Tyrosine kinase inhibitors in iodine-refractory differentiated thyroid cancer: experience in clinical practice.

PURPOSE: The aim of this study is to describe our clinical experience with tyrosine kinase inhibitors (TKIs) and to evaluate their efficacy and tolerability in patients with iodine-refractory differentiated thyroid cancer (DTC). METHODS: There were 17 patients (47.1% women, mean age: 65.7) with DTC iodine-refractory (9 papillary, 2 follicular and 3 Hürthle cell), treated with TKIs: 16 with sorafenib and 1 with lenvatinib as first-line treatment; 7 required second-line treatment (4 lenvatinib and 3 axitinib). Primary endpoints were progression-free survival (PFS) and radiographic response (determinate at 3, 6, 12, 18, and 24 months after the initiation of treatment) and second endpoints were determining differences in baseline characteristics depending on clinical course and describing toxicities and tolerability. RESULTS: Median PFS was 18 months. During the first 24 months of treatment with TKIs PR rate was 35.3% (only 5.8% ≥ 6 months) and SD ≥ 6 months was observed in 58.8%. There were no significant differences in baseline characteristics between patients with good and poor evolution. Adverse events (AEs) were present in 100% of patients, but most of them were grade 1 and 2. CONCLUSIONS: In our population of patients with iodine-refractory DTC, treatment with sorafenib, lenvatinib, and axitinib allows the stabilization of the disease in a high percentage of cases, with acceptable tolerability.

Aplicación de la TSH humana recombinante en el protocolo diagnóstico del cáncer diferenciado de tiroides / Application of recombinant human TSH in the diagnostic protocol of differentiated thyroidcarcinoma

Objetivos: Describir los resultados preliminares de la aplicación de esta nueva técnica en la práctica diagnóstica habitual en el manejo del cáncer diferenciado de tiroides (CDT). Material y métodos: Se realizó rastreo corporal total (RCT) con 131I tras estimulación con TSH recombinante humana (rhTSH) en un grupo de 102 pacientes con CDT en seguimiento, todos tratados mediante tiroidectomía total. La pauta de administración fue de 0,9 mg rhTSH los días primeros y segundo del procedimiento, seguidos de 185 MBq de 131I administrados vía oral el día siguiente y posterior rastreo gammagráfico a las 48 horas. Se determinaron TSH, tiroglobulina (Tg) y anticuerpos antitiroglobulina en suero, mediante técnicas inmunométricas, a las 24 y 72 horas de la última administración de la rhTSH. Resultados. Los valores de TSH a las 24 horas tras estimulación con rhTSH fueron de 147,54 ± 46,46 mUI/l. En 62 pacientes se obtuvieron valores de Tg negativa (< 1 ng/ml), de los que 50 presentaron rastreo negativo y doce positivo. Entre los que tuvieron Tg positiva (37), 17 presentaron rastreo negativo (confirmándose presencia de enfermedad en 7 pacientes mediante otras técnicas de imagen) y 20 positivo. Conclusiones: La administración de rhTSH produjo en todos los casos un significativo aumento de la TSH, permitiendo la realización de los controles habituales de seguimiento de los pacientes de forma similar a la supresión hormonal. No han existido evidencias de efectos secundarios significativos, y su utilización permite obviar los inconvenientes derivados de la supresión, manteniendo una buena calidad de vida en los pacientes

Objectives: To describe the preliminary results of the application of this new technique in the diagnostic protocol in the management of differentiated thyroid cancer (DTC).Material and methods: 131I Whole body scan (WBS) was made under rhTSH stimulation in a group of 102 patients with DTC in follow-up, all treated by means of total thyroidectomy. The administration guideline was a dose of 0.9 mg of rhTSH (intramuscular) for two consecutive days, followed by oral activity of 185 MBq of 131I 24 hours after the last rhTSH injection, and later scintigraphic scan after 48 hours of the administration of 131I. Serum samples for TSH, thyroglobulin and antithyroglobulin antibodies determination were collected at 24 and 72 hours of the last administration of the rhTSH. Measures were made by means of immunometric assays. Results: TSH values at 24 hours after exogenous stimulation were 147.54 ± 46.46 mIU/l. In 62 patients values of negative Tg were obtained (< 1 ng/ml), 50 of which presented negative WBS and 12 positive. 37 patients had positive Tg, 17 of whom presented negative WBS (confirming presence of disease in 7 patient by means of other imaging techniques) and 20 positive. Conclusions: In every case, administration of rhTSH produced a significant increase of the TSH, making it possible to perform the usual controls of patient management (determination of serum Tg and WBS), similarly to the hormone withdrawal situation. There is no evidence of significant side effects, and its use makes it possible to avoid disadvantages derived from the hormonal withdrawal, maintaining a good quality of life in patients

