullary thyroid carcinoma (0.69%). CONCLUSION: The rate of malignancy in follicular cytology after histologic correlation in our service was higher than that estimated in the literature, showing the value of fine needle aspiration as a screening test for thyroid nodules, and reinforcing the importance of histopathological confirmation for correct handling and follow-up of these patients.

Application of ultrasound in diagnosis of thyroid nodular disease / 中国医师杂志

Objective To explore the diagnostic value of ultrasound in thyroid nodular disease.Methods Eighty-seven patients with thyroid nodule in hospital from 2010-2011 were taken ultrasound examination,including 23 cases with benign nodules and 64 cases with malignant nodules.Univariate analysis and mutivariate Logistic regression analysis were taken to test the ultrasonic index (internal echo,boundary,size,shape,microcalcifications,and aspect ratio) for discovery of the best diagnostic ultrasonic index to identify benign and malignant nodules.Results The ultrasound in the patients with malignant thyroid nodules showed the hypoecho,unclear border,irregular shape,microcalcifications,low blood supply,the aspect ratio ＞ 1.The ultrasound in the patients with benign thyroid nodules showed high or equal echo,clear border,regular shape,high blood supply,and the aspect ratio≤ 1.The ultrasonic indices between two groups had statistically significant difference (P ＜ 0.05).The shape and microcalcifications were the best ultrasonic diagnostic index to indentify the benign and malignant nodules with an EXP(B) 20.12 and 19.14,respectively.Conclusions The ultrasound is helpful in the diagnosis of thyroid nodular disease and identification of benign and malignant thyroid nodules.The ultrasonic images are the basic data for the clinical diagnosis of thyroid nodules.