Endocrinology Service

Belo Horizonte, Brazil

Endocrinology Service

Belo Horizonte, Brazil
SEARCH FILTERS
Time filter
Source Type

Rosario P.W.,Postgraduation Program | Xavier A.C.M.,Postgraduation Program | Calsolari M.R.,Endocrinology Service
Thyroid | Year: 2010

Background: Most patients with well-differentiated thyroid cancer (WDTC) are first treated by total thyroidectomy followed by remnant ablation (RA) with 131I. There are less data regarding the efficacy of recombinant human thyrotropin (rhTSH) for patients with WDTC at high risk of relapse than for low-risk patients. This study compared the efficacies of rhTSH and thyroid hormone withdrawal (THW) to prepare patients at high risk of relapse for RA. Methods: Post-thyroidectomy patients with WDTC and complete tumor resection (n=275) were studied. They were at high risk of recurrence (tumor size >4cm and/or extrathyroidal extension [pT3] and/or lymph node metastases), and they did not have antithyroglobulin (Tg) antibodies. Group A (n=77) received 0.9mg rhTSH for 2 consecutive days followed by RA on day 3. The remaining 198 patients (group B) were prepared by THW for 4 weeks. Patients in groups A and B received 3.7 or 5.5GBq 131I. Results: The groups were similar in terms of gender, age, histology, TNM (tumor-node-metastases) stage, 131I activity, and frequency of metastases on post-therapy whole-body scanning (RxWBS). Among patients without metastases on RxWBS, RA was successful (stimulated Tg <1ng/mL and negative diagnostic whole body scan and neck ultrasonography) in 56 of 70 patients in group A (80%) and in 135 of 169 patients in group B (79.9%). Among patients with Tg >1ng/mL immediately before RA, the comparable success rates were 68.4% and 67.4%, respectively. Among patients with metastases on the first RxWBS, no uptake was observed on the RxWBS 1 year later in 5 of 7 patients in group A (71.4%) and in 17 of 29 patients in group B (58.6%). The rhTSH stimulated serum Tg was <1ng/mL in 3 of 5 and in 12 of 17 patients with a second negative RxWBS in groups A and B, respectively. Persistent disease (stimulated Tg >1ng/mL and RxWBS continuing to show ectopic uptake) occurred in 2 of 7 patients in group A (28.5%) and in 12 of 29 patients in group B (41.3%). Conclusions: rhTSH is as effective as THW for RA in patients with WDTC who are at a high risk of relapse. © Copyright 2010, Mary Ann Liebert, Inc.


Rosario P.W.,Postgraduation Program | Xavier A.C.M.,Postgraduation Program | Calsolari M.R.,Endocrinology Service
Thyroid | Year: 2011

Background: This study investigated the value of postoperative stimulated thyroglobulin (Tg) combined with neck ultrasonography for the prediction of the posttherapy whole-body scanning (RxWBS) and the efficacy of ablation with 30 mCi 131I in patients with thyroid cancer and low risk of recurrence to identify those who do not require ablation or only need a low 131I activity. Methods: A total of 237 consecutive patients with well-differentiated thyroid cancer and low risk of recurrence who were initially treated by total thyroidectomy followed by remnant ablation with 1.1 or 3.7 GBq (30 or 100 mCi) 131I were studied. Neck ultrasonography, Tg after levothyroxine withdrawal, and anti-Tg antibodies (TgAb) were obtained before, and RxWBS was performed 7 days after 131I administration. Patients with TgAb were excluded. Results: Postoperative ultrasonography revealed lymph node metastases in 5/237 (2%) patients. RxWBS showed ectopic uptake in 3/232 (1.3%) patients with negative ultrasonography. The negative predictive value of postoperative stimulated Tg <1 ng/mL (n = 132) or <10 ng/mL (n = 213) combined with negative ultrasonography was 100%. Among patients with detectable postoperative stimulated Tg <10 ng/mL and negative ultrasonography, 50 received 1.1 GBq 131I and 31 received 3.7 GBq. In the control assessment, stimulated Tg <1 ng/mL and neck ultrasonography without anomalies were achieved in 47/50 (94%) and in 29/31 patients (93.5%). All patients with stimulated Tg ≤1 ng/mL, negative TgAb, and normal ultrasonography before ablation continued to show the same results 8-12 months after initial therapy as expected, irrespective of the administration of 1.1 GBq (n = 82) or 3.7 GBq 131I (n = 50). Conclusions: Measurement of stimulated Tg combined with neck ultrasonography after total thyroidectomy may exclude the need for ablation in 56% of low-risk patients without TgAb (Tg <1 ng/mL) and permit the administration of an activity of 1.1 GBq 131I in another 34% with low Tg levels. © Copyright 2011, Mary Ann Liebert, Inc. 2011.


