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3.
Acta otorrinolaringol. esp ; 70(5): 301-305, sept.-oct. 2019. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-186374

RESUMO

El hipoparatiroidismo es la complicación más frecuente tras la tiroidectomía total. Se define por la presencia de hipocalcemia con unos niveles de hormona paratiroidea (PTH) bajos o inadecuadamente normales. La hipocalcemia aguda es una complicación potencialmente grave. Su tratamiento se basa, según la gravedad del cuadro, en la administración de calcio por vía oral o intravenosa, pudiendo requerir asimismo calcitriol oral. El riesgo de hipocalcemia sintomática tras una tiroidectomía es muy bajo si la PTH postoperatoria desciende menos del 80% respecto de la preoperatoria. Estos pacientes podrían ser dados de alta sin tratamiento, aunque los umbrales son variables entre laboratorios y recomendamos extremar la vigilancia en los casos de riesgo aumentado (enfermedad de Graves, grandes bocios, reintervenciones o constancia de la extirpación de alguna paratiroides). El tratamiento a largo plazo busca controlar los síntomas manteniendo la calcemia en el límite bajo de la normalidad, vigilando el producto calcio-fósforo y la aparición de hipercalciuria


Hypoparathyroidism is the most common complication after total or completion thyroidectomy. It is defined as the presence of hypocalcemia accompanied by low or inappropriately normal parathyroid hormone (PTH) levels. Acute hypocalcemia is a potential lethal complication. Hypocalcemia treatment is based on endovenous or oral calcium supplements as well as oral calcitriol, depending on the severity of the symptoms. The risk of clinical hypocalcemia after bilateral thyroidectomy is considered very low if postoperative intact PTH decrease less than 80% with respect to preoperative levels. These patients could be discharged home without treatment, although this threshold may vary between institutions, and we recommend close surveillance in cases with increased risk (Graves disease, large goiters, reinterventions or evidence of parathyroid gland removal). Long-term treatment objectives are to control the symptoms and to keep serum calcium levels at the lower limit of the normal range, while preserving the calcium phosphate product and avoiding hypercalciuria


Assuntos
Humanos , Hipoparatireoidismo/etiologia , Tireoidectomia/efeitos adversos , Calcitriol/uso terapêutico , Cálcio/sangue , Cálcio/uso terapêutico , Doença de Graves/cirurgia , Hipercalciúria/prevenção & controle , Hipercalciúria/terapia , Hiperfosfatemia/tratamento farmacológico , Hiperfosfatemia/etiologia , Hipocalcemia/etiologia , Hipoparatireoidismo/tratamento farmacológico , Hipoparatireoidismo/prevenção & controle , Cuidados Intraoperatórios , Glândulas Paratireoides/cirurgia , Glândulas Paratireoides/transplante , Hormônio Paratireóideo/sangue , Cuidados Pós-Operatórios , Reimplante
4.
Endocrinol. diabetes nutr. (Ed. impr.) ; 66(7): 459-463, ago.-sept. 2019. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-182865

RESUMO

El hipoparatiroidismo es la complicación más frecuente tras la tiroidectomía total. Se define por la presencia de hipocalcemia con unos niveles de hormona paratiroidea (PTH) bajos o inadecuadamente normales. La hipocalcemia aguda es una complicación potencialmente grave. Su tratamiento se basa, según la gravedad del cuadro, en la administración de calcio por vía oral o intravenosa, pudiendo requerir asimismo calcitriol oral. El riesgo de hipocalcemia sintomática tras una tiroidectomía es muy bajo si la PTH postoperatoria desciende menos del 80% respecto de la preoperatoria. Estos pacientes podrían ser dados de alta sin tratamiento, aunque los umbrales son variables entre laboratorios y recomendamos extremar la vigilancia en los casos de riesgo aumentado (enfermedad de Graves, grandes bocios, reintervenciones o constancia de la extirpación de alguna paratiroides). El tratamiento a largo plazo busca controlar los síntomas manteniendo la calcemia en el límite bajo de la normalidad, vigilando el producto calcio-fósforo y la aparición de hipercalciuria


