The aim of this study is to investigate the long-term (9 months) effects of variable doses (200/100 mg/day) of L-selenomethionine on autoimmune thyroiditis (AIT) and the parameters affecting the success rate of this therapy. The present study was designed in three steps: (1) 88 female patients with AIT (mean ageZ40$1G13$3 years) were randomized into two groups according to their initial serum TSH, thyroid peroxidase antibody (TPOAb) concentrations, and age. All the patients were receiving L-thyroxine to keep serum TSH%2 mIU/l. Group S2 (nZ48, mean TPOAbZ803$9G483$8 IU/ml) received 200 mg L-selenomethionine per day, orally for 3 months, and group C (nZ40, mean TPOAbZ770$3G 406$2 IU/ml) received placebo. (2) 40 volunteers of group S2 were randomized into two age-and TPOAb-matched groups. Group S22 (nZ20) went on taking L-selenomethionine 200 mg/day, while others (group S21) lowered the dose to 100 mg/day. (3) 12 patients of group S22 (group S222) went on taking L-selenomethionine 200 mg/day, while 12 patients of group S21 (S212) increased the dose to 200 mg/day. Serum titers of TPOAb decreased significantly in group S2 (26$2%, P!0$001), group S22 (23$7%, P!0$01) and group S212 (30$3%, P!0$01). There were no significant changes in group C and group S222 (PO0$05). TPOAb titers increased significantly in group S21 (38$1%, P!0$01). A significant decrease in thyroglobulin antibody titers was only noted in group S2 (5$2%, P!0$01). L-selenomethionine substitution suppresses serum concentrations of TPOAb in patients with AIT, but suppression requires doses higher than 100 mg/day which is sufficient to maximize glutathione peroxidase activities. The suppression rate decreases with time.

Measuring basal neutrophil counts may be considered as an alternative solution in the prediction of infarct size.

As far as we can ascertain, this is the first report of a radioiodine-accumulating cystadenofibroma. The mechanism for radioiodine accumulation in this patient's tumor is unclear.

No abstract

We read with interest the recently published article concerning recommended management guidelines for patients with medullary thyroid cancer (MTC) (1). In the suggested algorithm for the evaluation of MTC, it is stated that ultrasonography is the most sensitive method to detect metastases in the neck; computed tomography (CT) is the most sensitive method to detect lung and mediastinal lymph node metastases; and calcitonin (Ct) doubling time (DT) and the carcinoembryonic antigen (CEA) DT are better predictors of tumor progression than the fluorodeoxyglucose positron emission tomography (FDG PET) maximum standardized uptake value (SUVmax) (1). In our opinion, these recommendations are mainly based on many old references, and we may need to update clinical algorithm according to the current data.The recent developments of hybrid machines (PET=CT) allow to obtain images that simultaneously contain both anatomic (CT) and functional (PET) information, therefore having great impact on diagnostic efficacy. Functional status of lesions detected by CT can also be evaluated by the PET component. So it is clear that, in the detection of primary or metastatic lesions, PET=CT is much more sensitive than the sum of either component. Further, new radiopharmaceuticals allow for increased sensitivity of PET=CT in the evaluation of MTC.Like other neuroendocrine tumors (NETs), MTC is characterized by the presence of amine uptake mechanisms and=or peptide receptors at the cell membrane, allowing the clinical use of specific radiopharmaceuticals that reflect the different metabolic pathways of MTC. In particular we refer to the synthesis, storage, and release of the hormones [(18)F-dihydroxyphenilalanine, (18)F-DOPA, and (18)Ffluorodopamine, (18)F-FDA) and the expression of certain receptors such as (68)Ga-labeled somatostatin analogs] (2).Kauhanen et al. reported that, for the NETs located in the head-neck-thoracic region, the overall accuracy of (18)F-DOPA PET=CT was 89% including 12 cases of recurrent MTC with a sensitivity of 90%. In analysis of patients with biochemical proof of disease combined with negative conventional imaging methods, PET=CT had positive and negative predictive values of 92% and 95%, respectively. (18)F-DOPA PET=CT provided important additional information in the diagnosis of pheochromocytoma and restaging of known NET. Both in primary diagnosis and in patients with formerly known NET and increasing tumor markers, (18)F-DOPA PET=CT is a sensitive first-line imaging method (3). Koopmans et al. also documented the superiority of (18)F-DOPA PET to (18)F-FDG PET, dimercaptosuccinic acid-V, and morphologic imaging modalities (CT=magnetic resonance imaging). It is reported that MTC lesions are best detectable when serum Ct is >5004 ng=L and with short Ct DT (12 months); (18)F-FDG PET may be superior (4).In another prospective multicentric study, a total of 33 patients with mean CEA and Ct DTs of 1.90 years (range 0.21-8.50) and 1.52 years (range 0.09-6.01), respectively, were evaluated. The sensitivity of FDG PET=C...