ABSTRACT
We report a 35 years old female with left lobe thyroid hemiagenesis who initially was euthyroid and then developed hyperthyroidism due to Graves disease. Hemiagenesis of the thyroid gland is a rare anomaly with an uncertain incidence; up to now 256 cases have been reported. The detection is often made by either clinical symptoms of thyroid dysfunction, by imaginological studies or surgical/pathological procedures. No explanation has been given for the development of this anomaly; left lobe aplasia and predominance of occurrence in women have been most frequently reported
Subject(s)
Humans , Female , Adult , Graves Disease/complications , Hyperthyroidism/complications , Thyroid Gland/abnormalities , Propylthiouracil/therapeutic use , Graves Disease/diagnosis , Hyperthyroidism/diagnosis , Hyperthyroidism/drug therapy , Diagnosis, Differential , Thyroid Gland/physiopathologyABSTRACT
Multiple endocrine neoplasias (MEN) are syndromes inherited as autosomal dominant. The application of the techniques of molecular biology has made possible the identification of the genes causing MEN 1 and 2. The gene responsable for MEN 1 belongs to the family of tumor suppressor genes and encodes for a protein named MENIN whose function remains to be elucidated. The identification of mutant MEN 1 gene carriers who are at risk of developing this syndrome requires frequent biochemical screening for the development of endocrine tumors. MEN 2 is a consequence of mutations in the Ret proto- oncogene (c-Ret). This gene encodes for a tyrosine kinase receptor thought to play a role in the development of neural crest- derived tissue. Members of kindred with either MEN 2A or MEN 2B should be screened by direct DNA testing early in life for mutations in c-Ret. Those with the mutation should be advised to have thyroidectomy at five years of age in children with MEN 2A and earlier in children with MEN 2B . Some cases of sporadic MTC are actually MEN 2A or Familial MTC after c-Ret testing is done, therefore routine application of this test is recommended in all cases of apparent sporadic MTC
Subject(s)
Humans , Multiple Endocrine Neoplasia/genetics , Genetic Techniques , Pentagastrin , Pheochromocytoma/genetics , Pituitary Neoplasms/genetics , Proto-Oncogenes , Brain Stem Neoplasms/genetics , Hyperparathyroidism, Secondary/genetics , Mutation , Multiple Endocrine Neoplasia/diagnosis , Loss of HeterozygosityABSTRACT
Background: To stabilize Graves disease and deplete the preformed hormone, the use of antithyroid drugs prior 131I therapy has been suggested, specially in those patients with severe thyrotoxicosis and in the elderly. However, PTU may reduce the effectiveness of 131I. Aim: To study the effects of PTU pretreatment before 131I administration. Subjets and methods: A retrospective analysis of the medical records of patients with Graves disease treated with 131I from 1989 to 1997 was made. Of 244 patients with adequate follow-up for at least 12 months after 131I treatment, 142 had not been pretreated and 102 had received PTU prior to 131I therapy. Pretreated patients were distributed according to the number of days that PTU was discontinued before reciving 131I, forming four groups (a=5d, b=6-14 d, c=15-30 d and d=31-60 d). Radioiodine was delivered according to our protocol of 120 µCi per gram of thyroid tissue, as estimated by clinical examination. Therapy was considered successful when laboratory evidence of euthyroidism or hypothyroidism after one year of treatment was obtained and as a failure when undetectable TSH values persisted after 12 months of treatment with 131I. Results: All groups were comparable as to age, gender, goiter size, and 24 h radioiodine uptake. Control of hyperthyroidism was achieved in 76 percent of the non pretreated group. A similar percentage was observed in groups (b), (c) and (d). However, the disease was controlled in only 50 percent of group (a) patients (p <0.003). Conclusions: The therapeutic efficacy of 131I is significantly reduced when the PTU is stopped for only a few days prior to the use of radioiodine. We postulate that PTU has to be discontinued for at least 10 days before radioiodine administration
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Goiter/radiotherapy , Hyperthyroidism/radiotherapy , Iodine Radioisotopes/administration & dosage , Propylthiouracil/therapeutic use , Graves Disease/therapy , PremedicationABSTRACT
Se presenta un caso clínico de carcinoma de células en vidrio esmerilado de cuello uterino, en una mujer joven, embarazada, de curso agresivo, con rápida progresión a estadio clínico fuera del alcance terapéutico
Subject(s)
Humans , Female , Pregnancy , Adult , Uterine Cervical Neoplasms/diagnosis , Carcinoma, Adenosquamous/diagnosis , Vaginal Smears , Reproductive History , Carcinoma, Adenosquamous/pathology , Pregnancy, High-Risk , PrognosisABSTRACT
Se analiza a través de un aescuesta la conducta sexual de jóvenes adolescentes de los 4tos. medios de la comuna de Chanco. Se revisa la masturbaión, los juegos amorosos, las relaciones sexuales, en hombres y mujeres. Los resultados no varían de otras zonas del país