Gasto energético en reposo y concentración sérica de lipoproteínas de baja densidad en adultos con hipotiroidismo subclínico leve

La alta prevalencia de hipotiroidismo subclínico en Chile puede deberse a que el límite superior normal de la hormona estimulante del tiroides (TSH) sérica es bajo. Personas con TSH levemente mayor al límite superior pueden ser metabólicamente similares a personas sanas. Se compararon marcadores de acción tiroidea (gasto energético en reposo [GER] y lipoproteína de baja densidad [LDL]) en adultos con hipotiroidismo subclínico leve y con función tiroidea normal con o sin tratamiento con levotiroxina. Se midió GER, perfil lipídico y tiroideo en personas sanas con función tiroidea normal (TSH ≥0,4-<4,5 µUI/ml; n=91); con hipotiroidismo subclínico leve (TSH ≥4,5-≤6,5 µUI/ml; n=5); y con hipotiroidismo clínico tratado con levotiroxina y TSH normal (n=13). Se analizó la LDL en 838 personas sanas con función tiroidea normal y 89 con hipotiroidismo subclínico leve de la Encuesta Nacional de Salud 2016/17 (ENS). El GER, ajustado por peso, sexo y edad, fue similar entre grupos (p=0,71). La LDL fue similar entre personas con función tiroidea normal e hipotiroidismo subclínico leve (91±24 vs. 101±17 mg/dl; p=0,67), y menor en hipotiroidismo tratado (64±22 mg/dl; p<0,01). La LDL no se asoció con TSH pero si inversamente con T4L en mujeres (r=-0,33; p=0,02; n=53). En la ENS, ambos grupos tuvieron similar LDL (p=0,34), la que se asoció inversamente con T4L en mujeres (r=-0,12; p=0,01; n=569) pero no con TSH. Personas sanas con función tiroidea normal y con hipotiroidismo subclínico leve tienen similar GER y LDL. Esto apoya la idea de redefinir el límite superior normal de TSH.

The high prevalence of subclinical hypothyroidism in Chile may be due to the low normal upper limit of serum thyroid-stimulating hormone (TSH). People with TSH slightly higher than the upper limit may be metabolically similar to healthy people. Thyroid action markers (resting energy expenditure [REE] and low-density lipoprotein [LDL]) were compared in adults with mild subclinical hypothyroidism and with normal thyroid function with or without levothyroxine treatment. REE, lipid and thyroid profile were measured in healthy people with normal thyroid function (TSH ≥0,4-<4,5 µUI/ml (n=91); with mild subclinical hypothyroidism (TSH ≥4,5-≤6 µUI/ml; n=5); and with clinical hypothyroidism treated with levothyroxine and normal TSH (n=13). LDL was analyzed in 838 healthy people with normal thyroid function and 89 with mild subclinical hypothyroidism from the 2016/17 National Health Survey (NHS). REE, adjusted for weight, sex and age, was similar between the groups (p=0,71). LDL was similar between people with normal thyroid function and mild subclinical hypothyroidism (91±24 vs. 101±17 mg/dl; p=0,67), and lower in treated hypothyroidism (64±22 mg/dl; p<0,01). LDL was not associated with TSH but was inversely with FT4 in women (r=-0,33; p=0,02; n=53). In the NHS, both groups had similar serum LDL (p=0,34), which was inversely associated with FT4 in women (r=-0,12; p=0,01; n=569), but not with TSH. Healthy people with normal thyroid function and mild subclinical hypothyroidism have similar REE and LDL. These results support the idea of redefining the normal upper limit of TSH.

Síndrome metabólico e hipotiroidismo: un estudio transversal en una población ecuatoriana

Introducción: el síndrome metabólico y el hipotiroidismo son condiciones muy frecuentes y a menudo superpuestas. Ambos son precursores bien establecidos de la enfermedad cardiovascular aterogénica. Objetivo: evaluar la asociación entre el hipotiroidismo y el síndrome metabólico en pacientes que asisten a la consulta de medicina interna del Hospital IESS de Riobamba, Ecuador. Metodología: se realizó una investigación de tipo descriptiva, correlacional con un diseño no experimental de corte transversal desde enero de 2022 hasta julio de 2023. Se incluyeron 985 sujetos de ambos sexos, mayores de 25 años. A todos los pacientes se les realizó un exhaustivo examen físico y se tomaron muestras de sangre para la realización de pruebas bioquímicas y hormonales. Resultados: 84,97% de los participantes eran eutiroideos, 1,93% presentaron hipotiroidismo manifiesto y 4,97% hipotiroidismo subclínico, mientras que 32,99% tenían síndrome metabólico. Se encontraron diferencias significativas en la edad, peso, circunferencia de cintura, colesterol total, LDL colesterol, triglicéridos, glucosa postpandrial y HOMA-IR entre los sujetos con hipotiroidismo manifiesto y los eutiroideos (p<0,05). Se observó una correlación positiva entre la TSH y todos los componentes del síndrome metabólico (p<0,05). La prevalencia de síndrome metabólico fue significativamente mayor en los sujetos con hipotiroidismo manifiesto (p < 0,05) que en los demás grupos. Se observó que los niveles de T4L (OR 8,82; IC 95% 1,56-49,8) y TSH (OR 1,61; IC 95% 1,19-2,18) son factores de riesgo para el desarrollo de síndrome metabólico. Conclusión: el hipotiroidismo y el síndrome metabólico están altamente asociados. Es recomendable que los sujetos con hipotiroidismo sean examinados para detectar síndrome metabólico y viceversa. La evaluación de la función tiroidea en pacientes con este síndrome puede ayudar a identificar y prevenir el riesgo de eventos cardiovasculares y cerebrovasculares.

