Carcinoma diferenciado de tireóide: avaliação inicial e acompanhamento

Abstract

RESUMOO câncer de tireóide é responsável por cerca de 1% dos novos casos de doença maligna diagnosticados. A maioria destes tumores são carcinomas papilares e foliculares, também denominados de carcinomas diferenciados de tireóide (CDT). Estes carcinomas têm uma taxa de cura de aproximadamente 80%, enquanto 20% apresentarão recorrência local e 5 a 10% desenvolverão metástases à distância. Porém, alguns pacientes apresentam uma doença mais agressiva. A identificação de tais pacientes tem grande impacto no manejo clínico do CDT. Várias classificações de estádio clínico e fatores prognósticos são apresentados, bem como os principais exames para seguimento dos pacientes com CDT. Thyroid carcinoma accounts for roughly 1% of all new malignant diseases. Of these, at least 94% are differentiated thyroid carcinoma (DTC), either papillary thyroid carcinoma or follicular thyroid carcinoma. Patients with DTC are usually considered as having a good prognosis, 80% of patients are cured, 20% will develop loco-regional recurrence and 5-10% distant metastasis. However, the disease may have an aggressive course in some patients. The identification of these patients has a major impact in the clinical management of DTC. Several prognostic factors and classification will be addressed, as well the most useful tests for patient's follow-up. CARCINOMAS DIFERENCIADOS DE TIREÓIDEO CÂNCER DE TIREÓIDE é a neoplasia maligna mais freqüente do sistema endocrinológico, apesar de ser uma patologia relativamente rara, sendo responsável por aproximadamente 1% dos novos casos de doença maligna (1). A cada ano, nos EUA, surgem 14.000 novos casos, e ocorrem 1.100 mortes decorrentes do carcinoma diferenciado da tireóide (2). No Brasil, estes números são proporcionais, ocorrendo 66 novos casos em cada 100.000 habitantes por ano (3).As neoplasias da tireóide são classificadas de acordo com o tipo histológico em adenoma folicular, carcinoma papilar, carcinoma folicular e carcinoma anaplásico ou indiferenciado. A maioria dos tumores tireoi-

Clinical and epidemiological characteristics of patients in the head and neck surgery department of a university hospital

“…20 Regarding thyroid gland tumors, our results indicated that surgery was the most preva- seem to determine a more favorable prognosis for patients with thyroid cancer. 37 In analyzing the tumor stage, a high proportion of tumors classified as T3 and T4 was observed.…”

Is it necessary to reduce the radioiodine dose in patients with thyroid cancer and renal failure?

“…Arq Bras Endocrinol Metab. 2010;54(4): clinical case report 1 T hyroid cancer is the most frequently occurring endocrinal tumor, although it represents less than 1% of all malignant tumors diagnosed worldwide (1). Patient management usually consists of thyroidectomy, either entire or nearly so, followed by radioiodine therapy in the case of differentiated thyroid cancer (papillary and follicular tumors).…”

Familiar Papillary Thyroid Carcinoma in a Large Brazilian Family Is Not Associated with Succinate Dehydrogenase Defects

“…Medullary thyroid cancers that are parafollicular thyroid C cells in origin have been observed in about 5% of all thyroid cancers [1]. Follicular thyroid cell-derived tumors include papillary thyroid cancer (PTC), follicular thyroid cancer, and anaplastic thyroid cancer [5,6,7,8,9]. PTC and follicular thyroid cancer are collectively classified as well-differentiated thyroid cancers and account for around 95% of thyroid malignancies.…”

“…Mutations or loss of heterozygosity of the genes SDHA, SDHB, SDHC, and SDHD have been described in paragangliomas, pheochromocytomas [19,20,21,22], renal cell carcinoma [19,23,24], gastrointestinal carcinoma [19], familial pheochromocytoma and paraganglioma [14,24,25,26,27], Cowden's syndrome [22,23], medullar [1,19] and papillary thyroid carcinoma [14,19,24], and more recently pituitary adenomas [28,29,30]. …”