Carcinoma medular esporádico de tiroides / Sporadic Medullary Thyroid Carcinoma

Introducción: El carcinoma medular de tiroides, representa aproximadamente entre el 5 - 10 por ciento de todos los carcinomas tiroideos, aparece con más frecuencia entre los 25 y 60 años y en el sexo femenino. Se distinguen dos tipos: el esporádico (no hereditario) y el familiar (hereditario). La localización más frecuente es la unión del tercio superior de lóbulo tiroideo con el tercio medio, que es la zona de mayor concentración de células C. Objetivo: Presentar el caso de paciente masculino operado de carcinoma medular de tiroides, tipo esporádico, en la provincia de Cienfuegos. Caso clínico: Paciente masculino de 60 años de edad, piel blanca, que acudió a la consulta; refiere aumento de volumen del cuello acompañado de disfonía y disfagia a los alimentos sólidos. Al examen físico se constató la presencia del nódulo tiroideo. Se le realizó ultrasonido que corrobora la presencia de un nódulo en el lóbulo derecho del tiroides. La biopsia por aspiración con aguja fina informó el nódulo como sospechoso de malignidad. Se le realizó tiroidectomía total, informándose por la biopsia por parafina de la pieza como un carcinoma medular del tiroides. En la actualidad lleva 6 meses de operado con evolución favorable. Conclusiones: El carcinoma medular de tiroides constituye una entidad rara y agresiva más frecuente en los pacientes mayores de 45 años, cuyo tratamiento de elección es la cirugía(AU)

Introduction: Medullary thyroid carcinoma accounts for approximately 5-10 percent of all thyroid carcinomas. It appears more frequently at ages 25-60 years and in females. Two types are distinguished: sporadic (nonhereditary) and familial (hereditary). The most common location is the union of the upper third of the thyroid lobe to the middle third, the area with the highest concentration of C cells. Objective: To present the case of a male patient operated on for medullary thyroid carcinoma, of sporadic type, in the Cienfuegos Province. Clinical case: A 60-year-old male patient of white skin attended consultation. He reported an increase in neck volume accompanied by dysphonia and dysphagia for solid food. The physical examination revealed the presence of the thyroid nodule. Ultrasound was performed, which confirmed the presence of a nodule in the right lobe of the thyroid. Fine needle aspiration biopsy reported the nodule as suspicious for malignancy. A total thyroidectomy was performed, after which, paraffin biopsy of the specimen permitted to report a medullary carcinoma of the thyroid. At present, he has been operating for six months, with favorable evolution. Conclusions: Medullary thyroid carcinoma is a rare and aggressive entity, more frequent in patients over 45 years of age, whose treatment of choice is surgery(AU)

Influence of chronic lymphocytic thyroiditis on the risk of persistent and recurrent disease in patients with papillary thyroid carcinoma and elevated antithyroglobulin antibodies after initial therapy / Influência da tireoidite linfocítica crônica sobre o risco de doença persistente e recorrente em pacientes com carcinoma papilífero de tireoide e anticorpos antitireoglobulina elevados após a terapia inicial

Abstract Introduction In patients with papillary thyroid carcinoma who have negative serum thyroglobulin after initial therapy, the risk of structural disease is higher among those with elevated antithyroglobulin antibodies compared to patients without antithyroglobulin antibodies. Other studies suggest that the presence of chronic lymphocytic thyroiditis is associated with a lower risk of persistence/recurrence of papillary thyroid carcinoma. Objective This prospective study evaluated the influence of chronic lymphocytic thyroiditis on the risk of persistence and recurrence of papillary thyroid carcinoma in patients with negative thyroglobulin but elevated antithyroglobulin antibodies after initial therapy. Methods This was a prospective study. Patients with clinical examination showing no anomalies, basal Tg < 1 ng/mL, and elevated antithyroglobulin antibodies 8-12 months after ablation were selected. The patients were divided into two groups: Group A, with chronic lymphocytic thyroiditis on histology; Group B, without histological chronic lymphocytic thyroiditis. Results The time of follow-up ranged from 60 to 140 months. Persistent disease was detected in 3 patients of Group A (6.6%) and in 6 of Group B (8.8%) (p = 1.0). During follow-up, recurrences were diagnosed in 2 patients of Group A (4.7%) and in 5 of Group B (8%) (p = 0.7). Considering both persistent and recurrent disease, structural disease was detected in 5 patients of Group A (11.1%) and in 11 of Group B (16.1%) (p = 0.58). There was no case of death related to the disease. Conclusion Our results do not support the hypothesis that chronic lymphocytic thyroiditis is associated with a lower risk of persistent or recurrent disease, at least in patients with persistently elevated antithyroglobulin antibodies after initial therapy for papillary thyroid carcinoma.

