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Pitoia F, Scheffel RS, Califano I, Gauna A, Tala H, Vaisman F, Gonzalez AR, Hoff AO, Maia AL. Management of radioiodine refractory differentiated thyroid cancer: the Latin American perspective. Rev Endocr Metab Disord 2024; 25:109-121. [PMID: 37380825 DOI: 10.1007/s11154-023-09818-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/13/2023] [Indexed: 06/30/2023]
Abstract
Radioiodine (RAI) refractory differentiated thyroid cancer is an uncommon and challenging situation that requires a multidisciplinary approach to therapeutic strategies. The definition of RAI-refractoriness is usually a clear situation in specialized centers. However, the right moment for initiation of multikinase inhibitors (MKI), the time and availability for genomic testing, and the possibility of prescribing MKI and selective kinase inhibitors differ worldwide.Latin America (LA) refers to the territories of the world that stretch across two regions: North America (including Central America and the Caribbean) and South America, containing 8.5% of the world's population. In this manuscript, we critically review the current standard approach recommended for patients with RAI refractory differentiated thyroid cancer, emphasizing the challenges faced in LA. To achieve this objective, the Latin American Thyroid Society (LATS) convened a panel of experts from Brazil, Argentina, Chile, and Colombia. Access to MKI compounds continues to be a challenge in all LA countries. This is true not only for MKI but also for the new selective tyrosine kinase inhibitor, which will also require genomic testing, that is not widely available. Thus, as precision medicine advances, significant disparities will be made more evident, and despite efforts to improve coverage and reimbursement, molecular-based precision medicine remains inaccessible to most of the LA population. Efforts should be undertaken to alleviate the discrepancies between the current state-of-the-art care for RAI-refractory differentiated thyroid cancer and the present situation in Latin America.
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Affiliation(s)
- Fabian Pitoia
- Hospital de Clínicas José de San Martín - University of Buenos Aires, Buenos Aires, Argentina
| | - Rafael Selbach Scheffel
- Thyroid Unit, Medical School, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Department of Pharmacology, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Ines Califano
- Endocrinology Division, Instituto de Oncología AH Roffo, University of Buenos Aires, Buenos Aires, Argentina
| | - Alicia Gauna
- Endocrinology Division, Hospital Ramos Mejía, Gobierno Ciudad de Buenos Aires, Argentina
| | - Hernán Tala
- Centro de tiroides, Facultad de Medicina Clínica Alemana, Clínica Alemana de Santiago, Universidad del desarrollo, Santiago, Chile
| | - Fernanda Vaisman
- Onco endocrinology Service, Endocrinology Service, Faculdade de Medicina, Instituto Nacional do Cancer (INCa), Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Alejandro Roman Gonzalez
- Deparment of Internal Medicine, Endocrine Section, Universidad de Antioquia. Hospital Universitario San Vicente Fundación. Medellin, Medellín, Colombia
| | - Ana Oliveira Hoff
- Endocrine Oncology Unit, Instituto do Cancer do Estado de São Paulo (ICESP), Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil
| | - Ana Luiza Maia
- Thyroid Unit, Medical School, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
- Thyroid Unit, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos, Porto Alegre, RS, 2350 - CEP 90035-003, Brazil.
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Morosán Allo YJ, Bosio L, Morejón A, Parisi C, Faingold MC, Ilera V, Gauna A, Brenta G. Comparison of the prognostic value of AJCC cancer staging system 7th and 8th editions for differentiated thyroid cancer. BMC Endocr Disord 2022; 22:146. [PMID: 35650574 PMCID: PMC9158381 DOI: 10.1186/s12902-022-01054-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 05/20/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND In the last American Joint Committee on Cancer/Tumor, Node, Metastasis (AJCC/TNM) 8th edition (TNM8), several changes were introduced to this risk stratification system to improve the prognosis of differentiated thyroid cancer (DTC). AIM To validate the impact of TNM8 vs. TNM 7th edition (TNM7) in DTC in terms of predictive value in two hospitals from Buenos Aires, Argentina. METHODS Retrospective study of DTC patients from two institutions. Reclassification from TNM7 to TNM8, disease-specific survival (DSS), and final clinical outcomes at the end of follow-up (recurrent/persistent structural disease) (median 5 years) were analyzed. The proportion of variation explained (PVE) was used to compare the predictive capability of DSS of both classification systems. RESULTS Reclassification of 245 patients, aged (mean ± SD) 55 ± 15.36 years, 91% women, to TNM8 from TNM7 showed: 82% vs 57% stage I (SI), 10% vs 8.5% SII, 5% vs 22% SIII, 3% vs 12% SIV (p < 0.01). Forty percent of the population was downstaged with TNM8. Ten-year DSS rates for SI, SII, SIII and SIV in TNM7 were 100, 100, 100 and 74%, respectively and in TNM8: 97.6, 100, 100 and 37.5%, respectively. Out of 4 disease-specific deaths in SIV TNM7, one was subclassified to SI TNM8, corresponding to a 53-year-old patient with structural persistence. PVE for TNM8 (29%) was more than twice that of TNM7 (13%). CONCLUSION In this Argentinian DTC patients sample, it was confirmed that the new TNM8 classification is more accurate in predicting survival attributable to cancer than its previous version.
