Hugo Niepomniszcze

University of Buenos Aires, Buenos Aires, Buenos Aires F.D., Argentina

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Publications (62)76.78 Total impact

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    ABSTRACT: The objective of this study was to evaluate the initial response to treatment and the long-term outcome of patients with papillary thyroid cancer (PTC), according to the modified 2014 risk of recurrence classification of the American Thyroid Association and the presence or absence of insulin resistance (IR). We retrospectively reviewed our database of 636 records and selected 171 patients in whom we had previously validated the ATA risk of recurrence (RR) classification. From these patients, 38 non-diabetic subjects were included for analysis according to the following criteria: age older than 18 years, classic papillary thyroid carcinoma, stable body mass index 5 years previous to PTC diagnosis and during the entire time of follow-up, low and intermediate RR, follow-up after initial treatment at least for 3 years, and absence of any drug treatment for the metabolic syndrome. The IR was evaluated through the homeostasis model assessment (HOMA) index. When equal or higher than 2.5, patients were considered as harboring IR. The initial response to treatment was classified as remission or persistent disease (biochemical and/or structural). The clinical status at final follow-up was defined as no evidence of disease, biochemical persistent disease, structural persistent disease, or recurrence (biochemical or structural disease identified after a period of no evidence of disease). RR was as follows: low: n = 15, intermediate: n = 23. The median follow-up of this patient cohort was 5.5 years (range 3-22 years). We found no statistically significant differences when the response to initial treatment was considered in low-risk patients with or without IR. However, remission was more frequently found in those patients without IR when the intermediate RR was considered (36 vs. 11 %, p = 0.01). When considering the status at final follow-up, we found more frequency of structural persistent disease in both, low and intermediate RR patients with IR (10 vs. 0 %, p = 0.02 and 45 vs.7 %, p = 0.01, respectively). In this series of patients with PTC, the state of IR was associated with increased frequency of structural persistent disease at final follow-up. The IR could have a deleterious effect on the outcome of patients with PTC.
    Endocrine 09/2014; DOI:10.1007/s12020-014-0416-6 · 3.53 Impact Factor
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    ABSTRACT: A total of 1,470 primary school students were evaluated to monitor the prevalence of endemic goiter in four cit-ies of Santa Fe province: Reconquista (404) and Villa Ocampo (294) situated in the north, and Rufino (317) and Venado Tuerto (455) situated in the south of the province. Their age ranged from 6 to 14 years. Neck palpation was performed in all students; for the sake of consistency with monitoring performed in other provinces, palpation was performed by only one physician (HN). The goiter grading system was the same used in other surveys. After palpation, urine samples for iodine determination were randomly collected (109 from Reconquista, 105 from Villa Ocampo, 113 from Rufino and 139 from Venado Tuerto). Iodine was also measured in salt samples collected from the children's homes (337 from Reconquista, 227 from Villa Ocampo, 295 from Rufino and 422 from Venado Tuerto). Prevalence of goiter was 2.6 % without differences among cities. Urine iodine levels were significantly different between northern and southern cities: Reconquista had a mean of 238.6 ± 116 µg/L (median 213 µg/L) and Villa Ocampo had a mean of 241.6 ± 223.5 µg/L (median 188 µg/L), while in Rufino the mean was 544 ± 349 µg/L (median 442 µg/L) and in Venado Tuerto it was 550 ± 375 µg/L (median 418 µg/L; mean ± SD). Iodine contents in salt were similar across the province, with a mean of 35.5 mg/kg. Prevalence of salt samples with iodine concentration <15 mg/kg was 0.3 % in Reconquista, 1.3 % in Villa Ocampo, 3 % in Rufino, and 4 % in Venado Tuerto. We conclude that the province of Santa Fe, Argentina, is free from endemic goiter. No financial conflicts of interest exist.
    09/2013; 50(3).
