Postoperative serum magnesium levels as a predictor for the need for calcium replacement after total thyroidectomy: a prospective study

ABSTRACT Objective: Our aim was to assess the ability of serum magnesium (Mg), measured on the first postoperative day (Mg1PO), to predict the need for calcium (Ca) replacement in patients undergoing total thyroidectomy (TT). Subjects and methods: Eighty patients undergoing TT, with Mg1PO and PTH dosage in the first (PTH1h) and eighth (PTH8h) hours after TT, were evaluated for the need for Ca replacement. Data were evaluated by uni/multivariate logistic regression and Receiver Operating Characteristic (ROC) curve. Results: 32 patients (40%) required Ca replacement. Median PTH1h, PTH8h and Mg1PO were higher in the no replacement group: 17 versus (vs) 3 pg/mL (p < 0.001), 18.2 vs 3.0 pg/mL (p < 0.001) and 2 vs 1.6 mg/dL (p < 0.001), respectively. Mg1PO was the isolated predictor for this replacement (odds ratio = 0.0004, 95% confidence interval: 0.000003-0.04; p = 0.001), with the cut-off value of 1.8 mg/dL showing sensitivity and specificity of 78.1% and 87.5%, respectively. Conclusions: In this group of patients, serum Mg1PO was the isolated predictor for the need for Ca replacement.

Approach to adult patients with primary hypothyroidism in some special situations: a position statement from the Thyroid Department of the Brazilian Society of Endocrinology and Metabolism (SBEM)

ABSTRACT Primary hypothyroidism is a common disorder in clinical practice. The management of most cases of hypothyroidism is usually straightforward, but the best approach in some special situations may raise questions among physicians. This position statement was prepared by experts from the Brazilian Society of Endocrinology and Metabolism to guide the management of three special situations, namely, hypothyroidism in the elderly, subclinical hypothyroidism in patients with heart disease, and difficult-to-control hypothyroidism. The authors prepared the present statement after conducting a search on the databases MEDLINE/PubMed, LILACS, and SciELO and selecting articles with the best evidence quality addressing the selected situations. The statement presents information about the current approach to patients in these special situations.

Is there a relationship between preoperative cytological diagnosis and evolution in patients with differentiated thyroid carcinoma? A retrospective study

ABSTRACT Objective: Cytological analysis and Bethesda classification of thyroid nodules is the standard method of diagnosing differentiated thyroid carcinoma (DTC). However, even for nodules with a non-malignant cytological diagnosis, there is a not insignificant risk of cancer. There are doubts whether this lack of certainty would influence patient prognosis. Our aim was to compare patients with DTC, classified according to the preoperative cytological diagnosis, regarding their evolution. Subjects and methods: A retrospective study was carried out with 108 DTC patients submitted to total thyroidectomy (TT) between 2009 and 2015, divided into three groups according to preoperative cytological diagnosis (Bethesda classification): classes I/II, III/IV, and V/VI. Groups were compared for evolution considering response to treatment at last evaluation as well as time disease free. Statistical analysis used ANOVA, chi squared, and Kaplan-Meier curves with p<0.05 considered significant. Results: Groups differed for time between nodule puncture and TT [in months; V/VI (2.35 ± 2.48) < III/IV (7.32 ± 6.34) < I/II (13.36 ± 8.9); p < 0.0001]. There was no significant difference between groups for evolution at final evaluation (disease free status; classes I/II: 71.4%; classes III/IV: 60%; classes V/VI: 66.6%; p = 0.7433), as well as time disease free (in months; classes I/II: 34.57 ± 25.82; classes III/IV: 38.04 ± 26.66; classes V/VI: 30.84 ± 26.34; p = 0.3841). Conclusions: DTC patients classified according to preoperative cytological diagnosis did not differ for evolution. Although patients with non-malignant cytological diagnoses were submitted to TT later, this did not affect the evolution of the cases.

Thyroglobulin/thyrotropin ratio for predicting long-term response in differentiated thyroid carcinoma: a retrospective study

ABSTRACT Objective: Thyrotropin-stimulated thyroglobulin (STg) after total thyroidectomy is a prognosis marker for differentiated thyroid carcinoma (DTC). As Tg level is influenced by thyrotropin (TSH), perhaps the STg/TSH ratio is also a prognosis marker for these tumours. We aimed to compare STg/TSH ratio and first STg level in differentiated thyroid carcinoma patients for their ability to predict the long-term response to initial treatment. Subjects and methods: This retrospective study evaluated data from 181 DTC patients for first (1st) STg and STg/TSH ratio, at 1-3 months post-total thyroidectomy and before iodine-131 therapy, according to response to initial therapy [Excellent/Indeterminate or Incomplete (Biochemical/Structural)] observed at final evaluation, and with the survival time with excellent/indeterminate response. Results: Cases with incomplete response presented higher STg level [225.13 ± 585.26 ng/mL versus (vs) 20.4 ± 192.9 ng/mL; p < 0.001] and STg/TSH ratio (3.01 ± 7.8 vs 0.27 ± 2.58; p < 0.001). Cutoffs of 5 ng/mL for STg and 0.085 for STg/TSH displayed sensitivities of 76.7% and 76.9%, and specificities of 79.2% and 82.6%, respectively, in predicting response to therapy. Values below these cutoffs were associated with longer survival time in excellent/indeterminate response (140.4 vs 15.9 and 144.6 vs 15.9 months, respectively). Conclusion: STg/TSH ratio has a similar performance to the 1st STg in predicting long-term response to initial therapy.