Resumo Introdução Em pacientes com carcinoma papilífero de tireoide e com tireoglobulina sérica negativa após a terapia inicial, o risco de doença estrutural é maior entre aqueles com anticorpos antitireoglobulina elevados em comparação com pacientes sem anticorpos antitireoglobulina. Outros estudos sugerem que a presença de tireoidite linfocítica crônica está associada a um menor risco de persistência/recorrência do carcinoma papilífero de teireoide. Objetivo Este estudo prospectivo avaliou a influência da tireoidite linfocítica crônica sobre o risco de persistência e recorrência do carcinoma papilífero de tireoide em pacientes com tireoglobulina negativa, mas com anticorpos antitireoglobulinas elevados após a terapia inicial. Método Esse foi um estudo prospectivo, no qual foram selecionados pacientes com exame clínico sem anomalias; tireoglobulina basal < 1 ng/mL e anticorpos antitireoglobulina elevados 8-12 meses após ablação. Os pacientes foram divididos em dois grupos: Grupo A, com tireoidite linfocítica crônica no exame histológico; Grupo B, histologicamente sem tireoidite linfocítica crônica. Resultados O tempo de seguimento variou de 60 a 140 meses. Doença persistente foi detectada em 3 pacientes do Grupo A (6,6%) e em 6 do Grupo B (8,8%) (p = 1,0). Durante o seguimento, as recidivas foram diagnosticadas em 2 pacientes do Grupo A (4,7%) e em 5 do Grupo B (8%) (p = 0,7). Considerando tanto a doença persistente quanto a recorrente, doença estrutural foi detectada em 5 pacientes do Grupo A (11,1%) e em 11 do Grupo B (16,1%) (p = 0,58). Não houve nenhum caso de óbito relacionado à doença. Conclusão Nossos resultados não apoiam a hipótese de que a tireoidite linfocítica crônica esteja associada a um menor risco de doença persistente ou recorrente, pelo menos em pacientes com anticorpos antitireoglobulina persistentemente elevados após a terapia inicial do carcinoma papilífero de tireoide.

Papillary Thyroid Carcinoma within Thyroglossal Duct Cyst: Case Series and Literature Review

Abstract Introduction Thyroglossal duct cyst (TGDC) is themost common congenital anomaly of the neck, and approximately 7% of all the adult population presents it. Ectopic thyroid tissue is found in the thyroglossal duct cyst wall in up to 65% of cases. This thyroid tissue has the potential to develop some type ofmalignancy, themost common of which is the papillary carcinoma of the thyroid. There are just over 270 cases of thyroglossal duct cyst malignancy reported in the literature. Objectives We aimed to study our population of patients in order to identify cases with thyroglossal duct cyst malignancy. Methods A retrospective chart review was conducted in the section of otolaryngology/ head and neck surgery at a hospital in Karachi, Pakistan, from January of 2004 to December of 2014 on patients with the diagnosis of thyroglossal duct cyst. Results Fifty-eight patients were diagnosed with TGDC, two of whom also presented with thyroglossal duct cyst carcinoma. Both patients revealed papillary thyroid carcinoma on histopathology. Case 1 had an open biopsy before undergoing definitive surgery. Both patients underwent subsequent total thyroidectomy after Sistrunk procedure, and case 2 had selective neck dissection revealing lymph node metastasis. Conclusion Thyroglossal duct cyst carcinoma is a rare finding that comes as a surprise to both the patient and the surgeon. We report 2 out of 58 cases diagnosed with thyroglossal duct cyst carcinoma.

