Thyroid Consensuses - Guidelines For Clinical Practice

[No abstract available]573161162Projeto Diretrizes AMB/CFM/ANS, , http://www.projetodiretrizes.org.br/ans/diretrizes.html, Available at, Accessed on: Mar 3, 2013American Thyroid Association Professional Guidelines, , http://thyroidguidelines.net/, Available at, Accessed on: Mar 3, 2013European Thyroid Association guidelines, , http://www.eurothyroid.com/guidelines/eta_guidelines.php, Available at, Accessed on: Mar 3, 201

How frequently should a patient taking amiodarone be screened for thyroid dysfunction?

Amiodarone-induced thyroid dysfunction (AITD) is a common complication of amiodarone therapy and its prevalence varies according to iodine intake, subclinical thyroid disorders and the definition of AITD. There is no consensus about the frequency of screening for this condition. We evaluated 121 patients on chronic regular intake of amiodarone (mean intake = 248.5 ± 89 mg; duration of treatment = 5.3 ± 3.9 years, range = 0.57-17 years) and with stable baseline cardiac condition. Those with no AITD were followed up for a median period of 3.2 years (range: 0.6-6.7) and the incidence rate of AITD, defined by clinical and laboratorial findings as proposed by international guidelines, was obtained (62.8 per 1000 patients/year). We applied the Cox proportional hazard model to adjust for potential confounding factors and used sensitivity analysis to identify the best screening time for follow-up. We detected thyroid dysfunction in 59 (48.7%) of the 121 patients, amiodarone-induced hypothyroidism in 50 (41.3%) and hyperthyroidism in 9 (7.5%). Compared with patients without AITD, there was no difference regarding dosage or duration of therapy, heart rhythm disorder or baseline cardiac condition. During the follow-up of the 62 patients without AITD at baseline evaluation, 11 developed AITD (interquartile range, IR: 62.8 (95%CI: 31.3-112.3) cases per 1000 patients/year), 9 of them with hypothyroidism - IR: 11.4 (95%CI: 1.38-41.2), and 2 hyperthyroidism - IR: 51.3 (95%CI: 23.4-97.5). Age, gender, dose, and duration of treatment were not significant after adjustment. During the first 6 months of follow-up the incidence rate for AITD was 39.3 (9.2-61.9) cases per 1000 patients/year. These data show that AITD is quite common, and support the need for screening at 6-month intervals, unless clinical follow-up dictates otherwise or further information regarding the prognosis of untreated subclinical AITD is available.CNP

Neonatal screening for cystic fibrosis in São Paulo State, Brazil : a pilot study

Cystic fibrosis is one of the most common autosomal recessive hereditary diseases in the Caucasian population, with an incidence of 1:2000 to 1:3500 liveborns. More than 1000 mutations have been described with the most common being F508del. It has a prevalence of 23-55% within the Brazilian population. The lack of population-based studies evaluating the incidence of cystic fibrosis in São Paulo State, Brazil, and an analysis concerning the costs of implantation of a screening program motivated the present study. A total of 60,000 dried blood samples from Guthrie cards obtained from April 2005 to January 2006 for neonatal screening at 4 reference centers in São Paulo State were analyzed. The immunoreactive trypsinogen (IRT)/IRT protocol was used with the cut-off value being 70 ng/mL. A total of 532 children (0.9%) showed IRT >70 ng/mL and a 2nd sample was collected from 418 (80.3%) of these patients. Four affected children were detected at two centers, corresponding to an incidence of 1:8403. The average age at diagnosis was 69 days, and 3 of the children already showed severe symptoms of the disease. The rate of false-positive results was 95.2% and the positive predictive value for the test was 8%. The cost of detecting an affected subject was approximately US$8,000.00 when this cystic fibrosis program was added to an existing neonatal screening program. The present study clearly shows the difficulties involved in cystic fibrosis screening using the IRT/IRT protocol, particularly in a population with no long-term tradition of neonatal screening421