Introduction: Metabolic syndrome and hypothyroidism are widespread and often overlapping conditions. Both are well-established precursors of atherogenic cardiovascular disease. Objective: To evaluate the association between hypothyroidism and metabolic syndrome in patients attending the internal medicine consultation at the IESS Hospital in Riobamba, Ecuador. Methodology: A descriptive, correlational research study was conducted with a non-experimental cross-sectional design from January 2022 to July 2023. Nine hundred eighty-five subjects of both sexes and over 25 years of age, were included. All patients underwent a thorough physical examination and blood samples were taken for biochemical and hormonal tests. Results: Eighty-four-point ninety-seven percent of the participants were euthyroid, 1.93% presented overt hypothyroidism, 4.97% had subclinical hypothyroidism, and 32.99% had metabolic syndrome. Significant differences in age, weight, waist circumference, total cholesterol, LDL cholesterol, triglycerides, postprandial glucose, and HOMA-IR were found between subjects with manifest hypothyroidism and euthyroid subjects (p<0.05). A positive correlation was observed between TSH and all components of the metabolic syndrome (p<0.05). The prevalence of metabolic syndrome was significantly higher in subjects with overt hypothyroidism (p < 0.05) than in the other groups. It was observed that the levels of FT4 (OR 8.82; 95% CI 1.56-49.8) and TSH (OR 1.61; 95% CI 1.19-2.18) were risk factors for the development of the metabolic syndrome. Conclusion: Hypothyroidism and metabolic syndrome are highly associated. It is recommended that subjects with hypothyroidism be screened for metabolic syndrome and vice versa. Evaluation of thyroid function in patients with this syndrome can help identify and prevent the risk of cardiovascular and cerebrovascular events.

Tratamiento con TRIAC en pacientes pediátricos con deficiencia de MCT8 / Treatment with TRIAC in pediatric patients with MCT8

Los transportadores de monocarboxilatos (MCT) permiten el ingreso celular de hormonas tiroideas, especialmente en el sistema nervioso central (SNC), donde son indispensables para el neurodesarrollo. La deficiencia de MCT8 produce la combinación de hipotiroidismo en SNC e hipertiroidismo periférico, caracterizada por T3 elevada. El único tratamiento actualmente disponible es el ácido 3,3',5-triyodotiroacético (TRIAC), un análogo de hormonas tiroideas que tiene como objetivo mejorar la tirotoxicosis periférica y prevenir la progresión del deterioro neurológico. En el presente artículo, se evalúan las características clínicas, imagenológicas, bioquímicas y genéticas de 4 pacientes con deficiencia de MCT8 tratados con TRIAC hasta la fecha, las dosis utilizadas y la respuesta al tratamiento.

Monocarboxylate transporters (MCTs) allow the cellular entry of thyroid hormones, especially into the central nervous system (CNS), where they are crucial for neurodevelopment. MCT8 deficiency results in the combination of hypothyroidism in the CNS and peripheral hyperthyroidism, characterized by elevated T3 levels. The only treatment currently available is 3,3',5-triiodothyroacetic acid (TRIAC), a thyroid hormone analogue aimed at improving peripheral thyrotoxicosis and preventing the progression of neurological impairment. Here we assess the clinical, imaging, biochemical, and genetic characteristics of 4 patients with MCT8 deficiency who have received TRIAC to date, the doses used, and the response to treatment.

Prevalence of cancer in patients with hypothyroidism: Analysis using big data tools.

OBJECTIVE: To evaluate the frequency of different types of cancer in patients diagnosed with hypothyroidism using big data methodology on the Savana Manager platform. METHODS: An observational, retrospective study was carried out using electronic medical record (EMR) data from the Hospital Universitario Puerta de Hierro Majadahonda (Madrid). Information from the EMRs was extracted using artificial intelligence techniques and analysed using the Savana Manager v3.0 software. Searches were performed using the term "hypothyroidism" and the terms corresponding to the tumours analysed. RESULTS: Of a total population of 506,749 patients, 23,570 (4.7%) were diagnosed with hypothyroidism. Patients with this diagnosis had a significantly higher frequency of cancer than that found in non-hypothyroid subjects (OR 2.09, 95% confidence interval [CI] 2.01-2.17). This higher frequency was found both in women (OR 1.99, 95% CI 1.90-2.08) and in men (OR 2.83, 95% CI 2.63-3.05). However, this higher frequency of cancer was not observed in hypothyroid patients older than 60 years (OR 0.97, 95% CI 0.92-1.02). Although the frequency of most of the neoplasms studied individually was higher in the population with hypothyroidism, we observed that hypothyroid patients over 60 years of age had a significant decrease in the frequency of prostate, lung, colorectal, and liver cancer. CONCLUSION: Data from this hospital cohort suggest that there is a significant association between the diagnosis of hypothyroidism and cancer. However, this association is less evident in hypothyroid patients older than 60 years.

