Alemtuzumab induces severe orbitopathy in relapsing-remitting multiple sclerosis.

CONTEXT: Treatment with Alemtuzumab (ALZ) in patients with Relapsing-Remitting Multiple Sclerosis (RRMS) is associated with the development of ALZ-induced Graves' disease (GD-ALZ). Some cases may develop associated Graves´ Orbitopathy (GO-ALZ), with possible visual compromise. AIM: The aim of this study was to describe the main clinical and biochemical characteristics of GD-ALZ, as well as the clinical course of a case series of GO-ALZ METHODS: This study is a retrospective observational study, carried out in a reference hospital for the care of patients with RRMS in Spain. Cases treated with ALZ in the period 2014-2022 were included. GO-ALZ cases were identified among those with clinical symptoms compatible with thyroid eye disease after initiating ALZ treatment. RESULTS: A total of 135 cases, with a mean follow-up of 69.6 months after the first ALZ cycle, were included. The incidence of GD-ALZ was 32.6% (44/135), with a predominance of women (77.3%) and mean age of 41.9 years. The presence of first-degree relatives with hypothyroidism was identified as risk factor for the development of GD-ALZ (adjusted P-value: 0.02). GO-ALZ was diagnosed in 6 cases (incidence: 13.6%), of which 3 had severe clinical forms of GO, requiring anti-IL-6 treatment. A favorable response was reported in all of them, with a significant decrease in disease activity and improvement in proptosis. CONCLUSIONS: We report one of the largest cohorts of GD-ALZ and GO-ALZ cases. The diagnosis of these entities should be taken into account in patients treated with Alemtuzumab, given the risk of developing severe clinical forms. In moderate-severe forms of GO-ALZ, drugs with anti-IL-6 activity are a safe and effective option.

[Usefulness of the determination of thyroglobulin in lymph node aspirates of patients with papillary thyroid carcinoma and positive antithyroglobulin antibodies]. / Utilidad de la determinación de tiroglobulina en aspirado de ganglios linfáticos de pacientes con carcinoma papilar de tiroides y anticuerpos antitiroglobulínicos positivos.

OBJECTIVE: We wanted to study the utility of thyroglobulin determination in the washout of fine needle aspiration (FNAB-Tg) of lymph metastatic nodes in patients with papillar thyroid carcinoma (PTC) and positive serum thyroglobulin antibodies (AbTg). MATERIALS AND METHODS: We have studied 11 patients (49.9+/-11.8 years old, 70% females) with PTC and positive AbTg in which a whole-body scanning (WBS) after (131)I treatment showed pathological uptake in lymph cervical nodes. An ultrasound-guided fine-needle aspiration biopsy (US-FNAB) was performed for cytological research. Needle-washout with 1 ml ClNa 0.9% was employed to determine FNAB-Tg. RESULTS: In 16/17 suspicious nodes Tg-FNAB concentration was higher than 7 ng/dl (223.3+/-314.2 [7-1009]). AbTg were negative in the washout obtained. WBS was able to detect 94% lymphadenopathies, whereas 76.5% were detected with ultrasound and 70.6% using cytology. The FNAB-Tg was positive in 94% of nodules, which was higher than combining US and FNAB-cytology both together (88.2%). One hundred per cent of pathological nodules were detected using US plus FNAB-Tg. CONCLUSIONS: FNAB-Tg determination is an useful technique for diagnosis of metastatic lymph nodes of patients with PTC and is unaffected by the presence of serum AbTg.

Consensus statement for use and technical requirements of thyroid ultrasound in endocrinology units. / Criterios sobre la utilización y requerimientos técnicos de la ecografía tiroidea en los servicios de endocrinología y nutrición.

Thyroid nodule detection has increased with widespread use of ultrasound, which is currently the main tool for detection, monitoring, diagnosis and, in some instances, treatment of thyroid nodules. Knowledge of ultrasound and adequate instruction on its use require a position statement by the scientific societies concerned. The working groups on thyroid cancer and ultrasound techniques of the Spanish Society of Endocrinology and Nutrition have promoted this document, based on a thorough analysis of the current literature, the results of multicenter studies and expert consensus, in order to set the requirements for the best use of ultrasound in clinical practice. The objectives include the adequate framework for use of thyroid ultrasound, the technical and legal requirements, the clinical situations in which it is recommended, the levels of knowledge and learning processes, the associated responsibility, and the establishment of a standardized reporting of results and integration into hospital information systems and endocrinology units.