Is there a relationship between diet quality and bone health in elderly women? A cross-sectional study

ABSTRACT Objective: To evaluate whether there is a relationship between diet quality and bone health in a group of elderly Brazilian women. Subjects and methods: A cross-sectional study was performed with 105 elderly women. Participants were evaluated regarding diet quality (good, needing improvement, and poor) and its relationship with bone mineral density (BMD), bone-specific alkaline phosphatase (BSAP), and C-telopeptide (CTX). Results: Fifty eight participants (55.2%) presented a poor-quality diet and 47 (44.8%) required dietary improvements, while no subjects presented a good quality diet. The group requiring dietary improvements had lower CTX [0.35 (0.05;1.09) vs. 0.52 (0.10;1.45); p = 0.03)] and BSAP (38.7 ± 12.9 U/L vs. 46.10 ± 15.2 U/L; p < 0.01) levels than the poor-quality diet group. Groups did not differ in terms of BMD. Conclusion: In this group of elderly Brazilian women, there was a relationship between diet quality and bone health, where worse diet quality was associated with higher levels of bone remodelling markers.

Hypoparathyroidism: what is the best calcium carbonate supplementation intake form? / Hipoparatireoidismo: qual é a melhor forma de ingestão de suplemento de carbonato de cálcio?

Abstract Introduction: In hypoparathyroidism, calcium supplementation using calcium carbonate is necessary for the hypocalcemia control. The best calcium carbonate intake form is unknown, be it associated with feeding, juice or in fasting. Objective: The objective was to evaluate the calcium, phosphorus and calcium × phosphorus product serum levels of hypoparathyroidism women after total thyroidectomy, following calcium carbonate intake in three different forms. Methods: A crossover study was carried out with patients presenting definitive hypoparathyroidism, assessed in different situations (fasting, with water, orange juice, breakfast with a one-week washout). Through the review of clinical data records of tertiary hospital patients from 1994 to 2010, 12 adult women (18-50 years old) were identified and diagnosed with definitive post-thyroidectomy hypoparathyroidism. The laboratory results of calcium and phosphorus serum levels dosed before and every 30 min were assessed, for 5 h, after calcium carbonate intake (elementary calcium 500 mg). Results: The maximum peak average values for calcium, phosphorus and calcium × phosphorus product were 8.63 mg/dL (water), 8.77 mg/dL (orange juice) and 8.95 mg/dL (breakfast); 4.04 mg/dL (water), 4.03 mg/dL (orange juice) and 4.12 mg/dL (breakfast); 34.3 mg2/dL2 (water), 35.8 mg2/dL2 (orange juice) and 34.5 mg2/dL2 (breakfast), respectively, and the area under the curve 2433 mg/dL min (water), 2577 mg/dL min (orange juice) and 2506 mg/dL min (breakfast), 1203 mg/dL min (water), 1052 mg/dL min (orange juice) and 1128 mg/dL min (breakfast), respectively. There was no significant difference among the three different tests (p > 0.05). Conclusion: The calcium, phosphorus and calcium × phosphorus product serum levels evolved in a similar fashion in the three calcium carbonate intake forms.

