La tomografía por emisión de positrones-tomografía computarizada con 18F-fluordesoxiglucosa en los pacientes con cáncer diferenciado de tiroides en recurrencia y rastreo con radioyodo negativo. Rendimiento diagnóstico y relación con los niveles de tiroglobulina / Positron emission tomography-computed tomography with 18F-fluorodeoxyglucose in patients with recurrent differentiated thyroid carcinoma and negative radioiodine scan. Diagnostic performance and relation with tyroglobulin levels

Objetivo. Evaluar el rendimiento diagnóstico de la PET-TC con 18F-FDG y su relación con los niveles séricos de tiroglobulina (Tg) en los pacientes con cáncer diferenciado de tiroides con sospecha de persistencia o recurrencia de enfermedad y rastreo con radioyodo negativo. Material y métodos. Análisis retrospectivo de 35 estudios PET-TC en 25 pacientes (17 mujeres, edad media 48,8±15,2 años). Los resultados se comprobaron histológicamente, o mediante ecografía y seguimiento clínico. Se analizó la relación entre el rendimiento diagnóstico de la PET-TC y 3 niveles de Tg: ≤2ng/ml; entre 2 y 10 ng/ml, y >10ng/ml. Resultados. Se obtuvieron 26 verdaderos positivos, un falso positivo, 3 verdaderos negativos y 5 falsos negativos. De los 18 pacientes con una PET-TC clasificada como verdadero positivo, 3 mostraron lesiones en el lecho postiroidectomía, 15 mostraron afectación ganglionar y 5 presentaron metástasis a distancia. La sensibilidad fue del 83,9% (IC95%: 69,3-98,4%) y la especificidad del 75% (IC95%: 20-100%). Para 3 intervalos de Tg, la PET-TC mostró una tasa de verdaderos positivos del 37,5, del 83 y del 100% en los pacientes con niveles de Tg <2, entre 2 y 10, y >10 ng/ml, respectivamente. Conclusiones. La PET-TC con 18F-FDG muestra un alto rendimiento diagnóstico de la enfermedad locorregional y a distancia en la población de pacientes con cáncer diferenciado de tiroides en situación de persistencia de enfermedad y rastreo con yodo negativo con niveles de Tg >2ng/ml(AU)

Objective. To assess the diagnostic performance of 18F-FDG PET-CT scan and its relation to serum thyroglobulin (Tg) levels in patients with differentiated thyroid carcinoma with suspicion of persistence or recurrence of the disease and negative radioiodine scans. Materials and methods. This is a retrospective analysis of 35 PET-CT studies in 25 patients (17 women, average age 48.8±15.2 years). The results were confirmed by histology or by ultrasonography and clinical follow-up. We analyzed the relationship between the diagnostic performance of the PET-CT scans and three levels of Tg: ≤2ng/ml; between 2 and 10 ng/ml, and >10ng/ml. Results. We obtained 26 true-positives (TP), one false-positive (FP), 3 true-negatives (TN) and 5 false-negatives (FN). Of the 18 patients with PET-CTs classified as TP, 3 showed lesions at the post-thyroidectomy bed, 15 showed lymph node metastases and 5 were distant metastases. Sensitivity was 83.9% (95%CI: 69.3%-98.4%) and specificity was 75% (95%CI: 20%-100%). Regarding the three intervals of Tg, PET-CT scan showed TP rates of 37.5%, 83% and 100% in patients with Tg levels <2ng/ml, between 2 and 10ng/ml, and >10ng/ml, respectively. Conclusions. 18F-FDG PET-CT demonstrates high diagnostic yield in local disease and distant lesions for the population of patients with differentiated thyroid carcinoma and persistence of the disease with negative radioiodine scans at Tg levels above 2ng/ml(AU)

[Positron emission tomography-computed tomography with (18)F-fluorodeoxyglucose in patients with recurrent differentiated thyroid carcinoma and negative radioiodine scan. Diagnostic performance and relation with tyroglobulin levels]. / La tomografía por emisión de positrones-tomografía computarizada con (18)F-fluordesoxiglucosa en los pacientes con cáncer diferenciado de tiroides en recurrencia y rastreo con radioyodo negativo. Rendimiento diagnóstico y relación con los niveles de tiroglobulina.