Hypoparathyroidism is the most common complication after total or completion thyroidectomy. It is defined as the presence of hypocalcemia accompanied by low or inappropriately normal parathyroid hormone (PTH) levels. Acute hypocalcemia is a potential lethal complication. Hypocalcemia treatment is based on endovenous or oral calcium supplements as well as oral calcitriol, depending on the severity of the symptoms. The risk of clinical hypocalcemia after bilateral thyroidectomy is considered very low if postoperative intact PTH decrease less than 80% with respect to preoperative levels. These patients could be discharged home without treatment, although this threshold may vary between institutions, and we recommend close surveillance in cases with increased risk (Graves disease, large goiters, reinterventions or evidence of parathyroid gland removal). Long-term treatment objectives are to control the symptoms and to keep serum calcium levels at the lower limit of the normal range, while preserving the calcium phosphate product and avoiding hypercalciuria


Assuntos
Humanos , Consenso , Hipoparatireoidismo/complicações , Hipoparatireoidismo/epidemiologia , Tireoidectomia/métodos , Tireoidectomia/efeitos adversos , Cálcio/administração & dosagem , Cuidados Pré-Operatórios/métodos , Liberação de Cirurgia/normas
5.
Acta Otorrinolaringol Esp ; 70(5): 301-305, 2019.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-31387688

RESUMO

Hypoparathyroidism is the most common complication after total or completion thyroidectomy. It is defined as the presence of hypocalcemia accompanied by low or inappropriately normal parathyroid hormone (PTH) levels. Acute hypocalcemia is a potential lethal complication. Hypocalcemia treatment is based on endovenous or oral calcium supplements as well as oral calcitriol, depending on the severity of the symptoms. The risk of clinical hypocalcemia after bilateral thyroidectomy is considered very low if postoperative intact PTH decrease less than 80% with respect to preoperative levels. These patients could be discharged home without treatment, although this threshold may vary between institutions, and we recommend close surveillance in cases with increased risk (Graves disease, large goiters, reinterventions or evidence of parathyroid gland removal). Long-term treatment objectives are to control the symptoms and to keep serum calcium levels at the lower limit of the normal range, while preserving the calcium phosphate product and avoiding hypercalciuria.


Assuntos
Hipoparatireoidismo/etiologia , Tireoidectomia/efeitos adversos , Calcitriol/uso terapêutico , Cálcio/sangue , Cálcio/uso terapêutico , Doença de Graves/cirurgia , Humanos , Hipercalciúria/prevenção & controle , Hipercalciúria/terapia , Hiperfosfatemia/tratamento farmacológico , Hiperfosfatemia/etiologia , Hipocalcemia/etiologia , Hipoparatireoidismo/tratamento farmacológico , Hipoparatireoidismo/prevenção & controle , Cuidados Intraoperatórios , Glândulas Paratireoides/cirurgia , Glândulas Paratireoides/transplante , Hormônio Paratireóideo/sangue , Cuidados Pós-Operatórios , Reimplante
6.
Endocrine ; 66(2): 405-415, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31317524