Consideraciones con relación al documento de consenso español sobre el manejo del cáncer diferenciado de tiroides en fase avanzada y resistente al tratamiento con radioyodo (CDT-RAI) / Considerations about document of Spanish consensus for the management of patients with advanced radioactive iodine refractory differentiated thyroid cancer (CDT-RAI)

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Criterios sobre la utilización y requerimientos técnicos de la ecografía tiroidea en los servicios de endocrinología y nutrición / Consensus statement for use and technical requirements of thyroid ultrasound in endocrinology units

La ecografía se ha convertido en un instrumento imprescindible en la asistencia a los pacientes con enfermedades tiroideas. La detección de los nódulos tiroideos se ha incrementado con el uso generalizado de la misma, siendo la herramienta principal para su detección, orientación diagnóstica, seguimiento y, en ocasiones, también terapéutica. Los Grupos de Trabajo de Cáncer de Tiroides y de Técnicas ecográficas de la Sociedad Española de Endocrinología y Nutrición han promovido este documento en el que se resumen los requisitos necesarios para la mejor práctica clínica posible con esta técnica. Los objetivos del trabajo incluyen encuadrar su utilización dentro de la especialidad, los requisitos técnicos y legales necesarios, las situaciones clínicas de su aplicación, los niveles de conocimiento y aprendizaje, la responsabilidad asociada, la comunicación estandarizada de resultados e integración en los sistemas de información hospitalarios, posicionando la técnica ecográfica dentro de la cartera de servicios en las actuales unidades de Endocrinología y Nutrición (AU)

Thyroid nodule detection has increased with widespread use of ultrasound, which is currently the main tool for detection, monitoring, diagnosis and, in some instances, treatment of thyroid nodules. Knowledge of ultrasound and adequate instruction on its use require a position statement by the scientific societies concerned. The working groups on thyroid cancer and ultrasound techniques of the Spanish Society of Endocrinology and Nutrition have promoted this document, based on a thorough analysis of the current literature, the results of multicenter studies and expert consensus, in order to set the requirements for the best use of ultrasound in clinical practice. The objectives include the adequate framework for use of thyroid ultrasound, the technical and legal requirements, the clinical situations in which it is recommended, the levels of knowledge and learning processes, the associated responsibility, and the establishment of a standardized reporting of results and integration into hospital information systems and endocrinology units (AU)

[Age of menopause in patients with differentiated thyroid cancer treated with radioiodine]. / Edad de menopausia en pacientes tratadas con I131 por cáncer diferenciado de tiroides.

INTRODUCTION: Differentiated thyroid cancer (DTC) is an increasingly frequent endocrinological disease. Radioiodine is a key component of treatment. OBJECTIVE: To analyze the effects of I(131) therapy on ovarian and reproductive function. MATERIAL AND METHODS: We retrospectively analyzed data from 202 women treated with radioiodine for DTC in our service from 1985-2008. Data on age at menopause in patients and their mothers and sisters, menstrual history, fertility and neonatal abnormalities were collected. RESULTS: Menopause occurred in 34 patients at follow-up. The mean age at menopause in patients was 49.94+/-3.45 while that in their mothers and sisters was 49.20+/-5.37 and 48.73+/-3.74 years, respectively. Three patients had transient amenorrhea. No infertility or neonatal alterations were found. CONCLUSIONS: In our series, menopause did not occur earlier in patients than in their first degree relatives. No significant alterations in neonatal health, fertility or menstruation were found.

Edad de menopausia en pacientes tratadas con I131 por cáncer diferenciado de tiroides / Age of menopause in patients with differentiated thyroid cancer treated with radioiodine

Introducción El cáncer diferenciado de tiroides es la neoplasia endocrina mas frecuente. El tratamiento con radioyodo es una pieza importante del tratamiento. Objetivo Analizar los efectos de esta terapia sobre la función ovárica y reproductiva en las pacientes tratadas con I131.Material y método Se realizó un análisis retrospectivo de los datos de 202 mujeres afectas de cáncer diferenciado de tiroides y tratadas con I131 en nuestro servicio entre 1985–2008. Se recogieron datos acerca de la edad de la menopausia de las pacientes y de sus madres y hermanas, historia menstrual, fertilidad y patología neonatal.Resultados34 mujeres alcanzaron la edad de menopausia durante su seguimiento, con una edad media de 49,94±3,45 años mientras que en madres y hermanas fue de 49,20±5,37 y 48,73±3,74 años, respectivamente. Tres de estas pacientes presentaron oligoamenorrea transitoria. Ninguna tuvo infertilidad ni alteraciones en la descendencia. Conclusiones En nuestra serie no se halló un adelanto significativo de la edad de la menopausia respecto a sus familiares de primer grado ni una incidencia significativa de patología neonatal, infertilidad y/o alteraciones menstruales (AU)