OBJECTIVE: To assess the diagnostic performance of (18)F-FDG PET-CT scan and its relation to serum thyroglobulin (Tg) levels in patients with differentiated thyroid carcinoma with suspicion of persistence or recurrence of the disease and negative radioiodine scans. MATERIALS AND METHODS: This is a retrospective analysis of 35 PET-CT studies in 25 patients (17 women, average age 48.8±15.2 years). The results were confirmed by histology or by ultrasonography and clinical follow-up. We analyzed the relationship between the diagnostic performance of the PET-CT scans and three levels of Tg: ≤2ng/ml; between 2 and 10 ng/ml, and >10ng/ml. RESULTS: We obtained 26 true-positives (TP), one false-positive (FP), 3 true-negatives (TN) and 5 false-negatives (FN). Of the 18 patients with PET-CTs classified as TP, 3 showed lesions at the post-thyroidectomy bed, 15 showed lymph node metastases and 5 were distant metastases. Sensitivity was 83.9% (95%CI: 69.3%-98.4%) and specificity was 75% (95%CI: 20%-100%). Regarding the three intervals of Tg, PET-CT scan showed TP rates of 37.5%, 83% and 100% in patients with Tg levels <2ng/ml, between 2 and 10ng/ml, and >10ng/ml, respectively. CONCLUSIONS: (18)F-FDG PET-CT demonstrates high diagnostic yield in local disease and distant lesions for the population of patients with differentiated thyroid carcinoma and persistence of the disease with negative radioiodine scans at Tg levels above 2ng/ml.

[Comparison of administration of rhTSH with withdrawal of thyroid hormone. Follow-up of patients with differentiated thyroid carcinoma]. / Estudio comparativo entre la utilización de TSH recombinante y la estimulación endógena con TSH. Valoración en el seguimiento de los pacientes con carcinoma diferenciado de tiroides.

UNLABELLED: Recombinant human thyrotropin (rhTSH) has been introduced recently in follow up of differentiated thyroid cancer (DTC) patients, as an alternative of thyroid hormone withdrawal. The aim of this retrospective study is to compare recombinant human thyrotropin versus endogenous stimulation. MATERIAL AND METHODS: Thirty-three patients with DTC with previous thyroidectomy and thyroid ablation were selected. All patients underwent whole-body radioiodine scanning and third day serum thyroglobulin (TG) measurement by two techniques, the first one after conventional thyroid hormone withdrawal (TSHe, TGe), and the second one after rhTSH stimulation (TSHr, TGr). Measurement of TG was performed on the third day due to the infrastructure. We only included patients with stable disease, without therapeutic interventions between two consecutive controls in an interval inferior to one year. Two qualitative categories were defined for TG (positive TG > 2 ng/ml or negative TG<2 ng/ml) and whole-body radioiodine scan (positive or negative). RESULTS: TSHe: 62.9 +/- 55.48; TSHr: 113.16 +/- 50.6; (p: ns); TGe: 62.5 +/- 115.7; TGr: 54.6 +/- 111.1; (p: 0.044). Quantitative data analysis showed significant differences between two techniques. Qualitative data analysis showed no significant differences in clinical setting based in TG and radioiodine scan. CONCLUSIONS: Administration of rhTSH produces a significantly higher increase of TSH than thyroid hormone withdrawal and lower increase in TG levels. There were no significant differences in the stage of disease (TG and whole-body radioiodine scan).

Estudio comparativo entre la utilización de TSH recombinante y la estimulación endógena con TSH. Valoración en el seguimiento de los pacientes con carcinoma diferenciado de tiroides / Comparison of administration of rhTSH with withdrawal of thyroid hormone. Follow-up of patients with differentiated thyroid carcinoma

En el seguimiento habitual de los pacientes con cáncer diferenciado (CDT) se ha introducido recientemente el uso de la hormona tirotropa (TSH) humana recombinante (rhTSH) como alternativa a la retirada del tratamiento supresivo hormonal. El objetivo de este estudio retrospectivo es comparar el resultado de la administración de rhTSH con respecto a la estimulación con TSH endógena en el seguimiento del CDT. Material y métodos. Hemos seleccionado 33 pacientes con CDT a los que se había practicado previamente una tiroidectomía total y la ablación de restos tiroideos con 131I. Todos los pacientes tenían un control previo de rastreo con yodo y tiroglobulina (TG) sérica con suspensión del tratamiento hormonal (TSHe, TGe) y un nuevo control con rhTSH (TSHr, TGr). La determinación de la TG se realizó el tercer día por motivos de infraestructura. Se incluyeron sólo los pacientes sin cambios clínicos ni actuaciones terapéuticas entre los dos controles realizados con un intervalo máximo de un año. Se definieron dos categorías para la TG (positiva si TG > 2 ng/ml y negativa si TG < 2ng/ml) y para el rastreo (positivo o negativo). Resultados. Los valores analíticos obtenidos para cada control fueron los siguientes: TSHe: 62,9 ± 55,48 U/ml; TSHr: 113,16 ± 50,6 U/ml; (p: ns); TGe: 62,5 ± 115,7 mg/ml; TGr: 54,6 ± 111,1 mg/ml; (p: 0,044). La valoración cualitativa de los resultados obtenidos (prueba positiva o negativa) en ambos controles no mostró diferencias significativas ni en el resultado de la TG ni en rastreo con yodo. Conclusiones. El incremento de la TSH con previa administración de rhTSH es significativamente mayor que el incremento mediante estimulación endógena, mientras que las cifras de TG son globalmente menores. No se aprecian diferencias en la valoración de la presencia o ausencia de la enfermedad mediante TG y rastreo con yodo

