ABSTRACT
Anaplastic thyroid cancer (ATC) is the most aggressive solid tumour known and is a rare but highly lethal form of thyroid cancer that requires a multidisciplinary team approach. No Spanish consensus exists for management of patients with ATC. The Thyroid Cancer Group of the Spanish Society of Endocrinology and Nutrition and the GETHI (Grupo Español de Enfermedades Huérfanas e Infrecuentes) of the Spanish Society of Oncology, in agreement with the Boards of these Societies, commissioned an independent task force to develop a wide consensus on ATC. The relevant literature was reviewed, including serial PubMed searches supplemented with additional articles. The consensus includes the characteristics, diagnosis, initial evaluation, establishment of treatment goals, approaches to locoregional disease (surgery, radiotherapy, systemic therapy, supportive care during active treatment), approaches to advanced/metastatic disease, palliative care options, monitoring, and long-term follow-up of ATC. For operable disease, a combination of radical surgery with adjuvant radiotherapy or chemotherapy, using agents such as doxorubicin, cisplatin and paclitaxel, is the best treatment strategy. Cytotoxic drugs are poorly effective for advanced/metastatic ATC. On the other hand, targeted agents may represent a viable therapeutic option. Patients with stage IVA/IVB resectable disease have the best prognosis, particularly if a multimodal approach is used, and some stage IVB unresectable patients may respond to aggressive therapy. Patients with stage IVC disease should be considered for clinical trials or or for hospice/palliative care depending on their preference. This is the first Spanish consensus for ATC, and provides recommendations for management of this extremely aggressive malignancy. Novel systemic therapies are being tested, and more effective combinations are needed to improve patient outcomes. Although more aggressive radiotherapy has reduced locoregional recurrence, mean overall survival has not improved in the past 50 years
El cáncer anaplásico de tiroides (CAT) es el tumour sólido más agresivo conocido y es una forma rara pero muy letal de cáncer de tiroides que requiere un enfoque multidisciplinario. No existe ningún consenso español para definir la conducta a seguir en los pacientes con CAT. El Grupo de Cáncer de Tiroides de la Sociedad Española de Endocrinología y Nutrición y el GETHI (Grupo Español de Enfermedades Huérfanas e Infrecuentes) de la Sociedad Española de Oncología, de acuerdo con las Juntas Directivas de estas Sociedades decidieron que un grupo de trabajo independiente desarrollaran un amplio consenso sobre el CAT. Se revisó la literatura relevante, incluyendo la búsqueda en PubMed de las series más relevantes. En el consenso se incluyen las características, el diagnóstico, la evaluación inicial, el establecimiento de los objetivos del tratamiento, la actitud a seguir ante la enfermedad locorregional (cirugía, radioterapia, terapia sistémica, la atención de apoyo durante el tratamiento activo), acerca a la enfermedad avanzada/metastásica, las opciones de cuidados paliativos, la vigilancia y el seguimiento a largo plazo del CAT. Para la enfermedad operable, la combinación de la cirugía radical con radioterapia o quimioterapia adyuvante, utilizando agentes tales como doxorrubicina, cisplatino y paclitaxel, es la mejor estrategia de tratamiento. Los fármacos citotóxicos para los casos avanzados/metastásicos de CAT son poco eficaces. Por otra parte, los agentes dirigidos a dianas específicas pueden representar una opción terapéutica viable. Los pacientes con enfermedad resecable en estadio IVA/IVB tienen el mejor pronóstico, sobre todo si se utiliza un enfoque multimodal, y algunos pacientes no resecables etapa IVB pueden responder a una terapia agresiva. En los pacientes con enfermedad en estadio IVC se debe considerar o bien si son aptos para entrar en un ensayo clínico o bien para cuidados paliativos, dependiendo de la preferencia del paciente. Este es el primer consenso español para el CAT y ofrece recomendaciones para la conducta a seguir en este tumour maligno extremadamente agresivo. Las terapias sistémicas más recientes están siendo evaluadas, y se necesitan combinaciones más eficaces para mejorar los resultados en los pacientes tratados. Aunque la radioterapia más agresiva ha reducido las recurrencias locorregionales, la media de supervivencia global no ha mejorado en los últimos 50 años
Subject(s)
Humans , Thyroid Neoplasms/therapy , Anaplasia/therapy , Lymphatic Metastasis , Genetic Predisposition to Disease , Biopsy/methods , Thyroidectomy/methodsABSTRACT
Anaplastic thyroid cancer (ATC) is the most aggressive solid tumour known and is a rare but highly lethal form of thyroid cancer that requires a multidisciplinary team approach. No Spanish consensus exists for management of patients with ATC. The Thyroid Cancer Group of the Spanish Society of Endocrinology and Nutrition and the GETHI (Grupo Español de Enfermedades Huérfanas e Infrecuentes) of the Spanish Society of Oncology, in agreement with the Boards of these Societies, commissioned an independent task force to develop a wide consensus on ATC. The relevant literature was reviewed, including serial PubMed searches supplemented with additional articles. The consensus includes the characteristics, diagnosis, initial evaluation, establishment of treatment goals, approaches to locoregional disease (surgery, radiotherapy, systemic therapy, supportive care during active treatment), approaches to advanced/metastatic disease, palliative care options, monitoring, and long-term follow-up of ATC. For operable disease, a combination of radical surgery with adjuvant radiotherapy or chemotherapy, using agents such as doxorubicin, cisplatin and paclitaxel, is the best treatment strategy. Cytotoxic drugs are poorly effective for advanced/metastatic ATC. On the other hand, targeted agents may represent a viable therapeutic option. Patients with stage IVA/IVB resectable disease have the best prognosis, particularly if a multimodal approach is used, and some stage IVB unresectable patients may respond to aggressive therapy. Patients with stage IVC disease should be considered for clinical trials or for hospice/palliative care depending on their preference. This is the first Spanish consensus for ATC, and provides recommendations for management of this extremely aggressive malignancy. Novel systemic therapies are being tested, and more effective combinations are needed to improve patient outcomes. Although more aggressive radiotherapy has reduced locoregional recurrence, mean overall survival has not improved in the past 50 years.
