Variación de dosis de radioyodo en pacientes con cáncer diferenciado de tiroides post implementación de guías ATA 2015 / Variation of radioiodine dose in patients with differentiated thyroid cancer after implementation of the ATA 2015 guidelines

Introducción: El cáncer diferenciado de tiroides (CDT), es actualmente la neoplasia endocrina más frecuente. Su tratamiento estándar es la resolución quirúrgica, asociado a ablación con radioyodo (RI) según la clasificación propuesta por la American Thyroid Association (ATA). Las indicaciones y dosis de este último, han ido variando en los últimos años según avanzan las investigaciones en este ámbito. Objetivo: En el siguiente estudio se compararon las dosis de RI utilizadas previo y posterior a la implementación de las últimas guías de la ATA. Materiales y métodos: Estudio retrospectivo observacional de 70 pacientes con diagnóstico de CDT del Hospital Clínico de la Universidad de Chile entre 2012 y 2017. Se agruparon los pacientes en dos cohortes, los operados entre los años 2012-2015 y los 2016-2017 clasificándolos según riesgo ATA, TNM y riesgo de recurrencia. Se consignaron las dosis de RI utilizadas y se compararon entre las cohortes. Análisis estadístico: Mann Whithney. Resultados: Al comparar la dosis de RI entre ambas cohortes, según TNM y riesgo ATA, se obtuvo los siguientes resultados: los pacientes T1b de la cohorte 2012-2015 presentaron dosis de RI significativamente mayores que los de la cohorte 2016-2017; también se evidenció que en pacientes N0 hubo una diferencia estadísticamente significativa, mostrando una tendencia a disminuir la dosis de RI; además, en los pacientes de la cohorte 2012-2015 con riesgo ATA intermedio, se obtuvo que las dosis de RI fueron significativamente mayores que las utilizadas en la cohorte 2016-2017. Conclusión: Se concluye que las variaciones de las dosis de RI utilizadas en pacientes con CDT en un hospital universitario van acorde a las recomendaciones internacionales actuales, particularmente la publicación de la guía ATA 2015, aplicándose radioablación con menor dosis de RI. Dado este cambio, se ha evidenciado igualdad de efectos con dosis menores de RI y consecuentemente menos efectos adversos.

Introduction: Differentiated thyroid cancer (CDT) is currently the most frequent endocrine neoplasia. Its standard of care is surgical treatment, associated with radioiodine ablation (IR) according to the classification proposed by the American Thyroid Association (ATA). The indications and doses of the latter have changed in recent years as research in this area advances. Objective: In the following study, the doses of IR used before and after the implementation of the latest ATA guidelines were compared. Materials and methods: Retrospective observational study of 70 patients with a diagnosis of CDT from the Clinical Hospital of the University of Chile between 2012 and 2017. Patients were grouped into two cohorts, those surgically intervened between the years 2012-2015 and 2016-2017, classifying them according to ATA risk, TNM and recurrence risk. The IR doses used were reported and compared between the cohorts. Statistical analysis: Mann Whithney. Results: When comparing the IR dose between both cohorts, according to TNM and ATA risk, the following results were obtained: T1b patients in the 2012-2015 cohort had significantly higher IR doses than those in the 2016-2017 cohort; It was also evidenced that N0 patients showed a statistically significant tendency to decrease the IR dose; In addition, the 2012-2015 cohort with intermediate ATA risk, revealed IR doses significantly higher than those used in the 2016-2017 cohort. Conclusion: It is concluded that the variations in IR doses, used in patients with CDT in a university hospital, are in accordance with current international recommendations, particularly the publication of the ATA 2015 guidelines, applying radioablation with a lower dose of IR. Given this change, equality of effects has been evidenced with lower doses of IR and consequently fewer adverse effects.

Recordando a Rosalyn Yalow / Remembering Rosalyn Yalow

Breves relatos de experiencias personales de los autores relacionados con la vida de la Dra. Rosalyn Yalow.

