Correlación ultrasonográfica entre volumen tiroideo y ti-rads. Estudio prospectivo / Ultrasonographic correlation between thyroid volume and ti-rads. Prospective study

La comunidad científica se ha preocupado por cuantificar el volumen tiroideo según variables como sexo, edad y deficiencias de yodo asociadas, sin embargo, pese al uso globalizado de TI-RADS para estimación de riesgo de malignidad en la patología tiroidea, no existe suficiente información en relación a si el tamaño de la glándula guarda o no relación con esta escala. Objetivo: comparar el Volumen Tiroideo con TI-RADS en pacientes atendidos en la unidad de ecografía diagnóstica del Centro Clínico Naguanagua en el período enero 2022 - enero 2023. Métodos: estudio observacional-descriptivo de nivel comparativo, con diseño transversal y prospectivo. Muestra no probabilística censal, abarcando la totalidad de los pacientes a los cuales se les efectuó ecografía tiroidea en el período establecido. Se efectuó un registro en cuanto a la cuantificación del volumen de: lóbulo tiroideo derecho, lóbulo tiroideo izquierdo y total de tiroides, TI-RADS, edad y sexo del paciente. Se utilizó el estadístico ANOVA y se empleó el programa Statistical® de licencia libre. Resultados: muestra de 126 pacientes, con edad promedio de 51,71 años ± 1,44, mediana de 53 años. Cuando se comparó el Volumen Total de Tiroides con TI-RADS, se constató que el mayor promedio lo registraron aquellos pacientes clasificados como 4B (p <0,05). Conclusión: aun cuando se registran mayores promedios de volumen total glandular en pacientes con hallazgos nodulares, llama la atención que entre los datos registrados existan pacientes con valores muy similares a lo reportado en la literatura como volúmenes normales en presencia de patología nodular tiroidea(AU)

The scientific community has been concerned with quantifying thyroid volume according to variables such as sex, age, and associated iodine deficiencies; however, despite the global use of TI-RADS to estimate the risk of malignancy in thyroid pathologies, there is not enough information in regarding whether or not the size of the gland is related to this scale. Objective: to compare the Thyroid Volume with TI-RADS in patients treated in the diagnostic ultrasound unit of the Naguanagua Clinical Center in the period January 2022 - January 2023. Methods: observational-descriptive study of a comparative level, with a crosssectional and prospective design. Non-probabilistic census sample, covering all the patients who underwent thyroid ultrasound in the established period. A record was made regarding the quantification of the volume of: right thyroid lobe, left thyroid lobe and total thyroid, TI-RADS, age and sex of the patient. The ANOVA statistic was used and the free license Statistical® program was used. Results: sample of 126 patients, mean age 51.71 ± 1.44 years, median 53 years. When the Total Thyroid Volume was compared with TI-RADS, it was found that the highest mean was registered by those patients classified as 4B (p <0.05). Conclusion: even when higher total glandular volume averages are recorded in patients with nodular findings, it is noteworthy that among the recorded data there are patients with values very similar to those reported in the literature as normal volumes in the presence of thyroid nodular pathology(AU)

Morphometry, topography and arterial supply of the thyroid gland in brazilian shorthair cat

Thyroid gland diseases are the most common endocrinopathies in feline practice. Diagnosis and surgical treatment must base on solid anatomical knowledge about the gland size, localization, and blood supply. However, some textbooks provide a general anatomical description of the thyroid gland of domestic carnivores. Thus, specific details of the feline gland are missing. The present study aimed to investigate the dimensions, topography, and arterial supply of the thyroid gland in Brazilian shorthair cats and, therefore, provide additional data to diagnose and treat feline thyroid diseases. Thirty Brazilian shorthair cats formalin-fixed cadavers (15 male and 15 female) were injected with red-stained latex solution by a canula in the thoracic aorta. The necropsy unit of the Rural Federal University of Rio de Janeiro donated the specimens. The study included only adult animals with no history of thyroid disease. After the fixation period, the cadavers were dissected to investigate the measurements (length, width at cranial and caudal poles, and thickness), topography, and in situ arterial supply of the thyroid lobes. The mean measurements of the length, cranial pole width, caudal pole width, and thickness in the right lobe were 19.39 ± 3.10 mm, 5.36 ± 1.40 mm, 3.67 ± 0.93 mm, and 1.30 ± 0.29 mm, respectively; and 20.29 ± 3.35 mm, 4.85 ± 1.58 mm, 3.88 ± 0.91 mm, 1.64 ± 0.65 mm in the left lobe, respectively. There were no statistical differences (P > 0.05) in the comparison of the measures between sexes or antimers (sides). Pearson's linear correlation detected a positive, moderate (r = 0.55), and significant (P < 0.05) correlation between the right and left lobe lengths. In 70% of the cats, both left and right lobes had the cranial poles located at the same level. Typically, the lobes extended between the first to the eighth tracheal ring. However, the cranial pole of some lobes located as cranially as the cricoid cartilage level, and the caudal pole as caudally as the 12th tracheal ring. Fifty-six percent of the cats had a ventrally located isthmus. In all the sampling, one single thyroid artery emerged as a branch of the common carotid artery and provided branches directly to the thyroid lobe, isthmus and the adjacent muscles and esophagus. Besides establishing average dimensions of normal thyroid lobes in Brazilian shorthair cats, this study detected no significant difference between the average measurements of right and left lobes. Also, a positive linear correlation between the length and width of the right and left lobes became evident. Therefore, the practitioner must consider suspicious any length asymmetry between right and left thyroid lobes until further endocrine test proves otherwise. Most of the cats had the right and left thyroid lobe positioned at the same transversal level; however, positional asymmetries are not uncommon. Unlike dogs, Brazilian shorthair cats have only a single artery to supply each lobe: the thyroid artery. In a feline thyroidectomy, the surgeon must avoid blindly ligating the thyroid artery since this vessel also provided numerous branches to adjacent muscles and esophagus. In a bilateral thyroidectomy, the ventral region between lobes should be thoroughly inspected for the common presence of an isthmus. Sometimes, the surgeon may need to extend the incision caudally beyond the 12th tracheal ring level to visualize the gland tissue entirely.(AU)

