RESUMEN
INTRODUCTION: Carcinoid tumor is a rare neuroendocrine neoplasm with different locations, the most frequent ones during the pediatric age being the appendix and lung. Scintigraphy with (111)In-DTPA-d-Phe(1)-octreotide has led to an importance advance in the diagnosis of extension in carcinoid tumor patients. We present three pediatric patients with bronchial carcinoid studied with somatostatin analogue scintigraphy (SSRS). CLINICAL CASES: The first patient (9 years) was studied using the SSRS after surgery due to carcinoid tumor in the right lower lobe in which tumor remains was observed (this being clearer in the tomography study). The second patient (10 years) presented due to endobronchial tumor in the left lower lobe together with atelectasis of the LUL and emphysema of the LLL. Radiology imaging techniques suggested the differential diagnosis between the endobronchial carcinoid tumor or plasma cells or foreign body gramuloma. The SSRS showed an abnormal deposit of activity in the left hemithorax consisted with carcinoid tumor. No other areas suggesting metastasis were observed. After the surgery (endobronchial resection), new controls with SSRS showed absence of disease. The third patient (12 years) came after a lobectomy (RUL) due to bronchial carcinoid. The SSRS did not show any abnormal areas of activity. In the subsequent control (3 months), a deposit of activity was observed in the middle third of the right hemithorax, after which a lobectomy was performed (RLL and ML) that showed small remains of neuroendocrine carcinoid. Subsequent controls were negative. CONCLUSION: The SSRS has demonstrated great utility in the diagnosis, follow-up and staging of pediatric patients, carriers of neuroendocrine carcinoid tumors.
Asunto(s)
Biomarcadores de Tumor/análisis , Neoplasias de los Bronquios/diagnóstico por imagen , Tumor Carcinoide/diagnóstico por imagen , Neoplasias Pulmonares/diagnóstico por imagen , Proteínas de Neoplasias/análisis , Receptores de Somatostatina/análisis , Neoplasias de los Bronquios/química , Neoplasias de los Bronquios/cirugía , Tumor Carcinoide/química , Tumor Carcinoide/cirugía , Niño , Diagnóstico Diferencial , Femenino , Humanos , Radioisótopos de Indio , Neoplasias Pulmonares/química , Neoplasias Pulmonares/cirugía , Masculino , Octreótido/análogos & derivados , Neumonectomía , Cuidados Posoperatorios , Complicaciones Posoperatorias/etiología , Atelectasia Pulmonar/etiología , Enfisema Pulmonar/etiología , Cintigrafía , Radiofármacos , ReoperaciónRESUMEN
Ectopic thyroid tissue is a rare clinical entity, and more so when it is present in two different locations. We present the case of a 38-year-old euthyroid woman with submandibular and lingual ectopic thyroid tissue in the absence of a normally located thyroid gland, diagnosed after the extirpation of an asymptomatic mass misdiagnosed as a neoplasm of the submaxillary gland. Despite its low frequency, the possibility of ectopic thyroid should be considered when making a differential diagnosis of neck masses, using ultra-sound, thyroid scan and ultrasound-guided fine-needle aspiration biopsy.
Asunto(s)
Coristoma/diagnóstico por imagen , Errores Diagnósticos , Hipotiroidismo/etiología , Bocio Lingual/diagnóstico , Complicaciones Posoperatorias/etiología , Glándula Submandibular/cirugía , Glándula Tiroides , Adulto , Coristoma/diagnóstico , Coristoma/cirugía , Femenino , Humanos , Escisión del Ganglio Linfático , Imagen por Resonancia Magnética , Neoplasias de las Glándulas Salivales/diagnóstico , Glándula Submandibular/patología , Glándula Tiroides/anomalías , Tomografía Computarizada por Rayos XRESUMEN
OBJECTIVES: To compare the results of individual dosimetry in differentiated thyroid cancer patients treated with (131)I at our centre with the established limits and dosimetry results of published studies. Analysis of the optimal number of measurements necessary to reduce the impact of dosimetry for the comfort of the patient and, secondly, on the workload of health workers. MATERIAL AND METHODS: Dosimetry was performed in the Nuclear Medicine Department of the University and Polytechnic Hospital La Fe, on 29 patients suffering from differentiated thyroid cancer and treated with activities between 1.02 and 5.51 GBq (mean 2.68 GBq) of (131)I. The Spanish Society of Medical Physics (SEFM) protocol was used, based on measurements of external dose rate adjusted to a bi-exponential curve according to a two compartment model. Different dosimetries were performed on each patient, taking different selections of the available measurements in order to find the optimal number. RESULTS: Results are well below the dosimetry limits, and are consistent with those obtained in other centres. The number of measurements can be reduced from 5, as proposed in the SEFM protocol, to 4 without significant loss of accuracy. Further reducing measures may be justified in individual cases. CONCLUSIONS: The values obtained for the dosimetry quantities are significantly below the established limits. A reduction in measurements can be assumed at the cost of a moderate increase in uncertainty, benefiting the patient.