[Application of recombinant human TSH in the diagnostic protocol of differentiated thyroid carcinoma]. / Aplicación de la TSH humana recombinante en el protocolo diagnóstico del cáncer diferenciado de tiroides.

OBJECTIVES: To describe the preliminary results of the application of this new technique in the diagnostic protocol in the management of differentiated thyroid cancer (DTC). MATERIAL AND METHODS: 131I Whole body scan (WBS) was made under rhTSH stimulation in a group of 102 patients with DTC in follow-up, all treated by means of total thyroidectomy. The administration guideline was a dose of 0.9 mg of rhTSH (intramuscular) for two consecutive days, followed by oral activity of 185 MBq of 131I 24 hours after the last rhTSH injection, and later scintigraphic scan after 48 hours of the administration of 131I. Serum samples for TSH, thyroglobulin and antithyroglobulin antibodies determination were collected at 24 and 72 hours of the last administration of the rhTSH. Measures were made by means of immunometric assays. RESULTS: TSH values at 24 hours after exogenous stimulation were 147.54 +/- 46.46 mIU/l. In 62 patients values of negative Tg were obtained (< 1 ng/ml), 50 of which presented negative WBS and 12 positive. 37 patients had positive Tg, 17 of whom presented negative WBS (confirming presence of disease in 7 patient by means of other imaging techniques) and 20 positive. CONCLUSIONS: In every case, administration of rhTSH produced a significant increase of the TSH, making it possible to perform the usual controls of patient management (determination of serum Tg and WBS), similarly to the hormone withdrawal situation. There is no evidence of significant side effects, and its use makes it possible to avoid disadvantages derived from the hormonal withdrawal, maintaining a good quality of life in patients.

[The quality of the care in parenteral nutrition: the benefits after the incorporation of a nutritional support team]. / Calidad asistencial en nutrición parenteral: beneficios tras la incorporación de un equipo de soporte nutricional.

GOALS: The purpose of the study was to analyze the quality of the prescription and follow-up of the total parenteral nutrition (PNT) before and after the incorporation of a nutritional support team (NST). MATERIAL AND METHODS: A random sample of 96 patients was selected retrospectively, with 48 prior to the incorporation of the NST (the Non-NST group) and 48 after its incorporation (the NST group), to whom TPN was prescribed. The following points were assessed: 1. The existence of a minimum analytical and nutritional assessment, prior to the incorporation of TPN; 2. The follow-up of the same. RESULTS: The average duration of TPN per patient was 13.8 days without differences between the two groups. There is a written record of the weight and height in 15% and 10% of cases, respectively, in the Non-NST group as opposed to 100% and 99% in the NST group (p < 0.0001). Prior to the incorporation of the NST, the nutritional requirement was not verified in any patients (0%) as opposed to 97% afterwards. Statistically significant differences were detected in the measurement of albumin prior to the start of TPN (p < 0.01). During the analytical follow-up, statistically significant differences were detected in the measurement of: blood tests (p < 0.05); basic biochemistry (p < 0.01); general biochemistry, magnesium, zinc, pre-albumin, transferrin and nitrogen balance (p < 0.0001). In the TPN follow-up, the Non-NST group did not change any of the components contained in it (in terms of volume, macro or micronutrients) in 81% of patients, while 17% had one change and 2% had 2 or more changes, as opposed to 27%, 42% and 31%, respectively in the NST group (p < 0.0001). There were no significant differences in metabolic complications between the two groups. CONCLUSIONS: The implementation of a nutritional support team in charge of the prescription and follow-up of TPN has notably improved the quality of these follow-up studies.

