Coexistence of primary hyperparathyroidism and thyroid disease.

Primary hyperparathyroidism (HPT) and thyroid disease are both relatively common diseases, which can coexist in the same patient. However, mere coincidence does not seem to be a satisfactory explanation for this association. Some factors like prior exposure to radiation may play a role in the association. The aim of this study was to determine the frequency of thyroid disease associated with HPT in 54 consecutive patients who underwent parathyroidectomy in our center from January 1990 to December 1997. Twenty-eight (52%) patients had thyroid disease associated to HPT. The patients had a mean age of 61+/-13 yr; they were predominantly postmenopausal women. Thyroid disease was detected preoperatively in 20 (71%) patients and during the surgical procedure in 8 (29%). Two patients had previous radiation exposure; one of them with papillary carcinoma of the thyroid. Two patients had hypothyroidism. UItrasonography was performed in the majority of patients in their preoperative evaluation. A multinodular goiter was seen to be the most frequent finding (76%). In addition to parathyroidectomy, 23 (82%) patients were also thyroidectomized. In conclusion, patients with HPT showed a high prevalence of thyroid disease, especially in postmenopausal women. Unsuspected thyroid lesions were found with sufficient frequency to warrant careful preoperative and intraoperative evaluation of both glands, in order to obviate reoperation. In experienced hands, combined surgery can be safely performed. Cervical ultrasonography is useful in the preoperative detection of nodular thyroid disease in these patients.

Fine-needle aspiration biopsy of thyroid nodules: impact on clinical practice.

UNLABELLED: The aim of the present study was to analyze the changes in our clinical practice due to the use of FNAB in the management of nodular thyroid disease. Patients attended the thyroid unit for thyroid nodules. The study comprises three periods: First, from January 1980 to May 1984, 226 patient. Second, from June 1985 to December 1990, 166 patients. Third, from January 1991 to December 1993, 403 patients. DESIGN: retrospective the 1st period and prospective the 2nd and 3rd periods. During the 1st and 2nd periods, decision for surgery was based on clinical parameters together with results of 99Tc radionucleotide scan and B mode ultrasound studies. In the 3rd period surgical decision was based principally on cytologic results. We comparatively studied the frequency of surgical operation and frequency of malignancy in surgical thyroid specimens between the study periods. Determination of sensitivity, specificity and accuracy of the diagnostic methods was done. We observed a decrease in the frequency of patients requiring surgery, 89.9%, 67.8% and 46.6% for the 1st, 2nd and 3rd study periods, X2 = 114.7, p < 0.0001; and an increase in the frequency of malignancy in the surgical specimens, 14.7%, 24.4% and 32.9% for 1st, 2nd and 3rd periods respectively, X2 = 4.5, p < 0.05. The sensitivity 92.5% and 93.5%, the specificity 50.6% and 61.1%, and the accuracy 60.9% and 71.8% of the FNAB for the second and third periods respectively. The rates of false negative cytological specimens were 1.8% and 2.1% for 2nd and 3rd respectively, p > 0.05. Since the introduction of FNAB in the evaluation of our patients around 70% of these had a definitive preoperative diagnosis of either benign or malignant disease. Simplification in management of patients with nodular thyroid disease is the most important impact for the use of FNAB. Furthermore, a decrease in the number of patients requiring surgical treatment and an increase of malignant nodules in the specimens obtained by surgery were also observed. We think that FNAB is the most direct and accurate method in the management of patients with thyroid nodules.

Antithyroid drug and Graves' hyperthyroidism. Significance of treatment duration and TRAb determination on lasting remission.

OBJECTIVE: To investigate the significance of treatment with antithyroid drugs longer than 12 months on lasting remission in Graves' hyperthyroid patients, and to study clinical and laboratory parameters of prognostic value. PATIENTS: Fifty-two untreated Graves' hyperthyroid patients were assigned at random to two therapeutic groups. They were treated with carbimazole during 12 and 24 months in Group I (n = 28) and Group II (n = 24), respectively. MEASUREMENTS: Serum levels of FT4, T3, sTSH and TSH receptor antibody (TRAb) were measured before starting treatment and at regular intervals during treatment and follow-up after drug withdrawal. We compared the relapse rate in both groups of patients, at short (2-yr) and long-term (5-yr) periods after drug withdrawal. Also, we compared clinical and biochemical parameters between patients who stayed in remission and who had relapse. RESULTS: At the end of the short-term period, relapse had occurred in 13 (46.4%) Group I patients and in 13 (54.1%) Group II patients, p = 0.36. At the end of the long-term period, relapse had occurred in 24 (85.7%) Group I and 20 (83.3%) Group II patients, p = 0.78. No difference could be observed between patients who had stayed in remission and who had suffered relapse, within the 5-yr follow-up period regarding to goiter size, frequency of ophthalmopathy, TSH and TRAb levels. CONCLUSIONS: The high relapse rate observed could be due to high iodine intake in our country. In this study and in a review of the available data, we have been unable to find any rational basis for courses of antithyroid drugs longer than twelve months for the treatment of Graves' hyperthyroidism.(ABSTRACT TRUNCATED AT 250 WORDS)

[Influence of diabetes mellitus in hospital emergencies]. / Influencia de la diabetes mellitus en la Urgencia Hospitalaria.

A study performed at the Internal Medicine Emergency Department of the General Hospital "La Paz" (Madrid) over a six month period is presented. Its goal was to check the problems of the diabetic patient at his entrance to the medical emergency. We review the emergency pathological causes and we established that vascular (32%) and acute metabolic (17%) alterations were the most common pathologies, both in insulin-dependent (IDDM) and non-insulin-dependent (NIDDM) diabetic patients. We analyzed the acute metabolic alterations considering that they can be foreseeable with an adequate knowledge of the disease. We point out an aspect that to our knowledge is basic: the diabetological information-education of diabetic patients (only 5% had a good knowledge of the disease and, furthermore, only 18% declared to have received some diabetological information). We also highlight the overuse that diabetic patients do of the hospital emergency departments, as a consequence of the previously mentioned poor information received which also reflects the insufficient or inadequate medical assistance in Primary Care Centers.