Adriana Gonçalves Juliano

Low‐level laser therapy in chronic autoimmune thyroiditis: A pilot study

Chronic autoimmune thyroiditis (CAT) remains the most common cause of acquired hypothyroidism. There is currently no therapy that is capable of regenerating CAT‐damaged thyroid tissue. The objective of this study was to gauge the value of applying low‐level laser therapy (LLLT) in CAT patients based on both ultrasound studies (USs) and evaluations of thyroid function and thyroid autoantibodies.

Ethanol injection under ultrasound guidance to palliate unresectable parathyroid carcinoma

BACKGROUND Severe hypercalcemia is the leading cause of death in patients with parathyroid carcinoma. Non-curative resection and pharmacological measures may be useful for palliation in cases with recurrent and metastatic disease. Palliative treatment with intra-neoplastic ethanol injection has not been reported yet. METHODS Ultrasound-guided percutaneous alcohol injection in one patient with unresectable parathyroid carcinoma is reported. RESULTS One male patient with extensive recurrent parathyroid carcinoma suffering from severe hypercalcemia, refractory to all available medical measures has undergone two percutaneous ethanol injections. No major complications ensued and parathormone levels decreased from 2.990 pg/mL to 2.230 pg/ml after the first injection, and to 1.104 pg/mL after the second one. Calcium levels decreased from 19.8 mg/dL to 16.1 mg/dL and to 14.5 mg/dL, respectively. The patient died of metabolic hypercalcemia complications about two months later, probably due to mediastinal disease progression. CONCLUSION Ultrasound-guided percutaneous ethanol injection may be employed to palliate parathyroid carcinoma in selected cases, with a transitory decrease in PTH and calcium levels.

Assessment of the Effects of Low-Level Laser Therapy on the Thyroid Vascularization of Patients with Autoimmune Hypothyroidism by Color Doppler Ultrasound

Background. Chronic autoimmune thyroiditis (CAT) frequently alters thyroid vascularization, likely as a result of the autoimmune process. Objective. To evaluate the effects of low-level laser therapy (LLLT) on the thyroid vascularization of patients with hypothyroidism induced by CAT using color Doppler ultrasound parameters. Methods. In this randomized clinical trial, 43 patients who underwent levothyroxine replacement for CAT-induced hypothyroidism were randomly assigned to receive either 10 sessions of LLLT (L group, n = 23) or 10 sessions of a placebo treatment (P group, n = 20). Color Doppler ultrasounds were performed before and 30 days after interventions. To verify the vascularity of the thyroid parenchyma, power Doppler was performed. The systolic peak velocity (SPV) and resistance index (RI) in the superior (STA) and inferior thyroid arteries (ITAs) were measured by pulsed Doppler. Results. The frequency of normal vascularization of the thyroid lobes observed in the postintervention power Doppler examination was significantly higher in the L than in the P group (P = 0.023). The pulsed Doppler examination revealed an increase in the SPV of the ITA in the L group compared with the P group (P = 0.016). No significant differences in the SPV of the STA and in the RI were found between the groups. Conclusion. These results suggest that LLLT can ameliorate thyroid parenchyma vascularization and increase the SPV of the ITA of patients with hypothyroidism caused by CAT.

Aneurisma da artéria carótida interna extracraniana: relato de caso

Os aneurismas verdadeiros da arteria carotida interna extracraniana sao raros, ao contrario dos supraclinoideos, somando menos de 4% dos aneurismas perifericos. Eles se apresentam clinicamente como massas palpaveis cervicais, junto a margem inferior do ângulo da mandibula, causando rouquidao, disfagia e dor por compressao nervosa. Ha frequente associacao desta doenca com outros aneurismas perifericos devido a sua etiologia principal (aterosclerose). Os aneurismas perifericos sao comumente identificados a ultra-sonografia Doppler, quando na vigencia de janela acustica adequada. Nesta situacao, os aneurismas podem ser avaliados tanto morfologica como hemodinamicamente. Sua identificacao e estudo sao importantes para prevenir graves complicacoes, como tromboses, infartos macicos ou embolicos da area correspondente no sistema nervoso central, ruptura e disseccao, alem de auxiliar na indicacao da melhor conduta terapeutica.

Timo: caracterização ultra-sonográfica

O timo e uma pequena glândula responsavel pela producao de linfocitos T, importante na resposta imunitaria do organismo. E orgao relativamente grande no periodo perinatal e pode estender-se superiormente, atingindo o pescoco, com variantes anatomicas. E possivel identificar o timo normal, por meio da ultra-sonografia, pelo acesso supra-esternal, paraesternal e esternal e tambem na regiao cervical quando em localizacao atipica. A partir do inicio da puberdade, devido a sua involucao com diminuicao progressiva do seu tamanho e porque o pulmao aerado se interpoe entre o timo e o feixe sonoro, a sua visualizacao e mais dificil. O padrao da ecotextura normal timica e caracteristica: hipoecogenico em relacao ao parenquima normal da tireoide e apresenta multiplas estruturas ecogenicas lineares e focais, dispersas pelo parenquima, que correspondem aos septos e vasos sanguineos. O reconhecimento pela ultra-sonografia de tecido timico pode ser importante para evitar investigacoes desnecessarias ou cirurgias num timo normal que mimetiza massa patologica.

