Usefulness of neck ultrasonography in the follow-up of patients with differentiated thyroid cancer

Neck ultrasonography (US) is recommended for the assessment of all patients with thyroid carcinoma after initial therapy, since even low-risk patients with undetectable stimulated thyroglobulin (Tg) may present cervical metastases. In the case of these metastases, US is the most sensitive method and is superior to whole-body 131I scanning. Cervical lymph nodes with a diameter > 5 mm presenting thin calcifications and/or cystic degeneration have almost always a malignant etiology. In the absence of these characteristics, a round shape and the absence of an echogenic hilum are suspicious findings, whereas elongated lymph nodes with a visible echogenic hilum are considered benign. Doppler flow analysis helps with the differential diagnosis, usually revealing peripheral or mixed hypervascularization in malignant cases. In the presence of suspicious lymph nodes upon US, fine-needle aspiration cytology and measurement of Tg in the needle lavage fluid are useful and complementary exams for the definition of the etiology, with the combination of the two methods showing elevated sensitivity and 100% specificity. US is also useful before thyroidectomy, even contributing in some cases to modify the surgical planning, and before ablation for the measurement of thyroid remnants and detection of persistent lymph node metastases. Another application of this imaging method is to guide the injection of ethanol (sclerotherapy) or the introduction of electrodes for radiofrequency ablation in selected cases of isolated lymph node metastases as an alternative to traditional therapies.A ultra-sonografia (US) cervical é recomendada na avaliação de todos pacientes com carcinoma de tireóide após a terapia inicial, pois mesmo indivíduos de baixo risco com tireoglobulina (Tg) estimulada indetectável podem apresentar metástases cervicais. Para estas metástases, a US é o método mais sensível, superior à pesquisa de corpo inteiro (PCI) com 131I. Linfonodos cervicais com diâmetro > 5 mm com calcificações finas e/ou degeneração cística quase sempre são de etiologia maligna. Na ausência destas características, o formato arredondado e a ausência do hilo ecogênico são achados suspeitos, enquanto linfonodos alongados e com hilo ecogênico visível são considerados benignos. A avaliação do fluxo, através do doppler, auxilia no diagnóstico diferencial, usualmente revelando hipervascularização periférica ou mista nos casos malignos. Na presença de linfonodos suspeitos na US, a avaliação citológica do material obtido através da punção aspirativa por agulha fina (PAAF) e a dosagem da Tg, obtida do lavado da agulha, são testes úteis e complementares para definir a etiologia, com elevada sensibilidade quando combinados e especificidade de 100%. A US também é útil antes da tiroidectomia, auxiliando e até, em alguns casos, modificando o planejamento cirúrgico; e antes da ablação, para mensuração dos remanescentes tireoidianos e pesquisa de metástases linfonodais persistentes. Outra aplicação desse método de imagem é guiar a injeção de etanol (escleroterapia) ou a introdução de eletrodos para ablação com radiofreqüência em casos selecionados de metástases linfonodais isoladas, como alternativa às terapias convencionais.Santa Casa de Belo Horizonte Serviço de EndocrinologiaInstituto Alpha de GastroenterologiaUniversidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Departamento de MedicinaUNIFESP, EPM, Depto. de MedicinaSciEL

Thyroid nodules and differentiated thyroid cancer: Brazilian consensus

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.Os nódulos tireoidianos constituem a principal manifestação clínica de uma série de doenças da tireóide com uma prevalência de aproximadamente 10% na população adulta. O maior desafio é excluir o câncer da tireóide, que ocorre em 5 a 10% dos casos. Os carcinomas diferenciados respondem por 90% dos casos de todas as neoplasias malignas da tireóide. A maioria dos pacientes com carcinoma diferenciado apresenta, geralmente, um bom prognóstico quando tratada adequadamente, com índices de mortalidade similares à população geral. No entanto, alguns indivíduos apresentam doença agressiva, desafiando o conhecimento atual e ilustrando a complexidade do manejo dessa neoplasia. No presente trabalho, reunimos 8 membros do Departamento de Tireóide da Sociedade Brasileira de Endocrinologia & Metabologia, para elaborarmos, por consenso, as diretrizes brasileiras no manejo dos nódulos tireoidianos e do câncer diferenciado da tireóide. Os membros participantes representam diferentes Centros Universitários do Brasil, refletindo diferentes abordagens diagnósticas e terapêuticas. Inicialmente, cada participante ficou responsável pela redação de determinado tema a ser enviado ao Coordenador, que, após revisão editorial e elaboração da primeira versão do manuscrito, enviou ao grupo para sugestões e aperfeiçoamentos. Quando concluído, o manuscrito foi novamente enviado e revisado por todos. A elaboração dessas diretrizes foi baseada na experiência dos participantes e revisão pertinente da literatura.Sociedade Brasileira de Endocrinologia e Metabologia Departamento de TireóideUniversidade Federal do Rio Grande do Sul Hospital de Clínicas de Porto Alegre Serviço de EndocrinologiaUNICAMP Faculdade de Ciências Médicas Departamento de Clínica MédicaUniversidade Federal do Paraná Serviço de Endocrinologia e MetabologiaUniversidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Departamento de MedicinaUniversidade de São Paulo Faculdade de Medicina de Ribeirão Preto Departamento de Clínica MédicaSanta Casa de Belo Horizonte Serviço de Endocrinologia Departamento de TireóideUniversidade Federal do Rio de Janeiro Faculdade de Medicina Hospital Universitário Clementino Fraga FilhoUNIFESP, EPM, Depto. de MedicinaSciEL

