RESUMEN
BACKGROUND: Up to 20% of thyroid nodules subjected to fine-needle aspiration exhibit indeterminate cytology. The rate of malignancy in these nodules ranges from 10 to 40%. The objective of this prospective study was to evaluate the utility of fluorine-18-fluorodeoxyglucose (F-FDG) PET in nonautonomous thyroid nodules of more than 1 cm whose cytology is indeterminate (Bethesda categories III or IV) and that are not highly suspicious on ultrasonography. PATIENTS AND METHODS: Fifty-nine patients with 63 nodules were studied. RESULTS: F-FDG PET result was positive in 31 nodules. Of these, 22.6% were malignant, 25.8% were noninvasive follicular thyroid neoplasm with papillary-like nuclear features, 6.5% were tumors of uncertain malignant potential, and 45.1% were benign. F-FDG PET result was negative in 32 nodules. Of these, 3.1% were neoplasm with papillary-like nuclear features, 3.1% were tumors of uncertain malignant potential, and 93.8% were benign. CONCLUSION: This study suggests a high negative predictive value of F-FDG PET in thyroid nodules of more than 1 cm whose cytology is indeterminate and that are not highly suspicious on ultrasonography.
Asunto(s)
Fluorodesoxiglucosa F18 , Tomografía de Emisión de Positrones , Nódulo Tiroideo/diagnóstico por imagen , Nódulo Tiroideo/patología , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Adulto JovenRESUMEN
BACKGROUND: This study evaluated the recurrence in patients with papillary thyroid cancer and an excellent response to initial therapy, comparing those with and without chronic lymphocytic thyroiditis. METHODS: This was a prospective study. Patients who met the following criteria were selected: diagnosis of papillary thyroid cancer; submitted to total thyroidectomy followed or not by ablation with 131I; and neck ultrasonography without abnormalities, nonstimulated thyroglobulina (Tg) ≤0.2 ng/ml, and undetectable antithyroglobulin antibodies (TgAb) 12-18 months after initial therapy. The patients were divided into two groups: group A, with chronic lymphocytic thyroiditis on histology; group B, without chronic lymphocytic thyroiditis on histology. RESULTS: Groups A and B were similar in terms of sex and age of the patients, characteristics of the tumor, tumor-node-metastase stage and risk category. The time of follow-up ranged from 24 to 120 months (median 66 months). During follow-up, 5 patients of group A (2.6 %) and 9 patients of group B (2 %) developed recurrence (p = 0.77). Patients with chronic lymphocytic thyroiditis were more likely to progress to persistently borderline TgAb. No patient had positive TgAb (above the reference value) during follow-up. Recurrences occurred in 12/588 patients (2 %) with undetectable TgAb in all measurements, in 1/32 (3.1 %) with detectable TgAb on some occasion but that returned to undetectable spontaneously, and in 1/13 (7.7 %) with persistently borderline TgAb. These rates did not differ significantly (p = 0.25). CONCLUSION: The results of the present study showed the absence of an association between chronic lymphocytic thyroiditis and recurrence risk at least in patients with an excellent response to initial therapy.
Asunto(s)
Carcinoma Papilar/patología , Enfermedad de Hashimoto/complicaciones , Recurrencia Local de Neoplasia/patología , Neoplasias de la Tiroides/patología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma Papilar/complicaciones , Carcinoma Papilar/cirugía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia/complicaciones , Neoplasias de la Tiroides/complicaciones , Neoplasias de la Tiroides/cirugía , Resultado del Tratamiento , Adulto JovenRESUMEN
OBJECTIVE: To report the evolution of patients with a suggestive clinical scenario and elevated serum insulin-like growth factor-1 (IGF-1), but growth hormone (GH) suppression in the oral glucose tolerance test (OGTT), in whom acromegaly was not initially excluded. SUBJECTS AND METHODS: Forty six patients with a suggestive clinical scenario, who had elevated IGF-1 (outside puberty and pregnancy) in two measurements, but GH < 0.4 µg/L in the OGTT, were selected. Five years after initial evaluation, the patients were submitted to clinical and laboratory (serum IGF-1) reassessment. Patients with persistently elevated IGF-1 were submitted to a new GH suppression test and magnetic resonance imaging (MRI) of the pituitary. RESULTS: Four patients were lost to follow-up. During reassessment, 42 patients continued to show no "typical phenotype" or changes in physiognomy. Fifteen of the 42 patients had normal IGF-1. Among the 27 patients with persistently elevated IGF-1 and who were submitted to a new OGTT, GH suppression was confirmed in all. Two patients exhibited a lesion suggestive of microadenoma on pituitary MRI. In our interpretation of the results, acromegaly was ruled out in 40 patients and considered "possible" in only 2. CONCLUSION: Our results show that even in patients with a suggestive clinical scenario and elevated IGF-1, confirmed in a second measurement and without apparent cause, acromegaly is very unlikely in the case of GH suppression in the OGTT.
