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Bukasa JK, Bayauli-Mwasa P, Mbunga BK, Bangolo A, Kavula W, Mukaya J, Bindingija J, M’Buyamba-Kabangu JR. The Spectrum of Thyroid Nodules at Kinshasa University Hospital, Democratic Republic of Congo: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16203. [PMID: 36498276 PMCID: PMC9737877 DOI: 10.3390/ijerph192316203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 11/07/2022] [Accepted: 12/01/2022] [Indexed: 06/17/2023]
Abstract
We analyzed the spectrum of thyroid nodules in patients attending the endocrinology unit care of the Kinshasa University Hospital and assessed their associated factors. We conducted a cross-sectional study, performing descriptive statistics and logistic regression. From the 888 enrolled patients, thyroid nodules were detected in 658 patients (74.1%), as mononodules in 22.5% and multiple nodules in 77.5%. Thyroid function was normal in 71.3% cases, while hyperthyroidism and hypothyroidism were found in 26.1% and 2.6% of cases, respectively. Women were more affected than men (75.1% vs. 63.6%; p = 0.03). Patients with thyroid nodules were older (44 ± 12 vs. 38 ± 12 years; p < 0.001), with a family history of goiter (38.3% vs. 27.4%; p = 0.003) and residence in the iodine-deficient region (51.7% vs. 38.8%; p = 0.012); they had a higher proportion of longer delays to consultation (47% vs. 20%; p < 0.001), but a higher rate of normal thyroid function (85.5% vs. 3 1.3%; p < 0.001). Thyroid nodules were associated with the delay to consultation (for duration ≥ three years, OR: 6.560 [95% CI: 3.525−12.208)], multiparity (present vs. absent: 2.863 [1.475−5.557]) and family history of goiter (present vs. absent: 2.086 [95% CI:1.231−3.534]) in female patients alone. The high frequency of thyroid nodules observed requires measures aimed at early detection in the population, the training of doctors involved in the management and the strengthening of technical platforms in our hospitals.
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Affiliation(s)
- John Kakamba Bukasa
- Endocrinology Unit, Department of Internal Medicine, University of Kinshasa Hospital, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
- Department of Endocrinology, Liège University Hospital Center, 4000 Liège, Belgium
| | - Pascal Bayauli-Mwasa
- Endocrinology Unit, Department of Internal Medicine, University of Kinshasa Hospital, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Branly Kilola Mbunga
- Kinshasa School of Public Health, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Ayrton Bangolo
- Department of Internal Medicine, Hackensack University Medical Center/Palisades Medical Center, North Bergen, NJ 07047, USA
| | - Wivine Kavula
- Kinshasa School of Public Health, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Jean Mukaya
- Radiology and Medical Imaging Unit, Department of Internal Medicine, University Hospital of Kinshasa, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Joseph Bindingija
- Endocrinology Unit, Department of Internal Medicine, University of Kinshasa Hospital, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Jean-René M’Buyamba-Kabangu
- Cardiology Unit, Department of Internal Medicine, University of Kinshasa Hospital, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
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Domínguez JM, Nilo F, Martínez MT, Massardo JM, Muñoz S, Contreras T, Carmona R, Jerez J, González H, Droppelmann N, León A. Papillary thyroid microcarcinoma: characteristics at presentation, and evaluation of clinical and histological features associated with a worse prognosis in a Latin American cohort. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2018; 62:6-13. [PMID: 29694628 PMCID: PMC10118695 DOI: 10.20945/2359-3997000000013] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 10/03/2017] [Indexed: 11/23/2022]
Abstract
Objective We aimed to describe the presentation of papillary microcarcinoma (PTMC) and identify the clinical and histological features associated with persistence/recurrence in a Latin American cohort. Subjects and methods Retrospective study of PTMC patients who underwent total thyroidectomy, with or without radioactive iodine (RAI), and who were followed for at least 2 years. Risk of recurrence was estimated with ATA 2009 and 2015 classifications, and risk of mortality with 7th and 8th AJCC/TNM systems. Clinical data obtained during follow-up were used to detect structural and biochemical persistence/recurrence. Results We included 209 patients, predominantly female (90%), 44.5 ± 12.6 years old, 183 (88%) received RAI (90.4 ± 44.2 mCi), followed-up for a median of 4.4 years (range 2.0-7.8). The 7th and 8th AJCC/TNM system classified 89% and 95.2% of the patients as stage I, respectively. ATA 2009 and ATA 2015 classified 70.8% and 78.5% of the patients as low risk, respectively. Fifteen (7%) patients had persistence/recurrence during follow-up. In multivariate analysis, only lymph node metastasis was associated with persistence/recurrence (coefficient beta 4.0, p = 0.016; 95% CI 1.3-12.9). There were no PTMC related deaths. Conclusions Our series found no mortality and low rate of persistence/recurrence associated with PTMC. Lymph node metastasis was the only feature associated with recurrence in multivariate analysis. The updated ATA 2015 and 8th AJCC/TNM systems classified more PTMCs than previous classifications as low risk of recurrence and mortality, respectively.