Thyroid nodules and differentiated thyroid cancer: Brazilian consensus

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.Os nódulos tireoidianos constituem a principal manifestação clínica de uma série de doenças da tireóide com uma prevalência de aproximadamente 10% na população adulta. O maior desafio é excluir o câncer da tireóide, que ocorre em 5 a 10% dos casos. Os carcinomas diferenciados respondem por 90% dos casos de todas as neoplasias malignas da tireóide. A maioria dos pacientes com carcinoma diferenciado apresenta, geralmente, um bom prognóstico quando tratada adequadamente, com índices de mortalidade similares à população geral. No entanto, alguns indivíduos apresentam doença agressiva, desafiando o conhecimento atual e ilustrando a complexidade do manejo dessa neoplasia. No presente trabalho, reunimos 8 membros do Departamento de Tireóide da Sociedade Brasileira de Endocrinologia & Metabologia, para elaborarmos, por consenso, as diretrizes brasileiras no manejo dos nódulos tireoidianos e do câncer diferenciado da tireóide. Os membros participantes representam diferentes Centros Universitários do Brasil, refletindo diferentes abordagens diagnósticas e terapêuticas. Inicialmente, cada participante ficou responsável pela redação de determinado tema a ser enviado ao Coordenador, que, após revisão editorial e elaboração da primeira versão do manuscrito, enviou ao grupo para sugestões e aperfeiçoamentos. Quando concluído, o manuscrito foi novamente enviado e revisado por todos. A elaboração dessas diretrizes foi baseada na experiência dos participantes e revisão pertinente da literatura.86789

Antioxidant capacity and toxicological evaluation of pterospartum tridentatum flower extracts

Pterospartum tridentatum Willk. (prickled broom) is an autochthonous plant, common in Portuguese territory. The yellow flowers are used in traditional medicine, as a potential cure for all body illnesses, mainly for throat irritation treatment or for diabetes, hypertension and hypercholesterolemia therapy.Despite its traditional use, no toxicological assessment has been performed as we know. A high antioxidant activity of P. tridentatum flower water extract was acessed in good agreement with its ESI-MS spectrum that revealed the presence of several flavonoids, as luteolin-O-(O-acetyl)-glucuronide, luteolin-O- glucuronide or isorhamnetin-O-hexoside. Mitocondrial respiratory rates (state 4, state 3 and FCCP-stimulated respiration) and respiratory indexes (respiratory control and P/O ratios) showed no consistent decrease of respiratory and phosphorylative efficiencies for the concentrations tested (up to 500 μg.mL-1). Cytotoxicity evaluation, using MTT assay, was reliable with the previous results. In conclusion, for the concentration range commonly used P. tridentatum flowers usage can be regarded as harmless and trustworthy

Elevated plasma factor VIII and von Willebrand factor in women with type 2 diabetes

The association between type 2 diabetes and cardiovascular disease is long recognized. Although perturbations of haemostatic markers have been shown to be associated with macrovascular disease in patients with type 2 diabetes, it is unclear whether these are primarily due to endothelial dysfunction or a result of inflammation. The present study was undertaken to elucidate whether elevated levels of factor VIII (FVIII) and von Willebrand factor (vWF) in women with type 2 diabetes represent endothelial dysfunction, inflammation or an alternate mechanism. Sixty-four women with type 2 diabetes were evaluated using ultrasonography Doppler for carotid intima–media thickness (IMT) and were classified as group A – having no (<1?mm), group B – mild (?1?mm and no plaque) and group C – moderate (?1?mm and presence of plaque and stenosis) macrovascular disease. Several haemostatic markers including, FVIII, vWF and fibrinogen were assessed. In addition, thrombomodulin, a marker for endothelial damage, and high-sensitivity C-reactive protein (hsCRP), an inflammatory marker, were also measured. A significant association of elevated FVIII was found in group B and C patients (i.e. patients with IMT ?1?mm and with plaque). Elevated fibrinogen and vWF levels were also found but confined to group C patients. No significant difference among subgroups was found for any other variable evaluated (hsCRP, thrombomodulin and FVII). In conclusion, plasma FVIII levels are elevated in women with type 2 diabetes and macrovascular disease. It also appears that this is not mediated by inflammation or endothelial injury and is likely to be due to an alternate mechanism