¿Qué podemos esperar de las guías ATA 2014 en el manejo de cáncer temprano de tiroides?

  • Alvaro Sanabria Universidad de Antioquia
  • Alejandro Román González Universidad de Antioquia

Resumen

El carcinoma papilar de tiroides es un tumor frecuente en mujeres y el número de casos nuevos viene en crecimiento. La mayoría de estos casos de novo son tumores menores de 2 centímetros. Parte de la responsabilidad de este aumento es explicable por un uso mayor de ayudas diagnósticas. Esto ha permitido detectar el cáncer de tiroides temprano o clínicamente silente. En esta población, el manejo ha sido típicamente agresivo, incluyendo cirugías extensas (tiroidectomía total) seguidas por terapia con yodo radiactivo y supresión de TSH. Las próximas guías plantearán cuatro grandes modificaciones: 1. Estadificación dinámica del riesgo (respuesta completa, respuesta bioquímica incompleta, respuesta estructural incompleta e indeterminada) 2. Disminución de las indicaciones y de la dosis de ablación con yodo radiactivo, específicamente el uso de esta terapia debe estar ajustado al riesgo basal de recurrencia (bajo, intermedio, alto) del paciente y debe tenerse en cuenta el número de ganglios linfáticos afectados, el tamaño de las metástasis ganglionares, la histología y el tamaño del tumor. Una dosis de 30 mCi de 131yodo es igual de eficaz para negativizar la tiroglobulina que una dosis de 100 mCi. 3. Extensión de la cirugía (cirugía parcial en tumores menores de 4 cm con histología favorable) y 4. Terapia de supresión con levotiroxina con metas más laxas de TSH, dado el riesgo de osteoporosis y arritmias con una supresión exagerada de TSH, especialmente en la población de edad avanzada.

Abstract
Papillary thyroid carcinoma is a frequent cancer in women. An increase in the number of new cases has been detected in the last years. However, tumors smaller than 2 cms represent the largest sample in those new detected cancers. The cause of this increment is partially responsibility of an increased use of diagnostic aids such as ultrasound, even in asymptomatic patients. The management of these clinically silent tumors has been quite aggressive with extensive surgery (total thyroidectomy) followed by radioactive iodine therapy and TSH suppression. The next papillary thyroid carcinoma guidelines will address 4 important modifications: 1. Dynamic approach to risk stratification (Complete response, incomplete biochemical response, incomplete structural response and indeterminate response) 2. Decrease in the indication and dose of radioactive iodine. The use of this therapy must be adjusted to the basal risk of recurrence with consideration of the number of lymph node metastases, the size of the lymph node metastases, the histopathologic variant and the size of the primary tumor. A dose of 30mCi of 131I is as effective as a dose of 100 mCi for thyroid ablation. 3. Extension of the thyroidectomy (partial surgery in tumors smaller than 4 cms without unfavorable histopathology and 4. Higher TSH goal with levothyroxine suppression therapy. A strict TSH suppression has been associated with increased risk of osteoporosis and cardiac arrhythmias, especially in older population.

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Biografía del autor

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Cirujano de Cabeza y Cuello. Hospital Pablo Tobón Uribe. Profesor Asociado. Departamento de Cirugía. Facultad de Medicina. Universidad de Antioquia. Medellin, Colombia

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Internista Hospital Universitario San Vicente Fundación.Residente de Endocrinología. Grupo Endocrinología y Metabolismo.Universidad de Antioquia. Medellin, Colombia

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Publicado
2017-03-21
##submission.howToCite##
SANABRIA, Alvaro; ROMÁN GONZÁLEZ, Alejandro. ¿Qué podemos esperar de las guías ATA 2014 en el manejo de cáncer temprano de tiroides?. Revista Colombiana de Endocrinología, Diabetes & Metabolismo, [S.l.], v. 2, n. 4, p. 5-10, mar. 2017. ISSN 2389-9786. Disponible en: <http://revistaendocrino.org/index.php/rcedm/article/view/44>. Fecha de acceso: 09 dic. 2019
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