Presence of risk factors for thyroid cancer does not improve the performance of ultrasound screening for thyroid nodules in patients with obesity.

PURPOSE: It has been suggested, on a theoretical basis, that ultrasound screening of thyroid nodules in obese patients with additional risk factors (family history, chronic autoimmune thyroiditis or high thyrotropin) might be cost-effective for the early detection and treatment of thyroid cancer. The present study evaluates if this approach can be validated in a real clinical setting. METHODS: Patients with obesity who attended hospital-based clinics were evaluated for risk factors of thyroid cancer and ultrasound screened for thyroid nodularity. Detected nodules were evaluated according to current guidelines. RESULTS: A total of 429 patients were evaluated (70.2% women, mean age 49.1 ± 11.0, mean body mass index 42.6 ± 5.8 kg/m2 ). Risk factors were present in 129 (30.1%) patients. Thyroid nodules with indication for fine-needle aspiration biopsy were detected in 69 (16.1%). We did not find differences in the risk of harbouring thyroid nodules according to the presence of risk factors (no risk factors 16.6%, risk factors 14.1%, P = .64). No single risk factor conferred an increased risk for thyroid nodules During the screening procedure, four cases of thyroid cancer were detected, none of them with the evaluated risk factors. CONCLUSION: The presence of known risk factors for thyroid cancer does not improve the performance of a US screening strategy aimed at the detection of thyroid nodules in obese patients. According to current guidelines, screening for thyroid nodules in obese patients is not recommended regardless of the presence of thyroid cancer risk factors.

Use of communication technologies by people with type 1 diabetes in the social networking era. A chance for improvement.

AIMS: To evaluate the health-related use of Web 2.0 tools by patients with type 1 diabetes. METHODS: Cross-sectional survey assessing views and usage of the Internet, Apps and Web 2.0. RESULTS: Number of participants: 289 (age 42.8±13.5 years; diabetes duration 18.4±12.2 years; 58.7% males; 39% with an upper secondary or higher education level). Web 2.0 usage for health purposes was low with 19.6% and 14% of Web 2.0 members (147; 50.9%) having health-related contacts and posting health comments. Health-related Apps were used by 35.4% of Smartphone owners (161; 55.7%). 75.3% patients would share information online with professionals, preferably through e-mail (78.7%) rather than Facebook (47.7%). 141 (66.5%) of those willing to share information would participate in a professional-moderated Facebook group. CONCLUSIONS: Web 2.0 and Apps usage for health purposes is low. The difference between the use of Web 2.0 networks and the willingness to participate in professional-moderated Web 2.0 groups points to the need of a higher implication of health professionals in promoting Web 2.0 technologies if these are to be adopted in a clinical setting. Currently, e-mail is the tool to be considered when aiming to increase online communication with patients with type 1 diabetes.

Impacto asistencial tras la introducción de la ecografía tiroidea en una unidad monográfica de atención al nódulo tiroideo / Healthcare impact of introduction of thyroid ultrasound in a thyroid nodule pathology unit

Introducción La incidencia de cáncer de tiroides ha aumentado en las últimas décadas en todo el mundo. Objetivo Aportar evidencias sobre la eficiencia diagnóstica y asistencial si la atención al nódulo tiroideo se realiza en una consulta monográfica que integre exploración clínica, estudio ecográfico y citología con valoración in situ. Pacientes y métodos Pacientes que acudieron a la consulta monográfica de nódulo tiroideo entre enero 2004 y junio 2010. Basado en la disposición del ecógrafo en el momento de la visita 2 períodos son definidos: primer periodo (P1: 01/2004-09/2007) sin ecógrafo en la consulta, PAAF por palpación; y segundo periodo (P2: 10/2007-06/2010) con ecógrafo, PAAF eco-guiada. Resultados Un total de 1.036 pacientes [P1: 537 (52%), P2: 499 (48%)] fueron consultados e incluidos. Eficiencia diagnóstica (P1 vs P2): número de pacientes visitados/año fue 143 vs 181, p<0,001; número de PAAF/nódulo: 1,68 vs 1,17, p<0,001; porcentaje de PAAF con material insuficiente: 26 vs 5,3%, p<0,001; tamaño medio (DE) del nódulo: 23,6 (12,4) vs 21,7 (11,7) mm, p 0,040; porcentaje de nódulos estudiados menores a 10mm: 9,9 vs 13,7%, p 0,030.Eficiencia asistencial: tiempo medio (rango) entre primera visita e indicación de cirugía: 332 (0-2177) vs 108 (0-596) días, p<0,001; relación de pacientes derivados a cirugía por sospecha citológica/por otros motivos: 1,06 vs 2,21, p<0,001; y de neoplasia/patología benigna intervenida: 0,47 vs 0,93, p=0,002.ConclusiónLa consulta monográfica del nódulo tiroideo, que integra exploración clínica, ecografía y citología con valoración in situ, aumenta la eficiencia diagnóstica y asistencial del nódulo tiroideo (AU)