Recombinant human thyrotropin (rhTSH) has been introduced recently in follow up of differentiated thyroid cancer (DTC) patients, as an alternative of thyroid hormone withdrawal. The aim of this retrospective study is to compare recombinant human thyrotropin versus endogenous stimulation. Material and methods. Thirty-three patients with DTC with previous thyroidectomy and thyroid ablation were selected. All patients underwent whole-body radioiodine scanning and third day serum thyroglobulin (TG) measurement by two techniques, the first one after conventional thyroid hormone withdrawal (TSHe, TGe), and the second one after rhTSH stimulation (TSHr, TGr). Measurement of TG was performed on the third day due to the infrastructure. We only included patients with stable disease, without therapeutic interventions between two consecutive controls in an interval inferior to one year. Two qualitative categories were defined for TG (positive TG > 2ng/ml or negative TG < 2ng/ml) and whole-body radioiodine scan (positive or negative). Results. TSHe: 62.9 ± 55.48; TSHr: 113.16 ± 50.6; (p: ns); TGe: 62.5 ± 115.7; TGr: 54.6 ± 111.1; (p: 0.044). Quantitative data analysis showed significant differences between two techniques. Qualitative data analysis showed no significant differences in clinical setting based in TG and radioiodine scan. Conclusions. Administration of rhTSH produces a significantly higher increase of TSH than thyroid hormone withdrawal and lower increase in TG levels. There were no significant differences in the stage of disease (TG and whole-body radioiodine scan)

[Pathological characteristics of patients with diabetes mellitus type 2, in Spanish Primary Care]. / Perfil de los pacientes con diabetes mellitus tipo 2, en la Atención Primaria española.

CONTEXT: To know the characteristics, related risk factors, and degree of control in patients with diabetes mellitus type 2 (DM2) in our country. METHODS: Observational, unrandom, opened, and multicenter study. Anthropometric characteristics, substance abuse, medication, control of diabetes, cholesterol, and triglycerides were analyzed in 5,395 patients. The patients were classified according to the length of the diagnosis: recent diabetes (RD) and known diabetes (KD). The chi-square test was utilized in order to compare the categorical variables, and the Student's t test for compare the continuous variables. The relationship between these variables was analyzed through the Pearson's correlation coefficient, and an analysis of multiple correspondence was carried out. RESULTS: Median age, 63 years; obese, 34%; smokers, 11%; drinkers, 24%; hypertensives, 44%; lipemic, 42%. Control degree: HbA1c>6.5% in 79%, LDLc>115 mg/dl in 80%. Hypoglycemic treatment: sulfonylureas, 62.8%; antidiabetics combination, 5%; only insulin, 4.3%; insulin combined with antidiabetics, 20.6%. Control of diabetics, of lipids, and of weight was lower in the patients with KD that in the patients with RD (HbA1c, 7.6% versus 7%; LDLc 148 mg/dl versus 136 mg/dl; percentage of obese, 27.2% versus 38.62%). A relationship between the length of evolution of diabetes and the deterioration of the control of blood glucose and of lipids was detected. CONCLUSION: DM2 and its associated risk factors are insufficiently controlled in our country. The drug combination and insulin are utilized scarcely.

Perfil de los pacientes con diabetes mellitus tipo 2, en la Atención Primaria española / Pathological characteristics of patients with diabetes mellitus tipe 2, in Spanish Primary Care

Fundamento. Conocer las características, factores de riesgo asociados y el grado de control de los pacientes con diabetes mellitus tipo 2 (DM2) de nuestro país. Métodos. Estudio observacional, no aleatorizado, abierto y multicéntrico. Se analizó en 5.395 pacientes sus características antropométricas, hábitos tóxicos, medicación, control de la diabetes, colesterol y triglicéridos. Se dividieron según la antigüedad del diagnóstico en diabetes reciente (DR) y diabetes conocida (DC). Se utilizó la prueba de 2 para comparar las variables categóricas y la "t" de Student para comparar las variables continuas. La relación entre estas variables se analizó mediante el coeficiente de correlación de Pearson y se realizó un análisis de correspondencias múltiples. Resultados. Edad media, 63 años; obesos, 34 por ciento; fumadores, 11 por ciento; bebedores, 24 por ciento; hipertensos, 44 por ciento; hiperlipidémicos, 42 por ciento. Grado de control: HbA1c > 6,5 por ciento en el 79 por ciento, c-LDL>115 mg/dl en el 80 por ciento. Tratamiento hipoglucemiante: sulfonilurea, 62,8 por ciento; combinación de antidiabéticos, 5 por ciento; insulina sola 4,3 por ciento, y combinada con antidiabéticos, 20,6 por ciento. El control de la diabetes, de los lípidos y del peso fue peor en los pacientes con DC que en los DR (HbA1c, 7,6 por ciento frente al 7 por ciento; LDL, 148 mg/dl frente a 136 mg/dl; porcentaje de obesos, 27,2 por ciento frente al 38,62 por ciento). Encontramos relación entre el tiempo de evolución de la diabetes y el deterioro del control de la glucemia y de los lípidos. Conclusión. La DM2 y los factores de riesgo asociados están mal controlados en nuestro país. Se utiliza poco la combinación de fármacos y la insulina (AU)