Rosario P.W.,Santa Casa de Belo Horizonte | Calsolari M.R.,Endocrinology Service
Arquivos Brasileiros de Endocrinologia e Metabologia | Year: 2014

Objective: To establish serum TSH reference values for a population of Brazilian elderly, and to compare them to those found in the adult population. Subjects and methods: Healthy volunteers aged 70 to 85 years, without known thyroid disease or risk factors for thyroid dysfunction, who did not use any medication that could potentially interfere with TSH, were selected. Subjects with goiter, palpable thyroid nodules, anti-thyroperoxidase antibodies, or altered free T4 were excluded. The sample consisted of 360 older adults (180 per sex). Results: TSH values corresponding to the 2.5th and 97.5th percentile of the sample were 0.2 and 4.62 mIU/L, respectively. TSH > 2.5 mIU/L was seen in 25.26% of the volunteers, > 3 mIU/L in 15.26%, and > 4 mIU/L in 6.1% of them. TSH values were slightly higher than those previously reported for adults (18- 60 years). Conclusion: This study suggests an upper limit for normal TSH of approximately 4.6 mIU/L for the Brazilian elderly population. © ABE&M todos os direitos reservados.


Farias J.M.,Endocrinology Service | Tinetti M.,Cardiologic Image | Khoury M.,Research and Statistics Service | Umpierrez G.E.,Emory University
Journal of Clinical Endocrinology and Metabolism | Year: 2014

Background: Low total T is associated with an increased risk of atherosclerotic complications. However, the magnitude of this association in middle-aged patients with type 2 diabetes (T2D) has not been determined. Materials and Methods: This cross-sectional study evaluated atherosclerotic disease markers in T2D patients with normal and low plasma total T. A total of 115 male patients, aged younger than 70 years, without a history of cardiovascular events, and with normal [≥3.5 ng/mL (≥12.1 nmol/L), n = 79] or low [<3.5 ng/mL (≤12.1 nmol/L), n = 36] total T underwent the measurement of highly sensitive C-reactive protein, carotid artery carotid intima-media thickness (IMT), and atherosclerotic plaque by high-resolution B-mode ultrasound and to asses endothelial function by brachial artery flow-mediated dilation. Results: Carotid IMT was negatively correlated with total T concentration (r = -0.39, P < .0001). Compared with subjects with normal T, a higher proportion of patients with low total T had carotid IMT of 0.1 cm or greater [80% vs 39%, odds ratio (OR) 6.41; 95% CI 2.5-16.4, P < .0001], atherosclerotic plaques (68.5% vs 44.8%, OR 2.60, 95% CI 1.12-6.03, P < .0001); endothelial dysfunction (80.5% vs 42.3%, OR 5.77, 95% CI 2.77-14.77, P < .003), and higher highly sensitive C-reactive protein levels (2.74 ± 5.82 vs 0.89 ± 0.88 mg/L, P < .0001). Similar results were found when free T was considered. Multiple logistic regression analyses adjusted for age, diabetes mellitus duration, hemoglobin A1c, lipids, treatment effect, and body mass index reported that a low total T level was independently associated with greater IMT [OR 8.43 (95% CI 2.5-25.8)] and endothelial dysfunction [OR 5.21 (95% CI 1.73-15.66)] but not with the presence of atherosclerotic plaques (OR 1.77, 95% CI 0.66-4.74). Conclusions: Low T is associated with more advanced atherosclerotic disease markers in middle-aged patients with T2D. Copyright © 2014 by the Endocrine Society.