Introduction Differentiated thyroid cancer (DTC) is an increasingly frequent endocrinological disease. Radioiodine is a key component of treatment. Objective To analyze the effects of I131 therapy on ovarian and reproductive function. Material and methods We retrospectively analyzed data from 202 women treated with radioiodine for DTC in our service from 1985–2008. Data on age at menopause in patients and their mothers and sisters, menstrual history, fertility and neonatal abnormalities were collected. Results Menopause occurred in 34 patients at follow-up. The mean age at menopause in patients was 49.94±3.45 while that in their mothers and sisters was 49.20±5.37 and 48.73±3.74 years, respectively. Three patients had transient amenorrhea. No infertility or neonatal alterations were found. ConclusionsIn our series, menopause did not occur earlier in patients than in their first degree relatives. No significant alterations in neonatal health, fertility or menstruation were found (AU)

Utilidad de la determinación de tiroglobulina en aspirado de ganglios linfáticos de pacientes con carcinoma papilar de tiroides y anticuerpos antitiroglobulínicos positivos / Usefulness of thyroglobulin determination in lymph node aspirates of patients with papillary thyroid carcinoma and positive antithyroglobulin antibodies

Objetivo: Precisar la utilidad de la determinación de tiroglobulina (Tg)en el líquido de lavado de la aguja de citología (Tg-PAAF) en el diagnóstico de adenopatías metastásicas de pacientes con cáncer papilarde tiroides (CPT) y anticuerpos antitiroideos positivos (AbTg).Material y métodos: Estudiamos a 11 pacientes (49,9 ± 11,8 años; el70%, mujeres) con antecedentes de CPT y concentraciones de AbTgséricas positivas quienes habían recibido tratamiento con 131I y mostraron captación patológica en el cuello compatible con adenopatías metastásicas. Se realizó punción aspirativa con aguja fina (PAAF) guiada; la aguja de punción se lavó con 1 ml de suero fisiológico y se determinóla Tg. Resultados: Se detectaron 17 nódulos sospechosos y 16 de ellos mostraron concentraciones de Tg en el líquido de lavado ≥ 7 ng/ml (223,3± 314,2 [7-1.009]). No se objetivaron AbTg en ellas. El rastreo corporaltotal (RCT) detectó el 94% de las adenopatías, mediante ecografía y citología se detectaron el 76,5 y el 70,6%, respectivamente. La Tg-PAAF fue positiva en el 94% de los nódulos, con superiorioridad al conjunto de ecografía y citología (88,2%) y la suma de los hallazgos ecográficos y Tg-PAAF detectó el 100% de los ganglios. Conclusiones: La determinación de Tg-PAAF es una técnica útil para el diagnóstico de adenopatías metastásicas de CPT y no resulta afectada por la presencia de AbTg séricos (AU)

Objective: We wanted to study the utility of thyroglobulin determination in the washout of fine needle aspiration (FNABTg) of lymph metastatic nodes in patients with papilar thyroid carcinoma (PTC) and positive serum thyroglobulin antibodies (AbTg).Materials and methods: We have studied 11 patients (49.9 ± 11.8 years old,70% females) with PTC and positive AbTgin which a whole-body scanning (WBS)after 131I treatment showed pathologicaluptake in lymph cervical nodes. An ultrasound-guided fine-needle aspiration biopsy (US-FNAB) was performed for cytological research. Needle-washout with1 ml ClNa 0.9% was employed to determine FNAB-Tg. Results: In 16/17 suspicious nodes Tg-FNAB concentration was higher than 7 ng/dl (223.3 ± 314.2 [7-1009]). AbTg were negative in the washout obtained. WBS was able to detect 94%lymphadenopathies, whereas 76.5% were detected with ultrasound and 70.6% using cytology. The FNAB-Tg was positive in 94%of nodules, which was higher than combining US and FNAB-cytology both together (88.2%). One hundred per cent of pathological nodules were detected using US plus FNAB-Tg. Conclusions: FNAB-Tg determination isan useful technique for diagnosis of metastatic lymph nodes of patients with PTC and is unaffected by the presence of serum AbTg (AU)