array:23 [ "pii" => "S169988551930042X" "issn" => "16998855" "doi" => "10.1016/j.patol.2019.04.001" "estado" => "S300" "fechaPublicacion" => "2021-04-01" "aid" => "552" "copyright" => "Sociedad Española de Anatomía Patológica" "copyrightAnyo" => "2019" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Rev Esp Patol. 2021;54:123-6" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 14 "formatos" => array:2 [ "HTML" => 1 "PDF" => 13 ] ] "itemSiguiente" => array:18 [ "pii" => "S1699885519300078" "issn" => "16998855" "doi" => "10.1016/j.patol.2019.01.005" "estado" => "S300" "fechaPublicacion" => "2021-04-01" "aid" => "531" "copyright" => "Sociedad Española de Anatomía Patológica" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Rev Esp Patol. 2021;54:127-31" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "es" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">ARTÍCULO BREVE</span>" "titulo" => "Corazón en «asta de ciervo». Estudio anatomopatológico del corazón explantado de una paciente con diagnóstico clínico y variantes genéticas de miocardiopatía no compactada" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "127" "paginaFinal" => "131" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "“Staghorn” heart. The pathology of the explanted heart of a patient with clinical diagnosis and genetic variants of non-compacted myocardiopathy" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figura 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1192 "Ancho" => 1583 "Tamanyo" => 391651 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Estudio ultraestructural. (a) Se identificaron miocitos con una organización sarcolemal habitual, con fibras musculares paralelas y presencia de mitocondrias dispuestas entre ellas.(b) Ocasionalmente las crestas mitocondriales mostraban degeneración hidrópica.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Juan Luis García Pérez, Justino Jiménez Almonacid, Addison Julián Palomino Doza, Juan Francisco Delgado Jiménez, Ana Belén Enguita Valls" "autores" => array:5 [ 0 => array:2 [ "nombre" => "Juan Luis" "apellidos" => "García Pérez" ] 1 => array:2 [ "nombre" => "Justino" "apellidos" => "Jiménez Almonacid" ] 2 => array:2 [ "nombre" => "Addison Julián" "apellidos" => "Palomino Doza" ] 3 => array:2 [ "nombre" => "Juan Francisco" "apellidos" => "Delgado Jiménez" ] 4 => array:2 [ "nombre" => "Ana Belén" "apellidos" => "Enguita Valls" ] ] ] ] ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1699885519300078?idApp=UINPBA00004N" "url" => "/16998855/0000005400000002/v1_202103140819/S1699885519300078/v1_202103140819/es/main.assets" ] "itemAnterior" => array:18 [ "pii" => "S1699885520300556" "issn" => "16998855" "doi" => "10.1016/j.patol.2020.04.005" "estado" => "S300" "fechaPublicacion" => "2021-04-01" "aid" => "614" "copyright" => "Sociedad Española de Anatomía Patológica" "documento" => "article" "crossmark" => 1 "subdocumento" => "rev" "cita" => "Rev Esp Patol. 2021;54:114-22" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Review</span>" "titulo" => "Ber-EP4 staining in effusion cytology: A potential source of false positives" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "114" "paginaFinal" => "122" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Expresión de Ber-EP4 en citología de derrames cavitarios: una posible causa de falsos positivos" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1130 "Ancho" => 1500 "Tamanyo" => 184494 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">(A) Pericardial fluid. Atypical tridimensional cell groups. Papanicolaou, ×200. (B) Pericardial fluid. Intense membranous positivity for Ber-EP4. Ber-EP4, ×200. (C) Pericardial biopsy. Benign reactive mesothelium. H-E, ×100. (D) Pericardial biopsy. Reactive mesothelial cells showing Ber-EP4 positivity. Ber-EP4, ×200.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Cristina Díaz del Arco, Melchor Saiz-Pardo Sanz, Luis Ortega Medina, Mª Jesús Fernández Aceñero" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Cristina" "apellidos" => "Díaz del Arco" ] 1 => array:2 [ "nombre" => "Melchor" "apellidos" => "Saiz-Pardo Sanz" ] 2 => array:2 [ "nombre" => "Luis" "apellidos" => "Ortega Medina" ] 3 => array:2 [ "nombre" => "Mª Jesús" "apellidos" => "Fernández Aceñero" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1699885520300556?idApp=UINPBA00004N" "url" => "/16998855/0000005400000002/v1_202103140819/S1699885520300556/v1_202103140819/en/main.assets" ] "en" => array:19 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Brief report</span>" "titulo" => "Pathological thyroid findings in amiodarone-induced thyrotoxicosis" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "123" "paginaFinal" => "126" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Laura Gómez-Isaza, Noel González-Ortega, José Manuel Cameselle-Teijeiro" "autores" => array:3 [ 0 => array:3 [ "nombre" => "Laura" "apellidos" => "Gómez-Isaza" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 1 => array:3 [ "nombre" => "Noel" "apellidos" => "González-Ortega" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:4 [ "nombre" => "José Manuel" "apellidos" => "Cameselle-Teijeiro" "email" => array:2 [ 0 => "josemanuel.cameselle@usc.es" 1 => "jose.manuel.cameselle.teijeiro@sergas.es" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">?