Perfil clínico, paraclínico e imagenológico de pacientes con nódulos tiroideos atendidos en el Hospital Militar Central

Introducción: El nódulo tiroideo es una entidad común en el contexto de la práctica clínica diaria en todos los niveles de atención primaria. En Colombia existen pocos estudios relacionados con la caracterización de la población con nódulo tiroideo y específicamente carecemos de ellos en la població...

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Autores:: Urquijo, Tatiana Margarita
Carreño, Marisol

Tipo de recurso:: Trabajo de grado de pregrado

Fecha de publicación:: 2020

Institución:: Universidad Militar Nueva Granada

Repositorio:: Repositorio UMNG

Idioma:: spa

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dc.title.spa.fl_str_mv	Perfil clínico, paraclínico e imagenológico de pacientes con nódulos tiroideos atendidos en el Hospital Militar Central
dc.title.translated.spa.fl_str_mv	Clinical, paraclinical and Imagenological profile of patients with thyroid nodules treated at the Central Military Hospital
title	Perfil clínico, paraclínico e imagenológico de pacientes con nódulos tiroideos atendidos en el Hospital Militar Central
spellingShingle	Perfil clínico, paraclínico e imagenológico de pacientes con nódulos tiroideos atendidos en el Hospital Militar Central Thyroid nodule TIRADS Ultrasound Goiter MEDICINA INTERNA NODULO TIROIDEO TIROIDES ENFERMEDADES DE LA TIROIDES Nodulo Tiroideo TIRADS Ecografia Bocio
title_short	Perfil clínico, paraclínico e imagenológico de pacientes con nódulos tiroideos atendidos en el Hospital Militar Central
title_full	Perfil clínico, paraclínico e imagenológico de pacientes con nódulos tiroideos atendidos en el Hospital Militar Central
title_fullStr	Perfil clínico, paraclínico e imagenológico de pacientes con nódulos tiroideos atendidos en el Hospital Militar Central
title_full_unstemmed	Perfil clínico, paraclínico e imagenológico de pacientes con nódulos tiroideos atendidos en el Hospital Militar Central
title_sort	Perfil clínico, paraclínico e imagenológico de pacientes con nódulos tiroideos atendidos en el Hospital Militar Central
dc.creator.fl_str_mv	Urquijo, Tatiana Margarita Carreño, Marisol
dc.contributor.author.none.fl_str_mv	Urquijo, Tatiana Margarita Carreño, Marisol
dc.contributor.other.none.fl_str_mv	Rincón, Oswaldo
dc.subject.keywords.spa.fl_str_mv	Thyroid nodule TIRADS Ultrasound Goiter
topic	Thyroid nodule TIRADS Ultrasound Goiter MEDICINA INTERNA NODULO TIROIDEO TIROIDES ENFERMEDADES DE LA TIROIDES Nodulo Tiroideo TIRADS Ecografia Bocio
dc.subject.decs.spa.fl_str_mv	MEDICINA INTERNA NODULO TIROIDEO TIROIDES ENFERMEDADES DE LA TIROIDES
dc.subject.proposal.spa.fl_str_mv	Nodulo Tiroideo TIRADS Ecografia Bocio
description	Introducción: El nódulo tiroideo es una entidad común en el contexto de la práctica clínica diaria en todos los niveles de atención primaria. En Colombia existen pocos estudios relacionados con la caracterización de la población con nódulo tiroideo y específicamente carecemos de ellos en la población usuaria del sistema de salud en el Hospital Militar Central y el Sistema General de Seguridad Social en Salud (SGSS). Materiales y métodos: Estudio de corte transversal de pacientes con diagnóstico de nódulo tiroideo atendidos en el Hospital Militar Central. Se realizó un muestreo sistemático de todos los pacientes con diagnóstico de nódulo tiroideo. Se realizó un análisis descriptivo mediante medas o medinas en las variables continuas y frecuencias en las variables categóricas, para las variables clínicas, de laboratorio y ecográficas de los pacientes que cumplieron los criterios de selección. Resultados: Se analizaron 166 pacientes, edad mediana 59 años (RIC 49-71), hombres 16,9%, hipertensión 38,5%, dislipidemia 37,8%, bocio 71,7%, se observó un nódulo en el 49,1%, microcalcificaciones 32,9%, hipoecoico 44,4%, un sistema de catalogación de nódulo tiroideo (NT) (abreviado TIRADS del inglés Thyroid Imaging. Reporting and Data System) III y IV 32,9%, respectivamente. Conclusiones: El presente estudio nos permite describir la población de paciente con nódulo tiroideo que asistieron evidenciando una población con hallazgos predominantemente benignos comparable con otras poblaciones, sin embargo, se requiere promover la adherencia el uso de la clasificación de TIRADS ecográfico de acuerdo a los lineamientos nacionales e internacionales.
