Pub Date : 2025-09-01DOI: 10.1016/j.rmclc.2025.10.005
Juan Moukarzel MD, MSc , Guillermia Esperón MD , Claudio Militello MD , Juan Fernández MD , Gustavo Bastianelli MD
Tricuspid regurgitation (TR) has become increasingly relevant in recent years as a key prognostic determinant in patients with heart failure (HF). It is now recognized that its prevalence is significant, affecting up to 7% of the general population and reaching significant figures in subgroups with HF.
Emerging evidence links TI with clinical deterioration, increased risk of hospitalization and mortality, which has prompted the development of new diagnostic and therapeutic tools. This article reviews the epidemiology, pathophysiology, prognostic implications, and current approaches to medical, surgical, and percutaneous treatment of TR in the context of HF.
{"title":"Insuficiencia cardíaca e insuficiencia tricuspídea: revisión y estado actual","authors":"Juan Moukarzel MD, MSc , Guillermia Esperón MD , Claudio Militello MD , Juan Fernández MD , Gustavo Bastianelli MD","doi":"10.1016/j.rmclc.2025.10.005","DOIUrl":"10.1016/j.rmclc.2025.10.005","url":null,"abstract":"<div><div>Tricuspid regurgitation (TR) has become increasingly relevant in recent years as a key prognostic determinant in patients with heart failure (HF). It is now recognized that its prevalence is significant, affecting up to 7% of the general population and reaching significant figures in subgroups with HF.</div><div>Emerging evidence links TI with clinical deterioration, increased risk of hospitalization and mortality, which has prompted the development of new diagnostic and therapeutic tools. This article reviews the epidemiology, pathophysiology, prognostic implications, and current approaches to medical, surgical, and percutaneous treatment of TR in the context of HF.</div></div>","PeriodicalId":31544,"journal":{"name":"Revista Medica Clinica Las Condes","volume":"36 5","pages":"Pages 432-443"},"PeriodicalIF":0.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145425700","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-01DOI: 10.1016/j.rmclc.2025.09.001
José Tomás Museli MD
Constrictive pericarditis is an uncommon but potentially curable cause of heart failure with preserved ejection fraction. It results from pericardial inflammation and fibrosis, and its diagnosis remains challenging due to the need to differentiate it from other entities, particularly restrictive cardiomyopathy. Loss of pericardial compliance leads to impaired diastolic filling and systemic venous congestion, explained by two key pathophysiological mechanisms: dissociation between intrathoracic and intracardiac pressures, and enhanced ventricular interdependence.
Imaging techniques are essential for diagnosis. Doppler echocardiography typically demonstrates restrictive filling patterns, septal bounce, and marked respiratory variation, while cardiac magnetic resonance provides detailed assessment of active inflammation and pericardial fibrosis.
Therapeutic strategies depend on disease stage: cases with active inflammation may respond to anti-inflammatory therapy, whereas chronic constriction requires radical pericardiectomy, which must be complete to achieve optimal long-term outcomes.
This review summarizes current knowledge on the pathophysiology, diagnostic approach, and management of constrictive pericarditis, highlighting its importance as a differential diagnosis in patients with heart failure and preserved ejection fraction.