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    ABSTRACT: Objective: To establish the frequency of U Tg (undetectable pre-ablation thyroglobulin) in TgAb-negative patients and to evaluate the outcome in the follow-up. Subjects and methods: We re-trospectively reviewed 335 patients' records. Twenty eight patients (9%) had U Tg. Mean follow--up was 42 ± 38 months. All subjects had undergone total thyroidectomy, and lymph nodes were positive in 13 (46%) patients. Tg and TgAb levels were measured 4 weeks after surgery by IMA technology in hypothyroid state. No evidence of disease (NED) status was defined as undetectable (< 1 ng/mL) stimulated Tg and negative Tg-Ab and/or negative WBS, together with normal imaging studies. Results: Seventeen patients (61%) were considered with NED. Four pa-tients (14%) had persistent disease (mediastinum, n = 1, lung n = 2, unknown n = 1), and 7 (25%) had detectable TgAb by other method during their follow-up. Conclusions: U Tg levels usually is associated to a complete surgery. However, in a low percentage of patients, this may be related to false negative Tg or TgAb measurement. Arq Bras Endocrinol Metab. 2013;57(4):300-6
    Arquivos Brasileiros de Endocrinologia & Metabologia 06/2013; 57(4):300-306. DOI:10.1590/S0004-27302013000400004 · 0.68 Impact Factor
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    ABSTRACT: To establish the frequency of U Tg (undetectable pre-ablation thyroglobulin) in TgAb- negative patients and to evaluate the outcome in the follow-up. We retrospectively reviewed 335 patients' records. Twenty eight patients (9%) had U Tg. Mean follow-up was 42 ± 38 months. All subjects had undergone total thyroidectomy, and lymph nodes were positive in 13 (46%) patients. Tg and TgAb levels were measured 4 weeks after surgery by IMA technology in hypothyroid state. No evidence of disease (NED) status was defined as undetectable (< 1 ng/mL) stimulated Tg and negative Tg-Ab and/or negative WBS, together with normal imaging studies. Seventeen patients (61%) were considered with NED. Four patients (14%) had persistent disease (mediastinum, n = 1, lung n = 2, unknown n = 1), and 7 (25%) had detectable TgAb by other method during their follow-up. U Tg levels usually is associated to a complete surgery. However, in a low percentage of patients, this may be related to false negative Tg or TgAb measurement.
    Arquivos brasileiros de endocrinologia e metabologia 06/2013; 57(4):292-306. · 0.68 Impact Factor
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    ABSTRACT: To supplement limited relevant literature, we retrospectively compared ablation and disease outcomes in high-risk differentiated thyroid carcinoma (DTC) patients undergoing radioiodine thyroid remnant ablation aided by recombinant human thyrotropin (rhTSH) versus thyroid hormone withdrawal/withholding (THW). Our cohort was 45 consecutive antithyroglobulin antibody- (TgAb-) negative, T3-T4/N0-N1-Nx/M0 adults ablated with high activities at three referral centers. Ablation success comprised negative (<1 μg/L) stimulated serum thyroglobulin (Tg) and TgAb, with absent or <0.1% scintigraphic thyroid bed uptake. "No evidence of disease" (NED) comprised negative unstimulated/stimulated Tg and no suspicious neck ultrasonography or pathological imaging or biopsy. "Persistent disease" was failure to achieve NED, "recurrence," loss of NED status. rhTSH patients (n = 18) were oftener ≥45 years old and higher stage (P = 0.01), but otherwise not different than THW patients (n = 27) at baseline. rhTSH patients were significantly oftener successfully ablated compared to THW patients (83% versus 67%, P < 0.02). After respective 3.3 yr and 4.5 yr mean follow-ups (P = 0.02), NED was achieved oftener (72% versus 59%) and persistent disease was less frequent in rhTSH patients (22% versus 33%) (both comparisons P = 0.03). rhTSH stimulation is associated with at least as good outcomes as is THW in ablation of high-risk DTC patients.
    Thyroid Research 01/2012; 2012:481568. DOI:10.1155/2012/481568
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    Pitoia Fabian, Hugo Niepomniszcze
    Edited by Online, 11/2011; Online.