Variações metabólicas e endócrinas de cachaços híbridos (Landrace x Large White) durante o primeiro ano de vida e sua relação com o estabelecimento da puberdade / Metabolic and endocrine changes of hybrid boars (Landrace x Large White) during the first year of life and its relation to the establishment of puberty

O objetivo deste estudo foi determinar variações em parâmetros metabólicos e endócrinos de suínos machos durante o primeiro ano de vida e sua relação com a puberdade. Foram utilizados seis suínos acompanhados, de 22 a 360 dias deidade, com pesagens corporais e coletas de sangue a cada sete dias para avaliação dos níveis séricos de glicose, insulina, colesterol, albumina, ureia, cálcio, fósforo, aspartato aminotransferase (AST), gama glutariltransferase (GGT), ácidos graxos não esterificados (NEFA) e testosterona. A partir do ganho de peso e níveis de testosterona foram estabelecidos três períodos: pré-puberdade (1-5 meses de idade); puberdade (6-9 meses de idade); pós-puberdade (10-12 meses de idade), em que os níveis de testosterona foram de 0,6 ± 0,1 ng/mL, 1,8 ± 0,2 ng/mL e 1,8 ± 0,2 ng/mL, respectivamen- te (P < 0,0001). Foi observada correlação positiva entre a testosterona e níveis de albumina, idade e peso corporal, e correlação negativa entre testosterona e os níveis de cálcio, GGT e glicose. Os níveis de glicose diminuíram ao longo do desenvolvimento (P < 0,0001), e os níveis de NEFA foram maiores em pré-púberes (P = 0,01). A enzima GGT teve diminuição dos seus níveis a partir da puberdade (P < 0,0001), e a AST teve seus menores níveis na puberdade (P = 0,0003). A albumina apresentou maiores níveis durante a puberdade (P < 0,0001) e a ureia no período pós-puberdade (P < 0,0001). Os níveis de cálcio e fósforo apresentaram menores níveis no período pós-puberdade (P<0,0001). Assim, a puberdade representa um período de flutuação nos níveis de marcadores metabólicos de suínos machos híbridos, devido ao efeito da testosterona sobre o metabolismo energético, proteico e mineral.

The present study aimed to determine changes in endocrine and metabolic parameters in male pigs during the first year of life and its relation with the puberty. Six male pigs of 22 at 360 days of age were used in this study. Body weights and blood collection were performed every seven days for evaluation of serum glucose, insulin, cholesterol, albumin, urea,calcium, phosphorus, aspartate aminotransferase (AST), gamma glutamyltransferase (GGT), non-esterified fatty acids (NEFA) and testosterone. From the weight gain and testosterone levels were established three periods: prior to puberty (1-5 months old); puberty (6-9 months old); postpubertal (10-12 months old). During these periods testosterone levels were 0.6 ± 0.1 ng/mL, 1.8 ± 0.2 ng/mL and 1.8 ± 0.2 ng/mL, respectively (P < 0.0001). Positive correlation was observed between testosterone levels and albumin levels, age and body weight, and a negative correlation between testosterone levels and calcium, glucose and GGT. Glucose levels decreased throughout development (P < 0.0001) whereas NEFA levels were higher in pre-pubertal (P = 0.01). The enzyme GGT levels had decreased from puberty (P < 0.0001), and AST had their lowest levels at puberty (P = 0.0003). Albumin showed higher levels during puberty (P < 0.0001). The urea values were stable until puberty, and increased post-puberty (P < 0.0001). The levels of calcium and phosphorus levels had lower post-puberty (P < 0.0001). Thus, puberty is a period of fluctuation in the levels of metabolic markers of hybrid male pigs due to the effect of testosterone on energy, protein and mineral metabolism.

