Medullary thyroid carcinoma (MTC) is a rare tumor and accounts for 5-10% of thyroid cancers. Tuberous sclerosis (TS) is a complex autosomal dominant neurocutaneous syndrome. In literature, a few endocrine neoplasias have been reported in association with TS, but never a case of TS associated with sporadic MTC. We describe a unique case, which has never been reported previously, of MTC associated with TS. The MTC up to today has been associated with other endocrine neoplasia, and TS increases risk of neoplasia in various organs. The case reported shows one more circumstance and suggests thyroid screening in patients with diagnosis of TS.
Serum thyroglobulin levels measurement after injection of recombinant human thyrotropin (rh-TSH) represents the most important advance in the follow-up of patients with differentiated thyroid cancer, obtaining TSH elevation without L-thyroxine withdrawal, avoiding marked hypothyroidism symptoms. During a 4-yr period (2004-2008), 66 consecutive patients with DTC (59 papillary and 7 follicular carcinomas) were examined after rh-TSH Tg test and neck ultrasonography. In all patients basal Tg was <0.25 ng/ml. In twelve (18.5%) examined patients rh-TSH Tg was >0.25 ng/ml, and in seven (58.3%) of these was demonstrated persistent or recurrent disease. These data indicate that rhTSH-Tg>0.25 ng/ml should be considered diagnostic for persistent or recurrent disease and suggests further exams (neck ultrasonography, whole body scan or cytology) to localize the disease. Furthermore, neck ultrasonography has demonstrated high accuracy in detecting lymph nodal metastases and should be always combined with rh-TSH test.
BackgroundPericardial involvement is sporadic during pregnancy and pericarditis is the most common pericardial disease requiring medical therapy.ObjectivesThe aim was to evaluate the management and outcome of recurrent pericarditis during pregnancy.MethodsThe study included 18 pregnancies in 12 women with a history of pericarditis (mean maternal age 31.4 years, mean gestational age 38.82 weeks). These pregnancies were collected in 3 Italian centers from 2002 to 2015.ResultsTwelwe pregnancies ended with a live births, two spontaneous abortions occurred within the first ten weeks, one fetal death al 19TH weeks while 3 pregnancies are ongoing. Corticosteroids were used in twelwe women, nine were also treated with aspirin: six at low dose and continued till delivery, four at high dose; only one continued high dose after gestational week 20. Indomethacin was used in one patient and stopped at gestational week 19; one patient was on colchicine. Five pregnancies were uneventful, in six (33%) recurrences occurred. Recurrences were treated by adding acetaminophen in five cases and ibuprofen in one; in four patients the dose of corticosteroids and aspirin were started/increased. One HELLP syndrome was observed, and one woman experienced mild hypertension and elevation of transaminase. All the infants had a good outcome (mean birth weight 2996g, 6 males). Five recurrences occurred after delivery, three during the puerperium.ConclusionsIn women with a history of pericardial diseases, pregnancy should be accurately planned in a period of disease quiescence. Nonselective cyclooxygenase inhibitors and aspirin can be safely used during the first and second trimester but should be withdrawn after gestational week 20 for the risk of ductus constriction. When corticosteroids are needed they are safe when used at low dosages.The effects of colchicine during pregnancy are only studied in patients with familial Mediterranean fever condition in which it appeared to be safe. Nowadays the general outcomes of pregnancies in patients with pericarditis can be similar to the general population, especially when carefully followed by multidisciplinary teams. A rheumatological approach to these pregnancies was safe and effective.ReferencesImazio M, Brucato A, Belli R, Forno D, Ferro S, Trinchero R, Adler Y. Colchicine for the prevention of pericarditis: what we know and what we do not know in 2014 - systematic review and meta-analysis. J Cardiovasc Med (Hagerstown). 2014 Dec;15(12):840-6.1)Imazio M, Belli R, Brucato A, Cemin R, Ferrua S, Beqaraj F, Demarie D, Ferro S, Forno D, Maestroni S, Cumetti D, Varbella F, Trinchero R, Spodick DH, Adler Y. Efficacy and safety of colchicine for treatment of multiple recurrences of pericarditis (CORP-2): a multicentre, double-blind, placebo-controlled, randomised trial. Lancet. 2014 Jun 28;383(9936):2232-7.Imazio M, Brucato A, Adler Y. A randomized trial of colchicine for acute pericarditis. N Engl J Med. 2014 Feb 20;370(8):781.Imazio M, Spodick D.H., Brucato A., Trinchero R., Adler Y. Controversial issue in...
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