publishDate	2020
dc.date.accessioned.none.fl_str_mv	2020-10-22T13:00:56Z
dc.date.available.none.fl_str_mv	2020-10-22T13:00:56Z
dc.date.issued.none.fl_str_mv	2020-08-24
dc.type.local.spa.fl_str_mv	Tesis/Trabajo de grado - Monografía - Especialización
dc.type.driver.spa.fl_str_mv	info:eu-repo/semantics/bachelorThesis
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dc.identifier.uri.none.fl_str_mv	http://hdl.handle.net/10654/36717
dc.identifier.instname.spa.fl_str_mv	instname:Universidad Militar Nueva Granada
dc.identifier.reponame.spa.fl_str_mv	reponame:Repositorio Institucional Universidad Militar Nueva Granada
dc.identifier.repourl.spa.fl_str_mv	repourl:https://repository.unimilitar.edu.co
url	http://hdl.handle.net/10654/36717
identifier_str_mv	instname:Universidad Militar Nueva Granada reponame:Repositorio Institucional Universidad Militar Nueva Granada repourl:https://repository.unimilitar.edu.co
dc.language.iso.spa.fl_str_mv	spa
language	spa
dc.relation.references.spa.fl_str_mv	Reiners C, Wegscheider K, Schicha H, Theissen P, Vaupel R, Wrbitzky R, et al. Prevalence of Thyroid Disorders in the Working Population of Germany: Ultrasonography Screening in 96,278 Unselected Employees. Thyroid. 2004 Nov;14(11):926–32. Gharib H, Papini E, Garber JR, Duick DS, Harrell RM, Hegedüs L, et al. American Association Of Clinical Endocrinologists, American College Of Endocrinology, And Associazione Medici Endocrinologi Medical Guidelines For Clinical Practice For The Diagnosis And Management Of Thyroid Nodules – 2016 Update. Endocr Pract. 2016 May;22(Supplement 1):1–60. Xiong Y, Yan L, Nong L, Zheng Y, Li T. Pathological diagnosis of thyroid nodules based on core needle biopsies: comparative study between core needle biopsies and resected specimens in 578 cases. Diagn Pathol. 2019 Dec 2;14(1):10. Rosenbaum MA, McHenry CR. Contemporary management of papillary carcinoma of the thyroid gland. Expert Rev Anticancer Ther. 2009 Mar 10;9(3):317–29. Durante C, Costante G, Lucisano G, Bruno R, Meringolo D, Paciaroni A, et al. The Natural History of Benign Thyroid Nodules. JAMA. 2015 Mar 3;313(9):926. Burch HB, Burman KD, Cooper DS, Hennessey J V., Vietor NO. A 2015 Survey of Clinical Practice Patterns in the Management of Thyroid Nodules. J Clin Endocrinol Metab. 2016 Jul;101(7):2853–62. Burman KD, Wartofsky L. Thyroid Nodules. Solomon CG, editor. N Engl J Med. 2015 Dec 10;373(24):2347–56. Flynn JP, Morawiecki PA, Ayala MA. An Incidental Thyroid Nodule. Ear, Nose Throat J. 2017 Aug 4;96(8):294–6. Dean DS, Gharib H. Epidemiology of thyroid nodules. Best Pract Res Clin Endocrinol Metab. 2008 Dec;22(6):901–11. Angell TE, Vyas CM, Medici M, Wang Z, Barletta JA, Benson CB, et al. Differential Growth Rates of Benign vs. Malignant Thyroid Nodules. J Clin Endocrinol Metab. 2017 Dec 1;102(12):4642–7. Wong R, Farrell SG, Grossmann M. Thyroid nodules: diagnosis and management. Med J Aust. 2018;209(2):92–8. Pemayun TGD. Current Diagnosis and Management of Thyroid Nodules. Acta Med Indones. 2016 Jul;48(3):247–57. Valderrabano P, McIver B. Evaluation and Management of Indeterminate Thyroid Nodules. Cancer Control. 