ABSTRACT
El cáncer de tiroides es una entidad infrecuente en población pediátrica, tiene un conjunto único de características clínicas, patológicas y moleculares en niños. La clínica típica es un nódulo tiroideo de meses de evolución asintomático, como en el caso descrito. En comparación con los adultos, los niños presentan con mayor frecuencia una enfermedad agresiva en etapa avanzada. La conducta de manejo y tratamiento es la cirugía de tiroides radical y el vaciamiento ganglionar amplio, luego yodoterapía y suplencia tiroidea. La supervivencia es excelente, a los 10 años es mayor a 98% sin embargo, se deben recordar las complicaciones relacionadas con el tratamiento de por vida las cuales no son infrecuente.
Thyroid cancer is a rare condition in the pediatric population, it has a unique set of clinical, pathological and molecular characteristics in children. The typical presentation is an asymptomatic thyroid nodule of months of evolution, as in the described case. Compared with adults, children more often present with late-stage aggressive disease. The management and treatment approach is radical thyroid surgery and extensive lymph node dissection, then iodotherapy and thyroid replacement. Survival is excellent, at 10 years it is greater than 98%, however, complications related to lifelong treatment, which are not uncommon, should be kept in mind.
ABSTRACT
INTRODUCTION: It's difficult to make a scientific, evidence-based approach about the timing of radioiodine remnant ablation (RRA) in patients with differentiated thyroid carcinomas (DTCs). Primary aim of the study was to reveal whether timing of RRA relates to achievement of non- structurally incomplete response (non-SIR) in low/intermediate and high-risk patients. Another aim was to reveal the correlation of timing with non-SIR status in reproductive-age women. MATERIALS AND METHODS: Records of 279 low, intermediate, and high-risk patients were analysed, retrospectively. Number of days between surgery and RRA is referred to as timing. Low/intermediate-risk patients, high-risk patients, and low/intermediate-risk reproductive-age women were divided into non-SIR and SIR groups, according to 2015 American Thyroid Association guidelines for therapy response. The relationship between timing and therapy response was analysed statistically. RESULTS: We could not find any significant relationship in patients with low/intermediate risk between timing and non-SIR, including women between 18-49 years of age (p >0.1). For high-risk patients, we found a statistically significant relationship between timing and non-SIR response. According to ROC analysis, RRA ≤58 days was found as a cut-off value. The sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio were calculated as 83.3%, 70.0%, 2.78, and 0.24, respectively. CONCLUSION: RRA must be initiated within 58 days after surgery in patients with high-risk DTCs. Under this approach, risk of SIR and associated mortality risk may be reduced. RRA timing for women in reproductive ages with low/intermediate risk groups may be planned according to their pregnancy/breastfeeding intent. For other low/intermediate risk groups, they can safely proceed according to the capacity of the medical facility and related logistical considerations.
Subject(s)
Carcinoma/radiotherapy , Carcinoma/surgery , Iodine Radioisotopes/therapeutic use , Thyroid Neoplasms/radiotherapy , Thyroid Neoplasms/surgery , Thyroidectomy , Ablation Techniques , Adult , Combined Modality Therapy , Correlation of Data , Female , Humans , Male , Middle Aged , Retrospective Studies , Risk Assessment , Thyroidectomy/methods , Time FactorsABSTRACT
OBJECTIVE: To present our experience treating 38 patients with pediatric thyroid carcinoma. METHOD: We received 44 pediatric patients with thyroid cancer between 2008 and 2016 in a specialized cancer center. A team of two surgeons treated all patients. We reviewed patient charts, treatment, pathology report, recurrence, and mortality. Qualitative variables were analyzed using Chi-square. Quantitative variables have a 95% confidence interval. RESULTS: 82% (n = 31) of cases were female. Average age at diagnosis was 12 years. The most frequent symptom was a thyroid nodule (74%), and the most frequent method of diagnosis was fine needle aspiration. 11 patients (29%) had pulmonary metastasis. All patients underwent total thyroidectomy, and 33 cases (86%) also had lymph node dissection. There were 5 (13%) postoperative complications. 33 cases received radioactive iodine treatment after surgery. CONCLUSIONS: Pediatric thyroid cancer usually presents with multifocal disease. Female adolescents are affected more frequently than males. Differentiated thyroid cancer is the most frequent type, and it has excellent survival rates.