Introduction: Worldwide incidence of thyroid cancer has increased in recent decades. Objective: To provide evidence of the diagnostic and care efficiency of a monographic thyroid nodule clinic integrating clinical examination, ultrasound examination, and cytology with onsite evaluation. Patients and methods: Patients attending the monographic thyroid nodule clinic from January2004 to June 2010. Two periods may be distinguished based on availability of ultrasound equipment at the time of the (..) (AU)

[Healthcare impact of introduction of thyroid ultrasound in a thyroid nodule pathology unit]. / Impacto asistencial tras la introducción de la ecografía tiroidea en una unidad monográfica de atención al nódulo tiroideo.

INTRODUCTION: Worldwide incidence of thyroid cancer has increased in recent decades. OBJECTIVE: To provide evidence of the diagnostic and care efficiency of a monographic thyroid nodule clinic integrating clinical examination, ultrasound examination, and cytology with on site evaluation. PATIENTS AND METHODS: Patients attending the monographic thyroid nodule clinic from January 2004 to June 2010. Two periods may be distinguished based on availability of ultrasound equipment at the time of the visit: a first period (P1: 01/2004-09/2007) where no ultrasound equipment was available at the clinic and FNA by palpation was performed, and a second period (P2: 10/2007-06/2010) where this equipment was available and ultrasound-guided FNA was performed. RESULTS: A total of 1036 patients [P1: 537 (52%), P2: 499 (48%)] were seen and enrolled. Diagnostic efficiency (P1 vs P2): 143 vs 181 patients were seen annually, p<0.001; FNA number/nodule: 1.68 vs 1.17, p<0.001; percent FNAs with inadequate material: 26% vs 5.3%, p<0.001; mean (SD) nodule size: 23.6 (12.4) vs 21.7 (11.7) mm, p 0.040; proportion of nodules examined less than 10mm in size: 9.9% vs 13.7%, p 0.030. Care efficiency: mean time (range) from the first visit to surgery indication: 332 (0-2177) vs 108 (0-596) days, p<0.001; proportion of patients referred for surgery due to suspect cytology/other reasons: 1.06 vs 2.21, p<0.001; and operated benign neoplasm/pathology: 0.47 vs 0.93, p=0.002. CONCLUSION: A monographic thyroid nodule clinic integrating clinical examination, ultrasound, and cytology evaluated on site increases diagnostic and care efficiency in patients with thyroid nodules.

Serum free triiodothyronine (T3) to free thyroxine (T4) ratio in treated central hypothyroidism compared with primary hypothyroidism and euthyroidism.

UNLABELLED: The standard treatment of hypothyroidism (central and primary) consists of thyroxine (T4) administration alone. However, the normal thyroid gland produces a small proportion of triiodothyronine (T3) directly into the circulation. AIM: We aimed to study the free T3 to free T4 ratio in treated central hypothyroidism compared with euthyroidism and treated primary hypothyroidism. METHODS: Eighty-three subjects were included in this cross-sectional study: 36 with central hypothyroidism, 20 with primary hypothyroidism and 27 healthy controls. A clinical history and a physical examination, including height and weight measurement, were performed and body mass index (BMI) was calculated. Fasting blood was drawn to measure T3, T4, free T3, free T4 and TSH. RESULTS: The free T3 to free T4 ratio was lower in treated central hypothyroidism than in euthyroidism but was similar to treated primary hypothyroidism. Free T4 was higher in treated central and primary hypothyroidism than in euthyroidism. Age, sex and BMI did not affect the free T3 to free T4 ratio. CONCLUSIONS: Treated patients with central hypothyroidism had a lower free T3 to free T4 ratio, similar free T3 levels and higher free T4 concentrations than euthyroid controls, whereas all these parameters were similar in central and primary hypothyroid patients treated with T4. The question of whether these findings translate into adequate tissue concentrations of free thyroid hormones in all tissues remains to be answered. Further studies should aim to determine whether clinical outcomes could be improved by a treatment achieving more physiological plasma concentrations.

