Thyroid antibody status, subclinical hypothyroidism, and the risk of coronary heart disease: an individual participant data analysis.

CONTEXT: Subclinical hypothyroidism has been associated with increased risk of coronary heart disease (CHD), particularly with thyrotropin levels of 10.0 mIU/L or greater. The measurement of thyroid antibodies helps predict the progression to overt hypothyroidism, but it is unclear whether thyroid autoimmunity independently affects CHD risk. OBJECTIVE: The objective of the study was to compare the CHD risk of subclinical hypothyroidism with and without thyroid peroxidase antibodies (TPOAbs). DATA SOURCES AND STUDY SELECTION: A MEDLINE and EMBASE search from 1950 to 2011 was conducted for prospective cohorts, reporting baseline thyroid function, antibodies, and CHD outcomes. DATA EXTRACTION: Individual data of 38 274 participants from six cohorts for CHD mortality followed up for 460 333 person-years and 33 394 participants from four cohorts for CHD events. DATA SYNTHESIS: Among 38 274 adults (median age 55 y, 63% women), 1691 (4.4%) had subclinical hypothyroidism, of whom 775 (45.8%) had positive TPOAbs. During follow-up, 1436 participants died of CHD and 3285 had CHD events. Compared with euthyroid individuals, age- and gender-adjusted risks of CHD mortality in subclinical hypothyroidism were similar among individuals with and without TPOAbs [hazard ratio (HR) 1.15, 95% confidence interval (CI) 0.87-1.53 vs HR 1.26, CI 1.01-1.58, P for interaction = .62], as were risks of CHD events (HR 1.16, CI 0.87-1.56 vs HR 1.26, CI 1.02-1.56, P for interaction = .65). Risks of CHD mortality and events increased with higher thyrotropin, but within each stratum, risks did not differ by TPOAb status. CONCLUSIONS: CHD risk associated with subclinical hypothyroidism did not differ by TPOAb status, suggesting that biomarkers of thyroid autoimmunity do not add independent prognostic information for CHD outcomes

Subclinical Hypothyroidism and the Risk of Stroke Events and Fatal Stroke: An Individual Participant Data Analysis.

OBJECTIVE: The objective was to determine the risk of stroke associated with subclinical hypothyroidism. DATA SOURCES AND STUDY SELECTION: Published prospective cohort studies were identified through a systematic search through November 2013 without restrictions in several databases. Unpublished studies were identified through the Thyroid Studies Collaboration. We collected individual participant data on thyroid function and stroke outcome. Euthyroidism was defined as TSH levels of 0.45-4.49 mIU/L, and subclinical hypothyroidism was defined as TSH levels of 4.5-19.9 mIU/L with normal T4 levels. DATA EXTRACTION AND SYNTHESIS: We collected individual participant data on 47 573 adults (3451 subclinical hypothyroidism) from 17 cohorts and followed up from 1972-2014 (489 192 person-years). Age- and sex-adjusted pooled hazard ratios (HRs) for participants with subclinical hypothyroidism compared to euthyroidism were 1.05 (95% confidence interval [CI], 0.91-1.21) for stroke events (combined fatal and nonfatal stroke) and 1.07 (95% CI, 0.80-1.42) for fatal stroke. Stratified by age, the HR for stroke events was 3.32 (95% CI, 1.25-8.80) for individuals aged 18-49 years. There was an increased risk of fatal stroke in the age groups 18-49 and 50-64 years, with a HR of 4.22 (95% CI, 1.08-16.55) and 2.86 (95% CI, 1.31-6.26), respectively (p trend 0.04). We found no increased risk for those 65-79 years old (HR, 1.00; 95% CI, 0.86-1.18) or ≥ 80 years old (HR, 1.31; 95% CI, 0.79-2.18). There was a pattern of increased risk of fatal stroke with higher TSH concentrations. CONCLUSIONS: Although no overall effect of subclinical hypothyroidism on stroke could be demonstrated, an increased risk in subjects younger than 65 years and those with higher TSH concentrations was observed

Thyroid Function Within the Reference Range and the Risk of Stroke: An Individual Participant Data Analysis.