Administración subcutánea de levotiroxina en hipotiroidismo refractario / Subcutaneous administration of levothyroxine in refrac tory hypothyroidism

Resumen El hipotiroidismo generalmente se puede tratar de manera efectiva con levotiroxina (LT-4) oral. Sin em bargo, el hipotiroidismo refractario al tratamiento con LT-4 es una condición clínica frecuente. Entre las causas se encuentra la falta de adherencia, interacciones con alimentos u otros medicamentos y enfermedades gas trointestinales, como enfermedad inflamatoria intestinal y síndromes de intestino corto. El aumento de la dosis oral de LT-4 no siempre es eficaz en estos escenarios. Por lo tanto, pueden ser necesarias otras vías de administración. En este reporte, evaluamos modalidades alternativas de tratamiento para el hipotiroidismo re fractario y presentamos dos pacientes con malabsorción intestinal tratadas con éxito mediante la administración subcutánea de LT-4.

Abstract Hypothyroidism can usually be treated effectively with oral levothyroxine (LT-4) supplementation. However, hypothyroidism refractory to treatment with LT-4 is a common clinical condition. Causes include poor com pliance, interactions with food or other medications, and gastrointestinal diseases, such as inflammatory bowel disease and short bowel syndromes. Increasing the oral dose of LT-4 is not always effective in these scenarios. Therefore, other routes of administration may be neces sary. In this report, we evaluate alternative treatment modalities for refractory hypothyroidism and present two patients with intestinal malabsorption successfully treated by subcutaneous administration of LT-4.

Clinical course of autoimmune thyroid diseases in women with prolactinomas: Results from a prospective study in a single tertiary centre.

INTRODUCTION: Several retrospective and cross-sectional studies have revealed a higher prevalence of autoimmune thyroid diseases (AITD) with a predominance of autoimmune hypothyroidism in prolactinoma patients compared to the general population. To date, we have no data on the clinical course of AITD in these patients. The aim of this prospective study was to assess the clinical course of AITD in female patients with prolactinomas compared to an age- and thyroid-risk factors-matched control group. MATERIALS AND METHODS: The study population consisted of 144 females (71 patients/73 controls) who underwent approximately a 6-year follow-up. Physical examination, thyroid ultrasound and laboratory testing (measurement of antibodies to thyroglobulin, thyroid peroxidase, TSH-receptor; serum TSH and FT4 levels) were performed twice - at the baseline and at the follow-up visits. RESULTS: AITD were diagnosed in 26.8% (n=19) of the patients and 9.6% (n=7) of the controls (p=0.007) at baseline visit. At the end of the follow-up (FU), these percentages increased to 33.8% (n=24) among the patients versus 12.3% (n=9) in the control group (p=0.002). Hypothyroidism was significantly more frequent in prolactinoma patients than in controls at the end of the study (19.7% vs. 4.1%; p=0.003). Two prolactinoma patients had hyperthyroidism at the baseline visit and restored euthyroid state with negative TSH-receptor antibodies during the follow-up. We did not observe hyperthyroidism in the control group. Among the hypothyroid subsets, the average daily levothyroxine dose at FU visit varied from 25 to 200mcg in the prolactinoma group compared to 25 to 50mcg in the control group. CONCLUSIONS: Female patients with prolactinomas seem to be prone to autoimmune hypothyroidism. As a pathogenetic mechanism, we could suggest the selective immunomodulatory action of PRL predominantly on cell autoimmunity, complement activation and antibody-dependent cytotoxicity, resulting in earlier and more rapid progression of Hashimoto's thyroiditis towards hypothyroid state in genetically predisposed individuals.

Uso adecuado de las pruebas de laboratorio para la evaluación de la función tiroidea en pediatría / Appropriate use of laboratory tests for evaluation of thyroid function in pediatrics

Las pruebas de función tiroidea (PFT) son esenciales para el diagnóstico preciso y el seguimiento eficaz de la disfunción tiroidea. Existe un incremento progresivo y estable de los pedidos de PFT, incluso se han incorporado las mismas a los exámenes de salud anuales en niños sanos. Representan más del 60% de las pruebas realizadas en el laboratorio de endocrinología, tanto en adultos como en los laboratorios especializados en pediatría. Para hacer un uso eficiente de las PFT, antes de solicitarlas debemos preguntarnos… ¿Para quién? ¿Cuándo solicitarlas? ¿Qué pruebas solicitar? ¿Cómo solicitarlas? y ¿Cómo interpretar correctamente los resultados? Un resultado anormal en las PFT no siempre implica patología tiroidea asociada. Las PFT tienen importante variabilidad intra e interindividual lo que hace más compleja su correcta interpretación. La pesquisa de enfermedad tiroidea neonatal es un importante aporte a la prevención de la deficiencia mental en la infancia, su aplicación obligatoria posibilita un diagnóstico temprano, para asegurar su éxito debe considerarse en el marco de un programa integral de detección con estrategias de confirmación, tratamiento temprano y seguimiento a corto, mediano y largo plazo. No debe hacerse un uso indiscriminado de la prueba de estímulo con TRH en el diagnóstico de la patología tiroidea. En pediatría la estrategia de tamiz de enfermedad tiroidea es conveniente realizarla mediante la medición de por lo menos TSH y T4 libre e incluir la determinación de ATPO en grupos de riesgo, a diferencia de la determinación aislada de TSH como es recomendado en adultos. (AU)

