Objetivo : As diretrizes atuais alertam contra a execução da cintigrafia de corpo inteiro com iodo-131 (dxWBS) para minimizar a ocorrência de atordoamento e garantir a eficiência do tratamento com radioiodo (RIT). O objetivo deste estudo foi avaliar o impacto do atordoamento sobre a eficácia do RIT e desfechos da doença.Sujeitos e métodos : Esta análise retrospectiva incluiu 208 pacientes com câncer diferenciado de tireoide submetidos ao mesmo protocolo e acompanhados por 12-159 semanas (média de 30 ± 69 meses). Os pacientes receberam RIT com doses variando de 3.700 a 11.100 MBq (100 mCi a 300 mCi). As imagens da cintigrafia após a RIT foram feitas 10 dias depois da RIT em todos os pacientes. Além disso, as imagens foram também obtidas após 24-48h em 22 pacientes. O desfecho foi classificado como nenhuma evidência de doença (NED), doença estável (SD) e doença progressiva (PD).Resultados : O atordoamento da tireoide ocorreu em 40 pacientes (19,2%), incluindo 26 pacientes com NED e 14 pacientes com SD. A análise multivariada não mostrou associação entre o desfecho da doença e a ocorrência de atordoamento (p = 0,3476).Conclusão : A eficácia da RIT e o desfecho da doença não parecem estar relacionados com o atordoamento da tireoide. Arq Bras Endocrinol Metab. 2014;58(3):292-300

Objective : Current guidelines have advised against the performance of 131I-iodide diagnostic whole body scintigraphy (dxWBS) to minimize the occurrence of stunning, and to guarantee the efficiency of radioiodine therapy (RIT). The aim of the study was to evaluate the impact of stunning on the efficacy of RIT and disease outcome.Subjects and methods : This retrospective analysis included 208 patients with differentiated thyroid cancer managed according to a same protocol and followed up for 12-159 months (mean 30 ± 69 months). Patients received RIT in doses ranging from 3,700 to 11,100 MBq (100 mCi to 300 mCi). Post-RIT-whole body scintigraphy images were performed 10 days after RIT in all patients. In addition, images were also performed 24-48 hours after therapy in 22 patients. Outcome was classified as no evidence of disease (NED), stable disease (SD) and progressive disease (PD).Results : Thyroid stunning occurred in 40 patients (19.2%), including 26 patients with NED and 14 patients with SD. A multivariate analysis showed no association between disease outcome and the occurrence of stunning (p = 0.3476).Conclusion : The efficacy of RIT and disease outcome do not seem to be related to thyroid stunning. Arq Bras Endocrinol Metab. 2014;58(3):292-300

OBJETIVO: Avaliar a eficácia de doses cumulativas (DCs) da terapia com iodeto-131I (RIT) no câncer diferenciado de tiroide (CDT). SUJEITOS E MÉTODOS: A probabilidade de doença em progressão conforme a DC foi calculada em pacientes com idade < 45 e > 45 anos e correlacionada com o TNM, valores de tiroglobulina sérica, tipos histológicos e variantes, idade e tempo de doença. RESULTADOS: Ao final de um seguimento de 69 ± 56 meses, 85 dos 150 pacientes CDT submetidos a doses fixas de RIT não tinham evidência de doença, 47 tinham doença estável e 18, doença progressiva. DCs mais elevadas foram usadas nas variantes agressivas (p < 0,0001), maior estágio TNM (p < 0,0001) e nos carcinomas foliculares (p = 0,0034). A probabilidade de doença em progressão foi maior com DCs > 600 mCi em pacientes > 45 anos e com DCs > 800 mCi em pacientes < 45 anos. CONCLUSÃO: Apesar de alguns pacientes ainda responderem a altas DCs, o impacto de RITs deve ser cuidadosamente avaliado e outras estratégias terapêuticas devem ser consideradas.

