Therapeutic Plasmapheresis Enabling Radioactive Iodine Treatment in a Patient with Thyrotoxicosis

Therapeutic plasma exchange (TPE) is one possible treatment for patients resistant to conventional antithyroid drugs or requiring urgent attention for thyrotoxicosis. We report a 35-yr-old man with thyrotoxicosis, ultimately attributed to Graves' disease in whom antithyroid drug used initially was soon discontinued, due to abnormal liver function, and replaced by Lugol's solution. Three weeks later, an escape phenomenon (to Lugol's solution) was apparent, so we performed TPE to control the thyrotoxicosis. Two courses of TPE by a centrifugal type machine resulted in diminished levels of thyroid hormone levels, which then rebounded after another two courses of membrane filtration type TPE. However, the patient could be treated with radioactive iodine therapy without any complications at present.

Treatment outcome of Graves' disease in Thai children.

BACKGROUND: Graves' disease is the most common cause of thyrotoxicosis in children. Treatment of Graves' disease consists of anti-thyroid drugs, radioactive iodide and thyroidectomy but the optimal treatment of GD in children is still controversial. OBJECTIVE: To review treatment outcome of Graves' disease in Thai children. MATERIAL AND METHOD: Retrospective review of 32 children with Graves' disease, diagnosed between Jan. 1994 and Dec. 2004, at the Division of Pediatric Endocrinology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Thailand was performed. RESULTS: All patients (median age 10.5 yrs, range 2.85-15 yrs) presented with goiter and increased serum T4 (median 18.4 mcg/dL, range 8.8-30 mcg/dL), serum T3 (median 443 ng/dL, range 206-800 ng/dL) and suppressed TSH levels (median 0.009 mU/L, range 0-0.18 mU/L). Anti-thyroglobulin and Anti-microsomal antibodies were positive in 70% and 82% respectively. All patients except two were initially treated with propylthiouracil (PTU). Two patients were initially treated with methimazole. Adverse reaction of PTU occurred in two patients (One girl had arthralgia, positive pANCA, nephritis and another girl had skin rash and arthralgia). Clinical course of 32 patients after treatment with anti-thyroid drugs mainly PTU for 3.4 (range 0.3-11.2) years is as follows: six (18.8%) underwent remission (cessation of PTU > 2 yrs), three (9.4%) relapsed, one (3.1%) underwent subtotal thyroidectomy, and seven (21.9%) had I131 treatment. All patients (6 of 7) who received I131 dose of 100 microCi/g of thyroid tissue required more than a single dose of I131 treatment. Further outcome in fifteen patients (46.9%) is yet to be followed. Among these patients PTU was just discontinued in four and eleven had never been off anti-thyroid drugs (four still had biochemical hyperthyroidism and seven were biochemically euthyroid). CONCLUSION: PTU was the most common first line therapy in the presented patients with Graves' disease. Remission rate was only 18.8% after an average 3.5 years of treatment with anti-thyroid drugs. I131 or thyroidectomy was used as second line therapy in the present study. They were offered to those who developed side effects, had poor compliance or failed medication. For those who received I131, higher dose (200 microCi/g of thyroid tissue) seemed to be more effective than the lower dose (100 microCi/g).

Manejo actual del hipertiroidismo / Current treatment of hypertiroidism

El hipertiroidismo es una enfermedad común, que afecta tanto a hombres como a mujeres, tiene expresiones clínicas semejantes; sin embargo, las causas son diferentes y por ello hay diversas maneras de tratarlo. A continuación se hace una revisión de los diferentes esquemas de tratamiento farmacológico (medicamentos antitiroideos, iodo inorgánico, iodo radiactivo) y quirúrgico

Açäo de agentes químicos e físicos sobre ovos de Lagochilascaris minor, (Leiper, 1909) / In vitro effect of chemical and physical agents on viability and embriogenesis of eggs of Lagochilascaris minor (Liper, 1909)

Ovos recém-eliminados em fezes de gatos indectados experimentalmente com Lagochilascaris minor foram testados quanto à ação de vários agentes químicos (álcool etílico, hipoclorito, formaldeído e lugol em várias concentrações) e agentes físicos (congelamento - 10ºC, auecimento 80 /97 ºC) para se verificar o índice de letalidade através do percentual de embiogênese. Estes ovos foram colocados sob a ação desses agentes por um período de 24 horas. Após este período foram lavados por 3 vezes em água destilada e mantidos em placas de pertri com solução entre lâminas e lamínulas ao microscópio óptico. O aquecimento a 90 ºC, álcool etílico a 99 ºC, lugol (100 pôr cento, 50 pôr cento, 25 pôr cento, 12,5 pôr cento, 6,25 pôr cento, 3,125 pôr cento) apresentaram o índice de letalidade de 100 pôr cento

Quimioterapia das micoses profundas

As doenças humanas causadas por fungos patogênicos säo classificados em quatro grupos naturais: micose superficiais, cutâneas, subcutâneas e sistêmicas. A expressäo micoses profundas designa o agrupamento de doenças que englobam as micoses subcutâneas, as micoses sistêmicas e as micoses oportunistas de localizaçäo subcutânea e sistêmica. O trabalho a seguir apresenta um estudo dos principais antifúngicos e antibióticos empregados no controle das micoses

El caso de infecciosas: itraconazol como terapia alterna a los yoduros en el tratamiento de la esporotricosis / The infectious case: itraconazole as alternative therapy to iodides in the treatment of sporotrichosis

Se presentan 8 pacientes con diagnostico de esporotricosis, comprobado por el aislamiento de Sporothrix schenckii en cultivo, quienes habian recicido tratamiento previo con yoduro de potasio si presentar mejoria o experimentar efectos secundarios que obligaran a la supresion del tratamiento. Tales pacientes fueron tratados con el nuevo derivado imidazolico, itraconazol. Todas las lesiones desaparecieron y los cultivos se negativizaron en un periodo variable de 60 - 180 dias. No se presentaron efectos secundarios, ni alteracion de las pruebas de laboratorio. Por todo lo anterior, el itraconazol se convierte en una alternativa para el tratamiento de la esporotricosis

Tratamento näo-cirúrgico das fístulas de ducto mamário / Non-surgical treatment of mamary duct fistula

Pacientes com fístula mamária foram tratadas de modo näo cruento pela injeçäo local de soluçäo a 1:1 de Lugol + polímero ácido metacresolsufônico a 36%, mediante cateterizaçäo do trajeto fistuloso. Foram estudadas 18 pacientes. Expöem-se a técnica utilizada, analisam-se os resultados baseado no seguimento e conclui-se pela validade deste novo método terapêutico