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(1) Background&mdash, low-dose radioiodine ablation is an accepted strategy for the treatment of low- and intermediate-risk thyroid carcinomas, although there is no international consensus. The aim of this study is to describe the clinical experience with low-dose radioiodine ablation in patients with low- and intermediate-risk thyroid cancer compared to high-dose ablation. (2) Methods&mdash, 174 patients with low- and intermediate-risk thyroid cancer, 90 treated with low-dose ablation and 84 treated with high-dose ablation, were included. The primary endpoint was response to treatment one year after ablation, defined by stimulated thyroglobulin, whole body scan and ultrasound imaging. (3) Results&mdash, an excellent response rate of 79.8% in the low-dose group and 85.7% in the high-dose group was observed (p = 0.049). Stimulated thyroglobulin at the moment of ablation (p = 0.032) and positive antithyroglobulin antibodies (p &lt, 0.001) were independent predictive factors for nonexcellent response. Young age (p = 0.023), intermediate initial recurrence risk (p &lt, 0.001) and low-dose ablation (p = 0.004) were independent predictive factors for recurrence. (4) Conclusion&mdash, low-dose ablation seemed to be less effective than high-dose ablation, especially in those patients with positive antithyroglobulin antibodies or higher stimulated thyroglobulin levels at the moment of ablation. Low dose was associated with higher recurrence rates, and lower age and intermediate initial recurrence risk were independent risk factors for recurrence in our sample.

Resumen La ecografia se ha convertido en un instrumento imprescindible en la asistencia a los pacientes con enfermedades tiroideas. La deteccion de los nodulos tiroideos se ha incrementado con el uso generalizado de la misma, siendo la herramienta principal para su deteccion, orientacion diagnostica, seguimiento y, en ocasiones, tambien terapeutica. Los Grupos de Trabajo de Cancer de Tiroides y de Tecnicas ecograficas de la Sociedad Espanola de Endocrinologia y Nutricion han promovido este documento en el que se resumen los requisitos necesarios para la mejor practica clinica posible con esta tecnica. Los objetivos del trabajo incluyen encuadrar su utilizacion dentro de la especialidad, los requisitos tecnicos y legales necesarios, las situaciones clinicas de su aplicacion, los niveles de conocimiento y aprendizaje, la responsabilidad asociada, la comunicacion estandarizada de resultados e integracion en los sistemas de informacion hospitalarios, posicionando la tecnica ecografica dentro de la cartera de servicios en las actuales unidades de Endocrinologia y Nutricion.

Introduction: Antibiotic treatments modify gut microbiota. Microbiota alterations (in composition and biodiversity) are fundamental pieces in the development of metabolic disorders (T2DM and obesity). Objective: To evaluate the relationship between microbiota changes due to antibiotic treatment in patients colonized by H. pylori and GLP-1 secretion. Methods: A prospective case control study was assessed. We evaluated a H. pylori positive patient model before and two months after a short-term eradication therapy and a control group. Anthropometric measurements, carbohydrate and lipid metabolisms, GLP-1 levels and fecal microbiota composition (determined by 16S rRNA gene (V3-V4) sequencing with an Illumina Miseq) were analyzed. Results: We studied 40 cases and 20 controls (60% women, respectively). Average age was 47.0±2 vs. 43.6±2.7 years. 42.5% vs. 40% had clinical history of gastrointestinal disease. After eradication treatment, we found significant changes in microbiota profile at phylum, family, genus and species levels. The Chao1 and Shannon indices showed a decreased in bacterial richness and diversity in patients (pre and post H. pylori eradication) compared to controls. GLP-1 secretion and carbohydrate metabolism were improved after antibiotic treatment. GLP-1 changes were related to microbial community disturbances through correlation analysis, specifically with Bifidobacterium adolescentis (r=0.354, p=0.034), Lachnobacterium (r=-0.332, p=0.048) and Coriobacteriaceae (r=0.372, p=0.026). Conclusions: Antibiotic treatment to eradicate H. pylori increased the secretion of GLP-1 and improved the carbohydrate metabolism. This GLP-1 secretion improvement was related to changes in microbial community because of the antibiotic treatment, particularly in Bifidobacterium adolescentis, Lachnobacterium and Coriobacteriaceae. These taxa could play their roles through the production of short chain fatty acids (SCFA) and/or bile acid metabolism. Disclosure I. Cornejo-Pareja: None. G. Martin-Nuñez: None. I. Moreno-Indias: None. F.F. Cardona-Díaz: None. M. Roca-Rodriguez: None. L. Coin-Arangüez: None. I. Mancha-Doblas: None. F. Tinahones: Advisory Panel; Self; Lilly Diabetes, Novo Nordisk A/S, Regeneron Pharmaceuticals, Sanofi-Aventis. Consultant; Self; AstraZeneca. Research Support; Self; AstraZeneca. Speaker’s Bureau; Self; Danone Nutricia Research, Lilly Diabetes, Novo Nordisk A/S, Regenerative Medical Solutions, Sanofi-Aventis.

