Sobre la profesionalidad en el manejo de los tumores de la tiroides y los grupos de trabajo multidisciplinarios / On professionalism in the management of thyroid tumors and multidisciplinary working groups

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Long-term remission following antithyroid drug withdrawal in patients with Graves' hyperthyroidism: parameters with prognostic value.

OBJECTIVE: To assess the predictive value of some clinical and biochemical parameters, and of the +49 A/G polymorphism of the CTLA-4 gene, for long-term remission following the withdrawal of antithyroid drugs before starting antithyroid drug therapy. STUDY DESIGN: Observational, prospective and longitudinal study. METHODS: Seventy-two patients (11 of whom were men) with newly diagnosed Graves' hyperthyroidism who had been attended consecutively at a University Clinic in a population with sufficient iodine intake were included in the study. EXCLUSION CRITERIA: patients under the age of 18, pregnant women and non-Caucasian patients. All subjects were treated following a well-defined protocol. Long-term remission was calculated at 12 and 36 months following withdrawal of the antithyroid drug. RESULTS: Thirty-six of the 72 study subjects experienced a remission of at least 12 months following withdrawal of methimazole, with no differences according to their age or sex. A comparison made between the remission rates seen in both groups yielded significant differences regarding the presence of Graves' orbitopathy, the duration of the treatment with methimazole and the absence of the CTLA-4 G/G genotype. In the univariate and multivariate analyses performed, only lower frequencies of Graves' orbitopathy and an absence of the CTLA-4 G/G genotype were considered independent predictors of long-term remission. CONCLUSIONS: The absence of Graves' orbitopathy and of the CTLA-4 G/G genotype are independent predictors of long-term remission following a first course of antithyroid drugs.

Retos éticos que plantea el uso de la inteligencia artificial en el diagnóstico y tratamiento clínico / Ethical challenges posed by the use of Artificial Intelligence in the diagnosis and clinical treatment

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Limitations of current thyroid function tests / Limitaciones de las pruebas actuales de la función tiroidea

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Eating disoders in type 2 diabetic people: Brief review.

BACKGROUND: Relationship between type 1 diabetes and Eating disorders is well-known, less information exists on the relationship between type 2 diabetes (T2DM) people and eating disorders. AIM: Review information on the prevalence and impact of type 2 diabetes and eating disorders comorbidity. METHODS: Search in Medline and PubMed relevant articles on the aforementioned co-morbidity. Review includes articles on epidemiological, clinical and therapeutics aspects. CONCLUSIONS: Disordered eating behaviours may affect around 40% of T2DM people, being the predominant clinical forms: Eating Disorders Non otherwise specified (EDNOS), Night Eating Syndrome (NES) and Binge Eating Disorder (BED), however, population-based estimates of T2DM and ED comorbidity are mandatory to determine the prevalence of ED in T2DM people. The association between both entities has a consequence which is an impairment of metabolic control, associated to increase risk of vascular complications and difficult body weight loss, basis of T2DM treatment.

Adherencia a la dieta Mediterránea en una muestra de la población adulta del sur de Galicia / Mediterranean diet adherence in a sample of population in South Galicia

Objetivo: Conocer el grado de adherencia a la dieta mediterránea en Galicia. Métodos: En el estudio fueron incluidos 201 personas, 103 mujeres, con una edad media de 56,6 ± 19 años, (rango 18- 88 años). El IMC medio fue de 25 ± 4. Fueron sometidos a un cuestionario sencillo y muy útil en la práctica clínica, sobre la adherencia a la dieta mediterránea, que consiste en 9 preguntas, utilizado en los estudios del grupo PREMID. Resultados: El porcentaje de personas con baja, intermedia y alta adherencia fue de 62,2%, 23,8% y 13,9% respectivamente. El 89,3% de los sujetos con normopeso tenían una puntuación de alta adherencia, mientras que en el grupo con IMC ≥ 30 fue de 10,7%, p < 0,05. Conclusiones: Observamos una baja adherencia en la muestra de población estudiada y las personas con baja adherencia tenían mayor tendencia a ser obesos (AU)

