ABSTRACT Objective: Although thyroid microcarcinoma (TMC) usually has a favorable prognosis, some patients present a higher risk of disease recurrence or persistence. Thus, we aimed at identifying possible risk factors associated with an incomplete response to therapy in TMC. Subjects and methods: This was a retrospective study of 517 patients with TMC treated with total thyroidectomy, with or without radioactive iodine (RAI) therapy, reclassified after 1.1 ± 0.4 years according to the response to treatment into “favorable” (excellent/indeterminate) or “unfavorable” (biochemical/structural incomplete) responses. We evaluated participants' age, sex, tumor size, histological variants, multifocality, presence of vascular/lymphatic/perineural invasion, extrathyroidal extension, metastatic lymph nodes (LN), and distant metastasis. The effect of RAI therapy on the response range was analyzed in a given subgroup. Results: The mean age observed was 46.4 ± 12.0 years, and 89.7% were female. We noted 97.5% with papillary carcinoma, 27.8% with multifocality and 11.2% with LN metastasis. Although the majority of patients had a low risk of recurrence/persistence (78%), 75% were submitted to RAI therapy. Incomplete response (20.7%) was associated with multifocality (p=0.041; OR=1.619) and metastatic LN (p=0.041; OR=1.868). These variables were strongly correlated (p=0.000; OR=3.283). No cut-off of tumor size was identified as a predictor of incomplete response by the receiver operating curve analysis. RAI treatment did not influence the response of patients with multifocality or LN metastasis. Conclusion: Multifocality and LN metastasis are independent risk factors for incomplete response in TMC patients and are strongly correlated. Additional RAI therapy was not associated with a more favorable response in these subgroups.

ABSTRACT Objective: The intermediate-risk (IR) category includes tumors with different degrees of aggression. We aimed to identify the risk factors associated with unfavorable response to initial treatment and compare the effect of low/high radioactive iodine (RAI) therapy. Subjects and methods: A total of 614 IR patients were selected from a database, during 1972-2015. All patients underwent total thyroidectomy and RAI therapy and were reclassified after 12-18 months into the favorable (complete/indeterminate) response group and the unfavorable (biochemical/incomplete structural) response group. A total of 92 patients were assessed for late response (mean: 9.19 ± 5.73 years). Age, gender, tumor size, histology, multifocality, vascular invasion, extrathyroidal extension, presence and number of lymph node metastasis, and stimulated thyroglobulin at ablation (sTg) were evaluated. Results: Mean age at diagnosis was 41.47 ± 15.81 years, and 83.6% of the patients were female. Within 12-18 months after initial therapy, unfavorable response was detected in 41.2% of the patients and was associated, in multivariate analysis, with lymph node metastasis (p = 0.041; odds ratio [OR] = 1.9), presence of more than five metastatic lymph nodes (p = 0,017; OR = 2.6), and sTg > 10 ng/mL (p = 0.005; OR = 10.0). For patients with a longer follow-up, sTg >10 ng/mL was associated with unfavorable response (p = 0.002; OR = 6.8). A higher RAI dose was not related to better prognosis at the end of the follow-up. Conclusion: A sTg level of >10 ng/mL and lymph node metastasis were associated with an unfavorable response 12-18 months after initial treatment. A RAI dose below 150 mCi was proven sufficient to treat IR patients.

ABSTRACT Objective We aimed to evaluate the impact of minimal extrathyroidal extension (mETE) alone on the risk of recurrence of papillary thyroid carcinoma (PTC). The impact of other factors, including multifocality, age, tumor size, and stimulated thyroglobulin (sTg) values was also assessed. Subjects and methods We retrospectively analyzed 1,108 PTC patients from a medical institution, who presented tumors ≤ 4 cm without any adverse characteristics other than mETE. Patients were classified according to their response to initial treatment 12 to 24 months after surgery as proposed by the 2015 American Thyroid Association (ATA) guideline. Statistical analysis was performed using multivariate logistic regression and receiver operating characteristic (ROC) curve. Results In the multivariate logistic regression analysis, mETE did not have an impact on the response to initial treatment (p = 0.44), similar to multifocality, age, and tumor size. Initial Tg value was the only variable associated with a poor response (p < 0.01, odds ratio = 1.303, 95% confidence interval 1.25-1.36). The ROC analysis revealed that Tg was significant (area under curve = 0.8750); the cutoff value of sTg as a predictor of poor response was 10 ng/mL (sensitivity = 72.2%, specificity = 98.5%). Conclusion For low-risk PTC presenting mETE as the only aggressive feature, the initial sTg value is essential to identify patients who may have a poor response after initial treatment and benefit from further treatment. Arch Endocrinol Metab. 2020;64(3):251-6

