covid
Buscar en
Endocrinología y Nutrición
Toda la web
Inicio Endocrinología y Nutrición ¿Son uniformes los criterios en el tratamiento del nódulo tiroideo?
Información de la revista
Vol. 49. Núm. 3.
Páginas 79-83 (marzo 2002)
Compartir
Compartir
Descargar PDF
Más opciones de artículo
Vol. 49. Núm. 3.
Páginas 79-83 (marzo 2002)
Acceso a texto completo
¿Son uniformes los criterios en el tratamiento del nódulo tiroideo?
Are the criteria in the management of thyroid nodule uniform?
Visitas
2103
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.
Este artículo ha recibido
Información del artículo
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
El Texto completo está disponible en PDF
Bibliografía
[1.]
E.L. Mazzaferri.
Management of a solitary thyroid nodule.
N Engl J Med, 328 (1993), pp. 553-559
[2.]
H. Gharib.
Changing concepts in the diagnosis and management of thyroid nodules.
Endocrinol Metab Clin North Am, 26 (1997), pp. 777-800
[3.]
A.R. Hermus, D.A. Huysmans.
Treatment of benign nodular thyroid disease.
N Engl J Med, 338 (1998), pp. 1438-1447
[4.]
L.A. Boyd, R.C. Earnhardt, J.T. Dunn, H.F. Frierson, J.B. Hanks.
Preoperative evaluation and predictive value of fine-needle aspiration and frozen section of thyroid nodules.
J Am Coll Surg, 187 (1998), pp. 494-502
[5.]
J.B. Vander, E.A. Gaston, T.R. Dawber.
The significance of non-toxic thyroid nodules. Final report of a 15-year study of the incidence of thyroid malignancy.
Ann Intern Med, 69 (1968), pp. 537-540
[6.]
K.A. Woeber.
Cost-effective evaluation of the patient with a thyroid nodule.
Surg Clin North Am, 75 (1995), pp. 357-363
[7.]
H. Gharib.
Fine-needle aspiration biopsy of the thyroid nodules: advantages, limitations, and effect.
Mayo Clin Proc, 69 (1994), pp. 44-49
[8.]
A. Carpi, A. Nicolini, A. Sagripanti.
Protocols for the preoperative selection of palpable thyroid nodules. Review and progress.
Am J Clin Oncol, 22 (1999), pp. 499-504
[9.]
A.R. Shaha.
Controversies in the management of thyroid nodule.
Laryngoscope, 110 (2000), pp. 183-193
[10.]
R. Mornex, L. Pazard, J. Massol.
Diagnostic strategy for a solitary thyroid nodule. Example of development of recommendations for a practice guideline.
Bull Acad Natl Med, 181 (1997), pp. 103-112
[11.]
S.J. Bonnema, F.N. Bennedbaek, W.M. Wiersinga, L. Hegedüs.
Management of the nontoxic multinodular goitre: a European questionnaire study.
Clin Endocrinol (Oxf), 53 (2000), pp. 5-12
[12.]
L. Wartofsky, D. Glinoer, B. Solomon, S. Nagataki, R. Lagasse, Y. Nagayama, et al.
Differences and similarities in the diagnosis and treatment of Graves' disease in Europe, Japan and the United States.
Thyroid, 1 (1991), pp. 129-135
[13.]
F.N. Bennedbaek, H.J. Perrild, L. Hegedüs.
Danske endokrinologers udredning og behandling af en solitaer knude i glandula thyroidea. En sporgeskemaundersogelse.
Ugeskr Laeger, 161 (1999), pp. 1264-1269
[14.]
F.N. Bennedbaek, H. Perrild, L. Hegedüs.
Diagnosis and treatment of the solitary thyroid nodule. Results of a European survey.
Clin Endocrinol (Oxf), 50 (1999), pp. 357-363
[15.]
F.N. Bennedbaek, L. Hegedus.
Management of the solitary thyroid nodule: results of a North American Survey.
J Clin Endocrinol Metab, 85 (2000), pp. 2493-2498
[16.]
P.A. Singer, D.S. Cooper, G.H. Daniels, P.W. Ladenson, F.S. Greenspan, E.G. Levy, et al.
Treatment guidelines for patients with thyroid nodules and well-differentiated thyroid cancer.
Arch Intern Med, 156 (1996), pp. 2165-2172
[17.]