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Affiliation(s)
- Y. J. Morosán Allo
- Endocrinology Division, Cesar Milstein Hospital, CABA, Buenos Aires, Argentina
| | - L. Bosio
- Endocrinology Division, Cesar Milstein Hospital, CABA, Buenos Aires, Argentina
| | - A. Morejón
- Endocrinology Division, Cesar Milstein Hospital, CABA, Buenos Aires, Argentina
| | - C. Parisi
- Endocrinology Division, Cesar Milstein Hospital, CABA, Buenos Aires, Argentina
| | - M. C. Faingold
- Endocrinology Division, Cesar Milstein Hospital, CABA, Buenos Aires, Argentina
| | - V. Ilera
- Endocrinology Division Ramos Mejía Hospital, CABA, Buenos Aires, Argentina
| | - A. Gauna
- Endocrinology Division Ramos Mejía Hospital, CABA, Buenos Aires, Argentina
| | - G. Brenta
- Endocrinology Division, Cesar Milstein Hospital, CABA, Buenos Aires, Argentina
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Ilera V, Delfino LC, Zunino A, Glikman P, Drnovsek M, Reyes A, Dios A, Toibaro J, Pachioli V, Lannes N, Guida A, Gauna A. Correlation between inflammatory parameters and pituitary-thyroid axis in patients with COVID-19. Endocrine 2021; 74:455-460. [PMID: 34515958 PMCID: PMC8436010 DOI: 10.1007/s12020-021-02863-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 08/31/2021] [Indexed: 01/15/2023]
Abstract
PURPOSE Inflammation plays a critical role in the progression of COVID-19. Nonthyroidal illness syndrome (NTIS) has been increasingly recognized in affected patients. We aim to evaluate the correlation of thyroid hormones with markers of inflammation and association with disease outcome in hospitalized patients with COVID-19, and in two profiles of NTIS (low T3-normal/low FT4 vs. low T3-high FT4). METHODS consecutive patients admitted to a nonintensive care unit for COVID-19 were recruited. Infection was mild in 22%, moderate in 27.1% and severe in 50.8%; 7.41% died. T4, T3, FT4, FT3, and their ratios (T3/T4, FT3/FT4) were correlated with albumin, ferritin, fibrinogen, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), lactate dehydrogenase (LDH), and D-dimer. RESULTS Fifty five patients (50.9% men, median age 56 years) were included. Albumin correlated positively with T3 and hormones ratios, but negatively with FT4. T3, FT3, T3/T4, and FT3/FT4 correlated inversely with ferritin, fibrinogen, ESR, CRP, LDH, and D-dimer. FT4 showed direct correlation with fibrinogen and ESR. T3/T4 was lower in severe compared to mild/moderate disease [7.5 (4.5-15.5) vs. 9.2 (5.8-18.1); p = 0.04], and lower in patients who died than in those discharged [5 (4.53-5.6) vs. 8.1 (4.7-18.1); p = 0.03]. A low T3/high FT4 profile was associated with lower albumin, higher ferritin, and severity. CONCLUSION In this cohort, thyroid hormones correlated with inflammation and outcome. T3 and T3/T4 correlated inversely with inflammatory markers; a low T3/T4 ratio was associated with severity and poor prognosis. Patients with low T3 but high FT4 had higher ferritin, lower albumin, and more severe disease at presentation.
