Introduction: Graves’ disease is the most common cause of hyperthyroidism. Its treatment uses synthetic antithyroid drugs but the use of aggressive radical therapy such as surgery or non-aggressive therapy such as io...Introduction: Graves’ disease is the most common cause of hyperthyroidism. Its treatment uses synthetic antithyroid drugs but the use of aggressive radical therapy such as surgery or non-aggressive therapy such as iodine-131 is not uncommon. Treatment of Graves’ disease with radioactive iodine or iratherapy is a simple, inexpensive, well-tolerated treatment. It was introduced in Senegal in 2016. We report through this work the preliminary assessment of the only nuclear medicine service in Senegal in the management of Graves’ disease by iodine-131. Patients and Methods: Retrospective study of the first cases of Graves’ disease treated with iratherapy in Senegal. Socio-demographic, clinical, paraclinical, therapeutic and evolutionary aspects were studied. Radiation protection rules have been implemented and contraception has been effective for six months in women of childbearing age. Results: 25 patients were collected with a mean age of 45 years, twenty women (80%), a family goiter in 24% and a psycho-affective context in 64% of cases. Thyrotoxicosis syndrome was associated with goiter in 68% of patients and exophthalmos in 64%. Thyroid ultrasound performed in 20 patients showed vascular goiter in 80% and thyroid scintigraphy in 3 patients, homogeneous and diffuse hyperfixation. TRAK dosed in 8 patients was still positive. All patients had received first-line medical treatment. The average duration of this treatment was more than 18 months in 92%. The empirically used iodine-131 activity averaged 15.35 mCi. Oral corticosteroid therapy was prescribed in 7 patients for the prevention of malignant orbitopathy. No early side effects were noted. The remission rate at 3 months was 52% and at 6 months was 88% to 92%. Conclusion: The effectiveness of radioactive iodine, in particular ablative doses in the treatment of hyperthyroidism, is no longer to be demonstrated. Taking into account our socioeconomic context, iratherapy should be a treatment of choice for hyperthyroidism with a good quality/price ratio and excellent tolerance.展开更多
Introduction: The acronym SAPHO (Synovitis, Acne, Pustulosis, Hyperostosis and Osteitis) is a syndrome combining osteoarticular and cutaneous manifestations. It occurs mainly between the ages of 30 and 50. Sternocosto...Introduction: The acronym SAPHO (Synovitis, Acne, Pustulosis, Hyperostosis and Osteitis) is a syndrome combining osteoarticular and cutaneous manifestations. It occurs mainly between the ages of 30 and 50. Sternocostoclavicular hyperostosis is one of the main distinguishing features. We report a case of SAPHO in Dakar diagnosed by bone scintigraphy. Observation: 28-year-old Senegalese women presented with left shoulder pain and relative functional impotence for over 2 years. Examination revealed right sternoclavicular hyperostosis and left shoulder pain on palpation. Questioning revealed a history of acne and hyperostosis of the right first toe. Bone scintigraphy, performed after injection of 630 MBq of <sup>99m</sup>Tc-HMDP, revealed: hyperfixation of the bilateral (right++) manubrio-sternal and sternoclavicular junction, producing the classic bull’s horn image;hyperfixation of the left shoulder with an inflammatory appearance;hyperfixation of the sacroiliac joints suggestive of bilateral sacroiliitis;hyperfixation of the right first toe;two mandibular hyper fixations probably related to dental damage. This scintigraphic appearance in one was strongly suggestive of SAPHO syndrome. Conclusion: SAPHO syndrome, related to spondyloarthropathy, associates cutaneous and osteoarticular signs. It is characterized by frequent delays in diagnosis due to poor recognition. Soy is an invaluable diagnostic tool, enabling us to assess the extent of the disease and its evolution.展开更多
文摘Introduction: Graves’ disease is the most common cause of hyperthyroidism. Its treatment uses synthetic antithyroid drugs but the use of aggressive radical therapy such as surgery or non-aggressive therapy such as iodine-131 is not uncommon. Treatment of Graves’ disease with radioactive iodine or iratherapy is a simple, inexpensive, well-tolerated treatment. It was introduced in Senegal in 2016. We report through this work the preliminary assessment of the only nuclear medicine service in Senegal in the management of Graves’ disease by iodine-131. Patients and Methods: Retrospective study of the first cases of Graves’ disease treated with iratherapy in Senegal. Socio-demographic, clinical, paraclinical, therapeutic and evolutionary aspects were studied. Radiation protection rules have been implemented and contraception has been effective for six months in women of childbearing age. Results: 25 patients were collected with a mean age of 45 years, twenty women (80%), a family goiter in 24% and a psycho-affective context in 64% of cases. Thyrotoxicosis syndrome was associated with goiter in 68% of patients and exophthalmos in 64%. Thyroid ultrasound performed in 20 patients showed vascular goiter in 80% and thyroid scintigraphy in 3 patients, homogeneous and diffuse hyperfixation. TRAK dosed in 8 patients was still positive. All patients had received first-line medical treatment. The average duration of this treatment was more than 18 months in 92%. The empirically used iodine-131 activity averaged 15.35 mCi. Oral corticosteroid therapy was prescribed in 7 patients for the prevention of malignant orbitopathy. No early side effects were noted. The remission rate at 3 months was 52% and at 6 months was 88% to 92%. Conclusion: The effectiveness of radioactive iodine, in particular ablative doses in the treatment of hyperthyroidism, is no longer to be demonstrated. Taking into account our socioeconomic context, iratherapy should be a treatment of choice for hyperthyroidism with a good quality/price ratio and excellent tolerance.
文摘Introduction: The acronym SAPHO (Synovitis, Acne, Pustulosis, Hyperostosis and Osteitis) is a syndrome combining osteoarticular and cutaneous manifestations. It occurs mainly between the ages of 30 and 50. Sternocostoclavicular hyperostosis is one of the main distinguishing features. We report a case of SAPHO in Dakar diagnosed by bone scintigraphy. Observation: 28-year-old Senegalese women presented with left shoulder pain and relative functional impotence for over 2 years. Examination revealed right sternoclavicular hyperostosis and left shoulder pain on palpation. Questioning revealed a history of acne and hyperostosis of the right first toe. Bone scintigraphy, performed after injection of 630 MBq of <sup>99m</sup>Tc-HMDP, revealed: hyperfixation of the bilateral (right++) manubrio-sternal and sternoclavicular junction, producing the classic bull’s horn image;hyperfixation of the left shoulder with an inflammatory appearance;hyperfixation of the sacroiliac joints suggestive of bilateral sacroiliitis;hyperfixation of the right first toe;two mandibular hyper fixations probably related to dental damage. This scintigraphic appearance in one was strongly suggestive of SAPHO syndrome. Conclusion: SAPHO syndrome, related to spondyloarthropathy, associates cutaneous and osteoarticular signs. It is characterized by frequent delays in diagnosis due to poor recognition. Soy is an invaluable diagnostic tool, enabling us to assess the extent of the disease and its evolution.