</span>" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Department of Anatomic Pathology and Clinical Pathology, University of Valle, Cali, Valle del Cauca, Colombia" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Department of Anatomic Pathology, Clinical University Hospital, SERGAS, University of Santiago de Compostela, Santiago de Compostela, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "?" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Hallazgos tiroideos patológicos en tirotoxicosis inducida por amiodarona" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1787 "Ancho" => 1305 "Tamanyo" => 614371 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Pathological findings associated with amiodarone-induced thyrotoxicosis. (a) Hematoxylin–eosin stain at 100× magnification showing multiple follicles containing a variable proportion of histiocytes. (b) Intrafollicular aggregates of histiocytes with foamy cytoplasm often partially adhere to the follicular lining (hematoxylin–eosin, 200×). (c) Immunohistochemistry with CD68 showed a greater number of follicles containing numerous histiocytes (100×). (d, e) Immunostains for thyroperoxidase and TTF-1, respectively, highlighted the loss of follicular cells (200×). (f) The ruptures of the follicular basal membrane were evidenced by the collagen IV immunostain (400×).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Amiodarone (AMD) is a class III antiarrhythmic drug whose chronic or high dosage administration is associated with multiple adverse side effects, mainly affecting the thyroid gland, lungs, liver, skin, cornea and the central nervous system.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1,2</span></a> In the thyroid, AMD therapy alters the tests of thyroid functioning and is also associated with hypothyroidism or thyrotoxicosis. There are two main forms of AMD-induced thyrotoxicosis (AIT): AIT type I, an iodine-induced hyperthyroidism which occurs in patients with multinodular goiter or Graves’ disease, and AIT type II which develops in the normal thyroid gland.<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3,4</span></a> In spite of AMD being a widely-used drug whose thyroid pathological alterations were first described in 1987,<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> the majority of surgical pathologists have little knowledge of its histopathological features.<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">6,7</span></a> We describe the typical histological alterations of the thyroid gland in an AIT type II patient.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Case presentation</span><p id="par0010" class="elsevierStylePara elsevierViewall">A 50-year-old male presented as an emergency with severe progressive dyspnea that had developed during the previous week together with atrial fibrillation. He had a medical history of arterial hypertension and had undergone electrical cardioversion three years previously for persistent atrial fibrillation. Since then, he had been treated with amiodarone. Four months before the present episode he underwent cardioversion again due to a new episode of atrial fibrillation and at this time laboratory tests showed the following serum levels: thyroid stimulating hormone (TSH) <0.01<span class="elsevierStyleHsp" style=""></span>mUI/L (reference values: 0.35–5.50), free thyroxine (T4) 3.69<span class="elsevierStyleHsp" style=""></span>ng/dL (0.89–1.76), free triiodothyronine (T3) 6.57<span class="elsevierStyleHsp" style=""></span>pg/mL (2.3–4.2), antithyroperoxidase antibodies 45.6<span class="elsevierStyleHsp" style=""></span>UI/mL (0–60) and thyroid stimulating immunoglobulin (TSI) <0.10<span class="elsevierStyleHsp" style=""></span>UI/L (<0.50). The patient was diagnosed as having an AMD-induced thyrotoxicosis and treated with angiotensin-converting enzyme inhibitors, beta-adrenergic blockers, thiamazole and low molecular-weight heparin. Due to the poor response to the pharmacological therapy a total thyroidectomy was performed.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Histopathology</span><p id="par0015" class="elsevierStylePara elsevierViewall">The surgical specimen weighed 12.8<span class="elsevierStyleHsp" style=""></span>g, the right thyroid lobe measured 4<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>1.5<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>0.5<span class="elsevierStyleHsp" style=""></span>cm and the left lobe 3.6<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>1.7<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>0.5<span class="elsevierStyleHsp" style=""></span>cm. Cross-section of the thyroid tissue had a normal appearance. Histologically, several follicles containing aggregates of histiocytes with foamy cytoplasm in both lobes as well as