Trakya Üniversitesi Tıp Fakültesi endokrinoloji polikliniğinde tiroid nodüllerine yaklaşımda algoritmalardan sapmalar
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Tarih
2012
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Yayıncı
Trakya Üniversitesi Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Tiroid nodüllerine yaklaşım tartışmalı bir konu olup, Endokrinoloji ve Tiroidoloji konularında uzmanlardan oluşan çeşitli kuruluşlarca kılavuzlar oluşturulmuştur. Çalışmamızda bu kılavuzlardaki algoritmalara ne kadar uyulduğunu görmeyi ve verilerimizden çıkacak yeni sonuçlarla tartışmalı alanlarda literatüre katkıda bulunmayı amaçladık. Trakya Üniversitesi Tıp Fakültesi Endokrinoloji polikliniğine başvurmuş, tiroid malinitesi olmayan, 18 yaşından büyük 200 tiroid nodüllü hastann poliklinik dosyalarını retrospektif olarak incelendi. Hastaların yaş, cinsiyet gibi özellikleri, laboratuvar değerleri, sintigrafi bulguları, patoloji sonuçları, bu parametrelerinin aralarındaki ilişki ve algoritmalardaki önemi irdelendi. İleri yaştaki (yaş>60) hastalarda tiroid nodüllerinde neoplazi görülme sıklığında anlamlı artış saptanmıştır. Nodül sayısı ile serbest triiyodotironin arasında anlamlı (p=0.031; r=-0.227) negatif korelasyon, nodül boyutu ile serbest triiyodotironin arasında anlamlı (p=0.012) pozitif korelasyon saptandı. Sintigrafide sıcak nodül oranı (%20) saptandı. Ultrasonografinin neoplastik lezyonlar için olan negatif kestirim değeri %92 saptanmıştır.Sitoloji sonucu yetersiz gelen nodüllerin boyutu, yeterli olanlardan anlamlı olarak daha düşük bulundu (12.9±7.0'ye 3.5±12.9; p<0.001).Yetersiz sitoloji sonucuyla kistik içerik arasında anlamlı ilişki (p<0.05) saptandı.Neoplastik lezyonlar için sitolojinin pozitif prediktif değeri foliküler neoplazilerde %25, atipik örneklerdeyse %80 saptanmıştır. Sitoloji sonucu ile cerrahi patoloji sonucu anlamlı (p=0.019) olarak uyumluydu. Sitoloji ve ultrasonografinin tanıdaki en büyük güçleri negatif prediktif değerleridir. İlk yaklaşımda tirotropin düzeyiyle birlikte, ultrasonografi eşliğinde biyopsi alınmaması gereken nodülleri dışlayarak biyopsi alınacak nodül seçimi maliyet etkinliğini en çok artıracağını düşündüğümüz kombinasyondur. Sintigrafi ve serbest tiroid hormonları gibi tetkikler endikasyon dışı çok fazla istenmektedir. Bu tetkikler benin nodüllerin tanısı ve cerrahi veya medikal tedavi kararı açısından klinik ve radyolojik bulgularla birlikte değerlendirilmelidir. Tiroid nodüllerine yaklaşımın birçok aşamasında tartışmalı konuların temelini şüpheli lezyonlar oluşturmaktadır. Bu alanda daha fazla araştırma yapılmalıdır.Anahtar kelimeler: Tiroid nodülleri, tartışmalı konular, algoritmalar.
