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Belo Horizonte, Brazil

Rosario P.W.,Postgraduate Program | Calsolari M.R.,Endocrinology Service
Thyroid | Year: 2013

Background: By consensus, a thyrotropin (TSH) level persistently >10 mIU/L is an indication for the treatment of subclinical hypothyroidism (SCH). Controversy exists regarding patients whose TSH level is elevated but <10 mIU/L. Recently, the American Thyroid Association (ATA) and the American Association of Clinical Endocrinologists (AACE) published their position about factors that should be considered in the decision on treating SCH. This study evaluated the frequency of these factors among adult (non-pregnant) women with SCH whose TSH levels are ≤10 mIU/L. Methods: The presence of the conditions that should be considered for the treatment of SCH according to ATA and AACE was evaluated in 252 women who were diagnosed with SCH and had TSH levels ≤10 mIU/L. Pregnant women were excluded. Results: Antithyroperoxidase antibodies (TPOAbs) were detected in 137 (54.3%) women. A high cardiovascular risk was observed in 43 (17%) women. Eighty (31.7%) women who were not at high cardiovascular risk presented at least one classical risk factor (arterial hypertension, elevated level of low-density lipoprotein-cholesterol or low level of high-density lipoprotein-cholesterol, smoking, or first-degree family history of premature coronary artery disease). At least one symptom or sign of hypothyroidism that could not be explained by another condition was observed in 180 (71.4%) women. Two hundred thirty-two (92%) women had positive TPOAbs, or at least one classical cardiovascular risk factor, or at least one symptom or sign of hypothyroidism. Conclusions: According to the new ATA and AACE guidelines, L-T4 therapy would be considered for 92% of women with SCH and TSH ≤10 mIU/L. © 2013, Mary Ann Liebert, Inc.

Background: One of the adverse effects of radioactive iodine ( 131I) treatment in patients with thyroid cancer is damage to the salivary and lacrimal glands. In almost all studies evaluating salivary and lacrimal gland dysfunction, the patients received 131I after levothyroxine (L-T4) withdrawal. Since the biokinetics of 131I after recombinant human thyrotropin (rhTSH) is not the same as in hypothyroidism, studies need to evaluate 131I-induced salivary and lacrimal toxicity after preparation with rhTSH. This prospective study investigated the occurrence of salivary and lacrimal damage after ablation with 131I using this preparation. Methods: One hundred forty-eight patients who had a total thyroidectomy were included in the study. The subjects were evaluated after thyroidectomy during L-T4 use to exclude those who already showed symptoms or had a history of ocular or oral disease. Symptoms were investigated 12 and 18 months after ablation. In patients who had persistent symptoms, specific tests were performed to confirm glandular dysfunction and to rule out other causes. Results: Twelve months after ablation, symptoms of salivary or lacrimal dysfunction were observed in 10 (6.7%) patients, including oral symptoms in 8 (5.4%) and ocular symptoms in 6 (4%). Eighteen months after 131I, symptoms persisted in eight (5.4%) patients, including oral symptoms in seven (4.7%) and ocular symptoms in five (3.4%). In all of the patients, glandular dysfunction was confirmed by specific tests and other causes were ruled out. No symptoms were seen in the patients who received a low 131I dose (30 mCi). In the patients who received high 131I doses (100 or 150 mCi), symptoms were noted 12 months after 131I in 10 patients (9.2%), and 18 months after 131I in 8 patients (7.4%). Conclusions: Apparently, the rates of salivary and lacrimal damage were lower than those reported in prospective studies that used similar 131I activities, but these studies were performed in patients who were hypothyroid at the time of 131I ablation. Further studies are needed to compare radiotoxicity between patients prepared for 131I ablation with rhTSH and those prepared for 131I ablation with L-T4 withdrawal. © 2013, Mary Ann Liebert, Inc.

Rosario P.W.,Postgraduate Program | Calsolari M.R.,Endocrinology Service
Thyroid | Year: 2014

Background: Little is known about the medium- and long-term outcomes of thyroid ablation with 1.1GBq (30mCi) 131I in patients with papillary thyroid carcinoma who have a tumor >4cm or accompanied by extrathyroid invasion or clinically detected lymph node metastases (cN1). The objective of this study was to evaluate the efficacy of ablation with 30mCi 131I in this subgroup of patients and to report the medium-term outcomes. Methods: We studied 152 patients with papillary thyroid carcinoma submitted to total thyroidectomy with apparently complete tumor resection, who had a tumor >4cm or 2-4cm accompanied by extrathyroid invasion or lymph node metastases, or ≤2cm accompanied by both extrathyroid invasion and lymph node metastases. Patients with extensive extrathyroid invasion by the primary tumor were excluded. Lymph node involvement was detected by ultrasonography or palpation (cN1). Results: Forty-two patients were prepared by administration of recombinant human thyrotropin and 110 by levothyroxine withdrawal. Posttherapy whole-body scanning revealed unequivocal ectopic uptake in three patients. When evaluated 9-12 months after ablation, 123 patients had achieved complete ablation (stimulated thyroglobulin [Tg] <1ng/mL, negative anti-Tg antibodies, and neck ultrasonography); a new posttherapy whole-body scanning revealed persistent disease in 2 patients whose initial posttherapy whole-body scanning (obtained at the time of ablation) had already shown ectopic uptake; 12 patients presented with a Tg >1ng/mL and 14 had positive anti-Tg antibodies without apparent metastases; 1 patient had metastases not detected at the time of ablation. Recurrence was observed in an additional 6 patients during follow-up (median 76 months). There was no case of death related to the disease. Therefore, an activity of 30mCi failed in only 9 (6%) patients with persistent disease or recurrence after ablation. None of the variables analyzed (sex, age, tumor size, multicentricity, extrathyroid invasion, lymph node metastases, preparation [recombinant human thyrotropin or levothyroxine withdrawal]) was a predictor of ablation failure. Conclusions: An activity of 30mCi 131I is effective in thyroid ablation in patients with stage T3 and/or N1papillary thyroid carcinoma. © Mary Ann Liebert, Inc.

