RESUMEN
Recombinant human thyrotropin (rhTSH) reduces the activity of radioiodine required to treat multinodular goiter (MNG), but acute airway compression can be a life-threatening complication. In this prospective, randomized, double-blind, placebo-controlled study, we assessed the efficacy and safety (including airway compression) of different doses of rhTSH associated with a fixed activity of 131I for treating MNG. Euthyroid patients with MNG (69.3 +/- 62.0 mL, 20 females, 2 males, 64 +/- 7 years) received 0.1 mg (group I, N = 8) or 0.01 mg (group II, N = 6) rhTSH or placebo (group III, N = 8), 24 h before 1.11 GBq 131I. Radioactive iodine uptake was determined at baseline and 24 h after rhTSH and thyroid volume (TV, baseline and 6 and 12 months after treatment) and tracheal cross-sectional area (TCA, baseline and 2, 7, 180, and 360 days after rhTSH) were determined by magnetic resonance; antithyroid antibodies and thyroid hormones were determined at frequent intervals. After 6 months, TV decreased significantly in groups I (28.5 +/- 17.6%) and II (21.6 +/- 17.8%), but not in group III (2.7 +/- 15.3%). After 12 months, TV decreased significantly in groups I (36.7 +/- 18.1%) and II (37.4 +/- 27.1%), but not in group III (19.0 +/- 24.3%). No significant changes in TCA were observed. T3 and free T4 increased transiently during the first month. After 12 months, 7 patients were hypothyroid (N = 3 in group I and N = 2 in groups II and III). rhTSH plus a 1.11-GBq fixed 131I activity did not cause acute or chronic changes in TCA. After 6 and 12 months, TV reduction was more pronounced among patients treated with rhTSH plus 131I.
Asunto(s)
Bocio Nodular/terapia , Radioisótopos de Yodo/administración & dosificación , Tirotropina/administración & dosificación , Adulto , Anciano , Obstrucción de las Vías Aéreas/etiología , Autoanticuerpos/sangre , Terapia Combinada , Método Doble Ciego , Femenino , Humanos , Radioisótopos de Yodo/efectos adversos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Proteínas Recombinantes/administración & dosificación , Pruebas de Función de la Tiroides , Tirotropina/efectos adversos , Resultado del TratamientoRESUMEN
Recombinant human thyrotropin (rhTSH) reduces the activity of radioiodine required to treat multinodular goiter (MNG), but acute airway compression can be a life-threatening complication. In this prospective, randomized, double-blind, placebo-controlled study, we assessed the efficacy and safety (including airway compression) of different doses of rhTSH associated with a fixed activity of 131I for treating MNG. Euthyroid patients with MNG (69.3 ± 62.0 mL, 20 females, 2 males, 64 ± 7 years) received 0.1 mg (group I, N = 8) or 0.01 mg (group II, N = 6) rhTSH or placebo (group III, N = 8), 24 h before 1.11 GBq 131I. Radioactive iodine uptake was determined at baseline and 24 h after rhTSH and thyroid volume (TV, baseline and 6 and 12 months after treatment) and tracheal cross-sectional area (TCA, baseline and 2, 7, 180, and 360 days after rhTSH) were determined by magnetic resonance; antithyroid antibodies and thyroid hormones were determined at frequent intervals. After 6 months, TV decreased significantly in groups I (28.5 ± 17.6 percent) and II (21.6 ± 17.8 percent), but not in group III (2.7 ± 15.3 percent). After 12 months, TV decreased significantly in groups I (36.7 ± 18.1 percent) and II (37.4 ± 27.1 percent), but not in group III (19.0 ± 24.3 percent). No significant changes in TCA were observed. T3 and free T4 increased transiently during the first month. After 12 months, 7 patients were hypothyroid (N = 3 in group I and N = 2 in groups II and III). rhTSH plus a 1.11-GBq fixed 131I activity did not cause acute or chronic changes in TCA. After 6 and 12 months, TV reduction was more pronounced among patients treated with rhTSH plus 131I.
Asunto(s)
Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Bocio Nodular/terapia , Radioisótopos de Yodo/administración & dosificación , Tirotropina/administración & dosificación , Obstrucción de las Vías Aéreas/etiología , Autoanticuerpos/sangre , Terapia Combinada , Método Doble Ciego , Radioisótopos de Yodo/efectos adversos , Imagen por Resonancia Magnética , Estudios Prospectivos , Proteínas Recombinantes/administración & dosificación , Pruebas de Función de la Tiroides , Resultado del Tratamiento , Tirotropina/efectos adversosRESUMEN
Between October 1985 and the end of 1998, 259 renal transplantations were performed at Al-Mouassat University Hospital in Damascus, from living related donors (LRD). The age of the patients ranged from 14 to 57 years with a mean age of 31.1 years. There were 208 (80.3%) males and 51 (19.7%) females. The follow-up ranged from 1-159 months. The immunosupression therapy was azathioprine and prednisone in 71 patients, and cyclosporine, azathioprine and prednisone in 188 patients. The one, three and five year graft survival was 98.2%, 92.1% and 85.8% respectively. The one, three and five year patient survival was 99%, 97.2% and 90.1% respectively. The ten years overall patient survival was 70.2%. The incidence of complications encountered was acceptable and similar to that reported in the literature. Our study shows that the efficacy of the overall results in our center is comparable to that published in the western world.