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PURPOSE: Thyroid lobectomy (TL) is an appropriate treatment for up to 4 cm intrathyroidal differentiated thyroid cancer (DTC). There is scarce data regarding TL outside first-world centers. Our aim is to report a cohort of patients with DTC treated with TL in Chile. METHODS: We included DTC patients treated with TL, followed for at least 6 months, characterized their clinicopathological features and classified their risk of recurrence and response to treatment. RESULTS: Eighty-two patients followed for a median of 2.3 years (0.5-7.0). Seventy-three (89%) patients had papillary, 8 (9.8%) follicular and 1 (1.2%) high-grade DTC. The risk of recurrence was low in 56 (68.3%) and intermediate in 26 (31.7%). Eight (9.8%) patients required early completion thyroidectomy and radioiodine. At last follow-up, 52 (70.3%) had excellent, 19 (25.7%) had indeterminate, and 1 (1.4%) had structural incomplete response. CONCLUSION: In a developing country, TL is an adequate option for appropriately selected DTC patients.
Assuntos
Neoplasias da Glândula Tireoide , Tireoidectomia , Humanos , Neoplasias da Glândula Tireoide/cirurgia , Neoplasias da Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide/radioterapia , Feminino , Masculino , Pessoa de Meia-Idade , Tireoidectomia/métodos , Chile/epidemiologia , Adulto , Idoso , Resultado do Tratamento , Centros de Atenção Terciária , Recidiva Local de Neoplasia/epidemiologia , Adulto Jovem , Radioisótopos do Iodo/uso terapêutico , Seguimentos , Adenocarcinoma Folicular/cirurgia , Adenocarcinoma Folicular/patologia , Adenocarcinoma Folicular/radioterapia , Adolescente , Estudos Retrospectivos , Carcinoma Papilar/cirurgia , Carcinoma Papilar/patologiaRESUMO
BACKGROUND: Osteoarthritis (OA) is a health problem affecting millions of individuals worldwide. AIM: To evaluate risk factors for hip and knee osteoarthritis (OA) in women aged 40 to 59 years. MATERIAL AND METHODS: Analysis of a prospective cohort of 1159 women attending preventive health care programs and followed during 28 years. They underwent a clinical and laboratory evaluation from 1990 to 1993. The diagnosis of OA was retrieved from registries of a special program for osteoarthritis in 2020. RESULTS: Twenty four percent of participants developed osteoarthritis during the follow-up. At the beginning of the study and compared with women without OA, they were older (median [interquartile range or IQR]: 49.6 [8.5] and 47.2 [8.2] years respectively), had a higher body mass index (26.3 [5.3] and 25.1 [5.3] respectively), and a higher frequency of jobs with low qualification (76 and 62% respectively). The presence of type 2 diabetes mellitus, chronic hypertension, a previous history of alcohol or cigarette consumption, postmenopausal status and lipid and glucose blood levels did not differ between women with or without OA. Cox regression showed a final model that incorporates body mass index (hazard ratio (HR): 1.04; 95% confidence intervals (CI): 1.01-1.07), age (HR: 1.05; 95% CI: 1.03-1.08) and having an unqualified job (HR: 1.88; 95% CI: 1.43-2.47) as risk factors for OA. CONCLUSIONS: Obesity and the type of job are the most relevant risk factors found for OD: both may be modified with proper care.
