Diagnóstico, manejo e evolução de pacientes com nódulos tiroidianos tóxicos tratados com radioiodo
Data
2020-09-24
Orientadores
Martins, João Roberto Maciel 
Tipo
Dissertação de mestrado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Contexto: Hipertiroidismo associado a nódulo(s) autônomo(s) (Doença de Plummer), corresponde à segunda maior causa de tirotoxicose. Radioiodoterapia é uma opção terapêutica reconhecidamente eficaz. Objetivo: Descrever as formas de apresentação da Doença de Plummer e sua evolução após tratamento com radioiodo e determinar fatores que influenciam na eficácia do tratamento. Pacientes e Métodos: Foram avaliados, retrospectivamente, prontuários de pacientes com mais de 18 anos, com bócio nodular tóxico, tratados com radioiodo entre 1997 e 2017, acompanhados no Ambulatório de Doenças Tiroidianas da Disciplina de Endocrinologia e Metabologia da Escola Paulista de Medicina. Resultados: A eficácia do tratamento com radioiodo foi maior do que 90%, com apenas uma única dose. A dose média de radioiodo foi de 28,9 ± 3,4 mCi (mediana= 30mCi [15-30mCi]). O tempo médio entre a realização do radioiodo e a resolução do hipertiroidismo foi de 3,6 ± 3,0 meses (mediana= 2 [1-12 meses]). Após o primeiro ano, 33,9% dos pacientes apresentavam hipotiroidismo, 59,4%, eutiroidismo e 6,7%, permaneciam em hipertiroidismo. Nos não-respondedores ao radioiodo, as variáveis que apresentaram diferença estatística foram o diagnóstico (bócio multinodular tóxico) e a dose de radioiodo (média= 25,5 ± 6,5 mCi; mediana= 30 (15-30mCi)]. A taxa acumulada de hipotiroidismo foi de 48,9% em 20 anos de seguimento. Conclusão: a radioterapia é uma medida eficaz e segura. Na Doença de Plummer, são esperadas altas taxas de eutiroidismo pós radioiodo. Falha terapêutica foi observada em pacientes com bócios maiores, multinodulares, tratados com menores doses. A evolução para hipotiroidismo foi observada principalmente em pacientes mais jovens, com bócios maiores e uninodulares.
Background: Hyperthyroidism associated with autonomous nodule(s) (Plummer’s disease) is the second main cause of thyrotoxicosis. Radioiodine therapy’s efficacy in this context is widely recognized. Objective: This article aims to describe the presentation of Plummer’s disease and its evolution after radioiodine treatment and determine factors that may influence treatment efficacy. Patients and Methods: The sample included retrospective medical records of patients over 18 years old, with toxic nodular goiter, treated with radioiodine between 1997 and 2017, who were followed up at a single thyroid center in Brazil. Results: The efficacy of treatment with radioiodine was higher than 90%, with just one dose. The mean radioiodine dose was 28.9 ± 3.4 mCi (median = 30 mCi [15- 30mCi]). The mean time between radioiodine and hyperthyroidism resolution was 3.6 ± 3.0 months (median = 2 [1-12 months]). After the first year, 33.9% of the patients were under hypothyroidism, 59.4% under euthyroidism, and 6.7% under hyperthyroidism. Among the non-responders, the variables that showed statistical difference were the presence of multinodular goiter and the radioiodine dose (mean = 25.5 ± 6.5 mCi; median = 30 (15-30 mCi)]. The cumulative rate of hypothyroidism was 48.9% over 20 years of follow-up. Conclusion: Radiotherapy is an effective and safe treatment. In Plummer’s disease, high rates of euthyroidism are expected after the radioiodine treatment. Therapeutic failure was observed mainly in patients with larger multinodular goiters treated with lower doses of radioiodine. The evolution to hypothyroidism was mostly observed in younger patients with larger and uninodular goiters.
Background: Hyperthyroidism associated with autonomous nodule(s) (Plummer’s disease) is the second main cause of thyrotoxicosis. Radioiodine therapy’s efficacy in this context is widely recognized. Objective: This article aims to describe the presentation of Plummer’s disease and its evolution after radioiodine treatment and determine factors that may influence treatment efficacy. Patients and Methods: The sample included retrospective medical records of patients over 18 years old, with toxic nodular goiter, treated with radioiodine between 1997 and 2017, who were followed up at a single thyroid center in Brazil. Results: The efficacy of treatment with radioiodine was higher than 90%, with just one dose. The mean radioiodine dose was 28.9 ± 3.4 mCi (median = 30 mCi [15- 30mCi]). The mean time between radioiodine and hyperthyroidism resolution was 3.6 ± 3.0 months (median = 2 [1-12 months]). After the first year, 33.9% of the patients were under hypothyroidism, 59.4% under euthyroidism, and 6.7% under hyperthyroidism. Among the non-responders, the variables that showed statistical difference were the presence of multinodular goiter and the radioiodine dose (mean = 25.5 ± 6.5 mCi; median = 30 (15-30 mCi)]. The cumulative rate of hypothyroidism was 48.9% over 20 years of follow-up. Conclusion: Radiotherapy is an effective and safe treatment. In Plummer’s disease, high rates of euthyroidism are expected after the radioiodine treatment. Therapeutic failure was observed mainly in patients with larger multinodular goiters treated with lower doses of radioiodine. The evolution to hypothyroidism was mostly observed in younger patients with larger and uninodular goiters.
Descrição
Citação
MOROTO, Débora. Diagnóstico, manejo e evolução de pacientes com nódulos tiroidianos tóxicos tratados com radioiodo. São Paulo, 2020. 58 p. Dissertação (Mestrado em Endocrinologia e Metabologia) - Escola Paulista de Medicina (EPM) - Universidade Federal de São Paulo (UNIFESP), São Paulo, 2020.