ACAF, tiroiditis de Hashimoto y cáncer de tiroides: estudio de rendimiento diagnóstico en un hospital universitario

ilustraciones, gráficas, tablas

Autores:: González Villa, Ana María

Tipo de recurso:

Fecha de publicación:: 2022

Institución:: Universidad Nacional de Colombia

Repositorio:: Universidad Nacional de Colombia

Idioma:: spa

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dc.title.spa.fl_str_mv	ACAF, tiroiditis de Hashimoto y cáncer de tiroides: estudio de rendimiento diagnóstico en un hospital universitario
dc.title.translated.eng.fl_str_mv	FNAB, Hashimoto thyroiditis and thyroid cancer: diagnostic performance study in a university hospital
title	ACAF, tiroiditis de Hashimoto y cáncer de tiroides: estudio de rendimiento diagnóstico en un hospital universitario
spellingShingle	ACAF, tiroiditis de Hashimoto y cáncer de tiroides: estudio de rendimiento diagnóstico en un hospital universitario 610 - Medicina y salud::616 - Enfermedades Enfermedades de la Tiroides Enfermedad de Hashimoto Biopsia con Aguja Fina Thyroid Diseases Hashimoto Disease Biopsy, Fine-Needle Thyroidectomy Thyroid cancer Ultrasonography Hashimoto Disease Aspiration biopsy, fine needle Ultrasonografía Neoplasias de la tiroides Tiroiditis de Hashimoto Tiroidectomía Biopsia por aspiración con aguja fina
title_short	ACAF, tiroiditis de Hashimoto y cáncer de tiroides: estudio de rendimiento diagnóstico en un hospital universitario
title_full	ACAF, tiroiditis de Hashimoto y cáncer de tiroides: estudio de rendimiento diagnóstico en un hospital universitario
title_fullStr	ACAF, tiroiditis de Hashimoto y cáncer de tiroides: estudio de rendimiento diagnóstico en un hospital universitario
title_full_unstemmed	ACAF, tiroiditis de Hashimoto y cáncer de tiroides: estudio de rendimiento diagnóstico en un hospital universitario
title_sort	ACAF, tiroiditis de Hashimoto y cáncer de tiroides: estudio de rendimiento diagnóstico en un hospital universitario
dc.creator.fl_str_mv	González Villa, Ana María
dc.contributor.advisor.spa.fl_str_mv	Maldonado Acosta, Luis Miguel
dc.contributor.author.spa.fl_str_mv	González Villa, Ana María
dc.subject.ddc.spa.fl_str_mv	610 - Medicina y salud::616 - Enfermedades
topic	610 - Medicina y salud::616 - Enfermedades Enfermedades de la Tiroides Enfermedad de Hashimoto Biopsia con Aguja Fina Thyroid Diseases Hashimoto Disease Biopsy, Fine-Needle Thyroidectomy Thyroid cancer Ultrasonography Hashimoto Disease Aspiration biopsy, fine needle Ultrasonografía Neoplasias de la tiroides Tiroiditis de Hashimoto Tiroidectomía Biopsia por aspiración con aguja fina
dc.subject.decs.spa.fl_str_mv	Enfermedades de la Tiroides Enfermedad de Hashimoto Biopsia con Aguja Fina
dc.subject.decs.eng.fl_str_mv	Thyroid Diseases Hashimoto Disease Biopsy, Fine-Needle
dc.subject.proposal.eng.fl_str_mv	Thyroidectomy Thyroid cancer Ultrasonography Hashimoto Disease Aspiration biopsy, fine needle Ultrasonografía
dc.subject.proposal.spa.fl_str_mv	Neoplasias de la tiroides Tiroiditis de Hashimoto Tiroidectomía Biopsia por aspiración con aguja fina
description	ilustraciones, gráficas, tablas
publishDate	2022
dc.date.accessioned.none.fl_str_mv	2022-02-10T14:34:53Z
dc.date.available.none.fl_str_mv	2022-02-10T14:34:53Z
dc.date.issued.none.fl_str_mv	2022-01-26
dc.type.spa.fl_str_mv	Trabajo de grado - Especialidad Médica
dc.type.driver.spa.fl_str_mv	info:eu-repo/semantics/masterThesis
