RESUMEN
OBJECTIVE: To validate urinary iodine (I) excretion and the simplified classification of goiter by palpation, comparing them with ultrasound of the thyroid gland as the gold standard, to identify endemic goiter in pregnant women. POPULATION AND SETTING: 300 pregnant women identified in referral hospitals, in three geographic regions. METHODS: Two endocrinologists, previously trained, evaluated thyroid size by palpation and by ultrasound. Urinary iodine excretion in a sample of urine was determined. Thyroid size below the 90th centile by ultrasound was considered normal. RESULTS: Mean age of study women was 23 years old. The prevalence of low weight for gestational age was 39% and of anaemia 47%. Our sample distribution showed that 120 microg I/L was the best cut off for low urinary iodine excretion to identify endemic goiter in pregnant women (sensitivity 57% and specificity 70%, likelihood ratio of 1.4). The prevalence of goiter was 10% using ultrasound. Palpation had a sensitivity of identification goiter of 94% (95% CI 89-99%), a specificity of 80% (95% CI 75-85%), a likelihood ratio of 4.7, positive post-test probability of 36.5% and negative post-test probability of 99%. CONCLUSIONS: Low urinary iodine excretion identified up to 46% of women with goiter. This test by itself is not useful as a screening tool to identify pregnant women at risk of goiter. Identification of thyroid size by palpation was a better screening test. However, when both tests were combined in parallel, up to 100% of women with goiter were correctly identified. Our results suggest that the commonly used cut off point of 100 microg I/L to identify low urinary iodine excretion may under-estimate the prevalence of iodine deficiency disorders when used during pregnancy.
Asunto(s)
Bocio Endémico/patología , Yodo/orina , Complicaciones del Embarazo/patología , Glándula Tiroides/patología , Adulto , Femenino , Bocio Endémico/diagnóstico por imagen , Bocio Endémico/orina , Humanos , Tamizaje Masivo , Palpación/métodos , Embarazo , Complicaciones del Embarazo/diagnóstico por imagen , Complicaciones del Embarazo/orina , Factores de Riesgo , Sensibilidad y Especificidad , Glándula Tiroides/diagnóstico por imagen , Ultrasonografía Prenatal/métodosRESUMEN
Se realiza un estudio comparativo en 88 pacientes con diagnóstico de cáncer de tiroides, de los cuales 43 eran procedentes del Estado Trujillo y 45 del Estado Zulia; analizándose los datos referentes a la edad, el sexo, motivo de consulta, signos y síntomas presentes, método de diagnóstico, estudio clínico de la enfermedad, intervenciones quirúrgicas realizadas y resultados de la anatomía patológica. En el Estado Trujillo la edad promedio de los pacientes fue de 50 ñ 14,97 años y el Estado Zulia de 41,56 ñ 17, la incidencia fue mayor en el sexo femenino y la forma de presentación clínica más frecuente fue como un nódulo único. En el Estado Trujillo se observó una mayor incidencia del carcinoma indiferenciado y una mayor incidencia del carcinoma papilar, siendo estas diferencias estadísticamente significativas (p:0009507 y p:0.0101282)
Asunto(s)
Adolescente , Adulto , Persona de Mediana Edad , Humanos , Masculino , Femenino , Neoplasias de la Tiroides , Adenocarcinoma Papilar , Incidencia , Bocio Endémico/patología , Glándula Tiroides/patología , VenezuelaRESUMEN
AIMS: To analyse the benefits and limitations of fine needle aspiration in the cytological differentiation of parenchymatous nodular goitres from follicular tumours in an endemic area. METHODS: Cytological smears of fine needle aspirates from 31 parenchymatous nodular goitres were studied. A sample from the punctured nodules was fixed in formalin and stained with haematoxylin and eosin for histological analysis. RESULTS: All nodules occurred in a multinodular gland, were well circumscribed, did not compress surrounding thyroid tissue, and for the most part, were unencapsulated. Two cases showed cytological features of nodular goitre, two of colloid cysts; the remaining 27 were cytologically indistinguishable from follicular lesions. CONCLUSIONS: Most of the parenchymatous nodules studied had features suggestive of follicular lesions or neoplasia, but surgical treatment should only be considered after hormone treatment has proved unsuccessful, and when they are not suspected as malignant clinically. Fine needle aspiration is useful as a diagnostic and screening aid, but the results should be interpreted with caution to prevent unnecessary surgery.