Asunto(s)
Acromegalia/sangre , Hormona del Crecimiento/sangre , Factor I del Crecimiento Similar a la Insulina/análisis , Acromegalia/diagnóstico , Adulto , Reacciones Falso Positivas , Femenino , Estudios de Seguimiento , Prueba de Tolerancia a la Glucosa/métodos , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Fenotipo , Hipófisis/diagnóstico por imagenRESUMEN
ABSTRACT Objective To report the evolution of patients with a suggestive clinical scenario and elevated serum insulin-like growth factor-1 (IGF-1), but growth hormone (GH) suppression in the oral glucose tolerance test (OGTT), in whom acromegaly was not initially excluded. Subjects and methods Forty six patients with a suggestive clinical scenario, who had elevated IGF-1 (outside puberty and pregnancy) in two measurements, but GH < 0.4 µg/L in the OGTT, were selected. Five years after initial evaluation, the patients were submitted to clinical and laboratory (serum IGF-1) reassessment. Patients with persistently elevated IGF-1 were submitted to a new GH suppression test and magnetic resonance imaging (MRI) of the pituitary. Results Four patients were lost to follow-up. During reassessment, 42 patients continued to show no “typical phenotype” or changes in physiognomy. Fifteen of the 42 patients had normal IGF-1. Among the 27 patients with persistently elevated IGF-1 and who were submitted to a new OGTT, GH suppression was confirmed in all. Two patients exhibited a lesion suggestive of microadenoma on pituitary MRI. In our interpretation of the results, acromegaly was ruled out in 40 patients and considered “possible” in only 2. Conclusion Our results show that even in patients with a suggestive clinical scenario and elevated IGF-1, confirmed in a second measurement and without apparent cause, acromegaly is very unlikely in the case of GH suppression in the OGTT.
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Acromegalia/sangre , Factor I del Crecimiento Similar a la Insulina/análisis , Hormona del Crecimiento/sangre , Fenotipo , Hipófisis/diagnóstico por imagen , Acromegalia/diagnóstico , Imagen por Resonancia Magnética , Estudios de Seguimiento , Reacciones Falso Positivas , Prueba de Tolerancia a la Glucosa/métodosAsunto(s)
Hipotiroidismo/tratamiento farmacológico , Tirotropina/sangre , Tiroxina/administración & dosificación , Adulto , Autoantígenos/inmunología , Femenino , Humanos , Hipotiroidismo/sangre , Yoduro Peroxidasa/inmunología , Proteínas de Unión a Hierro/inmunología , Persona de Mediana Edad , Estudios Prospectivos , Factores de Tiempo , Privación de Tratamiento , Adulto JovenRESUMEN
AIM: This study evaluated the long-term results of ablation with low iodine-131 (131I) activity in patients with papillary thyroid carcinoma (PTC) with a lower risk of recurrence and who remained with nonstimulated thyroglobulin (Tg) of at least 0.3 ng/ml after total thyroidectomy. METHODS: This was a prospective study including 119 patients with PTC (except for microcarcinoma restricted to the thyroid and tumor with extensive extrathyroidal extension, aggressive histology, extensive lymph node involvement, or known residual disease). After thyroidectomy, all patients had nonstimulated Tg of at least 0.3 ng/ml (range: 0.3-8.5 ng/ml). The patients were treated with low 131I activity (30 or 50 mCi). RESULTS: Post-therapy whole-body scanning showed ectopic uptake in two patients. When evaluated 12 months after ablation, nonstimulated Tg up to 0.2 ng/ml with negative antithyroglobulin antibodies and neck ultrasonography, defined as excellent response to initial therapy, was achieved in 92 patients (77.3%). Only one patient had persistent structural disease. During follow-up, 3/118 patients (2.5%) developed structural recurrence. In the last assessment, 102/115 patients who were not subjected to any additional therapy had nonstimulated Tg up to 0.2 ng/ml, negative antithyroglobulin antibodies, and ultrasonography with no anomalies. No death occurred because of the tumor. CONCLUSIONS: Postoperative nonstimulated Tg up to 2 ng/ml had a negative predictive value of 98% for recurrent or persistent structural disease. In patients with PTC who have a lower risk of recurrence and who remain with nonstimulated Tg of at least 0.3 ng/ml after total thyroidectomy, Tg up to 2 ng/ml can be used as a criterion for ablation with low 131I activity.