discreet fibrotic areas with no inflammatory cells in the stroma (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>a) were seen. The affected follicles were of normal or slightly increased size and were totally or partially occupied by foamy (vacuolated), clear histiocytes, sometimes multinucleated (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>b). The histiocytes were frequently found associated with the follicular lining and a loss of the follicular epithelium and basal membrane breaks were detected. The immunohistochemical study was performed using a peroxidase-conjugated labeled dextran polymer (EnVision FLEX/HRP; Dako; Agilent Technologies, Inc., Santa Clara, CA, USA). Positivity for CD68 (clone PG-M1; ready to use; Dako) confirmed the histiocytic nature of the follicular infiltrate (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>c) occasionally rupturing the basal membrane (anti-collagen IV; clone CIV22; dilution 1:25; pH 9.0; Dako) (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>d). The loss of follicular cells was also evidenced by means of thyroid transcription factor 1 (TTF-1) (clone SPT24; 1:100; pH 6.0; Novocastra, Newcastle Upon Tyne, UK) and thyroperoxidase (clone MoAb47; 1:50; pH 9.0; Dako) immunostains (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>e).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Discussion</span><p id="par0020" class="elsevierStylePara elsevierViewall">AMD has complex pharmacokinetics and pharmacodynamics, with significant side effects which can be associated with an increased risk of hypothyroidism and thyrotoxicosis.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1,2</span></a> Although hypothyroidism generally responds well to medical treatment, controlling hyperthyroidism is more complicated and requires the use of thionamides, non-radioactive iodine and even thyroidectomy in cases that prove difficult to control.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a> Even if the diagnosis is made at an early stage, mortality associated with thyroid storm can reach 30%, thus surgery is considered the best therapeutic option in the majority of cases.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a> Suspension of AMD treatment is not usually a practical option,<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> which means that thyroidectomy is the best indication in thyrotoxicosis resistant to medical therapy, worsening of cardiac function and/or severe thyrotoxicosis that requires a rapid resolution.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Recent studies showed that thyroidectomy resulted in rapid resolution of thyrotoxicosis.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a> In AIT patients the rate of thyroidectomy complications was higher than that for other thyrotoxic etiologies (Graves’ disease and toxic multinodular goiter) but lower than previously reported in a similar population of high-risk surgical patients.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a> Furthermore, total or near-total thyroidectomy produces a rapid control of thyrotoxicosis and is the only antithyroid treatment that reliably permits the maintenance of AMD therapy.<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">2,4</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">The effects of AMD on the thyroid gland are related to the high iodine content of AMD; however, this is not enough to explain the broad spectrum of alterations associated with this drug.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> In AMD-induced hypothyroidism, the iodine released during AMD metabolism inhibits thyroid hormone synthesis (Wolff–Chaikoff effect) and release.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> Type I AIT generally occurs in abnormal thyroid glands due to an iodine-induced hyperthyroidism (Jod-Basedow phenomenon), but type II AIT is a destructive thyroiditis that leads to increased circulating levels of thyroid hormones from damage to thyroid follicular cells.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> Other mechanisms involved in the AMD-induced destructive thyroiditis may be endoplasmic reticulum stress<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a> and a dose-dependent direct toxic effect.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Histiocytic intrafollicular infiltrates with random disruption of follicles and areas of fibrosis were reported in the very few articles illustrating thyroid lesions associated with AMD-induced thyrotoxicosis<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">5,6</span></a>; these findings agree with those found in the thyroid gland of the present case. As seen in the present case, intrafollicular clear, vacuolated (foamy) histiocytic infiltration, loss of thyrocytes, breaks in the follicular basal membrane and stromal fibrosis are typical thyroid findings associated with AMD-induced thyrotoxicosis. Knowledge of such data is particularly useful for pathologists given the scarcity of publications on this subject.