Obesity and activated protein C resistance.

It has been reported that obesity may be associated with activated protein C resistance, which could increase the thrombotic risk in these patients. The aim of our study was to evaluate this parameter in obese patients and controls, as well as the effect of weight loss on this parameter. In 63 severely or morbidly obese patients and in 65 healthy volunteers, an anthropometric and analytical evaluation (activated protein C resistance and prothrombin fragment F1 + 2) was performed at baseline and after 3 months of diet. Obese patients showed higher levels of F1 + 2 than controls, whereas activated protein C sensitivity ratios showed no differences. After weight loss, prothrombin fragment F1 + 2 was reduced, but no differences were found in activated protein C sensitivity. We did not find an activated protein C-resistant phenotype in obese subjects.

Características clínicas, histológicas y evolutivas de una serie de 11 casos de cáncer diferenciado de tiroides con hipertiroidismo / Clinical and histopathological characteristics and outcomes in eleven patients with hyperthyroidism and concurrent differentiated thryoid cancer

Introducción: La coexistencia de cáncer diferenciado de tiroides (CDT) e hipertiroidismo se considera infrecuente. El objetivo de este trabajo es describir las características de los casos detectados en nuestro centro. Pacientes y métodos: Estudio descriptivo con 11 pacientes (3 varones y 8 mujeres), diagnosticados de CDT, en los que coexistía hipertiroidismo. Se les realizó de forma preoperatoria ecografía tiroidea, gammagrafía, analítica con TSH, T4 libre, T3 libre, anticuerpos antitiroperoxidasa (ATPO) y anticuerpos antirreceptor de TSH (TSI). Se realizó punción-aspiración con aguja fina (PAAF) de tiroides a los pacientes con nódulos fríos iguales o mayores de 2 cm (5 pacientes). Se les practicó tiroidectomía total y ablación posterior con radioyodo. La mediana de seguimiento fue de 64 meses (límites 17 a 161). Resultados: Tres pacientes tenían un nódulo tóxico único (NT), 4 un bocio multinodular tóxico (BMN-T) y 4 una enfermedad de Graves-Basedow (EGB). De los 3 pacientes con NT, se intervino a 2 por sospecha de malignidad y el restante por nódulo superior a 3 cm. De los 4 pacientes con BMN-T, se reintervino a 3 por nódulos fríos, y el restante por crecimiento del bocio y mal control del hipertiroidismo. De los 4 pacientes con EGB, se intervino a 3 por presentar nódulos (1 con citología sospechosa de malignidad) y al restante por recidiva de la enfermedad. La anatomía patológica definitiva fue, en todos los casos, de carcinoma papilar, 2 de variedad papilofolicular y uno esclerosante. El estadio según la clasificación TNM fue de riesgo bajo en 6 pacientes y riesgo alto riesgo en 5 (un caso con metástasis pulmonares). La evolución ha sido favorable en todos los casos. Conclusiones: El hipertiroidismo no excluye la posibilidad de CDT, especialmente si hay nódulos fríos en la gammagrafía. En la EGB, la existencia de nódulos en la ecografía nos obliga a plantearnos tratamiento quirúrgico. El estadio al diagnóstico no es siempre de riesgo bajo. La evolución del CDT no parece diferente de la que se presenta en pacientes eutiroideos (AU)

Introduction: The coexistence of differentiated thyroid cancer (DTC) and hyperthyroidism is considered a rare event. The aim of this study was to analyze the characteristics of the patients with both entities attended at our institution. Patients and methods: A descriptive study of 11 patients (3 men and 8 women) with concurrent hyperthyroidism and DTC was performed. Ultrasound scan, thyroid scintigraphy and measurement of thyroid-stimulating hormone (TSH), free triiodothyronine, free thyroxine, autoantibodies to thyroid peroxidase, and TSH receptor autoantibodies were performed preoperatively. Thyroid fine-needle biopsy was performed in patients with cold nodules equal to or larger than 2 cm (5 patients). All patients underwent total thyroidectomy and 131I therapy. The median follow-up was 64 months (range 17 to 161). Results: Toxic uninodular goiter (TUG) was found in 3 patients, toxic multinodular goiter (TMG) in 4 patients, and Graves' disease (GD) in 4 patients. The 3 patients with TUG underwent surgery, 2 for suspected malignancy and the third due to a nodule larger than 3 cm. Of the 4 patients with TMG, 3 underwent surgery due to the presence of cold nodules and the fourth because of goiter growth and uncontrolled hyperthyroidism. Of the 4 patients with GD, 3 underwent surgery due to the presence of nodules (one suspicious for malignancy on cytological analysis), and the fourth because of GD recurrence. Postsurgical histological diagnosis was papillary carcinoma in all patients, a follicular variant of papillary carcinoma in two and sclerosing carcinoma in one. According to TNM classification, 6 patients had a low risk and 5 had a high risk of recurrence (one patient had lung metastases). Outcome was favorable in all patients. Conclusions: Diagnosis of hyperthyroidism does not exclude DTC, especially in the presence of cold nodules on scintigraphy. When nodules are detected on ultrasound scan in GD patients, surgery should be considered. At diagnosis, not all patients were low risk. The behavior of DTC in patients with hyperthyroidism seems to be similar to that in euthyroid patients (AU)