[Acromegaly and Graves-Basedow disease. Report of 3 cases]. / Acromegalia y enfermedad de Graves-Basedow. A propósito de 3 casos.

Acromegaly is associated to thyroidal disorders such as hyperthyroidism. The Graves-Basedow disease as a cause of thyroid hyperfunction is very infrequent, with only 8 cases having been reported up to 1993. The authors present 3 patients with acromegaly who developed hyperthyroidism due to Graves-Basedow disease in the course of their disease. Two of the patients had acromegaly of 30 years of evolution and the third patient underwent consultation for clinical symptoms of hyperthyroidism with acromegaly being simultaneously diagnosed. All the patients had weight loss prior to diagnosis and the possibility of neoplasia associated to acromegaly was excluded. The hyperthyroidism responded well to initial treatment with antithyroid drugs in the three cases. The authors conclude that hyperthyroidism should be taken into consideration in the diagnosis of a patient with acromegaly and weight loss.

[Glycemic control and lipoprotein profile in type I diabetes mellitus]. / Control glucémico y perfil lipoproteico en la diabetes mellitus tipo I.

BACKGROUND: To analyze the relation between the degree of glycemic control and the lipoprotein profile in type I diabetes mellitus. METHODS: Seventy-five diabetics were studied in whom the total glycohemoglobin (GHb), total triglycerides (TG), triglycerides of very low density lipoproteins (TG-VLDL), total cholesterol (TC), cholesterol of very low density lipoproteins (C-VLDL), cholesterol of high density lipoproteins (c-HDL), apolipoprotein AI (Apo AI) and apolipoprotein B (Apo B) were determined. Patients were classified according to their GHb: less than 9% (good glycemic control), 9-11% (moderate glycemic control) and greater than 11% (bad glycemic control). There was homogeneity in the 3 groups with regards to other variables which influenced the lipoprotein profile. RESULTS: The concentrations of TG, TG-VLDL, TC, C-VLDL and C-LDL were significantly higher in the groups of greater GHb while those of C-HDL, Apo I and Apo B were independent of the degree of glycemic control. The number of patients whose lipid profiles may be considered as atherogenic risk increases progressively in groups with greater GHb. CONCLUSIONS: In patients with type I diabetes mellitus, bad glycemic control is accompanied by decreases in TG, TC and C-LDL up to a magnitude which frequently reaches risk values for developing vascular disease. However, in these subjects, a less protector effect dependent on C-HDL is not to be expected since their concentrations are similar to those patients with good glycemic control.

[A clinically unsuspected pheochromocytoma]. / Feocromocitoma clínicamente insospechado.

Pheochromocytomas are often unnoticed, and diagnosis is performed on autopsy examination, or more rarely it is noticed during surgery or abdominal exam for a different reason. In many of these patients the lack of hypertension is a characteristic feature. We contribute a singular case of a patient with pheochromocytoma found by chance during an abdominal exam and which in spite of secreting noradrenaline, did not provoke hypertension or other symptoms. We review literature on this stage form of presentation and the different physio-pharmacological hypothesis which could condition the absence of clinical manifestations. We discuss the preoperative management in patients without hypertension.

[Addison's disease: a clinico-epidemiologic study of 45 cases]. / Enfermedad de Addison: estudio clinicoepidemiológico de 45 casos.

We present the clinical-epidemiological results obtained in a series of 45 patients diagnosed of Addison disease between 1967 and 1988. The incidence was 0.83 cases/100,000 inhabitants/year and the prevalence was 10 cases/100,000 inhabitants. The etiology was unknown in 44.4% of cases tuberculous in 24.4% and in 31.1% of cases the caused could not be established with the classical clinical and radiological criteria. Amongst the studied variables in each etiological group, we highlight the association with other autoimmune processes and the development of extraadrenal tuberculous infection after Addison disease diagnosis. We discuss the approach to etiological diagnosis and the convenience of tuberculostatic treatment in EAT cases.