Thyroid Nodules And Differentiated Thyroid Cancer: Update On The Brazilian Consensus [nódulo Tireoidiano E Câncer Diferenciado De Tireoide: Atualização Do Consenso Brasileiro]

Thyroid nodules are frequent findings, especially when sensitive imaging methods are used. Although thyroid cancer is relatively rare, its incidence is increasing, particularly in terms of small tumors, which have an uncertain clinical relevance. Most patients with differentiated thyroid cancer exhibit satisfactory clinical outcomes when treatment is appropriate, and their mortality rate is similar to that of the overall population. However, relapse occurs in a considerable fraction of these patients, and some patients stop responding to conventional treatment and eventually die from their disease. Therefore, the challenge is how to identify the individuals who require more aggressive disease management while sparing the majority of patients from unnecessary treatments and procedures. We have updated the Brazilian Consensus that was published in 2007, emphasizing the diagnostic and therapeutic advances that the participants, representing several Brazilian university centers, consider most relevant in clinical practice. The formulation of the present guidelines was based on the participants' experience and a review of the relevant literature. © ABE&M todos os direitos reservados.574240264vander, J.B., Gaston, E.A., Dawber, T.R., The significance of nontoxic thyroid nodules. 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P.W., Borges, M.A., Purisch, S., Preparation with recombinant human thyroid-stimulating hormone for thyroid remnant ablation with 131I is associated with lowered radiotoxicity (2008) J Nucl Med., 49, pp. 1776-1782Rosário, P.W., Fagundes, T.A., Fagundes, A.V., Barroso, A.L., Rezende, L.L., Padrao, E.L., Radioiodine therapy and age at menopause in patients with thyroid cancer (2006) Clin Endocrinol (Oxf)., 64, pp. 225-226Rosário, P.W., Calsolari, M.R., Salivary and lacrimal gland dysfunction after remnant ablation with radioactive iodine in patients with differentiated thyroid carcinoma prepared with recombinant human TSH (2013) Thyroid., 23, pp. 617-619Rubino, C., de Vathaire, F., Dottorini, M.E., Hall, P., Schvartz, C., Couette, J.E., Second primary malignancies in thyroid cancer patients (2003) Br J Cancer., 89, pp. 1638-1644Rosário, P.W., Fagundes, T.A., Rezende, L.L., Padrão, E.L., Borges, M.A., Barroso, A.L., Assessing hypothyroidism in the preparation of patients with thyroid 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aspiration cytology in a large series of patients with nodular thyroid disease (2010) Eur J Endocrinol., 162, pp. 763-770Rosário, P.W., Xavier, A.C., Calsolari, M.R., Recombinant human thyrotropin in thyroid remnant ablation with 131-iodine in high-risk patients (2010) Thyroid., 20, pp. 1247-1252Rosário, P.W., Mineiro Filho, A.F., Lacerda, R.X., Calsolari, M.R., Longterm follow-up of at least five years after recombinant human thyrotropin compared to levothyroxine withdrawal for thyroid remnant ablation with radioactive iodine (2012) Thyroid., 22, pp. 332-333Rosário, P.W., Salles, D.S., Purisch, S., Area under the curve of TSH after levothyroxine withdrawal versus administration of recombinant human TSH (rhTSH): Possible implications for tumor growth (2009) Arq Bras Endocrinol Metabol., 53, pp. 767-770Rosário, P.W., Mineiro Filho, A.F., Lacerda, R.X., Calsolari, M.R., Recombinant human TSH for thyroid remnant ablation with (131)I in children and adolescents with papillary carcinoma (2012) Horm Res Paediatr., 77, pp. 59-62Rosário, P.W., Reis, J.S., Barroso, A.L., Rezende, L.L., Padrão, E.L., Fagundes, T.A., Efficacy of low and high 131I doses for thyroid remnant ablation in patients with differentiated thyroid carcinoma based on post-operative cervical uptake (2004) Nucl Med Commun., 25, pp. 1077-1081Barbaro, D., Grosso, M., Boni, G., Lapi, P., Pasquini, C., Orsini, P., Recombinant human TSH and ablation of post-surgical thyroid remnants in differentiated thyroid cancer: The effect of pre-treatment with furosemide and furosemide plus lithium (2010) Eur J Nucl Med Mol Imaging., 37, pp. 242-249Rosário, P.W., Xavier, A.C., Recombinant human thyroid stimulating hormone