Nodulo de tiroide : punção com agulha fina

Dissertação (Mestrado) - Universidade Federal de Santa Catarina, Centro de Ciencias da SaudeEstudo do método de punção com agulha fina na avaliação de nódulo de tiróide em 379 pacientes. Comparação entre o diagnóstico clínico, cito e histopatológico foi realizada em 95 nódulos, após a 1a punção. Seguimento clínico e repetidas punções foram efetuados em 163 pacientes, sendo 28 operados. O rnétodo de punção com agulha fna empregado mostrou-se altamente acurado na análise de nódulos tiróideos, devendo ser repetido apenas em casos selecionados no decorrer do acompanhamento clínico. Abstract : The purpose of the study was to evaluate the use of fine-needle puncture or aspiration cytopathology (FNPc) in non-toxic, solitary or dominant thyroid nodule investigation in our environment. The values of cytophatological and clinical diagnoses were evaluated in cases with histopathological study after the first FNPc (FNP1c). Repeated FNPc were carried out in the follow-up routine, except for cases of hot nodules, inadequate FNP1c, and nodules no longer palpable. A single operator carried out all punctures, by palpation, and clinical evaluations. Cytophatological and histopathological results were performed by a same pathologist who had no previous knowledge of the cases. Clinical data were analyzed by chi-square tests and Student's t - test and logistic linear regression. Several stepwise logistic linear regression were performed, with and without cytopathological results, and diagnostic comparisons between the FNPlc, clinical data and clinical data + FNP1c were performed, including cases with FNP1c indeterminate as malignant or excluded from the analysis. Repeated FNPc were compared. In current study, 379 patients performed an average of 4.6 punctures/nodule and 9.0 representative glass slides to FNPlc, obtaining 73.6% benign FNPlc, 13.7% indeterminate, 7.4% malignant and 5.3% unsatisfactory. Ninety five patients realized hystopathological study of the nodules after adequate FNPlc, being 67 and 28 of them benign and malign, respectively. By univariate analysis, male sex; constitucional symptoms; hard consistency, irregular surface, tissue fixation of the nodule; and cervical lymphadenopathy were the significant parameters to establish the maligancy of the thyroid nodule. By logistic linear regression analysis, only male sex and hard consistency were the clinical determinants of malignancy. The sensibility, specificity and accuracy of FNPlc (nodules indeterminate included as malignant nodules) of clinical and FNPlc + clinical were, respectively, 96.4%, 61.2%, and 71.6%; 85.7%, 79.1%, and 81.1%; 85.7%, 94%, and 91.6%. Excluding the indeterrninate cytopathological cases, the diagnostic values for FNPlc were, respectively, 95.8%, 97.6%, and 97%, being superior to those of clinical values and unaltered when combined to them. FNPlc was concordant with the histopathology in 93.7% of the cases. From 163 patients submitted to follow-up and repeated FNPc, at mean intervals of 12.4 montbs, 152 had benign FNPlc and 11 indeterminate. A concordance of 92.6% was observed from the total of repeated FNPc and in 95.4% of the previously benign ones. Alteration from indeterminate FNPlc to benign occurred in 5 cases. From the 28 patients operated after repeated FNPc, malignancy was confirmed in 1 case out of 2 with initial benign cytodiagnostic altered to malignant, and in 2 persistently indeterminate cases. The FNPc was a simple and safe method, and well accepted by our patients. The inclusion of clinical data irnproved diagnostic accuracy of FNPc, specifically when indeterminate nodules were considered; however, the finding of neoplasm in 90.9% of these nodules warn us to consider surgery. The FNPc was a diagnostic instmmental of great accuracy and must be utilized in the initial evaluation of patients with thyroid nodules and repeated in clinical follow-up only on selected cases

Prevalence and clinical features of celiac disease in patients with autoimmune thyroiditis: cross-sectional study

CONTEXT AND OBJECTIVE: Celiac disease is an autoimmune disorder with an average prevalence of 1% in Europe and the United States. Because of strong European ancestry in southern Brazil, this study aimed to evaluate the seroprevalence of celiac disease among autoimmune thyroiditis patients.DESIGN AND SETTING: Cross-sectional study in a public university hospital.METHODS: This cross-sectional prevalence study included autoimmune thyroiditis patients who were tested for anti-endomysial and anti-transglutaminase antibodies between August 2010 and July 2011.RESULTS: Fifty-three patients with autoimmune thyroiditis were included; 92.5% were women, with mean age of 49.0 ± 13.5 years. Five patients (9.3%) were serologically positive for celiac disease: three of them (5.6%) were reactive for anti-endomysial antibodies and two (3.7%) for anti-transglutaminase. None of them exhibited anemia and one presented diarrhea. Endoscopy was performed on two patients: one with normal histology and the other with lymphocytic infiltrate and villous atrophy.CONCLUSION: The prevalence of celiac disease among patients with autoimmune thyroid disease was 9.3%; one patient complained of diarrhea and none presented anemia. Among at-risk populations, like autoimmune thyroiditis patients, the presence of diarrhea or anemia should not be used as a criterion for indicating celiac disease investigation. This must be done for all autoimmune thyroiditis patients because of its high prevalence

Functional analysis of monocarboxylate transporter 8 mutations identified in patients with X-linked psychomotor retardation and elevated serum triiodothyronine

Context: T-3 action in neurons is essential for brain development. Recent evidence indicates that monocarboxylate transporter 8 (MCT8) is important for neuronal T-3 uptake. Hemizygous mutations have been identified in the X-linked MCT8 gene in boys with severe psychomotor retardation and elevated serum T-3 levels. Objective: The objective of this study was to determine the functional consequences of MCT8 mutations regarding transport of T-3. Design: MCT8 function was studied in wild-type or mutant MCT8-transfected JEG3 cells by analyzing: 1) T-3 uptake, 2) T-3 metabolism in cells cotransfected with human type 3 deiodinase, 3) immunoblotting, and 4) immunocytochemistry. Results: The mutations identified in MCT8 comprise four deletions (24.5 kb, 2.4 kb, 14 bp, and 3 bp), three missense mutations (Ala224Val, Arg271His, and Leu471Pro), a nonsense mutation (Arg245stop), and a splice site mutation (94 amino acid deletion). All tested mutants were inactive in uptake and metabolism assays, except MCT8 Arg271His, which showed approximately 20% activity vs. wild-type MCT8. Conclusion: These findings support the hypothesis that the severe psychomotor retardation and elevated serum T-3 levels in these patients are caused by inactivation of the MCT8 transporter, preventing action and metabolism of T-3 in central neurons