Thyroid function tests (TFTs) are essential for accurate diagnosis and effective monitoring of thyroid dysfunction. There is a progressive and steady increase in requests for TFTs, and they have even been incorporated into annual health examinations in healthy children. They represent more than 60% of the tests performed in the endocrinology laboratory, both in adults and in specialized pediatric laboratories. To efficiently use TFTs, before requesting them we should ask ourselves... For whom? When to request them? Which tests to request? How to request them? and How to correctly interpret the results? An abnormal TFT result does not always imply thyroid disease. TFTs have significant intra- and inter-individual variability, which makes their correct interpretation more complex. Screening for newborn thyroid disease is an important contribution to the prevention of intellectual disability in childhood and its mandatory use enables early diagnosis; however, to ensure the test to be successful, it should be considered within the framework of a comprehensive screening program with strategies for confirmation, early treatment, and short-, medium-, and long-term follow-up. The TRH stimulation test in the diagnosis of thyroid disease should not be used indiscriminately. In children, the screening strategy for thyroid disease should be performed by measuring at least TSH and free T4 and include the measurement of TPO-ab in risk groups, as opposed to the isolated measurement of TSH as recommended in adults. (AU)

Obtener un mejor tratamiento para el paciente con hipotiroidismo / Establishing Better Treatment for Hypothyroidism Patients

Introducción: El hipotiroidismo es una entidad de visita frecuente al endocrinólogo, establecer el mejor tratamiento es un desafío, a pesar del manejo adecuado y de un control hormonal óptimo, en ocasiones los pacientes continúan con los síntomas que afectan su calidad de vida, por lo que el tratamiento debe ser individualizado, basado en la mejor evidencia. Objetivo: Establecer las mejores opciones terapéuticas en las diferentes formas de presentación del hipotiroidismo. Métodos: Se realizó una búsqueda bibliográfica no sistemática en las bases de datos de PubMed, Medline, LILACS, EMBASE, Redalyc y guías internacionales. Los criterios de inclusión fueron publicaciones en inglés y español, en las que el título, palabras clave o resumen incluyen información pertinente al objetivo de estudio, periodicidad no mayor a los 5 años a excepción de las guías que son las últimas revisiones. En la búsqueda se obtuvieron 30 artículos de los cuales fueron 14 seleccionados. Conclusiones: Se establecieron las opciones terapéuticas con el fin de obtener un mejor tratamiento para el paciente hipotiroideo que debe ser individualizado y basado en la mejor evidencia, para alcanzar un control adecuado de su enfermedad, mejorar la calidad de vida y evitar complicaciones relacionadas con esta patología(AU)

Introduction: Hypothyroidism is an entity that is frequently seen at the endocrinologist´s. establishing the best treatment is a challenge, despite proper management and optimal hormonal control, sometimes patients continue with symptoms which affect their quality of life, therefore that treatment should be individualized, based on the best evidence. Objective: To establish the best therapeutic options in hypothyroidism different forms of presentation. Methods: A non-systematic bibliographic search was carried out in PubMed, Medline, LILACS, EMBASE, Redalyc databases and in the international guidelines. The inclusion criteria were publications in English and Spanish, in which the title, keywords or abstract include relevant information to the objective of the study, with a periodicity of no more than 5 years, except for the guidelines that the latest revisions were used. In the search, 30 articles were retrieved, 14 which were selected. Conclusions: The therapeutic options were established in order to find better treatment for hypothyroid patients, which must be individualized and based on the best evidence, to achieve adequate control of the disease, to improve the quality of life and to avoid related complications(AU)

[Cardiovascular and metabolic toxicity secondary to sorafenib]. / Toxicidad cardiovascular y metabólica secundaria a sorafenib.

Tyrosine kinase inhibitors are a family of chemotherapy drugs used in first and second line for many solid and hematological neoplasms. Its toxicity is relatively low, since the mechanism of action is based on the inhibition of some tyrosine kinases involved in the explosion of neoplastic cells. However, this blockade is not selective, so it can produce secondary effects. Sorafenib can produce arterial hypertension, thyroid disorders, abdominal pain or hyperamylasemia, among others. We must monitor these patients during treatment to avoid side effects.

Momento de administración de la levotiroxina en pacientes con hipotiroidismo / Timing of levothyroxine administration in patients with hypothyroidism

El hipotiroidismo primario, caracterizado por una disminución en la síntesis de hormonas tiroideas, es el trastorno endocrinológico más frecuente, y la levotiroxina, el tratamiento de elección. Usualmente se recomienda su administración por la mañana, una hora antes del desayuno. A partir de la consulta de una paciente con dificultades para la adherencia ala toma de la medicación en ayunas, la autora de este artículo lleva a cabo una búsqueda bibliográfica para revisar la evidencia que avala la administración de levotiroxina antes de acostarse. (AU)

Primary hypothyroidism, characterized by a decrease in the synthesis of thyroid hormones, is the most common endocrine disorder, and levothyroxine being the treatment of choice. Its administration is usually recommended in the morning, one hour before breakfast. Based on the consultation of a patient with difficulties in sticking to taking medication on an empty stomach, the author of this article carried out a bibliographic search to review the evidence that supports the administrationof levothyroxine before bedtime. (AU)