in thyroid remnant ablation with 1.1 GBq 131iodine in low-risk patients (2012) Am J Clin Oncol., 35, pp. 101-104Yamazaki, C.A., Padovani, R., Biscolla, R.P., Ikejri, E.S., Matsumura, L.K., McIel, R.M., Lithium as an adjuvant in the postoperative ablation of remnant tissue in low risk thyroid carcinoma (2012) Thyroid., 22, pp. 1002-1006Rosário, P.W., Purisch, S., Vasconcelos, F.P., Padrão, E.L., Rezende, L.L., Barroso, A.L., Long-term recurrence of thyroid cancer after thyroid remnant ablation with 1.1 and 3.7 GBq radioiodine (2007) Nucl Med Commun., 28, pp. 507-508Tuttle, R.M., Leboeuf, R., Robbins, R.J., Qualey, R., Pentlow, K., Larson, S.M., Empiric radioactive iodine dosing regimens frequently exceed maximum tolerated activity levels in elderly patients with thyroid cancer (2006) J Nucl Med., 47, pp. 1587-1591Rosario, P.W., Mineiro Filho, A.F., Prates, B.S., Silva, L.C., Lacerda, R.X., Calsolari, M.R., Ultrasonographic screening for thyroid cancer in siblings of patients with apparently sporadic papillary carcinoma (2012) Thyroid., 22, pp. 805-808Sawka, A.M., Ibrahim-Zada, I., Galacgac, P., Tsang, R.W., Brierley, J.D., Ezzat, S., Dietary iodine restriction in preparation for radioactive iodine treatment or scanning in well-differentiated thyroid cancer: A systematic review (2010) Thyroid., 20, pp. 1129-1138Rosário, P.W., Guimarães, V.C., Maia, F.F., Fagundes, T.A., Purisch, S., Padrão, E.L., Thyroglobulin before ablation and correlation with posttreatment scanning (2005) Laryngoscope., 115, pp. 264-267Kendler, D.B., Vaisman, F., Corbo, R., Martins, R., Vaisman, M., Preablation stimulated thyroglobulin is a good predictor of successful ablation in patients with differentiated thyroid cancer (2012) Clin Nucl Med., 37, pp. 545-549Valadão, M.M., Rosário, P.W., Borges, M.A., Costa, G.B., Rezende, L.L., Padrão, E.L., Positive predictive value of detectable stimulated Tg during the first year after therapy of thyroid cancer and the value of comparison with Tg-ablation and Tg measured after 24 months (2006) Thyroid., 16, pp. 1145-1149Toubeau, M., Touzery, C., Arveux, P., Chaplain, G., Vaillant, G., Berriolo, A., Predictive value for disease progression of serum thyroglobulin levels measured in the postoperative period and after (131)I ablation therapy in patients with 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(2004) Clin Nucl Med., 29, pp. 795-798Rosário, P.W., Barroso, A.L., Rezende, L.L., Padrão, E.L., Reis, J.S., Purisch, S., Frequency of nonmetastatic (physiological) uptake on posttreatment scans in patients with differentiated thyroid carcinoma (2007) Endocrinologist., 17, pp. 78-82Rosário, P.W., Cardoso, L.D., Barroso, A., Padrão, E.L., Rezende, L., Purisch, S., Consequences of the persistence of large thyroid remnants after bilateral thyroidectomy for differentiated thyroid cancer (2004) Arq Bras Endocrinol Metabol., 48, pp. 379-383Rosário, P., Borges, M., Reis, J., Alves, M.F., Effect of suppressive therapy with levothyroxine on the reduction of serum thyroglobulin after total thyroidectomy (2006) Thyroid., 16, pp. 199-200Cooper, D.S., Specker, B., Ho, M., Sperling, M., Ladenson, P.W., Ross, D.S., Thyrotropin suppression and disease progression in patients with differentiated thyroid cancer: Results from the National Thyroid Cancer Treatment Cooperative Registry (1998) Thyroid., 8, pp. 737-744Soelberg, K.K., Bonnema, S.J., Brix, T.H., Hegedüs, L., Risk of malignancy in thyroid incidentalomas detected by (18)F-Fluorodeoxyglucose Positron Emission Tomography: A systematic review (2012) Thyroid., 22, pp. 918-925Jonklaas, J., Sarlis, N.J., Litofsky, D., Ain, K.B., Bigos, S.T., Brierley, J.D., Outcomes of patients with differentiated thyroid carcinoma following initial therapy (2006) Thyroid., 16, pp. 1229-1242Hovens, G.C., Stokkel, M.P., Kievit, J., Corssmit, E.P., Pereira, A.M., Romijn, J.A., Association of serum thyrotropin concentration with recurrence and death in differentiated thyroid cancer (2007) J Clin Endocrinol Metab., 92, pp. 2610-2615Rosário, P.W., Bone and heart abnormalities of subclinical hyperthyroidism in women below the age of 65 years (2008) Arq Bras Endocrinol Metabol., 52, pp. 1448-1451de Martins Almeida, J.F., Gonçalves Tsumura, W., Vaisman, M., Montalli