SUMMARYAlthough hypothyroidism is associated with an increased prevalence of psychiatric manifestations, myxedema madness is rarely observed. We report the case of a 62-year-old woman with no prior history of psychiatric disorders, who presented to the emergency department with psychomotor agitation 6 weeks after total thyroidectomy for papillary thyroid cancer. Serum thyroid stimulating hormone (TSH) on admission was 62.9 mIU/L and free T4 was < 0.35 ng/dL, indicating severe hypothyroidism. After ruling out other possible causes, the diagnosis of myxedema madness was considered; hence, antipsychotic drug treatment and intravenous levothyroxine were prescribed. Behavioral symptoms returned to normal within 4 days of presentation, while levels of thyroid hormones attained normal values 1 week after admission. Recombinant TSH (Thyrogen ® ) was used successfully to prevent new episodes of mania due to thyroid hormone withdrawal in further controls for her thyroid cancer. This case illustrates that myxedema madness can occur in the setting of acute hypothyroidism, completely reverting with levothyroxine and antipsychotic treatment. Recombinant TSH may be a useful tool to prevent myxedema madness or any severe manifestation of levothyroxine withdrawal for the follow-up of thyroid cancer.

Background American Thyroid Association (ATA) low‐intermediate‐risk papillary thyroid cancer (PTC) patients without structural and biochemical evidence of disease on initial post‐treatment evaluation have a low risk of recurrence. Studies have shown that with current ultrasound scans (US) and thyroglobulin assays, recurrences mostly occurred 2‐8 years after initial therapy. The ATA recommends that neck US be done 6‐12 months after surgery to establish patient's response to therapy, then periodically depending on risk of recurrence. The lack of clarity in recommendations on timing of follow‐up US and fear of recurrence leads to frequent tests. Objectives To evaluate the utility of routine neck US in ATA low‐intermediate‐risk PTC patients with no structural disease on neck US and non‐stimulated thyroglobulin <1.0 ng/mL after initial therapy. Methods A retrospective study of 93 patients from Singapore, Saudi Arabia and Argentina with ATA low (n = 49) to intermediate (n = 44) risk PTC was conducted between 1998 and 2017. The outcome was to measure the frequency of identifying structural disease recurrence and non‐actionable US abnormalities. Results Over a median follow‐up of 5 years, five of the 93 patients (5.4%) developed structural neck recurrence on US at a median of 2.5 years after initial treatment. Indeterminate US abnormalities were detected in 19 of the 93 patients (20.4%) leading to additional tests, which did not detect significant disease. Conclusion In ATA low‐intermediate‐risk PTC with no suspicious findings on neck US and a non‐stimulated thyroglobulin of <1.0 ng/mL after initial therapy, frequent US is more likely to identify non‐actionable abnormalities than clinically significant disease.

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.

Introducción: durante la consulta diabetológica estándar, la disponibilidad de retinografía no midriática (esto significa sin dilatación de la pupila del paciente) podría mejorar las tasas de detección de retinopatía diabética (RD). Este método de detección, además de evitar todos los inconvenientes asociados con la dilatación pupilar, permite el análisis inmediato de las imágenes digitales instantáneas y/o su envío para evaluación especializada mediante telemedicina, resultando además costo efectivo.Objetivos: determinar la frecuencia de RD con un retinógrafo no midriático mediante la implementación de telemedicina asincrónica y evaluar factores asociados con RD.Materiales y métodos: estudio transversal que incluyó pacientes >=18 años con diabetes que acudieron a control diabetológico en un centro médico en Buenos Aires entre agosto y diciembre de 2019. Se excluyeron pacientes con diabetes tipo 1 o post trasplante de menos de 5 años de evolución o con opacidades de los medios que impidieran la adquisición de imágenes de fondo de ojo. El Comité de Revisión y Ética institucional aprobó el protocolo de estudio. Todos los participantes dieron su consentimiento informado por escrito. Las retinografías se obtuvieron por profesionales diabetólogos durante la visita médica, mediante cámara de retina no midriática de 60° (Eidon®) y posteriormente enviadas vía electrónica a un único especialista en retina para su análisis definitivo. En pacientes con y sin RD se evaluaron: niveles de A1c, duración de diabetes, índice de masa corporal (IMC), frecuencia de hipertensión y dislipemia. Variables cualitativas descritas en frecuencia absoluta y/o porcentaje, variables cuantitativas en mediana/rango intercuartilo acorde su distribución. Pruebas no paramétricas y el test de Fisher se usaron para analizar diferencias.

Introducción: la diabetes mellitus (DM) es una complicación del trasplante de órgano sólido y generalmente es tratada con insulina; recientemente han sido implementadas nuevas terapéuticas con buenos resultados.Objetivos: describir y evaluar tipo de tratamiento farmacológico para diabetes en pacientes sometidos a trasplante de órgano sólido, así como su impacto en el control glucometabólico.Materiales y métodos: estudio observacional, retrospectivo que incluyó pacientes con trasplante de órgano sólido con diagnóstico reportado de DM post trasplante o DM pre trasplante, que concurrieron a control médico en un período de tiempo comprendido entre 7/2015 y 8/2019. Se excluyeron pacientes con menos de 2 visitas de control en un período de 2 años desde la primera consulta. Se evaluaron niveles de HbA1c y tasa de filtrado glomerular estimada (TGFe) calculada mediante la ecuación CKD-EPI. Se describió la tasa de cambio de la terapia inmunosupresora y tratamiento farmacológico de la diabetes a los 3, 6, 12, 18 y 24 meses de seguimiento. Las variables cualitativas se describen en frecuencia absoluta/porcentaje y las variables cuantitativas en mediana/rango acorde su distribución. Pruebas no paramétricas y el test de Fisher se emplearon para analizar diferencias.