Comparison of Iodine Concentrations in Kitchen Salt and Urine with the Thyroid Volume of Schoolchildren from Ribeirão Preto, São Paulo, Brazil: Warning of Worsening After 10 Years of Study.

Background: In 2007 and 2015, two studies were conducted in Ribeirão Preto, São Paulo, Brazil, on schoolchildren of both sexes attending schools of three different socioeconomic levels (school 1: low; school 2: middle; school 3: high). Methods: Iodine concentrations were measured in samples of kitchen salt from the home provided by the schoolchildren and in urine samples, and these levels were compared to the thyroid volume by clinical assessment. Results: In 2007, a marked discrepancy in iodine concentrations was found in salt samples in 300 schoolchildren of both sexes (age range 8-10 years). Urinary iodine excretion >100 µg/L was detected in all cases, and 55.2% had concentrations of >300 µg/L (considered to be the upper limit by the World Health Organization). There was no increase in thyroid volume among the schoolchildren. In 2015, after a change in the norms for salt iodination from 20-60 to 15-45 mg/kg, the study was repeated in 295 schoolchildren (age range 8-10 years) from the same three schools studied previously. An improved standardization of iodine concentration was observed in the salt samples provided by the children, as well as a significant reduction in ioduria, with 10.9% of the samples showing an iodine concentration of <100 µg/L and with a reduction to 30.5% of samples with >300 µg/L. An increase in thyroid volume was also observed in a greater proportion of children from school 1, with a 7.92%, 5.19%, and 0.85% prevalence of goiter at schools 1, 2, and 3, respectively. Conclusions: Despite the limitations of the present study, which include sample size and thyroid evaluation by palpation, it is inferred that the iodination of the Ribeirão Preto schoolchildren studied is adequate. However, the individual iodine intake of some students was <100 µg/L, and some students also had an increased thyroid volume, raising the possibility of a deterioration of iodine intake in 2015 compared to 2007.

Comparison of power Doppler and thermography for the selection of thyroid nodules in which fine-needle aspiration biopsy is indicated.

OBJECTIVE: To compare two methods-power Doppler and thermography-for the analysis of nodule vascularization and subsequent selection of nodules to be biopsied. MATERIALS AND METHODS: A total of 510 subjects with thyroid nodules were analyzed by power Doppler and submitted to fine-needle aspiration biopsy (FNAB). Thirty-seven patients were submitted to nodule excision (29 due to carcinoma or suspected carcinoma and 8 by patient choice). Among those patients, power Doppler had raised the suspicion of malignancy in 39 lesions, compared with 48 for FNAB. Another group, comprising 110 patients, underwent thermography, which raised the suspicion of malignancy in 124 thyroid nodules, as did FNAB. Malignant nodules were excised in all 110 of those patients (95 underwent nodulectomy and 15 underwent thyroidectomy), malignancy being confirmed by intraoperative examination of frozen biopsy samples. RESULTS: In relation to the FNAB findings, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of power Doppler were 95.16%, 23.52%, 96.22%, 16.70%, and 89.51%, respectively, compared with 100%, 58.06%, 87.73%, 100%, and 89.51%, respectively, for thermography. CONCLUSION: Thermography was more precise than was power Doppler for the selection of thyroid nodules to be biopsied.

OBJETIVO: Comparar dois métodos de análise de vascularização de nódulos - power Doppler e termografia - na seleção para submissão a biópsia. MATERIAIS E MÉTODOS: Foram analisados 510 pacientes portadores de nódulos tireoidianos pelo power Doppler, todos submetidos a punção aspirativa por agulha fina (PAAF). Desses pacientes, 37 tiveram seus nódulos ressecados (29 por carcinoma ou suspeito para carcinoma e 8 por decisão pessoal), totalizando 39 lesões suspeitas para malignidade ao power Doppler e 48 à PAAF. Em outros 110 pacientes foram detectados, pela termografia e PAAF, 124 nódulos tireoidianos, que foram submetidos a excisão (95 casos por nodulectomia e 15 casos por tireoidectomia total) e tiveram malignidade confirmada no exame de congelação intraoperatório. RESULTADOS: O power Doppler e a termografia apresentaram, respectivamente, sensibilidades de 95,16% e 100%, especificidades de 23,52% e 58,06%, valores preditivos positivos de 96,22% e 87,73%, valores preditivos negativos de 16,70% e 100% e acurácias de 91,83% e 89,51%, quando comparados com a PAAF. CONCLUSÃO: A termografia foi mais precisa que o power Doppler na seleção de nódulos tireoidianos com indicação de biópsia.

Comparison of power Doppler and thermography for the selection of thyroid nodules in which fine-needle aspiration biopsy is indicated / Comparação entre power Doppler e termografia na seleção de nódulos tireoidianos com indicação de punção aspirativa

Abstract Objective: To compare two methods-power Doppler and thermography-for the analysis of nodule vascularization and subsequent selection of nodules to be biopsied. Materials and Methods: A total of 510 subjects with thyroid nodules were analyzed by power Doppler and submitted to fine-needle aspiration biopsy (FNAB). Thirty-seven patients were submitted to nodule excision (29 due to carcinoma or suspected carcinoma and 8 by patient choice). Among those patients, power Doppler had raised the suspicion of malignancy in 39 lesions, compared with 48 for FNAB. Another group, comprising 110 patients, underwent thermography, which raised the suspicion of malignancy in 124 thyroid nodules, as did FNAB. Malignant nodules were excised in all 110 of those patients (95 underwent nodulectomy and 15 underwent thyroidectomy), malignancy being confirmed by intraoperative examination of frozen biopsy samples. Results: In relation to the FNAB findings, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of power Doppler were 95.16%, 23.52%, 96.22%, 16.70%, and 89.51%, respectively, compared with 100%, 58.06%, 87.73%, 100%, and 89.51%, respectively, for thermography. Conclusion: Thermography was more precise than was power Doppler for the selection of thyroid nodules to be biopsied.

Resumo Objetivo: Comparar dois métodos de análise de vascularização de nódulos - power Doppler e termografia - na seleção para submissão a biópsia. Materiais e Métodos: Foram analisados 510 pacientes portadores de nódulos tireoidianos pelo power Doppler, todos submetidos a punção aspirativa por agulha fina (PAAF). Desses pacientes, 37 tiveram seus nódulos ressecados (29 por carcinoma ou suspeito para carcinoma e 8 por decisão pessoal), totalizando 39 lesões suspeitas para malignidade ao power Doppler e 48 à PAAF. Em outros 110 pacientes foram detectados, pela termografia e PAAF, 124 nódulos tireoidianos, que foram submetidos a excisão (95 casos por nodulectomia e 15 casos por tireoidectomia total) e tiveram malignidade confirmada no exame de congelação intraoperatório. Resultados: O power Doppler e a termografia apresentaram, respectivamente, sensibilidades de 95,16% e 100%, especificidades de 23,52% e 58,06%, valores preditivos positivos de 96,22% e 87,73%, valores preditivos negativos de 16,70% e 100% e acurácias de 91,83% e 89,51%, quando comparados com a PAAF. Conclusão: A termografia foi mais precisa que o power Doppler na seleção de nódulos tireoidianos com indicação de biópsia.