Asunto(s)
Técnicas de Ablación , Carcinoma/metabolismo , Carcinoma/terapia , Radioisótopos de Yodo/uso terapéutico , Tiroglobulina/metabolismo , Neoplasias de la Tiroides/metabolismo , Neoplasias de la Tiroides/terapia , Adolescente , Adulto , Anciano , Carcinoma/cirugía , Carcinoma Papilar , Femenino , Humanos , Masculino , Persona de Mediana Edad , Periodo Posoperatorio , Valor Predictivo de las Pruebas , Recurrencia , Cáncer Papilar Tiroideo , Neoplasias de la Tiroides/cirugía , Factores de Tiempo , Adulto JovenAsunto(s)
Carcinoma/radioterapia , Radioisótopos de Yodo/uso terapéutico , Radioterapia Adyuvante/métodos , Tiroglobulina/sangre , Neoplasias de la Tiroides/radioterapia , Tiroidectomía/métodos , Adolescente , Adulto , Anciano , Carcinoma/patología , Carcinoma/cirugía , Carcinoma Papilar , Femenino , Estudios de Seguimiento , Humanos , Metástasis Linfática/patología , Masculino , Persona de Mediana Edad , Reoperación , Cáncer Papilar Tiroideo , Neoplasias de la Tiroides/patología , Neoplasias de la Tiroides/cirugía , Resultado del Tratamiento , Adulto JovenRESUMEN
We evaluated the negative predictive value (NPV) of thyroglobulin obtained 24 h after the second recombinant human TSH (rhTSH) ampoule (Tg-D3), before ablation with (131)I, for persistent/recurrent disease (PRD) in low/intermediate risk patients with papillary thyroid carcinoma. One hundred and one patients with Tg-D3 ≤ 1 ng/ml without anti-Tg antibodies (TgAb) were selected. Post-therapy whole-body scanning was negative for metastases in 98 (97 %) patients, and three patients showed discrete ectopic cervical uptake, but no corresponding disease was detected by neck ultrasound or computed tomography. One year after ablation, 98 (97 %) patients were free of the disease. Three patients had stimulated Tg >1 ng/ml, but no metastases were detected by the imaging methods. During follow-up (median 50 months), tumor recurrence was observed in only one patient. Thus, the NPV of Tg-D3 ≤ 1 ng/ml for PRD was 99 %. Among the 101 patients with Tg-D3 ≤ 1 ng/ml, Tg obtained 48 h after ablation (Tg-D5) continued to be ≤ 1 ng/ml in 56, and 45 had Tg-D5 >1 ng/ml. None of these 45 patients had PRD. In conclusion, Tg-D3 ≤ 1 ng/ml had a high NPV for PRD in patients without TgAb or known persistent disease and who are not at high risk. In these patients, Tg-D5 >1 ng/ml is more likely to reflect actinic damage to the remnant thyroid tissue rather than persistence of significant normal or tumor tissue.