Abstract
Approaches to the thyroid nodules has been a controversial subject, and although some guidelines and suggestions have been made by the endocrinology and thyroidology specialists, there is still a lack of consensus in many applications in this subject . In this study, we aimed to see the compliance in the algorithms indicated by the guidelines and to contribute to the existing literature by the new results obtained through our data. The polyclinic files of 200 patients, who applied to the Endocrinology Polyclinic of the Trakya University Medicine Faculty, above the age of 18 with throid nodules have been investigated retrospectively from the initial diagnosis stage until the stage of operation. The demographic properties such as age and gender, laboratory values, scintigraphy findings, patyhology results of the operational and fine needle aspiration cytology, the correlations between these parameters, and their importance in the generally acccepted guidelines of the approaches to the thyroid nodules have been discussed. There is a significant increase for neoplasia frequency in the thyroid nodules for patients over the age of 60. Significant negative correlation (p=0.031; r=-0.227) was determined between the number of nodules and free triiyodothyronine and pozitive correlation (p=0.012) was determined between the nodule size and free triiyodothyronine. Hot nodule ratio was determined as 20% in scintigraphy. The negative predictive value of ultrasonography for neoplastic lesions was determined as 92%. Nodule sizes from insufficient cytology results has found to be significantly lower than the ones with sufficient results (12.9±7.0 vs 23.5±12.9; p=<0.001). It was determined that there was a meaningful correlation between insufficient cytology results and cystic content. It was found that the cytological and pathological results were in good agreement (p=0.019). The strongest aspect of fine needle aspiration biopsy and ultrasound in diagnosis are negative predictive values 90% and 92%, respectively. At the first attempt, according to the thyrotropin values, the most cost-effective choice is to ignore the nodules that do not need ultrasound aided biopsy. The examinations such as scintigraphy and free thyroid hormones without indication are not preferrable. These examinations should be evaluated together with clinical and radiological findings for the diagnosis of benign nodules and operational or medical treatment options. Suspicious lesions constitute the basics of controversial issues in the approaches to the tyhroid nodules, therefore, it is essential that further research should focus on this subject area.Key words: Thyroid nodules, debated issues, algorithms
Abstract
Approaches to the thyroid nodules has been a controversial subject, and although some guidelines and suggestions have been made by the endocrinology and thyroidology specialists, there is still a lack of consensus in many applications in this subject . In this study, we aimed to see the compliance in the algorithms indicated by the guidelines and to contribute to the existing literature by the new results obtained through our data. The polyclinic files of 200 patients, who applied to the Endocrinology Polyclinic of the Trakya University Medicine Faculty, above the age of 18 with throid nodules have been investigated retrospectively from the initial diagnosis stage until the stage of operation. The demographic properties such as age and gender, laboratory values, scintigraphy findings, patyhology results of the operational and fine needle aspiration cytology, the correlations between these parameters, and their importance in the generally acccepted guidelines of the approaches to the thyroid nodules have been discussed. There is a significant increase for neoplasia frequency in the thyroid nodules for patients over the age of 60. Significant negative correlation (p=0.031; r=-0.227) was determined between the number of nodules and free triiyodothyronine and pozitive correlation (p=0.012) was determined between the nodule size and free triiyodothyronine. Hot nodule ratio was determined as 20% in scintigraphy. The negative predictive value of ultrasonography for neoplastic lesions was determined as 92%. Nodule sizes from insufficient cytology results has found to be significantly lower than the ones with sufficient results (12.9±7.0 vs 23.5±12.9; p=<0.001). It was determined that there was a meaningful correlation between insufficient cytology results and cystic content. It was found that the cytological and pathological results were in good agreement (p=0.019). The strongest aspect of fine needle aspiration biopsy and ultrasound in diagnosis are negative predictive values 90% and 92%, respectively. At the first attempt, according to the thyrotropin values, the most cost-effective choice is to ignore the nodules that do not need ultrasound aided biopsy. The examinations such as scintigraphy and free thyroid hormones without indication are not preferrable. These examinations should be evaluated together with clinical and radiological findings for the diagnosis of benign nodules and operational or medical treatment options. Suspicious lesions constitute the basics of controversial issues in the approaches to the tyhroid nodules, therefore, it is essential that further research should focus on this subject area.Key words: Thyroid nodules, debated issues, algorithms
Açıklama
Tıpta Uzmanlık Tezi
Anahtar Kelimeler
Tiroid Nodüller, Thyroid Nodules, Algoritmalar, Algorithms