Assuntos
Diabetes Mellitus Tipo 2 , Osteoartrite do Quadril , Osteoartrite do Joelho , Diabetes Mellitus Tipo 2/complicações , Feminino , Humanos , Pessoa de Meia-Idade , Osteoartrite do Quadril/diagnóstico , Osteoartrite do Quadril/epidemiologia , Osteoartrite do Quadril/etiologia , Osteoartrite do Joelho/epidemiologia , Osteoartrite do Joelho/etiologia , Estudos Prospectivos , Fatores de RiscoRESUMO
BACKGROUND: Osteoarthritis (OA) is a health problem affecting millions of individuals worldwide. Aim: To evaluate risk factors for hip and knee osteoarthritis (OA) in women aged 40 to 59 years. MATERIAL AND METHODS: Analysis of a prospective cohort of 1159 women attending preventive health care programs and followed during 28 years. They underwent a clinical and laboratory evaluation from 1990 to 1993. The diagnosis of OA was retrieved from registries of a special program for osteoarthritis in 2020. RESULTS: Twenty four percent of participants developed osteoarthritis during the follow-up. At the beginning of the study and compared with women without OA, they were older (median [interquartile range or IQR]: 49.6 [8.5] and 47.2 [8.2] years respectively), had a higher body mass index (26.3 [5.3] and 25.1 [5.3] respectively), and a higher frequency of jobs with low qualification (76 and 62% respectively). The presence of type 2 diabetes mellitus, chronic hypertension, a previous history of alcohol or cigarette consumption, postmenopausal status and lipid and glucose blood levels did not differ between women with or without OA. Cox regression showed a final model that incorporates body mass index (hazard ratio (HR): 1.04; 95% confidence intervals (CI): 1.01-1.07), age (HR: 1.05; 95% CI: 1.03-1.08) and having an unqualified job (HR: 1.88; 95% CI: 1.43-2.47) as risk factors for OA. CONCLUSIONS: Obesity and the type of job are the most relevant risk factors found for OD: both may be modified with proper care.
Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Osteoartrite do Quadril/diagnóstico , Osteoartrite do Quadril/etiologia , Osteoartrite do Quadril/epidemiologia , Osteoartrite do Joelho/etiologia , Osteoartrite do Joelho/epidemiologia , Diabetes Mellitus Tipo 2/complicações , Estudos Prospectivos , Fatores de RiscoRESUMO
PURPOSE: Latin American reports on pheochromocytomas and paragangliomas (PPGLs) are scarce. Recent studies demonstrate changes in clinical presentation and management of these patients. Herein, we assessed the main characteristics of PPGL patients in our academic center over the past 4 decades. METHODS: Demographic, clinical, biochemical, and perioperative data from 105 PPGL patients were retrospectively and prospectively collected over the 1980-2019 period. Data were organized into 4 periods by decade. RESULTS: Age at diagnosis, gender, tumor size and percentage of bilaterality, percentage of paragangliomas, and metastases remained stable across the 4 decades. The proportion of genetic testing and incidentalomas increased in recent decades (all P < 0.001). Therefore, we compared PPGLs diagnosed as incidentalomas (36%) with those clinically suspected (64%). Incidentalomas had fewer adrenergic symptoms (38 vs. 62%; P < 0.001) and lower rates of hypertension (64% vs. 80%; P = 0.01) and hypertensive crisis (28% vs. 44%; P = 0.02); also, they had lower functionality (79% vs. 100%; P = 0.01) and lower catecholamines levels (8.4-fold vs. 12.5-fold above upper cutoffs; P = 0.04). Regarding management of all PPGLs over the decades, we observed significant increases in both perioperative doxazosin dose (P = 0.003) and laparoscopic approach rates (P < 0.001), along with a decrease in the length of hospital stays (P = 0.007). CONCLUSIONS: We observed a change in the clinical presentation of PPGL in recent decades, with a marked increase in incidental cases and milder symptoms. The implementation of a multidisciplinary program for adrenal disorders in our institution has translated into more timely diagnoses, more genetic testing, and improvements in perioperative management.
