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The use of genomic medicine in health presents itself as promising in the management of several diseases and this does not differ for the investigation of thyroid nodules, in which the use of this technology directs to diagnostic of more accurate conduct and prognosis, allowing to reduce, for example, the incidence of invasive procedures and potential complications to the patient, such as successive fine needle aspiration biopsies or surgery in benign cases. Therefore, it is known today that there is a multitude of molecular markers related to thyroid nodules, including gene panels patented by pharmaceutical companies, However, there is still a lack of review studies that seek to list the importance in the medical practice of each of these markers and the outcomes in patient management, especially from the perspective of diagnosis, conduct and prognosis. Thus, this literature review sought to elucidate the medical importance of molecular markers based on several studies available with a good sample size and related to the theme, indicating the molecular markers with the best evidence of being important for the management of the patient with thyroid nodules, which can contribute to support and encourage the application of genomic medicine through public policies, for example. Hence, in our review, significant differences were observed in relation to the commercially available genetic panels regarding their power of risk stratification and, moreover, when the molecular markers are analyzed individually, performance variables differed greatly in the studies, although BRAF mutations and the TERT promoter were quite related to malignancy, which leads to a joint approach of markers when performing the individualization of thyroid nodules of a patient, whether from the point of view of diagnosis, conduct and prognosis., {"references":["Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2018;68(6):394–424; Disponível em: https://doi.org/10.3322/caac.21492","Releases e Notas | INCA - Instituto Nacional de Câncer. n.d. 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Introduction: Classically, thyroid nodules are initially evaluated by ultrasonography in Mode B. Despite being sensitive for the diagnosis of NT, it does not take into account the stiffness of the nodule, an important characteristic that is related to its malignancy. In this sense, elastography has been used as an instrument to assist in the diagnosis of thyroid nodules. With this in mind, the aim of the present study is to qualitatively assess the performance of manual pressure elastography in the differential diagnosis of malignant and benign thyroid nodules in adults. Method: This is a prospective, observational study, which included patients who had thyroid nodules and required fine needle aspiration (FNAB). The elastography was obtained in real time from the US in Mode B. The percentage of the nodule's rigid area was calculated using the ImageJ software. Results: The study included 41 patients, 87.8% female. Age ranged from 18 to 75 years, with an average of 46.4 years (SD: 13.57). Most of the nodules were classified as TI-RADS 3, 53.7%. As for the Bethesda classification, 82.9% of the sample was classified as Bethesda 2 (benign nodule). The percentage of rigid area (% AR) ranged from 3% to 73%, with an average of 28.73% (SD: 18.15). Highly suspicious nodules from the TI-RADS classification had a higher AR% (51.6%). Regarding cytological analysis, nodules characterized as benign had an average AR% of 24.23% (SD: 13.66), while malignant ones of 55% (SD: 19.94), a difference of 30.77% , which proved to be statistically significant (p

RESUMO Objetivo verificar a frequência de queixa para deglutir em pacientes com doença tireoidiana benigna não cirúrgica e comparar a autopercepção de intensidade da alteração de deglutição em diferentes tipos de doença tireoidiana. Método a amostra do estudo foi composta por 39 mulheres com idades entre 19 e 58 anos (38,54 ± 10,74 anos) e diagnóstico de hipotireoidismo (n=22; 56,4%) ou nódulos tireoidianos (n=17; 43,6%). Investigou-se a presença de queixa, tipo de queixa e autopercepção da intensidade da alteração de deglutição por meio da escala analógico-visual de 100 milímetros. Os dados foram analisados de forma descritiva e para comparar a autopercepção entre os diferentes diagnósticos clínicos utilizamos o teste não paramétrico de Mann-Whitney. O nível de significância foi