Asunto(s)
Adenocarcinoma/radioterapia , Radioisótopos de Yodo/uso terapéutico , Neoplasias de la Tiroides/radioterapia , Adenocarcinoma/patología , Adenocarcinoma/cirugía , Humanos , Dosificación Radioterapéutica , Neoplasias de la Tiroides/patología , Neoplasias de la Tiroides/cirugía , TiroidectomíaRESUMEN
A woman, thyroidectomised because of a thyroid papillary carcinoma, interrupted temporarily her levothyroxine intake in order to be subjected to an extension study five weeks later. To minimise her symptoms for the first three weeks, a treatment was prescribed consisting of one 25 micro g-capsule of triiodothyronine every 8 hours. Nine days later she complained of abdominal pain, nausea, vomiting, fever of 40 degrees C and chest discomfort. A serum total triiodothyronine of 575.2 nmol/l was measured by chemoluminiscent immunoassay eleven hours after the intake of the latest capsule (normal level: 1.1-2.9 nmol/l). Along the following ten days the patient suffered from delirium, agitation, tachycardia, hypertension, constipation and later diarrhoea, but neither arrythmias nor axillary temperature over 38 degrees C. Fifty-nine measurements of the serum total triiodothyronine were performed in order to determine the kinetics of elimination of this drug. We estimate that the maximal serum concentration after the intake of the latest capsule could be 794.3 nmol/l, i.e. 397 times higher than the mean normal value. The elimination half-life was 24 hours 40 minutes. The charcoal haemoperfusion had no impact on the velocity of elimination. The concentration of triiodothyronine became normal 200 hours after the intake of the latest capsule, but the clinical manifestations still lasted three days more. The pharmacokinetic data suggest that this intoxication could be due to the intake of capsules containing 5 mg of triiodothyronine, i.e. a dose 200 times higher than that prescribed by her physician.
Asunto(s)
Tirotoxicosis/inducido químicamente , Triyodotironina/envenenamiento , Absorción , Adulto , Disponibilidad Biológica , Carcinoma Papilar/cirugía , Femenino , Semivida , Hemoperfusión , Humanos , Pruebas de Función de la Tiroides , Neoplasias de la Tiroides/cirugía , Tiroidectomía , Tirotoxicosis/diagnóstico , Tirotoxicosis/terapia , Triyodotironina/sangreRESUMEN
The case of a patient who came to the Nuclear Medicine Department for a bone scintigraphy to rule out bone metastasis because of a lung neoplasm is presented. Some days before, the patient had suffered a right brain infarction. 99mTc-MDP uptake could be seen in the infarction area. Different mechanisms of 99mTc phosphates deposition in tissues other than bones are reviewed in this article.
Asunto(s)
Infarto Encefálico/diagnóstico por imagen , Radiofármacos/farmacocinética , Medronato de Tecnecio Tc 99m/farmacocinética , Anciano , Humanos , Masculino , CintigrafíaRESUMEN
Acute cholecystitis is an uncommon disease in childhood. Few cases in patients under 10 years of age have been found in literature. An eight-year old male patient with no history of interest who had acute acalculous cholecystitis was reported. Ultrasonographic and isotopic studies led to the diagnosis and control of the patient's evolution.