ABSTRACT Objectives: We sought to assess the relationship between stimulated thyroglobulin (sTg) before radioactive iodine therapy (RIT), and the dynamic risk stratification 1 year after treatment, and to establish the utility of the sTg as a predictor of response to therapy in these patients. A retrospective chart review of patients with differentiated thyroid cancer (DTC) who underwent RIT after surgery and were followed for at least 1 year, was carried out. Subjects and methods: Patients were classified according to the dynamic risk stratification 1 year after initial treatment. The sTg values before RIT were compared among the groups. ROC curve analysis was performed. Results: Fifty-six patients were enrolled (mean age 44.7 ± 14.4 years, 80.7% had papillary carcinoma). Patients with excellent response had sTg = 2.1 ± 3.3 ng/mL, those with indeterminate response had sTg = 8.2 ± 9.2 ng/mL and those with incomplete response had sTg = 22.4 ± 28.3 ng/mL before RIT (p = 0.01). There was a difference in sTg between excellent and incomplete response groups (p = 0.009) while no difference was found between indeterminate and either excellent or incomplete groups. The ROC curve showed an area under the curve of 0.779 assuming a sTg value of 3.75 ng/mL. Conclusion: Our study results suggest that the higher the sTg before RIT, the greater the likelihood of an incomplete response to initial treatment. A sTg cut-off of 3.75 ng/mL was found to be a good predictor of response to initial treatment in patients with DTC.

Objective Consuming a low-iodine diet (LID) is a widely accepted practice before administering radioiodine (131I) to evaluate and to treat thyroid disease. Although this procedure is well established for the management of patients with differentiated thyroid cancer, its use in patients with benign disease is unclear. So, we aimed to evaluate the influence of a LID on the outcome in patients with Graves’ disease (GD) treated with131I. Subjects and methods We evaluated 67 patients with GD who were divided into 2 groups: one group (n = 31) consumed a LID for 1-2 weeks, and the second group (n = 36) was instructed to maintain a regular diet (RD). Results The LID group experienced a 23% decrease in urinary iodine after 1 week on the diet and a significant 42% decrease after 2 weeks on the diet. The majority (53%) of the patients in the LID group had urinary iodine levels that were consistent with deficient iodine intake. However, there was no difference in the rate of hyperthyroidism’s cure between the LID and the RD groups 6 months after 131I therapy. Furthermore, the therapeutic efficacy did not differ in patients with varying degrees of sufficient iodine intake (corresponding urinary iodine levels: < 10 μg/dL is deficient; 10-29.9 μg/dL is sufficient; and > 30 μg/dL is excessive). Conclusion In the present study, we demonstrated that although a LID decreased urinary iodine levels, those levels corresponding with sufficient or a mild excess in iodine intake did not compromise the therapeutic efficacy of131I for the treatment of GD.

Brown tumors are rare skeletal manifestations that occur in less than 2% of primary hyperparathyroidism (PHPT) cases. Even rarer is the occurrence of brown tumor of the orbit, and few cases have been reported around the world. The rare instance of this benign tumor has prompted us to report the case and treatment of an orbital brown tumor in a patient with PHPT caused by parathyroid adenoma. We present the case of a patient undergoing follow-up at a referral center. The 60-year-old female patient, presented herself with progressive swelling in the nasal region, epistaxis and proptosis, she had noticed seven months prior to our examination. Multiple imaging and laboratory findings revealed parathyroid hormone (PTH)-dependent hypercalcemia (total calcium = 14.3 mg/dL and PTH = 1,573 pg/mL), a nodular lesion in the upper pole of the left thyroid lobe and increased uptake in left upper cervical region. The patient underwent left superior parathyroidectomy in September 2011, which led to the normalization of hypercalcemia and regression of the orbital tumor, as seen on control CT scan. This case highlights the spontaneous regression of the brown tumor after surgical management of the parathyroid adenoma.