Assumpcao, L.V., Ward, L.S., Current recommendations for levothyroxine treatment of differentiated thyroid cancer patients are not properly implemented in a clinical practice (2012) J Endocrinol Invest., 35, pp. 901-904McIel, R.M., O laboratório no diagnóstico e seguimento de doenças auto-imunes e neoplásicas de tiróide (2002) Arq Bras Endocrinol Metabol., 46, pp. 65-71Rosário, P.W., Maia, F.F., Fagundes, T.A., Vasconcelos, F.P., Cardoso, L.D., Purisch, S., Antithyroglobulin antibodies in patients with differentiated thyroid carcinoma: Methods of detection, interference with serum thyroglobulin measurement and clinical significance (2004) Arq Bras Endocrinol Metabol., 48, pp. 487-492Boldarine, V.T., McIel, R.M., Guimarães, G.S., Nakabashi, C.C., Camacho, C.P., Andreoni, D.M., 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 (2010) J Clin Endocrinol Metab., 95, pp. 1726-1733Rosário, P.W., Furtado, M.D., Filho, A.F., Lacerda, R.X., Calsolari, M.R., Value of diagnostic radioiodine whole-body scanning after initial therapy in patients with differentiated thyroid cancer at intermediate and high risk for recurrence (2012) Thyroid., 22, pp. 1165-1169Mazzaferri, E.L., Robbins, R.J., Spencer, C.A., Braverman, L.E., Pacini, F., Wartofsky, L., A consensus report of the role of serum thyroglobulin as a monitoring method for low-risk patients with papillary thyroid carcinoma (2003) J Clin Endocrinol Metab., 88, pp. 1433-1441Pacini, F., Molinaro, E., Castagna, M.G., Agate, L., Elisei, R., Ceccarelli, C., Recombinant human thyrotropin-stimulated serum thyroglobulin combined with neck ultrasonography has the highest sensitivity in monitoring differentiated thyroid carcinoma (2003) J Clin Endocrinol Metab., 88, pp. 3668-3673Wong, C.K., Wheeler, M.H., Thyroid nodules: Rational management (2000) World J Surg., 24, pp. 934-941McIel, R.M., Will the thyroglobulin assay with lower functional sensitivity whilst the patients are on L-T4 treatment replace the TSH-stimulated thyroglobulin assay in the follow-up of patients with differentiated thyroid cancer? (2007) Arq Bras Endocrinol Metabol., 51, pp. 862-866Castagna, M.G., Tala Jury, H.P., Cipri, C., Belardini, V., Fioravanti, C., Pasqui, L., The use of ultrasensitive thyroglobulin assays reduces but not abolishes the need for TSH stimulation in patients with differentiated thyroid carcinoma (2011) J Endocrinol Invest., 34, pp. e219-e223Rosário, P.W., Purisch, S., Does a highly sensitive thyroglobulin (Tg) assay change the clinical management of low-risk patients with thyroid cancer with Tg on T4 4 cm (2009) Arq Bras Endocrinol Metabol., 53, pp. 1143-1145Matos, P.S., Ferreira, A.P.C., Ward, L.S., Prevalence of papillary microcarcinoma of the thyroid in Brazilian autopsy and surgical series (2006) Endocr Pathol., 17, pp. 165-174Ito, Y., Miyauchi, A., Inoue, H., Fukushima, M., Kihara, M., Higashiyama, T., An observational trial for papillary thyroid microcarcinoma in Japanese patients (2010) World J Surg., 34, pp. 28-35Sugitani, I., Toda, K., Yamada, K., Yamamoto, N., Ikenaga, M., Fujimoto, Y., Three distinctly different kinds of papillary thyroid microcarcinoma should be recognized: Our treatment strategies and outcomes (2010) World J Surg., 34, pp. 1222-1231Cibas, E.S., Ali, S.Z., The Bethesda system for reporting thyroid cytopathology (2009) Thyroid., 19, pp. 1159-1165Kwak, J.Y., Kim, E.K., Kim, H.J., Kim, M.J., Son, E.J., Moon, H.J., How to combine ultrasound and cytological information in decision making about thyroid nodules (2009) Eur Radiol., 19, pp. 1923-1931Rosario, P.W., Purisch, S., Ultrasonographic characteristics as a criterion for repeat cytology in benign thyroid nodules (2010) Arq Bras Endocrinol Metabol., 54, pp. 52-55Maia, F.F., Matos, P.S., Pavin, E.J., Vassallo, J., Zantut-Wittmann, D.E., Value of repeat ultrasound-guided fine-needle aspiration in thyroid nodule with a first benign cytologic result: Impact of ultrasound to predict malignancy (2011) Endocrine., 40, pp. 290-296Matos, P.S., Ferreira, A.P., Facuri, F.O., Assumpcao, L.V.M., Metze, K., Ward, L.S., Usefulness of HBME-1, cytokeratin 19 and galectin-3 immunostaining in the diagnosis of thyroid malignancy (2005) Histopathology, 47, pp. 391-401Saleh, H.A., Feng, J., Tabassum,