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    Fabian Pitoia, Graciela Barria, Hugo Niepomniszcze
    Edited by H Niepomniszcze, 10/2011; online.
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    ABSTRACT: Introduction: the presence of palpable thyroid nodules in the general population is one of the most common clinical signs of thyroid disease in daily practice. Objectives: 1) To assess the prevalence of pathologies, clinical and cytological findings of single palpable thyroid nodules (SPTN) in Argentina. 2) Analyze the regional differences in Argentina. Methods: Prospective study of 739 patients with STPN were evaluated at centres in Buenos Aires, Bahía Blanca, Mendoza, and La Pampa between 1/1/00 and 12/31/01. Clinical examination, thyroid ultrasound scan (US), TSH, TPOAb and fine needle aspirations (FNA) were performed. Statistics: Pearson Correlation, X2 & Fisher Tests. Results: Age (X ± SD) 46 ± 14ys: 93.1 % were women. Previous history of neck radiation & familial thyroid disease were found in 1.6 and 29.9 % respectively. Clinical findings: dysphagia: 7.9 %; dysphonia: 3.5%; nodule growth: 19.2 %; hard consistence: 24.7 %; fixation to adjacent structure: 1.5 % and lymphadenopathies (ADP): 3 %. Biochemical findings: TSH was normal in 81.2 % & TPOAb+ in 30.3 %. US features: solid: 53.1 %; hypoechoic: 63.8 %; microcalcifications: 10.3 %; incomplete halo: 15 %; more than 1 nodule: 30.5 %; thyroid heterogeneity: 60.2 % and ADP: 3.8 %. Cytology: Only 1 FNA was needed in 86.8%. Unsatisfactory (excluding cysts): 3.2 %; benign: 77.2%; suspicious: 12.6 % and cancer: 7 % (42 papillary, 2 medullary and 3 non specified). A significant correlation (p<0.02) was established between malignant nodules and rapid growth, hard, fixed, solid nodule, incomplete halo and ADP, though these parameters were more frequent (in absolute number) in benign nodules. Surgery was mainly indicated based on FNA results. Histological diagnosis of 96 patients who underwent surgery showed 51 carcinomas, of which only 2 were cytologically benign and 31 adenomas. Conclusion: Palpable single nodules were more frequent in middle aged euthyroid women. One third had familial thyroid pathology, similar to the presence of TPOAb. On US, nodules were predominantly solid, hypoechoic, single with heterogeneous thyroid gland. FNA was predominantly benign. Rapid growth, hard, fixed, solid nodule, incomplete halo and ADP were associated with malignancy, but benignity was more common. In most of the patients surgery was recommended based on cytological findings. Our results are similar to those reported in other geographic areas.
    09/2011; 48(3):149-157.
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    ABSTRACT: Although overt thyrotoxicosis is associated with reduced insulin sensitivity (IS), the effects of subclinical thyrotoxicosis (SCTox) (i.e., suppressed serum thyroid-stimulating hormone with free thyroxine and tri-iodothyronine within the reference range) on glucose metabolism are not clear. SCTox may be of endogenous origin or due to ingestion of supraphysiological amounts of thyroid hormone. Our hypotheses were that reduced IS is present in SCTox and that the degree of reduction differs between SCTox of endogenous and exogenous origin. The study population consisted of 125 premenopausal, normal-weight women, divided into four groups: exogenous SCTox due to L-T4 treatment for benign goiter or hypothyroidism (SCTox-ExogG) (n = 53), endogenous SCTox (SCTox-Endog) (n = 12), exogenous SCTox due to L-T4 treatment for differentiated thyroid cancer (SCTox-ExogDTC) (n = 20), and finally euthyroid women (C) (n = 40) as a control group. After a mixed meal challenge, glucose and insulin were determined at baseline and 120 minutes later. IS was assessed by homeostasis model assessment of insulin resistance (HOMA-IR) index, quantitative IS check index (QUICKI), and 2 hours IS Avignon's index amended by Aloulou for mixed food. Secretion by pancreatic B-cells was calculated by HOMA-B index. Comparison among groups was done by analysis of variance followed by Tukey test. Linear regression analysis of T3 versus HOMA-IR was calculated. IS was reduced in all types of SCTox when compared with C. All SCTox groups had significantly higher levels of insulin (baseline and postmeal) and HOMA-IR and lower values of QUICKI and Aloulou when compared with controls. SCTox-Endog, however, had higher baseline insulin levels and HOMA-IR and a lower QUICKI index than the rest of the SCTox groups. Although within the normal range, total T4, free T4, and T3 levels were also significantly higher in the SCTox groups than in euthyroids. In SCTox-Endog, T3/T4 ratio was increased above the rest of SCTox groups. A moderate linear relationship between T3 and HOMA-IR was found in the whole population. IR is associated with SCTox of either endogenous or exogenous origin. However, based on our findings of lower IS compared with the rest of the SCTox groups, the endogenous subclinical form might have an even larger metabolic impact.