Rosario P.W.,Postgraduate Program | Calsolari M.R.,Endocrinology Service
Thyroid | Year: 2015

Background: Traditionally, repetition of fine-needle aspiration (FNA) is indicated for thyroid nodules with initially benign cytology if they exhibit growth. The importance of a repetition has also been demonstrated in the case of suspicious ultrasonography (US) findings. Some authors even consider routine repetition of FNA. The objective of this study was to evaluate the best criterion for FNA repetition in thyroid nodules with initially benign cytology. Methods: This was a prospective study. Patients with solid nodules that initially showed a benign cytology were selected. The first group was formed by nodules exhibiting suspicious features on initial US (group A, n=55). The other group consisted of growing nodules without suspicious US features (group B, n=82). Nongrowing nodules without suspicious features on initial US were divided into two groups: nodules that became suspicious on US (group C.1, n=18) and those that continued to be unsuspicious (group C.2, n=398). Results: In group A, the second FNA resulted in the diagnosis of malignancy in 10 cases (18.2%). In group B, malignancy was confirmed in two cases (2.4%). In group C.1, two nodules were confirmed to be malignant (11.1%). No case of carcinoma was observed in group C.2. Considering the sensitivity and number of FNA biopsies necessary for the detection of each false-negative case of the first FNA, the best criterion to repeat FNA was a suspicious initial or subsequent US. The growth of nodules with unsuspicious US findings was of poorly specificity and required a larger number of FNA biopsies to detect one case of malignancy. Conclusions: Ultrasonographic features of the nodule are the best parameter for the indication of FNA repetition in nodules with initially benign cytology, while the growth of nodules with unsuspicious US findings has a poor positive predictive value for malignancy. © Mary Ann Liebert, Inc. 2015.

Rosario P.W.,Postgraduate Program | Mineiro Filho A.F.C.,Postgraduate Program | Prates B.S.S.,Postgraduate Program | Silva L.C.O.,Postgraduate Program | And 2 more authors.
Thyroid | Year: 2012

Background: Epidemiological studies have shown a higher risk of thyroid cancer among individuals who have a relative with papillary thyroid cancer (PTC) compared to those without a family history. This study evaluated the prevalence of thyroid cancer among subjects with only one first-degree relative (sibling) with PTC who had no palpable nodules, factors predictive of this malignancy, and the characteristics of tumors discovered during ultrasonographic screening. Methods: A total of 757 siblings of 447 patients with apparently sporadic PTC were examined. Nodules were palpable in 34 subjects (excluded). The 723 individuals without palpable abnormalities were submitted to thyroid ultrasonography and comprised the study group. The control group, consisting of 241 volunteers without a family history of thyroid cancer matched for gender and age to the study group, was also submitted to thyroid ultrasonography. All nodules ≥5 mm were examined by fine-needle aspiration cytology. Subjects with benign cytology were not submitted to surgery, whereas the subjects having malignant, suspicious for a malignancy, indeterminate, or inadequate cytology were referred for thyroidectomy. Results: Ultrasonography detected nodules in 303 (41.9%) study subjects. PTC was observed in 5.94% of the 723 subjects studied (8% women and 3.75% men, p=0.017) and in 14.2% of the 303 subjects with nonpalpable nodular disease. In the control group, 80 (33.2%) of the volunteers had nodules. PTC was observed in 1.2% of them and in 3.8% of those with nodular disease. In addition, 7.17% of the 447 patients had siblings with PTC detected only by ultrasonography. Multicentricity of the tumor was the main predictor of the presence of malignancy in siblings of patients with PTC. Twenty-two subjects (3% of those screened) had tumors that were not intrathyroid microcarcinomas (whereas all three tumors detected in controls were intrathyroid microcarcinomas). Screening permitted an earlier diagnosis of the disease when compared to siblings with a spontaneous diagnosis. Conclusions: The present results favor ultrasonographic screening of first-degree relatives of patients with apparently sporadic multicentric PTC, especially among women. © Copyright 2012, Mary Ann Liebert, Inc.

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