Objective: To know the Mediterranean diet (MD) adherence in a sample of the population in South Galicia. Methods: Two-hundred-one (103 females) were included in the present study, mean age 56.6 ± 19 years, range 18-88, with a mean BMI of 25 ± 4. They were submitted to a simple questionnaire, useful for clinical practice, used for the PREMID group, consists of 9 questions. Results: 13.9%, 23.8% and 62.2%, from the total sample had high, intermediate and low adherence to the Mediterranean diet. When the sample of subjects was split for BMI, in the normal-weight group, 89.3% of subjects have higher adherence to the MD, while those with BMI ≥ 30 only 10.7% have high adherence, p <0.05. Conclusions: Low adherence to MD was observed in the sample of the population studied. Low, MD adherence is associated with high risk to develop obesity (AU)

Estudio comparativo de psicoterapia cognitivo-conductual y terapia nutricional en pacientes con diferentes tipos de trastornos de la conducta alimentaria / Comparative study of cognitive-behavioral psychotherapy and nutritional support in patients with different types of eating disorders

Fundamento y objetivo: Existen varios enfoques psicológicos para el tratamiento de la disfunción eréctil con eficacia siendo revelado por la investigación empírica; sin embargo ninguno de ellos es universalmente aceptada. El objetivo fue comparar la respuesta a la terapia cognitivo-conductual en pacientes con diferentes formas clínicas de trastornos de la alimentación. Material y método: Setenta y cuatro pacientes con diagnóstico de trastornos de la alimentación, 32 con anorexia nerviosa (AN), 19 con bulimia nerviosa (BN) y 23 con trastornos no especificados (TCANE) Comer fueron incluidos. Se trata de un estudio prospectivo y comparativo. Los pacientes fueron tratados con psicoterapia, el tratamiento nutricional y farmacológico. Resultados:Las tasas de recuperación en los grupos de pacientes con AN, BN y TCANE fueron 14 (43,7%), 8 (42,1%), 10 (43,4%), respectivamente, p> 0,05. Las tasas de mejoría fueron 14 (43,7%), 10 (52,6%), 12 (52,1%) para la AN, BN y TCANE, respectivamente, p> 0,05. Por último, la tasa de pacientes que tuvieron un mal resultado fueron 3 (9,3%), 1 (5,2%), y 1 (4,3%), p> 0,05, para AN, BN y TCANE, respectivamente. El análisis de regresión de Cox mostró que la edad de inicio de la enfermedad y no uso de drogas psicotrópicas predijeron una buena respuesta en los pacientes con disfunción eréctil. Conclusiones: La respuesta al tratamiento con terapia cognitivo-conductual, el apoyo nutricional y las drogas psicotrópicas en la mayoría de los pacientes fue favorable y similar en la mayoría de los pacientes con diferentes tipos de trastornos de la alimentación. Por otra parte, una edad temprana y no uso de drogas psicotrópicas predicen un resultado favorable en los pacientes con disfunción eréctil (AU)

Background and objective: There are several psychological approaches to treat ED with efficacy being revealed by empirical research; however none of them are universally accepted. The objective was to compare response to Cognitive Behavioral Therapy in patients with different clinical forms of Eating Disorders. Material and method: Seventy-four patients diagnosed with eating disorders, 32 with Anorexia nervosa (AN), 19 with Bulimia nervosa (BN) and 23 with Eating disorders not otherwise specified (EDNOS) were included. This is a prospective and comparative study. Patients were treated by psychotherapy, nutritional treatment and pharmacotherapy. Results: The recovery rates in the groups of patients with AN, BN and EDNOS were 14 (43.7%), 8 (42.1%), 10 (43.4%), respectively, p > 0.05. The rates of improvement were 14 (43.7%), 10 (52.6%), 12 (52.1%) for AN, BN and EDNOS, respectively, p > 0.05. Finally, the rate of patients who had poor outcome were 3 (9.3%), 1 (5.2%), and 1 (4.3%), p > 0.05, for AN, BN, and EDNOS, respectively. Cox regression analysis showed that the age of disease onset and no use of psychotropic drugs predicted a good response in patients with ED. Conclusions: The treatment response to Cognitive Behavioral Therapy, nutritional support and psychotropic drugs in the majority of patients was favorable and similar in most patients with different types of Eating Disorders. Furthermore, a young age and no use of psychotropic drugs predict a favorable outcome in patients with ED (AU)