Seasonal differences in endocrine and ovarian patterns of Bos taurus indicus (Nelore) heifers estrous cycles / Diferenças sazonais no padrão endócrino e ovariano do ciclo estral de novilhas Bos taurus indicus (Nelore)

Estrous cycle of eight Nelore heifers were evaluated during different seasons of the year (autumn n=11; winter n=8; spring n=9 and summer n=9) with daily count and measurement of follicles ≥3mm, blood was collected every 12h for LH and progesterone (P4), and after estrous every 3h for LH peak. Five ovariectomized heifers were injected with 17β-estradiol (2μg/kg) every season and blood samples collected every 3h (for 30h) thereafter for LH quantification. The monthly percent body weight difference (Δ%) did not vary among seasons. P4 concentration was higher (p<0.01) and follicle number lower during autumn and summer compared to winter and spring. During winter there were more estrous cycles with three and during summer only cycles with two follicular waves (p<0.01). As LH secretion did not vary despite P4 concentration and as there was negative correlation between higher P4 values and daily percentile variation of photoperiod (Δ%, p<0.01; r= -0.45) it is possible to suppose that there is seasonal variation on luteal cell sensitivity to LH. In the ovariectomized Nelore heifers, the LH basal concentration (without estradiol stimulus, p=0.02) and the LH response to estradiol (p<0.01) were lower during summer, leading to the hypothesis that there is seasonal variation of hypothalamic sensitivity to estradiol. According to the present experiment there are suggestions of seasonal reproduction in Nelore heifers.

Ciclos estrais em oito novilhas Nelore foram acompanhados durante diferentes estações (outono n=11; inverno n=8; primavera n=9; verão n=9) com contagem e diâmetro de folículos ≥ 3 mm diariamente, com colheitas de sangue a cada 12 h para LH e P4, e a cada 3 h para o pico de LH. Cinco novilhas ovariectomizadas receberam 17β estradiol (2μg/kg) em cada estação, com colheitas de sangue a cada 3 h para quantificar LH. A diferença percentual (Δ%) do peso entre os meses não variou entre as estações. Durante o ciclo estral, a concentração de P4 (média e máxima) foi maior (p<0,01), e o número de folículos menor (p<0,01), no outono e verão, se comparados ao inverno e primavera. No inverno houve mais ciclos com três ondas e no verão somente ciclos com duas ondas foliculares (p<0,01). Como as características da secreção de LH não foram diferentes apesar da variação na concentração de P4, e como houve correlação negativa entre os valores máximos de P4 e a variação percentual (Δ%) diária no fotoperíodo (p<0,01; r= -0,45), supõe-se que haja variação sazonal na sensibilidade das células luteínicas ao LH. Nas novilhas ovariectomizadas, a concentração basal (sem estradiol) circanual de LH foi menor no verão (p=0,02), assim como a sua secreção em resposta ao estradiol (p<0,01), o que permite supor que também haja uma variação sazonal na sensibilidade hipotalâmica ao estradiol. De acordo com o presente experimento, há indícios de sazonalidade reprodutiva em novilhas Nelore.

Hemitiroidectomía mediante videoendoscopia, experiencia en el Hospital Hermanos Ameijeiras / Hemithyroidectomy by videoendoscopy: an experience from Hermanos Ameijeiras Clinical Surgical Hospital

Se presentan las 4 primeras pacientes operadas de hemitiroidectomía videoendoscópica en el Hospital Hermanos Ameijeiras, para introducir una técnica que elimine la cicatriz en el cuello de los(as) pacientes que necesitan un tratamiento quirúrgico por una enfermedad tiroidea. Se escogieron 4 pacientes con nódulos benignos del tiroides menores de 3 cm, remitidas para tratamiento quirúrgico por el servicio de endocrinología de nuestro centro, de enero a junio de 2009. Se les explicó en detalles el proceder y firmaron un consentimiento informado para participar en el estudio. En las 4 pacientes se pudo realizar la operación planificada, el promedio de tiempo quirúrgico fue de 2,9 h. El efecto cosmético fue mayor en las pacientes 2, 3 y 4 al no quedar ninguna cicatriz en el cuello. La laringoscopia posoperatoria demostró movilidad normal de las cuerdas vocales en las 4 pacientes. La cirugía videoendoscópica del tiroides es una realidad que no podemos obviar, y realmente tiene un único impacto demostrado hasta el momento actual, que es la posibilidad de eliminar la cicatriz residual en el cuello que tanto preocupa a los(as) pacientes jóvenes(AU)

