In an effort to unify treatment approaches to patients with well-differentiated thyroid cancer of follicular cell origin, the Section of Endocrinology, Section of Nuclear Medicine, Department of Surgery, and Department of Otorhinolaryngology of the Philippine General Hospital formulated and published a clinical practice guideline on the management of well-differentiated thyroid cancer in 2008. In recognition of the new literature on thyroid cancer, as well as the questions that have arisen from the use of the guideline, the group reconvened in 2011 to review and update the clinical practice guideline designed for patients seen at the Philippine General Hospital. This article summarizes the latest revisions and recommendations.

Endocrinology ; Hospitals, General ; Nuclear Medicine ; Otolaryngology ; Philippines ; Radionuclide Imaging ; Thyroid Neoplasms

BACKGROUND: Thyroid nodules may harbor cancer in 5% to 15% of cases. Specific clinical and sonographic features predictive of malignancy have been investigated in various populations, but due to differences in epidemiology, risk factors and iodine nutrition status, these predictors may not be valid in the Philippines. This study determined the clinicopathological, biochemical, and sonographic features of thyroid nodules predictive of malignancy among adult Filipino patients at the University of the Philippines-Philippine General Hospital (UP-PGH). METHODS: We reviewed the medical records of Filipino patients > or =19 years of age who underwent thyroid surgery in UP-PGH from 2008 to 2011. RESULTS: A total of 837 of 1,670 patients (50.1%) were enrolled in the study, which included 417 benign and 420 malignant tumors. The mean age at diagnosis was 38+/-11 years, with female predominance. Multiple logistic regression analysis showed that the presence of a hard or firm nodule (odds ratio [OR], 58.8, P<0.001; OR, 12.8, P<0.001), presence of microcalcifications (OR, 11.1; P<0.001), irregular margins on ultrasound (OR, 4.5; P<0.001), and absence of associated symptoms (OR, 2.3; P<0.002) increased significantly the likelihood of thyroid malignancy. CONCLUSION: Similar to international data, the absence of associated symptoms, firm to hard thyroid nodules, and the presence of microcalcifications and irregular margins were significant predictors of thyroid malignancy.
Adult* ; Diagnosis ; Epidemiology ; Female ; Hospitals, General ; Humans ; Iodine ; Logistic Models ; Medical Records ; Nutritional Status ; Philippines* ; Risk Factors ; Tertiary Care Centers* ; Thyroid Gland ; Thyroid Nodule* ; Ultrasonography*

Background: Asians with Graves’ ophthalmopathy (GO) may have earlier compressive features due to narrower orbital apex and increased orbital volume. Objective: To determine the risk factors associated with activity and severity of GO among adults. Methodology: This was a cross-sectional analytical study of 163 adults with Graves’ disease (GD) from the outpatient clinics of the Philippine General Hospital. Demographics, clinical data, thyrotropin receptor antibody (TRAb) and urine iodine (UIE) levels were obtained. All participants were evaluated for activity and severity of GO by a single ophthalmologist. Results: The population was predominantly composed of females (81%) and nonsmokers (69%), with a mean age of 35 + 11 years and median GD duration of 2 years. Median TRAb was 8.9 U/L while UIE was 171 mcg/L. Eight percent exhibited active GO, with 85% having mild disease. Multivariate analysis showed male sex to be associated with severe disease (OR 3.71, p=0.041), while elevated TRAb was associated with both active (OR 1.03, p=0.002) and severe GO (OR 1.02, p=0.007). Conclusion Lower rates of active and severe GO were seen compared to previous reports. In this population of predominantly nonsmokers, elevated TRAb emerged as a risk factor for active and severe GO.
Graves Ophthalmopathy ; Graves Disease ; Long-Acting Thyroid Stimulator