OBJECTIVE: Evaluate the efficacy of cumulative doses (CDs) of 131I-iodide therapy (RIT) in differentiated thyroid cancer (DTC). SUBJECTS AND METHODS: The probability of progressive disease according to CDs was evaluated in patients < 45 years old and > 45 years old and correlated to tumor-node-metastasis (TNM), thyroglobulin values, histological types and variants, age, and zduration of the disease. RESULTS: At the end of a follow-up period of 69 ± 56 months, 85 out of 150 DTC patients submitted to fixed doses RIT had no evidence of disease, 47 had stable disease and 18 had progressive disease. Higher CDs were used in the more aggressive variants (p < 0.0001), higher TNM stages (p < 0.0001), and follicular carcinomas (p = 0.0034). Probability of disease progression was higher with CDs > 600 mCi in patients > 45 years old and with CDs > 800 mCi in patients < 45 years. CONCLUSION: Although some patients may still respond to high CDs, the impact of further RIT should be carefully evaluated and other treatment strategies may be warranted.

O seguimento de pacientes com síndrome de Turner (ST) freqüentemente revela alterações transitórias, recorrentes e assintomáticas de TSH e/ou hormônios tireóideos (HT). Neste trabalho foram avaliadas estrutura e função da tireóide em portadoras da ST com história de alterações prévias desses hormônios. A casuística incluiu 24 pacientes, 17 com menos de 20 anos, avaliadas laboratorialmente pelas concentrações séricas de TSH, T4 livre, T3 e anticorpos anti-TPO e anti-Tg, e morfologicamente por ultra-sonografia (USG) e cintilografia com pertecnetato-99mTc. Havia alterações de TSH e/ou HT em 13 casos, e em 23 havia alterações USG compatíveis com doença crônica da tireóide, particularmente tireomegalia (estabelecida de acordo com o volume esperado para a estatura) e heterogeneidade do parênquima. A captação foi normal em 21 casos e a distribuição do radiofármaco, homogênea em 22. As alterações hormonais foram independentes da idade, do tempo de evolução, da presença de anticorpos, do número de anomalias USG e de alterações cintilográficas. Pacientes maiores de 20 anos apresentaram maior freqüência de anticorpos e de hipoecogenicidade do parênquima, e houve correlação positiva entre o volume tireóideo e o tempo de evolução, indicando comprometimento progressivo da glândula. Esses resultados sugerem que as alterações encontradas decorram de doença tireóidea auto-imune crônica.

Patients with Turner syndrome (TS) frequently exhibit transient, recurrent and asymptomatic variations of TSH and/or thyroid hormones (TH). This work was carried out to evaluate thyroid function and structure in patients with TS who had had such variations in hormone concentrations. Our sample comprised 24 patients, 17 less than 20-years old. Evaluation included serum levels of TSH, free T4, total T3, TPO and Tg autoantibodies, thyroid ultrasound (US) and scintigraphy with 99mTc-pertechnetate. Thirteen patients had abnormal TSH and/or TH levels; 23 exhibited US features compatible with chronic thyroid disorder, particularly thyromegaly (established according to volume expected for stature) and heterogeneous echogenicity. Uptake was normal in 21 cases and tracer distribution was homogeneous in 22. The finding of abnormal hormone concentrations was independent of age, length of time since the first similar finding, thyroid autoantibodies, number of abnormalities at US and abnormal scintigraphic findings. Patients aged more than 20 years had higher frequency of thyroid antibodies and heterogeneous echogenicity, and thyroid volume was significantly correlated to length of time since detection of the first hormone variation, indicating progressive thyroid disease. These results suggest that subclinical thyroid dysfunction in TS is due to chronic autoimmune thyroid disease.