Relación entre linfocitos T reguladores (T regs) y anticuerpos anti-receptores de TSH (TRab) y el riesgo de cáncer de tiroides en enfermedad de Graves / Relationship between T regulatory lymphocytes (Tregs) and TSH receptor antibodies (TRab) on risk of thyroid cancer in Graves disease

Durante los últimos años se ha estudiado la relación entre enfermedad de Graves (EG), TSH, TRAb y cáncer de tiroides, existiendo estudios que demuestran mayor prevalencia y agresividad del cáncer de tiroides en pacientes con EG, mientras otros refutan estos hallazgos sugiriendo que serían producto del sesgo de selección. Aquellos estudios que plantean una relación causal entre EG y el desarrollo de cáncer de tiroides, la atribuyen a la presencia de autoanticuerpos TSI, que estimularían el foco de malignidad. Se cree que las citoquinas producidas localmente en pacientes con EG trabajarían en conjunto con los TRAb para determinar la agresividad del cáncer papilar de tiroides en estos pacientes. Dentro de las células reclutadas por el tumor para evadir la respuesta inmune se encuentran los linfocitos Treg, que estarían elevados en paciente con EG, llevando a la disminución de la respuesta inmune y creando un ambiente permisivo para la proliferación celular. Por tratarse de una línea de investigación reciente, no existe consenso sobre el tema y sus implicancias en el tratamiento de los pacientes con EG. La finalidad de este artículo es realizar una revisión de la literatura que exponga y contraste la información disponible a la fecha.

In recent years the relationship between Graves’ disease (GD), TSH, TRAb and thyroid carcinoma has been studied. Research studies show a higher prevalence and aggressiveness of thyroid carcinoma in patients with GD, however other researchers refute these findings suggesting it’s due to selection bias. Increasing evidence suggests a causal relationship between GD and the development of thyroid carcinoma, mainly because of the existence of TSI autoantibodies that could stimulate the focus of malignancy. It is believed that cytokines produced locally in patients with GD work alongside with TRAb regulating the aggressiveness of papillary thyroid carcinoma in these patients. Within the cells recruited by the tumor to elude the immune system we find Treg lymphocytes, which have been found to be increased in patients with GD, leading to a diminished immune response, creating a permissive environment for cell proliferation. Since this is a relatively new line of research, there is no consensus on the subject and its relevance for the treatment of patients with GD. The aim of this article is to show recent literature available on the subject.

Factores Asociados a la Recurrencia Tumoral en Mujeres con Carcinoma Diferenciado de Tiroides / Descriptive Research: Factors Associated with Tumor Recurrence In Women with Differentiated Thyroid Carcinoma

INTRODUCCIÓN: El Carcinoma Diferenciado de Células Foliculares del Tiroides es la endocrinopatía maligna más frecuente. El objetivo del presente estudio fue determinar los factores, dependientes del paciente e histopatológicos, que están asociados a la recurrencia tumoral, en mujeres con carcinoma diferenciado de tiroides. MÉTODO: El presente estudio es descriptivo de corte transversal. Participaron Mujeres entre 17 y 60años con tiroidectomía total por carcinoma diferenciado de células foliculares del tiroides diagnosticadas en el periodo 2000 - 2011 en la consulta del Instituto de Oncología y Radiobiología y del Instituto Nacional de Endocrinología - Cuba. Para el análisis, los casos se dividieron en 2 grupos: A (sin recurrencia tumoral) y B (con recurrencia de la enfermedad).Las variables fueron: edad, antecedentes patológicos personales de enfermedad tiroidea o diabetes, antecedente patológico de carcinoma diferenciado de células foliculares del tiroides en familiares de primer grado, variables antropométricas, Hábito de fumar, TSH prequirúrgica (mU/l). Variables histopatológicas: Tamaño del nódulo (mm). Tipo histológico del carcinoma y presencia de Tiroiditis de Hashimoto o linfocítica. Se utilizó SPSS versión 18.0 para el análisis. El comité de ética Instituto Superior de Ciencias Médicas de la Habana aprobó el presente estudio. RESULTADOS: Se incluyeron 64 mujeres, tiempo de seguimiento de las pacientes menopaúsicas 5.93 ±2.9 años. Las 45 pacientes sin recurrencia (Grupo A), las 19 pacientes con recurrencia (Grupo B). La edad media de 39.0 ±8.7 años en el grupo A y de 39.0 ±11.6 años en el grupo B (p: 0.142). El peso de 67.13 ±12.09¿en el grupo A y de 71.42 ± 23.74 en el grupo B (p: 0.013). El tiempo libre de enfermedad para el grupo B fue de 1.13 ±1.29 años. pacientes menopaúsicas, 11.1 % en el grupo A y 21.1 % en el grupo B (p: 0.458). El uso de anticoncepción en el grupo A 23 casos (51.1 %) en el grupo B 9 casos (47.4 %) (p: 0.075). La variante histológica Papilar en el grupo A 40 casos (88.9 %) en el grupo B 18 casos (94.7 %) (p: 0.418). La variante Folicular 5 casos (11.1 %) en el grupo A, 1 caso (5.3 %) en el grupo B (p: 0.418). Tiroiditis de Hashimoto 6 casos (13.3 %) en el grupo A versus 4 casos (21.1 %) en el grupo B (p: 0.346). CONCLUSIÓN: El mayor peso corporal fue el único factor asociado a la recurrencia tumoral en los casos estudiados.(au)