2017 Dec 27;24(5):107327481772923. Singaporewalla RM, Hwee J, Lang TU, Desai V. Clinico-pathological Correlation of Thyroid Nodule Ultrasound and Cytology Using the TIRADS and Bethesda Classifications. World J Surg. 2017 Jul 1;41(7):1807–11. Durante C, Grani G, Lamartina L, Filetti S, Mandel SJ, Cooper DS. The Diagnosis and Management of Thyroid Nodules. JAMA. 2018 Mar 6;319(9):914. Guth S, Theune U, Aberle J, Galach A, Bamberger CM. Very high prevalence of thyroid nodules detected by high frequency (13 MHz) ultrasound examination. Eur J Clin Invest. 2009 Aug;39(8):699–706. Grant EG, Tessler FN, Hoang JK, Langer JE, Beland MD, Berland LL, et al. Thyroid Ultrasound Reporting Lexicon: White Paper of the ACR Thyroid Imaging, Reporting and Data System (TIRADS) Committee. J Am Coll Radiol. 2015 Dec;12(12):1272–9. Hernández-flórez CE. Cáncer de tiroides en Colombia , un común desconocido. Médicas UIS. 2018;31(3):9–11. Bartolotta T V., Midiri M, Runza G, Galia M, Taibbi A, Damiani L, et al. Incidentally discovered thyroid nodules: incidence, and greyscale and colour Doppler pattern in an adult population screened by real-time compound spatial sonography. Radiol Med. 2006 Oct 1;111(7):989–98. Campanella P, Ianni F, Rota CA, Corsello SM, Pontecorvi A. DIAGNOSIS IN ENDOCRINOLOGY: Quantification of cancer risk of each clinical and ultrasonographic suspicious feature of thyroid nodules: a systematic review and meta-analysis. Eur J Endocrinol. 2014 May;170(5):R203–11. Boelaert K, Horacek J, Holder RL, Watkinson JC, Sheppard MC, Franklyn JA. Serum Thyrotropin Concentration as a Novel Predictor of Malignancy in Thyroid Nodules Investigated by Fine-Needle Aspiration. J Clin Endocrinol Metab. 2006 Nov;91(11):4295– 301. Paschou S, Vryonidou A, Goulis DG. Thyroid nodules: Α guide to assessment, treatment and follow-up. Maturitas. 2017;96(2017):1–9. Hong YJ, Son EJ, Kim E-K, Kwak JY, Hong SW, Chang H-S. Positive predictive values of sonographic features of solid thyroid nodule. Clin Imaging. 2010 Mar;34(2):127–33. Papini E, Guglielmi R, Bianchini A, Crescenzi A, Taccogna S, Nardi F, et al. Risk of malignancy in nonpalpable thyroid nodules: predictive value of ultrasound and color- Doppler features. J Clin Endocrinol Metab. 2002 May;87(5):1941–6. Kwak JY, Jung I, Baek JH, Baek SM, Choi N, Choi YJ, et al. Image Reporting and Characterization System for Ultrasound Features of Thyroid Nodules: Multicentric Korean Retrospective Study. Korean J Radiol. 2013;14(1):110. Frates MC, Benson CB, Doubilet PM, Kunreuther E, Contreras M, Cibas ES, et al. Prevalence and Distribution of Carcinoma in Patients with Solitary and Multiple Thyroid Nodules on Sonography. J Clin Endocrinol Metab. 2006 Sep 1;91(9):3411–7. Frates MC, Benson CB, Charboneau JW, Cibas ES, Clark OH, Coleman BG, et al. Management of Thyroid Nodules Detected at US: Society of Radiologists in Ultrasound Consensus Conference Statement. Radiology. 2005 Dec;237(3):794–800. Lee M-J, Kim E-K, Kwak JY, Kim MJ. Partially Cystic Thyroid Nodules on Ultrasound: Probability of Malignancy and Sonographic Differentiation. Thyroid. 