Comparative study of cognitive-behavioral psychotherapy and nutritional support in patients with different types of eating disorders.

BACKGROUND AND OBJECTIVE: There are several psychological approaches to treat ED with efficacy being revealed by empirical research; however none of them are universally accepted. The objective was to compare response to Cognitive Behavioral Therapy in patients with different clinical forms of Eating Disorders. MATERIAL AND METHOD: Seventy-four patients diagnosed with eating disorders, 32 with Anorexia nervosa (AN), 19 with Bulimia nervosa (BN) and 23 with Eating disorders not otherwise specified (EDNOS) were included. This is a prospective and comparative study. Patients were treated by psychotherapy, nutritional treatment and pharmacotherapy. RESULTS: The recovery rates in the groups of patients with AN, BN and EDNOS were 14 (43.7%), 8 (42.1%), 10 (43.4%), respectively, p>0.05. The rates of improvement were 14 (43.7%), 10 (52.6%), 12 (52.1%) for AN, BN and EDNOS, respectively, p>0.05. Finally, the rate of patients who had poor outcome were 3 (9.3%), 1 (5.2%), and 1 (4.3%), p>0.05, for AN, BN, and EDNOS, respectively. Cox regression analysis showed that the age of disease onset and no use of psychotropic drugs predicted a good response in patients with ED. CONCLUSIONS: The treatment response to Cognitive Behavioral Therapy, nutritional support and psychotropic drugs in the majority of patients was favorable and similar in most patients with different types of Eating Disorders. Furthermore, a young age and no use of psychotropic drugs predict a favorable outcome in patients with ED.

Factors influencing the outcome of patients with incidental papillary thyroid microcarcinoma.

Objective. To analyze some factors that could influence the outcome of patients with PTMC. Material and Methods. This is a longitudinal observational study. All patients diagnosed and treated for papillary thyroid microcarcinoma at the University Hospital of Vigo, between January 1994 and December 2003, were included in the present study. Demographic characteristics, tumour characteristics, TNM stage, rate of recurrence, and treatment with (131)I were the study variables. Results. Ninety-one patients (75 females) with an average age of 47.7 ± 13.4 years, range 19-81, were studied. Initial tumour staging was T1 in 90 patients and T4a in 1 case. Initial lymph node involvement was present in 4 cases (4.4%). We only found one case with distant metastases at diagnosis. Postsurgical evaluation of thyroid specimens revealed that 28 (30.7%) tumours were multifocal. The average size of the tumour was 0.44 ± 0.25 cm, range 0.1-1. Univariate analysis reveals a statistically significant association between tumour multifocality and postsurgical (131)I therapy with the recurrence rate. In the multivariate analysis only multifocality (P = 0.037, HR 5.7) was a significant risk factor for the recurrence rate. Conclusions. Our results indicate that tumour multifocality is an independent predictor of relapse but neither the tumour size nor postsurgical (131)I therapy.