dc.type.version.spa.fl_str_mv	info:eu-repo/semantics/acceptedVersion
dc.type.content.spa.fl_str_mv	Text
dc.type.redcol.spa.fl_str_mv	http://purl.org/redcol/resource_type/TM
status_str	acceptedVersion
dc.identifier.uri.none.fl_str_mv	https://repositorio.unal.edu.co/handle/unal/80929
dc.identifier.instname.spa.fl_str_mv	Universidad Nacional de Colombia
dc.identifier.reponame.spa.fl_str_mv	Repositorio Institucional Universidad Nacional de Colombia
dc.identifier.repourl.spa.fl_str_mv	https://repositorio.unal.edu.co/
url	https://repositorio.unal.edu.co/handle/unal/80929 https://repositorio.unal.edu.co/
identifier_str_mv	Universidad Nacional de Colombia Repositorio Institucional Universidad Nacional de Colombia
dc.language.iso.spa.fl_str_mv	spa
language	spa
dc.relation.indexed.spa.fl_str_mv	Bireme
dc.relation.references.spa.fl_str_mv	la Vecchia C, Malvezzi M, Bosetti C, et al. Thyroid cancer mortality and incidence: A global overview. International Journal of Cancer. 2015;136(9). doi:10.1002/ijc.29251 Hernández-Flórez CE. Cáncer de tiroides en Colombia, un común desconocido. MEDUIS. 2018;31(3):9-11. Romero-Rojas A, Cuervo-Martínez J, Osorio-Arango K, Olaya N. Variantes histológicas y factores pronósticos del carcinoma papilar de tiroides en el Instituto Nacional de Cancerología de Colombia, 2006-2012. Biomédica. 2015;35(3). doi:10.7705/biomedica.v35i3.2598 Instituto Nacional de Cancerología. Cáncer En Cifras.; 2020. Accessed November 6, 2021. https://www.cancer.gov.co/recursos_user/sites/default/files/infografias/archivos/INFOGRAFIA_CANCER_EN_CIFRAS.pdf Rusinek D, Chmielik E, Krajewska J, et al. Current Advances in Thyroid Cancer Management. Are We Ready for the Epidemic Rise of Diagnoses? 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Pattern Recognition of Benign Nodules at Ultrasound of the Thyroid: Which Nodules Can Be Left Alone? American Journal of Roentgenology. 2009;193(1). doi:10.2214/AJR.08.1820 Wang C, Crapo LM. THE EPIDEMIOLOGY OF THYROID DISEASE AND IMPLICATIONS FOR SCREENING. Endocrinology and Metabolism Clinics of North America. 1997;26(1). doi:10.1016/S0889-8529(05)70240-1 Bakhos R, Selvaggi SM, DeJong S, et al. Fine-needle aspiration of the thyroid: Rate and causes of cytohistopathologic discordance. Diagnostic Cytopathology. 2000;23(4). doi:10.1002/1097-0339(200010)23:4<233::AID-DC3>3.0.CO;2-L Bujang MA, Adnan TH. Requirements for Minimum Sample Size for Sensitivity and Specificity Analysis. Journal of clinical and diagnostic research : JCDR. 2016;10(10). doi:10.7860/JCDR/2016/18129.8744 Hoang JK, Lee WK, Lee M, Johnson D, Farrell S. US Features of Thyroid Malignancy: Pearls and Pitfalls. RadioGraphics. 2007;27(3). doi:10.1148/rg.273065038 Lloyd RV, Osamura RY, Klöppel G, Rosai J. WHO Classification of Tumours of Endocrine Organs. In: WHO Classification of Tumours. Vol 10. 4rth Edition. ; 2017:66-143. Patel KN, Yip L, Lubitz CC, et al. The American Association of Endocrine Surgeons Guidelines for the Definitive Surgical Management of Thyroid Disease in Adults. Annals of Surgery. 2020;271(3). doi:10.1097/SLA.0000000000003580 Feldkamp J, Führer D, Luster M, Musholt TJ, Spitzweg C, Schott M. Fine Needle Aspiration in the Investigation of Thyroid Nodules. Deutsches Aerzteblatt Online. Published online May 20, 2016. doi:10.3238/arztebl.2016.0353 Taki S, Terahata S, Yamashita R, et al. Thyroid calcifications. Clinical Imaging. 