Resumo Introdução: No hipoparatireoidismo, a suplementação de cálcio com carbonato de cálcio é necessária para o controle da hipocalcemia. A melhor forma de ingestão de carbonato de cálcio ainda é desconhecida, seja concomitante com alimentação, no suco ou em jejum. Objetivo: Avaliar os níveis séricos de cálcio, fósforo e produto cálcio-fósforo em mulheres pós-tireoidectomia por hipoparatireoidismo, após a ingestão de carbonato de cálcio em três formas diferentes. Método: Foi realizado um estudo cruzado em pacientes com hipoparatireoidismo definitivo, avaliados em diferentes situações (em jejum, com água, suco de laranja, café da manhã, após washout de uma semana). A revisão dos prontuários dos pacientes de um hospital terciário de 1994 a 2010 identificou 12 mulheres adultas (18-50 anos), diagnosticadas com hipoparatireoidismo definitivo pós-tireoidectomia. Os resultados laboratoriais dos níveis séricos de cálcio e fósforo foram mensurados antes e a cada 30 minutos durante 5 horas, após a ingestão de carbonato de cálcio (cálcio elementar 500 mg). Resultados: Os valores de pico máximo médio de cálcio, fósforo e produto cálcio-fósforo foram 8,63 mg/dL (água), 8,77 mg/dL (suco de laranja) e 8,95 mg/dL (café da manhã); 4,04 mg/dL (água), 4,03 mg/dL (suco de laranja) e 4,12 mg/dL (café da manhã); 34,3 mg2/dL2 (água), 35,8 mg2/dL2 (suco de laranja) e 34,5 mg2/dL2 (café da manhã), respectivamente, e a área sob a curva foi 2.433 mg/dL.min. (água), 2.577 mg/dL.min. (suco de laranja) e 2.506 mg/dL.min. (café da manhã), 1.203 mg/dL.min. (água), 1.052 mg/dL.min. (suco de laranja) e 1.128 mg/dL.min. (café da manhã), respectivamente. Não houve diferença significante entre os três diferentes testes (p > 0,05). Conclusão: Os níveis séricos de cálcio, fósforo e produto cálcio-fósforo evoluíram de forma semelhante nas três formas de ingestão de carbonato de cálcio.

Graves' ophthalmopathy: low-dose dexamethasone reduces retinoic acid receptor-alpha gene expression in orbital fibroblasts

ABSTRACT Objective: Graves' ophthalmopathy (GO) is an autoimmune disease that leads to ocular proptosis caused by fat accumulation and inflammation, and the main treatment is corticosteroid therapy. Retinoid acid receptor-alpha (RARα) seems to be associated with inflammation and adipocyte differentiation. This study aimed to assess the effect of glucocorticoid treatment on orbital fibroblasts of GO patient treated or not with different glucocorticoid doses. Materials and methods: Orbital fibroblasts collected during orbital decompression of a female patient with moderately severe/severe GO were cultivated and treated with 10 nM and 100 nM dexamethasone (Dex). rRARα gene expression in the treated and untreated cells was then compared. Results: Fibroblast RARα expression was not affected by 100 nM Dex. On the other hand, RARα expression was 24% lower in cells treated with 10 nM Dex (p < 0.05). Conclusions: Orbital fibroblasts from a GO patient expressed the RARα gene, which was unaffected by higher, but decreased with lower doses of glucocorticoid.

Thyroglobulin levels and thyroglobulin/thyrotropin ratio could predict the success of the ablative/therapeutic 131I in the differentiated thyroid cancers.

BACKGROUND: Stimulated thyroglobulin (STg) levels in patients with differentiated thyroid carcinomas (DTCs) after total thyroidectomy (TT) and before radioactive iodine (131I) ablation/therapy (RIT) are predictive of therapeutic success but can be influenced by the thyroid-stimulating hormone (TSH) level. OBJECTIVES: This study compared the reliability of the STg/TSH ratio and STg measurement in predicting the success of RIT. METHODS: Sixty-three DTC patients submitted to TT were assessed retrospectively to compare the ability of STg level and the STg/TSH ratio to predict successful RIT. RESULTS: In this study 48 (76.2%) patients had successful RIT. The successful and unsuccessful groups received different 131I doses and had different STg levels and STg/TSH ratios. The STg and STg/TSH ratio cutoff values that predicted successful RIT were 4.41 ng/mL (sensitivity of 86.7% and specificity of 77%) and 0.093 (sensitivity of 80% and specificity of 79.2%), respectively. Age, STg level, STg/TSH ratio, and 131I dose were associated with successful RIT, but after multivariate analysis only STg remained associated (p < 0.05). CONCLUSION: In conclusion, our data suggest that the STg/TSH ratio and measurement of STg are equally reliable in predicting successful RIT in DTC patients.

Physical Activity Level of Post-menopausal Women with Low Bone Mineral Density.