de 5%. Resultados vinte e seis (66,7%) participantes relataram queixa para deglutir. As queixas referidas foram sensação de estase em região laringofaríngea (37,15%), engasgo (34,29%) e odinofagia (28,57%). O valor médio da autopercepção de intensidade da alteração de deglutição por meio da escala analógico-visual foi 59,35 (± 27,38) milímetros. A autopercepção não foi diferente entre os diagnósticos clínicos de doença tireoidiana. Conclusão nessa amostra, queixas para deglutir foram frequentes em mulheres com doenças tireoidianas benignas não cirúrgicas. Essas pacientes percebem a alteração de forma moderada, independentemente do diagnóstico clínico da patologia tireoidiana. ABSTRACT Purpose To verify the frequency of swallowing complaints in patients with benign nonsurgical thyroid disease and compare the self-perception of swallowing disorder intensity between different types of thyroid disease. Methods The study sample comprised 39 women aged 19-58 years (38.54 ± 10.74) with hypothyroidism (n=22; 56.4%) or thyroid nodules (n=17; 43.6%). Presence and type of swallowing complaint and self-perception of swallowing disorder intensity were investigated by means of self-ratings recorded on a 100-millimeter visual analog scale. The data were analyzed by descriptive measures and the Mann-Whitney nonparametric test was used to compare the self-perception of swallowing disorder intensity between both clinical diagnoses of thyroid disease. The level of 5% was adopted for statistical significance. Results Twenty-six (66.7%) individuals reported the following swallowing complaints: pharyngolaryngeal stasis sensation (37.15%), chocking (34.29%), and odynophagia (28.57%). The mean value of self-perception of swallowing disorder intensity by the visual analog scale was 59.35 (± 27.38) millimeters. No difference in self-perception was reported between the clinical diagnoses of thyroid disease. Conclusion In this sample, swallowing complaint was frequently observed in patients with benign nonsurgical thyroid disease. Moderate self-perception of swallowing disorder intensity was reported regardless of the clinical diagnosis of thyroid disease.

Nódulos tireoidianos são muito frequentes, sobretudo quando se empregam métodos sensíveis de imagem. Embora o câncer seja proporcionalmente raro, sua incidência vem aumentando, especialmente de tumores pequenos, cuja evolução clínica é incerta. A maioria dos pacientes com carcinoma diferenciado de tireoide evolui bem quando adequadamente tratada, com índices de mortalidade similares à população geral. Por outro lado, um percentual não desprezível apresenta recidivas e alguns eventualmente não respondem às terapias convencionais, evoluindo para óbito. Assim, o desafio é distinguir os pacientes merecedores de condutas mais agressivas e, ao mesmo tempo e não menos importante, poupar a maioria de tratamentos e procedimentos desnecessários. Atualizamos o Consenso Brasileiro publicado em 2007, ressaltando os avanços diagnósticos e terapêuticos que os participantes, de diferentes Centros Universitários do Brasil, consideram mais relevantes para prática clínica. A elaboração dessas diretrizes foi baseada na experiência dos participantes e revisão da literatura pertinente. Arq Bras Endocrinol Metab. 2013;57(4):240-64 Thyroid nodules are frequent findings, especially when sensitive imaging methods are used. Although thyroid cancer is relatively rare, its incidence is increasing, particularly in terms of small tumors, which have an uncertain clinical relevance. Most patients with differentiated thyroid cancer exhibit satisfactory clinical outcomes when treatment is appropriate, and their mortality rate is similar to that of the overall population. However, relapse occurs in a considerable fraction of these patients, and some patients stop responding to conventional treatment and eventually die from their disease. Therefore, the challenge is how to identify the individuals who require more aggressive disease management while sparing the majority of patients from unnecessary treatments and procedures. We have updated the Brazilian Consensus that was published in 2007, emphasizing the diagnostic and therapeutic advances that the participants, representing several Brazilian university centers, consider most relevant in clinical practice. The formulation of the present guidelines was based on the participants’ experience and a review of the relevant literature. Arq Bras Endocrinol Metab. 2013;57(4):240-64