2004;28(5). doi:10.1016/S0899-7071(03)00190-6 Chan BK, Desser TS, McDougall IR, Weigel RJ, Jeffrey RB. Common and Uncommon Sonographic Features of Papillary Thyroid Carcinoma. Journal of Ultrasound in Medicine. 2003;22(10). doi:10.7863/jum.2003.22.10.1083 Papini E, Guglielmi R, Bianchini A, et al. Risk of Malignancy in Nonpalpable Thyroid Nodules: Predictive Value of Ultrasound and Color-Doppler Features. The Journal of Clinical Endocrinology & Metabolism. 2002;87(5). doi:10.1210/jcem.87.5.8504 Frates MC, Benson CB, Doubilet PM, Cibas ES, Marqusee E. Can Color Doppler Sonography Aid in the Prediction of Malignancy of Thyroid Nodules? Journal of Ultrasound in Medicine. 2003;22(2). doi:10.7863/jum.2003.22.2.127 Frates MC, Benson CB, Charboneau JW, et al. Management of Thyroid Nodules Detected at US: Society of Radiologists in Ultrasound Consensus Conference Statement. Radiology. 2005;237(3). doi:10.1148/radiol.2373050220 Kim EK, Park CS, Chung WY, et al. New Sonographic Criteria for Recommending Fine-Needle Aspiration Biopsy of Nonpalpable Solid Nodules of the Thyroid. American Journal of Roentgenology. 2002;178(3). doi:10.2214/ajr.178.3.1780687 Lu C, Chang TC, Hsiao YL, Kuo MS. Ultrasonographic findings of papillary thyroid carcinoma and their relation to pathologic changes. Journal of the Formosan Medical Association = Taiwan yi zhi. 93(11-12). Watters DAK, Ahuja AT, Evans RM, et al. Role of ultrasound in the management of thyroid nodules. The American Journal of Surgery. 1992;164(6). doi:10.1016/S0002-9610(05)80728-7 Cheng SP, Lee JJ, Lin JL, Chuang SM, Chien MN, Liu CL. Characterization of thyroid nodules using the proposed thyroid imaging reporting and data system (TI-RADS). Head & Neck. 2013;35(4). doi:10.1002/hed.22985 Jabar ASS, Koteshwara P, Andrade J. Diagnostic reliability of the Thyroid Imaging Reporting and Data System (TI-RADS) in routine practice. Polish Journal of Radiology. 2019;84. doi:10.5114/pjr.2019.86823 Skowrońska A, Milczarek-Banach J, Wiechno W, et al. Accuracy of the European Thyroid Imaging Reporting and Data System (EU-TIRADS) in the valuation of thyroid nodule malignancy in reference to the post-surgery histological results. Polish Journal of Radiology. 2018;83. doi:10.5114/pjr.2018.81556 Tessler FN, Middleton WD, Grant EG, et al. ACR Thyroid Imaging, Reporting and Data System (TI-RADS): White Paper of the ACR TI-RADS Committee. Journal of the American College of Radiology. 2017;14(5). doi:10.1016/j.jacr.2017.01.046 Mincer DL, Jialal I. Hashimoto Thyroiditis.; 2021. American Thyroid Association (ATA) Guidelines Taskforce on Thyroid Nodules and Differentiated Thyroid Cancer, Cooper DS, Doherty GM, et al. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid : official journal of the American Thyroid Association. 2009;19(11). doi:10.1089/thy.2009.0110 Gan T, Randle RW. The Role of Surgery in Autoimmune Conditions of the Thyroid. Surgical Clinics of North America. 2019;99(4). doi:10.1016/j.suc.2019.04.005 Pradeep P, Ragavan M, Ramakrishna B, Jayasree B, Skandha S. Surgery in Hashimoto′s thyroiditis: Indications, complications, and associated cancers. Journal of Postgraduate Medicine. 2011;57(2). doi:10.4103/0022-3859.81867 Uhliarova B, Hajtman A. Hashimoto’s thyroiditis – an independent risk factor for papillary carcinoma. Brazilian Journal of Otorhinolaryngology. 