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.

Síndrome dos ovários policísticos: a importância da avaliação endócrino-metabólica / Polycystic ovary syndrome: the importance of endocrino-metabolic evaluation

A fisiopatologia multifatorial da síndrome dos ovários policísticos (SOP) encontra-se estabelecida, assim como sua associação com a resistência insulina (RI) e, conseqüentemente, com a síndrome metabólica (SM). Entretanto, a avaliação da SM e do risco cardiovascular (RCV) inerente a este estado tem sido dificultado pela multiplicidade de critérios que definem a SM e pela dificuldade de diagnóstico laboratorial da RI incluso nos critérios. O objetivo deste artigo é revisar, de forma acessível à prática clínica, os critérios diagnósticos atuais para a SOP, associada ou não à SM, possibilitando o embasamento para opções terapêuticas que permitam não apenas tratar a anovulação crônica, como também reduzir o risco cardiovascular das mulheres com SOP.

The multifactorial pathophysiology of the Polycystic Ovary Syndrome is established, as well as its association with insulin resistance and consequently with the Metabolic Syndrome. On the other hand, the evaluation of the Metabolic Syndrome and Cardiovascular risk (CV), inherent to this illness, has been made difficult due to the multiplicity of criteria that define the Metabolic Syndrome and the difficulty of the insulin resistance laboratorial diagnosis, which is included in those criteria. The purpose of this article is to review, in an accessible form the clinic practice, the current diagnosis criteria of the Polycystic Ovary Syndrome, whether associated or not with the Metabolic Syndrome, making possible to set the basis for the therapeutical options that allows not only the chronic anovulation treatment, but also to reduce the cardiovascular risk for women with polycystic ovary syndrome.