INTRODUCTION: Differentiated thyroid follicular cell carcinoma is the most common malignant endocrinopathy. The aim of the present study was to determine the patient-dependent and histopathological factors associated with tumor recurrence in women with differentiated thyroid carcinoma. METHODS: The present study is descriptive cross-sectional. Women between the ages of 17 and 60 with total thyroidectomy for Differentiated thyroid follicular cell carcinoma diagnosed in the period 2000-2011 in the consultation of the Institute of Oncology and Radiobiology and the National Institute of Endocrinology - Cuba participated. For the analysis, the cases were divided into 2 groups: A (without tumor recurrence) and B (with disease recurrence). The variables were: age, personal pathological history of thyroid disease or diabetes, pathological history of Differentiated thyroid follicular cell carcinoma in relatives First degree, anthropometric variables, smoking habit, preoperative TSH (mU / l), histopathological variables: nodule size (mm), histological type of carcinoma and presence of Hashimoto or lymphocytic thyroiditis. The SPSS version 18.0 was used for analysis. The ethics committee the Higher Institute of Medical Sciences of Havana approved the present study. RESULTS: Sixty-four women were included, with a follow-up time of 5.93 ± 2.9 years. The 45 patients without recurrence (group A), the 19 patients with recurrence (Group B). The average age was of 39.0 ±8.7 years in group A and 39.0 ± 11.6 years in group B (p: 0.142). The weight of 67.13 ± 12.09 in group A and 71.42 ± 23.74 in group B (p: 0.013). The disease free time for group B was 1.13 ± 1.29 years. Menopausal patients, 11.1 % in group A and 21.1 % in group B (p: 0.458). Use of contraception in group A 23 cases (51.1 %) in group B 9 cases (47.4 %) (p: 0.075). Histological variant Papillary in group A 40 cases (88.9 %) in group B 18 cases (94.7 %) (p: 0.418). Follicular variant 5 cases (11.1 %) in group A, 1 case (5.3 %) in group B (p: 0.418). Hashimoto's thyroiditis 6 cases (13.3 %) in group A versus 4 cases (21.1 %) in group B (p: 0.346). CONCLUSION: The highest body weight is the only factor associated with tumor recurrence in the cases studied.(au)

Carcinoma papilar de tiroides en un niño con hipotiroidismo congénito dishormonogénico: Reporte de un caso / Papillary thyroid carcinoma in a child with congenital dyshormonogenetic hypothyroidism: Case report

Introducción: El cáncer papilar de tiroides (CPT) es una enfermedad infrecuente en pediatría. La presentación de CPT asociado a hipotiroidismo congénito (HC) dishormonogénico es excepcional, y hay pocos casos reportados en la literatura. Objetivo: Presentar un caso de CPT en un paciente con HC dishormonogénico sin bocio, expuesto a radiación ionizante. Evaluar asociaciones entre estos factores y el desarrollo de CPT. Caso clínico: Paciente varón con antecedentes de HC dishormonogénico, por lo que recibió suplementación precoz con levotiroxina, logrando niveles normales de tirotropinas y hormonas tiroideas. Con antecedentes de cardiopatía congénita, fue sometido tratamiento intervencional con 10 cateterismos cardíacos y aproximadamente 26 radiografías de tórax con dosis pediátrica. A la edad de 6 años se encontró un nódulo tiroideo mediante ecografía. La citología por punción aspirativa con aguja fina confirmó alta sospecha de carcinoma tiroideo (Bethesda 5). El estudio de etapificación no mostró metástasis en el tórax ni en el cerebro. Fue sometido a tiroidectomía total y el análisis histopatológico reveló un microcarcinoma papilar de 0,5 cm intratiroideo, sin evidencia de diseminación. Conclusión: Las mutaciones genéticas propias de esta enfermedad y la exposición a radiación ionizante pudieran estar implicadas en el desarrollo de CPT. Es probable que haya vías fisiopatológicas comunes que requieren mayor investigación.