{"title":"Pericarditis constrictiva e insuficiencia cardíaca","authors":"José Tomás Museli MD","doi":"10.1016/j.rmclc.2025.09.001","DOIUrl":"10.1016/j.rmclc.2025.09.001","url":null,"abstract":"<div><div>Constrictive pericarditis is an uncommon but potentially curable cause of heart failure with preserved ejection fraction. It results from pericardial inflammation and fibrosis, and its diagnosis remains challenging due to the need to differentiate it from other entities, particularly restrictive cardiomyopathy. Loss of pericardial compliance leads to impaired diastolic filling and systemic venous congestion, explained by two key pathophysiological mechanisms: dissociation between intrathoracic and intracardiac pressures, and enhanced ventricular interdependence.</div><div>Imaging techniques are essential for diagnosis. Doppler echocardiography typically demonstrates restrictive filling patterns, septal bounce, and marked respiratory variation, while cardiac magnetic resonance provides detailed assessment of active inflammation and pericardial fibrosis.</div><div>Therapeutic strategies depend on disease stage: cases with active inflammation may respond to anti-inflammatory therapy, whereas chronic constriction requires radical pericardiectomy, which must be complete to achieve optimal long-term outcomes.</div><div>This review summarizes current knowledge on the pathophysiology, diagnostic approach, and management of constrictive pericarditis, highlighting its importance as a differential diagnosis in patients with heart failure and preserved ejection fraction.</div></div>","PeriodicalId":31544,"journal":{"name":"Revista Medica Clinica Las Condes","volume":"36 5","pages":"Pages 444-452"},"PeriodicalIF":0.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145425701","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-01DOI: 10.1016/j.rmclc.2025.10.001
Claudio Velásquez-Silva MD, Sebastián V. Rojas MD
End-stage heart failure carries a significant burden of morbidity and mortality. In the absence of suitable donors for heart transplantation -or access to transplantation- as well as in the presence of certain contraindications, long-term mechanical ventricular assistance represents a valuable alternative that significantly improves both survival and quality of life. In some patient subgroups, its outcomes are even comparable to heart transplantation up to five years post-implantation.
For this reason, a solid understanding of its physiology, hemocompatibility, and hemodynamics has become essential in modern cardiology and cardiac surgery practice. In recent years, there has been a sustained increase in patients receiving this therapy under a destination strategy, effectively creating a new heart failure phenotype: long-term left ventricular support. This has introduced novel paradigms and challenges, particularly in efficiently managing and preventing complications.
The next generation of devices still faces the challenge of eliminating the driveline, which significantly increases the risk of infections, sometimes even leading to urgent transplantation. New devices are under development to provide alternatives to the currently sole FDA and CE approved ventricular assist device: HeartMate 3. Therefore, the objective of this review is to describe advanced heart failure and the factors associated with decision-making, follow-up, and prognosis in the context of LVAD therapy.
{"title":"Asistencia circulatoria mecánica en falla cardíaca avanzada: definiciones, avances y desafíos actuales","authors":"Claudio Velásquez-Silva MD, Sebastián V. Rojas MD","doi":"10.1016/j.rmclc.2025.10.001","DOIUrl":"10.1016/j.rmclc.2025.10.001","url":null,"abstract":"<div><div>End-stage heart failure carries a significant burden of morbidity and mortality. In the absence of suitable donors for heart transplantation -or access to transplantation- as well as in the presence of certain contraindications, long-term mechanical ventricular assistance represents a valuable alternative that significantly improves both survival and quality of life. In some patient subgroups, its outcomes are even comparable to heart transplantation up to five years post-implantation.</div><div>For this reason, a solid understanding of its physiology, hemocompatibility, and hemodynamics has become essential in modern cardiology and cardiac surgery practice. In recent years, there has been a sustained increase in patients receiving this therapy under a destination strategy, effectively creating a new heart failure phenotype: long-term left ventricular support. This has introduced novel paradigms and challenges, particularly in efficiently managing and preventing complications.</div><div>The next generation of devices still faces the challenge of eliminating the driveline, which significantly increases the risk of infections, sometimes even leading to urgent transplantation. New devices are under development to provide alternatives to the currently sole FDA and CE approved ventricular assist device: HeartMate 3. Therefore, the objective of this review is to describe advanced heart failure and the factors associated with decision-making, follow-up, and prognosis in the context of LVAD therapy.</div></div>","PeriodicalId":31544,"journal":{"name":"Revista Medica Clinica Las Condes","volume":"36 5","pages":"Pages 461-472"},"PeriodicalIF":0.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145425704","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-01DOI: 10.1016/j.rmclc.2025.10.008
María Eugenia Delle Donne MD, Federico Zeppa MD
Heart failure (HF) is a frequent and challenging complication in adults with congenital heart disease (ACHD), a growing population thanks to advances in medical and surgical care. Its origin is multifactorial and varies depending on the type of congenital heart defect, leading to a wide range of clinical signs and symptoms, some of which are specific to certain congenital heart diseases (CHD).