These are the cases of the first patients operated on of Hemithyroidectomy by videoendoscopy in Hermanos Ameijeiras Clinical Surgical Hospital to introduce a technique eliminating the neck scar of patients needing surgical treatment by thyroid disease. Four patients presenting with benign thyroid nodules referred to surgical treatment by Endocrinology service of our institution from January to June, 2009. Procedure was explained in details and they signed the informed consent to participate in study. In four patients it was possible to perform the planned operation; the surgical time average was of 2, 9 hr. Cosmetic effect was greater in patients 2, 3 and 4 without neck scar. Postoperative laryngoscopy showed a normal motility of vocal cords in the four patients. Thyroid videoendoscopy surgery is a reality that cannot be obviated and with a unique impact proved until present time that is the possibility to eliminate the neck residual scar so worrying for young patients(AU)

Enfermedad tiroidea autoinmune: estudio clínico epidemiológico / Autoimmune thyroid disease: clinical-epidemiology study

Este estudio prospectivo sobre los aspectos clínico-epidemiológicos de la enfermedad tiroidea autoinmune en una muestra venezolana de 1000 pacientes, estableció en 9,9 % la prevalencia de enfermedad tiroidea; a su vez, la enfermedad tiroidea autoinmune fue la enfermedad tiroidea más común con una frecuencia relativa de 42% de todos los casos de enfermedad tiroidea y una prevalencia de 4,2%. Se observaron 42 casos de enfermedad tiroidea autoinmune: 27 de tiroiditis crónica autoinmune, 4 de tiroiditis silente y postpartum, uno de hipertiroidismo inducido por amiodarona y 11 de enfermedad de Graves. Una anciana con tiroiditis crónica autoinmune había presentado enfermedad de Graves 40 años antes, siendo esta una posibilidad evolutiva de la enfermedad tiroidea autoinmune. La enfermedad tiroidea fue más frecuente en las mujeres, especialmente en las tiroiditis autoinmunes, cuya relación hembra: varón fue 9,7: 1. Las hembras que constituyeron el 55 % de los 1000 casos, resultaron el 88% de los casos de enfermedad tiroidea autoinmune, diferencia también encontrada entre las ancianas de ambas muestras. En los mil pacientes, una de cada 22 mujeres presentó tiroiditis crónica autoinmune, clínica o subclínica. En los casos de enfermedad tiroidea autoinmune, 40% refirió enfermedad tiroidea familiar, particularmente autoinmune, 3 casos tenían historia familiar de enfermedad autoinmune sistémica y 17% se asoció con otra enfermedad autoinmune endocrina o sistémica. La positividad de los anticuerpos antitiroideos séricos, prueba suficiente para el diagnóstico de tiroiditis crónica autoinmune, se encontró en 89% de nuestros casos. El hipotiroidismo permanente es la secuela funcional más importante de tiroiditis crónica autoinmune, especialmente en las ancianas, tal como ocurrió en 55,5 % de 27 casos, 22,2 % como hipotiroidismo clínico y 33,3% como hipotiroidismo subclínico. En 12 casos con función tiroidea normal el promedio de la edad fue 46,75 ± 17,06. años...

This prospective clinical-epidemiologic study about autoimmune thyroid disease, in a Venezuelan sample of 1000 patients, established in 9.9% the prevalence of thyroid diseases; autoimmune thyroid disease was the most common thyroid disease with a relative frequency of 42% of all thyroid diseases cases and with prevalence of 4.2%. Forty two cases of autoimmune thyroid disease were observed: 27 with chronic autoimmune thyroiditis, 4 with silent and postpartum thyroiditis, one with amiodarone-induce thyrotoxicosis and 11 with Graves’ disease. One female initially with Graves’ disease was observed after 40 years with chronic autoimmune thyroiditis, an alternative in autoimmune thyroid disease evolution. In our study, all thyroid diseases were more frequent in women, especially in autoimmune thyroiditis, which female: male ratio was 9.7: 1. Females that represented 55% of 1000 cases were 88% of autoimmune thyroid disease cases, and this difference was found also between elderly females of both samples. In the 1000 patients, one of each 22 females presented clinical or subclinical chronic autoimmune thyroiditis. Forty percent of autoimmune thyroid disease cases referred familiar thyroid disease, particularly autoimmune, 3 cases had family history of systemic autoimmune disease and 17% was associated with other autoimmune endocrine or systemic disease. Antithyroid antibody confirmation is sufficient proof for diagnosis, as was observed in 89% of our cases. Permanent hypothyroidism is the most important functional consequence of chronic autoimmune thyroiditis, especially in older females, such as occurred in 55.5% of 27 cases, 22.2% as clinic hypothyroidism and 33.3% as subclinic hypothyroidism. In 12 cases with normal thyroid function the mean age was 46.75 ± 17,06 years, in 9 cases of subclinical hypothyroidism was 49,00 ± 18,97 years and in 6 cases of clinical hypothyroidism 53,50 ± 20,57 years. In chronic autoimmune thyroiditis, this progressive decline...