Evaluación endocrinológica del paciente con enfermedad nodular tiroidea / Endocrinologic approach to the patient with thyroid nodules

Llamamos nódulo tiroideo a aquella lesión concreta palpable o radiológicamente distinguible del parénquima tiroideo. La enfermedad nodular tiroidea tiene una prevalencia progresivamente creciente a medida que ha mejorado la calidad de las técnicas de imagen, principalmente la ecografía. El objetivo de la presente revisión es señalar cuales son los pasos en la evaluación endocrinológica del paciente con enfermedad nodular tiroidea. Más concretamente, cual es la mejor estrategia coste/efectiva para diagnosticar los nódulos tiroideos malignos. Tras una buena anamnesis y exploración clínica, el estudio se completa con una determinación de TSH y la realización de una ecografía tiroidea, que es la prueba diagnóstica que más criterios aporta para poder hacer la indicación de PAAF. La muestra obtenida se estudiará según el sistema Bethesda

Thyroid nodule is defined as a palpable lesion o radiologically distinguishable from thyroid parenchyma. Its prevalence is increasing with the improvement of the imagine techniques, mainly the ultrasonography. The aim of this review is to indicate the steps for the endocrinology evaluation of the patient with thyroid nodules, particularly to choose the best cost/effective strategy to diagnose the malignant thyroid nodules. After having the anamnesis and physical examination done, a TSH determination and an thyroid ultrasound are needed. The sample obtained will be studied according to the Bethesda system

Anatomía quirúrgica de las glándulas tiroides y paratiroides / Surgycal anatomy of the thyroid and parathyroid glands

Nuestro objetivo es lograr un relato de los detalles anatómicos que ayude al cirujano a conseguir intervenciones seguras, se elude el estilo de las anatomías descriptivas o topográficas tratando de producir una anatomía verdaderamente quirúrgica. Para ello se mencionan las fascias, estructuras capsulares y ligamentos que envuelven a la tiroides. Se hace hincapié en la vascularización, principalmente en lo referente a la arteria tiroidea inferior, fundamental para la localización del nervio recurrente. También en lo relacionado con el conjunto del drenaje venoso, que con su complicada distribución dificulta notablemente la disección. Relatamos minuciosamente las variantes anatómicas y las anomalías que afectan a la estructura de la región, su conocimiento es fundamental ante la posibilidad de que el cirujano encuentre en sus operaciones alguna de ellas. Describimos el aspecto, las relaciones y lo referente a la localización de las glándulas paratiroides, detalles necesarios para evitar su resección inopinada en las tiroidectomías y para el reconocimiento de la glándula patológica en el hiperparatiroidismo

The aim of this article is describe the anatomical details that helps the surgeon to achieve safe surgeries, the style of descriptive or topographic anatomies is avoided trying to produce a truly surgical anatomy. For this, fascias, capsular structures and ligaments that surround the thyroid gland are mentioned. Emphasis is placed on vascularization, mainly in relation to the inferior thyroid artery, essential for the location of the recurrent nerve. Also in relation to the whole of the venous drainage, which with its complicated distribution makes dissection remarkably difficult. We carefully describe the anatomical variants and the anomalies that affect the structures of the region, their knowledge is fundamental to the possibility that the surgeons finds in their surgeries. We describe the appearance, the relationships and the reference to the location of the parathyroid glans. Neccesary details to avoid their inopinate resection in thyroidectomies and for the recognition of the pathological gland in the hyperparathyroidism