2009 Apr;19(4):341–6. Wienke JR, Chong WK, Fielding JR, Zou KH, Mittelstaedt CA. Sonographic Features of Benign Thyroid Nodules. J Ultrasound Med. 2003 Oct;22(10):1027–31. Moon W-J, Baek JH, Jung SL, Kim DW, Kim EK, Kim JY, et al. Ultrasonography and the Ultrasound-Based Management of Thyroid Nodules: Consensus Statement and Recommendations. Korean J Radiol. 2011;12(1):1. Peccin S, de Castro JAS, Furlanetto TW, Furtado APA, Brasil BA, Czepielewski MA. Ultrasonography: Is it useful in the diagnosis of cancer in thyroid nodules? J Endocrinol Invest. 2002;25(1):39–43. Chala AI, Pava R, Franco HI, Álvarez A, Franco A. Criterios ecográficos diagnósticos de neoplasia maligna en el nódulo tiroideo: correlación con la punción por aspiración con aguja fina y la anatomía patológica. Rev Colomb Cirugía. 2013;28(1):15– 23. Horvath E, Majlis S, Rossi R, Franco C, Niedmann JP, Castro A, et al. An Ultrasonogram Reporting System for Thyroid Nodules Stratifying Cancer Risk for Clinical Management. J Clin Endocrinol Metab. 2009 May;94(5):1748–51. Moon W-J, Jung SL, Lee JH, Na DG, Baek J-H, Lee YH, et al. Benign and Malignant Thyroid Nodules: US Differentiation—Multicenter Retrospective Study. Radiology. 2008 Jun;247(3):762–70. Kim E-K, Park CS, Chung WY, Oh KK, Kim DI, Lee JT, et al. New Sonographic Criteria for Recommending Fine-Needle Aspiration Biopsy of Nonpalpable Solid Nodules of the Thyroid. Am J Roentgenol. 2002 Mar;178(3):687–91. Lee YH, Kim DW, In HS, Park JS, Kim SH, Eom JW, et al. Differentiation between Benign and Malignant Solid Thyroid Nodules Using an US Classification System. Korean J Radiol. 2011;12(5):559. Romero-Rojas A, Melo-Uribe MA. Implementación del Sistema Bethesda para el informe de citología aspirativa de tiroides con seguimiento histopatológico: experiencia en un centro de tratamiento de cáncer. Rev Colomb Cancerol. 2014;18(1):3–7. Herrera F, Castañeda S, Costreras S, Fernandez A, Perez E. Rendimiento diagnóstico de la citología por aspiración con aguja fina en pacientes con nódulo tiroideo en la E.S.E. Hospital Universitario del Caribe. Rev Colomb Cir. 2014;24:313–8. Sughayer MA, Abdullah N. The Bethesda System for Reporting Thyroid Cytopathology: A Meta-Analysis. Acta Cytol. 2017;61(2):172–172. Anda E, Ernaga A. Protocolo de manejo clínico del nódulo tiroideo. Med - Programa Form Médica Contin Acreditado. 2016 Jun;12(13):754–7. Tumino D, Grani G, Di Stefano M, Di Mauro M, Scutari M, Rago T, et al. Nodular Thyroid Disease in the Era of Precision Medicine. Front Endocrinol (Lausanne). 2020;10(January):1–10. Azizi G, Keller J, Lewis M, Puett D, Rivenbark K, Malchoff C. Performance of Elastography for the Evaluation of Thyroid Nodules: A Prospective Study. Thyroid. 2013 Jun;23(6):734–40. Trimboli P, Guglielmi R, Monti S, Misischi I, Graziano F, Nasrollah N, et al. Ultrasound Sensitivity for Thyroid Malignancy Is Increased by Real-Time Elastography: A Prospective Multicenter Study. J Clin Endocrinol Metab. 