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) OBJETIVO: Avaliar risco de malignidade de nódulos tiroidianos por meio de aspectos clínicos, laboratoriais, ultrassonográficos e citológicos. PACIENTES E MÉTODOS: 741 nódulos de 407 pacientes. RESULTADOS: A citologia foi benigna (60,5%), indeterminada (23,3%), maligna (8,6%) ou não diagnóstica (7,6%). A prevalência de câncer nas citologias indeterminadas foi 18,5% (16% nas lesões foliculares, 44% nas suspeitas). O diagnóstico de malignidade foi 17,2% (n = 70). A frequência de câncer em mulheres (15,2%) foi menor do que em homens (27,9%). Houve uma relação inversa entre idade e risco de câncer. Não houve significância estatística na prevalência de câncer de acordo com número, tamanho dos nódulos ou níveis de TSH. Hipoecogenicidade e microcalcificações ao ultrassom foram fatores de risco. CONCLUSÃO: O risco de malignidade foi maior em homens, nódulos hipoecogênicos, com microcalcificações e inversamente relacionado à idade. O nível de TSH não foi um preditor independente de malignidade. OBJECTIVE: To evaluate the risk of malignancy in thyroid nodules through clinical, laboratory, ultrasonographic and cytological aspects. PATIENTS AND METHODS: 741 nodules of 407 patients. RESULTS: The cytology was benign (60,5%), indeterminate (23,3%), malignant (8,3%) or nondiagnostic (7,6%). The prevalence of cancer in indeterminate citology was 18,5% (16% in follicular lesions, 44% in suspicious). The diagnosis of malignancy was 17,2% (n = 70). The frequency of cancer in women (15,2%) was lower than in men (27,9%). There was an inverse relation between age and cancer risk. There was no statistical significance in the prevalence of cancer according to number, size of nodules or TSH levels. Hypoechogenicity and microcalcifications on ultrasound were risk factors. CONCLUSION: The risk of malignancy was higher in men, hypoechoic nodules, with microcalcifications and was inversely related to age. The TSH level was not an independent factor predictive of malignancy. Universidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Departamento de Medicina Instituto Israelita de Ensino e Pesquisa Albert Einstein Centro de Doenças Tiroidianas Fleury Medicina e Saúde UNIFESP, EPM, Depto. de Medicina SciELO

OBJETIVO: Relatar os efeitos endócrinos tardios em crianças e adolescentes após tratamento oncológico e associá-los à doença de base e ao tratamento. SUJEITOS E MÉTODOS: Foram realizadas avaliações clínicas e laboratoriais visando à detecção de distúrbios endócrinos em 320 pacientes após terapia oncológica, seguidos por seis anos. RESULTADOS: Em 94 pacientes, detectaram-se: 32 pacientes apresentaram baixa estatura (nove em tratamento com hormônio de crescimento), 14 tiveram puberdade precoce (10 em uso de análogo de GnRH) e 19 revelaram ser portadores de distúrbios de tireoide (12 com hipotireoidismo, seis com nódulos de tireoide e um com tireoidite linfocitária crônica). Obesidade foi encontrada em 18 deles. Seis com diabetes insípido e cinco com puberdade atrasada, três com pan-hipopituitarismo. Houve associação entre a radioterapia e a presença de endocrinopatias. CONCLUSÃO: Noventa e quatro de 320 (30%) dos pacientes fora de terapia apresentaram alteração endócrina, o que enfatiza a importância do seguimento precoce e regular, possibilitando-lhes, com tratamento, melhor qualidade de vida. OBJECTIVE: To report the main endocrine effects after cancer treatment in children and adolescents and associate them to the disease and its treatment. SUBJECTS AND METHODS: Clinical and lab evaluation for endocrinopathy was performed in 320 patients after cancer therapy have been followed for six years. RESULTS: The most prevalent endocrine late effects in patients were: 32 patients had short stature, nine of them were under growth hormone therapy. Precocious puberty was found in 14 patients, 10 of them received GnRH analog. Thyroid diseases were present in 19 patients (12 with hypothyroidism; six with thyroid nodules/cysts; one with chronic lymphocytic thyroidytis). Obesity was found in 18 patients. Six presented insipidus diabetes, five delayed puberty and three panhypopituitarism. Radiation was associated with the appearance of the aforementioned endocrinopathies. CONCLUSION: Ninety four of 320 (30%) patients presented endocrine late effects which emphasize the importance for these patients to be regularly followed-up in order to precociously diagnose endocrine late effects and provide them a better quality of life.