Asunto(s)
Biomarcadores de Tumor/sangre , Carcinoma/sangre , Carcinoma/terapia , Radioisótopos de Yodo/uso terapéutico , Recurrencia Local de Neoplasia/sangre , Tiroglobulina/sangre , Neoplasias de la Tiroides/sangre , Neoplasias de la Tiroides/terapia , Tirotropina Alfa/uso terapéutico , Técnicas de Ablación , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma Papilar , Niño , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Cuello/diagnóstico por imagen , Valor Predictivo de las Pruebas , Radiografía , Cáncer Papilar Tiroideo , Ultrasonografía , Imagen de Cuerpo Entero , Adulto JovenRESUMEN
CONTEXT: Congenital generalized lipodystrophy, or Berardinelli-Seip syndrome, is a rare autosomal recessive disease caused by mutations in either the BSCL2 or AGPAT2 genes. This syndrome is characterized by an almost complete loss of adipose tissue usually diagnosed at birth or early infancy resulting in apparent muscle hypertrophy. Common clinical features are acanthosis nigricans, hepatomegaly with or without splenomegaly and high stature. Acromegaloid features, cardiomyopathy and mental retardation can also be present. DESIGN: We investigated 11 kindreds from different geographical areas of Brazil (northeast and southeast). All coding regions as well as flanking intronic regions of both genes were examined. Polymerase chain reaction (PCR) amplifications were performed using primers described previously and PCR products were sequenced directly. RESULTS: Four AGPAT2 and two BSCL2 families harboured the same set of mutations. BSCL2 gene mutations were found in the homozygous form in four kindreds (c.412C>T c.464T>C, c.518-519insA, IVS5-2A>G), and in two kindreds compound mutations were found (c.1363C>T, c.424A>G). In the other four families, one mutation of the AGPAT2 gene was found (IVS3-1G>C and c.299G>A). CONCLUSIONS: We have demonstrated four novel mutations of the BSCL2 and AGPAT2 genes responsible for Berardinelli-Seip syndrome and Brunzell syndrome (AGPAT2-related syndrome).
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1-Acilglicerol-3-Fosfato O-Aciltransferasa/genética , Subunidades gamma de la Proteína de Unión al GTP/genética , Lipodistrofia Generalizada Congénita/genética , Adolescente , Adulto , Brasil , Preescolar , Consanguinidad , Femenino , Humanos , Lactante , Masculino , Mutación , Linaje , Mutación Puntual , Reacción en Cadena de la PolimerasaRESUMEN
The type 1 diabetic patient pregnancy is subjected to various attempts to obtain good glycemic control, since the pre-conception period throughout the gestation. Continuous subcutaneous insulin infusion (CSII) is a therapeutic tool to achieve the glycemic targets. Here it is presented the case of a Type 1 diabetic woman, who was not under multiple insulin daily injections therapy, and whose insulin therapy started on CSII during the second trimester of gestation, obtaining successful therapeutic outcome.
Asunto(s)
Diabetes Mellitus Tipo 1/tratamiento farmacológico , Hipoglucemiantes/administración & dosificación , Sistemas de Infusión de Insulina , Insulina/administración & dosificación , Embarazo en Diabéticas , Administración Cutánea , Femenino , Humanos , Bombas de Infusión Implantables , Embarazo , Resultado del Embarazo , Segundo Trimestre del Embarazo , Adulto JovenRESUMEN
A gestação em portadoras de diabetes tipo 1 é alvo de múltiplas tentativas para o bom controle glicêmico desde o período pré-concepcional, com a terapia com infusão de insulina subcutânea contínua apresentando opção terapêutica adicional na tentativa de alcançar as metas glicêmicas. Apresentamos o caso de uma paciente com diabetes tipo 1, não controlada com múltiplas injeções diárias, cuja instalação da bomba de insulina ocorreu durante o segundo trimestre de gestação, com sucesso terapêutico.
The type 1 diabetic patient pregnancy is subjected to various attempts to obtain good glycemic control, since the pre-conception period throughout the gestation. Continuous subcutaneous insulin infusion (CSII) is a therapeutic tool to achieve the glycemic targets. Here it is presented the case of a Type 1 diabetic woman, who was not under multiple insulin daily injections therapy, and whose insulin therapy started on CSII during the second trimester of gestation, obtaining successful therapeutic outcome.
