The use of Hormone Replacement Therapy (HRT) has evolved from a massive utilization to a restricted use under very precise medical indications, in the light of the deletereous effects its indiscriminate prescription could entail. It is not beneficial for secondary prevention, but rather implies additional cardiocerebrovascular risks, and therefore it must be preferentially employed during perimenopausic and non-late periods, in the smallest possible dose and only over short periods of time, restricting its prescription to women presenting with severe estrogen deprivation syndrome or to osteoporotic patients intolerant to calcium and bifosfonates therapy. Breast cancer risk-which is low-is related to a estrogen theraphy extended for more than seven years or associated with the use of progesterone for a period exceeding five years. Personal medical records of breast cancer imply absolute contraindication. Currently, there are no research work supporting the safe use of phytoestrogens as an altenative therapy. It is likely that in upcoming days transdermal estrogen administration associated with natural progesterone could allow an increased use of them, but for the time being there are no massive studies supporting their recommendation.
Depending on age, sex, and geographic area, 19 to 67% of the general population is found to have thyroid nodules when submitted to ultrasonically-guided diagnostic puncture. Being benign in more than a 80%, most of them corresponds to colloid nodules. Indiscriminate fine-needle aspiration not only increases health costs but also generates anxiety in patients. The echographic-histological correlation of thyroid nodules made it possible to define five typical patterns (colloid patterns 1, 2, 3; neoplastic type, and malignant pattern). Thirty three percent of colloid nodules may appear as follicular neoplasms or malign nodules, being puncture the only means for recognizing and establishing the difference between them. Nevertheless, 67% of nodules presents a typical appearance that corresponds to colloid patterns 1, 2, and 3, which show a weak association to cancer risk (0%, 0% and 1,5%, respectively). On this basis, ultrasound follow-up is advised to recognize them in order to significantly diminish unnecessary diagnostic histological punctures.
Thyroid nodular disease is a highly prevalent condition. Most nodules are asymptomatic and only identifiable on images. We have established a relationship between the particular "spoke wheel" pattern of thyroid masses and a benign histology. A review of our institutional database of thyroid punctured under ultrasound guidance, histologically studied between 2003 and 2011, was performed. Node selection criteria included: mixed /solid, round /oval, surrounded by a halo, with radial structures converging toward a central point, with or without calcifications, and with peripheral vessels along with others oriented toward the center of the thyroid masses. Seventy-nine (2.5%) out of 3.204 punctured masses exhibited this sign. Average size: 28.3 mm. Fifty-eight masses were benign colloid nodules as diagnosed on FNA biopsy. Remaining masses corresponded to Lesion Follicular (4 benign, surgically treated; 7 under follow-up, stable; 10 with no information). Despite being a rare radiologic finding, the "spoke wheel" sign may be another element contributing to ultrasonographic discrimination between benignity and malignancy, especially in large thyroid masses.
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