Introduction: Papillary thyroid carcinoma (PTC) is a rare childhood disease. The development of PTC in dyshormonogenetic congenital hypothyroidism (CH) is infrequent, with very few case reports in literature. Objective: To report a case of PTC in a boy with dyshormonogenetic CH without goitre and exposed to ionising radiation. To evaluate relationships between these factors and development of PTC. Case report: We present a boy with dyshormonogenetic CH since birth. Early hormonal substitution was initiated, with subsequent normal levels of thyrotropin and thyroid hormones. He has also congenital cardiomyopathy, exposed to interventional treatment with 10 heart catheterisations, and approximately 26 chest X-rays at paediatric doses. A thyroid nodule was found in thyroid echography at the age of 6 years old. Fine needle aspiration biopsy confirmed high probability of thyroid carcinoma (Bethesda 5). The pre-surgical thorax and cerebral scan showed no evidence of metastasis. The patient underwent total thyroidectomy. Pathological examination revealed a 0.5 cm papillary thyroid micro-carcinoma in the right lobe, with no evidence of dissemination. Conclusion: Genetic mutations and radiation exposure may play an important role in the development of PTC. There may be common pathways between dyshormonogenetic CH and thyroid carcinoma that need further investigation.

Síndrome de Cushing secundario a carcinoma medular de tiroides: descripción de un caso y revisión de la literatura / Cushing syndrome secondary to a medullary thyroid carcinoma: report of a case and review of the literature

Se describe el caso de una paciente evaluada a los 29 años por un tumor tiroideo, clasificado inicialmente como un carcinoma insular de tiroides; presentaba gran compromiso tumoral en cuello, mediastino y pulmones. Tres años después de recibir tratamiento específico para su neoplasia tiroidea, desarrolló un síndrome de Cushing y lesiones hepáticas sugestivas de metástasis del tumor primario. Al revisar la patología se encontró, en lo que inicialmente se había clasificado como un carcinoma insular, un carcinoma medular de tiroides productor de hormona adrenocorticotrópica (ACTH). Con base en este caso, se presenta una revisión de la literatura médica sobre el tema.

Cushing syndrome secondary to a medullary thyroid carcinoma: report of a case and review of the literature We report the case of a 29-year old female who was evaluated because of a thyroid tumor. The initial pathological classification was an insular thyroid carcinoma. There was strong involvement in the neck, mediastinum and lungs. Three years after receiving specific therapy for her thyroid neoplasia, she developed a Cushing syndrome and liver lesions suggestive of metastases from the primary tumor. A review of the previous pathological material revealed a medullary thyroid carcinoma producing ACTH, instead of the insular carcinoma. Based on this case a review of the literature is presented.

Prevalence of thyroid diseases in patients with acromegaly: experience of a Brazilian center / Prevalência das doenças tireoidianas em pacientes com acromegalia: experiência de um centro brasileiro

OBJECTIVES: Acromegaly is frequently associated with thyroid diseases. In this study, we evaluated the frequency of thyroid disorders in a series of acromegalic patients. SUBJECTS AND METHODS: We evaluated 106 acromegalic patients using thyroid ultrasonography (US) and measurements of GH, IGF-I, free T4, TSH and anti-thyroperoxidase antibody levels. IGF-I was expressed in mass units and age-related standard deviation scores (SD-scores). Fine-needle aspiration biopsy (FNAB) was performed on thyroid nodules with a diameter greater than one centimeter or with suspicious characteristics. RESULTS: Thyroid disorders were found in 75 patients. Eleven patients had diffuse goiter, 42 patients had nodular goiter, and 22 patients had unspecific morphological abnormalities. Four patients (3.8%) had thyroid carcinoma. Considering the patients with diffuse or nodular goiter, thyroid volume was greater in patients with active acromegaly, and was positively correlated with GH, IGF-I, and IGF-I SD-score. CONCLUSIONS: Our study confirmed that benign thyroid diseases are frequent in acromegalic patients. The prevalence of thyroid cancer was higher than in the overall population. We suggest that thyroid US should be routinely performed in patients with acromegaly.