Introduction Proper physical activity is related to the prevention and the treatment of osteoporosis. Purpose To assess the level of physical activity (PA) in post-menopausal women with low bone mineral density (BMD). Methods This cross-sectional clinical study included 123 post-menopausal women. The inclusion criteria were: age of ≥ 45 years with last menses at least 12 months prior to the initiation of the study, and bone density scan (BDS) values measured over the preceding 12 months. Women with severe osteoarthritis were excluded. Women were allocated into three groups, according to BMD measured by BDS [osteoporosis (OP; 54 women), osteopenia (35 women), and normal bone density (NBD; 35 women)], and compared for general, clinical, and anthropometric data, and for PA level. The latter was assessed using the International Physical Activity Questionnaire (IPAQ), in metabolic equivalent of task (MET) units. Participants were classified as sedentary, active or very active. Quantitative variables were compared using ANOVA followed by Tukey's test. Associations between qualitative variables were tested by Chi-square (χ2) or Fisher's exact test. In order to check for differences among groups and IPAQ domains, a generalized linear model with Gamma distribution was adjusted for values in METs. Results The OP group differed from the NBD group regarding age (61.8 ± 10.1 and 52.9 ± 5.4 years), percentage of participants with self-declared white ethnicity (43.9 and 28.0%), body mass index (BMI - 25.7 ± 5.4 and 30.9 ± 5.1 kg/m(2)), and time since menopause (15.5 ± 7.5 and 5.8 ± 4.5 years). Smoking rates were higher in the OP (55.6%) and NBD groups (33.3%) than in the osteopenia group (11.1%). Within the OP group, the rate of subjects with sedentary lifestyles was higher (42.6%), and time spent sitting was greater (344.3 ± 204.8 METs) than in the groups with osteopenia (20.0% and 300.9 ± 230.6 METs) and NBD (17.7% and 303.2 ± 187.9 METs). Conclusions The rate of sedentary lifestyles was higher in post-menopausal women with OP than in those with either osteopenia or NBD. In order to change this physical inactivity profile, strategies should be created to address this group of patients.

Physical Activity Level of Post-menopausal Women with Low Bone Mineral Density / Nível de atividade física de mulheres menopausadas com baixa densidade mineral óssea

Abstract Introduction Proper physical activity is related to the prevention and the treatment of osteoporosis. Purpose To assess the level of physical activity (PA) in post-menopausal women with low bone mineral density ( BMD ). Methods This cross-sectional clinical study included 123 post-menopausal women. The inclusion criteria were: age of 45 years with last menses at least 12 months prior to the initiation of the study, and bone density scan (BDS) values measured over the preceding 12 months. Women with severe osteoarthritis were excluded. Women were allocated into three groups, according to BMD measured by BDS [osteoporosis (OP; 54 women), osteopenia (35 women), and normal bone density (NBD; 35 women)], and compared for general, clinical, and anthropometric data, and for PA level. The latter was assessed using the International Physical Activity Questionnaire (IPAQ), in metabolic equivalent of task (MET) units. Participants were classified as sedentary, active or very active. Quantitative variables were compared using ANOVA followed by Tukey's test. Associations between qualitative variables were tested by Chi-square (χ2) or Fisher's exact test. In order to check for differences among groups and IPAQ domains, a generalized linear model with Gamma distribution was adjusted for values in METs. Results The OP group differed from the NBD group regarding age (61.8 10.1 and 52.9 5.4 years), percentage of participants with self-declared white ethnicity (43.9 and 28.0%), body mass index (BMI - 25.7 5.4 and 30.9 5.1 kg/m2), and time since menopause (15.5 7.5 and 5.8 4.5 years). Smoking rates were higher in the OP (55.6%) and NBD groups (33.3%) than in the osteopenia group (11.1%). Within the OP group, the rate of subjects with sedentary lifestyles was higher (42.6%), and time spent sitting was greater (344.3 204.8 METs) than in the groups with osteopenia (20.0 % and 300.9 230.6 METs) and NBD (17.7% and 303.2 187.9 METs). Conclusions The rate of sedentary lifestyles was higher in post-menopausal women with OP than in those with either osteopenia or NBD. In order to change this physical inactivity profile, strategies should be created to address this group of patients.

Resumo Introdução Atividade física adequada está relacionada com a prevenção e o tratamento da osteoporose. Objetivo Avaliar o nível de atividade física em mulheres na pós-menopausa com baixa densidade mineral óssea ( DMO ). Métodos Este estudo clínico transversal incluiu 123 mulheres na pós-menopausa. Os critérios de inclusão foram idade 45 anos, com última menstruação pelo menos 12 meses antes do início do estudo, e DMO medida nos últimos 12 meses. Foram excluídas mulheres com osteoartrite grave. As mulheres foram divididas em três grupos, de acordo com DMO medida por densitometria óssea [osteoporose (OP; 54 mulheres), osteopenia (35 mulheres) e DMO normal (NBD; 35 mulheres)], e comparadas com dados gerais, clínicos e antropométricos, e quanto ao nível de atividade física. Este último foi avaliado pelo International Physical Activity Questionnaire (IPAQ), em unidades de metabolic equivalent of task (METs). As participantes foram classificadas como sedentárias, ativas ou muito ativas. As variáveis quantitativas foram comparadas por ANOVA seguida pelo teste de Tukey. As associações entre as variáveis qualitativas foram testadas por Qui-quadrado (χ2) ou exato de Fisher. Para verificar diferenças entre os grupos e domínios do IPAQ, um modelo linear generalizado com distribuição Gama foi ajustado para os valores em METs. Resultados O grupo OP diferiu do NBD quanto à idade (61,8 10,1 e 52,9 5 , 4 anos), porcentagem de etnia autorrelatada branca (43,9 e 28,0%), índice de massa corporal (25,7 5,4 e 30,9 5,1 kg/m2) e tempo da menopausa (15,5 7,5 e 5,8 4,5 anos). As taxas de tabagismo foram maiores nos grupos com OP (55,6 % ) e NBD (33,3%) do que no com osteopenia (11,1%). No grupo com OP, sedentarismo (42,6%) e tempo gasto sentado foram maiores (344,3 204.8 METs) do que nos com osteopenia (20,0% e 300,9 230,6 METs) e NBD (17,7% e 303,2 187,9 METs). Conclusões O sedentarismo foi maior em mulheres na pós-menopausa com osteoporose do que naquelas com osteopenia ou NBD. Estratégias devem ser criadas para alterar este perfil de inatividade física neste grupo de pacientes.