The Brazilian Consensus For The Clinical Approach And Treatment Of Subclinical Hypothyroidism In Adults: Recommendations Of The Thyroid Department Of The Brazilian Society Of Endocrinology And Metabolism [consenso Brasileiro Para A Abordagem Clínica E Tratamento Do Hipotireoidismo Subclínico Em Adultos: Recomendações Do Departamento De Tireoide Da Sociedade Brasileira De Endocrinologia E Metabologia]

Introduction: Subclinical hypothyroidism (SCH), defined as elevated concentrations of thyroid stimulating hormone (TSH) despite normal levels of thyroid hormones, is highly prevalent in Brazil, especially among women and the elderly. Although an increasing number of studies have related SCH to an increased risk of coronary artery disease and mortality, there have been no randomized clinical trials verifying the benefit of levothyroxine treatment in reducing these risks, and the treatment remains controversial. Objective: This consensus, sponsored by the Thyroid Department of the Brazilian Society of Endocrinology and Metabolism and developed by Brazilian experts with extensive clinical experience with thyroid diseases, presents these recommendations based on evidence for the clinical management of SCH patients in Brazil. Materials and methods: After structuring the clinical questions, the search for evidence in the literature was initially performed in the MedLine-PubMed database and later in the Embase and SciELO - Lilacs databases. The strength of evidence was evaluated according to the Oxford classification system and established based on the experimental design used, considering the best available evidence for each question and the Brazilian experience. Results: The topics covered included SCH definition and diagnosis, natural history, clinical significance, treatment and pregnancy, and the consensus issued 29 recommendations for the clinical management of adult patients with SCH. 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Neonatal screening for cystic fibrosis in São Paulo State, Brazil: a pilot study

