RESUMO
UNLABELLED: The thyroid carcinoma (TC) is not very frequent among all cancers. Its course is slow and is high potentially curable. Our aim was to analyse the characteristics in patients with TC. A retrospective analysis on 171 patients, with an average age of 41.1 (+/- 14.6), who asked for TC to our service between the years 2000-04, was performed. From case histories it was evaluated: anamnesis, diagnostic image, histopathology and evolution. Tumours were grouped for size and TNM (tumour-nodule-metastasis) in stages (S). A stimulated serum thyroglobulin level >2 ng/ml and positive image with 131I or another nuclear marker were considered as positive for residual TC. In the totality of the analyzed patients 88% were female, 62% below 45 years old, and in 77% the thyroid function was normal. The fine needle aspiration (FNA) was diagnostic in 78%. Papillary thyroid carcinoma (PTC) in 96%. The 63% was SI; 14% SII; 19% SIII and 4% SIV. During follow-up, we observed that 90% of patients with Tg between 2 and 10 had evidence of residual TC, and 100% with Tg >10 ng/ml, whereas 18% of those whose stimulated Tg <2 presented positive image. There was not found significative correlation with pathologic antecedents or relevant image signs. IN CONCLUSION: TCP was the most frequent carcinoma in women, in patients younger than 45 years and in those who have euthyroid function. A stimulated serum thyroglobulin level was a good indicator for residual TC, but failed to select those patients who were disease free.
Assuntos
Carcinoma Papilar/patologia , Neoplasias da Glândula Tireoide/patologia , Adulto , Biomarcadores Tumorais/sangue , Carcinoma Papilar/sangue , Feminino , Bócio Nodular/sangue , Bócio Nodular/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Neoplasia Residual , Prognóstico , Estudos Retrospectivos , Fatores Sexuais , Tireoglobulina/sangue , Neoplasias da Glândula Tireoide/sangue , Nódulo da Glândula Tireoide/sangue , Nódulo da Glândula Tireoide/patologia , Tireotropina/sangueRESUMO
Entre todos los tumores, el carcinoma tiroideo (CT) es poco frecuente, se caracteriza por su lenta evolución y elevado porcentaje de curación. Nuestro objetivo es estudiar las características de los pacientes con CT. Analizamos retrospectivamente a 171 pacientes, edad media al diagnóstico 41.1( ± 14.6 años), que consultaron entre los años 2000-04 por CT. Se evaluaron datos de anamnesis, métodos de diagnóstico, anatomía patológica y evolución. Agrupamos a los tumores por el tamaño y según TNM (tumor-adenopatía-metástasis) en estadios (E). La presencia de tiroglobulina estimulada (Tg) > 2 ng/ml e imagen positiva (con 131I u otro radiotrazador) fueron consideradas como positivas para CT residual. De la población total el 88% fue sexo femenino, el 62% menores de 45 años, y el 77.1% tuvo función tiroidea normal. La punción con aguja fina (PAAF) fue diagnóstica en 78%. El 96% fue carcinoma papilar (CTP), 63% presentaban E I; 14% E II; 19% E III y 4% E IV. Se detectó CT residual en el 90% de los pacientes con Tg entre 2 y 10, y en el 100% con Tg > 10 ng/ml, mientras que con Tg < 2 el 18% mostró imagen positiva. No encontramos correlación significativa con antecedentes patológicos ni con ningún signo relevante en imágenes. En conclusión, en nuestra población el CTP fue predominante. Más frecuente en mujeres, en menores de 45 años y en eutiroideos. El nivel de Tg estimulada es un buen indicador de CT residual, pero no es una prueba suficiente para seleccionar pacientes libres de enfermedad
The thyroid carcinoma (TC) is not very frequent among all cancers. Its course is slow and is high potentially curable. Our aim was to analyse the characteristics in patients with TC. A retrospective analysis on 171 patients, with an average age of 41.1 (±14,6), who asked for TC to our service between the years 2000-04, was performed. From case histories it was evaluated: anamnesis, diagnostic image, histopathology and evolution. Tumours were grouped for size and TNM (tumour-nodule-metastasis) in stages (S). A stimulated serum thyroglobulin level > 2 ng/ml and positive image with 131I or another nuclear marker were considered as positive for residual TC. In the totality of the analyzed patients 88% were female, 62% below 45 years old, and in 77% the thyroid function was normal. The fine needle aspiration (FNA) was diagnostic in 78%. Papillary thyroid carcinoma (PTC) in 96%. The 63% was SI; 14% SII; 19% SIII and 4% SIV. During follow-up, we observed that 90% of patients with Tg between 2 and 10 had evidence of residual TC, and 100% with Tg > 10 ng/ml, whereas 18% of those whose stimulated Tg < 2 presented positive image. There was not found significative correlation with pathologic antecedents or relevant image signs. In conclusion: TCP was the most frequent carcinoma in women, in patients younger than 45 years and in those who have euthyroid function. A stimulated serum thyroglobulin level was a good indicator for residual TC, but failed to select those patients who were disease free