RESUMO

PURPOSE: The prevalence of postoperative hypoparathyroidism has been studied in registries and in surgical series with highly variable and imprecise results. However, the frequency of this hormonal deficiency in the clinical practice of endocrinologists is not known with accuracy. We aimed to assess the prevalence and risk factors of hypoparathyroidism in patients undergoing total thyroidectomy in Spain. METHODS: We designed a retrospective, multicentre and nation-wide protocol including all patients with total thyroidectomy who were seen in the endocrinology clinic of the participant centers from January to March 2018. Prevalence of hypoparathyroidism was evaluated at discharge of surgery, 3-6 months after surgery, 12 months after surgery and at last visit. Twenty hospitals participated in the study. RESULTS: Of 1792 patients undergoing total thyroidectomy, 866 (48.3%) developed postoperative hypoparathyroidism at discharge of surgery. Most of them recover parathyroid function over time. Prevalence of hypoparathyroidism at 3-6 months, 12 months and at last visit was 22.9%, 16.7% and 14.5%, respectively. The risk of developing definitive hypoparathyroidism was related to the presence of parathyroid tissue at histology, lymph node dissection, and two-stage thyroidectomy. Patients with thyroid cancer, with higher postoperative calcium levels and treated by expert surgical teams exhibited lower risk of developing permanent hypoparathyroidism. CONCLUSIONS: Although most patients with postsurgical hypoparathyroidism recover parathyroid function, the prevalence of permanent disease in clinical practice is non negligible (14.5%). Postoperative calcium, extent and timing of surgery, the presence of cancer, expert surgical team, and parathyroid tissue at histology are predictors of permanent hypoparathyroidism.

7.
Endocrinol Diabetes Nutr ; 66(7): 459-463, 2019.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-31182347

RESUMO

Hypoparathyroidism is the most common complication after total or completion thyroidectomy. It is defined as the presence of hypocalcemia accompanied by low or inappropriately normal parathyroid hormone (PTH) levels. Acute hypocalcemia is a potential lethal complication. Hypocalcemia treatment is based on endovenous or oral calcium supplements as well as oral calcitriol, depending on the severity of the symptoms. The risk of clinical hypocalcemia after bilateral thyroidectomy is considered very low if postoperative intact PTH decrease less than 80% with respect to preoperative levels. These patients could be discharged home without treatment, although this threshold may vary between institutions, and we recommend close surveillance in cases with increased risk (Graves disease, large goiters, reinterventions or evidence of parathyroid gland removal). Long-term treatment objectives are to control the symptoms and to keep serum calcium levels at the lower limit of the normal range, while preserving the calcium phosphate product and avoiding hypercalciuria.

9.
Endocrinol. diabetes nutr. (Ed. impr.) ; 66(2): 74-82, feb. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-175798

RESUMO

Introducción: En nuestro país no se ha estudiado la opinión de los profesionales sobre los equipos multidisciplinares en cáncer de tiroides. El objetivo de este estudio ha sido conocer la opinión de los especialistas sobre las características de los profesionales y las ventajas que aportan estos estos equipos. Métodos: Se diseñó una encuesta para valorar la opinión sobre las características de profesionalidad y las ventajas de los equipos multidisciplinares para pacientes, profesionales y sistema sanitario. La encuesta se mantuvo activa online del 15 de noviembre de 2017 al 15 de febrero de 2018. Resultados: Se recibieron 226 encuestas. La capacidad para trabajar en equipo fue considerada la característica más importante que deben cumplir los profesionales por el 37,2% de los encuestados, mientras que la competencia científica fue el indicador de profesionalidad más importante para el 37,6%. Más de 2/3 de los especialistas opinan que los equipos multidisciplinares mejoran la elección de tratamientos y procedimientos diagnósticos, reducen la variabilidad clínica, facilitan la implementación de las guías clínicas, mejoran la formación continuada y aumentan la satisfacción de los pacientes, así como el prestigio del hospital. El grado de acuerdo con las ventajas de los EMD fue significativamente superior entre los especialistas que contaban con un EMD en su hospital. Conclusiones: Estos resultados muestran una opinión globalmente muy favorable de los profesionales hacia el modelo de trabajo multidisciplinar. Los responsables de los hospitales y las autoridades sanitarias deberían tener en cuenta estos hechos para favorecer y apoyar la implantación de estos equipos