Calidad de vida en pacientes con enfermedades tiroideas

Introducción: Las enfermedades del tiroides son relativamente frecuentes, constituyen un importante grupo dentro de las enfermedades crónicas no transmisibles. Objetivo: Determinar la calidad de vida en pacientes con enfermedades tiroideas. Métodos: Se realizó un estudio observacional, descriptivo y transversal. El universo estuvo constituido por 210 pacientes con diagnóstico de enfermedades tiroideas, que cumplieron con los criterios de inclusión y exclusión previstos en el estudio, previo consentimiento informado y la muestra no probabilística de 198 pacientes. Se utilizaron las variables: edad, sexo, enfermedad tiroidea diagnosticada (hipertiroidismo, hipotiroidismo, bocio difuso eutiroideo) y calidad de vida (facetas según dimensiones, según la clasificación de expertos y enfermedades tiroideas y la calidad de vida integral según enfermedades tiroideas). Se utilizó el cuestionario World Health Organization Quality of Life. Resultados: Predominó el hipotiroidismo como afección tiroidea más frecuente en las féminas entre 50 a 59 años. Las manifestaciones clínicas que puntuaron las medias más bajas fueron el dolor y malestar, seguido de indicaciones médicas y sentimientos negativos; las dimensiones físicas y psicológicas puntuaron con medias bajas, al igual que el ambiente, valores considerados como deficientes. Conclusiones: Predominó una calidad de vida integral media en el mayor por ciento de los pacientes, estas enfermedades deben ser identificadas a tiempo, para evitar otras complicaciones en diferentes sistemas del organismo que pudieran comprometer la vida del paciente.

Introduction: Thyroid diseases are relatively frequent; they constitute an important group within chronic non-communicable diseases. Objective: To determine the quality of life in patients with thyroid diseases. Methods: An observational, descriptive and cross-sectional study was carried out. The universe (210 patients) with a diagnosis of thyroid diseases, who met the inclusion and exclusion criteria provided for in the study, prior informed consent, and the non-probabilistic sample (198 patients). The variables used were: age, sex, diagnosed thyroid disease (hyperthyroidism, hypothyroidism, diffuse euthyroid goiter) and quality of life (facets according to dimensions, according to expert classification and thyroid diseases and comprehensive quality of life according to diseases thyroid). The World Health Organization Quality of Life questionnaire was used. Results: Hypothyroidism predominated as the most frequent thyroid condition in women between 50 and 59 years of age. The clinical manifestations that scored the lowest average were pain and discomfort, followed by medical indications and negative feelings; the physical and psychological dimensions scored with low averages, as well as the environment, values ​​considered deficient. Conclusions: An average comprehensive quality of life prevailed in the highest percentage of patients; these diseases must be identified in time, to avoid other complications in different body systems that could compromise the patient's life.

Hipotiroidismo y su asociación con otras patologías: una revisión narrativa / Hypothyroidism and its association with other pathologies: a narrative review

Introducción: El hipotiroidismo es la insuficiente producción de hormona tiroidea, para satisfacer las necesidades corporales. Este puede ser primario (con pérdida de la función de la glándula tiroidea) o secundario (por falta de estimulación de la glándula). Dada la alta prevalencia del hipotiroidismo, y frecuentes asociaciones con otras enfermedades, se realizó una revisión que puntualiza aspectos de interés clínico en esta patología, que pueden resultar útiles en la práctica médica. Metodología: Se efectuó una búsqueda bibliográfica en PubMed, PubMed Central, MEDLINE Complete, Epistemonikos, Europe PMC y Scielo. Se buscaron los términos "hipotiroidismo" y "tiroides", y se acortaron los artículos a los últimos 5 años. Resultados: Se incluyeron en total 36 artículos publicados en Inglés y en Español. Se seleccionaron aquellos relacionados al hipotiroidismo que exponen asociaciones con otras patologías. Entre estas patologías se encuentra la diabetes, las dislipidemias, enfermedades cardiovasculares, hepáticas, entre otras. Conclusiones: El hipotiroidismo es una patología prevalente que se asocia de forma frecuente con muchas otras comorbilidades que hay que tener en cuenta a la hora de abordar estos pacientes, y con ello tomar las mejores decisiones diagnósticas y terapéuticas.

Introduction: Hypothyroidism is the insufficient production of thyroid hormone to meet the bodily needs. This can be primary (with loss of function of the thyroid glands) or secondary (due to lack of stimulation of the glands). Given the high prevalence of hypothyroidism, and frequent associations with other diseases, a review was carried out that points out aspects of clinical interest in this pathology, which may be useful in medical practice. Methodology: A bibliographic search was carried out in PubMed, PubMed Central, MEDLINE Complete, Epistemonikos, Europe PMC and Scielo. The terms "hypothyroidism" and "thyroid" were searched, and the articles were shortened to the last 5 years. Results: A total of 36 articles published in English and Spanish were included. Those related to hypothyroidism that exhibit associations with other pathologies were selected. These pathologies include diabetes, dyslipidemia, cardiovascular and liver diseases, among others. Conclusions: Hypothyroidism is a prevalent pathology that is frequently associated with many other comorbidities that must be taken into account when dealing with these patients, and thus make the best diagnostic and therapeutic decisions.

Educational and research needs in hypothyroidism of primary care physicians in the Community of Madrid.

AIM: To document the opinion of primary care physicians on hypothyroidism and explore their educational and research needs. METHODS: A web-based survey was released through Healthcare Management offices in Madrid to be answered anonymously by the doctors at the health centers. RESULTS: Five hundred and forty-six out of 3897 (14%) physicians completed the survey. More than 90% of respondents agreed that hypothyroidism is a common and easily managed health problem and that its poor control increases healthcare costs. This percentage was higher in older doctors and those with longer professional experience. 88.1% of respondents showed interest in educational activities (86.6% in receiving and 20.9% in providing education). The preference for clinical sessions in the health center (71.5%) exceeded that of sessions in the hospital (20.2%), while the preference for online courses (67.8%) exceeded that of face-to-face courses (50.9%). 53.5% of interviewees expressed interest in research on hypothyroidism. Women and professionals with a higher number of hypothyroid patients under their care were more likely to be interested in educational and research activities. CONCLUSION: Primary care physicians in the Community of Madrid are aware of the health problem posed by thyroid hormone deficiency and are clearly in favour of participating in educational and research activities in this area of knowledge.