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Metformin may decrease cell senescence, including bone; hence we aimed at evaluating the association between metformin use and osteoporosis. This was a cross-sectional study carried out in 1259 Latin American adult women aged 40 or more who were not on anti-osteoporotic drugs, were on metformin and had a bone densitometry performed. Of the whole sample, 40.3% reported being on metformin (at least 1 year), 30.2% had type 2 diabetes mellitus and 22.6% had osteoporosis. Median (interquartile range) body mass index (BMI) for the whole cohort was 27.7 (4.6) kg/m2 and 30.2% had type 2 diabetes mellitus. Current use of hormone therapy, calcium, and vitamin D corresponded respectively to 10.7%, 47.7%, and 43.1% of all surveyed women. A logistic regression model was used to analyze the association of osteoporosis with various covariates incorporated into the model such as age (OR: 1.07, 95% CI: 1.05-1.09), BMI (OR: 0.92, 95% CI: 0.89-0.96) and metformin use (OR: 0.44, 95% CI: 0.32-0.59). Metformin use, regardless of the presence of type 2 diabetes or obesity, was associated with a lower risk of osteoporosis in adult women. We propose that one explanation for this observation could be the effect of the drug over cellular senescence.
Assuntos
Diabetes Mellitus Tipo 2/tratamento farmacológico , Hipoglicemiantes/uso terapêutico , Metformina/uso terapêutico , Obesidade/tratamento farmacológico , Osteoporose/prevenção & controle , Idoso , Estudos Transversais , Diabetes Mellitus Tipo 2/complicações , Feminino , Humanos , Hipoglicemiantes/farmacologia , América Latina/epidemiologia , Metformina/farmacologia , Pessoa de Meia-Idade , Obesidade/complicações , Osteoporose/epidemiologiaRESUMO
PURPOSE: 21-hydroxylase deficiency (21-OHD) is a congenital adrenal disease with more than 200 mutations published to date. The aim of this report is to describe a severe novel mutation of the CYP21A2 gene. METHOD: We describe a case of a 39-year-old male diagnosed with a salt wasting congenital adrenal hyperplasia (SWCAH) due to 21-OHD. The genetic testing was done using a combination of three methods (PCR XL, SALSA-MLPA, and bidirectional sequencing) and finally an in silico analysis. RESULTS: The genetic testing demonstrated three severe mutations of the CYP21A2 gene (p.Gln318*; c.290-13C>G; and p.Trp86*), being the last one a novel mutation not previously reported. The in silico modeling of the p.Trp86* (c.258G>A) showed a truncated CYP21A2 protein that loses all the main structural features required for activity, such as the HEM binding domain and the hormone binding site. CONCLUSION: We present an adult man with an SWCAH due to 21-OHD who carried three severe mutations of the CYP21A2 gene, one of them, p.Trp86* (c.258G>A) has not been previously described.
Assuntos
Hiperplasia Suprarrenal Congênita , Hiperplasia Suprarrenal Congênita/genética , Adulto , Testes Genéticos , Genótipo , Humanos , Masculino , Mutação , Reação em Cadeia da Polimerase , Esteroide 21-Hidroxilase/genéticaRESUMO
The hormonal deficit of post menopause is not only linked to the classic hot flashes, but also to a higher risk of chronic diseases. Menopausal hormone therapy (MHT) adequately treats climacteric symptoms and can prevent some chronic diseases such as osteoporosis. The Women's Health Initiative (WHI) study, which indicated risks of MHT in elderly postmenopausal women, caused a massive withdrawal of this therapy. But, in recent years the results of the WHI have been challenged by methodological problems and by several studies indicating that, if MHT is initiated early and the non-oral route is preferred, the risks could be minimized and it could improve not only the quality of life but also reduce the risk of chronic diseases. However, the US Preventive Services Task Force (USPSTF) recommends against the use of MHT for the prevention of chronic diseases, a position that has been challenged by publications of the North American Menopause Society and the International Menopause Society. This controversy persists so far. We report data that suggest a preventive role of MHT in perimenopausal women.