Current progress in shrimp endocrinology-a review.

One problem in aquaculture is obtaining brood because many commercially important species are incapable of spontaneous maturation under artificial conditions. Commercial shrimp hatcheries commonly use eyestalk ablation to stimulate gonadal maturation in shrimps. Research has been conducted on the inhibition of reproductive maturation by hormones originating in the eyestalk glands and on other endocrine sources (e.g.,brain, thoracic ganglion, ovary, mandibular organ, androgenic gland and Y-organs) to determine their roles. Alternate techniques for acceleration of gonad maturation through the use of synthetic hormones or neurotransmitters may benefit aquaculture. Neurohormones and neuroregulators have been shown to accelerate gonadal maturation but an effective delivery technique must be developed for use in a large-scale aquaculture operation.

Síndrome del paciente eutiroideo con enfermedades no tiroideas / Patient enthoyroid syndrome with sick non thgroid

El síndrome del eutiroideo enfermo se caracteriza por alteraciones transitorias en las pruebas de funcionamiento tiroideo en pacientes con enfermedades sistémicas agudas y crónicas, críticamente enfermos, sometidos a intervenciones quirúrgicas con traumatismos físicos; describiéndose en estos pacientes varios síndromes de alteración de la función tiroidea: T3 baja, T3 y T4 baja, T4 elevada. Se realiza una revisión del síndrome del eutiroideo enfermo haciendo un especial énfasis en los aspectos relativos a la fisiopatología, a las alteraciones en el funcionalismo tiroideo y a las enfermedades sistémicas agudas y crónicas que se han relacionado con la presencia del síndrome.

Patologías Endocrinas y metabólicas: diabetes mellitus, hipotiroidismo, hiperplasia suprarrenal congenita / Endocrine diseases and metabolic: diabetes mellitus, hypothyroidesm, adrenal hyperplasia congenital

Las anormalidades de la diferenciación sexual y el desarrollo, siempre en combinación con hipertensión o pérdida de sal, son los marcados clínicos de la Hiperplasia Suprarrenal Congénita. El diagnóstico debe hacerse tan rápido como sea posible, con el propósito de iniciar el tratamiento y detener los efectos de la anomalía enzimática. El diagnóstico y una decisión racional en la asignación del sexo dependerá de la determinación del sexo genético, la determinación hormonal de la enzima deficiente y de la valoracción del potencial del paciente para su actividad sexual futura y fertilidad. Es necesario y urgente que el médico reconozca, en el recién nacido, los signos clínicos de ambiguedad genital así como la pérdida de sal, característicos de la HSC, y refiera estos pacientes al endocrinólogo pediatra para una evaluación completa. En caso de que esta evaluación no sea posible hacerla en forma inmediata, sugerimos tomar una muestra de sangre al paciente (aproximadamente 8 cc. sin anticoagulante) centrifugarla y guardar el suero congelado e iniciar el tratamiento substitutivo, para luego gestionar la consulta con el especialista. Recordemos que el diagnóstico precoz conlleva a la instauración del tratamiento adecuado, que corregirá los síntomas específicos causados por la deficiencia enzimática que, junto con el control adecuado, resultará en un crecimiento y desarrollo normales del paciente