Asunto(s)
Colecistitis/diagnóstico por imagen , Enfermedad Aguda , Niño , Humanos , Masculino , Cintigrafía , Radiofármacos , Ácido Dietil-Iminodiacético de Tecnecio Tc 99mRESUMEN
Thyroid hemiagenesis is a very infrequent abnormality. We present a case of Graves disease associated to a congenital hemiagenesis of the thyroid gland. The thyroid scintigraphy, ultrasonography and laboratory analysis (that showed the existence of thyroid hyperfunction and the present of thyroid stimulating antibodies) were decisive in the diagnosis.
Asunto(s)
Enfermedades Autoinmunes/complicaciones , Enfermedad de Graves/complicaciones , Glándula Tiroides/anomalías , Atrofia , Enfermedades Autoinmunes/sangre , Enfermedades Autoinmunes/diagnóstico por imagen , Enfermedad de Graves/sangre , Enfermedad de Graves/diagnóstico por imagen , Humanos , Hipertensión/complicaciones , Inmunoglobulinas Estimulantes de la Tiroides/sangre , Riñón/patología , Masculino , Persona de Mediana Edad , Cintigrafía , Radiofármacos , Pertecnetato de Sodio Tc 99m , Glándula Tiroides/diagnóstico por imagen , Hormonas Tiroideas/sangre , UltrasonografíaRESUMEN
The case of a patient who had undergone surgery for papillary carcinoma of the thyroid is reported. After administering a therapeutic 131I capsule, the radionuclide scan showed a diffuse, "halo-like" thoracic uptake in the precordial region. The patient's normal thyroglobulin levels and the characteristics of radionuclide uptake did not suggest metastasis. Chest radiography and ultrasonography identified pericardial effusion, which was attributed to hypothyroidism.
Asunto(s)
Radioisótopos de Yodo , Derrame Pericárdico/diagnóstico por imagen , Glándula Tiroides/diagnóstico por imagen , Adulto , Carcinoma Papilar/radioterapia , Carcinoma Papilar/cirugía , Ecocardiografía , Reacciones Falso Positivas , Femenino , Humanos , Hipotiroidismo/complicaciones , Hipotiroidismo/etiología , Radioisótopos de Yodo/uso terapéutico , Metástasis de la Neoplasia/diagnóstico por imagen , Derrame Pericárdico/etiología , Radiografía Torácica , Cintigrafía , Neoplasias de la Tiroides/radioterapia , Neoplasias de la Tiroides/cirugía , Tiroidectomía/efectos adversos , Recuento Corporal TotalRESUMEN
Four cases are presented of ectopic thyroid tissue in adult women who underwent for thyroid study for different motives. Radioisotopic uptake was absent in the usual thyroid location. Thyroid function was normal in every case and no psychomotor abnormalities were present. In one case, echography revealed an atrophic thyroid in the usual location in association with thyroid ectopy. The literature of thyroid ectopy was reviewed and the preponderant role of radioisotopic scan is underlined, together with thyroid echography in the imaging diagnosis of neck masses.
Asunto(s)
Coristoma , Cuello , Glándula Tiroides , Adulto , Coristoma/diagnóstico por imagen , Femenino , Humanos , Persona de Mediana Edad , Cuello/diagnóstico por imagen , Cintigrafía , Pruebas de Función de la Tiroides , Glándula Tiroides/diagnóstico por imagen , UltrasonografíaRESUMEN
Simple or true thyroid cysts are very rare. We only have found one case in which colorless and acellular transparent fluid has been found by means of the fine needle aspiration puncture (FNAP). We report the case of a 33 year old female who first presented with a rapidly growing thyroid nodule. The thyroid scintigraphy revealed the existence of a cold nodule and the ultrasonography showed a lesion having a cystic appearance. The FNAP was performed and was both diagnostic and therapeutic in this case.
