Estudio de los factores que influyen en el resultado del tratamiento con 131I en el hipertiroidismo por bocio nodular / Study of factors that influence the outcome of 131I treatment in hyperthyroidism secondary to nodular goitre

Objetivo. Determinar el resultado obtenido tras tratamiento con 131I en pacientes con bocio multinodular (BMN) y nódulo autónomo tóxico (NAT) en función de la dosis administrada (555 o 740MBq) y de otros factores relacionados con el paciente, la enfermedad o tratamientos previos. Material y métodos. Es un estudio retrospectivo sobre 108 pacientes (67 BMN y 41 NAT) tratados un nuestra unidad y con un seguimiento mínimo de 2 años. Se valoró el desarrollo de hipotiroidismo y el fracaso del tratamiento así como su relación con la dosis administrada u otros factores dependientes del paciente (edad o sexo), de la enfermedad (autoinmunidad, grado de hipertiroidismo o tipo de bocio) o la toma previa de antitiroideos. Resultados. El 36,9% de los pacientes con BMN desarrollaron hipotiroidismo no transitorio llegando al 51,2% en el caso de los NAT y sobre todo en aquellos que recibieron 740MBq (66,7%) sin encontrarse relación con ninguna otra variable así como tampoco en el desarrollo precoz del hipotiroidismo antes de un año. El fracaso del tratamiento no tuvo relación significativa con la dosis administrada pero sí con el sexo varón, la presencia de autoinmunidad o la toma previa de antitiroideos en el caso de los BMN. Conclusiones. La elevada tasa de hipotiroidismo obtenida con dosis altas en el tratamiento de hipertiroidismo en el bocio nodular indica que dosis más bajas podrían ser suficientes para controlar la enfermedad sin producir un aumento de fracasos del tratamiento. Únicamente en los pacientes con BMN de sexo masculino, con autoinmunidad positiva o toma previa de antitiroideos se podría estudiar la posibilidad de administrar una dosis mayor pues tienen una tasa de fracasos más elevada (AU)

Objective. To assess the outcome after 131I treatment in patients with multinodular (MNG) and nodular toxic goitre (NTG) according to the administered dose and other factors related to the patient, pathology, or previous treatments. Material and methods. A retrospective study was conducted on 108 patients (67 MNG and 41 NTG) treated in our department, with a follow-up period of at least 2 years. Development of hypothyroidism and treatment failure were evaluated along with their relationship with the administered dose and other factors such as age, sex, grade of hyperthyroidism, type of goitre, presence of autoimmunity, or previous antithyroid medication. Results. More than one-third (36.9%) of MNG patients, and even higher proportion of NTG patients (51.2%) developed non-transient hypothyroidism, particularly in those receiving 740MBq (66.7%). No relationship was found with any other variable. The development of early hypothyroidism (before one year) was also not related to any variable. Treatment failure was not related to the dose, but in MNG there was a relationship with male gender, presence of autoimmunity, or previous antithyroid drugs use. Conclusions. The high rate of hypothyroidism obtained with high doses of 131I in hyperthyroidism secondary to nodular goitre treatment suggests that lower doses might be sufficient to control the disease without an increase in treatment failures. Only patients with positive autoimmunity, in previous anti-thyroid medication, and perhaps male gender in MNG might be given higher doses, as the failure rate increases, but further studies are required (AU)

Study of factors that influence the outcome of 131I treatment in hyperthyroidism secondary to nodular goitre. / Estudio de los factores que influyen en el resultado del tratamiento con 131I en el hipertiroidismo por bocio nodular.

OBJECTIVE: To assess the outcome after 131I treatment in patients with multinodular (MNG) and nodular toxic goitre (NTG) according to the administered dose and other factors related to the patient, pathology, or previous treatments. MATERIAL AND METHODS: A retrospective study was conducted on 108 patients (67 MNG and 41 NTG) treated in our department, with a follow-up period of at least 2 years. Development of hypothyroidism and treatment failure were evaluated along with their relationship with the administered dose and other factors such as age, sex, grade of hyperthyroidism, type of goitre, presence of autoimmunity, or previous antithyroid medication. RESULTS: More than one-third (36.9%) of MNG patients, and even higher proportion of NTG patients (51.2%) developed non-transient hypothyroidism, particularly in those receiving 740MBq (66.7%). No relationship was found with any other variable. The development of early hypothyroidism (before one year) was also not related to any variable. Treatment failure was not related to the dose, but in MNG there was a relationship with male gender, presence of autoimmunity, or previous antithyroid drugs use. CONCLUSIONS: The high rate of hypothyroidism obtained with high doses of 131I in hyperthyroidism secondary to nodular goitre treatment suggests that lower doses might be sufficient to control the disease without an increase in treatment failures. Only patients with positive autoimmunity, in previous anti-thyroid medication, and perhaps male gender in MNG might be given higher doses, as the failure rate increases, but further studies are required.

Síndrome de Cushing debido a hiperplasia suprarrenal macronodular independiente de ACTH tratado mediante adrenalectomía unilateral: dos casos / Cushing’s syndrome due to ACTH-independent macronodular adrenal hyperplasia treated through unilateral adrenalectomy: report of two cases

La hiperplasia adrenal bilateral macronodular como causa de síndrome de Cushing es una entidad debatida en cuanto a su etiología (hipofisaria frente a adrenal) e incluso en cuanto a su tratamiento idóneo. Cada vez más se opta por medidas terapéuticas menos agresivas como la suprarrenalectomía unilateral. A continuación, se presentan 2 casos cuyo proceso diagnóstico nos ha servido para reabrir el debate del origen de la enfermedad, dada la presencia de nódulos hipofisarios en ambos casos y una determinación inicialmente elevada de corticotropina en el segundo. En cuanto al tratamiento, se ha practicado suprarrenalectomía unilateral de la glándula dominante (valoración realizada mediante imágenes de tomografía y gammagrafía) en ambos casos, con resultado satisfactorio en la evolución a medio plazo (AU)

The causes and treatment of ACTH-independent macronodular adrenal hyperplasia as a cause of Cushing's syndrome remain unclear. A pituitary adenoma could be responsible for the adrenal hyperplasia, but the adrenal gland could be the primary problem in many cases. Less aggressive treatments such as unilateral laparoscopic adrenalectomy are increasingly used. We present two cases of ACTH-independent macronodular adrenal hyperplasia. These cases led us to reopen the debate about the etiology of the disease, given the presence of pituitary nodules in both patients and initially elevated ACTH values in the second patient. In both patients, unilateral adrenalectomy of the dominant gland (evaluated through computed tomography and scintigraphy) was performed with satisfactory outcomes in the medium term (AU)