Tratamiento con dosis fija de tiroxina en gestantes con hipotiroidismo subclínico / Treatment with fixed thyroxine doses in pregnant women with subclinical hypothyroidism

Introducción El tratamiento del hipotiroidismo se hace habitualmente calculando la dosis de tiroxina en función del peso del paciente. En algunas situaciones se ha comprobado la utilidad de administrar dosis fijas de la hormona para normalizar la concentración de TSH, cuyo control es especialmente importante en el caso de pacientes gestantes. Pacientes y métodos Se administró una dosis fija de 50 mcg/día de tiroxina a 68 mujeres con hipotiroidismo subclínico diagnosticado durante la gestación, autoinmune o no, y se evaluó trimestralmente a través de la concentración de TSH la necesidad de modificarla. Se programaron incrementos o decrementos de 25 mcg/día en los casos en los que el cambio de dosis fuese necesario. Resultados El 42% de las pacientes alcanzaron una concentración plasmática de TSH inferior a 3μU/mL con la dosis de 50 mcg/día de tiroxina. Si se toman como referencia los valores de la población general no gestante, dicha dosis fue óptima durante el embarazo en el 79,4% de las pacientes; y no lo fue en el 20,6% restante. Discusión Nuestros datos sugieren que una dosis fija de 50 mcg/día de tiroxina es insuficiente en un porcentaje elevado de pacientes con hipotiroidismo diagnosticado en la gestación, tanto si se toman como valores de referencia de concentración de TSH los de la población general como (especialmente) si se usan las recomendaciones más recientes. Dosis de 75 mcg/día serán probablemente más adecuadas, aunque se necesitan estudios que evalúen la posibilidad de sobretratamiento con dichas dosis (AU)

Background Hypothyroidism is usually treated with thyroxine doses on patient weight. In some cases, however, fixed doses have proved to useful to normalize TSH levels, which is especially important during pregnancy. Patients and methods Sixty-eight women diagnosed with subclinical hypothyroidism, autoimmune or not, during pregnancy were given a fixed dose of thyroxine 50mcg/day. TSH measurements were performed to assess the need to change the dose, which was increased or decreased by 25mcg/day when necessary. Results With a dose of 50mcg/day of thyroxine, 42% of patients reached a TSH level less than 3μU/mL, 79.4% reached a TSH level less than 4.5μU/mL, and 20.6% had TSH levels higher than 4.5μU/mL.Discussion Our data suggest that a fixed dose of thyroxine 50mcg/day is inadequate in a significant proportion of pregnancy-diagnosed hypothyroidism regardless of whether the reference of TSH level used is 4.5 or 3μU/mL. Starting dose of 75mcg/day is probably more adequate, but studies are needed to evaluate the possibility of overtreatment with such dose (AU)

¿Es necesario suspender durante 4 semanas el tratamiento con tiroxina antes de la realización de un rastreo-ablación? / Should thyroxine treatment be discontinued for four weeks before I 131 thyroid ablation?

Introducción Es frecuente que la suspensión de aporte de tiroxina como preparación para un rastreo-ablación se prolongue durante 4 semanas, en las que es habitual la aparición de clínica de hipotiroidismo. Una alternativa útil en algunos casos es utilizar TSHhr, pero sus problemas de disponibilidad durante el año 2012 limitarán su uso. Pacientes y métodos Se realizó un análisis de la concentración de TSH y T4 libre en los días 7, 14, 21 y 28 desde el momento de la realización de una tiroidectomía total (12 pacientes) o desde la suspensión del tratamiento con tiroxina (20 pacientes). Se usó el test de Mann Wittney para analizar las comparaciones de variables cuantitativas y el Chi-cuadrado para las nominales. Resultados En el día 14, la concentración plasmática de TSH fue igual o superior a (..) (AU)

Background It is a usual practice to discontinue thyroxine treatment for four weeks before 131I ablation. Symptoms of hypothyroidism usually occur during this time. Use of rhTSH is a helpful alternative in some cases, but problems of availability of this agent during 2012 will limit its use. Patients and methods Plasma TSH and FT4 levels were measured on days 7, 14, 21, and 28 after total thyroidectomy (12 patients) or discontinuation of thyroxine treatment (20 patients). A Mann-Whitney U test was used to compare quantitative variables, and a Chi-square test was used for nominal variables. Results On day 14, TSH levels were (..) (AU)