The currently applied reference ranges for thyroid function are under debate. Despite evidence that thyroid function within the reference range is related with several cardiovascular disorders, its association with the risk of stroke has not been evaluated previously. We identified studies through a systematic literature search and the Thyroid Studies Collaboration, a collaboration of prospective cohort studies. Studies measuring baseline TSH, free T4, and stroke outcomes were included, and we collected individual participant data from each study, including thyroid function measurements and incident all stroke (combined fatal and nonfatal) and fatal stroke. The applied reference range for TSH levels was between 0.45 and 4.49 mIU/L. We collected individual participant data on 43 598 adults with TSH within the reference range from 17 cohorts, with a median follow-up of 11.6 years (interquartile range 5.1-13.9), including 449 908 person-years. Age- and sex-adjusted pooled hazard ratio for TSH was 0.78 (95% confidence interval [CI] 0.65-0.95 across the reference range of TSH) for all stroke and 0.83 (95% CI 0.62-1.09) for fatal stroke. For the free T4 analyses, the hazard ratio was 1.08 (95% CI 0.99-1.15 per SD increase) for all stroke and 1.10 (95% CI 1.04-1.19) for fatal stroke. This was independent of cardiovascular risk factors including systolic blood pressure, total cholesterol, smoking, and prevalent diabetes. Higher levels of TSH within the reference range may decrease the risk of stroke, highlighting the need for further research focusing on the clinical consequences associated with differences within the reference range of thyroid function

Subclinical Hyperthyroidism and the Risk of Coronary Heart Disease and Mortality

Geriatrics in primary car

Valor preditivo da dosagem das iodotironinas na avaliação prognóstica de doentes graves Predictive value of the measurement of iodotironines on the prognosis of patients with severe nonthyroidal illnesses

Os valores das dosagens de T3 e de T4 diferenciaram os pacientes com boa e má evolução durante a internação em unidade de terapia intensiva. OBJETIVO. Procurar indicadores para o prognóstico de doentes graves por meio do estudo seqüencial dos níveis séricos dos hormônios tiroidianos. MÉTODOS. Os autores mediram as iodotironinas (T3, T4 e rT3) por ocasião da entrada e da alta de 42 pacientes internados em unidade de terapia intensiva. Verificaram, também, os dados referentes à última coleta de outros 17 doentes, transferidos para a UTI após o início do quadro clínico. RESULTADOS. Comparando pacientes que evoluíram bem com aqueles que foram a óbito, observaram, nos primeiros, níveis iniciais normais de T4 em 76% dos casos, valores que se mantiveram estáveis ou se elevaram em 65% dos pacientes durante a internação, de tal forma que níveis normais de T4 estavam presentes em 70% dos casos por ocasião de sua alta. Ao contrário, 56% dos pacientes que evoluíram mal já apresentavam T4 inicial baixo, que diminuiu ainda mais em 95% dos pacientes durante a internação, notando-se valores baixos em 81% dos casos por ocasião da última amostra. Os valores de T3 e de T4 em conjunto também diferenciaram os pacientes com boa e má evolução. CONCLUSÃO. Os autores sugerem que a observação dos níveis séricos das iodotironinas pode oferecer importante subsídio na avaliação prognóstica de doentes em estado grave.<br>In order to find prognostic parameters in patients with severe diseases, we analyzed sequentially the levels of thyroid hormones. METHODS. We measured iodothyronines (T3, T4 and rT3) in 42 patients before the admission and after the discharge in an intensive care unit. In addition, we also measured the iodothyronines in other 17 patients after the discharge. RESULTS. Comparing the group of good outcome with the patients who died, we observed in the former group initial normal T4 levels in 76% of the patients, which were maintained in 65% of them during hospitalization and in 70% of them at the time of delivery from the intensive care unit. Patients who died, however, presented initial low T4 levels in 56% of them, decreasing values in 95% of them during hospitalization and low levels in 81% of patients at the last dosage. The combined profile of T3 and T4 also differentiated good and bad outcome. CONCLUSION. We suggest that serial analysis of serum levels of thyroid hormones may help the evaluation of critical care patients