Asunto(s)
Quistes/diagnóstico por imagen , Nódulo Tiroideo/diagnóstico por imagen , Adulto , Biopsia con Aguja , Quistes/patología , Femenino , Humanos , Cintigrafía , Pruebas de Función de la Tiroides , Nódulo Tiroideo/patología , UltrasonografíaRESUMEN
The case of a 60-year old woman first presented a rapidly growing left cervical mass is presented. The fine needle aspiration-puncture (FNAP) lead to a diagnosis of thyroiditis. Due to the persistence of the symptoms, the FNAP was repeated again but was not conclusive, so that a surgical biopsy was performed. The pathological diagnosis was diffuse large cell primary thyroid lymphoma (PTL). The PTL is a rare entity that accounts for less than 1% of all the Non-Hodgkin's lymphomas. The thyroid scintigraphy showed the existence of a cold nodule in the left thyroid lobule and the 67Ga scan revealed a large abnormal lesion in the mediastinum that extended to the right latero-cervical region. After two chemotherapy courses, the 67Ga scan was normal.
Asunto(s)
Radioisótopos de Galio , Linfoma de Células B Grandes Difuso/diagnóstico por imagen , Radiofármacos , Glándula Tiroides/diagnóstico por imagen , Neoplasias de la Tiroides/diagnóstico por imagen , Protocolos de Quimioterapia Combinada Antineoplásica/administración & dosificación , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Biopsia con Aguja , Terapia Combinada , Ciclofosfamida/administración & dosificación , Errores Diagnósticos , Doxorrubicina/administración & dosificación , Humanos , Linfoma de Células B Grandes Difuso/patología , Linfoma de Células B Grandes Difuso/terapia , Neoplasias del Mediastino/diagnóstico por imagen , Neoplasias del Mediastino/terapia , Persona de Mediana Edad , Estadificación de Neoplasias , Prednisona/administración & dosificación , Cintigrafía , Radioterapia Adyuvante , Inducción de Remisión , Glándula Tiroides/patología , Neoplasias de la Tiroides/patología , Neoplasias de la Tiroides/terapia , Tiroidectomía , Tiroiditis/diagnóstico , Vincristina/administración & dosificaciónRESUMEN
INTRODUCTION: The neuroblastoma (NB) is one of the most common pediatric malignant neoplasms. The most commonly used tumor markers in the diagnosis and follow-up of this tumor are the serum neuron-specific enolase (NSE), ferritin and lactic dehydrogenase and urinary vanillymandelic and homovanillic acid. The common imaging modalities are CT, MRI and 123I or 131I-meta-iodobenzylguanidine scintigraphy. AIM: The aim of this study is to assess the value of 123I-meta-iodobenzylguanidine (MIBG) scintigraphy and serum determinations of NSE and ferritin in the diagnosis and evolution of NB patients. MATERIAL AND METHODS: 20 patients (8 female, 12 male) whose ages ranged from 2 months to 9 years with a mean age of 2.64 years diagnosed of NB. 47 123I-MIBG scans, 47 NSE determinations and 47 ferritin ones were selected. RESULTS: At the time of diagnosis, 100% of the 123I-MIBG scans were positive. 65% of NSE determinations presented clearly pathological levels and 15% were very near to the cut-off point. Only 45% of the ferritin levels were increased. The differences between the lesions visible by 123I-MIBG scanning before and 3 months after treatment as well as NSE and ferritin levels were studied. When the Student's T test was applied, we found statistically significant pre and post-treatment differences in 123I-MIBG scanning and NSE. In the case of ferritin, there was no statistical significance in spite of the decrease in the values. The direct correlation and Spearman correlation between laboratory data and 123I-MIBG scanning as well as correlation between NSE and ferritin were also studied. There was a good correlation between 123I-MIBG and NSE and between NSE and ferritin. We have also studied the data in 7 relapses. CONCLUSIONS: 123I-MIBG scintigraphy and serum determination of NSE are two successful diagnostic tools for the diagnosis and evolution of NB patients.