OBJETIVO: Avaliar as classificações da vascularização dos nódulos de tireoide ao Doppler colorido descritas por Lagalla e cols. e Chammas e cols. MÉTODOS: Foram estudados 265 nódulos de tireoide com Doppler colorido e citopatologia. RESULTADOS: No diagnóstico de nódulos com citopatologia maligna, os padrões IV e V de Chammas mostraram sensibilidade de 16,7%, especificidade de 97,6%, valor preditivo positivo de 33,3%, valor preditivo negativo de 94,1% e acurácia de 92,1%. O padrão III de Lagalla mostrou sensibilidade de 44,4%, especificidade de 19,4%, valor preditivo positivo de 3,9%, valor preditivo negativo de 82,8% e acurácia de 21,1%. CONCLUSÃO: A classificação de Lagalla mostrou baixas sensibilidade e acurácia na detecção de nódulos com citopatologia maligna, enquanto a classificação de Chammas mostrou alta acurácia, porém baixa sensibilidade. O Doppler colorido mostrou-se insuficiente para substituir a punção com agulha fina e o estudo citopatológico no diagnóstico dos nódulos malignos da tireoide.

The role of intraoperative frozen sections (FS) during thyroidectomy is controversial. AIM: to evaluate the role of FS for thyroid nodules management. PATIENTS AND METHODS: All patients who had thyroid surgery for nodular disease and previous USG-guided FNAB in 2006 were prospectively analyzed. They underwent intraoperative FS evaluation, and the biopsy material was classified as benign, malignant or follicular neoplasm. FNAB, FS and paraffin sections were compared. RESULTS: Under the FS, 54% of the nodules were benign, 30% were follicular neoplasms, and 16% were malignant. All cases considered benign and malignant under the FS evaluation were confirmed through the histological "paraffin" analysis. Since it is not considered a definitive indication for total thyroidectomy, if the follicular neoplasms were classified as "benign" under the FS, their sensitivity, specificity, positive and negative predictive values and global diagnostic accuracy were 69%, 100%, 100%, 91,5% e 77%, respectively. Among the 42 cases classified as "follicular neoplasm" under the FNAB, in 1 case the FS conclusion was for papillary carcinoma, in 3 cases as benign (all confirmed through the "paraffin"); and 38 cases continued as "follicular pattern", being 29 follicular adenomas and 9 carcinomas through the "paraffin". CONCLUSION: The FS is only indicated when the FNAB reports "follicular neoplasm".

Esse artigo tem o objetivo de discutir o papel da tomografia por emissão de pósitrons (PET) com 18F-FDG na avaliação pré-operatória de pacientes com nódulos de tireóide com citologia indeterminada. Para o cálculo da sensibilidade, foram selecionados todos os estudos com pacientes com carcinoma de tireóide. Para o cálculo da especificidade, foram selecionados apenas estudos desenhados para avaliação dos pacientes com nódulos com citologia indeterminada. O achado de captação focal na PET-18F-FDG relacionou-se com a presença de carcinoma de tireóide na maioria dos estudos. A sensibilidade do exame foi bastante alta na detecção de malignidade tireoidiana, porém sua especificidade variou de 0% a 66%, sendo de 39% em estudo brasileiro. Concluindo, os estudos indicam que a PET-18F-FDG pode reduzir o número de tireoidectomias desnecessárias em pacientes com nódulos de tireóide com citologia indeterminada. Entretanto, o percentual relativamente elevado de resultados falso-positivos, o alto custo, a baixa disponibilidade do exame em países em desenvolvimento e a pouca experiência clínica ainda limitam o uso da PET-18F-FDG com essa finalidade. The aim of this article is to discuss the role of 18F-FDG Positron Emission Tomography (PET) in the preoperative evaluation of patients with cytologically indeterminate thyroid nodules. All studies with patients with thyroid cancer were selected to the calculation of sensitivity. Only studies aiming to evaluate patients with thyroid nodules whose cytological result was indeterminate were selected to establish the specificity. The finding of focal 18F-FDG uptake at PET was associated with the presence of thyroid malignancy in most of the studies. The sensitivity of the exam to the detection of thyroid malignancy was extremely high, but the specificity varied from 0 to 66%. In our experience, the specificity was 39%. In conclusion, the studies suggest that 18F-FDG PET can reduce the number of unnecessary thyroidectomies performed in patients with cytologically indeterminate thyroid nodules. However, the relatively high percentage of false positive results, the high costs, the low availability of this exam in developing countries and the low clinical experience still restrict the use of 18F-FDG PET when recommended with this aim.

