Revisión de indicación de tiroidectomía y su correlación con la anatomía patológica

Objetivo: 1. Determinar el porcentaje de patologia tiroidea maligna en tiroidectomia en un hospital interzonal de la provincia de Buenos Aires. 2. Evaluar la indicacion de tiroidectomias por motivos clinicos y/o citologicos, relacionandolos con la anatomia patologica. Materiales y Metodos: Evaluamos retrospectivamente las historias clinicas de 214 pacientes sometidos a cirugia tiroidea desde junio de 2004 a junio de 2010, correlacionando la indicacion quirurgica con la anatomia patologica. Para su analisis se dividieron a los mismos en dos grupos: 1) aquellos a los que se les indico tiroidectomia utilizando criterios clinicos como bocio de gran tamano, endotoraxico, crecimiento rapido del nodulo, fijeza, etc., presentando los mismos punciones tiroideas (PAF) benignas o insatisfactorias (n = 152), 2) aquellos a los que se les indico tiroidectomia por presentar citologia maligna o sospechosa de malignidad (n = 62). Resultados: De los 214 pacientes evaluados, 203 fueron mujeres y 11 varones, con una edad media de 43,3 anos (17-64 anos); realizandose tiroidectomia total en 117 casos y subtotal en 97. El 98 % de los pacientes (n = 210), tenian punciones prequirurgicas, de las cuales el 24,7 %, fueron insatisfactorias. Presentaron hipocalcemia transitoria 17 pacientes (7,9 %), definitiva 3 (1,4 %) y paralisis recurrencial unilateral 3 (1,4 %). El 21,5 % (n = 46) del total de casos presento patologia maligna. De los 152 pacientes operados por criterio clinico presentaron malignidad el 10,5 % (n = 16); mientras que los operados por sospechas de malignidad por PAF (n = 62) presentaron carcinoma el 48,4 % (n = 30). De los pacientes con bocio nodular operados por criterio clinico teniendo PAF insatisfactorias (n = 50), presentaron carcinoma 14 pacientes (28 %). Conclusiones: Del total de pacientes tiroidectomizados hemos hallado un alto porcentaje de patologia benigna (78,5 %). De los pacientes con bocio nodular operados por criterio clinico, con punciones insatisfactorias, el 28 % fueron malignos. Consideramos que es fundamental utilizar el criterio citologico al momento de indicar la tiroidectomia; y ante un alto porcentaje de citologias insatisfactorias, seria de importancia revisar la metodologia diagnostica en nuestro lugar de trabajo. Objective: 1. To determine the percentage of malignant thyroid pathology in thyroidectomy in an Hospital inside the province of Buenos Aires. 2. To evaluate the indication for thyroidectomy due to medical and/or cytological reasons relating them to the pathological anatomy. Materials and Methods: We retrospectively evaluated the medical records of 214 patients who had a thyroid surgery from June 2004 to June 2010, relating the surgical indication to the pathological anatomy. For its analysis, the patients were divided into two groups: 1) those ones who were treated as thyroidectomy using medical criteria such as: a large endothoracic goiter, a fast growing nodule, firmness, etc. These patients showed negative or unsatisfactory thyroid cytology (n = 152); 2) those ones who were treated as thyroidectomy because they showed a cytology suspected to be malignant (n = 62). Results: From 214 patients evaluated, 203 were women and 11 men, with an average age of 43.3 years old (17-64 years old); a total thyroidectomy was carried out in 117 cases and a subtotal one in 97 cases. Of all the patients 98 % (n = 210) had thyroid fine needle aspiration (FNA), 24.7 % of which were unsatisfactory. Seventeen patients had temporary hypoparathyroidism (7.9 %), 3 patients had permanent one (1.4 %) and 3 patients had unilateral vocal cord paralysis (1.4 %). Of all the cases 21.5 % (n = 46) showed malignant pathology. From 152 patients who had surgery due to medical criteria, 10.5 % (n=16) showed malignancy; whereas the patients who had surgery for FNA (n = 62) suspected to be malignant showed thyroid cancer in 48.4 % (n = 30). From the patients with nodular goiter operated due to medical criteria having unsatisfactory FNA (n = 50), 14 patients had carcinoma (28 %). Conclusions: From the total of patients with thyroidectomy we have found a high percentage of benign pathology (78.5 %). From the patients with nodular goiter who were operated due to medical criteria, with unsatisfactory cytology, 28 % were malignant. We consider that it is essential to use cytological criteria upon the thyroidectomy indication however, if there were high percentage of unsatisfactory cytology, it would be necessary to check the diagnostic methodology where we work.