Morfometría y vascularización de la glándula tiroides en conejo (Oryctolagus cuniculus) / Morphometry and vascularization of the thyroid glands in rabbits (Oryctolagus cuniculus)

Las glándulas tiroides consisten en dos partes denominadas lobos que se encuentran en ambos lados de la laringe. El objetivo de este estudio fue caracterizar las medidas, topografía y vascularización de la glándula tiroides de conejos Nueva Zelanda. Las disecciones anatómicas se realizaron en 36 cadáveres adultos, 17 machos y 19 hembras, con masa corporal media de 2,5 kg y longitud cara-sacral media de 40 cm. Los cadáveres fueron obtenidos del sector de necropsia de la Universidad. Los especímenes tuvieron la arteria aorta torácica canalada, por la cual se inyectó solución de formaldehído al 10 %, seguida de látex coloreado. En los machos, el lobo izquierdo de la glándula tiroidea midió 1,40 x 0,40 x 0,01 cm y el derecho 1,36 x 0,56 x 0,01 cm; en las hembras, el lobo izquierdo midió 1,50 x 0,49 x 0,01 cm y el derecho 1,37 x 0,48 x 0,01cm. No hubo diferencia significativa (p> 0,05) entre las medias de las medidas entre machos y hembras, pero la extensión del lóbulo izquierdo de las hembras y la anchura del lóbulo derecho de los machos fueran significativamente mayores (p <0,05). La extremidad craneal de los lobos tiroideos se encontraba al nivel del cartílago cricoide en casi todos los especímenes. El extremo caudal presentó topografía más variable, desde el tercer hasta el décimo anillo traqueal, habiendo predominado al nivel del quinto anillo. Invariablemente, la irrigación arterial fue determinada por las arterias tiroideas izquierda y derecha, originadas de la arteria carótida común. Las anastomosis entre las arterias tiroideas fueron comunes. La constancia en las dimensiones y irrigación de la glándula tiroidea puede ser ventajosa en la elección del Coelho como modelo experimental para el estudio de esta glándula.

The thyroid glands consist of two parts called lobes located on both sides of the larynx. The aim of this study was to characterize the measures, topography and arterial irrigation of New Zealand´s rabbits thyroid glands. The anatomical dissections were performed in 36 adult cadavers, 17 males and 19 females, with a mean body mass of 2.5 kg and a mean cranium-sacral length of 40 cm. The specimens were obtained from the necropsy unit of the University. The cadavers had the thoracic aorta artery cannulated, through which 10 % formaldehyde solution was injected, followed by injection colored latex. In males, the left lobe of the thyroid gland measured 1.40x0.40x0.01cm and the right 1.36x0.56x0.01cm; in females, the left lobe measured 1.50x0.49x0.01cm and the right one was 1.37x0.48x0.01cm. There was no significant difference (p> 0.05) between the means of the measurements between males and females, but the left lobe length of the females and the right lobe width of the males were significantly higher (p <0.05). The cranial extremity of the thyroid lobes was at the level of the cricoid cartilage in almost all specimens. The caudal end showed more variable topography, from the third to the tenth tracheal ring in few specimens, but predominated at the level of the fifth ring. Invariably, arterial irrigation was determined by the left and right thyroid arteries, originating from the common carotid artery. Anastomoses between the thyroid arteries were common. The constancy in dimensions and irrigation of the thyroid gland may be advantageous in choosing the rabbit as an experimental model for the study of this gland.

Ultrasonographic features of the normal thyroid gland in adult horses / Características ultrassonográficas da glândula tireoide hígida em equinos adultos

Few reports have been published regarding the use of ultrasonography as a method of evaluating the normal thyroid gland in horses. For these reasons, this study aimed at determining reliably of the thyroid measurements from the comparison between the left and right thyroid lobes, as well as assessing the contour, format, echotexture and echogenicity of the healthy thyroid by mode-B ultrasonography. Additionally, the equine thyroid vascularization was quali-quantitatively characterized the by Doppler. The sample size initially was determined by the animal selection with advanced age and without volume increase in the neck proximal region. Finally, eleven horses were selected by laboratory test, search of thyroid neoformations by ultrasonography and cytology thyroid. Next, these animals were submitted to thyroid lobes ultrasonographic evaluation. Excellent reproducibility was observed for all measurements obtained. Among the comparisons made between the quantitative parameters of the left and right lobes, it was observed that there was only difference between their respective lengths. Qualitatively, there was a significant variation between the lobes elliptical format in the longitudinal plane of some glands, which oscillated between a rounded and flattened conformation. Thus, we can conclude that the difference between the lobes format of some thyroids can be explained by the significant difference observed between the length of the left and right lobes. Additionally, it was verified that there was no difference between the Doppler quantitative parameters. Therefore, we may suggest that unilateral analysis of the cranial thyroid artery by spectral Doppler can be used to evaluate equine thyroid diffuse disorders.(AU)

