Thyroid lobectomy in patients with differentiated thyroid cancer: an analysis of the clinical outcomes in a nationwide multicenter study

Cirugía de tiroides; Lobectomía; Recurrencia del tumorCirurgia de tiroides; Lobectomia; Recurrència del tumorThyroid surgery; Lobectomy; Tumor recurrenceBackground: Total thyroidectomy is the standard initial surgery for differentiated thyroid carcinoma (DTC), but the extent of the thyroidectomy remains controversial. Thyroid lobectomy (TL) has been widely used in eastern countries; however, its use has not been generalized in western countries, including Spain. Our aims were to analyse the clinical outcome of a multicentre nation-wide cohort of DTC patients treated by TL and to assess the proportion of patients who required completion of the thyroidectomy and who presented disease recurrence. Methods: We retrospectively analyzed patients who underwent TL for DTC and were followed-up for ≥12 months. We collected demographic, clinical, and histopathological data. Dynamic risk stratification (DRS) was performed at 12 months and at last visit. Results: One hundred and sixty-four patients (128 women, mean age 50.8 years, median follow-up 45.4 months) from 9 hospitals were included. There were 158 cases of papillary and 6 of follicular thyroid carcinoma (FTC). Remission of the disease (excellent response) was shown in 71.6% of the patients at 12 months and in 74.4% at the end of follow-up. At that time, there were 34 patients (20.7%) with indeterminate response, 6 (3.7%) with biochemical incomplete response, and 2 (1.2%) with structural incomplete response. Completion of the thyroidectomy was necessary in 8 patients (4.9%), but only 3 of them (1.8%) had disease recurrence. Conclusions: These results, obtained in real clinical practice, suggest that TL is a safe operative option for selected patients with DTC and that the intensity of the treatment must be tailored according to the presurgical tumor-associated risk, in line with a personalized medicine

Characteristics of specialists treating hypothyroid patients:the “THESIS” collaborative

Introduction: Thyroid specialists influence how hypothyroid patients are treated, including patients managed in primary care. Given that physician characteristics influence patient care, this study aimed to explore thyroid specialist profiles and associations with geo-economic factors. Methods: Thyroid specialists from 28 countries were invited to respond to a questionnaire, Treatment of Hypothyroidism in Europe by Specialists: an International Survey (THESIS). Geographic regions were defined according to the United Nations Statistics Division. The national economic status was estimated using World Bank data on the gross national income per capita (GNI per capita). Results: 5,695 valid responses were received (response rate 33·0%). The mean age was 49 years, and 65·0% were female. The proportion of female respondents was lowest in Northern (45·6%) and highest in Eastern Europe (77·2%) (p &lt;0·001). Respondent work volume, university affiliation and private practice differed significantly between countries (p&lt;0·001). Age and GNI per capita were correlated inversely with the proportion of female respondents (p&lt;0·01). GNI per capita was inversely related to the proportion of respondents working exclusively in private practice (p&lt;0·011) and the proportion of respondents who treated &gt;100 patients annually (p&lt;0·01). Discussion: THESIS has demonstrated differences in characteristics of thyroid specialists at national and regional levels, strongly associated with GNI per capita. Hypothyroid patients in middle-income countries are more likely to encounter female thyroid specialists working in private practice, with a high workload, compared to high-income countries. Whether these differences influence the quality of care and patient satisfaction is unknown, but merits further study.</p

Manejo del hipertiroidismo subclínico

Management of subclinical hyperthyroidism (low TSH and normal thyroid hormones) is controversial. Knowledge of its causes, clinical context and associated morbidity is required. It is recommended to follow six steps in exploration and treatment: 1) confirmation, 2) estimation of severity, 3) cause assessment, 4) study of complications, 5) balance whether treatment is needed and 6) if necessary, choice of the most appropriate form. In its management, the same treatments are used as in overt hyperthyroidism.El manejo del hipertiroidismo subclínico (TSH baja asociado a hormonas tiroideas normales) esta sujeto a controversias. Es preciso conocer la causa, la morbilidad asociada y el contexto clínico. En el enfoque y tratamiento de esta alteración se deben seguir seis pasos: 1) confirmación, 2) evaluar la intensidad, 3) determinar la causa, 4) estudiar las complicaciones, 5) decidir si es necesario el tratamiento y 6) en caso afirmativo, elegir el más conveniente. Para su manejo se utilizan las mismas armas que en la alteración franca

