Repercussões da persistência de grandes remanescentes tireoideanos após tireoidectomia bilateral para carcinoma diferenciado de tireóide

Abstract

Twenty-three patients submitted to thyroidectomy and before ablative therapy and with cervical uptake >10% were compared to 48 patients with uptake <2%. All but 3 patients with large remnants reached TSH levels >30 mIU/l after thyroxin withdrawal. Cervical pain requiring anti-inflammatory treatment after radioiodine was more frequent in patients with larger remnants (34.7% vs. 10.4%). Remnant ablation was successful in 56% of the individuals with uptake >10% and in 93.3% of those with uptake <2%. The sensitivity of diagnostic scanning for pulmonary metastases was similar (71.4% vs. 77.7%). The specificity of stimulated thyroglobulin at a cut-off of 5 ng/ml was 100% for patients with discrete remnants but only 37.5% for the others. We conclude that significant thyroid remnants (cervical uptake >10%) result in a lower efficacy of ablation, cause more local symptoms after radioiodine, and compromise the specificity of thyroglobulin measurements.

Fatores que influenciam nas complicações das tireoidectomias

“…Snook et al 17 reported that total thyroidectomy is not the only safe procedure to treat benign thyroid goiter, but it is efficient and prevents relapses. According to Rosário et al 18 , the extension of surgery is associated with lower rates of recurrence, distant metastasis and mortality in patients with malignant thyroid neoplasia submitted to bilateral thyroidectomy.…”