Diagnosis requires a comprehensive clinical evaluation and personalized complementary studies, posing a challenge to traditional classification and risk stratification tools, which were originally developed for patients with acquired HF. We introduce the anatomical-physiological classification by the AHA/ACC, which enables better identification of patients at risk of progressing to advanced HF.
Medical treatment still relies on the extrapolation of guidelines for acquired HF, since current studies in ACHD are limited in sample size and patient diversity, with some even producing conflicting results. Therefore, there is a clear need for new, robust clinical trials tailored specifically to this population.
The aim of this review is to highlight the importance of an individualized approach to HF in ACHD, to describe the main mechanisms involved while emphasizing the complexity of each congenital heart defect, to summarize the current published scientific evidence regarding available pharmacological treatment, and to propose research that supports specific guidelines to improve the prognosis of these patients.
{"title":"Insuficiencia cardíaca en cardiopatías congénitas del adulto","authors":"María Eugenia Delle Donne MD, Federico Zeppa MD","doi":"10.1016/j.rmclc.2025.10.008","DOIUrl":"10.1016/j.rmclc.2025.10.008","url":null,"abstract":"<div><div>Heart failure (HF) is a frequent and challenging complication in adults with congenital heart disease (ACHD), a growing population thanks to advances in medical and surgical care. Its origin is multifactorial and varies depending on the type of congenital heart defect, leading to a wide range of clinical signs and symptoms, some of which are specific to certain congenital heart diseases (CHD).</div><div>Diagnosis requires a comprehensive clinical evaluation and personalized complementary studies, posing a challenge to traditional classification and risk stratification tools, which were originally developed for patients with acquired HF. We introduce the anatomical-physiological classification by the AHA/ACC, which enables better identification of patients at risk of progressing to advanced HF.</div><div>Medical treatment still relies on the extrapolation of guidelines for acquired HF, since current studies in ACHD are limited in sample size and patient diversity, with some even producing conflicting results. Therefore, there is a clear need for new, robust clinical trials tailored specifically to this population.</div><div>The aim of this review is to highlight the importance of an individualized approach to HF in ACHD, to describe the main mechanisms involved while emphasizing the complexity of each congenital heart defect, to summarize the current published scientific evidence regarding available pharmacological treatment, and to propose research that supports specific guidelines to improve the prognosis of these patients.</div></div>","PeriodicalId":31544,"journal":{"name":"Revista Medica Clinica Las Condes","volume":"36 5","pages":"Pages 422-431"},"PeriodicalIF":0.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145425698","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-01DOI: 10.1016/j.rmclc.2025.10.009
Raúl Rodrigo Neri Bale MD, Jaime A. Hernández-Montfort MD
Cardiogenic shock is a hyper-complex condition associated with a significant morbimortality. The diverse pathophysiological processes implicated in this disease converge into a spiral of progressively impaired tissue perfusion, leading to systemic inflammation and death. The hemodynamic assessment of these patients leads to improved disease staging, diagnosis and therapy escalation. The utilization of a Pulmonary Artery Catheter (PAC), although controversial, has been associated with better outcomes, especially when done in the first hours after diagnosis. The paradigm shift towards shock phenotyping fosters individualized care strategies, and eventually, a better prognosis.
