ABSTRACT
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)
Subject(s)
Humans , Female , Adult , Middle Aged , Positron Emission Tomography Computed Tomography/instrumentation , Positron Emission Tomography Computed Tomography/methods , Fluorodeoxyglucose F18 , Thyroid Neoplasms , Thyroglobulin , Sensitivity and Specificity , Positron Emission Tomography Computed Tomography/standards , Positron Emission Tomography Computed Tomography , Thyroid Gland/pathology , Thyroid Gland , Neoplasm Recurrence, Local , Retrospective Studies , Thyroidectomy/methods , Thyroidectomy , Radiopharmaceuticals/therapeutic useABSTRACT
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.
Subject(s)
Fluorodeoxyglucose F18 , Iodine Radioisotopes , Multimodal Imaging , Neoplasm Recurrence, Local/blood , Neoplasm Recurrence, Local/diagnosis , Positron-Emission Tomography , Radiopharmaceuticals , Thyroglobulin/blood , Thyroid Neoplasms/blood , Thyroid Neoplasms/diagnosis , Tomography, X-Ray Computed , Adult , Aged , False Negative Reactions , Female , Humans , Male , Middle Aged , Retrospective Studies , Young AdultABSTRACT
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).
Subject(s)
Adenocarcinoma, Follicular/diagnostic imaging , Carcinoma, Papillary/diagnostic imaging , Thyroid Neoplasms/diagnostic imaging , Thyrotropin/pharmacology , Thyroxine/administration & dosage , Adenocarcinoma, Follicular/blood , Adenocarcinoma, Follicular/surgery , Adult , Autoantibodies/blood , Carcinoma, Papillary/blood , Carcinoma, Papillary/surgery , Female , Follow-Up Studies , Hormone Replacement Therapy , Humans , Iodine Radioisotopes , Luminescent Measurements , Male , Middle Aged , Radionuclide Imaging , Radiopharmaceuticals , Recombinant Proteins/administration & dosage , Recombinant Proteins/pharmacology , Retrospective Studies , Sensitivity and Specificity , Thyroglobulin/blood , Thyroid Neoplasms/blood , Thyroid Neoplasms/surgery , Thyrotropin/administration & dosage , Thyroxine/therapeutic use , Triiodothyronine/administration & dosage , Triiodothyronine/therapeutic useABSTRACT
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)
Subject(s)
Male , Female , Aged , Middle Aged , Humans , Cell Differentiation , Iodine Radioisotopes/therapeutic use , Thyrotropin/therapeutic use , Thyroid Neoplasms/drug therapy , Thyroid Neoplasms , Recombinant Proteins/therapeutic use , Thyrotropin/blood , Thyroglobulin/blood , Retrospective Studies , Follow-Up Studies , Thyroid Neoplasms/bloodABSTRACT
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.
Subject(s)
Diabetes Mellitus, Type 1/blood , Lipoproteins/blood , Adolescent , Adult , Child , Cholesterol/blood , Diabetes Mellitus, Type 1/therapy , Female , Humans , Male , Middle Aged , Prospective Studies , Triglycerides/bloodABSTRACT
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.
Subject(s)
Adrenal Gland Neoplasms/diagnosis , Pheochromocytoma/diagnosis , Adrenal Gland Neoplasms/therapy , Adult , Colic/diagnosis , Colic/therapy , Diagnosis, Differential , Female , Humans , Liver Diseases/diagnosis , Liver Diseases/therapy , Pheochromocytoma/therapy , Preoperative CareABSTRACT
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.
Subject(s)
Addison Disease/epidemiology , Addison Disease/etiology , Tuberculosis/complications , Adult , Female , Humans , Incidence , Male , Middle Aged , Prevalence , Retrospective Studies , Spain/epidemiologySubject(s)
Cysts/pathology , Parathyroid Diseases/pathology , Biopsy, Needle , Humans , Male , Middle AgedABSTRACT
We present the clinical case of a patient affected of Hashimoto thyroiditis who after suffering hypothyroidism for 11 years developed Grave's disease with hyperthyroidism. This is a very rare evolution of the autoimmune thyroid disease. We discuss the possible etiopathogenesis with a literature review.