Objective MircroRNAs (miR) are small, noncoding RNA molecules of 18-25 nucleotides. Their dysregulation has been widely studied in many human tumours including differentiated thyroid cancer (DTC). miRs more frequently associated with these kinds of tumours are miR-146, miR-221 and miR-222. Our objective was to assess the relationship among circulating miR levels and the evolution and outcomes of disease. Design We analysed a sample of 60 patients with DTC assigning them to one of three groups according to the dynamic scale of risk (excellent response, incomplete biochemical response and incomplete structural response). Patients and measurements At study inclusion, we determined thyroid-stimulating hormone, thyroxine, thyroglobulin, antithyroglobulin antibodies and plasma levels of miR-146, miR-221 and miR-222. Results Male sex and advanced age at diagnosis were associated with the worst disease progression. miR-222 was twofold to threefold higher in tall cell papillary carcinomas (P = 0.038). miR-146 (P = 0.016) and miR-221 (P = 0.050) had a positive correlation with thyroglobulin at the time of sampling. In regression analysis, miR-146 (P = 0.006), miR-221 (P = 0.004) and miR-222 (P = 0.007) predicted more than 70% of the variation in thyroglobulin levels at the time of sampling. Conclusions Elevated miR-222 and miR-146 levels are associated with poorer outcomes of the disease and may have a prognostic value in the management and follow-up of DTC.

Introduction: Antibiotic treatments cause changes in gut microbiota. Dysbiosis of gut microbiota has been linked to metabolic diseases such as type 2 diabetes mellitus (T2DM). Objective: To evaluate whether changes in gut microbiota due to antibiotic treatment in patients colonized by H. pylori, could be related to improvements in carbohydrate metabolism. Material and Method: A prospective case-control study were performed. Clinical data, carbohydrate metabolism, and microbiota composition in feces (determined by 16S rRNA gene (V3-V4) sequencing using the Illumina Miseq) before and 2 months after eradication treatment were analyzed. Results: We studied 40 cases and 20 controls (60% women, respectively). Average age was 47.0 ± 2 vs. 43.6 ± 2.7 years old. 70% vs. 60% had family history of digestive disorders and 42.5% vs. 40% clinical history of gastrointestinal disease. After antibiotics, we found significant changes in gut microbiota profile at phylum, family, genus and species levels. The Chao and Shannon indices showed a decreased in bacterial richness and diversity in patients (pre and post H. pylori eradication) compared to controls. We observed an improvement in glucose homeostasis in cases 2 month after H. pylori eradication treatment, with decrease in HbA1c (p=0.014), 60’ (p=0.018) and 120’ (p=0.019) glucose post OGTT. Changes in Rikenellaceae, Butyricimonas, E. biforme, B. fragilis, and Megamonas were inversely associated with changes in glucose level and Hb1Ac in patients which got H. pylori eradication. Conclusion: H. pylori eradication treatment causes alteration in human gut microbiota. The glucose homeostasis improvement found after antibiotic treatment was related to changes in microbial community, particularly in Megamonas and Butyricimonas genus, Rikenellaceae family and E. biforme and B. fragilis species. SCFA-producing and glucose remover bacterias could play an important role in these associations. Disclosure I. Cornejo-Pareja: None. G. Martin-Nuñez: None. M. Roca-Rodriguez: None. I. Moreno-Indias: None. L. Vinuela: None. L. Coin-Arangüez: None. I. Mancha-Doblas: None. F. Tinahones: None.