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Affiliation(s)
- José M Domínguez
- Department of Endocrinology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Flavia Nilo
- Department of Endocrinology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - María T Martínez
- Department of Endocrinology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - José M Massardo
- Department of Endocrinology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Sueli Muñoz
- Department of Endocrinology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Tania Contreras
- Department of Endocrinology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Rocío Carmona
- Department of Endocrinology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Joaquín Jerez
- Department of Endocrinology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Hernán González
- Department of Surgery, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Nicolás Droppelmann
- Department of Surgery, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Augusto León
- Department of Surgery, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
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Domínguez JM, Nilo F, Contreras T, Carmona R, Droppelmann N, González H, Iturrieta V, Tuttle RM. Neck Sonography and Suppressed Thyroglobulin Have High Sensitivity for Identifying Recurrent/Persistent Disease in Patients With Low-risk Thyroid Cancer Treated With Total Thyroidectomy and Radioactive Iodine Ablation, Making Stimulated Thyroglobulin Unnecessary. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2017; 36:2299-2307. [PMID: 28543974 DOI: 10.1002/jum.14260] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 12/19/2016] [Accepted: 02/10/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES Follow-up of patients with low-risk differentiated thyroid cancer treated with total thyroidectomy and radioiodine requires neck sonography and thyroglobulin (Tg). The need to stimulate Tg is controversial. The goal of this study was to compare the diagnostic performances of sonography plus suppressed or stimulated Tg in low-risk thyroid cancer. METHODS After total thyroidectomy and radioiodine, patients with low-risk thyroid cancer were retrospectively identified as having structural or biochemical persistence/recurrence. We compared the diagnostic performance of suppressed and stimulated Tg to detect persistence/recurrence. RESULTS We included 148 patients with low-risk thyroid cancer who were followed for a median of 3.7 years. Persistence/recurrence was found in 8 patients (5.4%; 5 structural disease and 3 biochemical disease). Thyroglobulin was not stimulated in 72 patients (group 1) and stimulated in 76 (group 2). In group 1, 5 patients (6.9%) had structural neck persistence/recurrence (3 with suppressed Tg ≥ 1 ng/mL and 2 with suppressed Tg < 1 ng/mL). Four patients underwent surgery, and 1 was surveilled. All 5 patients had suppressed Tg lower than 1 ng/mL at the end of follow-up. In group 2, stimulated Tg did not identify additional cases of structural persistence/recurrence but classified 3 patients (3.9%) as having biochemical persistence/recurrence. One patient received a second dose of radioiodine, and the other 2 were surveilled; all were without disease at the end of follow-up. Suppressed and stimulated Tg had negative predictive values for persistence/recurrence of 97% and 100%, respectively. CONCLUSIONS In low-risk thyroid cancer treated with total thyroidectomy and radioiodine, sonography and suppressed or stimulated Tg have similar negative predictive values for persistence/recurrence. Importantly, the coexistence of negative sonographic findings and suppressed Tg lower than 1 ng/mL makes the addition of stimulated Tg unlikely to identify clinically important disease.
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Affiliation(s)
- José M Domínguez
- Departments of Endocrinology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Flavia Nilo
- Departments of Endocrinology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Tania Contreras
- Departments of Endocrinology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Rocío Carmona
- Departments of Endocrinology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Nicolás Droppelmann
- Departments of Surgery, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Hernán González
- Departments of Surgery, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Virginia Iturrieta
- Departments of Endocrinology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - R Michael Tuttle
- Endocrinology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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