Gene expression of estrogen receptor-alpha in orbital fibroblasts in Graves' ophthalmopathy.

Graves' ophthalmopathy (GO) is one of the most severe clinical manifestations of Graves' disease (GD), and its treatment might involve high-dose glucocorticoid therapy. The higher incidence of GO among females, and the reported association between polymorphisms of estrogen receptor (ER) and GD susceptibility have led us to question the role of estrogen and its receptor in GO pathogenesis. We, thus, assessed estrogen receptor-alpha (ERA) gene expression in cultures of orbital fibroblasts from a patient with GO before (controls) and after treatment with 10 nM and 100 nM dexamethasone (DEX). Orbital fibroblasts showed ERA gene expression. In the cells treated with 10 nM and 100 nM DEX, ERA gene expression was, respectively, 85% higher and 74% lower, than in the control group. We concluded that ERA gene expression is found in the orbital fibroblasts of patient with GO, which may be affected by glucocorticoids in a dose-related manner. Arch Endocrinol Metab. 2015;59(3):273-6.

Gene expression of estrogen receptor-alpha in orbital fibroblasts in Graves’ ophthalmopathy

Graves’ ophthalmopathy (GO) is one of the most severe clinical manifestations of Graves’ disease (GD), and its treatment might involve high-dose glucocorticoid therapy. The higher incidence of GO among females, and the reported association between polymorphisms of estrogen receptor (ER) and GD susceptibility have led us to question the role of estrogen and its receptor in GO pathogenesis. We, thus, assessed estrogen receptor-alpha (ERA) gene expression in cultures of orbital fibroblasts from a patient with GO before (controls) and after treatment with 10 nM and 100 nM dexamethasone (DEX). Orbital fibroblasts showed ERA gene expression. In the cells treated with 10 nM and 100 nM DEX, ERA gene expression was, respectively, 85% higher and 74% lower, than in the control group. We concluded that ERA gene expression is found in the orbital fibroblasts of patient with GO, which may be affected by glucocorticoids in a dose-related manner. Arch Endocrinol Metab. 2015;59(3):273-6.

Autoimmune thyroid disease as a risk factor for angioedema in patients with chronic idiopathic urticaria: a case-control study.

CONTEXT AND OBJECTIVE: An association between chronic idiopathic urticaria (CIU) and autoimmune thyroid disease (ATD) has been reported. However, there have not been any reports on whether ATD raises the risk of angioedema, which is a more severe clinical presentation of CIU. Thus, the aim of the present study was to evaluate whether the risk of angioedema is increased in patients with CIU and ATD. DESIGN AND SETTING: Case-control study including 115 patients with CIU at a tertiary public institution. METHODS: The patients were evaluated with regard to occurrence of angioedema and presence of ATD, hypothyroidism or hyperthyroidism. RESULTS: Angioedema was detected in 70 patients (60.9%). There were 22 cases (19.1%) of ATD, 19 (16.5%) of hypothyroidism and nine (7.8%) of hyperthyroidism. The risk among patients with ATD was 16.2 times greater than among those without this thyroid abnormality (confidence interval, CI = 2.07-126.86). The odds ratio for hypothyroidism was 4.6 (CI = 1.00-21.54) and, for hyperthyroidism, 3.3 (CI = 0.38-28.36). CONCLUSIONS: Patients with CIU and ATD presented greater risk of angioedema, which reinforces the idea that a relationship exists between this allergic condition and thyroid autoimmunity. This finding could imply that such patients require specifically directed therapy.

Factors influencing thyroidectomy complications.