Com o uso da ultra-sonografia de alta resolução, a prevalência de nódulos tem aumentado e, conseqüentemente, o número de punção aspirativa por agulha fina (PAAF), que é o método de escolha para diagnóstico inicial. Um dos maiores dilemas clínicos para o citologista é o diagnóstico diferencial das lesões foliculares comumente agrupadas na classe padrão folicular. Neste artigo de revisão, discutiremos quais são as lesões que podem ser assim classificadas e os marcadores moleculares, identificados por nós ou por outros grupos, que são capazes de distinguir as lesões benignas das malignas. There are an increasing number of thyroid nodules found by ultrasound and sampled by fine needle aspiration (FNA). A clinical problem is the accurate distinction between benign and malignant forms of follicular lesion. In this review we discuss the thyroid lesions that are common sources of diagnostic error, and grouped together as follicular patterned lesion, and the molecular markers identified by us and others, and that are able to distinguish the benign from the malignant ones.

Os nódulos tireoidianos constituem a principal manifestação clínica de uma série de doenças da tireóide com uma prevalência de aproximadamente 10% na população adulta. O maior desafio é excluir o câncer da tireóide, que ocorre em 5 a 10% dos casos. Os carcinomas diferenciados respondem por 90% dos casos de todas as neoplasias malignas da tireóide. A maioria dos pacientes com carcinoma diferenciado apresenta, geralmente, um bom prognóstico quando tratada adequadamente, com índices de mortalidade similares à população geral. No entanto, alguns indivíduos apresentam doença agressiva, desafiando o conhecimento atual e ilustrando a complexidade do manejo dessa neoplasia. No presente trabalho, reunimos 8 membros do Departamento de Tireóide da Sociedade Brasileira de Endocrinologia & Metabologia, para elaborarmos, por consenso, as diretrizes brasileiras no manejo dos nódulos tireoidianos e do câncer diferenciado da tireóide. Os membros participantes representam diferentes Centros Universitários do Brasil, refletindo diferentes abordagens diagnósticas e terapêuticas. Inicialmente, cada participante ficou responsável pela redação de determinado tema a ser enviado ao Coordenador, que, após revisão editorial e elaboração da primeira versão do manuscrito, enviou ao grupo para sugestões e aperfeiçoamentos. Quando concluído, o manuscrito foi novamente enviado e revisado por todos. A elaboração dessas diretrizes foi baseada na experiência dos participantes e revisão pertinente da literatura. Thyroid nodules are a common manifestation of thyroid diseases. It is estimated that ~10% of adults have palpable thyroid nodules with the frequency increasing throughout life. The major concern on nodule evaluation is the risk of malignancy (5-10%). Differentiated thyroid carcinoma accounts for 90% of all thyroid malignant neoplasias. Although most patients with cancer have a favorable outcome, some individuals present an aggressive form of the disease and poor prognostic despite recent advances in diagnosis and treatment. Here, a set of clinical guidelines for the evaluation and management of patients with thyroid nodules or differentiated thyroid cancer was developed through consensus by 8 member of the Department of Thyroid, Sociedade Brasileira de Endocrinologia e Metabologia. The participants are from different reference medical centers within Brazil, to reflect different practice patterns. Each committee participant was initially assigned to write a section of the document and to submit it to the chairperson, who revised and assembled the sections into a complete draft document, which was then circulated among all committee members for further revision. All committee members further revised and refined the document. The guidelines were developed based on the expert opinion of the committee participants, as well as on previously published information.