    Thyroid: official journal of the American Thyroid Association 08/2011; 21(9):945-9. DOI:10.1089/thy.2010.0402 · 2.60 Impact Factor
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    Fabian Pitoia, Hugo Niepomniszcze
    Edited by Hugo Niempomniszcze, 08/2011; online.
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    ABSTRACT: The purpose of this study was to determine whether familial non-medullary thyroid cancer (FNMTC) is more aggressive than sporadic thyroid cancer. We compared the clinical behavior and outcome of 16 subjects with FNMTC from 7 unrelated kindred with those observed in 160 subjects with sporadic PTC (SPTC) from our database. The only different baseline characteristics observed between both groups were: bilateral malignancy, 38% vs. 24%, respectively (p = 0.03), and lymph node metastasis, 56.2% vs. 39%, respectively (p = 0.01). Considering the outcome, in the FNMTC, 9 (56.2%) patients were rendered free of disease, one patient died from thyroid cancer (6%), and 6/16 (37.5%) had persistent disease. In the SPTC Group, 87 (54%) patients were considered free of disease, 11 (7%) died due to PTC, and 62 (38%) had persistent disease (p = ns). Despite the higher incidence of lymph node metastasis in FNMTC patients this situation seemed not to alter the compared outcome.
    Arquivos brasileiros de endocrinologia e metabologia 04/2011; 55(3):219-23. DOI:10.1590/S0004-27302011000300007 · 0.68 Impact Factor
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    ABSTRACT: It has been shown that patients with insulin resistance (IR) have a higher prevalence of thyroid nodules and bigger thyroid glands. We evaluated the ability of metformin (M) alone or combined with levothyroxine (L-T₄) to reduce the nodular size in benign thyroid hyperplastic nodules (<2 cm in diameter). A total of 66 women with IR and nodular hyperplasia, diagnosed by fine needle aspiration biopsy (FNAB), who completed this prospective 6-month duration protocol, were assigned to one of four groups: Group I (GI) (n = 14), patients treated with M; GII (n = 18), patients treated with M plus L-T₄; GIII (n = 19), patients treated with L-T₄; and GIV (n = 15), patients without any treatment. All groups of included patients had no statistically significant different mean baseline characteristics. Patients from GII and GIII showed drops in thyroid-stimulating hormone (TSH) levels and GI and GII normalized the homeostasis model assessment (HOMA) index after treatment, as expected. The median baseline size of all included nodules was 298 mm³ ≈0.84 cm in diameter (range, 32-3,616 mm³). After treatment, patients of Group I and II showed significant reductions in their nodule size [median reduction, 108.50 mm³ (30%) and 184.5 mm³ (55%), P < 0.008 and P < 0.0001, respectively]. Patients in GIII and GIV did not have a significant reduction of their nodules [P = not significant (N.S.)]. We conclude that M produced a significant decrease in the nodular size in patients with IR and small thyroid nodules, whereas the combination of M with L-T₄ was the best treatment in these women.