UNLABELLED: The postoperative outcome of thyroidectomies is related to factors concerning the patient, the thyroid disease, and the surgeon. OBJECTIVES: To analyze a clinic's experience with thyroidectomy complications. STUDY DESIGN: historical cross-sectional cohort study. MATERIALS AND METHODS: We reviewed the charts from 228 patients submitted to thyroidectomy, between 1991 and 2004. Transient, permanent and total complications as well as persistence and recurrence of the basal disease were studied in relation to clinical and laboratory factors. RESULTS: Total complications occurred in 34.65%, transient complications in 18.86% (9.21% had hypocalcemia, 0.44% had vocal cord paralysis), associated with the first postoperative years and pressure complaints, and permanent complications in 17.98% (8.77%: hypoparathyroidism; 1.75%: vocal cord paralysis), associated with malignancy and more radical surgeries. The thyroid disease persisted in 17.98% of the cases, associated with age and recurrence in 10.96%, associated with the first operative years, benign diseases and less radical surgeries. CONCLUSION: The complications were associated with pressure complaints, shorter complaining period, malignancy and more radical surgeries. The recurrence was associated with the first operative years, non-neoplastic thyroid diseases and less radical surgeries. The persistence of disease was associated with older age.

Fatores que influenciam nas complicações das tireoidectomias / Factors influencing thyroidectomy complications

O resultado pós-operatório das tireoidectomias é imputado a fatores relativos ao paciente, à tireopatia e ao cirurgião. OBJETIVO: Analisar a experiência de um serviço quanto a complicações com a tireoidectomia. Desenho do estudo: coorte histórica com corte transversal. MATERIAL E MÉTODO: Foram avaliados os prontuários de 228 pacientes submetidos à tireoidectomia, entre 1991 e 2004. Foram estudadas as complicações transitórias, definitivas e totais, persistência e recidiva da tireopatia de base, em relação a fatores clínico-laboratoriais. RESULTADOS: Ocorreram 34,65% de complicações totais, 18,86% de complicações transitórias (9,21% hipocalcemia, 0,44% paralisia de cordas vocais, 4,82% outras), associadas aos primeiros anos de cirurgia no serviço e queixas compressivas, e 17,98% de complicações definitivas (8,77% hipoparatireoidismo, 1,75% paralisia de cordas vocais, 0,44% rouquidão), associadas à malignidade e cirurgias mais radicais. Houve persistência da doença de base em 17,98% dos casos, associada à idade, e recidiva em 10,96%, associada aos primeiros anos de cirurgia, benignidade e cirurgias menos radicais. CONCLUSÃO: Complicações pós-operatórias se associaram a queixas compressivas, história curta, malignidade e cirurgias mais radicais. A recidiva se associou aos primeiros anos de cirurgia no serviço, tireopatias benignas e cirurgias menos radicais. A persistência da doença se associou à maior idade.

The postoperative outcome of thyroidectomies is related to factors concerning the patient, the thyroid disease, and the surgeon. OBJECTIVES: To analyze a clinic's experience with thyroidectomy complications. Study design: historical cross-sectional cohort study. MATERIALS AND METHODS: We reviewed the charts from 228 patients submitted to thyroidectomy, between 1991 and 2004. Transient, permanent and total complications as well as persistence and recurrence of the basal disease were studied in relation to clinical and laboratory factors. RESULTS: Total complications occurred in 34.65%, transient complications in 18.86% (9.21% had hypocalcemia, 0.44% had vocal cord paralysis), associated with the first postoperative years and pressure complaints, and permanent complications in 17.98% (8.77%: hypoparathyroidism; 1.75%: vocal cord paralysis), associated with malignancy and more radical surgeries. The thyroid disease persisted in 17.98% of the cases, associated with age and recurrence in 10.96%, associated with the first operative years, benign diseases and less radical surgeries. CONCLUSION: The complications were associated with pressure complaints, shorter complaining period, malignancy and more radical surgeries. The recurrence was associated with the first operative years, non-neoplastic thyroid diseases and less radical surgeries. The persistence of disease was associated with older age.

Autoimmune thyroid disease as a risk factor for angioedema in patients with chronic idiopathic urticaria: a case-control study / Doença autoimune da tireoide como um fator de risco para angioedema em pacientes com urticária crônica idiopática: um estudo caso-controle

CONTEXT AND OBJECTIVE: An association between chronic idiopathic urticaria (CIU) and autoimmune thyroid disease (ATD) has been reported. However, there have not been any reports on whether ATD raises the risk of angioedema, which is a more severe clinical presentation of CIU. Thus, the aim of the present study was to evaluate whether the risk of angioedema is increased in patients with CIU and ATD. DESIGN AND SETTING: Case-control study including 115 patients with CIU at a tertiary public institution. METHODS: The patients were evaluated with regard to occurrence of angioedema and presence of ATD, hypothyroidism or hyperthyroidism. RESULTS: Angioedema was detected in 70 patients (60.9%). There were 22 cases (19.1%) of ATD, 19 (16.5%) of hypothyroidism and nine (7.8%) of hyperthyroidism. The risk among patients with ATD was 16.2 times greater than among those without this thyroid abnormality (confidence interval, CI = 2.07-126.86). The odds ratio for hypothyroidism was 4.6 (CI = 1.00-21.54) and, for hyperthyroidism, 3.3 (CI = 0.38-28.36). CONCLUSIONS: Patients with CIU and ATD presented greater risk of angioedema, which reinforces the idea that a relationship exists between this allergic condition and thyroid autoimmunity. This finding could imply that such patients require specifically directed therapy.