2012 Dec 1;97(12):4524–30. Cong S. Comparison analysis between conventional ultrasonography and ultrasound elastography of thyroid nodules. Eur J Radiol. 2012;81(8):1806–11. Durante C, Grani G, Lamartina L, Filetti S, Mandel SJ, Cooper DS. The diagnosis and management of thyroid nodules a review. JAMA - J Am Med Assoc. 2018;319(9):919–24. Lamartina L, Grani G, Durante C, Borget I, Filetti S, Schlumberger M. Follow-up of differentiated thyroid cancer – what should (and what should not) be done. Nat Rev Endocrinol. 2018;14(9):538–51. Popoveniuc G, Jonklaas J. Thyroid Nodules. Med Clin North Am. 2012;96(2):329 Xu, W., Chen, Z., Li, N., Liu, H., Huo, L., Huang, Y., ... Yu, Y. (2015). Relationship of anthropometric measurements to thyroid nodules in a Chinese population. BMJ Open, 5(12) Fiore, E., Rago, T., Provenzale, M. A., Scutari, M., Ugolini, C., Basolo, F., ... Vitti, P. (2009). Lower levels of TSH are associated with a lower risk of papillary thyroid cancer in patients with thyroid nodular disease: thyroid autonomy may play a protective role. Endocrine Related Cancer, 16(4), 1251–1260. doi:10.1677/erc-09-0036
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spelling	Urquijo, Tatiana MargaritaCarreño, MarisolEspecialista en Medicina InternaRincón, OswaldoHospital Militar CentralEnero/2020 - Mayo/2020Medicina2020-10-22T13:00:56Z2020-10-22T13:00:56Z2020-08-24http://hdl.handle.net/10654/36717instname:Universidad Militar Nueva Granadareponame:Repositorio Institucional Universidad Militar Nueva Granadarepourl:https://repository.unimilitar.edu.coIntroducción: El nódulo tiroideo es una entidad común en el contexto de la práctica clínica diaria en todos los niveles de atención primaria. En Colombia existen pocos estudios relacionados con la caracterización de la población con nódulo tiroideo y específicamente carecemos de ellos en la población usuaria del sistema de salud en el Hospital Militar Central y el Sistema General de Seguridad Social en Salud (SGSS). Materiales y métodos: Estudio de corte transversal de pacientes con diagnóstico de nódulo tiroideo atendidos en el Hospital Militar Central. Se realizó un muestreo sistemático de todos los pacientes con diagnóstico de nódulo tiroideo. Se realizó un análisis descriptivo mediante medas o medinas en las variables continuas y frecuencias en las variables categóricas, para las variables clínicas, de laboratorio y ecográficas de los pacientes que cumplieron los criterios de selección. Resultados: Se analizaron 166 pacientes, edad mediana 59 años (RIC 49-71), hombres 16,9%, hipertensión 38,5%, dislipidemia 37,8%, bocio 71,7%, se observó un nódulo en el 49,1%, microcalcificaciones 32,9%, hipoecoico 44,4%, un sistema de catalogación de nódulo tiroideo (NT) (abreviado TIRADS del inglés Thyroid Imaging. Reporting and Data System) III y IV 32,9%, respectivamente. Conclusiones: El presente estudio nos permite describir la población de paciente con nódulo tiroideo que asistieron evidenciando una población con hallazgos predominantemente benignos comparable con otras poblaciones, sin embargo, se requiere promover la adherencia el uso de