2018;84(6). doi:10.1016/j.bjorl.2017.08.012 Mazokopakis EE, Tzortzinis AA, Dalieraki-Ott EI, et al. Coexistence of Hashimoto’s thyroiditis with papillary thyroid carcinoma. A retrospective study. Hormones (Athens, Greece). 9(4). doi:10.14310/horm.2002.1282 Erdogan M, Erdem N, Cetinkalp S, et al. Demographic, clinical, laboratory, ultrasonographic, and cytological features of patients with Hashimoto’s thyroiditis: results of a university hospital of 769 patients in Turkey. Endocrine. 2009;36(3). doi:10.1007/s12020-009-9258-z Wu G. Ultrasonography in diagnosis of Hashimoto rsquo s thyroiditis. Frontiers in Bioscience. 2016;21(5). doi:10.2741/4437 Yeh HC, Futterweit W, Gilbert P. Micronodulation: ultrasonographic sign of Hashimoto thyroiditis. Journal of Ultrasound in Medicine. 1996;15(12). doi:10.7863/jum.1996.15.12.813 Gul K, Dirikoc A, Kiyak G, et al. The Association Between Thyroid Carcinoma and Hashimoto’s Thyroiditis: The Ultrasonographic and Histopathologic Characteristics of Malignant Nodules. Thyroid. 2010;20(8). doi:10.1089/thy.2009.0118 Consorti F, Loponte M, Milazzo F, Potasso L, Antonaci A. Risk of Malignancy from Thyroid Nodular Disease as an Element of Clinical Management of Patients with Hashimoto’s Thyroiditis. European Surgical Research. 2010;45(3-4). doi:10.1159/000320954 Pisanu A, Piu S, Cois A, Uccheddu A. Coexisting Hashimoto’s thyroiditis with differentiated thyroid cancer and benign thyroid diseases: indications for thyroidectomy. Chirurgia italiana. 55(3). Shih ML, Lee JA, Hsieh CB, et al. Thyroidectomy for Hashimoto’s Thyroiditis: Complications and Associated Cancers. Thyroid. 2008;18(7). doi:10.1089/thy.2007.0384 Singh B, Shaha AR, Trivedi H, Carew JF, Poluri A, Shah JP. Coexistent Hashimoto’s thyroiditis with papillary thyroid carcinoma: Impact on presentation, management, and outcome. Surgery. 1999;126(6). doi:10.1067/msy.2099.101431 Kebebew E, Treseler PA, Ituarte PHG, Clark OH. Coexisting Chronic Lymphocytic Thyroiditis and Papillary Thyroid Cancer Revisited. World Journal of Surgery. 2001;25(5). doi:10.1007/s002680020165 Ho AS, Sarti EE, Jain KS, et al. Malignancy Rate in Thyroid Nodules Classified as Bethesda Category III (AUS/FLUS). Thyroid. 2014;24(5). doi:10.1089/thy.2013.0317 Cibas ES, Ali SZ. The 2017 Bethesda System for Reporting Thyroid Cytopathology. Thyroid. 2017;27(11). doi:10.1089/thy.2017.0500 Yaprak Bayrak B, Eruyar AT. Malignancy rates for Bethesda III and IV thyroid nodules: a retrospective study of the correlation between fine-needle aspiration cytology and histopathology. BMC Endocrine Disorders. 2020;20(1). doi:10.1186/s12902-020-0530-9 Larsen LV, Egset AV, Holm C, et al. Thyroid fine-needle aspiration and The Bethesda Classification System. Danish medical journal. 2018;65(3). Naz S, Hashmi A, khurshid A, et al. Diagnostic accuracy of Bethesda system for reporting thyroid cytopathology: an institutional perspective. International Archives of Medicine. 2014;7(1). doi:10.1186/1755-7682-7-46 Musani MA, Khan FA, Malik S, Khambaty Y. Fine needle aspiration cytology: sensitivity and specificity in thyroid lesions. Journal of Ayub Medical College, Abbottabad : JAMC. 23(1). Čáp, Ryška, Řehořková, Hovorková, Kerekes, Pohnětalová. Sensitivity and specificity of the fine needle aspiration biopsy of the thyroid: clinical point of view. Clinical Endocrinology. 