Importância da ecogenicidade da tireóide no diagnóstico da tireoidite crônica auto-imune

A tireoidite cronica auto-imune e, atualmente, a principal causa de hipotireoidismo e seu diagnostico baseiase nas manifestacoes clinico-laboratoriais. O marcador laboratorial mais importante e a presenca de anticorpos antitireoglobulina e antiperoxidase, sendo este ultimo o teste mais sensivel. A biopsia aspirativa apresenta alta sensibilidade e especificidade, porem, e um metodo invasivo e, por isso, reservado para quando ha presenca de nodulo ou bocio de crescimento rapido. A cintilografia e desnecessaria para o diagnostico, ja que apresenta baixa sensibilidade e especificidade. A ultra-sonografia, tanto ao modo B como ao duplexDoppler colorido, evoluiu de forma muito rapida e tornou-se um metodo simples, nao-invasivo, reprodutivel e com alta sensibilidade para o diagnostico da tireoidite cronica auto-imune. Ao modo B, a ecogenicidade e um parâmetro de extrema importância, ja que, alem de apresentar alta correlacao com o quadro citopatologico, tambem apresenta alta sensibilidade para o diagnostico da tireoidite cronica auto-imune. Embora este parâmetro nao seja especifico da tireoidite cronica auto-imune, pois tambem pode estar presente na doenca de Graves, na tireoidite pos-parto e na tireoidite subaguda, tais desordens podem ser facilmente diferenciadas tanto pelo quadro clinico-laboratorial quanto pelo duplex-Doppler colorido. Assim, este artigo tem o objetivo de revisar a importância do estudo da ecogenicidade no diagnostico da tireoidite cronica auto-imune. Unitermos: Ultra-sonografia; Ecogenicidade; Tireoidite; Cronica; Auto-imune. Chronic autoimmune thyroiditis is currently considered as the main cause for hypothyroidism and its diagnosis is based on clinical manifestations and laboratory tests results. The most significant laboratory marker for this disease is the presence of anti-thyroperoxidase and anti-thyroglobulin antibodies, the latter being the most sensitive one. Aspiration biopsy shows high sensitivity and specificity but, considering the invasiveness of this method it is reserved for cases of suspected nodules or fast growing goiter. Scintigraphy is unnecessary for the diagnosis, considering its low specificity and sensitivity. Both B-mode and duplex color Doppler ultrasonography have rapidly evolved, becoming a simple, noninvasive and reproducible method with high sensitivity for the diagnosis of chronic autoimmune thyroiditis. Echogenicity is a relevant parameter at Bmode ultrasonography because of the close correlation with cytopathological findings besides the high sensitivity in the diagnosis of the disease. Although this is not a specific parameter for chronic autoimmune thyroiditis, considering that it may also be found in Graves’ disease, postpartum thyroiditis and subacute thyroiditis, such disorders can be easily differentiated both by clinical-laboratory and duplex color Doppler findings. Thus, the present study is aimed at evaluating the significance of thyroid echogenicity in the diagnosis

Predicting malignant neck lymphadenopathy using color duplex sonography based on multivariate analysis.

To select the best predictors of cervical lymph node malignancy based on gray‐scale and power Doppler sonography using multivariate analysis.

Linfonodos cervicais: um dilema para o ultra-sonografista

Ultrasound assessment of neck lymphadenopathy can be difficult as sometimes the same pattern is seen both in inflammatory (specific or not) and neoplastic diseases (lymphoproliferative or metastatic). An adequate follow-up of these lymphadenopathies requires evaluation of some important ultrasound features, and relies on the ability of localizing these nodes. We reviewed the literature with the aim of establishing the most significant ultrasonographic features on gray-scale ultrasound and Doppler ultrasound that can help in the study of the lymph nodes of the neck. We also describe the localization of lymph nodes based on computed tomography anatomic landmarks. The aspects analyzed on B-mode were: number (isolated nodule or conglomeration), shape, echotexture/echogenicity, calcification, cystic necrosis and/or hemorrhagic necrosis, size, contours and extra nodal extension. Doppler aspects reviewed were color mapping and spectral analysis (pulsatility index and resistive index). Some patterns usually described for malignant nodes are round morphology, marked hypoechoic, peripheral vascularization and high pulsatility index and resistive index. We concluded that an accurate diagnosis requires the evaluation of multiple aspects seen on B-mode and Doppler ultrasound.A analise dos linfonodos cervicais e um assunto complexo, na medida em que obtemos, por vezes, padroes de imagens superponiveis para os processos benignos - reacionais (infecciosos especificos e inespecificos) - e para os malignos - doencas neoplasicas (linfoproliferativas e metastaticas). O seguimento adequado das linfadenopatias tambem requer do examinador detalhamento topografico e descricao dos aspectos ecograficos relevantes. Realizamos revisao literaria com os objetivos de ressaltar os criterios ultra-sonograficos mais significantes (modo-B e duplex-Doppler colorido) e fazer analogia aos reparos anatomicos utilizados na tomografia computadorizada, para uniformizar a descricao topografica dos niveis linfonodais por meio da ultra-sonografia. Os aspectos avaliados ao modo-B foram: numero (se agrupados ou isolado), forma, hilo ecogenico central, ecotextura/ecogenicidade, presenca de calcificacoes, necrose e/ou hemorragia interna, dimensoes, contornos (disseminacao extracapsular). Ao duplex-Doppler colorido os aspectos avaliados foram: padrao de vascularizacao e analise espectral - indice de resistividade e indice de pulsatilidade. Existem padroes ultra-sonograficos frequentemente descritos nos linfonodos malignos como morfologia globosa, hipoecogenicidade marcada, vascularizacao predominantemente periferica e indice de resistividade elevado, porem a analise deve ser multifatorial, levando-se em conta os parâmetros ao modo-B e ao duplex-Doppler colorido.