la clasificación de TIRADS ecográfico de acuerdo a los lineamientos nacionales e internacionales.Introduction: The thyroid nodule is a common entity in the context of daily clinical practice at all levels of primary care. In Colombia there are few studies related to the characterization of the population with a thyroid nodule and we specifically lack them in the user population of the health system at the Central Military Hospital and the General System of Social Security in Health (SGSS). Materials and methods: Cross-sectional study of patients with a diagnosis of thyroid nodule treated at the Central Military Hospital. A systematic sampling of all patients diagnosed with a thyroid nodule was carried out. A descriptive analysis was performed using measures or medinas in the continuous variables and frequencies in the categorical variables, for the clinical, laboratory and ultrasound variables of the patients who fulfilled the selection criteria. Results: 166 patients were analyzed, median age 59 years (IQR 49-71), men 16.9%, hypertension 38.5%, dyslipidemia 37.8%, goiter 71.7%, a nodule was observed in 49, 1%, microcalcifications 32.9%, hypoechoic 44.4%, a thyroid nodule (NT) cataloging system (abbreviated TIRADS from English Thyroid Imaging. Reporting and Data System) III and IV 32.9%, respectively. Conclusions: The present study allows us to describe the population of patients with thyroid nodules who attended, showing a population with predominantly benign findings comparable with other populations; however, adherence must be promoted using the ultrasound TIRADS classification according to national guidelines and international.Especializaciónapplicaction/pdfspahttp://creativecommons.org/licenses/by-nc-nd/4.0/info:eu-repo/semantics/openAccesshttp://purl.org/coar/access_right/c_abf2Attribution-NonCommercial-NoDerivatives 4.0 InternationalAcceso abiertoPerfil clínico, paraclínico e imagenológico de pacientes con nódulos tiroideos atendidos en el Hospital Militar CentralClinical, paraclinical and Imagenological profile of patients with thyroid nodules treated at the Central Military HospitalTesis/Trabajo de grado - Monografía - Especializacióninfo:eu-repo/semantics/bachelorThesishttp://purl.org/coar/resource_type/c_7a1fThyroid noduleTIRADSUltrasoundGoiterMEDICINA INTERNANODULO TIROIDEOTIROIDESENFERMEDADES DE LA TIROIDESNodulo TiroideoTIRADSEcografiaBocioMedicina InternaFacultad de MedicinaUniversidad Militar Nueva GranadaReiners C, Wegscheider K, Schicha H, Theissen P, Vaupel R, Wrbitzky R, et al. Prevalence of Thyroid Disorders in the Working Population of Germany: Ultrasonography Screening in 96,278 Unselected Employees. Thyroid. 2004 Nov;14(11):926–32.Gharib H, Papini E, Garber JR, Duick DS, Harrell RM, Hegedüs L, et al. American Association Of Clinical Endocrinologists, American College Of Endocrinology, And Associazione Medici Endocrinologi Medical Guidelines For Clinical Practice For The Diagnosis And Management Of Thyroid Nodules – 2016 Update. Endocr Pract. 