PURPOSE: Renal scintigraphy has been used for many years in the evaluation of renal transplants and can help in the diagnosis of graft complications, leading to prompt clinical management and preventing further deterioration of renal function. The purpose of this study was to evaluate the overall accuracy of renal scintigraphy with 99mTc-DTPA in the diagnosis of acute renal graft complications. MATERIALS AND METHODS: Seventy-six scintigraphic studies performed in 55 patients (ages ranging from 6 to 65 years), were reviewed. Scintigraphy results were compared to biopsies performed within 5 days of imaging. 99mTc-DTPA study was performed within a mean time of 19 days after kidney transplants. Dynamic images were performed in the anterior position of the abdomen and pelvis every 2 seconds for 80 seconds (flow phase) and every 15 seconds for 30 minutes (functional phase), after an intravenous injection of 370 MBq (10 mCi) of 99mTc-DTPA. RESULTS: The scintigraphic results were concordant with the biopsies in 86% of the cases studied. The sensitivities of renal scintigraphy for detection of acute tubular necrosis (ATN), acute rejection (AR) and cortical necrosis (CN) were 98%, 87% and 100%, respectively. Specificities and accuracies for detection of ATN, AR and CN were 89%, 86% and 100%, and 95%, 87% and 100%, respectively. CONCLUSION: Renal scintigraphy with 99mTc-DTPA showed a good overall accuracy in the detection of acute renal graft complications. It can be used as a reliable tool in the routine evaluation of these patients

A síndrome de Turner (ST) caracteriza-se pela perda parcial ou total de um dos cromossomos X, hipogonadismo hipergonadotrófico e baixa estatura. A maioria dos estudos de densidade mineral óssea (DMO) em ST atribuem a osteoporose à ausência do desenvolvimento puberal e ao hipoestrogenismo, enquanto o envolvimento das alterações ósseas intrínsecas à ST permanece obscuro. O objetivo deste estudo foi verificar a associação entre a DMO com as variáveis como idade cronológica e óssea, peso, altura, cariótipo, doenças associadas e reposição estrogênica em pacientes com ST. Realizou-se um estudo transversal da DMO areal de L2-L4 por DEXA em 34 pacientes com diagnóstico citogenético de ST. Encontrou-se diferença estatística em relação à idade (as pacientes com z DMO < -2,5 eram as de idade mais avançada), à altura (as pacientes com z DMO < -2,5 eram as mais altas) e a reposição estrogênica (o z DMO foi menor nas pacientes que necessitaram de reposição hormonal). Sugere-se, portanto, que a idade e a reposição estrogênica podem ser fatores associados à baixa DMO na ST.

Total or partial X chromosome loss, hypergonadotrophic hypogonadism and short stature characterize Turner syndrome (TS). Delayed puberty and hypoestrogenism are the determinant factors of osteoporosis in TS, and the compromise of intrinsic bone defect is yet obscure. The aim of this study was to evaluate the association between bone mineral density (BMD) and chronological and bone age, weight, height, karyotype, associated diseases, bone age and estrogen therapy in TS patients. We performed a transversal study with areal BMD of L2-L4 with DEXA in 34 patients with cytogenetic diagnosis of TS. Statistical differences were present concerning age and height, since TS patients with z BMD <2.5 were older and taller. The z BMD analysis revealed lower values in patients who needed estrogen therapy. These results suggest that in patients with TS, age and estrogen therapy could be associated with low BMD.

Olanzapina, um antipsicótico atípico, foi administrada a uma paciente com doença de Huntington (DH) com acentuados movimentos coreicos. O SPECT cerebral com HMPAO-99mTc foi realizado antes da paciente iniciar qualquer tratamento e após tratamento com olanzapina. O SPECT cerebral tem sido realizado em pacientes com DH para avaliar a perfusão dos núcleos da base. O uso do SPECT cerebral com HMPAO-99mTc antes e após terapia em pacientes com DH ainda não foi relatado. A acentuada hipoperfusão observada nos núcleos da base na imagem de SPECT cerebral, obtida antes da terapia com olanzapina, melhorou de forma significativa após o tratamento.

Olanzapine, an atypical antipsychotic drug, was administered to a patient with Huntington's disease (HD) with marked choreiform movements. Brain SPECT with 99mTc-HMPAO was performed before and after treatment. Brain SPECT imaging has been performed in patients with HD in order to determine the status of basal ganglia perfusion. The use of brain SPECT with 99mTc-HMPAO before and after treatment in patients with HD has not been yet reported. The marked hypoperfusion of the basal ganglia on brain SPECT performed before therapy with olanzapine improved significantly after treatment.