{"title":"Choque cardiogénico: del entendimiento profundo al diagnóstico oportuno","authors":"Raúl Rodrigo Neri Bale MD, Jaime A. Hernández-Montfort MD","doi":"10.1016/j.rmclc.2025.10.009","DOIUrl":"10.1016/j.rmclc.2025.10.009","url":null,"abstract":"<div><div>Cardiogenic shock is a hyper-complex condition associated with a significant morbimortality. The diverse pathophysiological processes implicated in this disease converge into a spiral of progressively impaired tissue perfusion, leading to systemic inflammation and death. The hemodynamic assessment of these patients leads to improved disease staging, diagnosis and therapy escalation. The utilization of a Pulmonary Artery Catheter (PAC), although controversial, has been associated with better outcomes, especially when done in the first hours after diagnosis. The paradigm shift towards shock phenotyping fosters individualized care strategies, and eventually, a better prognosis.</div></div>","PeriodicalId":31544,"journal":{"name":"Revista Medica Clinica Las Condes","volume":"36 5","pages":"Pages 453-460"},"PeriodicalIF":0.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145425699","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-01DOI: 10.1016/j.rmclc.2025.07.002
Pamela Trejo MD , Carolina Martínez MD
Secondary osteoporosis is a condition that arises as a consequence of underlying diseases or medical treatments that affect bone metabolism, in contrast to primary osteoporosis, which is associated with age-related bone loss and the hormonal changes of menopause. Its clinical presentation differs, as it can occur in younger patients and, in some cases, be associated with more severe bone loss, increasing the prevalence of fragility fractures.
Identifying secondary causes is crucial, as it directly impacts treatment strategies and fracture risk assessment. Early recognition is essential to ensure an adequate evaluation, individualize treatment based on the underlying etiology and patient needs, and ultimately prevent fragility fractures.
This review aims to highlight when to suspect secondary osteoporosis, how to properly assess it, as well as provide tools for its clinical management.
{"title":"Osteoporosis secundaria","authors":"Pamela Trejo MD , Carolina Martínez MD","doi":"10.1016/j.rmclc.2025.07.002","DOIUrl":"10.1016/j.rmclc.2025.07.002","url":null,"abstract":"<div><div>Secondary osteoporosis is a condition that arises as a consequence of underlying diseases or medical treatments that affect bone metabolism, in contrast to primary osteoporosis, which is associated with age-related bone loss and the hormonal changes of menopause. Its clinical presentation differs, as it can occur in younger patients and, in some cases, be associated with more severe bone loss, increasing the prevalence of fragility fractures.</div><div>Identifying secondary causes is crucial, as it directly impacts treatment strategies and fracture risk assessment. Early recognition is essential to ensure an adequate evaluation, individualize treatment based on the underlying etiology and patient needs, and ultimately prevent fragility fractures.</div><div>This review aims to highlight when to suspect secondary osteoporosis, how to properly assess it, as well as provide tools for its clinical management.</div></div>","PeriodicalId":31544,"journal":{"name":"Revista Medica Clinica Las Condes","volume":"36 4","pages":"Pages 306-314"},"PeriodicalIF":0.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144912555","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-01DOI: 10.1016/j.rmclc.2025.08.008
Enrique Ramos Maurell MD
Glucocorticoid-induced adrenal insufficiency is a common complication of prolonged exogenous corticosteroid use, caused by suppression of the hypothalamic-pituitary-adrenal (HPA) axis and resulting in insufficient endogenous cortisol production. Given the widespread use of glucocorticoids across multiple medical fields, a substantial proportion of the population is at risk. Although adrenal crises are rare, they can be severe or life-threatening if not promptly recognized and treated, particularly during acute physiological stress. This underscores the need for close and long-term monitoring. Recent guidelines and clinical studies recommend periodic assessment of the HPA axis using basal cortisol measurements and ACTH stimulation tests, especially in patients with persistent symptoms or without documented hormonal recovery. A significant proportion of patients may regain adrenal function even 12–24 months after discontinuing corticosteroids. Management should include patient education, crisis prevention strategies, recognition of withdrawal symptoms, and individualized adjustment of replacement therapy, including stress-dose steroids if required. In 2024, the European Society of Endocrinology and the Endocrine Society published the most up-to-date guideline, which serves as the basis for this work. This review synthesizes current recommendations and proposes a practical, evidence-based approach for the follow-up of adults with glucocorticoid-induced adrenal insufficiency.