Asunto(s)
3-Yodobencilguanidina , Biomarcadores de Tumor/sangre , Ferritinas/sangre , Radioisótopos de Yodo , Neuroblastoma/diagnóstico por imagen , Fosfopiruvato Hidratasa/sangre , Neoplasias de las Glándulas Suprarrenales/sangre , Neoplasias de las Glándulas Suprarrenales/diagnóstico , Neoplasias de las Glándulas Suprarrenales/diagnóstico por imagen , Neoplasias de las Glándulas Suprarrenales/mortalidad , Neoplasias de las Glándulas Suprarrenales/terapia , Niño , Preescolar , Terapia Combinada , Femenino , Ganglioneuroblastoma/sangre , Ganglioneuroblastoma/diagnóstico , Ganglioneuroblastoma/diagnóstico por imagen , Ganglioneuroblastoma/terapia , Humanos , Lactante , Masculino , Neoplasias del Mediastino/sangre , Neoplasias del Mediastino/diagnóstico , Neoplasias del Mediastino/diagnóstico por imagen , Neoplasias del Mediastino/mortalidad , Neuroblastoma/sangre , Neuroblastoma/diagnóstico , Neuroblastoma/mortalidad , Neuroblastoma/terapia , Valor Predictivo de las Pruebas , Cintigrafía , Neoplasias Retroperitoneales/sangre , Neoplasias Retroperitoneales/diagnóstico , Neoplasias Retroperitoneales/diagnóstico por imagen , Neoplasias Retroperitoneales/mortalidad , Neoplasias Retroperitoneales/terapia , Resultado del TratamientoAsunto(s)
Antebrazo/diagnóstico por imagen , Hiperparatiroidismo Secundario/diagnóstico por imagen , Glándulas Paratiroides/trasplante , Paratiroidectomía , Radiofármacos , Tecnecio Tc 99m Sestamibi , Trasplante Autólogo , Trasplante Heterotópico , Humanos , Hiperparatiroidismo Secundario/etiología , Fallo Renal Crónico/complicaciones , Fallo Renal Crónico/terapia , Masculino , Persona de Mediana Edad , Glándulas Paratiroides/diagnóstico por imagen , Hormona Paratiroidea/sangre , Enfermedades Renales Poliquísticas/complicaciones , Cintigrafía , Recurrencia , Diálisis RenalAsunto(s)
Enfermedad de Graves/cirugía , Hipertiroidismo/etiología , Tiroides Lingual/diagnóstico por imagen , Complicaciones Posoperatorias/etiología , Adulto , Femenino , Enfermedad de Graves/diagnóstico por imagen , Humanos , Tiroides Lingual/embriología , Tiroides Lingual/cirugía , Cintigrafía , Radiofármacos , Recurrencia , Pertecnetato de Sodio Tc 99m , Tiroidectomía , Factores de TiempoRESUMEN
Objetivos. Comparar los resultados de la dosimetría individual en pacientes de cáncer diferenciado de tiroides tratados con 131I en nuestro centro con los límites dosimétricos establecidos y con resultados obtenidos en estudios publicados. Analizar el número óptimo de medidas a realizar para reducir el impacto de la dosimetría en el bienestar del paciente y, en segundo término, en la carga de trabajo del personal sanitario. Material y métodos. Se realiza la dosimetría a 29 pacientes del Servicio de Medicina Nuclear del Hospital Universitario y Politécnico La Fe, afectados de cáncer diferenciado de tiroides y tratados con actividades de entre 1,02 y 5,51 GBq (promedio de 2,68 GBq) de 131I. Para ello se utiliza el protocolo de la Sociedad Española de Física Médica (SEFM) basado en medidas de tasa de dosis externa ajustadas a una curva biexponencial, de acuerdo con un modelo de dos compartimentos. Para cada paciente se realizan distintas dosimetrías tomando diferentes selecciones de las medidas disponibles a fin de buscar el número óptimo. Resultados. Los resultados están muy por debajo de los límites dosimétricos y son coherentes con los obtenidos en otros centros. El número de medidas puede reducirse de 5, como propone el protocolo de la SEFM, a 4 sin pérdida de precisión significativa. Una mayor reducción de medidas puede justificarse en casos particulares. Conclusiones. Los valores obtenidos para las magnitudes dosimétricas quedan muy por debajo de los límites establecidos. Se puede asumir la reducción de medidas a costa de un aumento de la incertidumbre moderado beneficiando del paciente (AU)