Serum free triiodothyronine (T3) to free thyroxine (T4) ratio in treated central hypothyroidism compared with primary hypothyroidism and euthyroidism

T he standard treatment of hypothyroidism (central and primary) consists of thyroxine (T4) administration alone. However, the normal thyroid gland produces a small proportion of triiodothyronine (T3) directly into the circulation. Aim We aimed to study the free T3 to free T4 ratio in treated central hypothyroidism compared with euthyroidism and treated primary hypothyroidism. Methods Eighty-three subjects were included in this cross-sectional study: 36 with central hypothyroidism, 20 with primary hypothyroidism and 27 healthy controls. A clinical history and a physical examination, including height and weight measurement, were performed and body mass index (BMI) was calculated. Fasting blood was drawn to measure T3, T4, free T3, free T4 and TSH. Results The free T3 to free T4 ratio was lower in treated central hypothyroidism than in euthyroidism but was similar to treated primary hypothyroidism. Free T4 was higher in treated central and primary hypothyroidism than in euthyroidism. Age, sex and BMI did not affect the free T3 to free T4 ratio. Conclusions Treated patients with central hypothyroidism had a lower free T3 to free T4 ratio, similar free T3 levels and higher free T4 concentrations than euthyroid controls, whereas all these parameters were similar in central and primary hypothyroid patients treated with T4. The question of whether these findings translate into adequate tissue concentrations of free thyroid hormones in all tissues remains to be answered. Further studies should aim to determine whether clinical outcomes could be improved by a treatment achieving more physiological plasma concentrations (AU)

El tratamiento habitual del hipotiroidismo (central y primario) consiste en administrar sólo tiroxina (T4). Sin embargo, la glándula tiroides normal produce una proporción pequeña de triyodotironina (T3) que va directamente a la circulación. Objetivo Estudiar la razón entre las concentraciones de T3 /T4 circulantes en el hipotiroidismo central tratado respecto al eutiroidismo y al hipotiroidismo primario también tratado. Métodos Se incluyeron 83 sujetos en este estudio transversal: 36 presentaban hipotiroidismo central, 20 hipotiroidismo primario y 27 eran controles sanos. Se realizó una historia clínica y una exploración física que incluía la altura y el peso, y se calculó el índice de masa corporal (IMC). Se extrajo sangre en ayunas para medir T3, T4, T3 libre, T4 libre y TSH. Resultados La razón T3/T4 circulantes fue inferior en el hipotiroidismo central que en el eutiroidismo, pero similar a la del hipotiroidismo primario. La T4 libre fue mayor en el hipotiroidismo central y en el primario que en el eutiroidismo. La edad, el sexo y el IMC no afectaron la razón T3 /T4 circulante. Conclusiones Los pacientes con hipotiroidismo central tratados presentan una razón T3/T4 circulante más baja, niveles de T3 circulante similares y concentraciones de T4 libre superiores a los controles eutiroideos; sin embargo, todos estos parámetros son similares en los pacientes con hipotiroidismo central y primario tratados con T4. No se sabe si esto se traduce en concentraciones tisulares adecuadas de hormonas tiroideas libres en todos los tejidos. Queda por investigar si un tratamiento que obtenga una concentración plasmática más fisiológica sería mejor desde el punto de vista de los resultados clínicos. Es de esperar que se diseñen estudios en esa dirección (AU)

Respuesta de los autores: Carcinoma de paratiroides / No disponible

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Dificultad en el diagnóstico y el tratamiento del carcinoma de paratiroides / Difficulty in the diagnosis and treatment of parathyroid carcinoma: a case report

El carcinoma de paratiroides es una causa poco frecuente de hiperparatiroidismo primario. El principal problema de esta afección es el diagnóstico diferencial inicial entre adenoma y carcinoma de paratiroides, dado que los criterios histológicos en estos casos es difícil que ofrezcan un diagnóstico definitivo, a diferencia de otras neoplasias. No obstante, se encuentran descritas series de signos clínicos y bioquímicos de alta sospecha inicial de malignidad. Asimismo, en los casos de hiperparatiroidismo primario más aparatosos estamos obligados a pensar en esta enfermedad, que se acaba confirmando en la mayor parte de las ocasiones, incluso años después por la aparición de metástasis a distancia. El objetivo de este artículo es la descripción de un caso de hiperparatiroidismo primario severo y persistente en un paciente varón de 40 años, que años después se confirmó como secundario a un carcinoma de paratiroides (AU)

Parathyroid carcinoma is an uncommon cause of primary hyperparathyroidism. Tha main difficulty is the initial differential diagnosis between adenoma and carcinoma of the parathyroid gland because, unlike in other neoplasms, histologic criteria do provide a definitive result. However, clinical and biochemical characteristics that are highly suspicious for malignancy have been described. Moreover, parathyroid carcinoma should be suspected when the primary hyperparathyroidism is severe. In some cases the diagnosis is made several years later with detection of distant metastases. We report the case of a 40-year-old man with severe and persistent primary hyperparathyroidism, which was confirmed years later as being secondary to parathyroid carcinoma (AU)

Apoplejía hipofisaria secundaria al tratamiento del síndrome coronario agudo / Pituitary apoplexy following treatment for acute coronary syndrome

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Causa inesperada de virilización en una mujer posmenopáusica / Unexpected etiology of virilization in postmenopausal woman

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