{"title":"Insuficiencia adrenal inducida por glucocorticoides: tratamiento y seguimiento clínico","authors":"Enrique Ramos Maurell MD","doi":"10.1016/j.rmclc.2025.08.008","DOIUrl":"10.1016/j.rmclc.2025.08.008","url":null,"abstract":"<div><div>Glucocorticoid-induced adrenal insufficiency is a common complication of prolonged exogenous corticosteroid use, caused by suppression of the hypothalamic-pituitary-adrenal (HPA) axis and resulting in insufficient endogenous cortisol production. Given the widespread use of glucocorticoids across multiple medical fields, a substantial proportion of the population is at risk. Although adrenal crises are rare, they can be severe or life-threatening if not promptly recognized and treated, particularly during acute physiological stress. This underscores the need for close and long-term monitoring. Recent guidelines and clinical studies recommend periodic assessment of the HPA axis using basal cortisol measurements and ACTH stimulation tests, especially in patients with persistent symptoms or without documented hormonal recovery. A significant proportion of patients may regain adrenal function even 12–24 months after discontinuing corticosteroids. Management should include patient education, crisis prevention strategies, recognition of withdrawal symptoms, and individualized adjustment of replacement therapy, including stress-dose steroids if required. In 2024, the European Society of Endocrinology and the Endocrine Society published the most up-to-date guideline, which serves as the basis for this work. This review synthesizes current recommendations and proposes a practical, evidence-based approach for the follow-up of adults with glucocorticoid-induced adrenal insufficiency.</div></div>","PeriodicalId":31544,"journal":{"name":"Revista Medica Clinica Las Condes","volume":"36 4","pages":"Pages 357-363"},"PeriodicalIF":0.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144912558","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-01DOI: 10.1016/j.rmclc.2025.08.005
Fernanda Olivé C RN , María Bernardita Sanhueza RN
The healthcare sector plays a crucial role in protecting the population, but its environmental impact is undeniable. Globally, healthcare is responsible for 4.4% of greenhouse gas emissions. In Chile, sustainable hospital waste management is inadequate, with only 2% of waste being recycled. Intensive Care Units (ICUs) have a particularly high environmental footprint, generating three times more CO2 per bed than other hospital areas.
The objective of this article is to analyze the environmental impact of the healthcare system in Chile and to highlight the strategic role of hospitals—particularly their clinical teams—in the transition toward more sustainable models of care.
In this context, it is essential for the Chilean healthcare system to shift toward a greener approach, addressing challenges such as waste generation, overuse of plastic materials, and CO2 emissions. Healthcare teams play a key role in leading sustainability initiatives, providing training, and promoting best practices. Several successful cases demonstrate the feasibility and associated benefits of such efforts. However, regulatory changes and institutional commitments are needed to align healthcare with global environmental sustainability goals, ensuring a healthier future for both people and the planet.