Disruptores endocrinos y obesidad: obesógenos / Endocrine disruptors and obesity: obesogens

La incidencia y prevalencia de sobrepeso y obesidad ha experimentado un gran incremento en las últimas tres décadas y afecta a casi todos los países del orbe. Este fenómeno no se explica fácilmente por los cambios del estilo de vida en las distintas poblaciones con hábitos de partida muy distintos. Por lo que además del cambio del estilo de vida, otros factores empiezan a tenerse en cuenta, los llamados disruptores endocrinos y más concretamente los obesógenos. Revisamos la evidencia que existe sobre sustancias químicas que polucionan el ambiente que potencialmente puedan ser obesógenos en humanos: el dietilestilbestrol (DES), la ginesteína, el bisfenol-A, los derivados orgánicos de estaño y los ftalatos. Los tres primeros actúan principalmente sobre los receptores estrogénicos y los derivados orgánicos del estaño y los ftalatos activando los PPARγ. En conclusión, existen evidencias del efecto obesógeno de estas sustancias en estudios en animales de experimentación, tanto in vitro como in vivo, pero muy pocas en humanos. (AU)

ncidence and prevalence of owerweight and obesity have greatly increased over the past three decades in almost all countries around the world. This phenomenon is not easily explained by lifestyle changes in populations with very different initial habits. This has led to consider the influence of other factors, the so-called endocrine disruptors, and more specifically obesogens. This study reviewed the available evidence about polluting chemical substances which may potentially be obesogens in humans: DES, genistein, bisphenol A, organotins (TBT, TPT), and phthalates. The first three groups of substances mainly act upon estrogen receptors, while organotins and phthalates activate PPARγ. It was concluded that evidence exists of the obesogenic effect of these chemical substances in tissues and experimental animals, but few data are available in humans (AU)

Treatment with fixed thyroxine doses in pregnant women with subclinical hypothyroidism.

BACKGROUND: Hypothyroidism is usually treated with thyroxine doses on patient weight. In some cases, however, fixed doses have proved to useful to normalize TSH levels, which is especially important during pregnancy. PATIENTS AND METHODS: Sixty-eight women diagnosed with subclinical hypothyroidism, autoimmune or not, during pregnancy were given a fixed dose of thyroxine 50 mcg/day. TSH measurements were performed to assess the need to change the dose, which was increased or decreased by 25 mcg/day when necessary. RESULTS: With a dose of 50 mcg/day of thyroxine, 42% of patients reached a TSH level less than 3 µU/mL, 79.4% reached a TSH level less than 4.5 µU/mL, and 20.6% had TSH levels higher than 4.5 µU/mL. DISCUSSION: Our data suggest that a fixed dose of thyroxine 50 mcg/day is inadequate in a significant proportion of pregnancy-diagnosed hypothyroidism regardless of whether the reference of TSH level used is 4.5 or 3 µU/mL. S starting dose of 75 mcg/day is probably more adequate, but studies are needed to evaluate the possibility of overtreatment with such dose.

[Should thyroxine treatment be discontinued for four weeks before I(131) thyroid ablation?]. / ¿Es necesario suspender durante 4 semanas el tratamiento con tiroxina antes de la realización de un rastreo-ablación?

BACKGROUND: It is a usual practice to discontinue thyroxine treatment for four weeks before (131)I ablation. Symptoms of hypothyroidism usually occur during this time. Use of rhTSH is a helpful alternative in some cases, but problems of availability of this agent during 2012 will limit its use. PATIENTS AND METHODS: Plasma TSH and FT4 levels were measured on days 7, 14, 21, and 28 after total thyroidectomy (12 patients) or discontinuation of thyroxine treatment (20 patients). A Mann-Whitney U test was used to compare quantitative variables, and a Chi-square test was used for nominal variables. RESULTS: On day 14, TSH levels were 30µIU/mL of higher in 71% of patients (66% in the thyroidectomy group and 75% in the group discontinued thyroxine treatment). On day 21, almost all patients from both groups (91% in the thyroidectomy group and 100% in the group discontinued thyroxine treatment) had TSH levels of 30µIU/mL or higher. On day 14, most patients in both groups had FT4 levels below the normal range. CONCLUSIONS: Discontinuation of thyroxine treatment for four weeks is not required. Fourteen days is an adequate time in most patients, and 21 days are sufficient in virtually all patients.

