Evaluation of thyroid nodules in the Brazilian Public Health Care System, Supplementary Health System, and Private Health System in the northeastern region of the State of São Paulo

OBJECTIVE

To obtain data about the evaluation of thyroid nodules (TNs) in the northeastern of the State of São Paulo, compared by health care type, and measure the performance of cytology as a screening test for thyroid cancer (TC).

METHODS

We collected data of 597 patients treated in the Brazilian public health care system (SUS), supplementary health (SH) and in private health system (PHS) in 2014. A total of 803 TNs were aspirated, and 125 patients underwent surgery.

RESULTS

The distribution of all cytologic results according to the Bethesda system was: I, 135 (16.8%); II, 475 (59.2%); III, 107 (13.3%); IV, 32 (4.0%); V, 20 (2.5%); VI, 34 (4.2%). The time between cytologic analysis and surgery was longer in the SUS than in the SH for TNs in general (p < 0.001) and for TNs with Bethesda V and VI cytology (p = 0.01). The sizes of the TNs and resected malignant TNs was larger in the SUS than in the SH (p = 0.001 and p = 0.02, respectively). The number of PHS surgeries was too small and was not compared. The prevalence of TC was 9.2% and 23.6% of them were treated in the SUS. Cytology showed a 93.6% sensitivity, 95.8% specificity, and 94.7% accuracy when Bethesda III and IV were excluded.

CONCLUSION

Cytology was a good screening test for TC categories Bethesda II, V, and VI. The differences between the SUS and SH indicate a need for improved access to consultations and specialized tests in the SUS.

CARCINOMA PAPILÍFERO DE CISTO DO DUCTO TIREOGLOSSO: RELATO DE CASO E DISCUSSÃO SOBRE A MELHOR ESCOLHA TERAPÊUTICA

Relatamos o caso clínico de um paciente de 51 anos diagnosticado com carcinoma papilífero (CP) de origem num cisto do ducto tireoglosso (CDT), identificado na peça anatomopatológica após ser submetido à cirurgia de Sistrunk. O CDT se origina durante a formação embriológica da tireoide, a partir da falha na obliteração do ducto tireoglosso. É uma lesão cística congênita, frequente na linha mediana do pescoço e raramente apresenta malignidade (menos de 1%). O tratamento dos pacientes com carcinoma do cisto do ducto tireoglosso (CCDT) ainda é controverso. Existe debate na literatura quanto à necessidade de abordagens complementares à cirurgia de Sistrunk, como a tireoidectomia total, o esvaziamento de linfonodos cervicais, a terapia com iodo radioativo e a terapia supressiva com levotiroxina.