Therapeutic plasmapheresis for the treatment of thyrotoxicosis: A retrospective multi-center study.

BACKGROUND AND AIMS: Thyroid storm and severe thyrotoxicosis remain among the most frequent endocrine emergencies, and first-line hyperthyroidism treatment is not always an option. Since the first report in 1970, plasmapheresis is a second-line treatment for severe or otherwise untreatable thyrotoxicosis when rapid euthyroidism is desired. METHODS: We present a retrospective study of the experience in treating thyrotoxicosis with plasmapheresis between 2012 and 2020 in two specialized centers in Colombia. We register the demographic and clinical characteristic and compare the thyroid hormones and other biochemical measurements before and after treatment. RESULTS: Data from 19 patients was obtained, 58% female with a median age of 35 years (IQR 23.5), and most of them with Graves' disease. The most frequent indication for plasmapheresis was thyroid storm. A median of 4 (IQR 2) sessions lead to a significant reduction in FT4 (P .0001) and TT3 (P < .0003) with a nonsignificant decrease in beta-blocker (P .7353) dose, no change in hepatic enzymes, and no adverse events. After plasmapheresis, thyroidectomy was performed in 10 patients. CONCLUSIONS: Plasmapheresis is an effective and safe treatment option for reducing circulating thyroid hormones in severe thyrotoxicosis when other forms of treatment are contraindicated or in case of urgent thyroid and non-thyroid surgery. It is limited by its cost and the need for highly specialized resources.

Systems of Risk Stratification of Malignancy by Ultrasound of Thyroid Nodules.

Thyroid nodules (TN) are more frequently identified with the use of thyroid ultrasonography, and they have a low risk of malignancy. Ultrasonographic features have been established that increase the probability of being faced with thyroid carcinoma; however, individually, these characteristics do not perform adequately in the diagnosis of malignancy, limiting their usefulness when indicating cytological studies by means of fine-needle aspiration (FNC). This situation motivated the development of risk stratification systems for thyroid nodules, which unified their ultrasound characteristics, with the aim of establishing risk categories, standardizing the preparation of reports, and providing the clinician with useful tools to define the surveillance option or form invasive studies. The objective of this review is to compare the different systems developed by some scientific societies for the stratification of thyroid nodules, with respect to their predictive capacities for malignancy, their operational characteristics for diagnosis, and, to suggest recommendations for the implementation of these systems, placing emphasis on those with the best ability to reduce the performance of unnecessary invasive studies and to guide decision-making in the face of undetermined cytological results.

Exposure to Degludec During Pregnancy: A Case Report.

A non-planned pregnancy in a patient with type 1 diabetes with ocular complications, was treated with degludec from pre-conception stages until the postpartum is reported. The newborn was healthy without any congenital abnormalities; however, due to respiratory distress required neonatal intensive care unit.

Feocromocitoma-paraganglioma: revisión de tema / Pheochromocytoma-paraganglioma: a review

Resumen: el feocromocitoma es una enfermedad poco frecuente, correspondiente a un tumor derivadode las células cromafines, originado en la médula de la glándula suprarrenal. Cuando este tumor se origina en los paraganglios el término correcto es paraganglioma. Las manifestaciones clínicas son variables y secundarias a la masa tumoral o a la producción exagerada de catecolaminas. Los síntomas originados por el crecimiento de la masa tumoral incluyen dolor abdominal, malestar epigástrico, obstrucción de estructuras cercanas como la vía biliar y los uréteres, y, cuando está localizado en otros sitios como el mediastino, disnea. Los síntomas secundarios a la hiperproducción de catecolaminas son diaforesis, palpitaciones, cefalea, crisis hipertensivas, hipertensión sostenida, constipación, náuseas, vómito y, en la forma más exagerada, crisis catecolaminérgicas. El diagnóstico se realiza mediante la medición de metanefrinas libres en orina de 24 horas o en plasma, y como alternativa se puede realizar medición de catecolaminas en orina de 24 horas. La medición de ácido vanilmandélico es poco sensible, lo mismo que la medición de catecolaminas en plasma, la cual no es recomendada. El tratamiento de esta enfermedad es quirúrgico. En aquellos pacientes con feocromocitomamaligno o paraganglioma se puede realizar una estrategia de observación activa y en quienes tengan progresión de la enfermedad el uso de quimioterapia o, según el grado de compromiso, el uso de metayodobencilguanidina marcada con yodo-131 es la terapia de elección. El uso de terapia molecular diana utilizando inhibidores de tirosina quinasa es un área de investigación activa.

Abstract: Pheochromocytoma is a rare disease, corresponding to a tumor originated in the chromaphincells, and located in the adrenal medulla. When the tumor is located in the paraganglia the appropriate term is paraganglioma. Clinical manifestations are variable and secondary to the tumoral local extension or to the overproduction of catecholamines. Symptoms secondary to local growth of the tumor includes abdominal pain, epigastric discomfort, obstruction of nearby structures such as biliary tree and ureters, and when is located in other regions such as the mediastinum, dyspnea. Symptoms secondary to overproduction of catecholamines are diaphoresis, headache, hypertensive emergencies, sustained hypertension, constipation, nausea, vomiting and, in the most extreme form, catecholaminergic crisis. Diagnosis is based on the measurement of free plasmatic or urinary metanephrines.As an alternative can be used 24 hours urinary catecholamines. The detection of vanillylmandelic acid and plasma catecholamines has poor sensibility and is no longer recommended. The treatment of this entity is surgical resection. In those patients with malignant pheochromocytoma or paraganglioma an observation and watch strategy can be used. If disease progression is detected, the use of chemotherapy or iodine-131-labeled meta-iodobenzylguanidine, according to the severity of compromise, is the next step. The use of targeted molecular therapies using tyrosine kinase inhibitoris an area under active research.