OBJETIVO: Presentar nuestra experiencia en el diagnóstico y tratamiento de 38 pacientes pediátricos con cáncer de tiroides. MÉTODO: Entre los años 2008 y 2016 recibimos 44 pacientes con cáncer de tiroides en un centro especializado de cáncer. Todos fueron tratados por un equipo de dos cirujanos. Se realizó una revisión retrospectiva de la historia clínica, el tratamiento recibido, los resultados histopatológicos, las recaídas y la mortalidad. Las variables cualitativas se analizaron con la prueba de ji al cuadrado. Las variables cuantitativas se trataron con medias e intervalos de confianza del 95%. RESULTADOS: El 82% (n = 31) de los casos fueron de sexo femenino. La edad promedio al diagnóstico fue de 12 años. El síntoma de presentación más frecuente (74%) fue un nódulo tiroideo. El método diagnóstico utilizado con mayor frecuencia fue el aspirado con aguja fina. Once pacientes (29%) tuvieron enfermedad metastásica, todos ellos en el pulmón. Todos los pacientes fueron sometidos a tiroidectomía total. Treinta y tres pacientes (86%) requirieron vaciamiento ganglionar. Hubo 5 pacientes (13%) con complicaciones posoperatorias. El 86% (n = 33) de los pacientes recibieron terapia complementaria con yodo. CONCLUSIONES: La presentación del cáncer de tiroides en la infancia generalmente es con enfermedad multifocal. Las adolescentes son las más afectadas. El cáncer diferenciado de tiroides es el tipo más frecuente y tiene una sobrevida excelente.
Subject(s)
Thyroid Neoplasms/diagnosis , Thyroid Neoplasms/surgery , Adolescent , Child , Female , Humans , Male , Retrospective Studies , Treatment Outcome , Young AdultABSTRACT
Resumen La asociación entre parálisis cordal y nódulo tiroideo es sugestiva de malignidad; por lo general, se trata de un carcinoma de la glándula tiroides con un tumor avanzado. Presentamos el caso de una paciente con carcinoma papilar de tiroides, parálisis cordal izquierda con aspiración bronquial y complicaciones pulmonares severas, a quien se le realizó hemitiroidectomía izquierda más tiroplastia con anestesia local y control endoscópico utilizando injerto de politetrafluoroetileno en forma artesanal. La evolución quirúrgica mostró buen resultado a corto plazo (13 meses), sin complicaciones relacionadas, fonación aceptable, con ganancia ponderal y sin nuevas complicaciones pulmonares. No existen hasta el momento de realizar este manuscrito reportes de cirugía de tiroides más tiroplastia con anestesia local. Se requiere una serie con mayor número de casos para llegar a conclusiones de validez.
Abstract The association between chordal paralysis and thyroid nodule is suggestive of malignancy, and it is usually a carcinoma of the thyroid gland with an advanced tumor. We present the case of a patient with papillary carcinoma of the thyroid, left cordal paralysis with bronchial aspiration and severe pulmonary complications who underwent left hemithyroidectomy plus thyroplasty with local anesthesia and endoscopic control using handcrafted polytetrafluoroethylene graft. The surgical evolution showed good short-term results (13 months) without related complications, acceptable phonation, with weight gain and without new pulmonary complications. There are no reports of thyroid surgery plus thyroplasty with local anesthesia at the time of this manuscript. A series with a greater number of cases is required in order to draw valid conclusions.