Marcadores de función tiroidea (I). Evaluación de la actividad glandular

Las hormonas tiroideas desempeñan un papel fundamental en el metabolismo de todos los órganos y sistemas. La disfunción tiroidea (DT) es un importante problema de salud pública que afecta al 10% de la población general. El diagnóstico actual de la DT se realiza de acuerdo con la concentración plasmática de hormonas determinadas en el laboratorio. El resultado permite clasificarla en clínica (TSH y hormonas tiroideas fuera del rango de normalidad) y subclínica (TSH alterada de forma aislada). El desarrollo de ensayos de tercera generación para la determinación de TSH ha supuesto un gran avance en el diagnóstico de la DT. Sin embargo ha aumentado el debate sobre el significado patológico de la morbilidad asociada a la DT subclínica, hasta el punto de que los expertos mantienen posturas divergentes sobre el mejor método diagnóstico y las necesidades terapéuticas de esta situación tan prevalente1-3. Ello es así porque carecemos de la capacidad de conocer cuales son los pacientes con enfermedad tiroidea subclínica que desarrollarán las complicaciones propias de la disfunción clínica4-7. La consecuencia práctica de todo ello es que con toda probabilidad estamos tratando de forma inadecuada a pacientes con hipotiroidismo subclínico: en algunos casos los sobretratamos, mientras que en otros no les proporcionamos la hormona que necesitan

Epidemiología de las enfermedades de la glándula tiroides en Galicia.

Tiroides. Epidemiología. Bocio. Tiroiditis postpartoLos estudios epidemiológicos realizados por nuestro grupo en la comunidad gallega en el periodo 1984-2004 han demostrado: 1. La población del sur de Galicia no padecía de bocio endémico y que el consumo de yodo de la población pediátrica en nuestra área era suficiente antes de la campaña de promoción del consumo de sal yodada. 2. El aumento del consumo de yodo en nuestra población indujo un aumento significativo en la incidencia de hipertiroidismo clínico en la población adulta. 3. Que la campaña de promoción del consumo de sal yodada ha sido beneficiosa a largo plazo sobre la población infantil. 4. Que pese a la existencia de la citada campaña, un porcentaje elevado de las mujeres gestantes y aquellas en edad fértil tienen un consumo deficiente de yodo dietético. 5. Poseemos en nuestra comunidad datos sobre la prevalencia de las distintas formas y grados de disfunción tiroidea. 6. Demostramos que la disfunción tiroidea asociada a la gestación o al periodo posparto es fundamentalmente del tipo subclínico y que la prevalencia de tiroiditis posparto es mayor a partir de los 6 meses. También que las anomalías psíquicas que presentan algunas mujeres en el posparto no se asocian con disfunción tiroidea o tiroiditis posparto

Clinical and Ultrasound Thyroid Nodule Characteristics and Their Association with Cytological and Histopathological Outcomes: A Retrospective Multicenter Study in High-Resolution Thyroid Nodule Clinics

Introduction: Thyroid nodules are a common finding. A high-resolution thyroid nodule clinic (HR-TNC) condenses all tests required for the evaluation of thyroid nodules into a single appointment. We aimed to evaluate the clinical outcomes at HR-TNCs. Design and Methods: A retrospective cross-sectional multicenter study including data from four HR-TNCs in Spain. We evaluated fine-needle aspiration (FNA) indications and the association between clinical and ultrasound characteristics with cytological and histopathological outcomes. Results: A total of 2809 thyroid nodules were included; FNA was performed in 82.1%. Thyroid nodules that underwent FNA were more likely larger, isoechoic, with microcalcifications, and in younger subjects. The rate of nondiagnostic FNA was 4.3%. A solid component, irregular margins or microcalcifications, significantly increased the odds of Bethesda IV-V-VI (vs. Bethesda II). Irregular margins and a solid component were independently associated with increased odds of malignancy. Thyroid nodules &lt;20 mm and &ge;20&ndash;&lt;40 mm had a 6.5-fold and 3.3-fold increased risk for malignancy respectively in comparison with those &ge;40 mm. Conclusion: In this large multicenter study, we found that the presence of a solid component and irregular margins are factors independently related to malignancy in thyroid nodules. Since nodule size &ge;40 mm was associated with the lowest odds of malignancy, this cut-off should not be a factor leading to indicate thyroid surgery. HR-TNCs were associated with a low rate of nondiagnostic FNA

Correction to: Prevalence and risk factors for hypoparathyroidism following total thyroidectomy in Spain: a multicentric and nation-wide retrospective analysis.

An amendment to this paper has been published and can be accessed via a link at the top of the paper