A injeção percutânea de etanol (IPE) guiada por ultra-som tem sido utilizada para o tratamento de nódulos tiroidianos autônomos, sólidos e císticos. Apresentamos nossa experiência em 50 pacientes tratados, sendo 26 portadores de nódulos sólidos, 17 de nódulos císticos e 7 de nódulos autônomos (NA). Avaliamos os pacientes 1 semana, 1 mês, 3 meses, 6 meses e 1 ano após a IPE. Após 1 ano, os nódulos sólidos reduziram a 74% do volume inicial, os císticos diminuíram 92% sem apresentar recidivas. Um ano após o tratamento dos nódulos autônomos, 5 pacientes estavam em eutiroidismo clínico e laboratorial e 2 em eutiroidismo mas com TSH subnormal. Não houve recorrência da tirotoxicose e a redução nodular foi de 66%. O procedimento foi bem tolerado por todos. Os resultados confirmam que a IPE é uma boa alternativa terapêutica para redução dos nódulos tiroidianos císticos e sólidos e no tratamento dos nódulos autônomos. Percutaneous ethanol injection (PEI) guided by ultrasound has been used for the treatment of cystic, solid and autonomous thyroid nodules. We present our experience in the treatment of 50 patients with thyroid nodules: 26 solid, 17 cystic and 7 autonomous (AN). Patients were evaluated 1 week, 1, 3, and 6 months and 1 year after PEI. After one year, solid nodules showed a mean 74% volume reduction, and cysts a volume reduction of 92%, with no recurrences. After one year, 5 patients with AN reached clinical and laboratory euthyroidism; the other 2 also became euthyroid, but with subnormal TSH. Recurrence of thyrotoxicosis was not observed and mean nodular reduction was 66%. The procedure was well tolerated by all patients. The results confirm that PEI is a good therapeutic alternative for reduction of solid and cystic thyroid nodules and for the treatment of autonomous nodules. Universidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Departamento de Medicina UNIFESP, EPM, Depto. de Medicina SciELO

O objetivo deste trabalho foi estudar a prevalência de bócio e nódulos em uma população com mais de 50 anos, comparando-a com grupo controle composto pelos filhos. Para isso, foram avaliados 101 indivíduos (19M / 82 F) com idades entre 51 e 85 anos e 65 filhos (18 M / 47 F) com idades entre 14 e 50 anos. Utilizamos o ultra-som para diagnóstico de bócio e nódulos, mas foi feita, também, avaliação clínica com palpação da tiróide. A prevalência de bócio e nódulos foi maior nos indivíduos com mais de 50 anos (15,8% e 18,8%, respectivamente), do que nos filhos (3,1% e 7,7%, respectivamente), Não observamos correlação entre volume tiroideano e idade. A palpação da tiróide se mostrou pouco sensível para detecção de bócio e nódulos, mas com alta especificidade. Concluímos que a prevalência de bócio e nódulos é maior na população com mais de 50 anos, embora sem correlação entre volume tiroideano e idade. O ultra-som se mostrou melhor que a palpação isoladamente, na detecção de alterações do volume e presença de nódulos tiroideanos. The aim of this study was to determine the prevalence of goiter and thyroid nodules in a population aged 50 years and older, matching with a younger control group, their offspring. We studied 101 subjects (19M/82F), 51 to 85 years and 65 offspring (18M / 47F), 14 to 50 years of age. Ultrasound was used to identify goiter and thyroid nodules, but all thyroids were also evaluated by palpation. The prevalence of goiter and thyroid nodules were higher in the older group (15.8% and 18.8%, respectively) as compared to their offspring (3.1% and 7,7%, respectively). No correlation was found between thyroid volume and age. Thyroid palpation has poor sensitivity but high specificity in identifying goiter and nodules. We conclude that goiter and nodules are more prevalent in the elderly, with no correlation between thyroid volume and age. Ultrasound was better than thyroid palpation to detect goiter and nodules.