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. Final report of a 15-year study of the incidence of thyroid malignancy (1968) Ann Intern Med., 69, pp. 537-540Tunbridge, W.M., Evered, D.C., Hall, R., Appleton, D., Brewis, M., Clark, F., The spectrum of thyroid disease in a community: The Whickham survey (1977) Clin Endocrinol (Oxf)., 7, pp. 481-493Tan, G.H., Gharib, H., Thyroid incidentalomas: Management approaches to nonpalpable nodules discovered incidentally on thyroid imaging (1997) Ann Intern Med., 126, pp. 226-231Guth, S., Theune, U., Aberle, J., Galach, A., Bamberger, C.M., Very high prevalence of thyroid nodules detected by high frequency (13 MHz) ultrasound examination (2009) Eur J Clin Invest., 39, pp. 699-706Hegedus, L., The thyroid nodule (2004) N Engl J Med., 351, pp. 1764-1771Davies, L., Welch, H.G., Increasing incidence of thyroid cancer in the United States, 1973-2002 (2006) JAMA., 295, pp. 2164-2167Veiga, L.H., Neta, G., Aschebrook-Kilfoy, B., Ron, E., Devesa, S.S., Thyroid cancer incidence patterns in São Paulo, Brazil and the U.S. SEER program, 1997-2008 (2013) Thyroid, , (in press)(2012) Síntese de resultados e comentários: Câncer da glândula tireoide., , http://www.inca.gov.br/estimativa/2012, Instituto Nacional do Câncer José Alencar Gomes da Silva (INCA). Estimativa: incidência de câncer no Brasil. Available at: Access: May 31, 2013Associação Médica Brasileira e Conselho Federal de Medicina., , http://www.projetodiretrizes.org.br/projeto_diretrizes/texto_introdutorio.pdf, Projeto Diretrizes. Available at: Access: May 31, 2013Tronko, M.D., Howe, G.R., Bogdanova, T.I., Bouville, A.C., Epstein, O.V., Brill, A.B., A cohort study of thyroid cancer and other thyroid diseases after the chornobyl accident: Thyroid cancer in Ukraine detected during first screening (2006) J Natl Cancer Inst., 98, pp. 897-903Raza, S.N., Shah, M.D., Palme, C.E., Hall, F.T., Eski, S., Freeman, J.L., Risk factors for well-differentiated thyroid carcinoma in patients with thyroid nodular disease (2008) Otolaryngol Head Neck Surg., 139, pp. 21-26Rosário, P.W., Barroso, A.L., Rezende, L.L., Padrão, E.L., Borges, M.A., Guimaraes, V.C., Testicular function after radioiodine therapy in patients with thyroid cancer (2006) Thyroid., 16, pp. 667-670Souza Rosário, P.W., Alvarenga Fagundes, T., Villas-Boas Fagundes, A.S., Barroso, A.L., Lamego Rezende, L., Lanza Padrão, E., Ovarian function after radioiodine therapy in patients with thyroid cancer (2005) Exp Clin Endocrinol Diabetes., 113, pp. 331-333Rosário, 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 cancer: Cardiovascular risk, renal function, drug metabolism, persistence of elevated thyroid-stimulating hormone, and absence from work (2006) Endocrinologist., 16, pp. 25-29Mallick, U., Harmer, C., Yap, B., Wadsley, J., Clarke, S., Moss, L., Ablation with low-dose radioiodine and thyrotropin alfa in thyroid cancer (2012) N Engl J Med., 366, pp. 1674-1685Schlumberger, M., Catargi, B., Borget, I., Deandreis, D., Zerdoud, S., Bridji, B., Strategies of radioiodine ablation in patients with low-risk thyroid cancer (2012) N Engl J Med., 366, pp. 1663-1673Hugo, J., Robenshtok, E., Grewal, R., Larson, S.M., Tuttle, R.M., Recombinant human TSH-assisted radioactive iodine remnant ablation in thyroid cancer patients at intermediate to high risk of recurrence (2012) Thyroid., 22, pp. 1007-1015Rago, T., Fiore, E., Scutari, M., Santini, F., Di Coscio, G., Romani, R., Male sex, single nodularity, and young age are associated with the risk of finding a papillary thyroid cancer on fine-needle 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 differentiated thyroid cancer (2004) J Nucl Med., 45, pp. 988-994Souza Rosário, P.W., Barroso, A.L., Rezende, L.L., Padrão, E.L., Fagundes, T.A., Penna, G.C., Post I-131 therapy scanning in patients with thyroid carcinoma metastases: An unnecessary cost or a relevant contribution? (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,