Severe primary hypothyroidism presenting as polymorphic ventricular tachycardia / Hipotiroidismo primario grave que se presenta como taquicardia ventricular polimórfica

Abstract Introduction: Hypothyroidism may have various cardiovascular manifestations due to morphological, functional and electrical alterations in the heart. The usual electrocardiographic findings being sinus bradycardia, low voltage complexes, and slowed intraventricular conduction. Hypothyroidism manifesting as polymorphic ventricular tachycardia has only been reported in a few case reports. Clinical case. A 60-year-old lady presented to us in the emergency department in an unresponsive and unconscious state and electrocardiogram showed a polymorphic ventricular tachycardia. After initial resuscitation with direct current cardioversion and supportive care, she found to have severe hypothyroidism and responded well to thyroid replacement therapy. Conclusion. Polymorphic ventricular tachycardia is a life threatening emergency that can have various etiologies. Polymorphic ventricular tachycardia secondary to primary hypothyroidism is a rare presentation but it is treatable and reversible with thyroid replacement therapy. In patients presenting with QT interval prolongation and ventricular tachycardia, hypothyroidism should be one of the differential diagnosis.

Resumen Introducción: El hipotiroidismo puede presentar diferentes manifestaciones cardiovasculares dadas por alteraciones morfológicas, funcionales y eléctricas en el corazón, siendo los hallazgos electrocardiográficos usuales son la bradicardia sinusal, los complejos de bajo voltaje y la conducción intraventricular lenta. El hipotiroidismo manifestado como taquicardia ventricular polimórfica solo se ha descrito en unos pocos reportes de caso. Caso clínico: Se trata de una mujer de 60 años que acudió que acurdió al servicio de urgencias en un estado inconsciente y sin respuesta a estímulos, y el electrocardiograma reveló taquicardia ventricular polimórfica. Luego de la reanimación inicial con cardioversión con corriente directa y tratamiento sintomático se le encontró un hipotiroidismo grave, el cual se trató con terapia de reemplazo con hormona tiroidea. y se obtuvo una buena respuesta Conclusión. La taquicardia ventricular polimórfica es una emergencia vital que puede tener varias etiologías. La taquicardia ventricular polimórfica secundaria a un hipotiroidismo primario es una presentación poco común, pero es tratable y reversible con la terapia de reemplazo con hormona tiroidea. En los pacientes que presentan una prolongación del intervalo QT y taquicardia ventricular, es pertinente incluir el hipotiroidismo en el diagnóstico diferencial.

Elementos básicos para el diagnóstico y manejo terapéutico del hipotiroidismo primario en el paciente adulto / Basic Elements for the Diagnosis and Treatment of Primary Hypothyroidism in the Adult Patient

Introducción: El hipotiroidismo primario, con frecuencia, es diagnosticado de forma tardía y no siempre las dosis indicadas de levotiroxina son las más convenientes. Urge llamar la atención sobre estos aspectos y actualizar el conocimiento sobre este tema. Objetivo: Describir los elementos básicos para el diagnóstico y manejo terapéutico del hipotiroidismo primario en el paciente adulto, en el primer nivel de atención. Métodos: Se realizó una búsqueda de literatura relevante sobre el tema. Se utilizaron como buscadores de información científica a Pubmed y a Google Académico. La estrategia de búsqueda incluyó los siguientes términos como palabras claves: hipotiroidismo primario; hipotiroidismo subclínico; diagnóstico y tratamiento. Fueron evaluados artículos que, en general, tenían menos de 10 años de publicados, en idioma español e inglés, que hicieran referencia específicamente al tema de estudio a través del título. Fueron excluidos los artículos que no cumplieron con estas condiciones. Esto permitió que 72 fueran referenciados. Conclusiones: Para realizar el diagnóstico del hipotiroidismo primario, es fundamental conocer los factores de riesgo y el cuadro clínico correspondiente. La elevación de la tirotropina en suero es la mejor prueba diagnóstica y casi siempre indica la presencia de hipotiroidismo primario. Se debe tener presente al inicio del tratamiento, la edad del paciente, el tiempo de evolución de la enfermedad, la intensidad del hipotiroidismo, el momento fisiológico y la presencia de enfermedades asociadas. Todos los pacientes con hipotiroidismo primario manifiesto deben ser tratados con levotiroxina sódica, pero aquellos con hipotiroidismo subclínico no siempre se benefician con este tratamiento(AU)

Introduction: Primary hypothyroidism is often diagnosed lately and not always are the indicated doses of levothyroxine the most convenient. It is urgent to draw attention towards these aspects and to update knowledge on this subject. Objective: To describe the basic elements for the diagnosis and therapeutic management of primary hypothyroidism in adult patients at the first level of care. Methods: A search for relevant literature on the subject was carried out. Pubmed and Google Scholar were used as search engines for retrieving scientific information. The search strategy included the following terms as keywords: hipotiroidismo primario [primary hypothyroidism], hipotiroidismo subclínico [subclinical hypothyroidism], diagnóstico y tratamiento [diagnosis and treatment]. Generally speaking, articles within ten years of having been published were assessed, written in Spanish and English and making a specific reference to the subject of the study in their respective titles. Articles not meeting these conditions were excluded. This allowed for 72 articles be referenced. Conclusions: To make the diagnosis of primary hypothyroidism, it is essential to know the risk factors and the corresponding clinical picture. Serum thyrotropin elevation is the best diagnostic test and almost always indicates the presence of primary hypothyroidism. The patient's age, the time of evolution of the disease, the intensity of the hypothyroidism, the physiologic time and the presence of associated diseases should be taken into account at the beginning of treatment. All patients with overt primary hypothyroidism should be treated with levothyroxine sodium, but those with subclinical hypothyroidism do not always benefit from this treatment(AU)

Clinical usefulness of thyroid ultrasonography in patients with primary hypothyroidism.