ABSTRACT
Resumen El cáncer de tiroides es una enfermedad cada vez más frecuente. Uno de los factores que contribuye, es el uso de las imágenes de radiología para evaluar dolencias del área de cabeza y cuello. Una vez se completa el manejo, se continúa con el seguimiento usando la tiroglobulina y los anticuerpos tiroideos tiroglobulínicos, acompañados de ecografía de alta resolución. Esta puede detectar recaídas de escasos milímetros que no son palpables, y que en zonas ya operadas son difíciles de resecar. La técnica ROLL (radioguided occult lesion localization) ha sido usada en los últimos años con gran éxito en estos casos. Para optimizar la cirugía radioguiada en cáncer tiroideo recurrente, aplicamos la ventaja que tienen los estudios tomográficos en medicina nuclear denominados SPECT/CT (single photon emision tomography, por su sigla en inglés) fusionados con técnicas de imágenes anatómicas de tomografía (CT) para refinar la localización anatómica precisa de las lesiones radiomarcadas.
Abstract Differentiated thyroid cancer is an increasingly diagnosed disease. One of the contributing factors is the routine use of high-resolution imaging techniques to assess patients with head and neck symptoms. Serum thyroglobulin monitoring and neck ultrasound are the cornerstone of early detection of recurrent disease after surgery and radioiodine remnant ablation. Resection of non-palpable small tumour foci in previously operated sites is difficult. In recent years, the use of a radioguided technique for locating lesions (ROLL) has shown to be useful for optimising recurrent thyroid cancer surgery. SPECT/CT has also been added to refine the anatomical location of the radio-marked tumour foci.
Subject(s)
Humans , Thyroid Neoplasms , Tomography, Emission-Computed, Single-Photon , Neck , Tomography , Ultrasonography , Methods , Sentinel Lymph Node BiopsyABSTRACT
Objective Hypocalcaemia is a frequently arising complication following total thyroidectomy. Routine postoperative prophylactic administration of vitamin D or metabolites and calcium reduce the incidence of symptomatic hypocalcaemia; this article reports evaluating its cost-effectiveness in Colombia. Methods Meta-analysis was used for comparing the administration of vitamin D or metabolites to oral calcium or no treatment at all in patients following total thyroidectomy and a cost-effectiveness analysis was designed based on a decision-tree model with local costs. Results The OR value for the comparison between calcitriol and calcium compared to no treatment and to exclusive calcium treatment groups was 0.32 (0.13-0.79 95 %CI) and 0.31 (0.14-0.70 95 %CI), respectively. The most cost-effective strategy was vitamin D or metabolites and calcium administration, having a US $0.05 incremental cost-effectiveness ratio. Conclusion Prophylactic treatment of hypocalcaemia with vitamin D or metabolites + calcium or calcium alone is a cost-effective strategy.
Objetivos La hipo calcemia es la complicación más frecuente después de tiroidectomía. La administración profiláctica de vitamina D o metabolitos y calcio reduce la incidencia de hipocalcémia sintomática. Se evalúa su costo-efectividad en Colombia. Materiales y métodos Utilizamos la información de un meta-análisis que comparó la administración de vitamina D o metabolitos contra calcio no tratamiento en pacientes llevados a tiroidectomía total y diseñamos un análisis de costo-efectividad basados en un modelos de decisiones con costos locales. Resultados El valor del OR para la comparación entre calcitriol y calcio comparado con no tratamiento o calcio exclusivo fue de 0.32 (95 % IC, 0.13- 0.79) y 0.31 (95 % IC, 0.14-0.70), respectivamente. La estrategia más costo-efectiva fue la administración de vitamina D o metabolitos y calcio, con una relación de costo-efectividad incremental de US $0.05. Conclusiones El tratamiento profiláctico de la hipo calcemia con vitamina D o metabolitos y calcio o calcio exclusivo después de tiroidectomía total es una estrategia costo-efectiva.
