scholarly journals Recombinant human TSH versus thyroid hormone withdrawal in adjuvant therapy with radioactive iodine of patients with papillary thyroid carcinoma and clinically apparent lymph node metastases not limited to the central compartment (cN1b)

2017 ◽  
Vol 61 (2) ◽  
pp. 167-172 ◽  
Author(s):  
Pedro Weslley Rosario ◽  
Gabriela Franco Mourão ◽  
Maria Regina Calsolari
2017 ◽  
Vol 2 (4) ◽  
pp. 5-10
Author(s):  
Alvaro Sanabria ◽  
Alejandro Román González

El carcinoma papilar de tiroides es un tumor frecuente en mujeres y el número de casos nuevos viene en crecimiento. La mayoría de estos casos de novo son tumores menores de 2 centímetros. Parte de la responsabilidad de este aumento es explicable por un uso mayor de ayudas diagnósticas. Esto ha permitido detectar el cáncer de tiroides temprano o clínicamente silente. En esta población, el manejo ha sido típicamente agresivo, incluyendo cirugías extensas (tiroidectomía total) seguidas por terapia con yodo radiactivo y supresión de TSH. Las próximas guías plantearán cuatro grandes modificaciones: 1. Estadificación dinámica del riesgo (respuesta completa, respuesta bioquímica incompleta, respuesta estructural incompleta e indeterminada) 2. Disminución de las indicaciones y de la dosis de ablación con yodo radiactivo, específicamente el uso de esta terapia debe estar ajustado al riesgo basal de recurrencia (bajo, intermedio, alto) del paciente y debe tenerse en cuenta el número de ganglios linfáticos afectados, el tamaño de las metástasis ganglionares, la histología y el tamaño del tumor. Una dosis de 30 mCi de 131yodo es igual de eficaz para negativizar la tiroglobulina que una dosis de 100 mCi. 3. Extensión de la cirugía (cirugía parcial en tumores menores de 4 cm con histología favorable) y 4. Terapia de supresión con levotiroxina con metas más laxas de TSH, dado el riesgo de osteoporosis y arritmias con una supresión exagerada de TSH, especialmente en la población de edad avanzada.Abstract Papillary thyroid carcinoma is a frequent cancer in women. An increase in the number of new cases has been detected in the last years. However, tumors smaller than 2 cms represent the largest sample in those new detected cancers. The cause of this increment is partially responsibility of an increased use of diagnostic aids such as ultrasound, even in asymptomatic patients. The management of these clinically silent tumors has been quite aggressive with extensive surgery (total thyroidectomy) followed by radioactive iodine therapy and TSH suppression. The next papillary thyroid carcinoma guidelines will address 4 important modifications: 1. Dynamic approach to risk stratification (Complete response, incomplete biochemical response, incomplete structural response and indeterminate response) 2. Decrease in the indication and dose of radioactive iodine. The use of this therapy must be adjusted to the basal risk of recurrence with consideration of the number of lymph node metastases, the size of the lymph node metastases, the histopathologic variant and the size of the primary tumor. A dose of 30mCi of 131I is as effective as a dose of 100 mCi for thyroid ablation. 3. Extension of the thyroidectomy (partial surgery in tumors smaller than 4 cms without unfavorable histopathology and 4. Higher TSH goal with levothyroxine suppression therapy. A strict TSH suppression has been associated with increased risk of osteoporosis and cardiac arrhythmias, especially in older population.


2010 ◽  
Vol 2 (1) ◽  
pp. 1-7 ◽  
Author(s):  
Gerard M Doherty ◽  
Travis J McKenzie ◽  
Joseph B Lillegard ◽  
Clive S Grant ◽  
Ian D Hay ◽  
...  

ABSTRACT The need for prophylactic central compartment lymph node dissection in patients with papillary thyroid carcinoma continues to be a subject of ongoing debate. Regional lymph node metastases are a common finding with papillary thyroid carcinoma, with an incidence as high as 50% or more. With the widespread use of high resolution ultrasound and sensitive thyroglobulin assays, lymph node metastases, not appreciated at the time of surgery, are showing up in the follow-up period, creating significant angst amongst patients, endocrinologists, and their surgeons. It was previously thought that lymph node metastases in papillary thyroid carcinoma had little bearing on survival, but this has more recently been challenged. Opponents of prophylactic central compartment node dissection cite high perioperative morbidity as a word of caution in performing prophylactic central neck dissections. The following review will look at the most up-to-date literature and best evidence for arriving at logical and sensible recommendations. This review will also look at specific definitions of what is a central compartment lymph node dissection. In the hands of experienced thyroid surgeons, prophylactic central compartment lymph node dissection, performed in a meticulous manner, can limit persistent or recurrent disease in the central compartment, and can diminish the need for routine administration of radioactive iodine, with acceptable perioperative morbidit


2020 ◽  
Author(s):  
Vanessa Guerreiro ◽  
Cláudia Costa ◽  
Joana Oliveira ◽  
Ana Paula Santos ◽  
Mónica Farinha ◽  
...  

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