1999;51(4). doi:10.1046/j.1365-2265.1999.00847.x Lan L, Luo Y, Zhou M, et al. Comparison of Diagnostic Accuracy of Thyroid Cancer With Ultrasound-Guided Fine-Needle Aspiration and Core-Needle Biopsy: A Systematic Review and Meta-Analysis. Frontiers in Endocrinology. 2020;11. doi:10.3389/fendo.2020.00044 Georgescu R, Oprea AL, Contra A, Hanko OB, Colcer I, Coroș MF. The Sensitivity and Specificity of Fine-Needle Aspiration in Thyroid Neoplasia. Journal of Interdisciplinary Medicine. 2017;2(2). doi:10.1515/jim-2017-0047 Menegassi J, Bordin V, Santos Oliveira S. Diagnostic accuracy between fine needle aspiration biopsy (FNA) and pathological examination of the thyroid. J Bras Patol Med Lab. Published online 2013:228-293.
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dc.rights.license.spa.fl_str_mv	Atribución-NoComercial-CompartirIgual 4.0 Internacional
dc.rights.uri.spa.fl_str_mv	http://creativecommons.org/licenses/by-nc-sa/4.0/
dc.rights.accessrights.spa.fl_str_mv	info:eu-repo/semantics/openAccess
rights_invalid_str_mv	Atribución-NoComercial-CompartirIgual 4.0 Internacional http://creativecommons.org/licenses/by-nc-sa/4.0/ http://purl.org/coar/access_right/c_abf2
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dc.format.extent.spa.fl_str_mv	38 páginas
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dc.publisher.spa.fl_str_mv	Universidad Nacional de Colombia
dc.publisher.program.spa.fl_str_mv	Bogotá - Medicina - Especialidad en Endocrinología
dc.publisher.department.spa.fl_str_mv	Departamento de Medicina Interna
dc.publisher.faculty.spa.fl_str_mv	Facultad de Medicina
dc.publisher.place.spa.fl_str_mv	Bogotá, Colombia
dc.publisher.branch.spa.fl_str_mv	Universidad Nacional de Colombia - Sede Bogotá
institution	Universidad Nacional de Colombia
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spelling	Atribución-NoComercial-CompartirIgual 4.0 Internacionalhttp://creativecommons.org/licenses/by-nc-sa/4.0/info:eu-repo/semantics/openAccesshttp://purl.org/coar/access_right/c_abf2Maldonado Acosta, Luis Miguel3c245ccb4381a1a7d3e7103850940281González Villa, Ana Maríaeb474addb9afaa5f76c2a2c6f24bc2e56002022-02-10T14:34:53Z2022-02-10T14:34:53Z2022-01-26https://repositorio.unal.edu.co/handle/unal/80929Universidad Nacional de ColombiaRepositorio Institucional Universidad Nacional de Colombiahttps://repositorio.unal.edu.co/ilustraciones, gráficas, tablasObjetivo Evaluar el rendimiento diagnóstico del ACAF de tiroides al comparar con el Gold Standard, la patología de la tiroidectomía y describir en ella la frecuencia de tiroiditis de Hashimoto en los especímenes de patología. Métodos Se realizó un estudio descriptivo retrospectivo de una muestra de tiroidectomías realizadas por el equipo de cirugía de cabeza y cuello del Hospital Universitario Nacional de Colombia desde 2016 a 2021. Se obtuvo el ACAF de nódulo tiroideo prequirúrgico y la última ecografía prequirúrgica de los pacientes llevados a estos procedimientos en quienes se sospechaba malignidad, para realizar una descripción demográfica y búsqueda de prevalencia de cáncer de tiroides y de tiroiditis de Hashimoto. Finalmente se realizó un estudio de rendimiento diagnóstico del ACAF prequirúrgico al compararlo con el espécimen quirúrgico. Resultados De 465 especímenes de tiroidectomía se encontraron 322 casos de cáncer (ca) papilar, 5 foliculares, 