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Affiliation(s)
- Verónica Ilera
- Endocrinology Division, Hospital José María Ramos Mejía, Ciudad Autónoma de Buenos Aires, Argentina.
| | - Laura C Delfino
- Endocrinology Division, Hospital José María Ramos Mejía, Ciudad Autónoma de Buenos Aires, Argentina
| | - Anabela Zunino
- Endocrinology Division, Hospital José María Ramos Mejía, Ciudad Autónoma de Buenos Aires, Argentina
| | - Patricia Glikman
- Endocrinology Division, Hospital José María Ramos Mejía, Ciudad Autónoma de Buenos Aires, Argentina
| | - Mónica Drnovsek
- Endocrinology Division, Hospital José María Ramos Mejía, Ciudad Autónoma de Buenos Aires, Argentina
| | - Adriana Reyes
- Endocrinology Division, Hospital José María Ramos Mejía, Ciudad Autónoma de Buenos Aires, Argentina
| | - Alicia Dios
- Endocrinology Division, Hospital José María Ramos Mejía, Ciudad Autónoma de Buenos Aires, Argentina
| | - Javier Toibaro
- Internal Medicine Division, Hospital José María Ramos Mejía, Ciudad Autónoma de Buenos Aires, Argentina
| | - Valeria Pachioli
- Internal Medicine Division, Hospital José María Ramos Mejía, Ciudad Autónoma de Buenos Aires, Argentina
| | - Nayla Lannes
- Endocrinology Division, Hospital José María Ramos Mejía, Ciudad Autónoma de Buenos Aires, Argentina
| | - Alberto Guida
- Internal Medicine Division, Hospital José María Ramos Mejía, Ciudad Autónoma de Buenos Aires, Argentina
| | - Alicia Gauna
- Endocrinology Division, Hospital José María Ramos Mejía, Ciudad Autónoma de Buenos Aires, Argentina
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Eugenio Russmann ML, Delfino L, Fierro F, Santoro S, Peréz M, Caruso G, Glikman P, Gauna A, Lupi S. Hiperaldosteronismo primario: puntos de corte del cociente aldosterona/renina. ENDOCRINOL DIAB NUTR 2019; 66:361-367. [DOI: 10.1016/j.endinu.2018.11.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 10/24/2018] [Accepted: 11/05/2018] [Indexed: 11/16/2022]
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Ilera V, Dourisboure R, Colobraro A, Silva Croome MDC, Olstein G, Gauna A. [BRAF V600E mutation in thyroid nodules in Argentina]. Medicina (B Aires) 2016; 76:223-229. [PMID: 27576281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023] Open
Abstract
This prospective study analyzed the frequency of V600E mutation of oncogene BRAF in patients operated for benign thyroid nodules and for papillary thyroid cancer in an Argentine population. In patients with papillary thyroid cancer we compared clinicopathological characteristics between those harboring BRAF mutation and those without it. Twenty five consecutive patients operated for benign nodules and for papillary carcinoma were prospectively included. Fresh tissue samples of thyroid nodules and of adjacent thyroid parenchyma were obtained. DNA was extracted and amplified by amplification refractory mutation system polymerase chain reaction (ARMS PCR). Direct sequencing was performed in four samples. Of those patients operated for papillary thyroid cancer, 77% harbored BRAF mutation. All samples from adjacent thyroid parenchyma and from patients operated for benign nodules tested negative for the mutation. Direct sequencing confirmed the results obtained by ARMS PCR. Patients with BRAF mutation were significantly older at the time of diagnosis (BRAF+ 47.7 ± 12.7 years vs. BRAF- 24.7 ± 8.1 years, p < 0.01). Nine out of ten papillary carcinomas with BRAF mutation corresponded to the classic histological subtype, which was not observed in BRAF negative tumors (p < 0.02). In conclusion, we found a high frequency of BRAF V600E mutation in this population of patients operated for papillary thyroid carcinoma in Argentina. These results are consistent with those reported in the literature.