BACKGROUND AND OBJECTIVE: Despite the value of ultrasonography in the detection of chronic thyroiditis (CT) as well as in nodular goitre, it is often only indicated in patients with hypothyroidism if a palpable goitre or a thyroid mass is identified. The objective of the study is to evaluate the clinical usefulness of thyroid ultrasonography in patients with primary hypothyroidism without clinical suspicion of nodular goitre. And more specifically, to analyse its value in the aetiological diagnosis of hypothyroidism, and to evaluate its contribution in the detection and characterisation of coexisting subclinical thyroid nodular disease. PATIENTS AND METHOD: Prospective cross-sectional observational study of 114 patients with primary hypothyroidism of CT or idiopathic aetiology, without symptoms or cervical palpation suspected of nodular goitre, who underwent a thyroid function test, a serological study of antithyroid antibodies, a thyroid ultrasonound and, when appropriate, a cytological study of the nodules found. RESULTS: Ultrasonound allowed CT to be recognised as the cause of hypothyroidism in 19% of patients who had a negative serological study, and detected nodules larger than 9mm in 22 patients (16 with antithyroid antibodies). A cytological study was performed in 18 of the cases. Five patients underwent surgery, with carcinoma found in two of them. CONCLUSIONS: Thyroid ultrasound is useful in the aetiological diagnosis of primary hypothyroidism as well as in the detection of a coexisting, unsuspected, but clinically relevant nodular goitre, so this examination should be indicated in the initial study of patients with primary hypothyroidism.

Prevalencia de hipotiroidismo subclínico y biomarcadores de riesgo cardiovascular en pacientes del Hospital General de Riobamba / Prevalence of subclinical hypothyroidism and biomarkers of cardiovascular risk in patients of the General Hospital of Riobamba

El Hipotiroidismo subclínico (HSC) es definido bioquímicamente por una elevación en la concentración sérica de la hormona TSH con niveles normales de T4 libre. El objetivo de este estudio fue determinar la prevalencia de HSC en los pacientes que asistieron a la consulta de medicina interna del Hospital General IESS de Riobamba. Así como, analizar la correlación entre los parámetros hormonales y ciertos marcadores bioquímicos asociados con el incremento de riesgo cardiovascular. Se realizó una investigación de tipo descriptiva, observacional, con un diseño no experimental de corte transversal, que abarcó el periodo comprendido desde enero de 2019 hasta septiembre de 2021. 245 pacientes fueron diagnosticados con HSC, lo cual representó el 10.58 % del universo poblacional estudiado, 61.2% eran del sexo femenino, mientras que el 38.8% del sexo masculino. El mayor número de casos (59.61 %) se observó en el grupo etario mayor de 65 años, distribuidos de la siguiente manera: (22.86% hombres y 36.75% mujeres), también se encontró que el HSC está asociado con un perfil lipídico aterogénico, caracterizado por un incremento en la concentración de colesterol total y LDL los cuales se correlacionaron positivamente con las concentraciones de TSH.

Subclinical hypothyroidism (SH) is biochemically defined by an elevation in the serum concentration of TSH hormone with normal levels of free T4. The aim of this study was to determine the prevalence of SH in patients attending the internal medicine clinic of the General Hospital IESS of Riobamba. Also, to analyze the correlation between hormonal parameters and certain biochemical markers associated with increased cardiovascular risk. A descriptive, observational, non-experimental cross-sectional design was performed, covering the period from January 2019 to September 2021. 245 patients were diagnosed with SH, which represented 10.58 % of the population universe studied, 61.2% were female, while 38.8% were male. The highest number of cases (59.61 %) was observed in the age group over 65 years, distributed as follows: (22.86% men and 36.75% women), it was also found that SH is associated with an atherogenic lipid profile, characterized by an increase in the concentration of total cholesterol and LDL which correlated positively with TSH concentrations.

Asociación entre el hipotiroidismo subclínico de anticuerpos antiperoxidasa tiroidea negativos y los resultados perinatales adversos diagnosticados con diferentes criterios en el tercer trimestre del embarazo

