[ID 57237] A INFLUÊNCIA DO ACESSO À SAÚDE NA APRESENTAÇÃO CLÍNICA DAS NEOPLASIAS BENIGNAS E MALIGNAS DA TIREOIDE EM PACIENTES SUBMETIDOS À TIREOIDECTOMIA TOTAL

THE INFLUENCE OF ACCESS TO HEALTH IN THE CLINICAL PRESENTATION OF BENIGN AND MALIGNANT THYROID NEOPLASMS IN PATIENTS UNDERGOING TOTAL THYROIDECTOMY

Abstract

Objective: To evaluate the influence of access to health care on the clinical and histopathological presentation of benign and malignant thyroid neoplasms in patients undergoing total thyroidectomy. Methodology: A review of medical records of patients undergoing total thyroidectomy was performed in a head and neck surgery service in the city of Guarapuava, Paraná, Brazil between 2003 and 2017. Demographic (age, sex, marital status and type of access to health) and clinical (total thyroid volume, pathological diagnosis, weight of postoperative specimens, and pathological and clinical staging) information were collected. The sample was divided into two groups, patients treated by public health insurance (SUS) and private health insurance. For data analysis, the statistical software SPSS version 20.0 was used. The significance level was p<0.05. Results: Among the 315 patients studied, 104 (33.02%) were public patient (SUS) and 211 (66.98%) had private insurance coverage. In both groups, the total thyroid volume was lower in patients under 45 years of age, in women and malignant neoplasms (p<0.001). The weight of the surgical specimen was lower in patients under 45 years of age, in patients with private insurance coverage (p<0.001), and in malignant neoplasms (p<0.049). The cases of public patients had higher total gland volume (p<0.001) and higher weight of the surgical specimen (p<0.001), in addition to a higher incidence of regional metastases (p=0.030). Conclusion: The type of access to health care influences the clinical presentation of thyroid neoplasms in relation to the total volume of the thyroid, presence of regional metastases and weight of the surgical specimen.