Assuntos
Humanos , Feminino , Osteoporose/prevenção & controle , Neoplasias da Mama/prevenção & controle , Menopausa , Doenças Cardiovasculares/prevenção & controle , Terapia de Reposição Hormonal/métodos , Demência/prevenção & controle , Qualidade de Vida , Doença Crônica/prevenção & controle , Fatores de Risco , Saúde da Mulher , Resultado do TratamentoRESUMO
OBJECTIVE: This study evaluated whether low bone density, a condition related to aging, is associated with low muscle mass, a surrogate for sarcopenia, and whether it could be used as a marker of the condition. METHODS: We studied 483 women aged 35 to 69 years old who appeared healthy and attended a preventive gynecological examination. Dual-energy X-ray absorptiometry was used to measure bone mineral density (BMD) and regional body composition. BMD was assessed using the T-score. Low appendicular lean mass (aLM) adjusted by height (aLM index) was defined according to Baumgartner et al (<5.45âkg/m). The association of low aLM index with bone mass was evaluated with a binary logistic regression using a cutoff point on the receiver operating characteristic curves for the T-score of -1.5. RESULTS: The participants had a mean age of 54.7â±â9.1 years, body mass index of 24.6â±â3.6âkg/m, aLM index of 5.9â±â0.6âkg/m (22.6% showed sarcopenia), abdominal fat percentage of 44.0â±â9.1%, and T-score of -0.48â±â0.97. In the logistic regression model, we found that low BMD implied a significant risk for sarcopenia (odds ratio [OR] 1.77; 95% CI, 1.02-3.06). In contrast, excess body weight was a protective factor (OR 0.12; 95% CI, 0.06-0.25). Neither age nor abdominal fat percentage, however, influenced the likelihood of sarcopenia in these women. CONCLUSIONS: A BMD T-score below -1.5 suggests low muscle mass in middle-aged women, which is a central element in the diagnosis of sarcopenia. Early diagnosis provides the opportunity to introduce preventive and therapeutic options.
Assuntos
Densidade Óssea/fisiologia , Músculo Esquelético/patologia , Sarcopenia/diagnóstico , Absorciometria de Fóton , Índice de Massa Corporal , Chile , Feminino , Colo do Fêmur/diagnóstico por imagem , Colo do Fêmur/patologia , Humanos , Modelos Logísticos , Pessoa de Meia-Idade , Músculo Esquelético/diagnóstico por imagem , Curva ROC , Fatores de RiscoRESUMO
The hormonal deficit of post menopause is not only linked to the classic hot flashes, but also to a higher risk of chronic diseases. Menopausal hormone therapy (MHT) adequately treats climacteric symptoms and can prevent some chronic diseases such as osteoporosis. The Women's Health Initiative (WHI) study, which indicated risks of MHT in elderly postmenopausal women, caused a massive withdrawal of this therapy. But, in recent years the results of the WHI have been challenged by methodological problems and by several studies indicating that, if MHT is initiated early and the non-oral route is preferred, the risks could be minimized and it could improve not only the quality of life but also reduce the risk of chronic diseases. However, the US Preventive Services Task Force (USPSTF) recommends against the use of MHT for the prevention of chronic diseases, a position that has been challenged by publications of the North American Menopause Society and the International Menopause Society. This controversy persists so far. We report data that suggest a preventive role of MHT in perimenopausal women.
Assuntos
Neoplasias da Mama/prevenção & controle , Doenças Cardiovasculares/prevenção & controle , Demência/prevenção & controle , Terapia de Reposição Hormonal/métodos , Menopausa , Osteoporose/prevenção & controle , Doença Crônica/prevenção & controle , Feminino , Humanos , Qualidade de Vida , Fatores de Risco , Resultado do Tratamento , Saúde da MulherRESUMO
Menopause is associated with several symptoms which, if they reach certain intensity, can severely impair the quality of life. Overall, 90.9% of Latin American women will have at least one climacteric symptom and in 25%, these will be severe. Musculoskeletal pain, physical and mental fatigue and depressed mood are the most common climacteric symptoms. Dyspareunia, mood disorders and irritability can significantly alter female sexuality. Hot flashes are the symptoms most frequently related to menopause by both physicians and patients. However, it is one of the less common menopausal symptoms. This symptom reflects the neurochemical brain disorders caused by estrogen deficiency. The central nervous system (CNS) is also involved in changes of body composition leading to higher adipose tissue accumulation during climacterium, deteriorating quality of life and increasing the risk for chronic non-transmittable diseases. Menopausal discomfort also overloads health systems increasing the demand for medical services and decreasing productivity by labor absenteeism. Hormone therapy of menopause (HTM) decreases menopausal symptoms and improves quality of life. If we do not prescribe HTM to those women who need it, we could deprive them from several potential health benefits.