A Doença de Graves constitui a forma mais comum de hipertireoidismo e três abordagens terapêuticas são atualmente utilizadas: uso de medicamentos antitireoideanos, cirurgia e iodo radioativo (I 131). Os efeitos do o I 131 e a indução precoce de hipotireoidismo são conseqüências da destruição induzida do I131 sobre o parênquima tireoideano. São poucos relatos encontrados na literatura acerca dos efeitos da radioioterapia sobre a laringe e conseqüentemente na produção vocal. OBJETIVO: Avaliar os efeitos agudos sobre a voz da radioiodoterapia em pacientes com hipertireoidismo por Doença de Basedow Graves. MATERIAL E MÉTODO: Estudo de corte contemporâneo longitudinal, prospectivo. Procedimentos: Investigação vocal, mensuração do tempo máximo fonatório de /a/ e relação s/z, análise freqüência fundamental (Software Praat), laringoscopia e análise perceptivo-auditiva em três momentos: pré-dose, 4 dias e 20 dias pós dose. Momentos baseados no perfil inflamatório do tecido tireoideano. RESULTADOS: Não houve mudanças estatisticamente significantes nos aspectos vocais e laringológicos nos três momentos avaliados. CONCLUSÃO: A radioiodoterapia não afeta a qualidade vocal.

Graves's disease is the most common cause of hyperthyroidism. There are three current therapeutic options: anti-thyroid medication, surgery, and radioactive iodine (I 131). There are few data in the literature regarding the effects of radioiodine therapy on the larynx and voice. The aim and the AIM: os this study was: to assess the effect of radioiodine therapy on the voice of Basedow-Graves patients. MATERIAL AND METHOD: A prospective study was done. Following the diagnosis of Grave's disease, patients underwent investigation of their voice, measurement of maximum phonatory time (/a/) and the s/z ratio, fundamental frequency analysis (Praat software), laringoscopy and (perceptive-auditory) analysis in three different conditions: pre-treatment, 4 days, and 20 days post-radioiodine therapy. Conditions are based on the inflammatory pattern of thyroid tissue (Jones et al. 1999). RESULTS: No statistically significant differences were found in voice characteristics in these three conditions. CONCLUSION: Radioiodine therapy does not affect voice quality.

Aproximadamente 10% das neoplasias de tireóide aparecem abaixo dos 21 anos e representam 3% das neoplasias da infância, com predomínio em meninas (2F:1M). São papilíferos em 90% casos e mais freqüentemente bilaterais, multifocais e de maior dimensão. Invasão de cápsula e metástases ganglionar ou pulmonar são mais freqüentes que no adulto. O efeito carcinogênico da radiação é especialmente importante na criança pré-púbere. Em 5% dos casos de PTC existe história familial. Genes como o RET/PTC, RAS e BRAF estão habitualmente envolvidos na gênese do processo. A apresentação clínica pode ser nódulo cervical (90% casos) sem que represente um fator de pior prognóstico. O US e a PAAF são procedimentos diagnósticos valiosos. O tratamento deve ser cirúrgico (tireoidectomia total com esvaziamento ganglionar) seguido de PCI e radioterapia ablativa. A substituição com L-tiroxina deve objetivar a supressão crônica do TSH. O prognóstico ao longo prazo é melhor que no adulto. A quantificação da Tg plasmática também é útil na detecção da doença residual.