Objectives. To compare the results of individual dosimetry in differentiated thyroid cancer patients treated with 131I at our centre with the established limits and dosimetry results of published studies. Analysis of the optimal number of measurements necessary to reduce the impact of dosimetry for the comfort of the patient and, secondly, on the workload of health workers. Material and methods. Dosimetry was performed in the Nuclear Medicine Department of the University and Polytechnic Hospital La Fe, on 29 patients suffering from differentiated thyroid cancer and treated with activities between 1.02 and 5.51 GBq (mean 2.68 GBq) of 131I. The Spanish Society of Medical Physics (SEFM) protocol was used, based on measurements of external dose rate adjusted to a bi-exponential curve according to a two compartment model. Different dosimetries were performed on each patient, taking different selections of the available measurements in order to find the optimal number. Results. Results are well below the dosimetry limits, and are consistent with those obtained in other centres. The number of measurements can be reduced from 5, as proposed in the SEFM protocol, to 4 without significant loss of accuracy. Further reducing measures may be justified in individual cases. Conclusions. The values obtained for the dosimetry quantities are significantly below the established limits. A reduction in measurements can be assumed at the cost of a moderate increase in uncertainty, benefiting the patient (AU)
Asunto(s)
Humanos , Masculino , Femenino , Neoplasias de la Tiroides , Dosimetría/métodos , Yodo , Isótopos de Yodo , Pruebas de Función de la Tiroides/métodos , Protocolos Clínicos/normas , Medicina Nuclear/métodos , Sociedades Médicas/normas , Diálisis Peritoneal/tendencias , Insuficiencia Renal/complicaciones , Insuficiencia RenalRESUMEN
IntroducciónEl tumor carcinoide es una rara neoplasia de origen neuroendocrino con localizaciones diversas, siendo las más frecuentes en la edad pediátrica el apéndice y el pulmón. La gammagrafía con 111In-DTPA-d-Phe1-octreótido ha supuesto un considerable avance en el diagnóstico de extensión de pacientes con tumor carcinoide. Presentamos tres pacientes pediátricos con carcinoide bronquial (CB) explorados con gammagrafía con análogos de la somatostatina (GRSS).La primera paciente (9 años) fue estudiada mediante GRSS tras cirugía por tumoración carcinoide en el lóbulo inferior derecho (LID), que objetivó resto tumoral (más evidente en el estudio tomográfico). Nuevos estudios de control con GRSS demostraron el aumento de tamaño del resto tumoral, la existencia de metástasis óseas, hepáticas y otro foco pulmonar de forma más precoz que las otras técnicas de imagen realizadas.La segunda paciente (10 años) acudió por tumoración endobronquial en el lóbulo inferior izquierdo (LII) junto con atelectasia del lóbulo superior izquierdo y enfisema del LII. Las técnicas de imagen radiológicas planteaban el diagnóstico diferencial entre tumor carcinoide endobronquial o granulomas de células plasmáticas o a cuerpo extraño. La GRSS mostró un depósito anormal de actividad en el hemitórax izquierdo compatible con tumoración carcinoide. No se visualizaron otras áreas sugestivas de metástasis. Tras la cirugía (resección endobronquial), los nuevos controles con GRSS mostraron ausencia de enfermedad.El tercer paciente (12 años) acudió tras lobectomía (lóbulo superior derecho) por CB. La GRSS no mostró áreas anormales de actividad. En un control posterior (3 meses) se visualizó un depósito de actividad en el tercio medio del hemitórax derecho, tras lo que se realizó lobectomía (LID y lóbulo medio), que objetivó pequeños restos de carcinoide neuroendocrino. Los controles posteriores fueron negativos...(AU)
IntroductionCarcinoid tumor is a rare neuroendocrine neoplasm with different locations, the most frequent ones during the pediatric age being the appendix and lung. Scintigraphy with 111In-DTPA-d-Phe1-octreotide has led to an importance advance in the diagnosis of extension in carcinoid tumor patients. We present three pediatric patients with bronchial carcinoid studied with somatostatin analogue scintigraphy (SSRS).Clinical casesThe first patient (9 years) was studied using the SSRS after surgery due to carcinoid tumor in the right lower lobe in which tumor remains was observed (this being clearer in the tomography study).The second patient (10 years) presented due to endobronchial tumor in the left lower lobe together with atelectasis of the LUL and emphysema of the LLL. Radiology imaging techniques suggested the differential diagnosis between the endobronchial