Asunto(s)
Bocio Endémico/patología , Bocio Nodular/patología , Glándula Tiroides/patología , Biopsia con Aguja , Núcleo Celular/patología , Citoplasma/patología , Diagnóstico Diferencial , Humanos , Neoplasias de la Tiroides/patologíaRESUMEN
The biochemical and morphological changes in thyroid glands were studied in 5 patients with endemic goitre in the region before and one year after the administration of iodized oil. Each patient received a tracer dose of 125-I 3-5 weeks before the biopsy and another tracer of 131-I 12 h before surgery. It was observed that: 1. Iodine deficient goitrous glands had more protein per gram of tissue and that this was corrected by iodination. 2. The goitrous glands exhibited a higher relative proportion of particulate iodoprotein that incorporates more labelled iodine in relation to time of labelling. This abnormal situation is reverted to normal by iodination. 3. A significantly higher proportion of T3 + T4 is synthetized by the glands treated with iodized oil. 4. The increased amount of 127-I per gram of tissue is followed by an increased iodination level of thyroglobulin. 5. The ultracentrifugal pattern of proteins observed for iodine deficient glands differed from the iodinated glands, indicating a failure of maturation of thyroglobulin and possibly a greater than normal degree of heterogeneity. 6. The shift in sedimentation pattern was clearly induced by the increased degree of iodination, as shown by the iodized oil injection. 7. The increased cellularity and the higher rate of protein synthesis in the goitrous glands are reverted to normal after the iodized oil injection.
Asunto(s)
Bocio Endémico/metabolismo , Yodo/metabolismo , Aceite Yodado/farmacología , Yodoproteínas/metabolismo , Glándula Tiroides/metabolismo , Biopsia , Brasil , ADN/metabolismo , Depresión Química , Bocio Endémico/tratamiento farmacológico , Bocio Endémico/patología , Humanos , Aceite Yodado/uso terapéutico , ARN/metabolismo , Estimulación Química , Tiroglobulina/metabolismo , Glándula Tiroides/patología , Tiroxina/metabolismo , Triyodotironina/metabolismoAsunto(s)
Hipotiroidismo Congénito/complicaciones , Bocio Endémico/complicaciones , Adolescente , Adulto , Estatura , Enfermedades Óseas/complicaciones , Niño , Preescolar , Hipotiroidismo Congénito/tratamiento farmacológico , Hipotiroidismo Congénito/patología , Ecuador , Femenino , Bocio Endémico/tratamiento farmacológico , Bocio Endémico/patología , Trastornos de la Audición/complicaciones , Humanos , Pruebas de Inteligencia , Masculino , Persona de Mediana Edad , Enfermedades Neuromusculares/complicaciones , Trastornos del Habla/complicaciones , Glándula Tiroides/patología , Hormonas Tiroideas/uso terapéuticoAsunto(s)
Humanos , Neoplasias de la Tiroides/clasificación , Neoplasias de la Tiroides/cirugía , Neoplasias de la Tiroides/diagnóstico , Neoplasias de la Tiroides/patología , Bocio Endémico/prevención & control , Bocio Endémico/patología , Argentina/epidemiología , Evolución Clínica , Pronóstico , Signos y Síntomas , Distribución por Edad , Distribución por SexoAsunto(s)
Humanos , Bocio Endémico/patología , Bocio Endémico/prevención & control , Neoplasias de la Tiroides/cirugía , Neoplasias de la Tiroides/clasificación , Neoplasias de la Tiroides/diagnóstico , Neoplasias de la Tiroides/patología , Argentina/epidemiología , Distribución por Edad , Distribución por Sexo , Evolución Clínica , Pronóstico , Signos y SíntomasRESUMEN
PIP: Endemic goiter is a health problem in many areas of the world; in some areas the disease is so severe that cretinism and other defects are found. In many areas geographic, economic, and other factors prevent the use of iodized salt as a preventive measure. Field studies were begun in 1966 to determine the feasibility and effectiveness of parenteral administration of iodized oil in goiter prevention. Studies were carried out in Ecuador and Peru. In Ecuador 2 villages were chosen in which the prevalence of goiter was about 60%; in Peru 3 villages were chosen where incidence was about 50%. Prevalence of goiter decreased for 20 months during the study but then began to rise again with the maximum reduction seen up to age 18 and minimal reduction after 40 years of age. The control groups in the study experienced only slight decreases in rate of incidence. Cretinism has not yet appeared among the progeny of the population injected with iodized oil but several instances have appeared in control groups. The use of iodized oil as a public health procedure for the prevention of endemic goiter and its associated defects is an acceptable measure in regions where salt iodization cannot be done.^ieng