Approximately 10% of thyroid cancers are present in patients less than 21 years of age, representing 3% of all cancers of children and adolescents, with predominance in females 2:1 in relation to males. Thyroid cancers in this age group are usually papillary (90%), bilateral, multifocal and bigger in size compared to adults. Capsule invasion and lymphatic and pulmonary metastases are more frequent in children. Radiation sensitivity seems to represent an important factor in prepubertal patients. Familial history is reported in 5% of the cases. Genes such as RET/PTC, RAS and BRAF are usually involved in thyroid carcinogenesis in this age group. Cervical adenomegaly is a common clinical presentation, but does not represent a poor prognostic factor in children. Ultrasound and fine needle aspiration biopsy are valuable diagnostic procedures. Surgery is the preferred treatment including thyroidectomy and ganglionary excision, followed by ablative radioiodine therapy. L-thyroxine replacement with suppressive dosage should be employed targeting chronic TSH suppression. Long-term prognosis is usually better in children when compared with adults. Plasma thyroglobulin measurement is also useful to detect residual thyroid cancer disease.

OBJETIVO: Avaliar se diferentes parâmetros de análise da linfocintilografia permitem a distinção entre membros com e sem linfedema em pacientes com quadro clínico de edema unilateral. MÉTODOS: Levantamento retrospectivo dos exames de 20 pacientes submetidos a linfocintilografia para investigação de edema unilateral de membros inferiores, divididos em pacientes com linfedema primário (grupo 1, n = 7) ou secundário pós-traumático (grupo 2, n = 13). Foi realizada linfocintilografia após injeção subdérmica de soroalbumina humana marcada com tecnécio-99m nos pés, com imagens da região inguinal durante 15 min e imagens dos membros inferiores após 15 min e 1 h. Os parâmetros analisados foram: tempo de aparecimento da cadeia inguinal, índice semiquantitativo (fluxo linfático, difusão intersticial, aspecto dos vasos, tempo de aparecimento e aspecto dos linfonodos inguinais) e inclinação da curva de atividade em função do tempo da região inguinal. As medidas nos membros clinicamente acometidos foram comparadas aos membros sem linfedema em ambos os grupos. RESULTADO: O tempo médio de aparecimento da cadeia inguinal e o índice semiquantitativo foram significativamente maiores nos membros com linfedema que nos membros sem linfedema quando considerados todos os pacientes, com maior retardo e índice semiquantitativo nos membros com linfedema do grupo 1 em relação aos do grupo 2. CONCLUSÃO: A análise do tempo de aparecimento da cadeia inguinal e o índice semiquantitativo fornecem parâmetros objetivos de avaliação do linfedema que podem auxiliar na detecção e seguimento dos pacientes com linfedema.

OBJECTIVE: To evaluate whether different parameters could be used in the analysis of lymphoscintigraphy to distinguish affected from unaffected limbs in patients with unilateral edema. METHODS: Twenty patients who underwent lymphoscintigraphy for screening of unilateral lower limb edema were retrospectively assessed and divided into patients with primary lymphedema (group 1, n = 7) or secondary post-traumatic edema (group 2, n = 13). Technetium 99m-labeled human serum albumin was subdermally administered in the feet, followed by a dynamic lymphoscintigraphy of the pelvis during 15 min and static images of the lower limbs after 15 min and 1 h. Analyzed parameters were detection time of groin activity, semi-quantitative index (lymph flow, interstitial diffusion, aspect of vessels, detection time and aspect of inguinal lymph nodes) and slope of groin time-activity curve. The parameters of clinically affected limbs were compared to those of the contralateral limbs in both groups. RESULTS: Detection time of groin activity and semi-quantitative index were significantly higher in affected limbs considering all patients, with a more severe delay and a higher semi-quantitative index in group 1 compared to group 2. CONCLUSION: Analysis of detection time of groin activity and semi-quantitative index can add objective parameters that can be used in the diagnosis and follow-up of patients with lymphedema.

OBJETIVO: Analisar medidas tomadas para aumentar a dose de radiação absorvida (DOSE) durante o tratamento do carcinoma diferenciado da tireóide (CDT) com iodo-131. MÉTODOS: As abordagens para aumentar a DOSE na radioiodoterapia são: redução da competição com iodo não-radioativo, estímulo da captação/retenção celular e aumento da atividade administrada. Revisaram-se os fundamentos e resultados de cada um destes métodos. RESULTADOS: Apesar de ser difícil confirmar aumento de sobrevida, existe relação direta entre a DOSE e a resposta no CDT. Diferentes abordagens permitem o aumento da DOSE nos tecidos, inferindo-se uma possível melhora na resposta dos tumores ao tratamento com iodo-131. Apesar do prognóstico relativamente benigno da doença, a melhoria da resposta é importante nos casos de alto risco, em que as alternativas de tratamento são limitadas. CONCLUSÕES: As intervenções descritas permitem aumentar a DOSE durante o tratamento do CDT, podendo ser empregadas para casos de alto risco.