Poucas análises foram publicadas com relação ao uso da ultrassonografia como método de avaliação da glândula tireoide hígida em equinos. Alguns trabalhos incluem a determinação das dimensões e características do parênquima. Por essas razões, este estudo teve como objetivo determinar com segurança as medidas tireoidianas a partir da comparação entre o lobo tireoidiano esquerdo e direito, bem como avaliar os contornos, formato, ecotextura e ecogenicidade das glândulas tireoides hígidas pela ultrassonografia em modo B. Além disso, a vascularização da tireoide equina foi caracterizada quali-quantitativamente pela ferramenta Doppler. O tamanho da amostra inicialmente foi determinado pela seleção dos animais com idade avançada e sem aumento de volume na região proximal do pescoço. Por fim, onze equinos foram selecionados por meio de exame laboratorial, pesquisa de neoformações tireoidianas por ultrassonografia e citologia da tireoide. Em seguida, estes animais foram submetidos à avaliação de lobos tireoidianos por ultrassonografia. Observou-se excelente reprodutibilidade em relação a todas as medidas deste estudo. Foram observadas diferenças qualitativas entre os lobos tireoidianos direito e esquerdo. Assim, podemos concluir que tais diferenças entre o formato dos lobos tireoidianos podem ser explicadas pela diferença significativa e/ou tendência observada no parâmetro comprimento entre os respectivos lobos. Além disso, não foi encontrada diferença significativa entre os valores da artéria tireoidiana cranial esquerda em relação aos obtidos na artéria tireoidiana cranial direita, sugerindo que a análise dos valores espectrais do Doppler de uma das artérias tireoidianas craniais possa ser utilizada como método de avaliação de distúrbios difusos da tireoide equina.(AU)

O tubérculo de Zuckerkandl pode auxiliar na localização do nervo laríngeo inferior durante tireoidectomias? / Can the Zuckerkandl tubercle assist in the location of the inferior laryngeal nerve during thyroidectomies?

RESUMO Objetivo: avaliar se a projeção lateral da glândula tireoide, chamada tubérculo de Zuckerkandl (TZ), pode auxiliar o cirurgião na identificação do nervo laríngeo inferior durante a tireoidectomia convencional aberta. Métodos: estudo prospectivo de 51 pacientes submetidos à tireoidectomia, com um total de 100 lobos tireoidianos ressecados, e observação da presença ou não do TZ em dimensões suficientes para ser identificado sem magnificação de imagem, suas dimensões de base e altura, sua localização na glândula e sua relação anatômica com o nervo laríngeo inferior. Resultados: o TZ estava presente em 68 dos 100 lobos de tireoide analisados (68%). A dimensão média da base foi 6,7mm no lado direito e 7,1mm no lado esquerdo, e a altura média foi 5,7mm no lado direito e 6,1mm no lado esquerdo. Na maioria dos lobos estudados, o tubérculo tinha altura mínima de 5mm (55,9%) sem diferença significativa entre o lobo direito e esquerdo da glândula tireoide. Durante a cirurgia, 100% dos TZ identificados estavam anteriores ao nervo laríngeo inferior, imediatamente abaixo da entrada do nervo na laringe. Conclusão: o TZ é bastante frequente e em dimensões suficientes para ser usado como referência anatômica na localização intraoperatória do nervo laríngeo inferior, próximo à sua entrada na laringe, junto com as demais referências anatômicas.

ABSTRACT Objective: to evaluate whether the lateral projection of the thyroid gland, called Zuckerkandl's tubercle (ZT), can assist the surgeon in identifying the inferior laryngeal nerve during conventional open thyroidectomy. Methods: we conducted a prospective study with 51 patients submitted to thyroidectomy, with a total of 100 resected thyroid lobes, and observed the presence or absence of ZT in sufficient dimensions to be identified without image magnification, its base and height, its location in the gland, and its anatomical relationship with the inferior laryngeal nerve. Results: ZT was present in 68 of the 100 thyroid lobes analyzed (68%). The mean base was 6.7mm on the right side and 7.1mm on the left side, and the average height was 5.7mm on the right side and 6.1mm on the left side. In most of the lobes studied, the tubercle had a minimum height of 5mm (55.9%), with no significant difference between the right and left lobes of the thyroid gland. During surgery, 100% of the identified ZTs were anterior to the inferior laryngeal nerve, just below the nerve entry in the larynx. Conclusion: the ZT is a quite frequent entity and large enough to serve as an intraoperative anatomical reference for the inferior laryngeal nerve, next to its entry in the larynx, along with other anatomical references.