J.R. Hahm, M.S. Lee, Y.K. Min, M.K. Lee, K.W. Kin, S.J. Nam, et al.
Routine measurement of serum calcitonin is useful for early detection of medullary thyroid carcinoma in patients with nodular thyroid diseases.
[18.]
P. Niccoli, N. Wion-Barbot, P. Caron, J.F. Henry, C. De Micco, J.P. Saint Andre, et al.
Interest of routine measurement of serum calcitonin: study in a large series of thyroidectomized patients.
J Clin Endocrinol Metab, 82 (1997), pp. 338-341
[19.]
F. Pacini, M. Fontanelli, L. Fugazzola, R. Elisei, C. Romei, G. Di Coscio, et al.
Routine measurement of serum calcitonin in nodular thyroid diseases allows the preoperative diagnosis of unsuspected sporadic medullary thyroid carcinoma.
J Clin Endocrinol Metab, 78 (1994), pp. 826-829
[20.]
M.J. Schlumberger.
Papillary and follicular thyroid carcinoma.
N Eng J Med, 338 (1998), pp. 297-306
[21.]
J.M. Manresa Presas, R. Caballol Angelats.
Estudio del nódulo tiroideo solitario en un hospital comarcal.
Endocrinol Nutr, 46 (1999), pp. 257-260
[22.]
G. McKee.
The role of fine needle aspiration cytology in the diagnosis of thyroid lesions.
J R Soc Med, 91 (1998), pp. 28-32
[23.]
M.F. Erdogan, N. Kamel, D. Aras, A. Akdogan, N. Baskal, G. Erdogan.
Value of re-aspirations in benign nodular thyroid disease.
Thyroid, 8 (1998), pp. 1087-1090
[24.]
P.D. Gutman, M. Henry.
Fine needle aspiration cytology of the thyroid.
Clin Lab Med, 18 (1998), pp. 461-482
[25.]
C.F. Russell.
Management of thyroid tumours.
Br J Hosp Med, 58 (1997), pp. 68-73
[26.]
R.V. García-Mayor, L.F. Pérez Méndez, C. Páramo, R. Luna Cano, A. Rego Iraeta, M. Regal, et al.
Fine-needle aspiration biopsy of thyroid nodules: impact on clinical practice.
J Endocrinol Invest, 20 (1997), pp. 482-487
[27.]
M. Boigon, D. Moyer.
Solitary thyroid nodules. Separating benign from malignant conditions.
Postgrad Med, 98 (1995), pp. 73-74
[28.]
F.S. Greenspan.
The role of fine-needle aspiration biopsy in the management of palpable thyroid nodules.
Am J Clin Pathol, 108 (1997), pp. 26-30
[29.]
Y.C. Oertel, J.E. Oertel.
Diagnosis of benign thyroid lesions: fine-needle aspiration and histopathologic correlation.
Ann Diagn Pathol, 2 (1998), pp. 250-263
[30.]
D. Danese, M. Centanni, A. Farsetti, M. Andreoli.
Diagnosis of thyroid carcinoma.
J Exp Clin Cancer Res, 16 (1997), pp. 337-347
[31.]
S.R.S. Mandreker, N.S. Nadkarni, R.G.W. Pinto, S. Menezes.
Role of fine needle aspiration cytology as the initial modality in the investigation of thyroid lesions.
Acta Cytol, 39 (1995), pp. 898-904
[32.]
R.M. Tuttle, H. Lemar, H.B. Burch.
Clinical features associated with an increased risk of thyroid malignancy in patients with follicular neoplasia by fine-needle aspiration.
Thyroid, 8 (1998), pp. 377-383
[33.]
M.S. Sabel, E.D. Staren, L.M. Gianakakis, S. Dwarakanathan, R.A. Prinz.
Use of fine-needle aspiration biopsy and frozen section in the management of the solitary thyroid nodule.
Surgery, 122 (1997), pp. 1021-1027
[34.]
A.M. Lucas Martín, N. Alonso Pedrol, A. Sanmartí Sala.
Enfermedad nodular tiroidea. Diagnóstico y tratamiento.
Med Clin (Barc), 114 (2000), pp. 181-184
[35.]
H. Gharib, J.R. Goellner.
Fine-needle aspiration biopsy of the thyroid: an appraisal.
Ann Intern Med, 118 (1993), pp. 282-289
[36.]