OBJECTIVES: Our aim was to analyze measures taken to increase the radiation absorbed dose (DOSE) during treatment of well-differentiated thyroid cancer (DTC) with iodine-131. METHODS: An increase in DOSE is achieved by: avoiding competition with non-radioactive iodine, stimulating cellular uptake/retention, increasing the administered activity. Basis and results of each one of these methods were reviewed. RESULTS: Although it is difficult to demonstrate an increase in survival, there is a direct relation between DOSE and tumoral response in DTC. Different approaches can be used aiming an increase in DOSE, with a possible improvement in tumoral response for treatment with iodine-131. Although DTC is a relatively benign disease, a better response to treatment is highly desirable in high-risk patients, who have few other options of therapy. CONCLUSIONS: An increase in DOSE during treatment of DTC can be achieved using the described interventions, which should be used in high-risk cases of DTC.

FUNDAMENTOS: A progressão linfática do melanoma maligno habitualmente se inicia pelo linfonodo sentinela (LNS), cuja análise histopatológica permite predizer o acometimento de toda a cadeia. OBJETIVO: O trabalho tem por objetivo descrever a utilização do 99mTc-Fitato na detecção do LNS em pacientes com melanoma maligno, revisando as indicações e informações fornecidas por sua biópsia. MÉTODO: A pesquisa de LNS foi realizada por meio da linfocintilografia com 99mTc-Fitato em 92 pacientes com melanoma (54,0±14,3 anos). Após 18-24 horas, 88 pacientes foram submetidos à localização intra-operatória com detector portátil, seguida da ressecção e análise histopatológica do LNS. RESULTADOS: A linfocintilografia permitiu a identificação do LNS em todos os estudos, havendo detecção intra-operatória em 98,8% dos casos. O LNS estava acometido em 23 pacientes (26%). O valor preditivo negativo foi de 100% e não se observaram reações adversas pelo uso do 99mTc-Fitato. CONCLUSÃO: A detecção do LNS pode ser realizada com diferentes radiofármacos, incluindo o 99mTc-Fitato, que apresenta vantagens de custo e disponibilidade no Brasil. A pesquisa de LNS resulta em maior acurácia e menor morbidade no estadiamento de pacientes com melanoma maligno

BACKGROUND: Sentinel lymph node (SLN), corresponding to the first lymph node draining the tumor, is usually the first one to receive its metastasis, and its biopsy is used to define the status of the whole lymphatic basin. OBJECTIVE: The aim of this paper is to describe the use 99mTc-Fitato in SLN localization in malignant melanoma patients, and to review the main indications and information provided by SLN biopsy. METHOD: A total of 92 patients with malignant melanoma was studied. Lymph node scintigraphy was carried out after the subdermal injection of 99mTc-Phytate. After 18-24 hours, intra-operative SLN localization was carried out using the gamma-probe and lymph node dissection was then performed. RESULTS: Lymphoscintigraphy identified the sentinel node in all studies and intra-operative detection using gamma-probe was reached in 98.8% of the cases. The SLN was involved in 23 patients (26%). The method's negative predictive value was 100%, and there were no side effects related to 99mTc-Phytate. CONCLUSION: Scintigraphic and intra-operative sentinel node detection was satisfactorily performed using 99mTc-Phytate, an easily available and low cost radiopharmaceutical. SLN mapping allows the use of more accurate tumor staging techniques and reduces surgical morbidity.