La diabetes mellitus, enfermedad cronica caracterizada por hiperglucemia, se ha convertido en uno de los mayores problemas de salud publica del siglo XXI. Su prevalencia alcanza cifras alarmantes, afectando a cerca de 382 millones de personas alrededor del mundo. Las perspectivas futuras, ademas, son realmente desalentadoras, ya que se estima que para el ano 2035 el numero de personas con diabetes mellitus aumentara hasta los 592 millones. La diabetes mellitus tipo 2 (DM2) aglutina el 90-95% de los diagnosticos de diabetes mellitus. La hiperglucemia cronica de la DM2, incluso en ausencia de sintomas, conlleva lesiones en multiples tejidos, siendo especialmente sensibles los pequenos vasos de la retina, los rinones y los nervios perifericos. En practicamente todas las sociedades desarrolladas, la

Resumen La aparicion de un nodulo tiroideo se ha convertido en un hecho cotidiano en la practica clinica diaria. Habitualmente, la adecuada evaluacion del nodulo tiroideo requiere la realizacion de diversas pruebas diagnosticas y multiples citas medicas, con la consiguiente demora diagnostica. La instauracion de una consulta de alta resolucion de nodulo tiroideo evita en gran medida estos inconvenientes, condensando en una unica cita todas las pruebas necesarias para la correcta evaluacion del nodulo tiroideo. En este trabajo revisamos cual debe ser la estructura diagnostica y funcional de una consulta de alta resolucion de nodulo tiroideo.

Resumen Objetivo Evaluar la tolerancia a lixisenatida y sus efectos sobre el peso y el control metabólico de pacientes con diabetes tipo 2 y obesidad. Diseño Estudio prospectivo. Emplazamiento Consultas de atención especializada de Endocrinología y Nutrición en Almería, Granada y Málaga. Participantes Pacientes con diabetes tipo 2 y obesidad. Intervenciones Respuesta y tolerancia al tratamiento con lixisenatida. Mediciones principales Se analizaron datos clínicos y analíticos con medidas de cambio intrasujeto antes-después del tratamiento. Resultados Evaluamos 104 pacientes (51% mujeres) con diabetes tipo 2 y obesidad (Almería 18,3%; Granada 40,4%; Málaga 41,3%). Edad media 58,4 ± 10,5 años y duración media de diabetes 11,2 ± 6,7 años. El tiempo medio desde la visita basal a la revisión tras inicio de tratamiento con lixisenatida fue de 3,8 ± 1,6 meses. Encontramos mejoría significativa del peso (p

Resumen Fundamentos y objetivos El hallazgo de un nodulo tiroideo es un hecho muy frecuente en la practica clinica habitual. El manejo del nodulo tiroideo necesita un abordaje multidisciplinar que puede ser facilitado con la creacion de unidades de alta resolucion de nodulo tiroideo. Describimos la experiencia clinica y los resultados obtenidos en una consulta de alta resolucion y acto unico de nodulo tiroideo. Material y metodos Se han evaluado todos los pacientes derivados a la consulta de nodulo tiroideo del Hospital Virgen de la Victoria (Malaga) desde el ano 2005 al 2007. Se han seguido las guias de practica clinica de nodulo tiroideo para la recomendacion de puncion aspirativa con aguja fina (PAAF) y cirugia tiroidea. Se realizo analisis estadistico con programa SPSS. Resultados Durante el periodo de estudio, la consulta de nodulo tiroideo atendio a 658 pacientes (edad media 48,6 anos, 89,8% mujeres). Mediante ecografia se confirmo la existencia de nodulo tiroideo en el 85,5% de los pacientes. Con un diametro medio de 1,96 cm, un 74,2% de nodulos fueron solidos, un 55,8% hipoecoicos, y un 4,7% presentaron microcalcificaciones. Se realizo la PAAF a 475 pacientes. El 76,5% de las citologias fueron benignas, el 19,1% sospechosas, el 2,1% malignas y el 2,3% insuficientes. Se derivo a cirugia al 23,3% de los pacientes (principalmente por tamano nodular o sospecha de malignidad). Se confirmo la existencia de patologia maligna (principalmente carcinoma papilar) en el 24,9% de los nodulos intervenidos. La sensibilidad/especificidad de la citologia (considerando la biopsia como el gold standard) fue del 81,8 y el 94,7%, respectivamente. Conclusiones La instauracion de una consulta monografica de nodulo tiroideo permite la optimizacion de recursos y reduce la demora diagnostica, obteniendo unos resultados clinicos ampliamente satisfactorios.

