Utilidad de la tiroglobulina sérica en el seguimiento del paciente con cáncer diferenciado de tiroides / Thyroglobulin in the follow up of patients with thyroid carcinoma

Serum thyroglobulin and cervical ultrasonography are the milestones of the follow up of patients with differentiated thyroid carcinoma. When levels of thyroglobulin, stimulated either by discontinuing thyroid hormone supplementation or by using human recombinant TSH are undetectable and cervical ultrasonography is negative for relapse, there is a 99 percent probability that the patient is free of disease. Twenty percent of patients with undetectable thyroglobulin levels under thyroid hormone supplementation, will have levels above 2 ng/ml when treatment is discontinued and in one third of them, a relapse will be detected. Pre ablative thyroglobulin levels below 27.5 ng/mg have a positive predictive value of 98 percent for a disease free survival in low risk patients. Anti thyroglobulin antibodies must be measured along with thyroglobulin value, rendering false negative results. Thyroglobolin determination in the needle washout is useful, when a suspicious cervical lymphadenopathy is aspirated. If this value is twice or highr than that of a simultaneous serum determination, it is suggestive of metastases even with a negative cytology.

Resultados Terapéuticos en pacientes acromegálicos: es tiempo de intervenir / Results of surgical treatment for acromegaly in 53 patients

Background: The treatment of choice for acromegaly is surgery that, according to the literature, is curative in 91 percent of pituitary microadenomas and 73 percent of macroadenomas. Aim: To report the results of surgical treatment in 53 patients with acromegaly. Material and methods: Retrospective review of medical records of all patients with acromegaly, operated between 1984 and 2004. When necessary, patients were contacted by telephone to complete information or to perform biochemical or imaging studies. A normal value of insulin like growth factor I (IGF-1) for age and sex, a growth hormone (GH) nadir of less than 1 ng/ml during a glucose tolerance test or a basal GH of less than 2.5 ng/ml, all assessed three months after surgery, were considered as criteria for cure. Results: Biochemical cure was achieved in 67 percent of patients with pituitary microadenomas and 21 percent of patients with macroadenomas. In 47 percent of patients with neuro-ophtalmological involvement, a partial or total recovery in the visual field defect was achieved. The most common surgical complications were transient diabetes insipidus in 19 percent, persistent diabetes insipidus in 4 percent and cerebrospinal fluid fistula in 4 percent. A lower size of the tumor and lower preoperative growth hormone levels were associated with a better chance of cure. Conclusions: The cure rates obtained in this group of patients are clearly lower than those reported abroad. These results stress the importance of having a national registry of acromegaly and the need to train neurosurgeons in the treatment of pituitary tumors.