    Metabolic Syndrome and Related Disorders 02/2011; 9(1):69-75. DOI:10.1089/met.2010.0026 · 1.92 Impact Factor
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    Hugo Niepomniszcze, Fabian Pitoia
    Thyroid 02/2011; 21(2):207; author reply 208. DOI:10.1089/thy.2010.0241 · 3.84 Impact Factor
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    ABSTRACT: Introduction: the presence of palpable thyroid nodules in the general population is one of the most common clinical signs of thyroid disease in daily practice. Objectives: 1) To assess the prevalence of pathologies, clinical and cytological findings of single palpable thyroid nodules (SPTN) in Argentina. 2) Analyze the regional differences in Argentina. Methods: Prospective study of 739 patients with STPN were evaluated at centres in Buenos Aires, Bahía Blanca, Mendoza, and La Pampa between 1/1/00 and 12/31/01. Clinical examination, thyroid ultrasound scan (US), TSH, TPOAb and fine needle aspirations (FNA) were performed. Statistics: Pearson Correlation, X2 & Fisher Tests. Results: Age (X ± SD) 46 ± 14ys: 93.1 % were women. Previous history of neck radiation & familial thyroid disease were found in 1.6 and 29.9 % respectively. Clinical findings: dysphagia: 7.9 %; dysphonia: 3.5%; nodule growth: 19.2 %; hard consistence: 24.7 %; fixation to adjacent structure: 1.5 % and lymphadenopathies (ADP): 3 %. Biochemical findings: TSH was normal in 81.2 % & TPOAb+ in 30.3 %. US features: solid: 53.1 %; hypoechoic: 63.8 %; microcalcifications: 10.3 %; incomplete halo: 15 %; more than 1 nodule: 30.5 %; thyroid heterogeneity: 60.2 % and ADP: 3.8 %. Cytology: Only 1 FNA was needed in 86.8%. Unsatisfactory (excluding cysts): 3.2 %; benign: 77.2%; suspicious: 12.6 % and cancer: 7 % (42 papillary, 2 medullary and 3 non specified). A significant correlation (p<0.02) was established between malignant nodules and rapid growth, hard, fixed, solid nodule, incomplete halo and ADP, though these parameters were more frequent (in absolute number) in benign nodules. Surgery was mainly indicated based on FNA results. Histological diagnosis of 96 patients who underwent surgery showed 51 carcinomas, of which only 2 were cytologically benign and 31 adenomas. Conclusion: Palpable single nodules were more frequent in middle aged euthyroid women. One third had familial thyroid pathology, similar to the presence of TPOAb. On US, nodules were predominantly solid, hypoechoic, single with heterogeneous thyroid gland. FNA was predominantly benign. Rapid growth, hard, fixed, solid nodule, incomplete halo and ADP were associated with malignancy, but benignity was more common. In most of the patients surgery was recommended based on cytological findings. Our results are similar to those reported in other geographic areas
    Revista Argentina de Endocrinologia y Metabolismo 01/2011; 48(3):149.
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    ABSTRACT: Differentiated thyroid carcinoma (DTC) in thyroglosal duct cyst (TGDC) is rare, ranging from 0.7 to 1.07% in different series. After the surgery of choice (Sistrunk procedure) the other alternative treatments such as thyroidectomy (Tx), radioiodine and L-T4 therapy are controversial. OBJECTIVE: to evaluate several and controversial aspects in the largest series of DTC in TGDC reported in the literature.Subjects and methods: retrospective multicentric study: n= 22, aged 10-69 yrs. (15 females and 7 men) who underwent the Sistrunk procedure for TGDC.Results: none of the TGDC was less than 1 cm (median 3.0 cm, Χ±SD= 3.7 ± 2.2cm). In half of them there was an increased cystic size in the last 6 months before surgery. Cyst FNA was suspicious in 2/5 and positive in one, whereas the histological diagnosis of the operated TGCD was papillary cancer in 21 and 1 follicular carcinoma. Thyroid ultrasound (US) (n=13) showed nodules in 30% of the cases. Tx was performed in 17/22 (total: 15, subtotal: 2). Thyroid DTC coexisted in 4/17 (23.5%), and was unilateral in all of them. Lymph node metastases were present in 2 adults and muscle involvement was found in the 10-year old girl. None of these 3 patients had overt thyroid lesions. 131-I therapy was performed in 10 patients. In 9 out of 11 subjects Tg remained undetectable during follow-up (1-14yrs.). Persistent high Tg was present in one case without thyroid DTC.Conclusions: 1) Ultrasonography and FNAB should be performed to every patient with thyroglossal duct cyst 2) In case of TGDC, total Tx and Sistrunk's procedure should be simultaneously combined 3) 131-I therapy and L-T4 suppressive treatment should be evaluated in every case 4) Follow-up as in the DTC.
