Tratamiento del hipertiroidismo con radioyodo: efecto de la dosis administrada sobre la función tiroidea y complicaciones asociadas / Treatment of hyperthyroidism with radioiodine: effects of administered dose on complications and thyroid function

Background: Radio-iodine is a definite therapy for Graves disease hyperthyroidism. However, the optimal dosage is still debatable. Aim: To assess the effects of different radioiodine doses on thyroid function and complications in patients with hyperthyroidism. Material and methods: A retrospective analysis of 139 patients with hyperthyroidism, treated with ratioiodine between 1988 and 1998. Radio iodine dose used was classified as low (<10 mCi), intermediate (10-14.9 mCi) or high (ü 15 mCi). Results: Thirty five patients were treated with low doses, 33 with intermediate doses and 71 with high doses. There were no differences between these patients in age, disease severity, frequency of post treatment euthyroidism or complications. Patients treated with low doses had a higher frequency of persistent hyperthyroidism than patients treated with high doses (25.7 and 4.2 percent respectively, p<0,001). Likewise, the frequency of subsequent hypothyroidism was 60 percent in patients treated with low doses and 84.5 percent of those with high doses, in whom it also appeared earlier. Associated complications were clinically irrelevant. In seven patients, Graves ophtalmopathy progressed after treatment, but this progression was not associated with the dose used. Conclusions: Radio iodine in high doses is useful, safe and effective for the treatment of Graves hyperthyroidism

Cáncer tiroideo: comunicación de 85 casos / Thyroid cancer: report of 85 cases

Background: Thyroid cancer is the most frequent endocrine cancer with important implications in terms of diagnosis and treatment. Aim: to report a population of patients with thyroid cancer diagnosed by pathological studies of the surgical piece. Patients and methods: Eighty five patients (68 female) with the definitive diagnosis of thyroid cancer were studied. Clinical, imaginological, cytological and pathological findings were analyzed. Results: The age range of patients was 10 to 77 years old. Sixty nine patients had ultrasonographic studies which showed a solid nodule in 84 percent, mixed solid-cystic area in 14.5 percent and a purely cystic nodule in 1.5 percent of the cases. Nineteen patients had non specific calcifications. Fine needle aspiration cytology was negative for malignancy in eight patients (false negative rate of 9.9 percent). The average size of the nodules was of 2.8 ñ 1.6 cm). Six nodules measured less than one cm (microcarcinoma). In the initial surgical procedure, 13 patients had lymph node metastases, 2 of them had a primary tumor of 1 cm and 5 patients had Graves's Disease. Frozen biopsies during operation had 9 false negative results for cancer (10.6 percent). Pathology showed 64 cases of papillary cancer (75 percent), 14 of follicular (16.5 percent), two were Hurthle cell cancer (2.4 percent), three were medullary (3.5 percent), and two anaplastic (2.4 percent). Conclusions: in our experience, thyroid cancer is more common in women, solid lesions predominate in the ultrasonography and calcifications are frequently found. The tumor size is variable and the most frequent pathological type corresponds to differentiated cancers. Using the definitive pathological study as the standard, the diagnostic sensitivity of fine needle cytology was 90.1 percent, and of frozen section 89.4 percent

Actualización en el manejo del cáncer diferenciado de tiroides / Update in the management of differentiated thyroid cancer

Esta revisión describe los avances más recientes en el diagnóstico y tratamiento del carcinoma diferenciado de tiroides. Esta neoplasia tiene una morbilidad relativamente elevada. Se presentan los principales procedimientos diagnósticos, haciendo énfasis en los estudios morfológicos y citológicos disponibles. Las diferentes modalidades terapéuticas, médicas y quirúrgicas son expuestas. Se discuten las ventajas y desventajas de los procedimientos quirúrgicos más utilizados. Se incluyen temas controversiales como la indicación de tiroidectomía subtotal en tumores de "buen iagnóstico", el uso del yodo 131 para terapia ablativa y las complicaciones asociadas a la terapia supresora con hormona tiroidea

El tratamiento médico de la obesidad desde una perspectiva multidisciplinaria / A multi professional perspective in the treatment of obesity

Obesity is a serious condition affecting the physical and psychological well being of a large number of individuals. There are many therapeutic options for the disease and their judicious selection is critical. The best results are obtained with well-organised multi professional programs. The aims of the treatment must be defined balancing risks and benefits. Eating behaviour patterns must be considered for the proper selection of therapy. Diet is an essential therapeutic component and has to be individually prescribed for each patient. Pharmacological agents inhibit appetite, increase thermogenesis or inhibit gastrointestinal absorption of nutrients. As these medications have important side effects and complications, extreme care must be taken for their prescription

Carcinoma suprarrenal productor de testosterona: 2 casos clínicos / Testosterone producing adrenal carcinoma: 2 clinical cases

We report 2 women aged 48 and 65 years old with hirsutism and a painful abdominal mass. Laboratory assessment showed serum testosterone levels of 500 and 321 ng/dl (normal values below 110 ng/ml). Abdominal CAT scans showed an adrenal mass in both patients. The younger woman was subjected to a surgical resection, the tumor relapsed 2 years later and the patient died. The other woman died during the first hospitalization. Adrenal tumors infrequently secrete testosterone as described in these 2 patients