Cystic fibrosis is one of the most common autosomal recessive hereditary diseases in the Caucasian population, with an incidence of 1:2000 to 1:3500 liveborns. More than 1000 mutations have been described with the most common being F508del. It has a prevalence of 23-55% within the Brazilian population. The lack of population-based studies evaluating the incidence of cystic fibrosis in São Paulo State, Brazil, and an analysis concerning the costs of implantation of a screening program motivated the present study. A total of 60,000 dried blood samples from Guthrie cards obtained from April 2005 to January 2006 for neonatal screening at 4 reference centers in São Paulo State were analyzed. The immunoreactive trypsinogen (IRT)/IRT protocol was used with the cut-off value being 70 ng/mL. A total of 532 children (0.9%) showed IRT >70 ng/mL and a 2nd sample was collected from 418 (80.3%) of these patients. Four affected children were detected at two centers, corresponding to an incidence of 1:8403. The average age at diagnosis was 69 days, and 3 of the children already showed severe symptoms of the disease. The rate of false-positive results was 95.2% and the positive predictive value for the test was 8%. The cost of detecting an affected subject was approximately US$8,000.00 when this cystic fibrosis program was added to an existing neonatal screening program. The present study clearly shows the difficulties involved in cystic fibrosis screening using the IRT/IRT protocol, particularly in a population with no long-term tradition of neonatal screening

The Brazilian Consensus For The Diagnosis And Treatment Of Hyperthyroidism: Recommendations By The Thyroid Department Of The Brazilian Society Of Endocrinology And Metabolism [consenso Brasileiro Para O Diagnóstico E Tratamento Do Hipertireoidismo: Recomendações Do Departamento De Tireoide Da Sociedade Brasileira De Endocrinologia E Metabologia]

Introduction: Hyperthyroidism is characterized by increased synthesis and release of thyroid hormones by the thyroid gland. Thyrotoxicosis refers to the clinical syndrome resulting from excessive circulating thyroid hormones, secondary to hyperthyroidism or due to other causes. This article describes evidence-based guidelines for the clinical management of thyrotoxicosis. Objective: This consensus, developed by Brazilian experts and sponsored by the Department of Thyroid Brazilian Society of Endocrinology and Metabolism, aims to address the management, diagnosis and treatment of patients with thyrotoxicosis, according to the most recent evidence from the literature and appropriate for the clinical reality of Brazil. Materials and methods: After structuring clinical questions, search for evidence was made available in the literature, initially in the database Medline, PubMed and Embase databases and subsequently in SciELO - Lilacs. The strength of evidence was evaluated by Oxford classification system was established from the study design used, considering the best available evidence for each question. Results: We have defined 13 questions about the initial clinical approach for the diagnosis and treatment that resulted in 53 recommendations, including the etiology, treatment with antithyroid drugs, radioactive iodine and surgery. We also addressed hyperthyroidism in children, teenagers or pregnant patients, and management of hyperthyroidism in patients with Graves' ophthalmopathy and various other causes of thyrotoxicosis. Conclusions: The clinical diagnosis of hyperthyroidism usually offers no difficulty and should be made with measurements of serum TSH and thyroid hormones. 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