Sabra M.M.,Endocrinology Service | Sabra M.M.,Sloan Kettering Cancer Center | Dominguez J.M.,Endocrinology Service | Grewal R.K.,Molecular Imaging and Therapy Service | And 4 more authors.
Journal of Clinical Endocrinology and Metabolism | Year: 2013

Background: Radioiodine (RAI) remains the mainstay of therapy for RAI-avid (RAIA) distant metastatic thyroid carcinoma. We previously demonstrated that RAI-refractory distant metastatic thyroid cancers commonly harbor BRAF mutations. However, the molecular profile of RAIA metastatic thyroid cancer is unknown. Here we describe the mutational profile of thyroid tumors from follicular cell-derived cancer (FCDTC) patients presenting with RAIA distant metastases. In addition, we aimed to correlate clinical outcomes of RAI therapy with clinicopathological factors and tumor mutational status. Methods: We retrospectively identified 43 patients with FCDTC who had RAI uptake in the lungs and/or bones on their initial 131I postablation scan. Primary tumors were genotyped for known mutations in thyroid cancer genes. Structural response to RAI was assessed 6-18 months after each administered RAI activity and at the end of follow-up. Results: RAS, BRAF, RET/PTC, and PIK3CA mutations were found in 42, 23, 10, and 2% of tumors, respectively, and the remaining 23% were wild type. None of these patients achieved cure after repeat RAI therapies, and most patients (54%) experienced disease progression despite repeated RAI administration. There was an increased prevalence of RAS mutations in these RAIA tumors. RAS-mutant cancers were more likely to concentrate iodine on diagnostic whole body scans. Despite this, structural response to RAI was not influenced by tumor genotype. Conclusions: RAIA metastatic FCDTC are overrepresented with RAS mutations, whereas RAI refractory metastatic thyroid cancers are enriched with BRAF mutations. Despite a seemingly preserved ability to concentrate iodine, RAI therapy is ineffective in achieving cure in most patients with RAIA metastatic FCDTC, even in RAS-mutant disease. These poor outcomes may be improved based on recent evidence that pretreatment with MAPK kinase 1/2 inhibitors enhances responses to RAI, particularly in patients with RAS-mutant tumors. Copyright © 2013 by The Endocrine Society.


Rosario P.W.,Institute of Education and Research | Calsolari M.R.,Endocrinology Service
Thyroid | Year: 2013

Background: Serum calcitonin (sCt) is measured in many patients with nodular thyroid disease, and the possibility of a false-positive result is a matter of concern, particularly in the case of mild hypercalcitoninemia. Among the conditions reported to cause sCt elevation, Hashimoto's thyroiditis (HT) and papillary thyroid carcinoma (PTC) are relevant. In view of the high frequency of these conditions in patients with nodular disease and the controversy regarding the extent to which they contribute to hypercalcitoninemia, the objective of this study was to determine the influence of the presence of HT and PTC on sCt levels. Methods: Three groups of patients >12 years of age were studied. The first group (group A, n=492) consisted of patients with nodular disease evaluated before thyroidectomy and without medullary thyroid carcinoma (MTC) upon histology. The second group (group B, n=583) consisted of subjects without nodules on ultrasound. The third group (group C, n=62) consisted of patients with PTC and distant metastases after total thyroidectomy. The levels of sCt and frequency of elevated sCt were compared in patients with versus without HT (groups A and B) and those with PTC>1 cm versus without PTC (group A). Results: No difference in sCt levels or in the frequency of elevated sCt was observed between patients with and without HT, irrespective of sex. Moreover, the presence of PTC>1 cm did not influence sCt levels or the frequency of hypercalcitoninemia. In fact, none of the 1075 patients in groups A and B had sCt>40 pg/mL, regardless of the presence of HT and PTC. Serum calcitonin was undetectable in any patient of group C. Conclusions: The finding of hypercalcitoninemia in patients with nodular disease should be interpreted as a suspicion of MTC, even in the presence of associated HT or cytology suggestive of PTC. © Copyright 2013, Mary Ann Liebert, Inc. 2013.