CONTEXTO E OBJETIVO: A associação de urticária crônica idiopática (UCI) com doença autoimune da tireoide (DAT) é relatada. Porém, não foram encontrados relatos se a DAT eleva o risco de angioedema, uma apresentação clínica mais grave da UCI. Assim, o objetivo do presente estudo foi avaliar se o risco de angioedema está aumentado em pacientes com UCI e DAT. TIPO DE ESTUDO E LOCAL: Estudo caso-controle, incluindo 115 pacientes com UCI em uma instituição pública terciária. MÉTODOS: Os pacientes foram avaliados quanto à ocorrência de angioedema e à presença de DAT, hiper ou hipotireoidismo. RESULTADOS: Angioedema ocorreu em 70 pacientes (60,9%). Foram observados 22 (19,1%) casos de DAT, 19 (16,5%) de hipotireoidismo e 9 (7,8%) de hipertireoidismo. Os pacientes com DAT apresentaram risco 16,2 vezes maior de angioedema do que os sem a alteração tireoidiana (intervalo de confiança, IC = 2.07-126.86). O odds ratio, para hipotireoidismo, foi de 4,6 (IC = 1.00-21.54) e para hipertireoidismo foi de 3,3 (IC = 0.38-28.36). CONCLUSÕES: Pacientes com UCI e DAT apresentaram maior risco de angioedema, reforçando a ideia de existência de relação entre o quadro alérgico e autoimunidade tireoidiana. Este achado poderia implicar em um direcionamento terapêutico específico para tais pacientes.

Does radioiodine therapy in patients with differentiated thyroid cancer increase the frequency of another malignant neoplasm?

Objectives. To compare the frequency of another primary malignancy in patients with differentiated thyroid carcinoma (DTC) who received radioiodine therapy or not ((131)I). Material and Methods. 168 cases of DTC patients were retrospectively evaluated as to the frequency of another neoplasia by comparing patients with and without it, taking into account clinical, laboratory, and therapeutic parameters. Results. Another primary malignancy occurred in 8.9% of patients. Of these, 53.3% showed the malignancy before (131)I and 46.7% after it. By comparing both groups, the age at the moment of diagnosis of another neoplasia was 46.1 ± 20.2 years for the group before (131)I therapy and of 69.4 ± 11.4 years for the group after it (P = 0.02). Of the 148 patients treated with (131)I, 4.7% developed another malignancy. The latter were older (61 ± 17 years) than those who did not show another cancer type (44.1 ± 14.2 years) (P < 0.05). Conclusion. The frequency of another neoplasia found after (131)I was similar to that found before (131)I.

Efeito de diferentes doses de ácido retinoico sobre a resistência óssea de ratos jovens / Effect of varied doses of retinoic acid on young rats' bone resistance

OBJETIVO: Avaliar os efeitos da suplementação de diferentes doses de todo-trans ácido retinóico sobre a resistência óssea, por meio de ensaio biomecânico de flexão, em tíbia de ratos jovens. MÉTODOS: Foram estudados 58 ratos jovens, com quatro diferentes doses de vitamina A em suas dietas, sendo divididos em 4 grupos: grupo-controle (n=15), sem acréscimo de todo-trans ácido retinoico; grupo com acréscimo de 0,3mg de todo-trans ácido retinoico por kg de ração (n=13); grupo com 10mg de todo-trans ácido retinoico por kg de ração (n=15); e grupo com 50mg de todo-trans ácido retinoico por kg de ração (n=15). O estudo durou 30 dias. Após o sacrifício dos animais, suas patas esquerdas foram congeladas, dissecadas e as tíbias submetidas ao ensaio de flexão. Foram avaliados a carga máxima e o coeficiente de rigidez. Foi aplicada análise de variância one-way. O nível de significância estatístico adotado foi p<0,05. RESULTADOS: Os valores médios de carga máxima (em Newton) foram: grupo-controle =37,94, DP=4,76; grupo todo-trans ácido retinoico 0,3=36,49, DP= 4,38; grupo todo-trans ácido retinoico 10=40,12, DP=6,03; grupo todo-trans ácido retinoico 50=35,68, DP=5,22 (p=0,107). Os valores médios de coeficiente de rigidez (em Newton/milímetros) foram: grupo-controle =31,84 DP=6,75; grupo todo-trans ácido retinoico 0,3=29,18, DP=4,35; grupo todo-trans ácido retinoico 10=35,48, DP=8,14; grupo todo-trans ácido retinoico 50=30,31, DP=7,14 (p=0,85). CONCLUSÃO: Conclui-se que a exposição a diferentes doses de todo-trans ácido retinoico, em ratos, durante 30 dias, não exerce efeito sobre a resistência óssea, quando avaliada por ensaios biomecânicos.