Subject(s)
Thyroid Carcinoma, Anaplastic/therapy , Thyroid Neoplasms/therapy , Algorithms , Humans , SpainABSTRACT
Subclinical thyroid disease is a biochemical diagnosis and is common during pregnancy. Because of the physiological hormonal changes that take place during pregnancy and the absence of normal ranges for thyroid hormones during this period, subclinical thyroid disease is difficult to interpret during pregnancy. Subclinical hyperthyroidism during pregnancy has few clinical consequences and no treatment is required. In contrast, subclinical hypothyroidism seems to improve with thyroxine treatment. Iodine supplements during pregnancy and lactation, even in iodine-sufficient areas, are also indicated.
Subject(s)
Hyperthyroidism/diagnosis , Hyperthyroidism/drug therapy , Hypothyroidism/diagnosis , Hypothyroidism/drug therapy , Pregnancy Complications/diagnosis , Pregnancy Complications/drug therapy , Adult , Embryonic Development , Female , Fetal Diseases/etiology , Fetal Diseases/prevention & control , Humans , Hyperthyroidism/blood , Hypothyroidism/blood , Iodine/administration & dosage , Iodine/deficiency , Iodine/therapeutic use , Lactation , Nutritional Requirements , Pregnancy , Pregnancy Complications/blood , Puerperal Disorders/drug therapy , Thyroid Hormones/blood , Thyroiditis, Autoimmune/blood , Thyroiditis, Autoimmune/diagnosis , Thyroiditis, Autoimmune/drug therapy , Thyrotropin/blood , Thyroxine/therapeutic useABSTRACT
La disfunción tiroidea subclínica es de diagnóstico bioquímico y es una entidad frecuente durante la gestación. Los cambios hormonales fisiológicos que acontecen durante la gestación, junto con la falta de valores de referencia de las hormonas tiroideas en este periodo, hacen que la disfunción tiroidea subclínica sea de difícil interpretación. Mientras el hipertiroidismo subclínico en la gestación carece de repercusión clínica y no requiere una actuación específica, el hipotiroidismo subclínico, en ese periodo, parece beneficiarse del tratamiento sustitutivo con tiroxina. Los suplementos de yodo en la gestación y lactación son necesarios incluso en zonas de yodosuficiencia (AU)
Subclinical thyroid disease is a biochemical diagnosis and is common during pregnancy. Because of the physiological hormonal changes that take place during pregnancy and the absence of normal ranges for thyroid hormones during this period, subclinical thyroid disease is difficult to interpret during pregnancy. Subclinical hyperthyroidism during pregnancy has few clinical consequences and no treatment is required. In contrast, subclinical hypothyroidism seems to improve with thyroxine treatment. Iodine supplements during pregnancy and lactation, even in iodine-sufficient areas, are also indicated (AU)
Subject(s)
Humans , Female , Pregnancy , Adult , Hyperthyroidism/diagnosis , Hypothyroidism/diagnosis , Pregnancy Complications/diagnosis , Hyperthyroidism/drug therapy , Hypothyroidism/drug therapy , Iodine/therapeutic use , Dietary Supplements , Thyroxine/therapeutic use , Thyroid HormonesABSTRACT
En la práctica clínica son frecuentes los pacientes con disfunción tiroidea subclínica. Es decir, pacientes con concentraciones de tirotropina (TSH) fuera de los valores de referencia pero con concentraciones de tiroxina libre y triyodotironina libre normales. En el presente artículo, se describe qué es la disfunción tiroidea subclínica, se revisa su epidemiología, se recomienda el abordaje más apropiado, se evalúan los riesgos y beneficios del tratamiento y se establece la utilidad de su cribado en ciertos grupos de población. En definitiva, son limitadas las evidencias que sugieren una asociación de la disfunción tiroidea subclínica con ciertos síntomas o con el beneficio o riesgos de su tratamiento. Las consecuencias de la disfunción tiroidea subclínica (TSH: 0,1-0,45 mU/l o 4,5-10 mU/l) son escasas y no se puede recomendar el tratamiento rutinario de estos pacientes. Asimismo, no se puede recomendar el cribado indiscriminado de la población. No obstante, se debe buscar con insistencia en mujeres embarazadas de riesgo, mujeres mayores de 60 años y en ciertos grupos de riesgo (AU)
Patients with serum thyroid-stimulating hormone (TSH) outside the reference range and levels of free thyroxine and free triiodothyronine within the reference range are common in clinical practice. In the present article, subclinical thyroid disease is defined and its epidemiology reviewed. Recommendations on appropriate evaluation and the risks and benefits of treatment and consequences of non-treatment are explored. The question of whether population-based screening is warranted is also discussed. Data supporting an association between subclinical thyroid disease and symptoms or adverse clinical outcomes or benefits of treatment are scarce. The consequences of subclinical thyroid disease (serum TSH 0.1-0.45 mU/l or 4.5-10.0 mU/l) are minimal and recommendations against routine treatment of patients with TSH levels in these ranges are provided. There is insufficient evidence to support population-based screening. Nevertheless, pertinacious case finding is appropriate in pregnant women at risk, women older than 60 years, and others at high risk for thyroid dysfunction (AU)