Rosario P.W.,Postgraduate Program | Calsolari M.R.,Endocrinology Service
Thyroid | Year: 2013

Background: By consensus, a thyrotropin (TSH) level persistently >10 mIU/L is an indication for the treatment of subclinical hypothyroidism (SCH). Controversy exists regarding patients whose TSH level is elevated but <10 mIU/L. Recently, the American Thyroid Association (ATA) and the American Association of Clinical Endocrinologists (AACE) published their position about factors that should be considered in the decision on treating SCH. This study evaluated the frequency of these factors among adult (non-pregnant) women with SCH whose TSH levels are ≤10 mIU/L. Methods: The presence of the conditions that should be considered for the treatment of SCH according to ATA and AACE was evaluated in 252 women who were diagnosed with SCH and had TSH levels ≤10 mIU/L. Pregnant women were excluded. Results: Antithyroperoxidase antibodies (TPOAbs) were detected in 137 (54.3%) women. A high cardiovascular risk was observed in 43 (17%) women. Eighty (31.7%) women who were not at high cardiovascular risk presented at least one classical risk factor (arterial hypertension, elevated level of low-density lipoprotein-cholesterol or low level of high-density lipoprotein-cholesterol, smoking, or first-degree family history of premature coronary artery disease). At least one symptom or sign of hypothyroidism that could not be explained by another condition was observed in 180 (71.4%) women. Two hundred thirty-two (92%) women had positive TPOAbs, or at least one classical cardiovascular risk factor, or at least one symptom or sign of hypothyroidism. Conclusions: According to the new ATA and AACE guidelines, L-T4 therapy would be considered for 92% of women with SCH and TSH ≤10 mIU/L. © 2013, Mary Ann Liebert, Inc.


Background: One of the adverse effects of radioactive iodine ( 131I) treatment in patients with thyroid cancer is damage to the salivary and lacrimal glands. In almost all studies evaluating salivary and lacrimal gland dysfunction, the patients received 131I after levothyroxine (L-T4) withdrawal. Since the biokinetics of 131I after recombinant human thyrotropin (rhTSH) is not the same as in hypothyroidism, studies need to evaluate 131I-induced salivary and lacrimal toxicity after preparation with rhTSH. This prospective study investigated the occurrence of salivary and lacrimal damage after ablation with 131I using this preparation. Methods: One hundred forty-eight patients who had a total thyroidectomy were included in the study. The subjects were evaluated after thyroidectomy during L-T4 use to exclude those who already showed symptoms or had a history of ocular or oral disease. Symptoms were investigated 12 and 18 months after ablation. In patients who had persistent symptoms, specific tests were performed to confirm glandular dysfunction and to rule out other causes. Results: Twelve months after ablation, symptoms of salivary or lacrimal dysfunction were observed in 10 (6.7%) patients, including oral symptoms in 8 (5.4%) and ocular symptoms in 6 (4%). Eighteen months after 131I, symptoms persisted in eight (5.4%) patients, including oral symptoms in seven (4.7%) and ocular symptoms in five (3.4%). In all of the patients, glandular dysfunction was confirmed by specific tests and other causes were ruled out. No symptoms were seen in the patients who received a low 131I dose (30 mCi). In the patients who received high 131I doses (100 or 150 mCi), symptoms were noted 12 months after 131I in 10 patients (9.2%), and 18 months after 131I in 8 patients (7.4%). Conclusions: Apparently, the rates of salivary and lacrimal damage were lower than those reported in prospective studies that used similar 131I activities, but these studies were performed in patients who were hypothyroid at the time of 131I ablation. Further studies are needed to compare radiotoxicity between patients prepared for 131I ablation with rhTSH and those prepared for 131I ablation with L-T4 withdrawal. © 2013, Mary Ann Liebert, Inc.


