A critical analysis of 33 patients with substernal goiter surgically treated by neck incision

The possibility of needing a combined access, with neck and chest incisions makes the treatment of substernal goiter a challenge both in the pre-op and the intraoperative. We hereby, discuss a standardization of the surgical technique to minimize the need for a chest approach, making the substernal goiter a surgically treatable disease, through a single neck incision, and with low indices of complication. AIM: to assess the substernal goiter surgically approach through a neck incision and to analyze the surgical complications. MATERIALS AND METHODS: we carried out a historical cohort by retrospective analysis of the charts of patients submitted to thyroidectomy, and 33 of them (10.4%) had substernal goiter. RESULTS: all 33 patients were surgically treated through a neck incision without the need for sternotomy. We did not observe definitive lesions in the inferior laryngeal nerve or definitive hypoparathyroidism. Only 2 patients had recurrent nerve paresis; and 2 patients were re-operated because of a neck hematoma. CONCLUSION: patients with substernal goiter can be safely treated surgically through a single neck incision, bearing low complication rates.A possibilidade de ser necessário um acesso combinado, com uma incisão cervical e outra torácica, torna o tratamento do bócio mergulhante um desafio tanto no pré quanto no intra-operatório. Discutimos uma padronização da técnica cirúrgica para minimizar a necessidade da abordagem torácica, tornando o bócio mergulhante uma patologia tratável cirurgicamente, por uma única incisão cervical, e com baixos índices de complicações. OBJETIVO: Avaliar a abordagem cirúrgica do bócio mergulhante por cervicotomia e analisar as complicações cirúrgicas. MATERIAL E MÉTODOS: Foi realizada uma coorte histórica com corte transversal por análise retrospectiva dos prontuários de pacientes submetidos à tireoidectomia no período de maio de 2002 a julho de 2007. Um total de 316 pacientes foi submetido à tireoidectomia sendo 33 (10,4%) por bócio mergulhante. RESULTADOS: Todos os 33 pacientes foram tratados cirurgicamente por via cervical sem necessidade de esternotomia. Não foram observadas lesões definitivas de nervo laríngeo inferior ou hipoparatireoidismo definitivo. Apenas 2 pacientes apresentaram paresia de nervo recorrente e 2 pacientes foram reabordados por hematoma cervical. CONCLUSÃO: Pacientes com bócio mergulhante podem ser tratados cirurgicamente por uma única incisão cervical com segurança e baixos índices de complicação.UNIFESPUNIFESPSciEL

Clinical utility of F-18-FDG PET/CT in the follow-up of a large cohort of patients with high-risk differentiated thyroid carcinoma

Objective: To evaluate the clinical utility of F-18-FDG PET/CT in patients with high-risk DTC. Subjects and methods: Single-center retrospective study with 74 patients with high-risk differentiated thyroid cancer (DTC), classified in 4 groups. Group 1: patients with positive sTg or TgAb, subdivided in Group 1A: negative RxWBS and no foci of metastases identified at conventional image (n = 9)Group 1B: RxWBS not compatible with suspicious foci at conventional image or not proportional to sTg level (n = 13)Group 2: patients with histological findings of aggressive DTC variants (n = 21) and Group 3: patients with positive RxWBS (n = 31). Results: F-18-FDG PET/CT identified undifferentiated lesions and helped restage the disease in groups 1B and 2. The scan helped guide clinical judgment in 9/13 (69%) patients of group 1B, 10/21 (48%) patients of group 2 and 2/31 (6%) patients of group 3. There was no clinical benefit associated with group 1A. F-18-FDG PET/CT was associated with progressive disease. Conclusion: F-18-FDG PET/CT is a useful tool in the follow-up of patients with high-risk DTC, mainly in the group of RxWBS not compatible with suspicious foci at conventional image or not proportional to sTg level and in those with aggressive DTC variants. Additionally, this study showed that F-18-FDG PET/CT was associated with progression and helped display undifferentiated lesions guiding clinical assessments regarding surgeries or expectant treatments.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Ministério da Saúde (MS)Univ Fed São Paulo EPM Unifesp, Escola Paulista Med, Ctr Doencas Tireoide, São Paulo, SP, BrazilUniv Fed São Paulo EPM Unifesp, Escola Paulista Med, Lab Endocrinol Mol & Translac, Dept Med,Div Endocrinol, São Paulo, SP, BrazilHIAE, Dept Imagem, São Paulo, SP, BrazilUniv Fed São Paulo EPM Unifesp, Escola Paulista Med, Ctr Doencas Tireoide, São Paulo, SP, BrazilUniv Fed São Paulo EPM Unifesp, Escola Paulista Med, Lab Endocrinol Mol & Translac, Dept Med,Div Endocrinol, São Paulo, SP, BrazilFAPESP: 2006/60402-1MS: 25000.168513/2008-11Web of Scienc

Evaluation of clinical, laboratorial and ultrasonographic predicting factors of malignancy in thyroid nodules