Origin of superior thyroid artery: under the surgeon's knife / Origem da artéria tireoidea superior: sob o bisturi do cirurgião

The major arterial supply to the thyroid gland is from the superior and inferior thyroid arteries, arising from the external carotid artery and the thyrocervical trunk respectively. The external laryngeal nerve runs in close proximity to the origin of the superior thyroid artery in relation to the thyroid gland. The superior thyroid artery is clinically important in head and neck surgeries. Objectives: To locate the origin of the superior thyroid artery, because wide variability is reported. To provide knowledge of possible variations in its origin, because it is important for surgical procedures in the neck. Methods: The origin of the superior thyroid artery was studied by dissecting sixty adult human hemineck specimens from donated cadavers in a Department of Anatomy. Results: The highest incidence observed was origin of the superior thyroid artery from the external carotid artery (88.33%), whereas origin from the common carotid bifurcation only occurred in 8.33%. However, in 3.33% of cases, the superior thyroid artery originated from the common carotid artery and in a single case, the external laryngeal nerve did not cross the stem of the superior thyroid artery at all, but ran ventral and parallel to the artery. Conclusions: It is important to rule out anomalous origin of superior thyroid artery and verify its relationship to the external laryngeal nerve prior to ligation of the artery in thyroid surgeries, in order to prevent iatrogenic injuries. Moreover, because anomalous origins of the superior thyroid artery are only anatomic variants, thorough knowledge of these is decisive for head and neck surgeries

O suprimento arterial principal para a glândula tireoide provém das artérias tireoideas superior e inferior, que têm origem na artéria carótida externa e no tronco tireocervical, respectivamente. O nervo laríngeo externo faz um percurso bem próximo à origem da artéria tireoidea superior em relação à glândula tireoide. A artéria tireoidea superior é clinicamente importante em cirurgias da cabeça e do pescoço. Objetivos: Localizar a origem da artéria tireoidea superior, considerando a ampla variabilidade descrita na literatura; e oferecer informações sobre possíveis variações em sua origem, devido à importância disso para procedimentos cirúrgicos realizados no pescoço. Métodos: A origem da artéria tireoidea superior foi estudada dissecando-se 60 espécimes de hemipescoço adulto de cadáveres humanos doados ao Departamento de Anatomia. Resultados: A maior incidência observada foi da artéria tireoidea superior com origem na artéria carótida externa (88,33%), enquanto a origem na bifurcação da artéria carótida comum ocorreu em apenas 8,33%. No entanto, em 3,33% dos casos, a artéria tireoidea superior teve origem na artéria carótida comum, e em um único caso, o nervo laríngeo externo não cruzou o tronco da artéria tireoidea superior em nenhum momento, embora tenha cursado ventral e paralelamente a essa artéria. Conclusões: É importante descartar origem anômala da artéria tireoidea superior e confirmar sua relação com o nervo laríngeo externo antes da ligadura da artéria em cirurgias da tireoide, para evitar efeitos iatrogênicos. Além disso, como origens anômalas da artéria tireoidea superior são apenas variantes anatômicas, o conhecimento detalhado dessas variações é decisivo para cirurgias da cabeça e do pescoço

Carcinoma papilar de tiroides variante Warthin-like / Warthin-like variant of thyroid papillary carcinoma

No disponible

Microcalcificaciones y focos ecogénicos puntiformes, ¿qué tan bien sabemos lo que estamos viendo? / Microcalcifications and punctate echogenic foci, how well do we know what we are seeing?

Resumen: La presencia de microcalcificaciones en nódulos tiroideos es un signo muy específico de malignidad, al corresponder a cuerpos de Psammoma. No existen suficientes estudios que demuestren una correlación entre su presencia histológica y su aspecto ecográfico real. Materiales y Métodos: Se seleccionaron todos los nódulos con tamaño mayor a 3 cm puncionados en el Hospital Clínico Universidad Católica entre los años 2010-2015 y se clasificó el aspecto ecográfico según la presencia de 3 tipos de focos ecogénicos con una definición más estricta a lo usual. Se correlacionó lo anterior con hallazgos en biopsias. Resultados: 44 nódulos correspondieron a cáncer papilar de tiroides. Hubo relación estadísticamente significativa entre una nueva definición ecográfica de las microcalcificaciones (focos ecogénicos puntiformes) y la presencia histológica de cuerpos de psamomma. Discusión: Habría una buena correlación entre una definición más estricta y la presencia real de microcalcificaciones en histología, mejorando la alta tasa de sobrediagnóstico advertido recientemente por algunos autores.