H.Y. Chang, J.D. Lin, J.F. Chen, B.Y. Huang, C. Hsueh, L.B. Jeng, et al.
Correlation of fine needle aspiration cytology and frozen section biopsies in the diagnosis of thyroid nodules.
J Clin Pathol, 50 (1997), pp. 1005-1009
[37.]
P.J. Klemi, H. Joensuu, E. Nylamo.
Fine needle aspiration biopsy in the diagnosis of thyroid nodules.
Acta Cytol, 35 (1991), pp. 434-438
[38.]
N. Alonso, A. Lucas, I. Salinas, J. Murillo, E. Castella, A. Sanmartí.
Enfermedad nodular tiroidea y diagnóstico citológico de proliferación folicular. Características clínicas asociadas.
Endocrinol Nutr, 46 (1999), pp. 40
[39.]
J.L. Ponce, M. Borrego Galán, P. Costa, J.F. Merino, J.M. Martínez, V. Ferrer, et al.
Rentabilidad de las pruebas diagnósticas en el nódulo tiroideo.
Endocrinol Nutr, 47 (2000), pp. 22
[40.]
N. Alonso, J.L. Molinero, E. Castella, M. Llatjós, A. Lucas.
Utilidad de la biopsia peroperatoria en la enfermedad nodular tiroidea con diagnóstico de proliferación folicular.
Endocrinol Nutr, 47 (2000), pp. 23
[41.]
L.B. Schnurer, A. Widstrom.
Fine-needle biopsy of the thyroid gland: a cytohistological comparison in cases of goiter.
Ann Otol Rhinol Laryngol, 87 (1978), pp. 224-227
[42.]
T. Löwhagen, J.S. Willems, G. Lundell, R. Sundblad, P.O. Granberg.
Aspiration biopsy cytology in diagnosis of thyroid cancer.
World J Surg, 5 (1981), pp. 61-73
[43.]
S.P. Bugis, J.E. Young, S.D. Archibald, V.S. Chen.
Diagnostic accuracy of fine-needle aspiration biopsy versus frozen section in solitary thyroid nodules.
Am J Surg, 152 (1986), pp. 411-416
[44.]
G. Altavilla, M. Pascale, I. Nenci.
Fine needle aspiration cytology of thyroid gland diseases.
Acta Cytol, 34 (1990), pp. 251-256
[45.]
J.F. Hamming, B.M. Goslings, G.J. Van Steenis, H. Van Ravenswaay Claasen, J. Hermans, C.J. Van de Velde.
The value of fine-needle aspiration biopsy in patients with nodular thyroid disease divided into groups of suspicion of malignant neoplasms on clinical grounds.
Arch Intern Med, 150 (1990), pp. 113-116
[46.]
R.H. Caplan, P.J. Strutt, W.A. Kisken, S.M. Wester.
Fine needle aspiration biopsy of thyroid nodules.
Wis Med J, 90 (1991), pp. 285-288
[47.]
G.L. La Rosa, A. Belfiore, D. Giuffrida, C. Sicurella, O. Ippolito, G. Russo, et al.
Evaluation of the fine needle aspiration biopsy in the preoperative selection of cold thyroid nodules.
Cancer, 67 (1991), pp. 2137-2141
[48.]
L.J. Layfield, R.L. Mohrmann, K.H. Kopald, A.E. Giuliano.
Use of aspiration cytology and frozen section examination for management of benign and malignant thyroid nodules.
Cancer, 68 (1991), pp. 130-134
[49.]
R.T. Schlinkert, J.A. Van Heerden, J.R. Goellner, H. Gharib, S.L. Smith, R.F. Rosales, et al.
Factors that predict malignant thyroid lesions when fineneedle aspiration is "suspicious for follicular neoplasm™.
Mayo Clin Proc, 72 (1997), pp. 913-916
[50.]
A. López-Guzmán, T. Aramendi, C. Álvarez EscoláC, V.M. Andía, A. Arranz.
Resultados histológicos en los casos de citología tiroidea sospechosa de malignidad.
Endocrinol Nutr, 48 (2001), pp. 2-5
[51.]
M. Aguilar-Diosdado, A. Contreras, I. Gavilán, L. Escobar-Jiménez, J.A. Girón, J.C. Escribano, et al.
Thyroid nodules. Role of fine needle aspiration and intraoperative frozen section examination.
Acta Cytol, 41 (1997), pp. 677-682
[52.]