carcinoid tumor or plasma cells or foreign body gramuloma. The SSRS showed an abnormal deposit of activity in the left hemithorax consisted with carcinoid tumor. No other areas suggesting metastasis were observed. After the surgery (endobronchial resection), new controls with SSRS showed absence of disease.The third patient (12 years) came after a lobectomy (RUL) due to bronchial carcinoid. The SSRS did not show any abnormal areas of activity. In the subsequent control (3 months), a deposit of activity was observed in the middle third of the right hemithorax, after which a lobectomy was performed (RLL and ML) that showed small remains of neuroendocrine carcinoid. Subsequent controls were negative.ConclusionThe SSRS has demonstrated great utility in the diagnosis, follow-up and staging of pediatric patients, carriers of neuroendocrine carcinoid tumors(AU)
Asunto(s)
Humanos , Masculino , Femenino , Niño , Somatostatina , Carcinoma/complicaciones , Carcinoma/diagnóstico , Carcinoma Broncogénico/diagnóstico , Ultrasonografía/métodos , Neumonectomía/métodos , Metástasis de la Neoplasia/patología , Diagnóstico Diferencial , PronósticoRESUMEN
A una mujer tiroidectomizada por carcinoma papilar de tiroides se le suspendió el tratamiento con L-tiroxina para realizar un estudio de extensión cinco semanas después. Para minimizar sus síntomas durante las tres primeras semanas se le prescribió tratamiento con cápsulas de 25 µg de triyodotironina cada 8 horas. Nueve días después consultó por dolor abdominal, náuseas, vómitos, fiebre de 40 ºC, mareo y molestia torácica. Mediante inmunoanálisis quimioluminiscente se detectó una triyodotironina sérica total de 575,2 nmol/l a las 11 horas de la toma de la última cápsula (valor normal: 1,1-2,9 nmol/l). A lo largo de los diez días siguientes la enferma presentó delirio, agitación, taquicardia, hipertensión arterial, estreñimiento y luego diarrea, pero no arritmias ni temperatura superior a 38 ºC. Se realizaron 59 determinaciones de triyodotironina total para determinar la cinética de eliminación de esta hormona. Se calcula que la máxima concentración sérica tras la ingestión de la última cápsula debió ser de 794,3 nmol/l, es decir, 397 veces superior al promedio de la normalidad. La vida media de eliminación fue de 24 horas y 40 minutos. La hemoperfusión con carbón activado no tuvo impacto alguno sobre la velocidad de eliminación. La concentración de triyodotironina se normalizó a las 200 horas de la toma de la última cápsula, pero las manifestaciones clínicas tardaron tres días más en desaparecer. Los datos farmacocinéticos sugieren que la intoxicación pudo deberse a que durante nueve días la paciente tomara cápsulas con 5 mg de triyodotironina, es decir, una dosis 200 veces mayor que la prescrita por su médico (AU)
Asunto(s)
Adulto , Femenino , Humanos , Tirotoxicosis , Triyodotironina , Tiroidectomía , Disponibilidad Biológica , Carcinoma Papilar , Absorción , Semivida , Hemoperfusión , Neoplasias de la Tiroides , Pruebas de Función de la TiroidesRESUMEN
La ectopia de tejido tiroideo es una entidad clínica poco frecuente, y más aún cuando se presenta en 2 localizaciones diferentes. Se presenta el caso de una mujer de 38 años a la que se diagnosticó ectopia tiroidea dual: submandibular y lingual, tras la exéresis de una masa cervical de crecimiento rápido sospechosa de neoplasia de la glándula submaxilar. A pesar de su baja frecuencia, la posibilidad de ectopia tiroidea se debe considerar cuando se realiza un diagnóstico diferencial de masas cervicales mediante ecografía, gammagrafía tiroidea y punción-aspiración con aguja fina guiada por ecografía (AU)
Ectopic thyroid tissue is a rare clinical entity, and more so when it is present in two different locations. We present the case of a 38-year-old euthyroid woman with submandibular and lingual ectopic thyroid tissue in the absence of a normally located thyroid gland, diagnosed after the extirpation of an asymptomatic mass misdiagnosed as a neoplasm of the submaxillary gland. Despite its low frequency, the possibility of ectopic thyroid should be considered when making a differential diagnosis of neck masses, using ultra-sound, thyroid scan and ultrasound-guided fine-needle aspiration biopsy (AU)