{"title":"Hacia un sistema de salud sustentable en Chile: el papel de los hospitales verdes","authors":"Fernanda Olivé C RN , María Bernardita Sanhueza RN","doi":"10.1016/j.rmclc.2025.08.005","DOIUrl":"10.1016/j.rmclc.2025.08.005","url":null,"abstract":"<div><div>The healthcar<strong>e</strong> sector play<strong>s a</strong> crucial <strong>r</strong>ole in protecting the population, but its environmental impact is undeniable. Globall<strong>y,</strong> healthcar<strong>e</strong> is <strong>r</strong>esponsible <strong>f</strong>or 4.4% of greenhouse gas emissions. In Chile, sustainable hospital wast<strong>e</strong> management is inadequate, with onl<strong>y</strong> 2% of wast<strong>e</strong> being <strong>r</strong>ecycled. Intensive C<strong>are</strong> Units (ICUs) have <strong>a p</strong>articularl<strong>y</strong> high environmental <strong>f</strong>ootprint, generating three times mor<strong>e CO</strong><sub><strong>2</strong></sub> per bed than other hospital areas.</div><div>The objective of this article is to analyze the environmental impact of the healthcare system in Chile and to highlight the strategic role of hospitals—particularly their clinical teams—in the transition toward more sustainable models of care.</div><div>In this context, it is essential for the Chilean healthcare system to shift toward a greener approach, addressing challenges such as waste generation, overuse of plastic materials, and CO<sub><strong>2</strong></sub> emissions. Healthcare teams play a key role in leading sustainability initiatives, providing training, and promoting best practices. Several successful cases demonstrate the feasibility and associated benefits of such efforts. However, regulatory changes and institutional commitments are needed to align healthcare with global environmental sustainability goals, ensuring a healthier future for both people and the planet.</div></div>","PeriodicalId":31544,"journal":{"name":"Revista Medica Clinica Las Condes","volume":"36 4","pages":"Pages 364-372"},"PeriodicalIF":0.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144912501","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-01DOI: 10.1016/j.rmclc.2025.08.009
Iván Solis MD
A thyroid nodule is a lesion structurally distinguishable from the thyroid parenchyma and is highly prevalent in the general population. Its detection has increased due to the widespread use of cervical ultrasonography. Although most nodules are benign, approximately 7–15% may correspond to cancer. The initial evaluation includes a detailed medical history, an assessment of risk factors, and a physical examination focused on signs of thyroid dysfunction or malignancy.
Thyroid ultrasound is the diagnostic method of choice due to its accuracy, safety, and low cost. Certain sonographic features allow estimation of malignancy risk, classified through systems such as TI-RADS. TSH measurement helps determine the functional status of the nodule.
Fine-needle aspiration biopsy (FNAB), guided by ultrasound, enables cytological analysis according to the Bethesda System (categories I–VI), which informs clinical management. For nodules with indeterminate cytology (Bethesda III and IV), molecular studies provide predictive value for malignancy.
Therapeutic decisions must consider the patient's age, comorbidities, the nodule's sonographic and cytological characteristics, and patient preferences. Management options range from ultrasound monitoring to surgical or ablative treatments.
In conclusion, the approach to thyroid nodules is based on an integrated and sequential strategy, guided by diagnostic tools and updated clinical guidelines, aimed at achieving personalized and safe decision-making.
{"title":"Enfrentamiento actual del nódulo tiroideo","authors":"Iván Solis MD","doi":"10.1016/j.rmclc.2025.08.009","DOIUrl":"10.1016/j.rmclc.2025.08.009","url":null,"abstract":"<div><div>A thyroid nodule is a lesion structurally distinguishable from the thyroid parenchyma and is highly prevalent in the general population. Its detection has increased due to the widespread use of cervical ultrasonography. Although most nodules are benign, approximately 7–15% may correspond to cancer. The initial evaluation includes a detailed medical history, an assessment of risk factors, and a physical examination focused on signs of thyroid dysfunction or malignancy.</div><div>Thyroid ultrasound is the diagnostic method of choice due to its accuracy, safety, and low cost. Certain sonographic features allow estimation of malignancy risk, classified through systems such as TI-RADS. TSH measurement helps determine the functional status of the nodule.</div><div>Fine-needle aspiration biopsy (FNAB), guided by ultrasound, enables cytological analysis according to the Bethesda System (categories I–VI), which informs clinical management. For nodules with indeterminate cytology (Bethesda III and IV), molecular studies provide predictive value for malignancy.</div><div>Therapeutic decisions must consider the patient's age, comorbidities, the nodule's sonographic and cytological characteristics, and patient preferences. Management options range from ultrasound monitoring to surgical or ablative treatments.</div><div>In conclusion, the approach to thyroid nodules is based on an integrated and sequential strategy, guided by diagnostic tools and updated clinical guidelines, aimed at achieving personalized and safe decision-making.</div></div>","PeriodicalId":31544,"journal":{"name":"Revista Medica Clinica Las Condes","volume":"36 4","pages":"Pages 260-266"},"PeriodicalIF":0.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144912548","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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