Thyroid Nodules And Differentiated Thyroid Cancer: Brazilian Consensus [nódulos De Tireóide E Câncer Diferenciado De Tireóide: Consenso Brasileiro]

Thyroid nodules are a common manifestation of thyroid diseases. It is estimated that ∼10% of adults have palpable thyroid nodules with the frequency increasing throughout life. The major concern on nodule evaluation is the risk of malignancy (5-10%). Differentiated thyroid carcinoma accounts for 90% of all thyroid malignant neoplasias. Although most patients with cancer have a favorable outcome, some individuals present an aggressive form of the disease and poor prognostic despite recent advances in diagnosis and treatment. Here, a set of clinical guidelines for the evaluation and management of patients with thyroid nodules or differentiated thyroid cancer was developed through consensus by 8 member of the Department of Thyroid, Sociedade Brasileira de Endocrinologia e Metabologia. The participants are from different reference medical centers within Brazil, to reflect different practice patterns. Each committee participant was initially assigned to write a section of the document and to submit it to the chairperson, who revised and assembled the sections into a complete draft document, which was then circulated among all committee members for further revision. All committee members further revised and refined the document. The guidelines were developed based on the expert opinion of the committee participants, as well as on previously published information.515867893Vander, J.B., Gaston, E.A., Dawber, T.R., The significance of non-toxic thyroid nodules. 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Estradiol decreases iodide uptake by rat thyroid follicular FRTL-5 cells

Estradiol has well-known indirect effects on the thyroid. A direct effect of estradiol on thyroid follicular cells, increasing cell growth and reducing the expression of the sodium-iodide symporter gene, has been recently reported. The aim of the present investigation was to study the effect of estradiol on iodide uptake by thyroid follicular cells, using FRTL-5 cells as a model. Estradiol decreased basal iodide uptake by FRTL-5 cells from control levels of 2.490 ± 0.370 to 2.085 ± 0.364 pmol I-/µg DNA at 1 ng/ml (P<0.02), to 1.970 ± 0.302 pmol I-/µg DNA at 10 ng/ml (P<0.003), and to 2.038 ± 0.389 pmol I-/µg DNA at 100 ng/ml (P<0.02). In addition, 4 ng/ml estradiol decreased iodide uptake induced by 0.02 mIU/ml thyrotropin from 8.678 ± 0.408 to 7.312 ± 0.506 pmol I-/µg DNA (P<0.02). A decrease in iodide uptake by thyroid cells caused by estradiol has not been described previously and may have a role in goiter pathogenesis

Comparação entre duas estratégias para a detecção precoce do hipotiroidismo congênito Comparison between two strategies for the precocious detection of congenital hypothyroidism