Introduction: The opinion of professionals about multidisciplinary teams (MDT) in thyroid cancer has not been studied in Spain. This study was intended to ascertain the opinion of specialists about the characteristics of the professionals and the advantages provided by these teams. Methods: A survey was designed to assess the opinion about the characteristics of professionalism and the advantages of MDT for patients, professionals, and the health care system. The survey was posted online from November 15, 2017 to February 15, 2018. Results: A total of 226 surveys were evaluated. The ability for teamwork was considered the most important characteristic to be met by professionals by 37.2% of respondents, while scientific competence was the most important indicator of professionalism for 37.6%. More than two thirds of specialists felt that MDTs improve the choice of treatments and diagnostic procedures, decrease clinical variability, facilitate implementation of clinical guidelines, improve ongoing training, and increase patient satisfaction and hospital prestige. The degree of agreement with the advantages of MDTs was significantly higher among specialists who had a MDT at their hospitals. Conclusions: The overall opinion of professionals on the MDT model is highly favorable. Hospital managers and health care authorities should take these facts into account in order to encourage and support implementation of these teams


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Especialização , Profissionalismo , Equipe de Assistência ao Paciente , Neoplasias da Glândula Tireoide , Pessoal de Saúde , Pesquisas sobre Serviços de Saúde/métodos
10.
Endocrinol Diabetes Nutr ; 66(2): 74-82, 2019 Feb.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-30612901

RESUMO

INTRODUCTION: The opinion of professionals about multidisciplinary teams (MDT) in thyroid cancer has not been studied in Spain. This study was intended to ascertain the opinion of specialists about the characteristics of the professionals and the advantages provided by these teams. METHODS: A survey was designed to assess the opinion about the characteristics of professionalism and the advantages of MDT for patients, professionals, and the health care system. The survey was posted online from November 15, 2017 to February 15, 2018. RESULTS: A total of 226 surveys were evaluated. The ability for teamwork was considered the most important characteristic to be met by professionals by 37.2% of respondents, while scientific competence was the most important indicator of professionalism for 37.6%. More than two thirds of specialists felt that MDTs improve the choice of treatments and diagnostic procedures, decrease clinical variability, facilitate implementation of clinical guidelines, improve ongoing training, and increase patient satisfaction and hospital prestige. The degree of agreement with the advantages of MDTs was significantly higher among specialists who had a MDT at their hospitals. CONCLUSIONS: The overall opinion of professionals on the MDT model is highly favorable. Hospital managers and health care authorities should take these facts into account in order to encourage and support implementation of these teams.


Assuntos
Medicina , Equipe de Assistência ao Paciente , Profissionalismo , Neoplasias da Glândula Tireoide/terapia , Atitude do Pessoal de Saúde , Feminino , Pesquisas sobre Serviços de Saúde , Humanos , Comunicação Interdisciplinar , Masculino , Prática Profissional , Espanha , Especialização
11.
Endocrinol. nutr. (Ed. impr.) ; 63(3): e1-e15, mar. 2016. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-150558

RESUMO

El cáncer de tiroides supone la primera causa de neoplasias del sistema endocrino. Recientemente hemos asistido a grandes avances en el conocimiento de sus causas y de la biología molecular que los hace crecer y proliferar, así como al perfeccionamiento de las técnicas diagnósticas y a una mayor disponibilidad de tratamientos eficaces, locales y sistémicos. Todo ello convierte a este tumor en un paradigma de cómo diversas especialidades deben trabajar de manera conjunta para conseguir el mayor beneficio para el paciente. La coordinación de los procedimientos y flujos que el paciente debe seguir a lo largo de su diagnóstico, tratamiento y seguimiento es fundamental para una optimización de recursos y tiempos. El presente artículo se ha redactado, a propuesta del Grupo de Trabajo de Cáncer de Tiroides de la Sociedad Española de Endocrinología y Nutrición, con la intención de presentar un documento de consenso sobre definición, composición, requisitos, estructura y funcionamiento de un equipo multidisciplinar para la atención integral de pacientes con cáncer de tiroides. Para ello se ha contado con las aportaciones de varios profesionales de distintas especialidades con experiencia en el tratamiento del cáncer de tiroides en centros donde los equipos multidisciplinares llevan años implantados con la voluntad de elaborar un consenso práctico y aplicable a la práctica médica asistencial (AU)