OBJECTIVE: To evaluate the risk of malignancy in thyroid nodules through clinical, laboratory, ultrasonographic and cytological aspects. PATIENTS AND METHODS: 741 nodules of 407 patients. RESULTS: The cytology was benign (60,5%), indeterminate (23,3%), malignant (8,3%) or nondiagnostic (7,6%). The prevalence of cancer in indeterminate citology was 18,5% (16% in follicular lesions, 44% in suspicious). The diagnosis of malignancy was 17,2% (n = 70). The frequency of cancer in women (15,2%) was lower than in men (27,9%). There was an inverse relation between age and cancer risk. There was no statistical significance in the prevalence of cancer according to number, size of nodules or TSH levels. Hypoechogenicity and microcalcifications on ultrasound were risk factors. CONCLUSION: The risk of malignancy was higher in men, hypoechoic nodules, with microcalcifications and was inversely related to age. The TSH level was not an independent factor predictive of malignancy.OBJETIVO: Avaliar risco de malignidade de nódulos tiroidianos por meio de aspectos clínicos, laboratoriais, ultrassonográficos e citológicos. PACIENTES E MÉTODOS: 741 nódulos de 407 pacientes. RESULTADOS: A citologia foi benigna (60,5%), indeterminada (23,3%), maligna (8,6%) ou não diagnóstica (7,6%). A prevalência de câncer nas citologias indeterminadas foi 18,5% (16% nas lesões foliculares, 44% nas suspeitas). O diagnóstico de malignidade foi 17,2% (n = 70). A frequência de câncer em mulheres (15,2%) foi menor do que em homens (27,9%). Houve uma relação inversa entre idade e risco de câncer. Não houve significância estatística na prevalência de câncer de acordo com número, tamanho dos nódulos ou níveis de TSH. Hipoecogenicidade e microcalcificações ao ultrassom foram fatores de risco. CONCLUSÃO: O risco de malignidade foi maior em homens, nódulos hipoecogênicos, com microcalcificações e inversamente relacionado à idade. O nível de TSH não foi um preditor independente de malignidade.Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)Universidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Departamento de MedicinaInstituto Israelita de Ensino e Pesquisa Albert Einstein Centro de Doenças TiroidianasFleury Medicina e SaúdeUNIFESP, EPM, Depto. de MedicinaSciEL

New mutations causing T4-binding globulin deficiency(TBG-CD): clinical, genetic, molecular and structural analysis

BV UNIFESP: Teses e dissertaçõe

Development of a Sensitive and Specific Quantitative Reverse Transcription-Polymerase Chain Reaction Assay for Blood Thyroglobulin Messenger Ribonucleic Acid in the Follow-Up of Patients with Differentiated Thyroid Carcinoma

Context: Serum thyroglobulin is a sensitive tumor marker in the follow-up of patients with differentiated thyroid carcinoma (DTC), but the presence of endogenous anti-thyroglobulin antibodies (TgAb) can interfere on its measurement. To prevent interference by TgAb, several investigators have tried to quantify blood mRNA Tg by real-time RT-PCR, but the results have been variable, not reporting a correlation between mRNA Tg and the presence of metastases.Objective: the aim of the study was to evaluate the development of a sensitive and specific quantitative RT-PCR assay for blood mRNA Tg in the follow-up of patients with DTC.Design and Patients: An assay employing primers located in a region not affected by alternative splicing or single nucleotide polymorphisms was developed to study 104 DTC patients (13 of 104 with positive TgAb).Results: the assay is specific for thyroid tissue because we found mRNA Tg expression in normal thyroid tissue, but we did not find any mRNA Tg expression in any extrathyroidal tissues. Quantitative mRNA Tg levels were significantly different between patients free of disease (82 of 104) and those with metastases (22 of 104) (2.61 +/- 0.26 vs. 27.58 +/- 1.62 pg mRNA Tg/mu g RNA) (P < 0.0001). A cutoff point of 5.51 was able to discriminate between the two groups. in addition, the measurement of mRNA Tg was not affected by the presence of TgAb.Conclusion: This new mRNA Tg quantification is a reliable method that allowed us to differentiate patients free of disease from those with metastases, and it could represent an appropriate molecular marker for the follow-up of patients with DTC, especially those with positive TgAb. (J Clin Endocrinol Metab 95: 1726-1733, 2010)Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Research-Fellowship GrantUniversidade Federal de São Paulo, Dept Med, Escola Paulista Med, Div Endocrinol,Lab Mol Endocrinol, BR-04039032 São Paulo, BrazilInst Israelita Ensino & Pesquisa Albert Einstein, Thyroid Dis Ctr, BR-05652000 São Paulo, BrazilFleury Med & Hlth, BR-01243001 São Paulo, BrazilUniversidade Federal de São Paulo, Dept Med, Escola Paulista Med, Div Endocrinol,Lab Mol Endocrinol, BR-04039032 São Paulo, BrazilFAPESP: 04/09934-7Research-Fellowship Grant: 05/55842-0Web of Scienc