OBJETIVO: Comparar em recém-nascidos (RN) duas estratégias diferentes para o rastreamento do hipotiroidismo congênito (HC), a dosagem primária de TSH no sangue colhido do cordão umbilical (método 1) e a dosagem primária de T4 no sangue colhido por punção de calcanhar no 2º dia de internação (método 2). MÉTODOS: Os autores compararam as duas estratégias em 10.000 RN. Dosaram o TSH por método imunofluorimétrico sensível em papel de filtro e o T4 por radioimunoensaio em papel de filtro. A coleta de sangue do calcanhar foi realizada no 2º dia de vida RESULTADOS: Os dois programas diagnosticaram todos os casos de HC nos RN (4 casos, 1/2.500 RN). O índice de rechamada por coleta inadequada foi nulo no método 1 e de 8,5% (850 RN) no método 2. O índice de reconvocação para confirmação de resultados foi de 0,06% (6 RN) no método 1 e de 2,25% (225 RN) no método 2; quando este método incluía também a dosagem suplementar de TSH, o índice baixou para 1,63% (163 RN). CONCLUSÃO: Os dados dos autores evidenciam a superioridade técnica da coleta de sangue a partir do cordão umbilical em relação à punção de calcanhar, assim como da dosagem primária de TSH em relação à de T4, uma vez que apresentam índices muito menores de reconvocação.<br>OBJECTIVE: Compare two different strategies in newborn screening for congenital hypothyroidism, primary TSH in the umbilical cord blood (method 1) and primary T4 in blood collected from the heel in the 2nd day of life (method 2). METHODS: We compared both strategies in 10,000 newborns, measuring TSH by a sensitive immunofluorimetric assay and T4 by a radioimmunoassay. RESULTS: Both strategies detected all cases of hypothyroidism (4 cases, 1/2,500 newborns). The recalling index owing to insufficient amount of blood to perform the assays was zero in method 1 and 8.5% (850 newborns) in method 2. The recalling index for confirmation of the results was 0.06% (6 newborns) in method 1 and 2.25% (225 newborns) in method 2; when method 2 included supplementary TSH, the recalling index was reduced to 1.63% (163 newborns). CONCLUSION: Our data indicate the technical superiority of the umbilical cord blood compared to heel and primary TSH compared to primary T4 in the neonatal thyroid screening for congenital hypothyroidism

Polymorphisms Of Cell Cycle Control Genes Influence The Development Of Sporadic Medullary Thyroid Carcinoma

Background: The role of key cell cycle regulation genes such as, CDKN1B, CDKN2A, CDKN2B, and CDKN2C in sporadic medullary thyroid carcinoma (s-MTC) is still largely unknown. Methods: In order to evaluate the influence of inherited polymorphisms of these genes on the pathogenesis of s-MTC, we used TaqMan SNP genotyping to examine 45 s-MTC patients carefully matched with 98 controls. Results: A multivariate logistic regression analysis demonstrated that CDKN1B and CDKN2A genes were related to s-MTC susceptibility. The rs2066827∗GT+GG CDKN1B genotype was more frequent in s-MTC patients (62.22%) than in controls (40.21%), increasing the susceptibility to s-MTC (ORZ2.47; 95% CI=1.048-5.833; P=0.038). By contrast, the rs11515∗CG+GG of CDKN2A gene was more frequent in the controls (32.65%) than in patients (15.56%), reducing the risk for s-MTC(OR=0.174; 95% CI=0.048-0.627; P=0.0075). A stepwise regression analysis indicated that two genotypes together couldexplain11%of the total s-MTC risk. In addition, a relationship was found between disease progression and the presence of alterations in the CDKN1A (rs1801270), CDKN2C (rs12885), and CDKN2B (rs1063192) genes.WTrs1801270 CDKN1A patients presented extrathyroidal tumor extension more frequently (92%)than polymorphic CDKN1A rs1801270 patients (50%; P=0.0376). Patients with theWTCDKN2C gene (rs12885) presented larger tumors (2.9±1.8 cm) than polymorphic patients (1.5±0.7 cm; P=0.0324). On the other hand, patients with the polymorphic CDKN2B gene (rs1063192) presented distant metastases (36.3%; P=0.0261). Conclusion: In summary, we demonstrated that CDKN1B and CDKN2A genes are associated with susceptibility, whereas the inherited genetic profile of CDKN1A, CDKN2B, and CDKN2C is associated with aggressive features of tumors. 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