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Carcinoma Papilar/patologia , Neoplasias da Glândula Tireoide/patologia , Biópsia por Agulha Fina , Carcinoma Papilar/sangue , Bócio Nodular/sangue , Bócio Nodular/patologia , Espectroscopia de Ressonância Magnética , Microscopia de Tunelamento , Metástase Neoplásica , Estadiamento de Neoplasias , Neoplasia Residual , Prognóstico , Estudos Retrospectivos , Fatores Sexuais , Tomógrafos Computadorizados , Tireoglobulina/sangue , Neoplasias da Glândula Tireoide/sangue , Nódulo da Glândula Tireoide/sangue , Nódulo da Glândula Tireoide/patologia , Tireotropina/sangue , Biomarcadores Tumorais/sangueRESUMO
Entre todos los tumores, el carcinoma tiroideo (CT) es poco frecuente, se caracteriza por su lenta evolución y elevado porcentaje de curación. Nuestro objetivo es estudiar las características de los pacientes con CT. Analizamos retrospectivamente a 171 pacientes, edad media al diagnóstico 41.1( ± 14.6 años), que consultaron entre los años 2000-04 por CT. Se evaluaron datos de anamnesis, métodos de diagnóstico, anatomía patológica y evolución. Agrupamos a los tumores por el tamaño y según TNM (tumor-adenopatía-metástasis) en estadios (E). La presencia de tiroglobulina estimulada (Tg) > 2 ng/ml e imagen positiva (con 131I u otro radiotrazador) fueron consideradas como positivas para CT residual. De la población total el 88% fue sexo femenino, el 62% menores de 45 años, y el 77.1% tuvo función tiroidea normal. La punción con aguja fina (PAAF) fue diagnóstica en 78%. El 96% fue carcinoma papilar (CTP), 63% presentaban E I; 14% E II; 19% E III y 4% E IV. Se detectó CT residual en el 90% de los pacientes con Tg entre 2 y 10, y en el 100% con Tg > 10 ng/ml, mientras que con Tg < 2 el 18% mostró imagen positiva. No encontramos correlación significativa con antecedentes patológicos ni con ningún signo relevante en imágenes. En conclusión, en nuestra población el CTP fue predominante. Más frecuente en mujeres, en menores de 45 años y en eutiroideos. El nivel de Tg estimulada es un buen indicador de CT residual, pero no es una prueba suficiente para seleccionar pacientes libres de enfermedad (AU)
The thyroid carcinoma (TC) is not very frequent among all cancers. Its course is slow and is high potentially curable. Our aim was to analyse the characteristics in patients with TC. A retrospective analysis on 171 patients, with an average age of 41.1 (±14,6), who asked for TC to our service between the years 2000-04, was performed. From case histories it was evaluated: anamnesis, diagnostic image, histopathology and evolution. Tumours were grouped for size and TNM (tumour-nodule-metastasis) in stages (S). A stimulated serum thyroglobulin level > 2 ng/ml and positive image with 131I or another nuclear marker were considered as positive for residual TC. In the totality of the analyzed patients 88% were female, 62% below 45 years old, and in 77% the thyroid function was normal. The fine needle aspiration (FNA) was diagnostic in 78%. Papillary thyroid carcinoma (PTC) in 96%. The 63% was SI; 14% SII; 19% SIII and 4% SIV. During follow-up, we observed that 90% of patients with Tg between 2 and 10 had evidence of residual TC, and 100% with Tg > 10 ng/ml, whereas 18% of those whose stimulated Tg < 2 presented positive image. There was not found significative correlation with pathologic antecedents or relevant image signs. In conclusion: TCP was the most frequent carcinoma in women, in patients younger than 45 years and in those who have euthyroid function. A stimulated serum thyroglobulin level was a good indicator for residual TC, but failed to select those patients who were disease free (AU)
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Neoplasias da Glândula Tireoide/patologia , Carcinoma Papilar/patologia , Neoplasias da Glândula Tireoide/sangue , Carcinoma Papilar/sangue , Nódulo da Glândula Tireoide/sangue , Nódulo da Glândula Tireoide/patologia , Bócio Nodular/sangue , Bócio Nodular/patologia , Tireotropina/sangue , Tireoglobulina/sangue , Biomarcadores Tumorais/sangue , Neoplasia Residual , Estadiamento de Neoplasias , Metástase Neoplásica , Prognóstico , Biópsia por Agulha Fina , Microscopia de Tunelamento , Estudos Retrospectivos , Fatores Sexuais , Tomógrafos Computadorizados , Espectroscopia de Ressonância MagnéticaRESUMO
Entre todos los tumores, el carcinoma tiroideo (CT) es poco frecuente, se caracteriza por su lenta evolución y elevado porcentaje de curación. Nuestro objetivo es estudiar las características de los pacientes con CT. Analizamos retrospectivamente a 171 pacientes, edad media al diagnóstico 41.1( ± 14.6 años), que consultaron entre los años 2000-04 por CT. Se evaluaron datos de anamnesis, métodos de diagnóstico, anatomía patológica y evolución. Agrupamos a los tumores por el tamaño y según TNM (tumor-adenopatía-metástasis) en estadios (E). La presencia de tiroglobulina estimulada (Tg) > 2 ng/ml e imagen positiva (con 131I u otro radiotrazador) fueron consideradas como positivas para CT residual. De la población total el 88% fue sexo femenino, el 62% menores de 45 años, y el 77.1% tuvo función tiroidea normal. La punción con aguja fina (PAAF) fue diagnóstica en 78%. El 96% fue carcinoma papilar (CTP), 63% presentaban E I; 14% E II; 19% E III y 4% E IV. Se detectó CT residual en el 90% de los pacientes con Tg entre 2 y 10, y en el 100% con Tg > 10 ng/ml, mientras que con Tg < 2 el 18% mostró imagen positiva. No encontramos correlación significativa con antecedentes patológicos ni con ningún signo relevante en imágenes. En conclusión, en nuestra población el CTP fue predominante. Más frecuente en mujeres, en menores de 45 años y en eutiroideos. El nivel de Tg estimulada es un buen indicador de CT residual, pero no es una prueba suficiente para seleccionar pacientes libres de enfermedad (AU)