    09/2010; 47(3):18-24.
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    ABSTRACT: Un total de 712 alumnos de escolaridad primaria, de ambos sexos, fue estudiado en este monitoreo de bocio endémico en dos localidades de la provincia de La Rioja: Ciudad de La Rioja (442 niños) y Chilecito (270 niños). La edad de los escolares osciló entre 5 y 16 años. La palpación tiroidea fue hecha por el conjunto de los médicos participantes. Sin embargo, con la finalidad de aunar criterios con lo realizado previamente (1-24), se tomó como única referencia la palpación de H.N., que se llevó a cabo en la totalidad de los niños estudiados. La definición del grado de bocio fue similar a la utilizada en los otros relevamientos (1). Se determinó la yoduria en muestras casuales de orina emitidas por los niños una vez que fueron palpados (125 de La Rioja y 128 de Chilecito). Se recolectaron 251 muestras de sal de consumo hogareño de La Rioja y 141 de Chilecito, para medir su contenido en yodo. El examen palpatorio de los niños reveló la existencia de bocio grado 1 solamente. La prevalencia de bocio encontrada fue de 1,8% en La Rioja y de 2,6% en Chilecito. Los niveles de yoduria alcanzaron, en La Rioja, una media de 226 ± 181 (DS) μg/L y una mediana de 186μg/L, al tiempo que en Chilecito la media fue de 217 ± 161μg/L y la mediana de 185μg/L. El contenido de yodo de las sales, que aportaron los alumnos desde sus hogares, fue adecuado para casi todas las marcas. De esta manera, observamos que en la ciudad de La Rioja el promedio de yodo en la sal, tomada en conjunto, fue de 33,1 ± 12,5 mg/Kg, mientras que para Chilecito fue de 28,1 ± 8,2 mg/Kg. Al analizar las concentraciones de yodo <15mg/Kg, observamos que fue del 10,7% en La Rioja y del 9,5% en Chilecito. Teniendo en cuenta la línea de corte del 10% que fija el ICCIDD (25) como valor óptimo, podemos observar que la situación fue prácticamente satisfactoria en ambas poblaciones. Concluímos que en estas dos poblaciones de la provincia de La Rioja no existe, actualmente, bocio endémico por deficiencia de yodo. Estos resultados indican que la profilaxis con sal yodada fue óptima en esta provincia, dado que en el pasado solía ser una típica zona yodo-deficiente con un muy alto porcentaje de bocio endémico.
    04/2010; 47(1):53-57.