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Affiliation(s)
- Verónica Ilera
- División Endocrinología, Hospital General de Agudos José María Ramos Mejía, Buenos Aires, Argentina. E-mail:
| | - Ricardo Dourisboure
- Sección Biología Molecular, División Laboratorio Central, Hospital General de Agudos José María Ramos Mejía, Buenos Aires, Argentina
| | - Antonio Colobraro
- División Anatomía Patológica, Hospital General de Agudos José María Ramos Mejía, Buenos Aires, Argentina
| | | | - Gustavo Olstein
- División Cirugía. Hospital General de Agudos José María Ramos Mejía, Buenos Aires, Argentina
| | - Alicia Gauna
- División Endocrinología, Hospital General de Agudos José María Ramos Mejía, Buenos Aires, Argentina
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Gauna A, Losada S, Lorenzo M, Bermúdez H, Toledo M, Pérez H, Chacón E, Noya O. Synthetic peptides for the immunodiagnosis of hepatitis A virus infection. J Immunol Methods 2015; 427:1-5. [PMID: 26321053 DOI: 10.1016/j.jim.2015.08.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 08/21/2015] [Accepted: 08/25/2015] [Indexed: 11/17/2022]
Abstract
VP1, VP2 and VP3 molecules of hepatitis A virus are exposed capsid proteins that have shown to be antigenic and are used for diagnosis in recombinant-antigen commercial kits. In this study, we developed a sequence analysis in order to predict diagnostic peptide epitopes, followed by their spot synthesis on functionalized cellulose paper (Pepscan). This paper with synthetic peptides was tested against a sera pool of hepatitis A patients. Two peptide sequences, that have shown an antigenic recognition, were selected for greater scale synthesis on resin. A dimeric form of one of these peptides (IMT-1996), located in the C-Terminus region of protein VP1, was antigenic with a recognition frequency of 87-100% of anti-IgG antibodies and 100% of anti-IgM antibodies employing the immunological assays MABA and ELISA. We propose peptide IMT-1996, with less than twenty residues, as a cheaper alternative for prevalence studies and diagnosis of hepatitis A infection.
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Affiliation(s)
- A Gauna
- Sección de Biohelmintiasis, Instituto de Medicina Tropical, Facultad de Medicina, UCV, Caracas, Venezuela.
| | - S Losada
- Sección de Biohelmintiasis, Instituto de Medicina Tropical, Facultad de Medicina, UCV, Caracas, Venezuela.
| | - M Lorenzo
- Sección de Biohelmintiasis, Instituto de Medicina Tropical, Facultad de Medicina, UCV, Caracas, Venezuela.
| | - H Bermúdez
- Sección de Biohelmintiasis, Instituto de Medicina Tropical, Facultad de Medicina, UCV, Caracas, Venezuela.
| | - M Toledo
- Cátedra de Parasitología, Escuela de Medicina "Luis Razetti", Universidad Central de Venezuela, Venezuela.
| | - H Pérez
- Departamento de Virología, Instituto Nacional de Higiene-INH "Rafael Rangel", Venezuela.
| | - E Chacón
- Departamento de Virología, Instituto Nacional de Higiene-INH "Rafael Rangel", Venezuela.
| | - O Noya
- Sección de Biohelmintiasis, Instituto de Medicina Tropical, Facultad de Medicina, UCV, Caracas, Venezuela; Centro para Estudios Sobre Malaria, Instituto de Altos Estudios "Dr. Arnoldo Gabaldón" INH-Ministerio del Poder Popular para la Salud, Caracas, Venezuela.
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Gauna A, Messuti H, Papadopulos G, Benchuga G, Viale F, Marlowe RJ, Silva Croome MC. Acute and chronic hypothyroidism are associated with similar left ventricular diastolic dysfunction relative to the euthyroid state: results of doppler echocardiographic comparisons. J Endocrinol Invest 2011; 34:e281-6. [PMID: 21597313 DOI: 10.3275/7740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
Abstract
BACKGROUND How the duration of hypothyroidism affects left ventricular diastolic function is not well-characterized. AIM We sought to compare left ventricular diastolic function in acutely vs chronically hypothyroid patients vs euthyroid controls, and within individuals while on vs off T4. SUBJECTS AND METHODS We prospectively performed such comparisons measuring pulsed-wave and color M-mode Doppler echocardiographic variables: early or late mitral peak velocities (E wave or A wave, respectively), E wave/A wave ratio, E wave deceleration time, isovolumic relaxation time (IVRT), mitral flow propagation velocity (Vp), E wave/Vp ratio. Subjects comprised the acute HYPO group, 10 patients undergoing T4 withdrawal ≥ 6 months post-primary treatment for differentiated thyroid cancer (DTC); the chronic HYPO group, 23 treatment-naïve Hashimoto thyroiditis patients; and 21 healthy euthyroid controls. Subjects were adults aged ≤ 60 yr, predominantly female, with sinus rhythm; exclusion criteria were cardiovascular or thyroid disorder besides DTC (Hashimoto thyroiditis) in acute (chronic) HYPO patients or medication (besides thyroid hormone) affecting cardiac or thyroid function. RESULTS Mean IVRT was significantly delayed and mean Vp, significantly slowed in both HYPO groups vs controls (p<0.0005), but did not differ between HYPO groups. These variables also were significantly impaired (p<0.05) within individuals when off vs on T4 (no.=8 acute, 10 chronic HYPO patients). Both HYPO groups had elevated mean E wave/Vp ratios vs controls, but the elevation reached significance (p<0.05) only in the larger chronic HYPO group. CONCLUSIONS Left ventricular diastolic dysfunction is largely similar in acutely or chronically hypothyroid patients off T4 vs healthy controls or the same patients on T4.
