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.

[Incidental diagnosis of lymph node tuberculosis in an 111-indium-octreotide scintigraphy during a study of acromegaly]. / Diagnóstico casual de tuberculosis ganglionar activa en una gammagrafía con octreótido-Indio 111 durante el estudio de una acromegalia.

A patient with clinical suspicion of acromegaly and no radiologic visualization of pituitary adenoma is presented. (111)In-DTPAOC scintigraphy was performed in order to localize an ectopic foci of GH production. Scintigraphy showed uptake in right paratracheal and hiliar lymph nodes that seemed residual in CT. Biopsy through mediastinoscopy showed tuberculous granulomas. After treatment, scintigraphy normalized. This case illustrate that (111)In-DTPAOC can be positive not only in tumoral but in benign pathology and, in specific cases, it can be a marker of inflammatory activity and useful for treatment monitoring.

Diagnóstico casual de tuberculosis ganglionar activa en una gammagrafía con octreótido-Indio 111 durante el estudio de una acromegalia / Causal diagnosis of lymph node tuberculosis in an 111 Indium-octreotide scintigraphy during a study of an acromegaly

Presentamos a un paciente con sospecha de acromegalia y ausencia radiológica de adenoma hipofisario al que se realizó una gammagrafía con 111In-DTPAOC para localizar un posible foco ectópico productor de hormona de crecimiento (GH). La gammagrafía mostró la existencia de adenopatías captantes paratraqueales e hiliares derechas que en la tomografía computarizada (TC) parecían residuales. La biopsia por mediastinoscopia de las adenopatías mostró la existencia de granulomas tuberculosos. Tras tratamiento tuberculostático la gammagrafía se normalizó. Este caso ilustra el hecho de que la gammagrafía con 111In-DTPAOC puede ser positiva no sólo en patología de origen tumoral, sino también en patología benigna y que en ocasiones puede ser un marcador de actividad inflamatoria y útil en la monitorización del tratamiento

A patient with clinical suspicion of acromegaly and no radiologic visualization of pituitary adenoma is presented. 111In-DTPAOC scintigraphy was performed in order to localize an ectopic foci of GH production. Scintigraphy showed uptake in right paratracheal and hiliar lymph nodes that seemed residual in CT. Biopsy through mediastinoscopy showed tuberculous granulomas. After treatment, scintigraphy normalized. This case illustrate that 111In-DTPAOC can be positive not only in tumoral but in benign pathology and, in specific cases, it can be a marker of inflammatory activity and useful for treatment monitoring

[Does brain blood flow HMPAO SPECT withhold the vascular etiopathogenic theory of transient global amnesia?]. / Apoya el SPECT de perfusión cerebral la teoría etiopatogénica vascular de la amnesia global transitoria?

INTRODUCTION: Transient global amnesia (TGA) is a neurological disorder that consists in a sudden loss of anterograd memory and temporospatial disorientation during less than 24 hours. Several precipitating factors have been reported. Conventional neuroimaging scans usually are negative. Different etiopathogenic theories have been postulated but the vascular etiology is the most commonly accepted. CASE REPORTS: Three patients with a typical presentation of TGA are studied. In all of them two brain blood flow HMPAO SPECT were performed, within the first 48 hours from the onset and three months after as an evolutive control. The first patient showed a left temporal perfusion defect and temporoparietal hypoperfusion. The second showed frontotemporal hypoperfusion, temporal mesial defect and hypoperfusion in basal ganglia, all in the left side. The third patient showed thalamic hyperperfusion and cerebellum hypoperfusion, both in the left. In all of them, control SPECT normalized. CONCLUSION: Three etiopatogenic theories about TGA have been reported: epilepsy, migraine and blood flow impairment. In TGA neuroanatomic image and neurophysiologic studies usually do not show significative alterations. Conversely, functional studies as brain blood flow HMPAO SPECT, do show changes being the most common bilateral temporobasal hypoperfusion, although this is not the only pattern described. Causes of this variable behaviour remain unclear but can be related to different clinic expressions and, over all, to time of evolution from onset. The three cases in this study show three different perfusion patterns reported in TGA and all of them withhold the vascular etiopathogenic theory.

¿Apoya el SPECT de perfusión cerebral la teoría etiopatogénica vascular de la amnesia global transitoria? / Does brain blood flow hmpao spect withhold the vascular etiopathogenic theory of transient global amnesia?

Introducción. La amnesia global transitoria (AGT) es un desorden neurológico consistente en una pérdida brusca de memoria anterógrada predominantemente y una desorientación temporoespacial cuya duración es inferior a 24 horas. Se han definido múltiples factores desencadenantes. Las pruebas de imagen convencionales suelen ser negativas. Existen varias teorías etiopatogénicas, de las que la más aceptada es la de origen vascular. Casos clínicos. Se presentan tres pacientes con cuadro típico de AGT a los que se realizó un SPECT de perfusión con HMPAO dentro de las primeras 48 del inicio del episodio y un control evolutivo a los tres meses. El primero mostró un defecto de perfusión temporal izquierdo e hipoperfusión temporoparietal ipsilateral. El segundo, una hipoperfusión frontotemporal, un defecto temporal mesial e hipoperfusión de los ganglios basales, todos ellos izquierdos. El tercer paciente mostró una hiperperfusión talámica e hipoperfusión cerebelosa, ambos izquierdos. En todos ellos, el SPECT de control mostró la normalización de los hallazgos. Conclusión. Las tres teorías etiopatogénicas de la AGT postulan un origen epileptógeno, migrañoso o vascular. En la AGT, las pruebas de imagen neuroanatómica y neurofisiológicas no suelen aportar datos significativos, pero las pruebas funcionales del SPECT de perfusión sí suelen mostrar alteraciones, la más frecuente de las cuales es la hipoperfusión temporobasal bilateral, aunque no es el único patrón descrito. Las causas del patrón variable de hipoperfusión no están claras, aunque pueden estar relacionadas con cambios en la expresividad clínica y, sobre todo, en el tiempo de evolución desde el inicio de la clínica. Los tres casos mostrados ilustran tres patrones de perfusión diferentes descritos en la AGT, y todos ellos apoyan la teoría etiopatogénica vascular (AU)

Introduction. Transient global amnesia (TGA) is a neurological disorder that consists in a sudden loss of anterograd memory and temporoespatial disorientation during less than 24 hours. Several precipitating factors have been reported. Conventional neuroimaging scans usually are negative. Different etiopathogenic theories have been postulated but the vascular etiology is the most commonly accepted. Case reports. Three patients with a typical presentation of TGA are studied. In all of them two brain blood flow HMPAO SPECT were performed, within the first 48 hours from the onset and three months after as an evolutive control. The first patient showed a left temporal perfusion defect and temporoparietal hypoperfusion. The second showed frontotemporal hypoperfusion, temporal mesial defect and hypoperfusion in basal ganglia, all in the left side. The third patient showed thalamic hyperperfusion and cerebellum hypoperfusion, both in the left. In all of them, control SPECT normalized. Conclusion. Three etiopatogenic theories about TGA have been reported: epilepsy, migraine and blood flow impairment. In TGA neuroanatomic image and neurophisiologic studies usually do not show significative alterations. Conversely, functional studies as brain blood flow HMPAO SPECT, do show changes being the most common bilateral temporobasal hypoperfusion, although this is not the only pattern described. Causes of this variable behaviour remain unclear but can be related to different clinic expressions and, over all, to time of evolution from onset. The three cases in this study show three different perfusion patterns reported in TGA and all of them withhold the vascular etiopathogenic theory (AU)