Abstract: The presence of microcalcifications in thyroid nodules is a very specific sign of malignancy, as it corresponds to Psammoma bodies. There are not enough studies that demonstrate a correlation between their histological presence and their actual ultrasound appearance. Materials and Methods: All nodules larger than 3 cm punctured at the Universidad Católica Clinical Hospital between 2010-2015 were selected, and the sonographic appearance was classified according to the presence of 3 types of echogenic foci according to a stricter definition than usual. The above was correlated with findings in biopsies. Results: 44 nodules corresponded to papillary thyroid cancer. There was a statistically significant relationship between a new ultrasound definition of the microcalcifications (punctate echogenic foci) and the histological presence of psamomma bodies. Discussion: There would be a good correlation between a stricter definition and the actual presence of microcalcifications in histology, improving the high rate of over diagnosis recently noticed by some authors.

Which method is gold standard for determination of thyroid volume? / ¿Cual es el método gold standard para determinar el volumen de la glándula tiroides?

Change of the thyroid gland volume is often the symptom of most common pathological conditions some thyroid diseases. The exact calculation for the thyroid volume is very important for the assessment and management of thyroid disorders. The volume of thyroid gland, using computed tomography (CT), ultrasound (USG) and magnetic resonance imaging (MRI) has been accessed in few studies published; however a gold standard method has not yet been determined. The purpose of this study was to estimate the volume of normal thyroid gland to define an optimal correction factor therefore was to compare different techniques using the CT. We used computed tomography images obtained from 8 cadavers (2 females, 6 males) to calculate the thyroid volumes. In the present study, the actual thyroid volumes were measured using the water-displacement method as a gold standard, point-counting as a stereology, and ellipsoid methods. Mean squared errors and correction factors were calculated and modeled for each model to find an optimal correction factor and from 0.450 to 0.600 in steps of 0.001 separately for thyroid volume estimation. The average volume of the thyroid glands were 14.58 ± 9.84, 15.28 ± 9.38, and 14.97 ± 8.35 cm3 by fluid displacement, stereology and ellipsoid formula, respectively. No significant difference was found among the methods (P >0.05). The results of this study suggested that the volume of thyroid gland can be measured on CT scans stereologically for diagnosis, as will as provide reliable measure of thyroid volume, management and follow-up of thyroid diseases and for preoperative planning.

El cambio de volumen de la glándula tiroides es a menudo el síntoma de las condiciones patológicas más comunes de algunas enfermedades de dicha glándula. El cálculo exacto del volumen tiroideo es muy importante para la evaluación y el tratamiento de los trastornos tiroideos. El volumen de la glándula tiroides, utilizando la tomografía computarizada (TC), el ultrasonido (USG) y la resonancia magnética (RM) ha sido presentados en varias publicaciones. Sin embargo, aún no se ha determinado un gold standard. El propósito de este estudio fue estimar el volumen de la glándula tiroides normal para definir un factor de corrección óptimo, por lo que se compararon diferentes técnicas utilizando TC. Para calcular los volúmenes tiroideos se utilizaron imágenes de tomografía computarizada obtenidas de 8 cadáveres (dos mujeres y seis hombres). En el presente estudio, los volúmenes reales de la glándula tiroides se midieron utilizando como gold standard los métodos esterológicos de desplazamiento de agua y conteo de puntos y el método volumétrico elipsoide. Se calcularon y modelaron los errores cuadráticos medios y los factores de corrección para cada modelo con el objetivo de encontrar un factor de corrección óptimo y de 0,450 a 0,600 en pasos de 0,001 por separado para la estimación del volumen tiroideo. El volumen medio de las glándulas tiroides fue de 14,58 ± 9,84, 15,28 ± 9,38 y 14,97 ± 8,35 cm3 calculados por desplazamiento de fluido, estereología y fórmula elipsoide, respectivamente. No se encontró diferencia significativa entre los métodos (P>0,05). Los resultados de este estudio sugieren que el volumen de la glándula tiroides puede ser medido estereológicamente por TC, estableciéndose como una medida fiable del volumen tiroideo, para el diagnóstico, manejo y seguimiento de las enfermedades tiroideas y la planificación preoperatoria.

Ultrasonographic assessment of thyroid volume in oldest-old individuals

ABSTRACT Objective The aim of this study was to describe the relationship between thyroid volume and age, gender, anthropometric characteristics, and echogenicity in oldest-old subjects in an iodine-sufficient area. Subjects and methods The study included 81 independent elderly individuals aged ≥ 80 years (65 [80.2%] women). We determined these individuals' anthropometric characteristics, body mass index (BMI), and lean body mass, as well as thyroid volume and echogenicity by ultrasonography. Results We observed that octogenarians and nonagenarians had different profiles of thyroid echogenicity. The volume of the thyroid was smaller in nonagenarians than octogenarians (p = 0.012, r = 0.176), and subjects aged 80-89 years had more often hypoechoic glands than those aged ≥ 90 years (p = 0.01 versus 0.602). Conclusion The identification of ultrasonographic differences in oldest-old individuals will contribute to establishing preclinical markers, such as echogenicity, to identify individuals at risk of developing autoimmune thyroid disease. Future prospective studies should identify if 80-89-year-old individuals with hypoechoic glands progress to hypothyroidism, and if the absence of changes in echogenicity (i.e. a normal thyroid parenchyma) would have a positive impact on longevity among nonagenarians.