OBJETIVOS: Acromegalia está frequentemente associada a doenças tireoidianas. Neste estudo, avaliamos a presença de tireoidopatias em uma série de pacientes acromegálicos. SUJEITOS E MÉTODOS: Foram avaliados 106 pacientes por ultrassonografia (US) e dosagens de GH, IGF-1, T4 livre, TSH e anticorpo antitireoperoxidase. O IGF-I foi expresso em unidades de massa e desvio-padrão (DP-IGF-I). Punção aspirativa por agulha fina (PAAF) foi realizada quando os nódulos eram maiores que um centímetro ou tinham características suspeitas. RESULTADOS: Alterações tireoidianas foram encontradas em 75 pacientes. Onze apresentavam bócio difuso, 42, bócio nodular e 22, alterações morfológicas inespecíficas. Houve quatro casos (3,8%) de câncer diferenciado de tireoide. Considerando os pacientes com bócio difuso ou nodular, o volume tireoidiano foi maior naqueles com acromegalia em atividade e correlacionou-se positivamente com os níveis de GH, IGF-1 e DP-IGF-1. CONCLUSÕES: Nosso estudo confirmou que as doenças tireoidianas benignas são frequentes nos pacientes acromegálicos. A prevalência de câncer diferenciado de tireoide foi maior que na população geral. Sugerimos que US de tireoide seja realizado rotineiramente nos pacientes com acromegalia.

Alterações tireoidianas associadas à radiação externa em crianças e adolescentes / Thyroid disorders associated with external radiation in children and adolescents

O efeito da radiação ionizante sobre a tireoide vem sendo estudado há várias décadas, e os acidentes nucleares têm sido a maior fonte de informação. Existe associação de hipotireoidismo, hipertireoidismo, nódulos e câncer de tireoide com a radiação, mas os limiares de dose, mecanismos de lesão e alguns fatores de risco ainda não estão bem estabelecidos. Crianças são mais suscetíveis à lesão tireoidiana por radiação e necessitam de seguimento prolongado após a exposição. Esse tema adquire maior relevância atualmente, pois um grande número de pessoas tratadas com radioterapia para câncer na infância sobrevive e poderá apresentar sequelas. Exames radiodiagnósticos também representam fonte de exposição à radiação na população pediátrica. Nesta revisão, analisamos as diferentes alterações clínico-patológicas e os mecanismos de lesões tireoidianas provocadas por tratamento radioterápico e tomografia computadorizada em crianças e adolescentes. É importante conhecer esses dados para prevenção, detecção precoce e tratamento da disfunção tireoidiana.

The effects of ionizing radiation on the thyroid have been studied for several decades, and nuclear accidents are the major source of information about the subject. There is an association of hypothyroidism, hyperthyroidism, thyroid nodules and cancer with radiation, but the threshold dose, mechanism of injury, and some risk factors have not been fully established. Children are more susceptible to thyroid injury caused by radiation and require prolonged follow-up after exposure. This issue is especially relevant nowadays, since a large number of people treated with radiation for childhood cancer survive and may have sequelae. Diagnostic radiology tests also represent a source of exposure to radiation in the pediatric population. In this review, we analyze different clinical and pathological changes, and the mechanisms of thyroid lesions caused by radiotherapy and computed tomography in children and adolescents. It is important to understand these data for prevention, early detection, and treatment of thyroid dysfunction.

Tasa de tiroidectomías por cáncer y por enfermedades benignas tiroídeas y su posible relación con un déficit de selenio ambiental / Rate of thyroidectomy by cancer and benign thyroid diseases and its possible relation with a deficit of selenium environmental

Recientemente hemos reportado el déficit de selenio ambiental, y el estatus alterado de selenio medido como actividad de Glutatión Peroxidasa en población beneficiaria del Servicio de Salud de Osorno. Estos déficits se asocian a alteraciones funcionales y estructurales del tiroides que se correlacionan con la aparición de enfermedades tiroídeas benignas y cáncer tiroídeo. El objetivo de este trabajo es mostrar la tasa de tiroidectomías por cáncer y por enfermedades benignas que se presentan en las comunas que habitan la población beneficiaria del Servicio de Salud Osorno y llamar la atención sobre su posible asociación con el estatus alterado de selenio y la menor actividad de Glutatión Peroxidasa descrita previamente.

We have recently reported the lack of environmental selenium and the altered selenium status measured as deficient glutathione peroxidase (GPx) activity in the population affiliated to the Osorno Health Service. These deficits are associated to functional and structural abnormalities of the thyroid gland that correlates with the appearance of benign thyroid pathologies and thyroid cancer. The aim of this investigation is to show the rate of thyroidectomy associated with malign and benign disease in the communities associated to the Osorno Health Service and warn about their possible link with the poor amount of selenium in the environment and the altered function of the GPx enzyme, previously described.