Assuntos
Humanos , Qualidade de Vida , Climatério/fisiologia , Menopausa/fisiologia , Terapia de Reposição Hormonal , Climatério/psicologia , Menopausa/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Medição de RiscoRESUMO
Benign intraperitoneal metastatic leiomyomatosis is a rare benign disease that is observed when a leiomyoma is present in the peritoneal surface. Women who have undergone hysterectomy for leiomyomas are most commonly affected. Patients are usually asymptomatic at presentation, being frequently an incidental finding in imaging studies. Ultrasound and CT play an important role in the diagnosis. The lesions are histologically identical to their uterine counterparts. There are different theories about the pathogenesis of the disease, including peritoneal seeding after laparoscopic hysterectomy. Others support the hypothesis of multiple independent foci of smooth muscle proliferation. Treatment, as in uterine leiomyomatosis, is generally conservative. We report a 53-year-old hysterectomized woman with intraperitoneal leiomyomas detected in a routine physical examination as mobile abdominal masses who underwent successful laparoscopic resection.
Assuntos
Leiomioma/patologia , Leiomiomatose/patologia , Neoplasias Peritoneais/secundário , Neoplasias Uterinas/patologia , Feminino , Humanos , Histerectomia , Leiomiomatose/diagnóstico por imagem , Leiomiomatose/cirurgia , Pessoa de Meia-Idade , Neoplasias Peritoneais/diagnóstico por imagem , Neoplasias Peritoneais/cirurgiaRESUMO
Benign intraperitoneal metastatic leiomyomatosis is a rare benign disease that is observed when a leiomyoma is present in the peritoneal surface. Women who have undergone hysterectomy for leiomyomas are most commonly affected. Patients are usually asymptomatic at presentation, being frequently an incidental finding in imaging studies. Ultrasound and CT play an important role in the diagnosis. The lesions are histologically identical to their uterine counterparts. There are different theories about the pathogenesis of the disease, including peritoneal seeding after laparoscopic hysterectomy. Others support the hypothesis of multiple independent foci of smooth muscle proliferation. Treatment, as in uterine leiomyomatosis, is generally conservative. We report a 53-year-old hysterectomized woman with intraperitoneal leiomyomas detected in a routine physical examination as mobile abdominal masses who underwent successful laparoscopic resection.
Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Neoplasias Peritoneais/secundário , Neoplasias Uterinas/patologia , Leiomiomatose/patologia , Leiomioma/patologia , Neoplasias Peritoneais/cirurgia , Neoplasias Peritoneais/diagnóstico por imagem , Leiomiomatose/cirurgia , Leiomiomatose/diagnóstico por imagem , HisterectomiaRESUMO
Musculoskeletal pain (MSP) has been recently linked with high plasma leptin levels. Our objective was to study if obese women, who have higher leptin levels, could have a higher frequency of MSP. We studied 6079 Latin-American women, 40-59 years old. Their epidemiological data were recorded and the Menopause Rating Scale (MRS), Golberg Anxiety and Depression Scale and Insomnia Scale were applied. MSP was defined as a score ≥2 on MRS11. Women with MSP were slightly older, had fewer years of schooling and were more sedentary. They also complained of more severe menopausal symptoms (29.2% versus. 4.4%, p < 0.0001). Furthermore, they had a higher abdominal perimeter (87.2 ± 12.0 cm versus 84.6 ± 11.6 cm, p < 0.0001) and a higher prevalence of obesity (23.1% versus 15.2%, p < 0.0001). Compared to normal weight women, those with low body weight (IMC <18.5) showed a lower risk of MSP (OR 0.71; 95%CI, 0.42-1.17), overweight women had a higher risk (OR 1.64; 95%CI, 1.44-1.87) and obese women the highest risk (OR 2.06; 95%CI, 1.76-2.40). Logistic regression analysis showed that obesity is independently associated to MSP (OR 1.34; 95%CI, 1.16-1.55). We conclude that obesity is one identifiable risk factor for MSP in middle-aged women.
