|
Machado et al., Rio de
Janeiro, Brazil, reported on the prevalence of thyroid nodules in
patients with ischemic heart disease (IHD). The presence of
hyperfunctioning nodules could deteriorate cardiac function in
patients with IHD. Incidental small thyroid nodules have been
detected in high frequency in asymptomatic persons in by
ultrasound of the neck. In order to evaluate the prevalence of
thyroid nodules in IHD, 61 patients were evaluated (17 women and
44 men), mean age of 56.8 ± 9.8 with coronary obstructive
lesions confirmed by coronary angiography. Twenty-one patients
(34.4%) presented nodules (47% women and 30% men). Only 3 of
these nodules were detected by palpation of the thyroid and 11
patients did not show any abnormality on physical examination,
the others presented lobar enlargements, diffuse goiters or
irregular surfaces. Nine patients had multinodular goiters, 8 in
the right lobe. Thirteen showed solitary nodules (5 in the right
lobe and 8 in the left lobe). Ultrasound revealed, 14 cysts, 10
solid and 3 mixed nodules. There was no correlation between serum
TSH or anti-TPO antibodies and the presence or absence of these
nodules. Since the size of the nodules varied from 4 to 20 mm,
the prevalence of these nodules did not differ from the frequency
of small nodules reported by several authors, varying between 14%
to 72% in the general population. However, in this patient group
most of the nodules were solitary, while in general population
the frequency of multiple nodules are twice the solitary ones.
The cytological diagnoses of aspirates of thyroid nodules were reported by Gama et al., from Curitiba, PR, Brazil. They submitted 155 patients (1996–1998) to a FNB. About 78% of aspirates were considered as benign (coloid goiter, cysts, lymphocytic thyroiditis, sub acute thyroiditis). Ten percent were not suitable for cytologic examination and 7% of were classified as malignant lesions (about 36% were papillary, 18% Hürthle cell and 45% follicular pattern). The most prevalent malignant lesion was follicular carcinoma with invasive pattern. The predominance of follicular type with aggressiveness may reflect the relative low iodine intake of the population. Novelli et al., Rosario, Argentina, similarly reported on their experience on FNB in 786 patients (1986–1998) from a mild iodine deficient area. After surgery, there was a confirmed diagnosis of 16% with invasive follicular cancer. In this paper the number of patients referred to surgery was relatively high (403/786 patients) indicating that the FNB was less effective in the setting of this hospital to avoid unnecessary operations. Two different groups reported on the treatment of benign solid thyroid nodules with percutaneous injection of ethanol (Bianchini et al., São Paulo, SP, and Almeida et al., São Paulo, SP, Brazil). Altogether 45 patients with either solid benign thyroid nodules or partially cystic lesions were treated with ethanol. In both studies the injections were guided by ultrasound, with a mean of three injections of ethanol/patient. In 75% of the patients there was a 50% reduction of the nodular volume within 6 months of treatment. About 15% of the nodules practically disappeared after the ethanol percutaneous injection. The authors concluded that percutaneous injection of ethanol is a simple, useful and highly effective therapeutic option for non-surgical treatment of benign thyroid nodules. Millner et al., São Paulo, SP, Brazil, reported on long-term TSH suppressive therapy by LT4 in patients with thyroid nodules. They followed 38 patients (34 women, 4 men) with a clinically and echographically diagnosed single solid nodule (n=20) or multinodular goiter (n=18). All patients had normal thyroid function and FNB confirming a benign lesion. All patients received a standard dose of 200 µg of LT4 (mean 2.23±0.9 µg LTD/kg weight) for a period of 36–92 months. Serial determinations of serum TSH indicated excellent compliance to the treatment as reflected by suppressed serum TSH levels. Total thyroid volume reduced from a mean value of 13.6±7.7 g to 10.1±5.8 g in the single nodule group and from 23.1±16.4 g to 18.1±14.1 g in the multinodular goiters. Overall a 50% reduction of the nodular volume was obtained in 45% of the single nodules and in 39% of the multinodular glands. They concluded that although prolonged suppressive therapy of TSH for treatment of thyroid nodules can not be considered very effective it is remarkably useful for prevention of the surge of new nodules. (Comments: As previously reported by Papini et al., JCEM 83:521, 1998. a control group of patients with thyroid nodules who were not treated with L-T4 suppressive therapy should be similarly analyzed for 5 years in order to reach a sound conclusion). The same group of authors (Millner et al., São Paulo, Brazil) reported on high efficacy of treatment of very large, compressive goiters with radioiodine. They selected six patients most being over 60 years of age, who had very large goiters (127–278 g) with compressive symptoms. No patients could be operated because a variety of associated morbidities., After a period of MMI and low iodine intake, the patients received 100 to 200 mCi of 131I in a single dose. There was a remarkable shrinkage of the goiters at 6 and 12 months (residual volume: 20.8–75.0 g) The major side effect was a transient oesophagitis and sialoadenitis, due to radiation to cervical structures. They concluded that RAI is a safe and effective alternative treatment for compressive, large multinodular goiters. |