3 medulares, 2 oncocíticos y 4 malignidades diferentes a cáncer de tiroides (paraganglioma, en clasificación y metástasis de ca escamocelular). Entre los hallazgos ecográficos prequirúrgicos más predominantes se encontraron los nódulos hipoecoicos (n=191), con calcificaciones (n=230), vascularizados (n=155), con márgenes irregulares (n=128), TIRADS 4 (n=124), mayores de 1 cm (n=186). Se encontró asociación estadística con malignidad en las primeras 4 características. No se encontró una asociación significativa entre Tiroiditis de Hashimoto y cáncer de tiroides y las dos patologías coexistieron en 16% (n=75) de las tiroidectomías. El rendimiento diagnóstico del ACAF para la detección del cáncer de tiroides tuvo una sensibilidad del 83%, una especificidad del 27%, VPP 75%, VPN 37% combinando Beth V y VI y en solitario se encontró la sensibilidad más alta en el Bethesda V (73%). Conclusión Se encontraron frecuencias de malignidad más altas y un rendimiento diagnóstico inferior al esperado del ACAF, lo que probablemente se atribuye a los criterios de inclusión y a la alta sospecha de malignidad para llevar a cabo las tiroidectomías. Existen dificultades en la selección del nódulo y en la interpretación de la citología prequirúrgica, lo que puede explicar el alto número de especímenes quirúrgicos que resultaron en malignidad. (Texto tomado de la fuente).Objective: To evaluate the diagnostic performance of the thyroid nodule FNAB compared to the Gold Standard, the thyroidectomy, and describe the frequency of Hashimoto Thyroiditis in the surgical specimens. Methods This is a retrospective descriptive study of a sample of thyroidectomies performed by the head and neck surgery team of the National University Hospital of Colombia since 2016 to 2021. The pre-surgical thyroid nodule FNAB was obtained, and the last thyroid ultrasonography of patients taken to thyroidectomy by suspicion of underlying malignancy, to make a demographic description and search for the prevalence of thyroid cancer and Hashimoto thyroiditis. Finally, a diagnostic performance study was conducted comparing the pre-surgical FNAB to the surgical specimen. Results From 465 surgical specimens, 322 cases of papillary thyroid cancer were found, as well as 5 follicular, 3 medullary, 2 oncocytic and 4 malignancies different from thyroid cancer (paraganglioma, non-classified neoplasia and squamous carcinoma metastases). Within the most predominant ultrasonographic findings of the nodules: hypoechoic (n=191), with calcifications (n=230), vascularized (n=155), irregular margins (n=128), TIRADS 4 (n=124), bigger than 1 cm (n=186). Statistically significant association with malignancy was found in the first 4 characteristics. There was no significant association found between Hashimoto thyroiditis and thyroid cancer and the two pathologies coexisted in 16% (n=75) of the thyroidectomies. The diagnostic performance of the FNAB for the detection of thyroid cancer had a sensitivity of 83%, a specificity of 27%, PPV 75%, NPV 37% by combining Bethesda V and VI and in solitary the highest sensitivity was found on Bethesda V (73%). Conclusion Higher malignancy frequencies and an inferior-than-expected diagnostic performance of the FNAB were found, which is probably attributed to the inclusion criteria and the high malignancy suspicion that led to thyroidectomy. There are