Assuntos
Dor Musculoesquelética/epidemiologia , Obesidade/epidemiologia , Adulto , Estudos Transversais , Feminino , Humanos , Leptina/sangue , Menopausa/fisiologia , Pessoa de Meia-Idade , Dor Musculoesquelética/sangue , Dor Musculoesquelética/etiologia , Obesidade/sangue , Obesidade/complicações , Prevalência , Fatores de Risco , Inquéritos e QuestionáriosRESUMO
OBJECTIVE: Thyroid dysfunction and obesity during pregnancy have been associated with negative neonatal and obstetric outcomes. Thyroid hormone reference ranges have not been established for the pregnant Hispanic population. This study defines thyroid hormone reference ranges during early pregnancy in Chilean women and evaluates associations of body mass index (BMI) with thyroid function. DESIGN, PATIENTS, MEASUREMENTS: This is a prospective observational study of 720 healthy Chilean women attending their first prenatal consultation at an outpatient clinic. Thyroid function [TSH, Free T4, Total T4 and antithyroid peroxidase antibodies (TPOAb)] and BMI were assessed at 8·8 ± 2·4 weeks of gestational age. RESULTS: Median, 2·5th percentile (p2·5), and 97·5th percentile (p97·5) TSH values were higher, while median, p2·5, and p97·5 free T4 values were lower in obese patients compared with normal weight patients. Obesity was associated with a median TSH 16% higher (P = 0·035) and a median free T4 6·5% lower (P < 0·01) than values from patients with normal weight. BMI had a small, but statistically significant effect on TSH (P = 0·04) and free T4 (P < 0·01) when adjusted by maternal age, TPO antibodies, parity, sex of the newborn, gestational age and smoking. In all TPOAb (-) patients, median (p2·5-p.97·5) TSH was 1·96 mIU/l (0·11-5·96 mIU/l) and median (p2·5-p.97·5) free T4 was 14·54 pmol/l (11·1 - 19·02 pmol/l). Applying these reference limits, we found a prevalence of overt and subclinical hypothyroidism of 0·9% and 3·05% respectively. CONCLUSIONS: TSH distributes at higher values and free T4 at lower values in obese pregnant women compared to normal weight pregnant women. Thyroid hormone reference ranges derived from Chilean patients with negative TPOAb are different from the fixed internationally proposed reference ranges and may be used in the Hispanic population.
Assuntos
Gravidez/sangue , Hormônios Tireóideos/normas , Adulto , Índice de Massa Corporal , Chile , Feminino , Humanos , Estudos Prospectivos , Valores de Referência , Tireotropina/sangue , Tiroxina/sangue , Adulto JovemRESUMO
BACKGROUND: Previously, the REDLINC VI study showed that the main reason for the low use of menopausal hormone therapy (MHT) was its low rate of prescription by doctors. OBJECTIVE: To determine the use of MHT and perceived related risks among gynecologists. METHODS: A self-administered and anonymous questionnaire was delivered to certified gynecologists in 11 Latin American countries. RESULTS: A total of 2154 gynecologists were contacted, of whom 85.3% responded to the survey (n = 1837). Mean age was 48.1 ± 11.4 years; 55.5% were male, 20.3% were faculty members and 85% had a partner. Overall, 85.4% of gynecologists responded that they would use MHT if they had menopausal symptoms (81.8% in the case of female gynecologists) or prescribe it to their partner (88.2% in the case of male gynecologists; p < 0.001). Perceived risk related to MHT use (on a scale from 0 to 10) was higher among female than among male gynecologists (4.06 ± 2.09 vs. 3.83 ± 2.11, p < 0.02). The top two perceived reported risks were thromboembolism (women 33.6% vs. men 41.4%, p < 0.009) and breast cancer (women 38.5% vs. men 33.9%, p < 0.03). Overall, gynecologists reported prescribing MHT to 48.9% of their symptomatic patients (women 47.3% vs. men 50.2%, p < 0.03) and 86.8% currently prescribed non-hormonal remedies and 83.8% alternative therapies for the management of the menopause. Gynecologists who were older and academic professionals prescribed MHT more often. CONCLUSION: Although this Latin American survey showed that gynecologists are mostly supporters of MHT use (for themselves or their partners), this is not necessarily reflected in their clinical practice.