Calidad asistencial en nutrición parenteral: beneficios tras la incorporación de un equipo de soporte nutricional / Quality of assistance in parenteral nutrition: benefits following the incorporation of a nutritional support team

Objetivos: El objetivo del trabajo fue analizar la calidad de la prescripción y seguimiento de la nutrición parenteral total (NPT) antes y después de la incorporación de un equipo de soporte nutricional (ESN).Material y métodos: Se seleccionó retrospectivamente una muestra aleatoria de 96 pacientes, 48 previos a la incorporación del ESN (grupo NOESN) y 48 posteriores (grupo ESN), a los que se les prescribió NPT. Se evaluó: l) la existencia de una valoración nutricional y analítica mínima, previa a la instauración de la NPT y 2) el seguimiento de la misma.Resultados: La duración media de la NPT por paciente fue de 13,8 días sin diferencias en ambos grupos. Existía constancia escrita del peso y la talla (respectivamente) en el 15 por ciento y 10 por ciento de los casos, en el grupo NOESN, frente al 100 por ciento y 99 por ciento en el ESN (p 2 modificaciones en el 2 por ciento, frente al 27 por ciento, 42 por ciento y 31 por ciento, respectivamente, en el grupo ESN (p < 0,0001). No existieron diferencias significativas en cuanto a complicaciones metabólicas entre los dos grupos.Conclusiones: La implantación de un equipo de soporte nutricional, encargado de la prescripción y seguimiento de la NPT, ha mejorado notablemente la calidad en el seguimiento de las mismas (AU)

Goals: The purpose of the study was to analyze the quality of the prescription and follow-up of the total parenteral nutrition (PNT) before and after the incorporation of a nutritional support team (NST). Material and methods: A random sample of 96 patients was selected retrospectively, with 48 prior to the incorporation of the NST (the Non-NST group) and 48 after its in-corporation (the NST group), to whom TPN was prescribed. The following points were assessed: 1. The existence of a minimum analytical and nutritional assessment, prior to the incorporation of TPN; 2. The follow-up of the same. Results: The average duration of TPN per patient was 13.8 days without differences between the two groups. There is a written record of the weight and height in 15% and 10% of cases, respectively, in the Non-NST group as opposed to 100% and 99% in the NST group (p < 0.0001). Prior to the incorporation of the NST, the nutritional requirement was not verified in any patients (0%) as opposed to 97% afterwards. Statistically significant differences were detected in the measurement of albumin prior to the start of TPN (p < 0.01). During the analytical follow-up, statistically significant differences were detected in the measurement of: blood tests (p < 0.05); basic biochemistry (p < 0.01); general biochemistry, magnesium, zinc, pre-albumin, transferrin and nitrogen balance (p < 0.0001). In the TPN follow-up, the Non-NST group did not change any of the components contained in it (in terms of volume, macro or micronutrients) in 81% of patients, while 17% had one change and 2% had 2 or more changes, as opposed to 27%, 42% and 31 %, respectively in the NST group (p < 0.0001). There were no significant differences in metabolic complications between the two groups. Conclusions: The implementation of a nutritional support team in charge of the prescription and follow-up of TPN has notably improved the quality of these follow-up studies (AU)

[Surreptitious intake of diuretics as the cause of pseudo-Bartter's syndrome: apropos of a case and differential diagnosis]. / Ingesta subrepticia de diuréticos como causa de "Pseudo-Síndrome Bartter", a propósito de un caso y diagnóstico diferencial.

We describe a 39 years old patient with a history of chronic symptomatic hypokalemia. She denied taking any drugs. She satisfied the clinical criteria for Bartter's syndrome and more precisely for Gitelman's syndrome: hypokalemia in the presence of inappropriately high potassium excretion, metabolic alkalosis, hyperreninemic hyperaldosteronism, hypomagnesemia with inappropriately high magnesium excretion, normocalcemia, hypocalciuria and normal blood pressure. A HPLC analysis detected the presence of furosemide in urine and chlorthalidone in urine and plasma samples. After the self administration of diuretics was stopped, the above alterations came back to normality. Prior to the verification of a self administration of diuretics, the patient showed clinical and biochemical parameters that oriented to surreptitious diuretic ingestion (Pseudo-Bartter's syndrome) not to Bartter's syndrome or Gitelman's syndrome, particularly the plasma potassium readily restored to normal by the administration of potassium chloride supplements, the increased plasma uric acid with low uric acid fractional clearance, the widely different urine and plasma electrolyte levels and the presence psychiatric disorders. The literature is reviewed and differential diagnosis, among this three syndromes, is made.