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Funding</span><p id="par0040" class="elsevierStylePara elsevierViewall">This work was supported (JMCT) by Grant <span class="elsevierStyleGrantNumber" refid="gs1">PI15/01501-FEDER</span> from the <span class="elsevierStyleGrantSponsor" id="gs1">Instituto de Salud Carlos III, Ministerio de Ciencia, Innovación y Universidades, Spain</span>.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conflict of interest</span><p id="par0045" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflict of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:3 [ "identificador" => "xres1480396" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1348189" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1480395" "titulo" => "Resumen" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1348188" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Case presentation" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Histopathology" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Funding" ] 9 => array:2 [ "identificador" => "sec0030" "titulo" => "Conflict of interest" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2019-03-25" "fechaAceptado" => "2019-04-18" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1348189" "palabras" => array:3 [ 0 => "Amiodarone" 1 => "Thyrotoxicosis" 2 => "Thyroid gland" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1348188" "palabras" => array:3 [ 0 => "Amiodarona" 1 => "Tirotoxicosis" 2 => "Glándula tiroides" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Amiodarone (AMD) is a class III antiarrhythmic drug whose chronic or high dosage administration alters the tests of thyroid function. AMD is also associated with hypothyroidism or thyrotoxicosis. Total thyroidectomy is an efficient treatment of AMD-induced thyrotoxicosis in cases resistant to medical therapy, worsening of cardiac function and/or severe thyrotoxicosis. Although AMD is a widely used drug, its pathological consequences are not well known. We describe the pathological findings in the thyroid gland of a patient who underwent total thyroidectomy due to AMD-induced thyrotoxicosis. The surgical specimen was macroscopically normal, but histologically showed multiple follicles totally or partially invaded by clear vacuolated (foamy) histiocytes, sometimes multinucleated. Loss of thyrocytes, breaks in the follicular basal membrane and stromal fibrosis could also be appreciated but no lymphocytic infiltrates were found. An awareness of these histopathological features is particularly important for surgical pathologists, especially as there are very few published reports describing these alterations.</p></span>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">La amiodarona (AMD) es un agente antiarrítmico de clase III, cuya dosificación crónica o elevada altera las pruebas de funcionamiento tiroideo. La AMD está también asociada a hipotiroidismo o tirotoxicosis. La tiroidectomía total es un tratamiento eficaz de la tirotoxicosis inducida por AMD en casos resistentes a la terapia médica, empeoramiento de la función cardiaca y/o tirotoxicosis grave. Aunque la AMD es un fármaco ampliamente utilizado, sus consecuencias patológicas son poco conocidas. Por tanto, describimos los hallazgos patológicos en la glándula tiroides de un paciente sometido a tiroidectomía total, debido a tirotoxicosis inducida por AMD. La muestra quirúrgica fue normal a nivel macroscópico, aunque histológicamente reveló múltiples folículos total o parcialmente invadidos por histiocitos vacuolados claros (espumosos), y a veces multinucleados. También pudo apreciarse pérdida de tirocitos, rotura de la membrana basal folicular y fibrosis estromal, aunque no se encontraron infiltrados linfocíticos. El conocimiento de estas características histopatológicas es particularmente interesante para los patólogos quirúrgicos, dado que existen pocos artículos publicados que ilustren estas alteraciones.</p></span>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1787 "Ancho" => 1305 "Tamanyo" => 614371 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Pathological findings associated with amiodarone-induced thyrotoxicosis. (a) Hematoxylin–eosin stain at 100× magnification showing multiple follicles containing a variable proportion of histiocytes. (b) Intrafollicular aggregates of histiocytes with foamy cytoplasm often partially adhere to the follicular lining (hematoxylin–eosin, 200×). (c) Immunohistochemistry with CD68 showed a greater number of follicles containing numerous histiocytes (100×). (d, e) Immunostains for thyroperoxidase and TTF-1, respectively, highlighted the loss of follicular cells (200×). (f) The ruptures of the follicular basal membrane were evidenced by the collagen IV immunostain (400×).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "2017 AHA/ACC/HRS guideline for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S.M. Al-Khatib" 1 => "W.G. Stevenson" 2 => "M.J. Ackerman" 3 => "W.J. Bryant" 4 => "D.J. Callans" 5 => "A.B. 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