Z.W. Baloch, M.J. Sack, G.H. Yu, V.A. Livolsi, P.K. Gupta.
Fine-needle aspiration of thyroid: an institutional experience.
Thyroid, 8 (1998), pp. 565-569
[53.]
P.P. Morosini, V. Mancini, S. Filipponi, A. Taccaliti, M. Ferretti, P. Gusella, et al.
Comparison between the diagnostic accuracy in diagnosis of thyroid nodules with fine needle biopsy and intraoperative histological evaluation of frozen tissue.
Minerva Endocrinol, 22 (1997), pp. 1-5
[54.]
C.K. Wong, M.H. Wheeler.
Thyroid nodules: rational management.
World J Surg, 24 (2000), pp. 934-941
[55.]
V. Puigdevall, L. San Martín, C. Laudo.
Nódulo tiroideo solitario benigno ¿Observación o tratamiento supresor?.
Med Clin (Barc), 107 (1996), pp. 115
[56.]
D.S. Cooper.
Thyroxine suppression therapy for benign nodular disease.
J Clin Endocrinol Metab, 80 (1995), pp. 331-334
[57.]
F. Zelmanovitz, S. Genro, J.L. Gross.
Suppressive therapy with levothyroxine for solitary thyroid nodules: a double-blind controlled clinical study and cumulative meta-analyses.
J Clin Endocrinol Metab, 83 (1998), pp. 3881-3885
[58.]
K.A. Woeber.
The year in review: the thyroid.
Ann Intern Med, 131 (1999), pp. 959-962
[59.]
G. Csako, D. Byrd, R.A. Wesley, N.J. Sarlis, M.C. Skarulis, L.K. Nieman, et al.
Assessing the effects of thyroid suppression on benign solitary thyroid nodules. A model for using quantitative research synthesis.
Medicine (Baltimore), 79 (2000), pp. 9-26
[60.]
N. Lima, M. Knobel, H. Cavaliere, C. Sztejnsznajd, E. Tomimori, G. Medeiros-Neto.
Levothyroxine suppressive therapy is partially effective in treating patients with benign, solid thyroid nodules and multinodular goiters.
Thyroid, 7 (1997), pp. 691-697
[61.]
J.L. Wemeau, C. Cousty, V. Vlaeminck.
Suppressive hormone therapy for thyroid nodules. Prospective evaluation. Preliminary results.
Ann Endocrinol (Paris), 61 (2000), pp. 119-124
[62.]
H. Gharib, E.L. Mazzaferri.
Thyroxine suppressive therapy in patients with nodular thyroid disease.
Ann Intern Med, 128 (1998), pp. 386-394
[63.]
J.L. Latapie, F. Leprat, D. N'Guyen, B. Catargi, M.J. Latapie.
Hormonal suppressive therapy of thyroid nodules.
Ann Endocrinol (Paris), 58 (1997), pp. 459-462
[64.]
E. Mainini, I. Martinelli, G. Morandi, S. Villa, I. Stefani, C. Mazzi.
Levothyroxine suppressive therapy for solitary thyroid nodule.
J Endocrinol Invest, 18 (1995), pp. 796-799
[65.]
F. Almodóvar Ruiz, G. Maldonado Castro, D. De Luis, M. Lahera, C. Varela da Costa.
Tratamiento con levotiroxina en el nódulo tiroideo solitario.
An Med Interna, 17 (2000), pp. 99-101
[66.]
J. Aguilar, J.M. Rodríguez, B. Flores, J. Sola, A. Bas, T. Soria, et al.
Value of repeated fine-needle aspiration cytology and cytologic experience on the management of thyroid nodules.
Otolaryngol Head Neck Surg, 119 (1998), pp. 121-124
[67.]
A. Lucas, M. Llatjos, I. Salinas, J. Reverter, E. Pizarro, A. Sanmartí.
Fineneedle aspiration cytology of benign nodular thyroid disease. Value of re-aspiration.
Eur J Endocrinol, 132 (1995), pp. 677-680
[68.]
S.H. Merchant, R. Izquierdo, K.K. Khurana.
Is repeated fine-needle aspiration cytology useful in the management of patients with benign nodular thyroid disease.
Thyroid, 10 (2000), pp. 489-492
Copyright © 2002. Sociedad Española de Endocrinología y Nutrición
Opciones de artículo
es en pt

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?

Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos