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Inicio Endocrinología y Nutrición ¿Son uniformes los criterios en el tratamiento del nódulo tiroideo?
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Vol. 49. Núm. 3.
Páginas 79-83 (marzo 2002)
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Vol. 49. Núm. 3.
Páginas 79-83 (marzo 2002)
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¿Son uniformes los criterios en el tratamiento del nódulo tiroideo?
Are the criteria in the management of thyroid nodule uniform?
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A. López-Guzmán**
Autor para correspondencia
alopez@hnss.insalud.es

Correspondencia: Dr. A. López-Guzmán. Canteros, 10–4. 05005 Ávila.
Unidad de Endocrinología. Hospital Nuestra Señora de Sonsoles. Ávila.
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Resumen
Bibliografía
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Estadísticas
Introducción

Las estrategias diagnósticas y terapéuticas en el nódulo tiroideo solitario son con frecuencia motivo de discusión. El objetivo del presente estudio fue analizar las estrategias en el tratamiento del nódulo tiroideo solitario normofuncionante en nuestro medio.

Material y métodos

El Cuestionario de Diagnóstico y Tratamiento del nódulo tiroideo fue enviado a todos los especialistas en endocrinología de Castilla y León. Este cuestionario incluía un caso índice (mujer de 40 años con un nódulo tiroideo solitario de 3,5 cm con normofunción tiroidea y sin sospecha de malignidad) con dos posibilidades de evolución. Cada endocrinólogo debía contestar a las diferentes preguntas del cuestionario y enviar sus respuestas por correo.

Resultados

En el estudio del caso índice, las determinaciones bioquímicas seleccionadas fueron anticuerpos antitiroideos (63,0%), calcitonina (29,6%), tiroglobulina (11,1%), estudio de coagulación (11,1%), prueba de embarazo (3,7%) y antígeno carcinoembrionario (3,7%). Todos los respondedores consideraron a la citología como una exploración necesaria en el estudio del nódulo. Un 70,4, un 14,8 y un 25,9% de los respondedores recomendaron la realización de ecografía, gammagrafía y radiografía de tórax, respectivamente. Cuando el resultado citológico fue de proliferación folicular, el 88,9% recomendó tratamiento quirúrgico y el 74,1% estudio intraoperatorio. Cuando el resultado citológico fue benigno, el 96,3% no recomendó tratamiento quirúrgico, el 51,9% recomendó tratamiento supresor con levotiroxina y el 59,3% repetiría el estudio citológico.

Conclusiones

Estos resultados demuestran que en nuestro medio existe uniformidad en los aspectos básicos del abordaje diagnóstico y terapéutico del nódulo tiroideo, aunque existen diferencias en otros aspectos entre los que cabe señalar las determinaciones bioquímicas y exploraciones necesarias para el estudio inicial, en la utilidad del estudio intraoperatorio de los nódulos con citología de proliferación folicular, en la utilidad del tratamiento supresor con levotiroxina y en el beneficio de repetir el estudio citológico.

Palabras clave:
Nódulo tiroideo
Diagnóstico
Tratamiento
Introduction

The diagnostic and therapeutic strategies for the solitary thyroid nodule are still a matter of debate. The aim of the present study was to analyse strategies for management of the nontoxic solitary thyroid nodule in our environment.

Material y methods

The questionnaire of Diagnosis and Treatment of the Thyroid Nodule was mailed to all clinical endocrinologists of Castilla and Leon. This questionnaire included a index case (a 40-year old woman with a solitary 3,5 cm thyroid nodule with normal thyroid function and without clinical suspicion of malignancy) with two possibilities of evolution. Each endocrinologist should answer to the different questions of the questionnaire and send their responses by mail.

Results

In the study of the index case, the biochemical determinations selected were thyroid autoantibodies (63.0%), calcitonin (29.6%), thyroglobulin (11.1%), coagulation study (11.1%), pregnancy test (3.7%) and carcinoembryonic antigen (3.7%). Cytology was considered as a necessary exploration by all respondents. Ultrasonography, scintigraphy and chest-ray were recommended by 70.4%, 14.8% and 25.9% of the respondents, respectively. When the cytology was of the follicular neoplasm, surgery treatment was recommended by the 88.9% and intraoperative examination was recommended by the 74.1%. When the cytology was benign, a nonsurgical strategy was the option of the 96.3%, the 51.9% would recommend levothyroxine suppresive therapy and the 59.3% will repeat the cytology study.

Conclusions

These results show that there is uniformity in our environment in the basic aspects of the diagnosis and treatment of the solitary thyroid nodule but there is differences in others aspects such as the biochemical determinations and the explorations necessaries in the initial study, in the usefulness of intraoperative histological study in the nodules with cytological result of the follicular neoplasm, in the usefulness of the levothyroxine suppresive therapy and in the benefit of the repetition of the cytology study.

Key words:
Thyroid nodule
Diagnosis
Treatment
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