Thyroid cancer is the leading endocrine system tumor. Great advances have recently been made in understanding of the origin of these tumors and the molecular biology that makes them grow and proliferate, which have been associated to improvements in diagnostic procedures and increased availability of effective local and systemic treatments. All of the above makes thyroid cancer a paradigm of how different specialties should work together to achieve the greatest benefit for the patients. Coordination of all the procedures and patient flows should continue throughout diagnosis, treatment, and follow-up, and is essential for further optimization of resources and time. This manuscript was prepared at the request of the Working Group on Thyroid Cancer of the Spanish Society of Endocrinology and Nutrition, and is aimed to provide a consensus document on the definition, composition, requirements, structure, and operation of a multidisciplinary team for the comprehensive care of patients with thyroid cancer. For this purpose, we have included contributions by several professionals from different specialties with experience in thyroid cancer treatment at centers where multidisciplinary teams have been working for years, with the aim of developing a practical consensus applicable in clinical practice (AU)


Assuntos
Humanos , Neoplasias da Glândula Tireoide , Equipe de Assistência ao Paciente/normas , /organização & administração , Unidades Hospitalares/normas , Acreditação de Instituições de Saúde
12.
Eur Radiol ; 26(1): 1-8, 2016 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-25956937

RESUMO

OBJECTIVES: To analyze the diagnostic accuracy of ultrasound-guided core-needle biopsy (CNB) of thyroid nodules. METHODS: Of 3517 CNBs performed using an 18G spring-loaded device in one institution, we retrospectively reviewed 676 nodules in 629 consecutive patients who underwent surgery. CNB and pathological examination were compared. CNB diagnosis was standardized in four categories: insufficient (I), benign (B), follicular lesion (FOL), and malignant (M). Main outcome measures were predictive positive values (PPV), false positives (FP), and false negatives (FN). RESULTS: CNB showed a low rate of insufficient and FOL diagnoses (5.8 % and 4.5 %). On surgery, there were eight FNs in 374 benign CNBs and three FPs in 148 malignant CNBs. The 154 nodules classified as FOL in CNB included, at surgery, 122 neoplasms; 28 of them malignant. PPV for malignancy of a malignant CNB was 98 %, and for a CNB diagnosis of FOL 18.2 %. Sensitivity for malignancy if CNB of FOL and M are considered positive was 95.6. Only one major complication was observed. CONCLUSIONS: CNB is reliable, safe, and accurate to evaluate thyroid nodules and can be an alternative technique to FNA. It has low rate of non-diagnostic and undetermined cases, with high sensitivity and PPV. KEY POINTS: Thyroid core-needle biopsy (CNB) has high sensitivity and PPV. Pitfalls of CNB are rare. Pitfalls are due to cystic cancer, histological heterogeneity, and mistakes in analysis. CNB is a reliable, safe, and accurate method to approach thyroid nodules. CNB can be used primarily or after insufficient or indeterminate FNA.


Assuntos
Neoplasias da Glândula Tireoide/patologia , Nódulo da Glândula Tireoide/patologia , Biópsia por Agulha Fina/métodos , Biópsia com Agulha de Grande Calibre/métodos , Feminino , Humanos , Biópsia Guiada por Imagem , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Neoplasias da Glândula Tireoide/diagnóstico por imagem , Neoplasias da Glândula Tireoide/cirurgia , Nódulo da Glândula Tireoide/diagnóstico por imagem , Nódulo da Glândula Tireoide/cirurgia , Ultrassonografia de Intervenção/métodos
13.
Endocrinol Nutr ; 63(3): e1-15, 2016 Mar.
Artigo em Espanhol | MEDLINE | ID: mdl-26456892

