Nódulos de tireóide e câncer diferenciado de tireóide: consenso brasileiro

Abstract

RESUMOOs 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. 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.

Evolution in the profile of thyroid cancer cases treated in an oncology reference service: what changed in the last 20 years

“…The operative treatment used has also changed, with more frequent use of total thyroidectomy, which has become the standard treatment in recent years, in relation to partial thyroidectomy or lobectomy, which, according to the consensus of the American Thyroid Association, of the Latin America thyroid Society and Brazilian Consensus, is now only considered sufficient treatment in cases of papillary carcinoma diagnosed after surgery, of less than 1cm, limited ti the thyroid, without adverse pathologic factors, without nodules in the contralateral lobe and in patients without a family history of thyroid cancer or prior exposure to radiation, ie, much selected cases. In all cases with a preoperative diagnosis of carcinoma, the recommended treatment is total thyroidectomy 11,18,19 . This trend is driven by the more frequent recognition of postpartial thyroidectomy hypothyroidism, both in our experience (not yet published) and in several other analyzes 19,[23][24][25][26][27] and also by the advantage of enabling the adjuvant radioiodine therapy when indicated, and the more accurate use of serum thyroglobulin and whole body scan with I 131 during postoperative follow-up, without increased risk of complications 28 .…”

“…According to the last consensus of specialist societies in thyroid disease, neck dissection is indicated only in the presence of clinically detectable nodal disease [11][12][13][14][15][16][17][18] . Adjuvant radioiodine therapy should be administered in high-risk patients and avoided in low-risk ones, and may or may not be used in moderate risk cases 11,18,19 . This study analyzes the changes in the pattern of thyroid cancer cases treated at a cancer reference hospital, correlating them with epidemiological, clinical and pathological changes, as well as treatment employed.…”

Comparação das classificações dos nódulos de tireoide ao Doppler colorido descritas por Lagalla e Chammas

“…Nossos resultados e a revisão da literatura vão ao encontro dos consensos das sociedades de endocrinologia (13,25) que consideram o tamanho (> 1 cm) como o principal fator na escolha dos nódulos de tireoide que deveriam ser puncionados. Acredita-se que as principais características suspeitas à ultrassonografia (hipoecogenicidade e presença de microcalcificações) (8) e a presença de significativo fluxo intranodular ao Doppler colorido sejam elementos secundários e auxiliares na seleção de nódulos menores ou presentes em tireoides multinodulares que tenham maior probabilidade de serem malignos.…”

“…Outros estudos não encontraram utilidade para tal recurso (29,30). Essa técnica não é sequer citada nos consensos especializados (13,25) e, por ser de execução mais difícil, demorada e de reprodutibilidade questionável, acredita-se que es- tudos futuros ainda são necessários antes que possa ser incorporada à prática clínica. Em conclusão, a classificação descrita por Lagalla e cols.…”

Autoavaliação vocal e avaliação perceptivo-auditiva da voz em mulheres com doença tireoidiana

“…The thyroid pathologies are more frequent in women and they show a good prognosis when they are treated in an appropriate way 1 . The surgery to remove the gland partially or totally is suggested as an effective procedure to treat benign, malign thyroid diseases or the ones with potential malignity 2 , due 2) A standardized collection form by the authors was used in interview format to collect personal and clinical data.…”