RESUMO
BACKGROUND: Clinical repercussions, progression to overt hypothyroidism, and treatment benefits have been well established in patients with subclinical hypothyroidism (SCH) and TSH >10 mIU/L. In contrast, these aspects of the disease are poorly understood in patients with even milder SCH as defined by TSH < or = 10 mIU/L and normal thyroid hormone levels. Therefore, we sought to evaluate the natural history of this milder form of SCH (TSH < or =10 mIU/L with normal thyroid hormone levels) in adult women patients. PATIENTS: One hundred seventeen patients with TSH levels ranging from 5 to 10 mIU/L and normal free T4, without a previously known history of thyroid disease, were followed for a period of 3 years and had two consecutive assessments. RESULTS: Sixty patients tested positive for antithyroperoxidase antibodies (TPOAb) and 36 were TPOAb negative but had diffuse hypoechogenicity on thyroid ultrasound (US). Twenty-one patients were TPOAb negative and had normal US. During follow-up, 20.5% of the patients had spontaneous normalization of their TSH, 27.3% required replacement therapy with levothyroxine (L-T4) because of progression to overt hypothyroidism or persistence of serum TSH >10 mIU/L, and 52.1% continued to meet the criteria for mild SCH (persistence of TSH < or =10 mIU/L). If the patients were classified into two groups, one with positive TPOAb and/or US alteration and the other with testing negative for TPOAb and not having US alteration, the first group had a greater progression toward overt hypothyroidism (31.2% vs. 9.5%, respectively) and a lower rate of normalization of TSH (15.6% vs. 43% respectively). These rates were similar in TPOAb-positive patients and patients with negative TPOAb but with positive US. CONCLUSIONS: Most patients with SCH and TSH < or = 10 mIU/L do not progress to overt hypothyroidism. The presence of chronic thyroiditis as demonstrated by US increases the evolution of SH to overt hypothyroidism or more severe SCH and thus the need for L-T4 treatment. US findings are important in determining the prognosis of mild SCH.
Assuntos
Hipotireoidismo/sangue , Hipotireoidismo/diagnóstico por imagem , Tireotropina/sangue , Adulto , Anticorpos Anti-Idiotípicos/sangue , Autoantígenos/imunologia , Progressão da Doença , Feminino , Humanos , Hipotireoidismo/tratamento farmacológico , Iodeto Peroxidase/imunologia , Proteínas de Ligação ao Ferro/imunologia , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Estudos Retrospectivos , Tiroxina/uso terapêutico , UltrassonografiaRESUMO
To evaluate tumor recurrence after total thyroidectomy in patients with single papillary carcinoma with size
Assuntos
Carcinoma Papilar/radioterapia , Carcinoma Papilar/cirurgia , Neoplasias da Glândula Tireoide/radioterapia , Neoplasias da Glândula Tireoide/cirurgia , Adulto , Biópsia , Carcinoma Papilar/patologia , Terapia Combinada , Feminino , Humanos , Radioisótopos do Iodo/uso terapêutico , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/prevenção & controle , Radioterapia Adjuvante , Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide/patologia , Tireoidectomia , Resultado do Tratamento , Imagem Corporal TotalRESUMO
This study evaluated the positive predictive value (PPV) of detectable stimulated thyroglobulin during the first year after treatment of thyroid carcinoma (Tg-1) and the value of comparison with Tg-ablation and measured after 24 months (Tg-2). Forty-two consecutive patients undergoing total thyroidectomy and ablation with detectable Tg-1 (>1ng/mL) were selected. The patients had well-differentiated tumors, which were completely resected, and there was no ectopic uptake on whole body scan after 3.7-5.5GBq I(131). Imaging methods during follow-up revealed metastases in 10 patients (24%) (15% if Tg-1