RESUMO

Thyroid cancer is the leading endocrine system tumor. Great advances have recently been made in understanding of the origin of these tumors and the molecular biology that makes them grow and proliferate, which have been associated to improvements in diagnostic procedures and increased availability of effective local and systemic treatments. All of the above makes thyroid cancer a paradigm of how different specialties should work together to achieve the greatest benefit for the patients. Coordination of all the procedures and patient flows should continue throughout diagnosis, treatment, and follow-up, and is essential for further optimization of resources and time. This manuscript was prepared at the request of the Working Group on Thyroid Cancer of the Spanish Society of Endocrinology and Nutrition, and is aimed to provide a consensus document on the definition, composition, requirements, structure, and operation of a multidisciplinary team for the comprehensive care of patients with thyroid cancer. For this purpose, we have included contributions by several professionals from different specialties with experience in thyroid cancer treatment at centers where multidisciplinary teams have been working for years, with the aim of developing a practical consensus applicable in clinical practice.


Assuntos
Neoplasias da Glândula Tireoide/terapia , Acreditação , Consenso , Humanos
14.
Endocrinol. nutr. (Ed. impr.) ; 62(6): e57-e72, jun.-jul. 2015. tab
Artigo em Espanhol | IBECS | ID: ibc-140173

RESUMO

La incidencia de cáncer de tiroides está aumentando en España y en todo el mundo. La supervivencia global, no obstante, es muy alta y se han desarrollado sistemas de estratificación para identificar adecuadamente a los pacientes con peor pronóstico. Sin embargo, en la práctica clínica se observan grandes diferencias en el tratamiento del cáncer de tiroides de bajo riesgo entre los diferentes especialistas responsables de su atención. Casi la mitad de los carcinomas papilares son microcarcinomas y el 90% son tumores menores de 2 cm que tienen un excelente pronóstico. A pesar de ello, en general son tratados de forma más agresiva de lo deseable, sin justificación científica que lo respalde hoy en día. El tratamiento quirúrgico sigue siendo la piedra angular en el tratamiento de estos tumores. Sin embargo, en la mayoría de los casos la hemitiroidectomía puede ser suficiente, sin necesidad de realizar tiroidectomía total. Del mismo modo, generalmente no es necesaria la disección profiláctica de los ganglios del compartimento central. Esta actitud más conservadora evita complicaciones postoperatorias como el hipoparatiroidismo o la lesión al nervio laríngeo recurrente. El tratamiento ablativo posterior con yodo radiactivo seguido por una terapia de supresión estricta de tirotropina, aunque es eficaz para las formas más agresivas de cáncer de tiroides, no ha demostrado ser beneficioso en el tratamiento de estas lesiones y puede empeorar la calidad de vida de estos pacientes. Esta guía clínica proporciona recomendaciones del grupo de trabajo de cáncer de tiroides de la Sociedad Española de Endocrinología y Nutrición orientadas al enfoque y gestión razonable y apropiada de los pacientes con cáncer de tiroides de bajo riesgo (AU)


Incidence of thyroid cancer is increasing in Spain and worldwide. Overall thyroid cancer survival is very high, and stratification systems to reliably identify patients with worse prognosis have been developed. However, marked differences exist between the different specialists in clinical management of low-risk patients with thyroid carcinoma. Almost half of all papillary thyroid carcinomas are microcarcinomas, and 90% are tumors < 2 cm that have a particularly good prognosis. However, they are usually treated more aggressively than needed, despite the lack of adequate scientific support. Surgery remains the gold standard treatment for these tumors. However, lobectomy may be adequate in most patients, without the need for total thyroidectomy. Similarly, prophylactic lymph node dissection of the central compartment is not required in most cases. This more conservative approach prevents postoperative complications such as hypoparathyroidism or recurrent laryngeal nerve injury. Postoperative radioiodine remnant ablation and strict suppression of serum thyrotropin, although effective for the more aggressive forms of thyroid cancer, have not been shown to be beneficial for the treatment of low risk patients, and may impair their quality of life. This guideline provides recommendations from the task force on thyroid cancer of the Spanish Society of Endocrinology and Nutrition for adequate management of patients with low-risk thyroid cancer (AU)