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Terapia de Reposição de Estrogênios/estatística & dados numéricos , Ginecologia/estatística & dados numéricos , Menopausa , Adulto , Estudos Transversais , Feminino , Terapia de Reposição Hormonal , Humanos , América Latina , Masculino , Pessoa de Meia-Idade , Risco , Inquéritos e QuestionáriosRESUMO
BACKGROUND: The determination of thyroid stimulating hormone (TSH) reference values is critical for the diagnosis of thyroid diseases. AIM: To explore and discuss different definitions to establish TSH reference values using a Chilean national survey sample. MATERIAL AND METHODS: The 2009-2010 Chilean National Health Survey recruited 5,416 participants between the ages of 15 and 96 years, from all geographic regions of Chile, including urban and rural zones. TSH was measured in a random subsample of 2,785 adults. Median value, 2.5 and 97.5 percentiles were described in three different populations: total survey population, "disease-free population" and the "laboratory kit disease free population". RESULTS: TSH values were higher among women, the elderly and the less educated population. The 97.5 percentile value in the disease-free population was 7.46 uUl/ml. Using this value as a cut-off, hypothyroidism prevalence would be 4.8% in Chile and estimated pharmacological treatment coverage would be 58%. When laboratory kit cut-offs are used, prevalence rises to 22% and treatment coverage drops to 12%. The 2.5 percentile value in the disease-free population was 0.83 uUl/ml, which yields an estimated hyperthyroidism prevalence of 3.89%. CONCLUSIONS: Median TSH concentration values in the Chilean "disease-free population" are higher than those proposed by laboratory kits and those of developed countries. TSH values in the general population of Chile are also higher in women, the elderly and the less educated population.
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Inquéritos Epidemiológicos/estatística & dados numéricos , Doenças da Glândula Tireoide/diagnóstico , Tireotropina/sangue , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Chile/epidemiologia , Feminino , Inquéritos Epidemiológicos/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Valores de Referência , Doenças da Glândula Tireoide/epidemiologia , Adulto JovemRESUMO
Background: The determination ofthyroid stimulating hormone (TSH) reference values is critical for the diagnosis ofthyroid diseases. Aim: To explore and discuss different definitions to establish TSH reference values using a Chilean national survey sample. Material and Methods: The 2009-2010 Chilean National Health Survey recruited 5,416participants between the ages of 15 and 96years, from all geographic regions of Chile, including urban and rural zones. TSH was measured in a random subsample of 2,785 adults. Median value, 2.5 and 97.5 percentiles were described in three different populations: total survey population, "disease-free population" and the "laboratory kit disease free population". Results: TSH values were higher among women, the elderly and the less educated population. The 97.5 percentile value in the disease-free population was 7.46 uUl/ml. Using this value as a cut-off, hypothyroidism prevalence would be 4.8% in Chile and estimated pharmacological treatment coverage would be 58%. When laboratory kit cut-offs are used, prevalence rises to 22% and treatment coverage drops to 12%. The 2.5 percentile value in the disease-free population was 0.83 uUl/ml, which yields an estimated hyperthyroidism prevalence of3.89%. Conclusions: Median TSH concentration values in the Chilean "disease-free population" are higher than those proposed by laboratory kits and those of developed countries. TSH values in the general population of Chile are also higher in women, the elderly and the less educated population.