Morphology and relationships of ultimobranchial body with pharyngeal pouches

The ultimobranchial body in humans is still controversial and different theories have been put forward. The aim of this study was to clarify the topographical anatomy of the ultimobranchial body and surrounding tissue during early development. Human embryos at 5-7 weeks of development were used for morphological observation. During the early stages, the sections displayed a ladder-like arrangement of the second to fourth endodermal pouches. The fourth pouch was located in front of the nodosa ganglion. The bilateral fifth pharyngeal pouches protruded anterolaterally to form a Ushaped lumen surrounding the arytenoid swelling. During the middle stages, the third pharyngeal pouch was identified near the fourth pharyngeal artery and the fourth pharyngeal pouch was located anterior to the parathyroid gland IV. We identified a cyst-like structure that is composed of a cell cluster facing to a small lumen as the ultimobranchial body. During the late stages, the lateral thyroid arising from the fourth pharyngeal pouch was located medial to the common carotid artery and joined to dorsal surface of the thyroid gland anlage. The thymus anlage arising from the third pharyngeal pouch was an independent structure that was located lateral to the common carotid artery. However, the ultimobranchial body had disappeared and did not integrate in the thyroid gland. We concluded that (1) the thymus originates from the third pharyngeal pouch; (2) the lateral thyroid originates from the fourth pharyngeal pouch; (3) the ultimobranchial body originates from the fifth pharyngeal pouch

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Hypoparathyroidism following thyroidectomy: predictive factors / Hipoparatiroidismo tras tiroidectomía: factores predictivos

Objective. To evaluate the incidence and predictive factors for transient and permanent hypocalcemia and hypoparathyroidism following thyroidectomy. Method. We studied all the 162 patients that underwent thyroid surgery in the ENT department of the Centro Hospitalar Vila Nova Gaia/Espinho from January 2005 to December 2014. We reviewed pre-operative, 6h and 12h after surgery ionized calcium and PTH levels. All patients were reviewed and evaluated according to the following criteria: gender, age, thyroid function, histologic diagnosis of the specimen, surgery extension and presence or absence of hypoparathyroidism. Results. There were 31 (19.1%) cases of transient hypoparathyroidism and 8 (5%) of permanent hypoparathyroidism. No significant difference was found for transient hypoparathyroidism when patients were analyzed by gender. However, all cases of permanent hypoparathyroidism were observed in female individuals. Comparing hemithyroidectomy with all other surgical procedures, we found that extension of surgery was a great predictor of transient (p=0.0001) and permanent (p=0.001) hypoparathyroidism. Diagnosis of malignancy was a strong predictor of transient hypoparathyroidism (p=0.002). It was also associated with permanent hypoparathyroidism, although differences did not reach statistical significance (p=0.096). Conclusion. Extension of surgery (total thyroidectomy) and diagnosis of malignancy are predictors of transient and permanent hypoparathyroidism (AU)

Objetivo. Evaluar la incidencia y los factores predictivos de hipocalcemia transitoria y permanente e hipoparatiroidismo tras la tiroidectomía. Método. Se estudiaron todos los pacientes sometidos a cirugía de tiroides en el Servicio de ORL del Centro Hospitalario de Vila Nova de Gaia/Espinho desde enero de 2005 a diciembre de 2014. Se revisaron los valores de calcio ionizado preoperatorio, a las 6 y a las 12h de la intervención, y los niveles de PTH. Se revisaron y evaluaron todos los archivos de acuerdo con los siguientes criterios: sexo, edad, función tiroidea, diagnóstico histológico de la muestra, extensión de la cirugía y presencia o ausencia de hipoparatiroidismo. Resultados. Encontramos 31 (19,1%) casos de hipoparatiroidismo transitorio y 8 (5%) de hipoparatiroidismo permanente. No se encontraron diferencias significativas en cuanto a hipoparatiroidismo transitorio cuando los pacientes fueron analizados por sexo. Sin embargo, todos los casos de hipoparatiroidismo permanente se observaron en individuos de sexo femenino. Comparando la hemitiroidectomía con el resto de los procedimientos quirúrgicos, se encontró que la extensión de la cirugía fue un gran factor predictivo de hipoparatiroidismo transitorio (p=0,0001) y permanente (p=0,001). El diagnóstico de malignidad es un fuerte factor predictivo de hipoparatiroidismo transitorio (p=0,002). También de hipoparatiroidismo permanente, aunque las diferencias no alcanzaron la significación estadística (p=0,096). Conclusión. La extensión de la cirugía y el diagnóstico de malignidad son factores predictivos de hipoparatiroidismo transitorio y permanente (AU)