Assuntos
Feminino , Humanos , Masculino , Neoplasias da Glândula Tireoide/epidemiologia , Neoplasias da Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide/terapia , Tireotropina/uso terapêutico , Células Oxífilas/patologia , Nódulo da Glândula Tireoide/diagnóstico , Nódulo da Glândula Tireoide/patologia
15.
Endocrinol Nutr ; 62(6): e57-72, 2015.
Artigo em Espanhol | MEDLINE | ID: mdl-25857691

RESUMO

Incidence of thyroid cancer is increasing in Spain and worldwide. Overall thyroid cancer survival is very high, and stratification systems to reliably identify patients with worse prognosis have been developed. However, marked differences exist between the different specialists in clinical management of low-risk patients with thyroid carcinoma. Almost half of all papillary thyroid carcinomas are microcarcinomas, and 90% are tumors < 2 cm that have a particularly good prognosis. However, they are usually treated more aggressively than needed, despite the lack of adequate scientific support. Surgery remains the gold standard treatment for these tumors. However, lobectomy may be adequate in most patients, without the need for total thyroidectomy. Similarly, prophylactic lymph node dissection of the central compartment is not required in most cases. This more conservative approach prevents postoperative complications such as hypoparathyroidism or recurrent laryngeal nerve injury. Postoperative radioiodine remnant ablation and strict suppression of serum thyrotropin, although effective for the more aggressive forms of thyroid cancer, have not been shown to be beneficial for the treatment of low risk patients, and may impair their quality of life. This guideline provides recommendations from the task force on thyroid cancer of the Spanish Society of Endocrinology and Nutrition for adequate management of patients with low-risk thyroid cancer.


Assuntos
Neoplasias da Glândula Tireoide/terapia , Humanos , Guias de Prática Clínica como Assunto , Medição de Risco , Neoplasias da Glândula Tireoide/patologia , Tireoidectomia/métodos , Tireoidectomia/normas
16.
Endocrinol Nutr ; 55(5): 202-16, 2008 May.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-22967914

RESUMO

Pheochromocytomas are catecholamine-secreting tumors that arise from chromaffin cells of the sympathetic nervous system. In 80-85% of cases, these tumors are located in the adrenal medulla while the remainder is located in extra-adrenal chromaffin tissues (paragangliomas). Pheochromocytomas account for 6.5% of incidentally discovered adrenal tumors. These tumors may be sporadic or the result of several genetic diseases: multiple endocrine neoplasia type 2, von Hippel-Lindau syndrome, neurofibromatosis type 1, and familial paraganglioma associated with mutations in succinate dehydrogenase subunits. Diagnosis of pheochromocytoma should first be established biochemically by measuring plasma free metanephrines and urinary fractionated metanephrines. The radiological imaging tests of choice are computed tomography (CT) or magnetic resonance imaging (MRI). The first-line specific functional imaging test is scintigraphy with (123)I-metaiodobenzylguanidine (MIBG); if this test is unavailable, scintigraphy with (131)I-MIBG is the second choice. Positron emission tomography (PET) with (18)F-F-fluorodopamine (F-DA) is useful in metastatic disease. The treatment of choice is laparoscopic surgery after adequate alpha adrenergic blockade. Approximately 10% of tumors are malignant. Chemotherapy is used for inoperable disease. Prognosis is good except in malignant disease, in which 5-year survival is less than 50%. The identification of the genes causing hereditary pheochromocytoma has led to changes in the recommendation for genetic testing.

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