OBJECTIVE: This study assessed the effects of different doses of all-trans retinoic acid on bone resistance by conducting a biomechanical flexion study on young rats' tibias. METHODS: Fifty-eight young rats were divided into four groups according to the all-trans retinoic acid content of their diets: control group (n=15), chow not enriched with all-trans retinoic acid; chow enriched with 0.3mg of all-trans retinoic acid per kilogram (n=13); chow enriched with 10mg of all-trans retinoic acid per kilogram (n=15); and chow enriched with 50mg of all-trans retinoic acid per kilogram (n-15). After 30 days of this diet, the animals were killed, their left paws were frozen and dissected and the tibias were submitted to the flexion study which assessed maximum force and shear modulus. One-way analysis of variance was used with significance set at p<0.05. RESULTS: The mean maximum force values in newtons (SD) were: control group =37.94, SD=4.76; 0.3mg group = 36.49, SD= 4.38; 10mg group = 40.12, SD=6.03; 50mg group =35.68, SD=5.22 (p=0.107). The mean shear modulus values (SD) in newtons/millimeter were: control group =31.84, SD=6.75; 0.3mg group =29.18, SD=4.35; 10mg group =35.48, SD=8.14; 50mg group =30.31, SD=7.14 (p=0.85). CONCLUSION: Biomechanical studies showed that different doses of all-trans retinoic acid for 30 days had no effect on young rats' bone resistance.

Concordância do international physical activity questionnaire como pedômetro, em mulheres pós-menopausadas portadoras de osteoporose / Concordance of the international physical activity questionnaire with the pedometer, in postmenopausal women with osteoporosis

JUSTIFICATIVA E OBJETIVOS: A osteoporose se constituiem um grave problema de saúde pública. A atividade física (AF) representa importante medida para a manutenção/recuperação da saúde óssea. O International Physical Activity Questionnaire (IPAQ), o qual representa uma ferramenta útil na avaliação da AF em diversas situações, ainda não foi validado para as pacientes de maior risco para a doença, ou seja, mulheres pós-menopausadas. O objetivo deste estudo foi avaliar a concordância entre o IPAQ e o pedômetro, em mulheres pós-menopausadas, portadoras de osteoporose. MÉTODO: Trata-se de estudo de série de casos, transversal e descritivo. Foram avaliadas 21 mulheres pós-menopausadas, portadoras de osteoporose, acompanhadas em ambulatório especializado. Os instrumentos utilizados foram o IPAQ, forma longa e o pedômetro. Foram avaliados o coeficiente de concordância (CC, %) e o índice kappa (k) entre os dois métodos. RESULTADOS: As pacientes apresentaram idade média de 63,43 ± 10,42 anos e índice de massa corpórea médio de 25,74± 4,75 kg/m2. De acordo com o IPAQ, 42,8% das pacientes foram consideradas como muito ativas, 28,6% como ativas; e 28,6%, como sedentárias. O CC entre o IPAQ e o pedômetro, considerando-se o número de passos, foi de 47,6%, com k de 0,21, e levando-se em conta o gasto calórico, de 42,9%, com k = 0,13. CONCLUSÃO: O IPAQ quando aplicado em mulheres pós-menopausadas e com osteoporose, apresenta concordância leve a moderada com os dados obtidos com o pedômetro.

BACKGROUND AND OBJECTIVES: Osteoporosis is a serious public health problem. Physical activity (PA) represents an important step towards the preservation/restoration of bone health. The International Physical Activity Questionnaire (IPAQ), which represents a useful tool in the evaluation of PA in various situations, has not yet been validated for patients at higher risk for disease, or postmenopausal women. The aim of this study was to evaluate the concordance between IPAQ and the pedometer, in osteoporosis carrier postmenopausal women. METHOD: This is the study of a case series, in a transversal and descriptive way. We have evaluated 21 osteoporosis carrier postmenopausal women, followed in a specialized ambulatory. The used tools were the IPAQ long form and the pedometer. The concordance factor (CF, %) and the kappa index (k) were evaluated between the two methods. RESULTS : The patients presented an average age of 63.43 ±10.42 years and an average body mass index of 25.74 ± 4.75 kg/m2. According to the IPAQ, 42.8% of patients were considered as very physically actives; 28.6%, as physically active and 28.6%, as sedentary. The CF between IPAQ and the pedometer, considering the number of steps, was of 47.6%, with a k of 0.21; when the caloric waste was taken into account, the CF between the two instruments was of 42.9%, with a k = 0.13. CONCLUSION: We can therefore conclude that IPAQ, when applied to osteoporosis carrier postmenopausal women, presents slight to moderate concordance with the obtained pedometer data.