CÂNCER DE TIREÓIDEO
Autor: UNIVERSO PATOLÓGICO | Publicado: 2010-11-27T05:47:00-08:00

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 <![endif]-->&nbsp;O câncer da glândula tireóide é uma doença que pode atingir todas as faixas etárias, sobretudo os extremos de idade (muito jovens ou muito velhos) e que acomete principalmente as mulheres. Possui, em geral, altos índices de cura quando o tratamento adequado é instituído. Ao contrário de outros tipos de tumores como o câncer do estômago, mama ou próstata, dificilmente o doente tratado evolui para morte pela doença, exceto em casos extremamente avançados.&nbsp;
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      DiagnósticoA principal queixa do paciente é a   de nódulo na região cervical anterior. O diagnóstico é feito através da   palpação do pescoço pelo especialista, ultra-sonografia da tireóide e punção   biópsia aspirativa por agulha fina (PAAF). Exames de imagem mais sofisticados   como a tomografia e a ressonância magnética trazem poucas informações e   raramente são necessários.Ultra-sonografiaDescreve o tamanho do(s) nódulo(s),   se é sólido, cístico ou misto e a presença de irrigação sanguínea no interior   do nódulo. Os nódulos únicos, sólidos, com irrigação sanguínea central são os   mais suspeitos para câncer.Punção biópsia   aspirativa por agulha fina (PAAF)É o exame mais importante para o   diagnóstico. Via de regra, todo nódulo sólido deve ser puncionado. O exame da   PAAF pode corresponder normalmente aos seguintes diagnósticos:
1. Bócio – trata-se de doença benigna que terá indicação de cirurgia   dependendo do tamanho e de sintomas de desconforto local.
2. Carcinoma Papilífero – é o câncer mais freqüente da tireóide e com maiores   índices de cura pela cirurgia que deverá ser realizada sempre.
3. Padrão Folicular – são as punções duvidosas em que existe a chance de   aproximadamente 15 a 20% de se tratar de um carcinoma folicular (2º tipo mais   frequente de câncer da tireóide). As outras possibilidades são de um adenoma   folicular (tumor benigno) ou de um bócio com muitas células tireoideanas   (área de hiperplasia benigna). Como o risco de 15 a 20% não é desprezível e a   diferenciação entre benigno e maligno não poderá ser feita com certeza por   nenhum outro exame, todos os pacientes com este resultado deverão, a   princípio, serem operados.
4. Tireoidite Linfocítica: trata-se de uma inflamação da tireóide.   Normalmente não há necessidade de cirurgia. Deve-se examinar a dosagem de   hormônios tireoideanos, pois a tireoidite pode levar a diminuição da produção   destes hormônios. Se isso ocorrer realiza-se a reposição hormonal com   medicamento.

Tipos de câncer   de tireóideOs principais tipos são:1. Carcinoma papilífero:   corresponde a aproximadamente 75% dos tumores malignos. Seu índice de cura é   alto com a cirurgia (90 a 95% dos casos).
2. Carcinoma folicular: é o 2º em freqüência (15% dos tumores). Sua   evolução também é favorável (80 a 85% dos casos) com o tratamento.
3. Carcinoma medular: mais agressivo, menos de 10% dos casos.   Dependendo de sua apresentação inicial (tamanho do tumor, comprometimento dos   gânglios do pescoço) consegue-se com a cirurgia um bom controle da doença.   Muitos pacientes depois de operados permanecem sem sinais de doença, mas com   exames de sangue que demonstram resquícios de atividade tumoral e podem   permanecer assim por anos, com vida normal.
4. Carcinoma anaplásico: gravíssimo e raro. O verdadeiro carcinoma   anaplásico ocorre em menos de 1% dos casos, em pacientes de idade muito   avançada e que possuíam bócio há anos. A doença é fatal na maioria dos casos,   levando à morte em pouco tempo.TratamentoO tratamento do câncer de tireóide   é sempre cirúrgico. Nos tumores papilífero e folicular procede-se,   normalmente à remoção completa da tireóide (tireoidectomia total) e pesquisa   de gânglios do pescoço comprometidos pelo câncer. Se forem encontrados   gânglios comprometidos realiza-se a retirada dos mesmos (esvaziamento   cervical). No pós- operatório o paciente deverá ser submetido ao exame de   pesquisa de corpo inteiro com iodo (PCI) e dosagem de tireoglobulina no   sangue, que é um marcador do tumor. Dependendo de alguns fatores como tamanho   do tumor, extensão do tumor para fora da tireóide, presença de gânglios   comprometidos, resultado da PCI e da tireoglobulina o paciente poderá ser   submetido no pós-operatório a uma dose maior de iodo para “queimar”   resquícios do câncer. Não é utilizada radioterapia, nem quimioterapia.   Após a cirurgia o paciente recebe a reposição do hormônio da tireóide em uma   quantidade que também o protege da reativação da doença.
Para o câncer medular somente a cirurgia é eficaz. Não se faz iodo no   pós-operatório. A operação consiste na remoção completa da tireóide   (tireoidectomia total) e retirada dos gânglios do pescoço (esvaziamento   cervical) mesmo não havendo aumento destes pois o índice de comprometimento é   muito alto.
O câncer anaplásico normalmente é intratável. Muitas vezes somente a biópsia   é feita e colocação de traqueostomia para garantir a respiração do paciente.   Tenta-se tratar com radioterapia e quimioterapia.
  
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; AUTORAS: AMANDA CAROLYNE BRANDÃO BEZERRA COSTA, MAGDA GLEICY PINTO E MARIA MADALENA MENDESEMAIL: gleyce_magda@hotmail.com