Asunto(s)
Femenino , Humanos , Embarazo , Adulto Joven , Diabetes Mellitus Tipo 1/tratamiento farmacológico , Hipoglucemiantes/administración & dosificación , Sistemas de Infusión de Insulina , Insulina/administración & dosificación , Embarazo en Diabéticas , Administración Cutánea , Bombas de Infusión Implantables , Resultado del Embarazo , Segundo Trimestre del Embarazo , Adulto JovenRESUMEN
An increase in oxidizing response above a certain threshold produces, in the absence of a concomitant rise in antioxidant/reducing response, oxidative stress that is associated with complications in diabetes. A simple technique involving reduction of 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) dye has been developed in order to determine quantitatively the antioxidant status of plasma. MTT (50microL; 5.0mg/mL in PBS) was incubated with plasma (100microL) in PBS for 30, 60 or 120min at 37 degrees C, the reaction terminated by addition of 1.0mL of 0.04M hydrochloric acid in isopropanol and the absorbance measured at 570nm. The modulation by plasma of the generation of reactive oxygen species (ROS) in 12,13-phorbol dibutyrate (PDB)-stimulated granulocytes was evaluated using a chemiluminescence luminol-dependent assay. Plasma from healthy subjects (n=15) showed significantly higher antioxidant status (p<0.05) over all time periods studied compared with plasma from diabetic patients (n=27). MTT was directly reduced by plasma although platelets were not involved. Moreover, the reduction of MTT by bovine serum albumin at levels equivalent to the concentration of human serum albumin in plasma was much lower. The antioxidant status of plasma, as evaluated by MTT dye reduction, may reflect an antioxidant response since ROS generation in PDB-stimulated granulocytes was rapidly down-regulated by the presence of plasma (3.3-fold in diabetic patients and 5.8-fold in healthy subjects) confirming the lower antioxidant activity of plasma from diabetic patients. The results demonstrate that extracellular reduction of MTT by plasma may occur via enzymatic and non-enzymatic processes.
Asunto(s)
Antioxidantes/metabolismo , Diabetes Mellitus Tipo 2/sangre , Glucemia/análisis , Índice de Masa Corporal , Colesterol/sangre , Hemoglobina Glucada , Granulocitos/fisiología , Humanos , Oxidación-Reducción , Especies Reactivas de Oxígeno/metabolismo , Valores de Referencia , Albúmina Sérica Bovina , Sales de Tetrazolio/metabolismo , Tiazoles/metabolismo , Triglicéridos/sangreRESUMEN
A gravidez associada à síndrome de Cushing (SC) é quadro raro e está relacionada com hipertensão arterial severa em 64,6 por cento dos casos, além de infertilidade e abortamento em 75 por cento das pacientes com SC. Quando ocorre a gravidez, a causa mais freqüente do hipercortisolismo é o adenoma adrenal produtor de cortisol. Uma das principais complicações da hipertensão arterial na gravidez é a HELLP síndrome. Os autores relatam dois casos de gestação em paciente portadora de síndrome de Cushing, que evoluíram com quadro súbito e severo de HELLP síndrome e conseqüente progressão para o óbito fetal. O primeiro caso foi ocasionado por adenoma adrenal e o segundo, por um carcinoma de supra-renal. A gestação associada à síndrome de Cushing predispõe a situações ameaçadoras à vida, como a HELLP síndrome, devendo-se dar atenção especial à paciente nesses casos. O diagnóstico precoce permite o tratamento específico em tempo hábil, tentando reduzir a alta morbi-mortalidade nesses casos.
Asunto(s)
Adulto , Femenino , Humanos , Embarazo , Síndrome de Cushing/complicaciones , Síndrome HELLP/complicacionesRESUMEN
Pregnancy is a rare occurrence in Cushing's syndrome (CS) and it is associated with severe arterial hypertension in 64.6% of cases; infertility and abortion occur in 75% of patients with CS. In the event of a pregnancy in CS the etiology of hypercortisolism is the cortisol-producing adrenal adenoma in most cases. A most severe complication of high blood pressure in pregnancy is the HELLP syndrome. We report two cases of pregnancy in patients with CS, who developed a severe, sudden and early situation of HELLP syndrome which progressed to fetal death. The first was caused by an adrenal adenoma and the second by an adrenal carcinoma. Pregnancy due to CS can lead to a serious life-threatening situation, like the HELLP syndrome. Special attention should be paid when pregnancy is associated to CS. Early diagnosis leads to specific treatment, in an attempt to reduce de high morbid-mortality in these cases.