Struma ovarii is a rare variant of teratoma characterized by the presence of thyroid tissue in more than 50%. Malignant transformation is rare (less than 5%) and the criteria to classify this condition have changed over time. Nowadays it must fulfill the histological categories of differentiated thyroid carcinoma. Its treatment is controversial and there is no unanimous management. We present three cases of women with malignant struma ovarii, diagnosed by the surgical specimen.

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Phantom hCG refers to persistent mild elevations of hCG, leading physicians to unnecessary treatments whereas neither a true hCG nor a trophoblastic disease is present. We report the case of a 23-year-old woman with persistent low levels of serum hCG detected one month after miscarriage. As choriocarcinoma was suspected, a chemotherapy trial of methotrexate was prescribed, without any hCG reduction. Subsequently, laparoscopy ruled out a trophoblastic residue and the patient was referred to the Endocrine Unit for further investigations. While low levels of hCG were still detected in serum, no hCG was detected in the urine. In addition, when serum was processed in a HBT tube for revealing heterophilic antibodies, hCG was no longer detected. Such finding indicated the presence of phantom hCG due to heterophilic mouse antibodies interaction. This case raises the need of clinico-biological discussion to avoid inappropriate therapeutic decisions. Based on this case experience and after review of the literature, we suggest that current gynecological protocols for the diagnosis and treatment of trophoblastic disease should consider the inclusion of urinary hCG and/or a test for serum heterophilic antibodies when appropriate.

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Background and Aims: “T-Coach® program” is a telephone support platform for type 2 diabetes (T2D) on glargine U300 insulin. This study aimed to evaluate whether this program was effective in helping patients reach their optimal insulin dose. Materials and Methods: Both T2D patients who were initiating glargine U300 or requiring dose titration, enrolled in T-Coach® program, were included in the study. Telephone intervention was delivered by diabetes nurse educators and consisted of regular telephone sessions, aimed at achievement of target fasting blood glucose (FBG) and reinforce diabetes education. The optimal insulin dose (OID) was defined as the dose of Glargine U300 required to achieve target FBG. The primary outcome was whether a patient reached the OID dose within 6 months. Results: A total of 589 patients consented and were included in TCoach program®. Median age was 65.4±11.2 years; 51.8% men; BMI 30.3±6 kg/m2. Of them, 65.9% were already on basal insulin (17.7% on Glargine U300). Mean glargine U300 dose was 27.4±15.9 UI. Mean baseline HbA1c was 9.4±1.8%, and basal FBG was 215.2±66.2 mg/dL. Mean FBG target was 88.7-132.3 mg/dl. Of them, 77.6% reached their OID at 6 months (75.7% at 3 months, and 41.2% at 1 month), and they did so in an average of 2.2±1.8 months. Mean FBG levels fell from 215.2 mg/dL to 137.9 mg/dL, 117.9 mg/dL and 115.9 mg/dL at months 1,3 and 6, respectively. Mean glargine U300 dose increased from 27.4 UI to 30.4 UI at month 6. Knowledge and adherence questionnaires were given to the patients. Mean score in knowledge questionnaire increased from 4.8 to 7.6 after the program. Moreover, a satisfaction survey was completed by 208 patients. The program was very well graded, with an average score of 9.1 out of 10. Conclusion: The T-Coach® program is an effective way to help patients reach their optimal insulin glargine U300 dose, improves glycemic control and can be an effective support for diabetes education. Disclosure D. Bellido Guerrero: None. V. Bellido: None. C. Morales: Other Relationship; Self; AstraZeneca, Janssen Pharmaceuticals, Inc., Lilly Diabetes, Merck Sharp & Dohme Corp., Novo Nordisk A/S, Sanofi. J. García: None. A. Muñoz-Garach: Speaker's Bureau; Self; Lilly Diabetes, Novo Nordisk A/S, Sanofi-Aventis. J.L. Fernandez Morera: None. B. Gonzalez Aguilera: None. M. López de la Torre: None. P. Fuentealba: Employee; Self; Sanofi.