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.

Hiponatremia grave como manifestación inicial de síndrome de Sheehan de diagnóstico tardío: caso clínico / Hyponatremia secondary to panhypopituirarism: report of one case

Hyponatremia is common among older people and its possible causes are not thoroughly investigated in this age group. We report a 69 years old female with a history of hypothyroidism in treatment that consulted for malaise, anorexia and a severe hyponatremia that required hospital admission. A new interrogation, revealed that the patient suffered an uterine hemorrhage in 1977, remaining with agalactia. She also referred asthenia since 1990. Her serum cortisol was below normal limits and a sella turcica magnetic resonance imaging revealed a pituitary atrophy. The patient was treated with cortisol and discharged in good conditions.