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Hospital de Órbigo, Spain

Diaz-Soto G.,Hospital Clinico Universitario Of Valladolid | Mora-Porta M.,Servei de Endocrinologia i Nutricio | Nicolau J.,Servei de Endocrinologia i Nutricio | Perea V.,Servei de Endocrinologia i Nutricio | And 2 more authors.
Hormone and Metabolic Research | Year: 2012

Vitamin D nonresponsive hypoparathyroidism is uncommonly seen in the clinical practice. The use of new treatment modalities, including teriparatide administration, provides an alternative requiring its validation. We report the first case of hypoparathyroidism refractory to vitamin D that was successfully controlled for 5 years by teriparatide treatment. A 53-year-old woman presented severe hypoparathyroidism after thyroidectomy. No therapeutic response was obtained with oral and i. v. calcium and magnesium, or even with 5 μg calcitriol/day. Digestive disorders were ruled out and heterologous parathyroid transplant was ineffective. Subcutaneous (s. c.) recombinant human PTH 1-34 (rhPTH-teriparatide) plus oral calcitriol, calcium, and magnesium, were partially effective, but effectiveness of 20 μg teriparatide lasted less than 4 h and stable calcemia was not possible even with 4-6 injections/day. Multipulse s. c. pump driven infusion of teriparatide achieved complete normalization of serum calcium, phosphate, magnesium, calciuria, and magnesuria with relatively low teriparatide doses (25-35 μg/day) after the first day of treatment. Effectiveness of this treatment modality was maintained for 5 years. The only significant side effect observed during these years was the development of subcutaneous nodules with occasional insufficient control of calcemia. A gain in bone mineral density was observed after the first year of treatment, which had remained stable and within normal values, thereafter until now. No abnormalities in bone scintigraphy were detected in the follow-up. Vitamin D unresponsive hypoparathyroidism maybe safely and effectively controlled at long term by s. c. multipulse pump treatment recombinant human PTH. © Georg Thieme Verlag KG Stuttgart - New York.

Diaz-Soto G.,Servei de Endocrinologia i Nutricio | Puig-Domingo M.,Servei de Endocrinologia i Nutricio | Martinez-Pino I.,Institute Salud Carlos III | Martinez-Pino I.,CIBER ISCIII | And 2 more authors.
Experimental and Clinical Endocrinology and Diabetes | Year: 2011

Objective: To evaluate the predictive value of disease free status of basal thyroglobulin (Tg) in differentiated thyroid carcinoma (DTC). Design: Basal and recombinant human TSH (rhTSH) stimulated Tg measured with a commercial immunoassay (Liaison DiaSorin, Italial), neck ultrasonography (US) and fine needle aspiration cytology if required were performed in DTC patients followed prospectively for 6.8 years in a university hospital. 92 consecutive DTC patients were included. 74 patients with basal and stimulated Tg <1.0ng/ml and Tg antibodies and US negative were considered as disease-free and persistent/recurrent disease was detected in 18 patients. In 25/74 disease-free patients rhTSH test was repeated within one year. Results: 63/92 patients had undetectable basal Tg (<0.5ng/ml), with rhTSH-Tg <0.5ng/ml in 52, in 6 rhTSH-Tg between 0.5 and 1ng/ml, in 2 between 12ng/ml (disease-free after 3 years of follow-up) and >2.0ng/ml (mean 4.1±2.4ng/ml) in another 3, with US lymphatic metastasis confirmed histologically. Disease-free state was predicted with a sensitivity (S) of 66.7% and specificity (Sp) of 75.7% for basal Tg-0.5ng/ml, and S 100% and Sp 85.1% for stimulated Tg-0.92. rhTSH test and US were repeated within one year in 25 disease-free patients with Tg<1.0ng/ml. No further elevation below 1ng/ml was observed. Conclusions: Low risk patients with undetectable basal Tg measured with current commercially available immunoassays should be followed with at least one rhTSH stimulated Tg and neck US because of the insufficient predictive value for recurrence/persistent disease of basal Tg. © Georg Thieme Verlag KG Stuttgart - New York.

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