Genetic and environmental influence on thyroid gland volume and thickness of thyroid isthmus: a twin study

Objectives Decreased thyroid volume has been related to increased prevalence of thyroid cancer. Subjects and methods One hundred and fourteen Hungarian adult twin pairs (69 monozygotic, 45 dizygotic) with or without known thyroid disorders underwent thyroid ultrasound. Thickness of the thyroid isthmus was measured at the thickest portion of the gland in the midline using electronic calipers at the time of scanning. Volume of the thyroid lobe was computed according to the following formula: thyroid height*width*depth*correction factor (0.63). Results Age-, sex-, body mass index- and smoking-adjusted heritability of the thickness of thyroid isthmus was 50% (95% confidence interval [CI], 35 to 66%). Neither left nor right thyroid volume showed additive genetic effects, but shared environments were 68% (95% CI, 48 to 80%) and 79% (95% CI, 72 to 87%), respectively. Magnitudes of monozygotic and dizygotic co-twin correlations were not substantially impacted by the correction of covariates of body mass index and smoking. Unshared environmental effects showed a moderate influence on dependent parameters (24-50%). Conclusions Our analysis support that familial factors are important for thyroid measures in a general twin population. A larger sample size is needed to show whether this is because of common environmental (e.g. intrauterine effects, regional nutrition habits, iodine supply) or genetic effects.

Classical Hodgkin's lymphoma of the thyroid / Linfoma de Hodgkin clásico del tiroides

Hodgkin's lymphoma is characterized by the presence of Reed–Sternberg cells. The majority of cases originate at nodal sites and only rarely does it occur in extranodal locations. Here we report a case of a woman with a classical Hodgkin's lymphoma of the thyroid developed from a Hashimoto thyroiditis. She presented with a mass in her thyroid which was surgically removed. Biopsy showed a nodular sclerosis classical Hodgkin's lymphoma. Our results were similar to previously reported cases. It would appear that the lesions grew over a MALT tissue created by the lymphoid proliferation of the thyroiditis. Differential diagnosis was made between the different types of lymphomas considering those most commonly occurring in extranodal lymphoid tissues. A final diagnosis was reached after consideration of the histopathology, immunophenotyping and molecular biology (AU)

El linfoma de Hodgkin se caracteriza por la presencia de células de Reed–Sternberg. La mayor parte de los casos se originan en ganglios linfáticos y raramente en localizaciones extranodales. Comunicamos un caso de una paciente con un linfoma de Hodgkin clásico desarrollado sobre una tiroiditis de Hashimoto. Se presentó como una masa tiroidea que fue extirpada. Histológicamente mostró un linfoma de Hodgkin clásico de tipo esclerosis nodular. Nuestros resultados concuerdan con casos publicados anteriormente. La lesión posiblemente se originó sobre un tejido MALT creado por la proliferación linfoide relacionada con la tiroiditis. Realizamos diagnósticos diferenciales entre diferentes tipos de linfoma que tienen lugar en tejido linfoide extranodal. El diagnóstico final fue realizado tras considerar su histopatología, inmunofenotipo y genética molecular (AU)

Valor actual de la ecografía en la caracterización de los nódulos tiroideos. Revisión de las últimas guías clínicas de actuación / Review of the current value of ultrasonography in the characterization of thyroid nodules

Debido al uso generalizado de la imagen médica para estudiar las enfermedades del cuello, la prevalencia de los nódulos tiroideos ha alcanzado el 67%. Esto es un problema sociosanitario relevante porque, después de evaluar las características del nódulo, hay que decidir cuándo hacer una aspiración con aguja fina ecoguiada para determinar cuáles son malignos. En este trabajo, revisamos la técnica ecográfica y la de la punción, las diferentes guías de actuación para caracterizar los nódulos tiroideos y los criterios que ayudan a determinar qué pacientes necesitan la punción diagnóstica y evitar procedimientos invasivos innecesarios. Colaborar estrechamente con los diferentes especialistas implicados en el manejo del nódulo tiroideo permite optimizar los recursos y obtener más rendimiento diagnóstico (AU)

The widespread use of medical imaging to study diseases of the neck reveals the prevalence of thyroid nodules can be as high as 67%. This is an important problem for the healthcare system because after analyzing the characteristics of the nodules a decision must be made regarding whether to perform fine-needle aspiration cytology to determine whether the lesion is malignant. In this article, we review the techniques for ultrasonographic study and fine-needle aspiration. We discuss the different guidelines for characterizing thyroid nodules and the criteria that help determine which patients need fine-needle aspiration for diagnosis and when an invasive procedure is unnecessary and can be avoided. Close collaboration with the different specialists involved in the management of thyroid nodules helps optimize resources and diagnostic performance (AU)