2016 May;22(Supplement 1):1–60.Xiong Y, Yan L, Nong L, Zheng Y, Li T. Pathological diagnosis of thyroid nodules based on core needle biopsies: comparative study between core needle biopsies and resected specimens in 578 cases. Diagn Pathol. 2019 Dec 2;14(1):10.Rosenbaum MA, McHenry CR. Contemporary management of papillary carcinoma of the thyroid gland. Expert Rev Anticancer Ther. 2009 Mar 10;9(3):317–29.Durante C, Costante G, Lucisano G, Bruno R, Meringolo D, Paciaroni A, et al. The Natural History of Benign Thyroid Nodules. JAMA. 2015 Mar 3;313(9):926.Burch HB, Burman KD, Cooper DS, Hennessey J V., Vietor NO. A 2015 Survey of Clinical Practice Patterns in the Management of Thyroid Nodules. J Clin Endocrinol Metab. 2016 Jul;101(7):2853–62.Burman KD, Wartofsky L. Thyroid Nodules. Solomon CG, editor. N Engl J Med. 2015 Dec 10;373(24):2347–56.Flynn JP, Morawiecki PA, Ayala MA. An Incidental Thyroid Nodule. Ear, Nose Throat J. 2017 Aug 4;96(8):294–6.Dean DS, Gharib H. Epidemiology of thyroid nodules. Best Pract Res Clin Endocrinol Metab. 2008 Dec;22(6):901–11.Angell TE, Vyas CM, Medici M, Wang Z, Barletta JA, Benson CB, et al. Differential Growth Rates of Benign vs. Malignant Thyroid Nodules. J Clin Endocrinol Metab. 2017 Dec 1;102(12):4642–7.Wong R, Farrell SG, Grossmann M. Thyroid nodules: diagnosis and management. Med J Aust. 2018;209(2):92–8.Pemayun TGD. Current Diagnosis and Management of Thyroid Nodules. Acta Med Indones. 2016 Jul;48(3):247–57.Valderrabano P, McIver B. Evaluation and Management of Indeterminate Thyroid Nodules. Cancer Control. 2017 Dec 27;24(5):107327481772923.Singaporewalla RM, Hwee J, Lang TU, Desai V. Clinico-pathological Correlation of Thyroid Nodule Ultrasound and Cytology Using the TIRADS and Bethesda Classifications. World J Surg. 2017 Jul 1;41(7):1807–11.Durante C, Grani G, Lamartina L, Filetti S, Mandel SJ, Cooper DS. The Diagnosis and Management of Thyroid Nodules. JAMA. 2018 Mar 6;319(9):914.Guth S, Theune U, Aberle J, Galach A, Bamberger CM. Very high prevalence of thyroid nodules detected by high frequency (13 MHz) ultrasound examination. Eur J Clin Invest. 2009 Aug;39(8):699–706.Grant EG, Tessler FN, Hoang JK, Langer JE, Beland MD, Berland LL, et al. Thyroid Ultrasound Reporting Lexicon: White Paper of the ACR Thyroid Imaging, Reporting and Data System (TIRADS) Committee. J Am Coll Radiol. 2015 Dec;12(12):1272–9.Hernández-flórez CE. 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Endocrine Related Cancer, 16(4), 1251–1260. doi:10.1677/erc-09-0036ORIGINALUrquijoRochaTatianaMargarita2020.pdfUrquijoRochaTatianaMargarita2020.pdfTrabajo de Gradoapplication/pdf479321http://repository.unimilitar.edu.co/bitstream/10654/36717/1/UrquijoRochaTatianaMargarita2020.pdf7381a59ee2d5c8a7229fb3da5056604aMD51UrquijoRochaTatianaMargarita2020.pdfUrquijoRochaTatianaMargarita2020.pdfDisertaciónapplication/pdf10211594http://repository.unimilitar.edu.co/bitstream/10654/36717/2/UrquijoRochaTatianaMargarita2020.pdfdfe1732ede79ffb0ab5e1407137b6f9aMD52UrquijoRochaTatianaMargarita2020.pdfUrquijoRochaTatianaMargarita2020.pdfCartas de 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