Cáncer papilar de tiroides a la luz de las evidencias actuales / Papillary thyroid cancer: an update

The new screening and diagnostic tools for thyroid cancer lead to a higher prevalence of the disease. This requiresa new approach to the therapy of thyroid cancer, that usually has an indolent and slow evolution. The incidence of microcarcinoma is increasing since the vast majority of thyroid cancers are diagnosed during a screening ultrasonography. In papillary thyroid cancer there is a familial aggregation and close relatives of an index patient have three to six times more risk of having the disease. Exposure to radiation, older age and association with other thyroid diseases are external risk factors for the disease. Thyroid cancer is staged using TNM classification, that allows to establish prognosis. There is still discussion about the best treatment in early stages of the disease. Our working group always recommends total thyroidectomy and radioiodine ablation to obtain a better control and survival and reduce the risk of relapse.

Ablación con yodo 131 en pacientes con cáncer diferenciado de tiroides en el Hospital Roberto Calderón / Ablation with iodine-131 in patients with differentiated thyroid cancer at the Hospital Roberto Calderón

Antecedentes: A pesar de las múltiples revisiones bibliográficas, metaanalisis y estudios de cohortes retrospectivo a largo plazo, persiste la controversia a cerca del uso de la ablación con yodo 131 en los pacientes con cáncer diferenciado de tiroides. Objetivo; Determinar la utilidad de la ablación con Yodo 131 como procedimiento terápéutico adyuvante en los pacientes con diagnóstico de cáncer diferenciado de tiroides en el Hospital ROberto Calderón G. Método: Estudio retrospectivo transversal de 83 pacientes con cáncer diferenciado de tiroides tratados integralmente de enero 2002 a diciembre 2007 en el Hospital Dr. Roberto Calderón, en quienes se analizaron los porcentajes de recurrencia en el grupo que recibió y en el que no recibió yodo131 como terapia ablativa post operatoria, identificándose además otros factores de mal positivo...

Secondary Thyroid Papillary Carcinoma in Osteosarcoma Patients: Report of Two Cases

We report two cases of papillary thyroid carcinoma occurring after the successful treatment of osteosarcoma. One of the patients was administered with several alkylating agents and topoisomerase II inhibitor as part of the primary treatment of osteosarcoma. The onset of thyroid carcinoma occurred after 5 and 12 yr after cessation of the osteosarcoma therapy. All the patients involved in this study are alive and free of their malignancies. There have been eight case reports of these two malignancies occurring in the same patient. Thyroid carcinoma rarely occurs in patients with osteosarcoma; however, vigilant surveillance and long-term follow-up should be emphasized for all survivors.

Relevance of iodine intake as a reputed predisposing factor for thyroid cancer

Iodine is a trace element that is essential for the synthesis of thyroid hormone. Both chronic iodine deficiency and iodine excess have been associated with hypertrophy and hyperplasia of follicular cells, attributed to excessive secretion of TSH. This may be associated to thyroid cancer risk, particularly in women. Experimental studies have documented thyroid cancer induction by elevation of endogenous TSH, although in a small number of animals. Iodine deficiency associated with carcinogenic agents and chemical mutagens will result in a higher incidence of thyroid malignancy. Inadequate low iodine intake will result in increased TSH stimulation, increased thyroid cell responsiveness to TSH, increased thyroid cell EGF-induced proliferation, decreased TGFbeta 1 production and increased angiogenesis, all phenomena related to promotion of tumor growth. Epidemiological studies associating iodine intake and thyroid cancer led to controversial and conflicting results. There is no doubt that introduction of universal iodine prophylaxis in population previously in chronic iodine-deficiency leads to a changing pattern of more prevalent papillary thyroid cancer and declining of follicular thyroid cancer. Also anaplastic thyroid cancer is practically not seen after years of iodine supplementation. Iodine excess has also been indicated as a possible nutritional factor in the prevalence of differentiated thyroid cancer in Iceland, Hawaii and, more recently, in China. In conclusion: available evidence from animal experiments, epidemiological studies and iodine prophylaxis has demonstrated a shift towards a rise in papillary carcinoma, but no clear relationship between overall thyroid cancer incidence and iodine intake.