Rosario P.W.,Postgraduate Program | Calsolari M.R.,Endocrinology Service
Thyroid | Year: 2014

Background: Little is known about the medium- and long-term outcomes of thyroid ablation with 1.1GBq (30mCi) 131I in patients with papillary thyroid carcinoma who have a tumor >4cm or accompanied by extrathyroid invasion or clinically detected lymph node metastases (cN1). The objective of this study was to evaluate the efficacy of ablation with 30mCi 131I in this subgroup of patients and to report the medium-term outcomes. Methods: We studied 152 patients with papillary thyroid carcinoma submitted to total thyroidectomy with apparently complete tumor resection, who had a tumor >4cm or 2-4cm accompanied by extrathyroid invasion or lymph node metastases, or ≤2cm accompanied by both extrathyroid invasion and lymph node metastases. Patients with extensive extrathyroid invasion by the primary tumor were excluded. Lymph node involvement was detected by ultrasonography or palpation (cN1). Results: Forty-two patients were prepared by administration of recombinant human thyrotropin and 110 by levothyroxine withdrawal. Posttherapy whole-body scanning revealed unequivocal ectopic uptake in three patients. When evaluated 9-12 months after ablation, 123 patients had achieved complete ablation (stimulated thyroglobulin [Tg] <1ng/mL, negative anti-Tg antibodies, and neck ultrasonography); a new posttherapy whole-body scanning revealed persistent disease in 2 patients whose initial posttherapy whole-body scanning (obtained at the time of ablation) had already shown ectopic uptake; 12 patients presented with a Tg >1ng/mL and 14 had positive anti-Tg antibodies without apparent metastases; 1 patient had metastases not detected at the time of ablation. Recurrence was observed in an additional 6 patients during follow-up (median 76 months). There was no case of death related to the disease. Therefore, an activity of 30mCi failed in only 9 (6%) patients with persistent disease or recurrence after ablation. None of the variables analyzed (sex, age, tumor size, multicentricity, extrathyroid invasion, lymph node metastases, preparation [recombinant human thyrotropin or levothyroxine withdrawal]) was a predictor of ablation failure. Conclusions: An activity of 30mCi 131I is effective in thyroid ablation in patients with stage T3 and/or N1papillary thyroid carcinoma. © Mary Ann Liebert, Inc.


Context One important aspect in the decision to treat or not elderly patients with subclinical hyperthyroidism (SCH) is the risk of progression to overt hyperthyroidism (OH). Objective To define the natural history of endogenous SCH in elderly patients with TSH between 0·1 and 0·4 mIU/l. Design Prospective study. One hundred and two women aged ≥60 years with persistently low TSH ranging from 0·1 to 0·4 mIU/l and normal free T4 and T3 were studied. Patients using L-T4 or antithyroid drugs, previously treated for hyperthyroidism, with pituitary disease, using corticosteroids, amiodarone, dopaminergic agonists, with atrial fibrillation or heart disease were excluded. Seven patients had Graves' disease, 91 had nodular disease and 4 presented no defined cause. The time of follow-up ranged from 12 to 70 months (median 41 months). Results Three patients progressed to OH (elevated T4 and/or T3) and four other patients to persistently low TSH (<0·1 mIU/l) in the presence of increase in serum T3 when compared with baseline. These patients were treated. Twenty-four women presented sustained normalization of TSH and none progressed to hypothyroidism. SCH with TSH in the 0·1-0·4 mIU/l range persisted in 71 patients, 4 of them (5·6%) being treated because of the development of atrial fibrillation or heart disease during follow-up. The only independent predictor of progression of SCH was an initial TSH value <0·2 mIU/l. Conclusions In elderly patients with endogenous SCH and TSH between 0·1 and 0·4 mIU/l progression to clinical hyperthyroidism is uncommon (approximately 1% per year), spontaneous TSH normalization may occur, and persistence of SCH for many years is the most likely. © 2010 Blackwell Publishing Ltd.

Loading Endocrinology Service collaborators
Loading Endocrinology Service collaborators