Recombinant human thyroid-stimulating hormone (rhTSH) enhances 131I uptake, permitting a decrease in radiation for the treatment of multinodular goiter (MNG). Our objective was to evaluate the safety and efficacy of a single 0.1-mg dose of rhTSH, followed by 30 mCi 131I, in patients with MNG. Seventeen patients (15 females, 59.0 ± 13.1 years), who had never been submitted to 131I therapy, received a single 0.1-mg injection of rhTSH followed by 30 mCi 131I on the next day. Mean basal thyroid volume measured by computed tomography was 106.1 ± 64.4 mL. 131I 24-h uptake, TSH, free-T4, T3, thyroglobulin, anti-thyroid antibodies, and thyroid volume were evaluated at regular intervals of 12 months. Mean 131I 24-h uptake increased from 18.1 ± 9.7 to 49.6 ± 13.4% (P < 0.001), a median 2.6-fold increase (1.2 to 9.2). Peak hormonal levels were 10.86 ± 5.44 mU/L for TSH (a median 15.5-fold increase), 1.80 ± 0.48 ng/dL for free-T4, 204.61 ± 58.37 ng/dL for T3, and a median of 557.0 ng/mL for thyroglobulin. The adverse effects observed were hyperthyroidism (17.6%), painful thyroiditis (29.4%) and hypothyroidism (52.9%). Thyroid volume was reduced by 34.3 ± 14.3% after 6 months (P < 0.001) and by 46.0 ± 14.6% after 1 year (P < 0.001). Treatment of MNG with a single 0.1-mg dose of rhTSH, followed by a fixed amount of radioactivity of 131I, leads to an efficacious decrease in thyroid volume for the majority of the patients, with a moderate incidence of non-serious and readily treatable adverse effects.

OBJETIVO: Determinar se o questionário CAGE (composto por quatro perguntas de fácil memorização) é capaz de suprir a dificuldade de detecção do alcoolismo. MATERIAL E MÉTODO: Realizamos um estudo transversal com amostragem consecutiva em pacientes da Clínica Médica do pronto-socorro do Hospital Universitário Cajuru, os quais foram submetidos a uma entrevista padronizada constituída pelo questionário CAGE e pelo CIDI (Composite International Diagnostic Interview, seções "demografia" e "desordens resultantes do uso de álcool"). Da amostra obtida (n=374), correlacionamos a prevalência de alcoolismo segundo ambos os questionários, considerando o CIDI (critérios do DSM-IV) como sendo o padrão-ouro. RESULTADOS: A prevalência de dependência de álcool segundo os critérios do DSM-IV foi de 15,77%. Nós verificamos que o CAGE possui sensibilidade igual a 84,74% e especificidade igual a 73,33% para um ponto de corte igual a duas respostas afirmativas. Conclusões: Concluímos que o questionário CAGE é um instrumento de fácil aplicação e boa sensibilidade e especificidade quando usado no ambiente de pronto-socorro, podendo suprir as dificuldades de detecção do alcoolismo. Sugerimos que o questionário CAGE seja adotado como rotina no pronto-socorro, permitindo que o índice de detecção de alcoolismo aumente.

BACKGROUND: Alcoholism is seldom detected among emergency room outpatients, which is attributed to the non-adoption of diagnostic routines, to the difficulty of doing a special anamnesis for diagnosing alcoholism, and to the lack of sensitivity and specificity of the laboratory tests. This study has the purpose to determine whether the CAGE assay (composed by 4 questions of easy memorization) is able to supply this difficulty in detecting alcoholism. MATERIAL AND METHODS: We did a transversal study with consecutive sampling among outpatients of the Internal Medicine Department at Cajuru University Hospital emergency room. They were submitted to a standardized interview constituted by the CAGE and the CIDI assays (Composite International Diagnostic Interview, "demographics" and "disorders resulting from the use of alcohol" sections). From the sample obtained (n=374), we correlated the prevalence of alcoholism according to both questionnaires, considering the CIDI (DSM-IV criteria) to be the gold standard. RESULTS: The prevalence of alcohol dependence according to the DSM-IV criteria was 15.77%. We verified that the CAGE has 84.74% of sensitivity and 73.33% of specificity, with a cut point of 2 positive responses. CONCLUSIONS: We concluded that the CAGE is an instrument of easy application and good sensitivity and specificity when used at the emergency room, being able to supply the difficulties of alcoholism detection. We suggest that the CAGE be adapted as a routine at emergency rooms, increasing the alcoholism detection rate.