O iodo é essencial para a síntese de hormônios tireóideos e tanto a deficiência crônica deste halogeno como o excesso nutricional de iodo levam a hiperplasia e hipertrofia dos elementos foliculares (por excesso de TSH). Esse fenômeno pode se associar a maior risco de câncer de tireóide, especialmente no sexo feminino. Estudos experimentais documentam indução de câncer de tireóide após prolongado excesso circulante de TSH, o qual induz aumento da proliferação celular medida por fator de crescimento epidermal (EGF), decréscimo de síntese de fator de transformação do crescimento (TGFbeta 1) e aumento da angiogenese. Estudos epidemiológicos entre nutrição de iodo e câncer de tireóide são conflitantes. É, todavia, aceito que a correção de prévia deficiência de iodo com aporte nutricional adequado deste halogeno leva à maior prevalência de carcinoma papilífero (e decréscimo de carcinoma folicular). Em alguns países, o excesso de iodo foi apontado como causa aparente de maior prevalência de câncer de tireóide. Em conclusão: não existe uma relação causa-efeito entre iodo nutricional e prevalência de câncer de tireóide, e outros fatores intervenientes ambientais devem ser considerados.

Identifying a risk profile for thyroid cancer

The large use of simple and effective diagnostic tools has significantly contributed to the increase in diagnosis of thyroid cancer over the past years. However, there is compelling evidence that most micropapillary carcinomas have an indolent behavior and may never evolve into clinical cancers. Therefore, there is an urgent need for new tools able to predict which thyroid cancers will remain silent, and which thyroid cancers will present an aggressive behavior. There are a number of well-established clinical predictors of malignancy and recent studies have suggested that some of the patientÆs laboratory data and image methods may be useful. Molecular markers have also been increasingly tested and some of them appear to be very promising, such as BRAF, a few GST genes and p53 polymorphisms. In addition, modern tools, such as immunocytochemical markers, and the measure of the fractal nature of chromatin organization may increase the specificity of the pathological diagnosis of malignancy and help ascertain the prognosis. Guidelines designed to select nodules for further evaluation, as well as new methods aimed at distinguishing carcinomas of higher aggressiveness among the usually indolent thyroid tumors are an utmost necessity.

O uso cada vez mais freqüente de métodos diagnósticos simples e efetivos tem contribuído significativamente para um aumento no diagnóstico de câncer da tiróide nos últimos anos. Entretanto, existem importantes evidências de que muitos dos microcarcinomas papilíferos têm um comportamento indolente e podem nunca evoluir para cânceres clínicos. Existe, portanto, uma necessidade urgente de desenvolver novas ferramentas capazes de predizer quais os tumores tiroidianos que permanecerão silenciosos e quais desenvolverão comportamento agressivo. Há uma série de marcadores clínicos de evolução bem estabelecidos e alguns estudos recentes sugerem que dados laboratoriais e métodos de imagem podem ser úteis. Marcadores moleculares também vêm sendo ativamente investigados e alguns, como BRAF, os genes GST e polimorfismos de p53, parecem promissores. Além disso, marcadores imunocitoquímicos e a medida da natureza fractal da cromatina podem aumentar a especificidade do diagnóstico anatomopatológico e ajudar a predizer o prognóstico. Existe uma necessidade imperiosa de elaborarmos diretrizes destinadas a selecionar os nódulos que merecem prosseguimento em sua avaliação, assim como novos métodos capazes de identificar lesões mais agressivas entre os geralmente indolentes tumores tiroidianos.

Carcinoma indiferenciado de tireóide / Anaplastic thyroid carcinoma

O carcinoma diferenciado de tireóide, papilífero ou folicular, usualmente tem um curso relativo benigno após a tireoidectomia total e ablação de remanescentes tireoideanos com 131I. Em contraste, o carcinoma anaplásico de tireóide ou carcinoma indiferenciado de tireóide, também derivado do epitélio folicular tireoideano, é uma das neoplasias humanas mais agressivas, que perdeu a maioria ou todas as características do tecido de origem. Crescimento tumoral rápido é um presságio de mortalidade precoce a menos que se institua tratamento combinado agressivo. Não dispomos ainda de um tratamento que leva à cura definitiva para a maioria dos pacientes. A melhor conduta se constitui de um tratamento cirúrgico agressivo associado com a combinação de novos agentes quimioterápicos e radioterapia externa.

A Case of Carcinoma of the Thyroid and Cervical Esophagus Following Irradiation / 대한소화기학회지

It is well recognized that radiation can be carcinogenic for a wide variety of tumors, especially, in breast, thyroid, and bone marrow which appear to be radiosensitive. The criteria for establishing the dignosis of radiation- induced malignancy are the knowledge of prior irradiation and the appearance of a malignancy in the irradiated area. We report a case of carcinoma of the thyroid and esophagus following prior neck irradiation for thyroid mass.