A medicina nuclear permite a caracterização funcional de tecidos, acrescentando dados à avaliação anatômica realizada por outros métodos de imagem, como a tomografia computadorizada, ressonância magnética ou ultra-som. Além do diagnóstico e estadiamento, as informações funcionais fornecidas pela medicina nuclear são particularmente úteis no seguimento e avaliação de resposta terapêutica dos pacientes com linfoma. A presença de massa residual após quimioterapia ou a infiltração de linfonodos de pequenas dimensões são exemplos de situações nas quais a avaliação isolada de características anatômicas é insuficiente. Os principais métodos utilizados são a cintilografia com gálio-67, traçador com alta afinidade por transferrina e receptores de ferro, e os estudos com flúor-deoxiglicose, emissor de pósitron que permite a caracterização do metabolismo de glicose nos tecidos. Outros traçadores, como o tálio-201, sestamibi-Tc99m e octreotide-In111, também são utilizados em menor escala na avaliação dos pacientes com linfoma. Os mecanismos de captação, principais indicações dos estudos, limitações e resultados de literatura serão revistos.

Nuclear medicine procedures allow functional characterization of organs and tissues, that can be compared to the anatomical evaluation provided by computed tomography, magnetic resonance imaging and ultrasonography. Functional information are usefull not only in diagnosis and staging, but mainly in the follow-up and evaluation of the therapeutic response of lymphoma patients. Persistent or residual mediastinal mass and and infiltration of small nodes are some examples of situations in which purely anatomical evaluation is insufficient. The main methods in use are scintigraphy with galium-67, a transferrin avid tracer, and PET with fluoro-desoxyglucose, indicated for the metabolic evaluation of tissues. Other tracers are also described, as thallium-201, 99mTc-sestamibi, and 111In-octreotide. Mechanisms of uptake, indications, limitations and results of the literature are and discussed in this review.

Estudamos retrospectivamente 120 pacientes (96 F/ 24 M) portadores de tirotoxicose por doença de Basedow-Graves submetidos à terapia com iodo radioativo (131I), que receberam inicialmente, para compensação da moléstia, drogas anti-tiroidianas (DAT). A indicação terapêutica posterior de radioiodo deveu-se a uma das seguintes condições clínicas: recidiva após compensação com DAT, falta de compensação devida à baixa aderência às DAT, bócios maiores que 60g, idade avançada ou doença grave associada. As DAT foram suspensas uma semana antes da administração da dose de 131I, calculada pela fórmula: volume glandular (em g) X radiação efetiva (80 mCi/g de tecido) ¸ captação tiroideana de 24hs. Reavaliamos os pacientes por até 48 meses após a radioiodoterapia. As medianas iniciais de idade, bócio e captação tiroideana de 24hs dos 120 pacientes foram, respectivamente, 34 anos (17-69), 54,5g (20-210) e 73% (21-99). A evolução para hipotiroidismo foi gradual, com 15% dos pacientes a cada 6m até o 18º mês, seguidos de 2 a 5% dos pacientes a cada 6m até o 48º mês. O número de pacientes em tirotoxicose decresceu continuamente, representando 52,2% do total inicial após 6m, 25% após 18m e 6,7% após 48m. Ao final, 8 pacientes continuaram em tirotoxicose. O número de pacientes sem tirotoxicose após o tratamento com 131I, ou seja a soma daqueles em eutiroidismo com aqueles em hipotiroidismo com reposição com T4 (denominada por nós de "cura da tirotoxicose"), alcançou 46,8% dos pacientes em óm, 63,3% em 12m, 81,7% em 24m, 87,5% em 36m e 93,3% em 48m. O número de pacientes que apresentaram hipotiroidismo transitório, ou seja, elevação do TSH acima de 4,5 mU/L até 12m após a dose de 131I, com normalização posterior, foi 7,5%. Correlacionaram-se positivamente: a) valores iniciais de T3 e ausência de evolução para a cura da tirotoxicose (p=0,02); b) doses totais de 131I administradas, únicas ou múltiplas, em relação ao tempo de cura da tirotoxicose (p=0,01); c) dose de 131 l/volume glandular em relação ao tempo de cura da tirotoxicose (p=0,02). Os efeitos adversos incluíram exacerbação da tirotoxicose em 3 pacientes e dor na região cervical anterior em um, com reversão dos quadros em todos. Outras duas pacientes engravidaram após o dose terapêutica de 131I para a tirotoxicose e tiveram gestações sem intercorrência e recém-nascidos normais.

