ACTA ENDOCRINOLOGICA (BUC)

Background. In most type 1 and mixed forms of amiodarone-induced thyrotoxicosis (AIT), after restoration of euthyroidism and whether amiodarone can be withdrawn, an ablative therapy (thyroidectomy or radioiodine) is required. Radioiodine ablation of the thyroid was reported to prevent recurrence of AIT after amiodarone reintroduction.\r\nAims. To assess the efficacy and safety of radioiodine treatment in type 1 and mixed forms of AIT.\r\nPatients and methods. 9 patients (6M/3F) with type 1 and mixed form of AIT, mean age 62.2 ? 13.3 years (range: 50-85 years), pretreated with methimazole, received radioiodine treatment. The underlying thyroid disease was Graves disease (n= 5), toxic multinodular goiter (n= 3) and toxic adenoma (n=1). TSH, total T3, total T4, free T4, TPOAb were measured by radioimmunoassay; radioiodine uptake, thyroid ultrasonography, color flow Doppler ultrasonography were performed.\r\nResults. Multiple radioiodine doses were required in 4 out of 9 patients. Pretreatment 24 hours radioiodine uptake exceeded 10% in 12 out of 16 doses. Mean cumulative dose was 23.17 ? 17.48 mCi 131I (range 6-50 mCi). The period between amiodarone withdrawal and 131I administration was 11.72 ? 12.45 months (range: 2-41 months). Mean cumulative 131I dose was higher in AIT due to toxic multinodular goiter and toxic adenoma (30.25 ? 20.09, range: 11-50 mCi) versus Graves disease (17.5 ? 14.76, range: 6.5-40 mCi). In one patient with toxic adenoma, thyroidectomy was contraindicated due to a comorbidity-central core disease - a non-progressive congenital myopathy, associated with an increased risk for malignant hyperthermia. Hypothyroidism occurred in all patients but one (euthyroid), within 14 ? 3 months (range: 5-27) after the first radioiodine dose. Sinus rhythm was restored in 3 out of 5 patients. One case of radiation thyroiditis occurred after a single 6.5 mCi 131I dose.\r\nConclusion. Radioiodine ablation therapy is an effective and safe alternative in patients with type 1 and mixed forms of amiodarone-induced thyrotoxicosis. Since amiodarone should need sometimes to be restarted, post radioiodine hypothyroidism should be viewed as a goal rather than a complication.

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Context. Abuse of topical steroids on the face for long periods of time is a condition that needs time to cure and also methods to better observe the clinical features and for the follow-up after the cessation of steroids. Objectives. To investigate which are the most prominent dermoscopic features of the Topical Steroid Induced Facial Rosaceiform Dermatitis(TSIFRD). Results. All 40 patients showed telangiectasias (100%) and dermoscopic polygonal vessels. 80% of the patients had dermoscopic features for Demodex Folliculorum, 80% had visible and dermoscopic pustules, 75 % had visible erythema on the face and by dermoscopy they all had red diffuse areas. The atrophy was clinically visible at 4 patients (Fig. 1a) as a severe skin thinning, but dermoscopy revealed also atrophic areas at another 4 as white structureless areas between vessels (Fig. 1b). The patients with dermoscopic atrophy were using 2 mometasone furoat, 6 clobetasol propionate – one of them in the periocular area developed a very strong clinically atrophy and also glaucoma but the cortisole levels were normal. Conclusion. Dermoscopy is a tool for early detection of the infraclinical signs of TSIFRD by dermoscopic features: polygonal vessels, telangiectasias, scales, depressible erythema, pustules, Demodex plugs and tails, atrophy