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Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Inquéritos Epidemiológicos/estatística & dados numéricos , Doenças da Glândula Tireoide/diagnóstico , Tireotropina/sangue , Chile/epidemiologia , Inquéritos Epidemiológicos/métodos , Valores de Referência , Doenças da Glândula Tireoide/epidemiologiaRESUMO
RATIONALE AND OBJECTIVES: Thyroid nodules are common on ultrasonographic examination and are mostly benign. Ultrasound characteristics may help discriminate thyroid carcinoma (TC) from benign nodules. The aims of this study were to identify ultrasonographic characteristics associated with TC and to validate a previously proposed model based on the presence of three ultrasonographic characteristics. MATERIALS AND METHODS: From a protocolized prospective registry of 1108 fine needle aspiration biopsies performed during a 16-month period at an ambulatory center, the ultrasonographic characteristics of TC and non-TC biopsies were compared. Adjusted odds ratios (ORs) and likelihood ratios for TC were estimated for eight combinations of three previously identified characteristics (microcalcifications, hypoechogenicity, and irregular borders). RESULTS: Microcalcifications (OR, 6.6; 95% confidence interval [CI], 4.4-9.9), hypoechogenicity (OR, 4.7; 95% CI, 2.8-8.0), and irregular borders (OR, 4.3; 95% CI, 2.8-6.5) were independently associated with TC. When added to a logistic regression model, the three ultrasonographic characteristics remained statistically significant. In the absence of these three features, the likelihood ratio for TC was 0.1 (95% CI, 0.0-0.2), while in their simultaneous presence, the likelihood ratio was 11 (95% CI, 6.6-19.0). CONCLUSIONS: The absence or simultaneous presence of three simple ultrasonographic characteristics generates a large change of pretest probability of TC and could avoid unnecessary fine needle aspiration biopsy.
Assuntos
Neoplasias da Glândula Tireoide/diagnóstico por imagem , Nódulo da Glândula Tireoide/diagnóstico por imagem , Biópsia por Agulha Fina , Calcinose/diagnóstico , Calcinose/diagnóstico por imagem , Calcinose/patologia , Diagnóstico Diferencial , Feminino , Humanos , Funções Verossimilhança , Masculino , Pessoa de Meia-Idade , Sensibilidade e Especificidade , Neoplasias da Glândula Tireoide/diagnóstico , Neoplasias da Glândula Tireoide/patologia , Nódulo da Glândula Tireoide/diagnóstico , Nódulo da Glândula Tireoide/patologia , UltrassonografiaRESUMO
Background: The aim of the surgical treatment of primary hyperparathyroidism (PHPT) is to achieve its complete cure, evidenced by normal serum calcium in the postoperative period. Measurement of intraoperative serum parathormone (PTH) can be useful to predict complete cure of the disease. Aim: To assess the usefulness of intraoperative PTH measurement to predict complete cure of PHPT Material and methods: Serum PTH was measured to all patients operated for PHPT between 2003 and 2008, before and five and ten minutes after the excision of the parathyroid gland causing the disease. The criteria for complete cure were normal serum calcium at 24 hours and 6 months after surgery and the pathological confirmation of parathyroid gland excision. Results: Eighty-eight operated patients, aged 58±15 years (72 females) were studied. Sixty four percent were asymptomatic and their preoperative serum calcium was 11.6± 1.2 mg/dl. A normal serum calcium was achieved in 86 patients (98 percent) at 24 hours and 50 of 52 patients followed for six months (96 percent). The pathological study disclosed an adenoma in 69 (78 percent), and multiglandular disease in 16 (18 percent), a parathyroid cancer in one and a normal gland in one patient. Intraoperative PTH predicted early and definitive cure in 97 percent and 100 percent of patients with a single adenoma, respectively. Among patients with multiglandular disease, the predictive figures were 94 percent and 100 percent, respectively. Conclusions: Intraoperative PTH measurement efficiently predicts early and definitive surgical cure of PHPT.