ABSTRACT Objective: Sorafenib significantly prolonged progression-free survival in patients with iodine-refractory advanced thyroid cancer. The present study was initiated before sorafenib was approved in Colombia and therefore represents an effort by an oncology institution to evaluate its efficacy and safety in this population. Subjects and methods: This phase II clinical trial had a single treatment arm. We included adult patients with progressive metastatic iodine-refractory thyroid cancer who received treatment with sorafenib 800 mg/day (400 mg every 12 hours) up to a maximum of 24 months or until the occurrence of limiting related toxicity, the progression of the disease, or voluntary withdrawal. Results: Nineteen patients received the treatment and were included in the safety analysis. However, for the efficacy analysis, 6 patients were excluded because they received only one month of therapy. Thirteen (68%) patients were women, and the mean age at diagnosis was 61.8 years. No complete responses were observed; 5 patients had a partial response (35.7%), 6 patients had stable disease, and 3 showed progression. Mean progression-free survival was calculated at 18 months (95% CI 10.7-20.3). Overall survival was estimated at 21.3 months (95% CI 17.8-24.8). Conclusion: For the first time in Colombia, the efficacy of sorafenib was evaluated in patients with advanced and progressive thyroid carcinoma refractory to radioactive iodine, with an efficacy and a safety profile similar to those previously reported.

Resumen Objetivo: Describir el caso de una paciente embarazada con enfermedad de Graves sin respuesta a antitiroideos, a fin de exponer las opciones terapéuticas adicionales disponibles como colestiramina, corticoesteroides, yoduro de potasio, plasmaféresis y tiroidectomía. Materiales y métodos: Se presenta el caso de una mujer de 18 años de edad con embarazo de 25 semanas y enfermedad de Graves desde hace 2 años, tratada con altas dosis de metimazol y propranolol. Se consideró diagnóstico de preeclampsia y tormenta tiroidea probable (Burch Wartofsky 25). Resultados: La evolución clínica posoperatoria fue satisfactoria; la paciente fue dada de alta con tratamiento sustitutivo con levotiroxina de 100 µg/día. A las 39 semanas de gestación, nació por cesárea una niña sana con peso 3200 g con medición de TSH neonatal en 6,21 mU/ml (0-15). Conclusiones: La tiroidectomía al final del segundo trimestre es una alternativa terapéutica favorable en pacientes embarazadas con enfermedad de Graves sin respuesta al tratamiento médico.

Abstract Objective: To describe the case of a pregnant patient with Graves’ disease who presented inadequate response to antithyroid medications with the aim to present the alternative therapeutics options such as cholestyramine, steroids, potassium iodide, plasmapheresis and thyroidectomy. Material and methods: 18 years-old-female patient, with 25-week pregnancy and history of Graves’ disease for 2 years, treated with high doses of methimazole and propranolol. Results Post-surgical evolution was satisfactory; patient was discharged with levothyroxine 100 mg/day treatment. At the 39th week of gestation, a healthy female baby was born, weighting 3200 grams with a normal neonatal TSH 6.21 mU/ml (0-15). Conclusions: Thyroidectomy at the end of the second trimester in pregnant women with Graves’ disease may be a favorable therapeutic alternative in case of inadequate response to medical treatment.