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Affiliation(s)
- A Gauna
- Division of Endocrinology, Ramos Mejía Hospital, 1405 Buenos Aires, Argentina.
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Camargo R, Corigliano S, Friguglietti C, Gauna A, Harach R, Munizaga F, Niepomniszcze H, Pitoia F, Pretell E, Vaisman M, Ward LS, Wohllk N, Tomimori E. Latin American Thyroid Society recommendations for the management of thyroid nodules. ACTA ACUST UNITED AC 2009; 53:1167-75. [DOI: 10.1590/s0004-27302009000900014] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2009] [Accepted: 10/10/2009] [Indexed: 01/08/2023]
Abstract
Several guidelines on diagnosis and treatment of thyroid nodules and cancer have recently been published. However, recommended practices are not always appropriate to different settings or countries. The aim of this consensus was to develop Clinical Guidelines for evaluation and management of patients with thyroid nodules applicable to Latin American countries. The panel was composed by 13 members of the Latin American Thyroid Society involved with research and management of thyroid nodules and cancer from different medical centers in Latin America. The consensus was produced based on the expert opinion of the panel with use of principles of evidence-based medicine. Following a group meeting, a first draft based on the expert opinion of the panel was elaborated and later circulated among panel members for further revision. After revision, this document was submitted to all LATS members for commentaries and considerations and finally revised and refined by the authors. The final recommendations represent state of the art on management of thyroid nodules applied to all Latin American countries.
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Pitoia F, Ward L, Wohllk N, Friguglietti C, Tomimori E, Gauna A, Camargo R, Vaisman M, Harach R, Munizaga F, Corigliano S, Pretell E, Niepomniszcze H. Recommendations of the Latin American Thyroid Society on diagnosis and management of differentiated thyroid cancer. ACTA ACUST UNITED AC 2009; 53:884-7. [DOI: 10.1590/s0004-27302009000700014] [Citation(s) in RCA: 112] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2009] [Accepted: 08/11/2009] [Indexed: 01/03/2023]
Abstract
The aims of these recommendations were to develop clinical guidelines for evaluation and management of patients with differentiated thyroid cancer applicable to Latin American countries. The panel was composed by 13 members of the Latin American Thyroid Society (LATS) involved with research and management of thyroid cancer from different medical centers in Latin America. The recommendations were produced on the basis of the expert opinion of the panel with use of principles of Evidence-Based Medicine. Following a group meeting, a first draft based on evidences and the expert opinions of the panel was elaborated and, later, circulated among panel members, for further revision. After, this document was submitted to the LATS members, for commentaries and considerations, and, finally, revised and refined by the authors. The final recommendations presented in this paper represent the state of the art on management of differentiated thyroid cancer applied to all Latin American countries.