also difficulties in the selection of the nodule and in the interpretation of the pre-surgical cytology, which can explain the high number of surgical specimens that resulted in malignancy.Especialidades MédicasEspecialista en EndocrinologíaSe realizó un estudio descriptivo retrospectivo de una muestra de tiroidectomías realizadas por el equipo de cirugía de cabeza y cuello del Hospital Universitario Nacional de Colombia desde 2016 a 2021. Se obtuvo el ACAF de nódulo tiroideo prequirúrgico y la última ecografía prequirúrgica de los pacientes llevados a estos procedimientos en quienes se sospechaba malignidad, para realizar una descripción demográfica y búsqueda de prevalencia de cáncer de tiroides y de tiroiditis de Hashimoto. Finalmente se realizó un estudio de rendimiento diagnóstico del ACAF prequirúrgico al compararlo con el espécimen quirúrgico.38 páginasapplication/pdfspaUniversidad Nacional de ColombiaBogotá - Medicina - Especialidad en EndocrinologíaDepartamento de Medicina InternaFacultad de MedicinaBogotá, ColombiaUniversidad Nacional de Colombia - Sede Bogotá610 - Medicina y salud::616 - EnfermedadesEnfermedades de la TiroidesEnfermedad de HashimotoBiopsia con Aguja FinaThyroid DiseasesHashimoto DiseaseBiopsy, Fine-NeedleThyroidectomyThyroid cancerUltrasonographyHashimoto DiseaseAspiration biopsy, fine needleUltrasonografíaNeoplasias de la tiroidesTiroiditis de HashimotoTiroidectomíaBiopsia por aspiración con aguja finaACAF, tiroiditis de Hashimoto y cáncer de tiroides: estudio de rendimiento diagnóstico en un hospital universitarioFNAB, Hashimoto thyroiditis and thyroid cancer: diagnostic performance study in a university hospitalTrabajo de grado - Especialidad Médicainfo:eu-repo/semantics/masterThesisinfo:eu-repo/semantics/acceptedVersionTexthttp://purl.org/redcol/resource_type/TMBiremela Vecchia C, Malvezzi M, Bosetti C, et al. 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Published online 2013:228-293.InvestigadoresPúblico generalORIGINAL1013629569.2022.pdf1013629569.2022.pdfTesis de Especialidad en Endocrinologíaapplication/pdf1373930https://repositorio.unal.edu.co/bitstream/unal/80929/1/1013629569.2022.pdf2812839304b8e98cce30594619aa0323MD51LICENSElicense.txtlicense.txttext/plain; charset=utf-84074https://repositorio.unal.edu.co/bitstream/unal/80929/2/license.txt8153f7789df02f0a4c9e079953658ab2MD52THUMBNAIL1013629569.2022.pdf.jpg1013629569.2022.pdf.jpgGenerated Thumbnailimage/jpeg6696https://repositorio.unal.edu.co/bitstream/unal/80929/3/1013629569.2022.pdf.jpgfdc5f3239ebc13c73f7d30c81fb565c1MD53unal/80929oai:repositorio.unal.edu.co:unal/809292023-07-31 23:04:38.483Repositorio Institucional Universidad Nacional de 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EVESURBIFBPUiBMQSBTRUNSRVRBUsONQSBHRU5FUkFMLiAqTEEgVEVTSVMgQSBQVUJMSUNBUiBERUJFIFNFUiBMQSBWRVJTScOTTiBGSU5BTCBBUFJPQkFEQS4gCgpBbCBoYWNlciBjbGljIGVuIGVsIHNpZ3VpZW50ZSBib3TDs24sIHVzdGVkIGluZGljYSBxdWUgZXN0w6EgZGUgYWN1ZXJkbyBjb24gZXN0b3MgdMOpcm1pbm9zLiBTaSB0aWVuZSBhbGd1bmEgZHVkYSBzb2JyZSBsYSBsaWNlbmNpYSwgcG9yIGZhdm9yLCBjb250YWN0ZSBjb24gZWwgYWRtaW5pc3RyYWRvciBkZWwgc2lzdGVtYS4KClVOSVZFUlNJREFEIE5BQ0lPTkFMIERFIENPTE9NQklBIC0gw5psdGltYSBtb2RpZmljYWNpw7NuIDE5LzEwLzIwMjEK

ACAF, tiroiditis de Hashimoto y cáncer de tiroides: estudio de rendimiento diagnóstico en un hospital universitario

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