Background and objectives The finding of a thyroid nodule is a very common occurrence in clinical practice. Management of thyroid nodules requires a multidisciplinary approach that may be eased by a high-resolution thyroid nodule clinic. We report our clinical experience and outcomes in a high-resolution thyroid nodule clinic. Patients and methods All patients referred to Virgen de la Victoria Hospital (Malaga) from 2005 to 2007 were evaluated following thyroid nodule guidelines. Statistical analysis was performed using SPSS software. Results In the study period, 658 patients (mean age 48.6 years, 89.8% females) were seen at the thyroid nodule clinic. Thyroid nodules were discovered in 85.5% of patients. Mean nodule diameter was 1.96 cm. Of these nodules, 74.2% were solid, 55.8% hypoechogenic, and 4.7% showed microcalcifications. Fine needle aspiration (FNA) was performed in 475 patients (76.5% of all cytological samples were benign, 19.1% had suspected malignancy, 2.1% were malignant, and 2.3% inadequate). Referral for surgery was required in 23.3% of patients (mainly because of nodule size or suspected malignancy). Malignancy was confirmed in 24.9% of nodules. Sensitivity and specificity of cytology (considering biopsy as gold standard) were 81.8% and 94.7% respectively. Conclusions Implementation of a high-resolution thyroid nodule clinic decreases delay in diagnosis and optimizes available resources, thus providing for satisfactory clinical outcomes.

Objetivos Comparar los resultados de tiroglobulina obtenidos ante estimulacion con tirotropina recombinante humana (rhTSH) con fines diagnosticos y tras privacion hormonal previa a la terapia con 131 I. Pacientes y metodo Se evaluo a 31 pacientes en seguimiento por cancer diferenciado de tiroides (CDT) a los que se indico dosis terapeutica de 131 I. Fueron sometidos de forma consecutiva a ambos protocolos de estimulacion, y el tratamiento con radioyodo disto 1-2 meses del procedimiento diagnostico con rhTSH. Se realizaron determinaciones analiticas de TSH, tiroglobulina (Tg) y anticuerpos anti-Tg por metodos inmunometricos. Resultados Las medianas de Tg obtenidas tras rhTSH y privacion fueron de 1,10 y 1,80 ng/ml, respectivamente. Analizados como positivos o negativos, dichos valores mostraron un indice kappa de concordancia de 0,633. Los casos discordantes mostraron una mayor elevacion de Tg en estimulo con rhTSH (3 casos) y solo en 1 caso se obtuvo un resultado negativo con estimulacion con rhTSH que luego se positivizo en la dosis ablativa. Conclusiones El estimulo con rhTSH consigue elevaciones diagnosticas de TSH en todos los casos aplicados. Los valores de Tg obtenidos con ambos estimulos muestran un grado de concordancia elevado.

Appearance of a thyroid nodule has become a daily occurrence in clinical practice. Adequate thyroid nodule assessment requires several diagnostic tests and multiple medical appointments, which results in a substantial delay in diagnosis. Implementation of a high-resolution thyroid nodule clinic largely avoids these drawbacks by condensing in a single appointment all tests required for adequate evaluation of thyroid nodule. This paper reviews the diagnostic and functional structure of a high-resolution thyroid nodule clinic.

To evaluate tolerance to lixisenatide and its effects on weight and metabolic control in type2 diabetes and obese patients. DESIGN: Prospective study. SETTING: Endocrinology clinics in Almeria, Granada and Malaga. PARTICIPANTS: Patients with type2 diabetes and obesity. INTERVENTIONS: Response and tolerance to lixisenatide treatment. MAIN MEASUREMENTS: Clinical and analytical data of the subjects were evaluated at baseline and after treatment. RESULTS: The study included 104 patients (51% women) with type2 diabetes and obesity (Almeria 18.3%; Granada 40.4%; Malaga 41.3%). The mean age was 58.4±10.5years, and the mean duration of diabetes was 11.2±6.7years. The patients were re-evaluated at 3.8±1.6months after treatment with lixisenatide. Significant improvements were found in weight (P