Session: SAT 449-497-Thyroid Neoplasia & Case Reports
Poster Board SAT-491
Cases Report:The first case is a 28-year-old male patient who began medical monitoring due to palpitations, oscillating between insomnia and sleepiness as hyperthyroidism and was treated with anti-thyroid drug (ATD) that stopped after eight years without medical advice. At 38 came our hospital with palpitations and was evidenced TSH 8.4 µUI /ml (0.27 - 4.2), FT4 3.34 ng/dl (1.0 - 1.7), FT3 3,0 ng/dl (0,25-0,45), USG (ultrasonography) with multinodular goiter, scintigraphy uptake suggestive of diffuse goiter, subunit α without change, anti-thyroid antibodies were not reactive (NR), Magnetic Resonance Imaging (MRI) of the sela changes without being chosen to β-blocker to control sinus tachycardia. The other case, a 35-year-old female, was diagnosed with hyperthyroidism and made use of ATD for 3 months it stopped without medical advice. At 37 she was referred to hospital due paroxysmal tachycardia and research evidenced TSH 2.65 µUI/ml, FT4 3.03 ng/dl, T3 246 ng/dl (40-180), USG of normal thyroid, thyroid scintigraphy with uptake, Anti-thyroid NR, Sub-unit α and MRI of sela without changes being chosen to maintain without medication because the patient was asymptomatic.
Conclusion:These reports emphasize the clinical importance and suspicion of the RHT diagnosis. The differential diagnosis is essential for therapeutic decision since the TSH-producing adenoma should be surgically treated and asymptomatic RTH patients are not candidates for treatment. When symptomatic, whose main symptom is tachycardia, β-blocker can be used, but if there is a predominance of symptoms of hypothyroidism treatment with high doses of 5,3-Triiodothyroacetic Acid is more effective, and there is no ATD indication in RHT or TSH-producing adenoma.
Nothing to Disclose: MRNC, GLPA, KMF, DDRP, RAG, ESP, LMS, AMCV
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