  • Medicina 04/2010; 70(2):139-142. · 0.42 Impact Factor
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    ABSTRACT: In the familial form of papillary thyroid cancer (PTC), two or more members of the same family have to be affected with PTC. Prevalence is around 5% of all PTC. We performed a clinical analysis in 79 relatives of 16 patients of 7 unrelated kindred with the diagnosis of familial papillary thyroid carcinoma (FPTC). The results were compared with a control group. Thyroid palpation and TSH and TPO-Ab assessment was carried out in the relatives without a diagnosed PTC. Additionally, molecular analysis was performed in the sixteen affected patients. Clinical screening of the 79 family members showed the presence of goiter in 22/79 (29 %). This frequency was much higher than that observed in the control group (8.7%), p < 0.001. Hypothyroidism was found in 4 of the relatives (5%) vs. 2.5% observed in the control group, p < 0.01, and anti-thyroid antibodies (TPO-Ab) were positive in 14% of the relative's group vs. 10 % in the control group, (p = NS). In the molecular analysis, only a protooncogene TRK rearrangement was observed in family # 6. In conclusion, we found a higher incidence of goiter and hypothyroidism in the relatives of patients with FPTC. Nevertheless, TPO-Ab frequency was not different. No molecular abnormalities were indicative of a specific pattern in this subset of patients with FPTC.
    Medicina 01/2010; 70(2):139-42. · 0.42 Impact Factor
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    ABSTRACT: Objective: Following radioiodine (RI) therapy for multinodular goiter (MNG), 4% to 5% of patients are reported to develop Graves' hyperthyroidism. To show a new protocol for the administration of RI in MNG and to illustrate an infrequent adverse event observed after the RI dose. Methods: A 70-year-old euthyroid woman with a tracheal compression and displacement. Baseline serum thyroid-stimulating hormone (TSH) was 1.1 mUI/mL, and RI uptake was 10% at 24 hours. The patient refused surgical treatment. We decided to employ a special protocol for increasing the thyroid uptake of 131I. Methyl mercaptoimidazol (MMI) was administered orally (30 mg/d) to increase TSH levels. Thyroid hormones were measured monthly. Three months after initiation of MMI treatment, TSH levels increased to 5.3 mUI/mL, and thyroid RI uptake increased to 57% at 24 hours with more uniform uptake. She received an RI dose of 30 mCI131I. Six weeks later, she was euthyroid. Six months later, a CT showed a decrease in the thyroid size, but she was overtly hyperthyroid (TSH <0.05 mUI/mL, T3 = 442 ng/dL, T4 = 4.8 μg/mL, and TSH receptor antibodies, TRAb >55% [NV <10%]). Conclusion: We present this case to describe an infrequent adverse complication of RI administration in patients with MNG. We also illustrate an alternative protocol for the administration of RI dose in such patients.
    The Endocrinologist 12/2009; 20(1):7-9. DOI:10.1097/TEN.0b013e3181c9fe34 · 0.12 Impact Factor
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    ABSTRACT: Several guidelines on diagnosis and treatment of thyroid nodules and cancer have recently been published. However, recommended practices are not always appropriate to different settings or countries. The aim of this consensus was to develop Clinical Guidelines for evaluation and management of patients with thyroid nodules applicable to Latin American countries. The panel was composed by 13 members of the Latin American Thyroid Society involved with research and management of thyroid nodules and cancer from different medical centers in Latin America. The consensus was produced based on the expert opinion of the panel with use of principles of evidence-based medicine. Following a group meeting, a first draft based on the expert opinion of the panel was elaborated and later circulated among panel members for further revision. After revision, this document was submitted to all LATS members for commentaries and considerations and finally revised and refined by the authors. The final recommendations represent state of the art on management of thyroid nodules applied to all Latin American countries.
    Arquivos Brasileiros de Endocrinologia & Metabologia 12/2009; 53(9):1167-75. DOI:10.1590/S0004-27302009000900014 · 0.68 Impact Factor

Publication Stats

359 Citations
76.78 Total Impact Points

Institutions

  • 2001–2013
    • University of Buenos Aires
      • • Clinical Hospital (UDH)
      • • Faculty of Medicine
      • • Endocrinology Laboratory
      Buenos Aires, Buenos Aires F.D., Argentina
  • 2011
    • Sociedad Argentina de Endocrinología y Metabolismo
      Buenos Aires, Buenos Aires F.D., Argentina
  • 2010
    • THE UNIVERSITY OF BAMENDA
      Bamenda, North-West Province, Cameroon
  • 2008
    • Facultad de Medicina
      Madrid, Madrid, Spain