We studied retrospectively the outcome of radioactive iodine therapy (RAI) in 120 thyrotoxic patients with Graves' disease (96 F/ 24 M) who were primarily treated with anti-thyroid drugs (ATD). The decision to use RAI was due either to relapse after ATD-induced remission, lack of compliance on ATD, goiter larger than 60g, old age or association with severe diseases. ATD were discontinued one week before RAI administration, calculated by the formula: glandular volume (g) vs. effective radiation (80 mCi/g of tissue) divided by 24h thyroid uptake (%). We reexamined the patients for 48 months after RAI. Medians of age, goiter size and 24h thyroid uptake were 34y (17-69), 54.5g (20-210) and 73% (21-99), respectively. After RAI, patients became gradually hypothyroid on a rate of 15%/ 6mo until the first 18mo, followed by a rate of 2-5%/ 6mo until the end of 48mo. The number of patients in thyrotoxicosis decreased continuously, being 52.2% 6mo after RAI, 25% after 18mo and 6.7% after 48mo; at the end of the study 8 patients were still thyrotoxic. The total of patients without thyrotoxicosis at the end of observation, that is, the sum of those in euthyroidism and hypothyroidism on T4 therapy ("cure of thyrotoxicosis") reached 46.8% in 6mo, 63.3% in 12mo, 81.7% in 24mo, 87.5% in 36mo and 93.3% in 48mo. Transient hypothyroidism, that is, elevation of TSH higher than 4.5 mU/L until 12mo after RAI, followed by normalization of TSH was found in 7.5% of patients. The following correlations were found in this study: a) initial T3 values and absence of cure of thyroxicosis (p=0.2); b) total RAI doses in relation to time for cure of thyrotoxicosis (p=0.01); c) dose of 131l/thyroid volume in relation to time for cure of thyrotoxicosis (p=0.02). Adverse effects included exarcebation of thyrotoxicosis in 3 patients and pain in the anterior cervical area in one, all reversible and of short duration. Two patients became pregnant after RAI but both gestations and their outcomes were normal.

OBJETIVO: Investigar a influência do peso corporal (PC), massa gorda (FM) e massa magra (LM) na densidade mineral óssea (BMD) de várias regiões do esqueleto. PARTICIPANTES: Sessenta e uma mulheres brancas na pós-menopausa (50.1±4.8 anos). MENSURAÇÃO: Medida do BMD através da densitometria duo-energética. Os resultados foram analisados através de regressão linear e os slopes de cada curva foram comparados. RESULTADOS: Mostraram que as correlações PC-, FM- e LM-BMD foram positivas, enquanto que as correlações idade- e anos de climatério-BMD foram negativos. LM foi o principal fator que influenciou o BMD em quase todas as regiões ósseas. CONCLUSÃO: FM e LM apresentam efeito positivo no BMD, entretanto, LM é o principal determinante da massa óssea. Além do mais, maiores valores de LM e FM têm um efeito protetor na diminuição do BMD decorrente da menopausa. Portanto, mulheres no climatério com baixo PC, especialmente, baixo LM apresentam maior risco de desenvolver osteoporose.

AIMS:To investigate the influence of body weight (BW), fat mass (FM) and lean mass (LM) on the bone mineral density (BMD) of several areas of the skeleton. PARTICIPANTS: Sixty one white postmenopausal women (50.1±4.8 years). MEASUREMENTS: Measurement of BMD by dual energy x-ray absorptiometry. The results were analyzed by linear regression and the slopes of each curve were compared. RESULTS: The results showed that the correlations between BW, FM and LM to BMD were positive, whilst the correlations between age and years since menopause to BMD were negative. LM was the main factor that influenced BMD in almost all areas. CONCLUSIONS: FM and LM present a positive effect on BMD, although LM is the main determinant of bone mass. Moreover, higher values of LM and FM present a protective effect against the reduction of BMD combined with menopause. Therefore postmenopausal women with low BW, especially low LM, present serious risk for developing osteoporosis.