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Doctor Ortiz, pionero en termoablación para tratar la tiroides: "Ya no hay que pasar por quirófano" El cansancio y el sueño pueden ser indicio de enfermedad tiroidea. Getty.
El tiroides desempeña un papel importantísimo en el mantenimiento del metabolismo del cuerpo y el perfecto funcionamiento del sistema cardiovascular . Las alteraciones en la función tiroidea, ya sea por inhabilidad de producir suficientes hormonas tiroideas o por sobreproducción de las mismas, son más comunes en mujeres que en hombres. Se estima que 1 de cada 10 mujeres desarrollará una disfunción de tiroides a lo largo de su vida.
La buena noticia es que las técnicas de detección son cada vez más rápidas y las terapias , más efectivas y menos agresivas. Lo que no ha cambiado es la importancia de diagnosticar la enfermedad a tiempo . La información es crucial porque cuanto antes demos con el diagnóstico correcto y la estrategia más adecuada , mejor pronóstico tendremos.
Otra buena noticia es que, ante un problema grave de tiroides ya no hay que pasar siempre por quirófano. El doctor Pedro Pablo Ortiz Remacha, endocrino, especialista en tiroides y pionero en el tratamiento de nódulos benignos de tiroides por termoablación con ultrasonidos, lo explica en esta entrevista para Uppers. En la actualidad, el experto, que también es profesor en la Universidad de Zaragoza, es el segundo facultativo con mayor número de intervenciones de este tipo a nivel mundial.
¿Por qué los problemas de tiroides afectan fundamentalmente a las mujeres?
No se sabe exactamente cuál es el motivo, pero la idiosincrasia hormonal de la mujer es un elemento que nadie duda. El sistema hormonal femenino es complejo y pone en marcha muchas hormonas que a la vez deben llevar cada una su ritmo y su ciclo. El desequilibrio en alguna de ellas desequilibra al resto, incluido el tiroides. En la menopausia hay una gran pérdida hormonal ovárica que también le afecta esta glándula. Y, finalmente, la mujer es más susceptible a enfermedades autoinmunes, como la tiroiditis, que está mucho más presente en mujeres que en hombres.
¿Sucede con todas las patologías tiroideas o les afecta más alguno de esos problemas en concreto?
Sobre todo, es la pérdida de la función tiroidea –el hipotiroidismo– la que va a prevalecer en el tiempo. Es cierto que, en este apagamiento progresivo de la función tiroidea, existen periodos cortos de hipertiroidismo que proporcionan síntomas inusuales y que despistan a pacientes y a médicos. La aparición de nódulos en este tiroides enfermo complica esta situación, ya que hay que definirlo bien y diagnosticarlo con precisión, valorando si es benigno o cuenta con potencialidad para malignizarse.
¿Qué consecuencias tienen estos problemas en la salud y bienestar de las mujeres?
La salud y el bienestar de la mujer se ven afectados por síntomas propios del hipotiroidismo, como el cansancio, el sueño, el aumento de peso, la apatía, el desinterés, el frío o el estreñimiento. Y también por los del hipertiroidismo, que son los contrarios: calor, pérdida de peso, diarrea, taquicardia, insomnio... Todos estos síntomas producen un empeoramiento de la calidad de vida de la mujer, además de un empeoramiento en sus perspectivas de esperanza de vida.
¿Podemos hacer algo para prevenir esos problemas?
¡Por supuesto! Lo primero es estar bien informadas y reconocer, cuanto antes mejor, los síntomas con los que puedan intuir que el tiroides no funciona correctamente. Y, a partir de ahí, realizar las pruebas analíticas y ecográficas precisas para definir el cuadro clínico que tenemos delante.
Una vez que hay diagnóstico, hay que plantear un tratamiento precoz, antes de que se instauren más síntomas y validando, con la misma importancia, cómo se encuentra el paciente, su mejoría y bienestar, junto con los resultados analíticos.
Una ecografía previa nos pone en el camino del diagnóstico de nódulos tiroideos. Al principio son pequeños y debemos observar su evolución, porque si crecen habrá que hacer una citología de nódulos tiroideos y plantear tratamientos preventivos como la termoablación.
Y cuando ya han aparecido, ¿qué soluciones tienen?
El tratamiento con fármacos para combatir el hipo o el hipertiroidismo es económico, seguro y eficaz. Lo tiene que prescribir un médico y con las dosis necesarias para que los síntomas desaparezcan.
Cuando los nódulos tienden a crecer en los controles ecográficos sucesivos, hay que plantear tratamientos selectivos de los nódulos con termoablación. Estas técnicas destruyen de forma selectiva al nódulo sin influir en el resto del funcionamiento del tiroides.
¿Hay alguna técnica que sea mejor?
De las técnicas actuales, la tecnológicamente más llamativa, es la que utiliza ultrasonidos focalizados de alta intensidad (HIFU), con la que se buscan tres objetivos principales: que el nódulo no siga creciendo, que además reduzca su tamaño y que alivie los síntomas locales cuando existen. Es una técnica pionera, en la que yo me he especializado, y con la que todavía no están completamente familiarizados ni médicos ni pacientes. Y supone un avance importante, ya que es completamente ambulatoria, evita la cirugía del paciente, se realiza solamente con anestesia local y se puede repetir las veces que sean necesarias hasta destruir el nódulo implicado. Presenta, además, muchos menos efectos secundarios que la radiofrecuencia o el láser y no necesita sedación como en ellas. El postoperatorio del paciente también es muy cómodo y le permite realizar sus actividades habituales prácticamente al día siguiente.
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