The thyroid carcinoma (TC) is not very frequent among all cancers. Its course is slow and is high potentially curable. Our aim was to analyse the characteristics in patients with TC. A retrospective analysis on 171 patients, with an average age of 41.1 (±14,6), who asked for TC to our service between the years 2000-04, was performed. From case histories it was evaluated: anamnesis, diagnostic image, histopathology and evolution. Tumours were grouped for size and TNM (tumour-nodule-metastasis) in stages (S). A stimulated serum thyroglobulin level > 2 ng/ml and positive image with 131I or another nuclear marker were considered as positive for residual TC. In the totality of the analyzed patients 88% were female, 62% below 45 years old, and in 77% the thyroid function was normal. The fine needle aspiration (FNA) was diagnostic in 78%. Papillary thyroid carcinoma (PTC) in 96%. The 63% was SI; 14% SII; 19% SIII and 4% SIV. During follow-up, we observed that 90% of patients with Tg between 2 and 10 had evidence of residual TC, and 100% with Tg > 10 ng/ml, whereas 18% of those whose stimulated Tg < 2 presented positive image. There was not found significative correlation with pathologic antecedents or relevant image signs. In conclusion: TCP was the most frequent carcinoma in women, in patients younger than 45 years and in those who have euthyroid function. A stimulated serum thyroglobulin level was a good indicator for residual TC, but failed to select those patients who were disease free (AU)
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Neoplasias da Glândula Tireoide/patologia , Carcinoma Papilar/patologia , Neoplasias da Glândula Tireoide/sangue , Carcinoma Papilar/sangue , Nódulo da Glândula Tireoide/sangue , Nódulo da Glândula Tireoide/patologia , Bócio Nodular/sangue , Bócio Nodular/patologia , Tireotropina/sangue , Tireoglobulina/sangue , Biomarcadores Tumorais/sangue , Neoplasia Residual , Estadiamento de Neoplasias , Metástase Neoplásica , Prognóstico , Biópsia por Agulha Fina , Microscopia de Tunelamento , Estudos Retrospectivos , Fatores Sexuais , Tomógrafos Computadorizados , Espectroscopia de Ressonância MagnéticaRESUMO
UNLABELLED: A dose limit-based criterion was proposed to authorize hospital discharge of thyroid carcinoma patients treated with 131I. Evaluation of accumulated doses to determine the effective half-life, the expected accumulated dose at 1 m, and the hospitalization time was performed to ensure that the dose limit was satisfied for each patient. Situations involving different dose limits and occupancy factors were analyzed. This study dealt only with external exposure; the problem of internal contamination was not considered. METHODS: Fourteen patients treated postoperatively with 131I were studied. The range of activity was 1,110-8,175 MBq. Electronic dosimeters and thermoluminescent dosimeter chips were placed on the left pectoral muscle. Dose was measured for a mean of approximately 2.5 d. The accumulated doses were plotted as a function of time and then fitted using an exponential model to obtain the parameters of total accumulated dose and effective half-life. The doses to the public and relatives at 1 m were calculated with point source approximation and several occupancy factors. RESULTS: The fit function parameters of accumulated doses in the first 36 h predicted the behavior of the total accumulated dose within a 5% error in the parameters. Estimated values of the accumulated dose 1 m from the patient were generally <5 mSv, even for an occupancy factor of 100%. For more restrictive dose constraints, hospitalization times were calculated according to different occupancy factors, as suggested in the European Commission guide. From the fit of the measured data, values of effective half-life for each patient were obtained. CONCLUSION: To apply the dose limit-based criterion, one must calculate the patient-specific parameters, as can be done using the accumulated dose. Knowledge of patient-specific parameters ensures that the patient will not expose any individual to levels greater than the dose limit. The calculated hospitalization times were less than those recommended, especially for countries with more restrictive dose limits. The type of measurements performed in this study reveals more realistic doses for the treatment of thyroid carcinoma with 131I.