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Affiliation(s)
| | - Laura Ward
- Universidade Estadual de Campinas, Brasil
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Rivolta CM, Olcese MC, Belforte FS, Chiesa A, Gruñeiro-Papendieck L, Iorcansky S, Herzovich V, Cassorla F, Gauna A, Gonzalez-Sarmiento R, Targovnik HM. Genotyping of resistance to thyroid hormone in South American population. Identification of seven novel missense mutations in the human thyroid hormone receptor beta gene. Mol Cell Probes 2009; 23:148-53. [PMID: 19268523 DOI: 10.1016/j.mcp.2009.02.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2008] [Revised: 02/18/2009] [Accepted: 02/18/2009] [Indexed: 10/21/2022]
Abstract
Thyroid Hormone Receptor beta (THRB) defects, typically transmitted as autosomal dominant traits, cause Resistance to Thyroid Hormone (RTH). We analyzed the THRB gene in thirteen South American patients with clinical evidence RTH from eleven unrelated families. Sequence analysis revealed seven novel missense mutations. Four novel mutations were identified in exon 9. The first, a c.991A>G transition which originates a substitution of asparagine by aspartic acid (p.N331D). The second nucleotide alteration consists of a guanine to cytosine transversion at position 1003 (c.1003G>C) and results in substitution of the alanine at codon 335 by proline (p.A335P). The third mutation, a c.1022T>C transition produces a change of leucine by proline (p.L341P). The fourth mutation detected in exon 9 was a c.1036C>T transition which replaces the leucine at codon 346 by phenylalanine (p.L346F). The sequencing of the exon 10 detected three novel missense mutations. The first, a c.1293A>G transition changing isoleucine 431 for methionine (p.I431M). The second, the cytosine at position 1339 was replaced by adenine (c.1339C>A) resulting in the replacement of proline by threonine (p.P447T). The third mutation detected in exon 10 was a c.1358C>T transition resulting in the substitution of proline at codon 453 by leucine (p.P453L). Finally, sequencing analysis of the THRB gene revealed three substitutions previously described (p.A268G, p.P453T and p.F459C). The p.P453T was found in two patients. In conclusion, we report thirteen patients with RTH caused by heterozygous mutations of the THRB gene. Seven of the identified mutations correspond to novel substitutions.
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Affiliation(s)
- Carina M Rivolta
- Laboratorio de Biología Molecular, Cátedra de Genética y Biología Molecular, Facultad de Farmacia y Bioquímica, Universidad de Buenos Aires, Buenos Aires, Argentina.
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Abstract
UNLABELLED Humoral immunological differences and the relation between circulating immune complexes (CIC) and the thyrotropin-receptor antibody (TRAB) were evaluated in newly diagnosed (n = 30), relapsed (n = 27) and remission patients (n = 29) with Graves' disease. CIC were assessed by C1q-binding assay (CIC-C1q) and the PEG precipitation test (CIC-PEG); TRAb by the radioreceptor method and microsomal antibody (MAb) by passive hemagglutination test. The data were expressed as mean +/- SE. No difference was observed in the CIC-C1q among newly diagnosed, relapsed and remission patients, but they were elevated vs controls (p less than 0.01, less than 0.05, less than 0.05, respectively). In newly diagnosed subjects with positive TRAb, CIC were higher than in those with negative TRAb (p less than 0.05) and also higher than in relapsed patients with positive TRAb (p less than 0.05). In newly diagnosed group CIC-C1q correlated to TRAb presence but not to TRAb values. CIC-PEG and TRAb levels were similar in newly diagnosed and relapsed patients, being higher than in controls (p less than 0.01) and in remission patients (p less than 0.01). No significant differences were observed in MAb in any of the groups. CONCLUSIONS i) Patients in remission were immunologically active and they differed from newly diagnosed and relapsed patients by CIC-PEG and TRAb values; ii) in hyperthyroid patients with positive TRAb, CIC-C1q were higher at the initial stage of the disease; iii) A direct correlation between CIC-C1q and TRAb presence was observed in newly diagnosed patients, but no relation could be seen in the other groups.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- A Gauna
- División Endocrinología, Hospital Ramos Mejía, Buenos Aires, Argentina
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Abstract
The water diffusional permeability, its activation energy and the lipid composition were studied in urinary bladders from toads adapted to different temperatures. It was observed that the unidirectional water flux greatly depends on the temperature at which the experiments are performed. This dependence is greater in the animals adapted to higher temperatures. Toads adapted to cold show strong reduction in the activation energy for water diffusion permeability (from 11.4+/-1.9 kcal-mol-1 to 4.4+/-1.1kcal-mol-1) and an increase of 30% in the amount of total lipids from bladder epithelial cells. There were no significant changes in the phospholipid/cholesterol ratio, composition of the parafinic chains or protein concentration between toads adapted to both temperatures. The possibility that water translocates through the mucosal border of the toad bladder by partitioning in the polar zone and diffusioning between the hydrocarbon chains of the membrane lipids and that cold adaptation would induce a stronger "packing" of lipids in the membrane is discussed.
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