[Endocrine disruptors and obesity: obesogens]. / Disruptores endocrinos y obesidad: obesógenos.

Incidence and prevalence of owerweight and obesity have greatly increased over the past three decades in almost all countries around the world. This phenomenon is not easily explained by lifestyle changes in populations with very different initial habits. This has led to consider the influence of other factors, the so-called endocrine disruptors, and more specifically obesogens. This study reviewed the available evidence about polluting chemical substances which may potentially be obesogens in humans: DES, genistein, bisphenol A, organotins (TBT, TPT), and phthalates. The first three groups of substances mainly act upon estrogen receptors, while organotins and phthalates activate PPARγ. It was concluded that evidence exists of the obesogenic effect of these chemical substances in tissues and experimental animals, but few data are available in humans.

High prevalence of eating disorders not otherwise specified in northwestern Spain: population-based study.

PURPOSE: To determine the incidence and prevalence of eating disorder and its clinical forms. METHODS: All new ED cases of both genders, ≥15 years old, diagnosed from January 2005 to December 2009 were included. All patients who suffered from ED in December 2009 were included in the prevalence study. This is a prospective, population-based study. Cumulative incidence rates and 20-year prevalence were calculated. RESULTS: The ED incidence was 14.1 (95% CI 11.4-16.1) cases per 100,000 inhabitants per year, for AN, BN and EDNOS 3.1 (95% CI 2.00-4.1), 4.4 (95% CI 3.0-8.00) and 6.5 (95% CI 4.8-7.9), respectively. The incidence of ED at the four age-intervals, 15-24, 25-34, 35-45 and >45 years, revealed that the 25-34-year interval had the highest incidence; moreover, new cases were observed even in the >45-year interval. The prevalence of ED was 82.8 (95% CI 69.4-94.5) per 100,000 inhabitants, being for AN, BN and EDNOS 18.6 (95% CI 12.5-24.4), 25.7 (95% CI 18.5-32.5) and 38.3 (95% CI 29.4-46.5), respectively. CONCLUSIONS: The incidence and prevalence of EDNOS are the highest in the ED cases; furthermore, new cases of ED are observed above the age of 45, which are remarkable data.

Disordered eating behaviors in type 1 diabetic patients.

Patients with type 1 diabetes mellitus are at high risk for disordered eating behaviors (DEB). Due to the fact that type 1 diabetes mellitus is one of the most common chronic illnesses of childhood and adolescence, the coexistence of eating disorders (ED) and diabetes often affects adolescents and young adults. Since weight management during this state of development can be especially difficult for those with type 1 diabetes, some diabetics may restrict or omit insulin, a condition known as diabulimia, as a form of weight control. It has been clearly shown that ED in type 1 diabetics are associated with impaired metabolic control, more frequent episodes of ketoacidosis and an earlier than expected onset of diabetes-related microvascular complications, particularly retinopathy. The management of these conditions requires a multidisciplinary team formed by an endocrinologist/diabetologist, a nurse educator, a nutritionist, a psychologist and, frequently, a psychiatrist. The treatment of type 1 diabetes patients with DEB and ED should have the following components: diabetes treatment, nutritional management and psychological therapy. A high index of suspicion of the presence of an eating disturbance, particularly among those patients with persistent poor metabolic control, repeated episodes of ketoacidosis and/or weight and shape concerns are recommended in the initial stage of diabetes treatment, especially in young women. Given the extent of the problem and the severe medical risk associated with it, more clinical and technological research aimed to improve its treatment is critical to the future health of this at-risk population.