Nódulos de tireóide são uma condição clínica comum e em seu diagnóstico diferencial inclui-se o câncer de tireóide. Como o câncer de tireóide é raro, é importante conhecer a prevalência de nódulos de tireóide em grupos fortemente pre-dispostos para dimensionar seu impacto e adequar estratégias diagnósticas. OBJETIVOS: O objetivo deste estudo foi verificar a prevalência de nódulos de tireóide diagnosticados por ecografia em mulheres na maturidade. MÉTODOS: Entre agosto de 1996 e dezembro de 1997 foram avaliadas, de forma consecutiva, pacientes do sexo feminino com idade de 40 anos ou mais que realizavam ecografia no Serviço de Radiologia do HCPA. Foram excluídas as mulheres encaminhadas para exame de tireóide. As 207 pacientes examinadas tiveram média de idade de 54,7 anos (mediana: 53 anos com mínimo de 40 e máximo de 86 anos). Cento e vinte e três (59,4%) apresentaram tireóide normal e 82 (39,6%) tiveram alguma alteração na glândula. CONCLUSÕES: Alterações nodulares foram encontradas em 73 (35,3%) mulheres, e 35 (16,9%) portavam nódulos tireoidianos com 1 cm ou mais. As mulheres sem nódulos de tireóide eram mais jovens (53,1 ± 10,7 anos) que as que apresentavam nódulos tireoidianos (58,2 ± 10,6 anos), p=0,001 e houve aumento do número de quaisquer nódulos (p=0.001) ou de nódulos maior que 1 cm (p=0.007) com o aumento da idade. Assim sendo, nódulos de tireóide são muito comuns em mulheres com 40 anos ou mais, a sua prevalência aumenta com a idade nesse grupo etário, e eles são potencialmente palpáveis (maiores que 1 cm) em 1 em cada 6 mulheres nesta faixa etária. É importante que tenhamos esses dados em mente quando indicamos avaliação ecográfica da tireóide em mulheres com 40 anos ou mais. OBJECTIVES: Thyroid nodules constitute a very common clinical problem and the differential diagnosis includes thyroid cancer. As thyroid cancer is rare, it is important to know the prevalence of thyroid nodules in cohorts strongly predisposed to this problem to be able to measure its impact on the health care system, and to devise appropriate diagnostic strategies. The aim of this study was to determine the prevalence of thyroid nodules in women 40 year-old or older by ecography. METHODS: Between August 1996 and December 1997, 207 women, 40 year-old or older, were consecutively evaluated by thyroid ecography in the Radiology Division of the Hospital de Clínicas de Porto Alegre. Patients who came to the Division to be submitted to thyroid ecography were excluded. The mean age of patients studied was 54.7 years (median: 53, range: 40-86 years). One hundred and twenty three patients (54.9%) had a normal thyroid and eighty-two had an abnormal gland (39.6%). Thyroid nodules were detected in seventy-three women (35.3%) and these were larger than 1 cm in 35 women (16.9%). Women without thyroid nodules were younger (53.1 ±10.7 years) than women with thyroid nodules (58.2 ±10.6 years) p=0.001; and the prevalence of any thyroid nodule (p=0.001) or nodules larger than 1 cm (p=0.007) increased with age. CONCLUSIONS: Thyroid nodules are very common in women 40 year-old or older, their prevalence increases with age in this cohort and these nodules are potentially palpable (larger than one cm) in one of six women in this age group It is important to have these data in mind when ordering thyroid ecographic studies in women 40 year-old or older.