Search

The Coronaviruses Disease 2019 (Covid-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is perhaps the most dramatic threat to human health since the Spanish flu in 1918. Almost 700 million cases and more than 6 million deaths have been reported worldwide by November 20, 2022 (1). The lung is the main affected organ, and the most critical clinical presentation has been characterized by interstitial pneumonia, acute respiratory distress syndrome, multiple organ failure, and death (2). Multiple endocrine organs, such as the pituitary, pancreas, adrenal, gonads, and thyroid gland, have also been affected (3). Detrimental effects on thyroid function have been reported in patients with and without pre-existing thyroid disease. Nonthyroidal illness syndrome (NTIS), subacute thyroiditis (SAT), Hashimoto’s thyroiditis, and Graves’ disease have been the most frequent thyroid dysfunctions associated with Covid-19 (4). Two major pathophysiological models have been implicated, a direct effect by virus attack causing follicular cells damage and an indirect effect caused by an immune-inflammatory abnormal response to the virus (5). Most recently, thyroid autoimmune diseases have also been reported following Covid-19 vaccination (6). info:eu-repo/semantics/publishedVersion

Orientador: Laura Sterian Ward Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas Resumo: Como a maior parte dos carcinomas diferenciados tem um excelente prognóstico, alguns autores consideram o tratamento convencional, isto é, a tireoidectomia total seguida de ablação actínica de remanescentes glandulares, excessivo. Combinações de fatores específicos do paciente e do tumor foram propostas para classificação prognóstica, mas na prática são pouco utilizadas. Os resultados de alguns trabalhos sugerem relação entre a expressão dos genes MUC, p53 e NIS e a evolução clínica das neoplasias tireoidianas. Com o objetivo de investigar a utilidade clínica de marcadores imonoistoquímicos de prognóstico, estudamos 67 nódulos tireoidianos, incluindo 57 carcinomas, dos quais incluiu 34 (50,74%) carcinomas papilíferos, sendo 21 (31,3%) casos do tipo histológico clássico, 7 (10,4%) da variante de células altas e 6 (9%) da variante folicular. Avaliamos também 16 (23,9%) carcinomas foliculares, 4 (6%) medulares e 3 carcinomas anaplásicos (4,5%). Dez casos (14,9%) foram obtidos de pacientes submetidos à cirurgia com o diagnóstico de doenças benignas da tiróide (3 casos de bócio nodular, 4 adenomas foliculares e 3 tecidos tireoidianos normais). Todos os pacientes foram submetidos a um mesmo protocolo de tratamento e acompanhados por 66±28 meses (mediana de 63 meses) sendo classificados como apresentando evolução favorável ou desfavorável. Consideramos de evolução desfavorável os 19 pacientes que possuíam evidência de recorrência local ou à distância ou que foram a óbito durante o seguimento pela doença. Realizamos estudos imunoistoquímicos da detecção das proteínas NIS, p53 e MUC1 comparando-os com a evolução dos pacientes. Mostramos que pacientes com carcinomas bem diferenciados, ausência de metástases, estadio II e estadiamento T2 têm uma evolução melhor em relação aos pacientes com carcinomas pouco diferenciados, presença de metástases, estadio IV e estadiamento T4. Não encontramos relação entre a expressão das proteínas NIS, p53 e MUC1 e a evolução dos pacientes estudados Abstract: Because most differentiated thyroid carcinomas have an excellent prognosis, some authors have been claiming that these patients have been over-treated. Combinations of patient-and tumor-specific factors have been proposed for prognostic stratification, but no clinicpathologic staging was demonstrated to be useful at the present time. In order to investigate the clinical utility of immunohistochemistry markers, we studied 67 thyroid nodules including 50 thyroid carcinomas. There were 34 (50,74%) papillary carcinomas, including 21 (31,3%) cases of the classical histological type, 7 (10,4%) tall cell variants and 6 (9%) of the follicular variant type. Also, there were 16 (23,9%) follicular carcinomas, 4 (6%) medullary and 3 anaplastic carcinomas (4,5%). Ten patients (14,9%) were submitted to surgery because of benign thyroid diseases (3 nodular goiter cases, 4 follicular adenomas and 3 thyroid tissues normal). All patients were submitted to a similar management protocol and followed-up for 66±28 months (median of 63 months) and classified as presenting a good or a bad evolution. We considered as presenting a bad evolution 19 patients that presented evidence of local or distant recurrence and the patients that died during the follow-up. Immunohistochemical expression of NIS, p53 and MUC1 proteins was compared to patient¿s evolution. We showed that patient with well differentiated thyroid carcinomas, absence of distant metastases, stage II and staging T2 have a better evolution in relation to the patients with poorly differentiated thyroid carcinomas, presence of metastases, stage IV and staging T4. We were able to find relation between the expression of proteins NIS, p53 and MUC1 and prognostic of the studied patients Doutorado Clínica Médica Doutor em Clínica Médica