[Treatment of Graves-Basedow's disease with 131I. Assessment of a "modulated fixed activity" protocol]. / Tratamiento de la enfermedad de Graves-Basedow con I. Valoración de un protocolo de "actividades fijas moduladas".

PURPOSE: The purpose of this study was to retrospectively evaluate the hypothyroidism rate, persistence of hyperthyroidism and the complications after the administration of 131I in 3 cohorts defined according to the activity of 131I administered. METHODS: We consecutively treated 659 patients diagnosed with Graves-Basedow disease (GBD) with 131I. The activity was determined on the basis of a protocol that we called "modulated fixed activity". A total of 45 patients (Group 1) who had previously undergone surgery were given small 131I activities of between 111-185 MBq (3-5 mCi), 247 patients (Group 2) with normal or almost normal-sized thyroids were given activities of between 222-333 MBq (6-9 mCi) and the 367 patients with diffuse goiters (Group 3) activities of between 370-555 MBq (10-15 mCi). RESULTS: A total of 69.2 % of the patients presented hypothyroidism at the end of the follow-up period. By groups, the percentages of hypothyroidism at the end of the follow-up period were 69 %, 68.8 % and 69.6 % respectively. The average time for the patients to present hypothyroidism was 2.7 years with a maximum de 12.3 years and a minimum of 2 months. No severe precocious complications after the administration of 131I were noted. CONCLUSION: The choice of the modulated fixed doses of 131I for treatment of the GBD is a simple method and permit treatment in only one day.

[Treatment of bone metastatic pain with Sm153-EDTMP. Evaluation of the analgesic response and the existence of differences according to the primary tumor and the metastatic pattern]. / Tratamiento del dolor óseo metastásico con Sm153-EDTMP. Valoración de la respuesta analgésica y de la existencia de diferencias según el tipo de tumor y el patrón metastásico.

AIMS: To evaluate the response to Sm153-EDTMP treatment in patients with metastatic bone pain and the existence of differences in the response according to the scintigraphic pattern (99mTc-MDP) and the primary tumor. MATERIAL AND METHODS: We have evaluated the response to Sm153-EDTMP treatment in 32 patients (17 male and 15 female) who received 38 doses (1 mCi/kg). The primary tumor was prostate cancer in 15 patients, breast in 13, lung in 2, intestinal carcinoid in one and unknown in one. Two types of response were considered: a) effective and b) non-effective. Patients were classified into 3 groups according to the metastatic pattern: 1) Superscan (SS), 2) Generalized metastases (GM) and 3) Regional metastases (RM). RESULTS: There was effective response in 24 doses (63.15%) and non-effective in 14 (36.84%). The mean duration of the response was 12.08 weeks. Patients with GM pattern showed 16 effective responses (76.19%) and 5 non-effective (23.8%). In SS pattern there were 6 effective responses (60%) and 4 non-effective (40%) and 2 effective (28.57%) and 5 non-effective (71.53%) in RM pattern. These differences did not reach statistical significance (p > 0.05). We did not find differences in the response between prostate cancer (12 effective and 6 non-effective) and breast cancer (10 effective and 6 non-effective) (p = 0.79968). CONCLUSIONS: Sm153-EDTMP treatment is efficacious in patients with metastatic bone pain with effective response in 63.15% of the treatments. The response percentage was lower in patients with RM pattern but the differences did not reach statistical significance. There were no differences in the response between prostate and breast cancer patients.

[Treatment with (131)I of toxic multinodular goiter. Assessment of a fixed dose protocol]. / Tratamiento con (131)I del bocio multinodular tóxico. Valoración de un protocolo de dosis fijas.

OBJECTIVE: Present the results of treatment with 131I in a cohort of 119 patients diagnosed of toxic multinodular goiter (TMG) from a specific geographic area who had been treated with fixed doses of isotopes (555 MBq). The indication for the administration of the 131I was hyperthyroidism correction in all of the cases. MATERIAL AND METHODS: 111 of the 119 patients treated were women (93%) and 8 were men (7%) and their ages ranged from 38 to 88 years. The follow-up periods were always greater than one year (1.78 +/- 1.05 years). Treatment with thyroid medication was discontinued in all of the patients at least 7 days prior to the administration of the isotope. RESULTS: 93 (78.1%) of the 119 patients remained euthyroidic, 10 (8.4%) presented hypothyroidism, 11 (9.2%) hyperthyroidism and 5 (4.2%) had sub-clinical levels of hyperthyroidism at the end of the follow-up period. No statistically significant relationship were found between hypothyroidism, gender and previous administration of thyroid medication. CONCLUSIONS: The use of 131I is an alternative to the treatment of TMG produced hyperthyroidism. The fixed doses of 555 Mbq that we propose are comfortable, make it unnecessary for the patients to travel in extensive geographic areas and produce a low rate of hypothyroidism. In our opinion, the differences in the iodine content of the diets that continue to exist are one of the factors that could influence in the differences in results observed in the different series, although other factors, such as the size of the goiter and the heterogeneity of the radioisotope uptake can contribute to the variations found in our patients.

[131I-treatment of the autonomous toxic nodule. Assessment of a fixed dose protocol]. / Tratamiento con 131I del nódulo autónomo tóxico. Valoración de un protocolo de dosis fijas.

Ninety six patients diagnosed of toxic thyroid adenomas received fixed doses of 131I (555MBq) for treatment of hyperthyroidism. The inclusion and exclusion criteria, the patient's characteristics and the advantages of the fixed doses are described. The hypothyroidism rate found at the end of the mean follow-up period (2.46 +/- 1.72 years) which was 27.08% significantly lower to that observed in patients treated for Graves-Basedow disease, is pointed out. No differences were found in the hypothyroidism rate when the patients were differentiated by sex or when this situation was related to pretreatment with the antithyroid drugs. The extensive differences in the hypothyroidism rates observed between the different series that have been published and the variability in the doses administered leads us to think that factors other than the dose of 131I may be responsible for this post-therapeutic hypothyroidism.