Antecedentes. El efecto del hipotiroidismo subclínico (HSC) en los resultados perinatales adversos no está claro, y los valores de referencia de la hormona tiroestimulante (TSH) en el embarazo son controvertidos. Objetivo. Evaluar los efectos del HSC negativo para los anticuerpos de la peroxidasa tiroidea (TPOAbs) sobre los resultados perinatales según los diferentes valores de referencia de la TSH. Métodos. Un total de 554 mujeres embarazadas, incluyendo 509 eutiroideas y 45 gestantes hipotiroideas subclínicas (TSH > 3 mIU/L), fueron incluidas en este estudio prospectivo de casos y controles. Todas las gestantes estaban en el tercer trimestre y eran negativas a los TPOAbs. Las funciones tiroideas fueron evaluadas utilizando los valores de referencia específicos para el trimestre recomendados por el Colegio Americano de Obstetricia y Ginecología (ACOG) (TSH > 3 mIU/L) y la Asociación Americana de Tiroides (ATA) (TSH > 4 mIU/L). Resultados. La mortalidad neonatal en el hipotiroidismo subclínico con un límite superior de TSH de 4 mIU/L fue significativamente menor que en el grupo eutiroideo (2 (0,4%) frente a 1 (4,5%); p=0,009). No hubo diferencias significativas en resultados maternos y perinatales adversos en las gestantes con HSC y eutiroideas en ambos valores de referencia de la TSH. No hubo correlación significativa entre los valores de TSH y las semanas de parto de las gestantes con parto prematuro (r=0,169, p=0,146). Conclusiones. En este estudio, utilizando los diferentes valores basales de TSH recomendados por las directrices del ACOG de 2020 y de la ATA de 2017 en el tercer trimestre del embarazo para el diagnóstico de hipotiroidismo subclínico, no hubo una relación significativa entre los casos de hipotiroidismo subclínico con TPOAbs negativos y los resultados perinatales adversos.

Background: The effect of subclinical hypothyroidism (SCH) on adverse perinatal outcomes is unclear, and thyroid-stimulating hormone (TSH) reference values in pregnancy are controversial. Objective: To evaluate the effects of thyroid peroxidase antibody (TPOAbs) negative SCH on perinatal outcomes according to the different TSH reference values. Methods: A total of 554 pregnant women, including 509 euthyroid and 45 subclinical hypothyroid (TSH > 3 mIU/L) pregnant women, were included in this prospective case-controlled study. All pregnant women were in the third trimester and were TPOAbs negative. Thyroid functions were evaluated using trimester-specific reference values recommended by the American College of Obstetrics and Gynecology (ACOG) (TSH > 3 mIU/L) and the American Thyroid Association (ATA) (TSH > 4 mIU/L) guidelines. Results: Neonatal mortality in subclinical hypothyroidism with a TSH upper limit of 4 mIU/L was significantly lower than in the euthyroid group (2 (0.4%) vs 1 (4.5%); p=0.009). There was no significant difference in terms of adverse maternal and perinatal outcomes in SCH and euthyroid pregnant women in both TSH reference values. There was no significant correlation between TSH values and delivery weeks of pregnant women with preterm delivery (r=0.169, p=0.146). Conclusions: In this study, using different baseline TSH values recommended by the 2020 ACOG and 2017 ATA guidelines in the third trimester of pregnancy for the diagnosis of subclinical hypothyroidism, it was shown that there was no significant relationship between cases of subclinical hypothyroidism with negative TPOAbs and adverse perinatal outcomes.

Impacto de la pandemia por COVID-19 en la consulta ambulatoria endocrinológica y teleconsulta en un hospital Peruano

Introducción: La pandemia por COVID-19 afectó la continuidad de las consultas médicas presenciales, así se implementaron estrategias, como las teleconsultas, para cerrar brechas de atención. El objetivo del estudio fue describir el impacto de la pandemia en la consulta endocrinológica en el Hospital Nacional Alberto Sabogal Sologuren (Callao, Perú). Materiales y métodos: Se realizó un estudio descriptivo de análisis de datos secundarios obtenidos del Sistema de Salud Inteligente del Seguro Social de Perú. Se analizó datos de las consultas ambulatorias entre mayo 2019 y noviembre 2021. Resultados: Debido a la pandemia, la proporción de consultas presenciales disminuyó de 100% (periodo prepandemia) a 29,4% (durante la pandemia), mientras que las teleconsultas predominaron tras su implementación. Mas del 68% de pacientes fueron mujeres, en las consultas presenciales la mediana de edad antes y durante la pandemia fue 59 y 56 años, respectivamente, mientras que en teleconsultas fue 58 años. La diabetes mellitus fue el principal motivo de consulta (entre 32,6% a 34,4% del total de consultas), seguido del hipotiroidismo y la enfermedad nodular tiroidea. Durante la pandemia, la proporción de consultas por hipotiroidismo fue mayor en teleconsultas vs consulta presencial (25,3% vs 18%). Conclusiones: Durante la pandemia, las teleconsultas predominaron sobre la consulta presencial. No hubo diferencias relevantes en la mediana de edad o sexo predominantes entre los pacientes antes o durante la pandemia. La diabetes mellitus fue el principal motivo de consulta en general y durante la pandemia las consultas por hipotiroidismo fueron mayor en teleconsulta.

ABSTRACS Background: The COVID-19 pandemic affected the continuity of face-to-face medical consultations, so strategies, such as teleconsultations, were implemented to close the gaps in care. The objective of this study was to describe the impact of the pandemic in the traditional endocrinology consultation at Hospital Nacional Alberto Sabogal Sologuren (Callao, Peru). Materials and methods: We carried out a descriptive study of analysis of secondary data, that was obtained from the Sistema de Salud Inteligente of the Social Security of Peru. Data from outpatient consultations between May 2019 and November 2021 were analyzed. Results: Due to the pandemic, the proportion of face-to-face consultations decreased from 100% (pre-pandemic period) to 29,4% (during the pandemic), while teleconsultations predominated after its implementation. More than 68% of patients were women, in face-to-face consultations the median age before and during the pandemic was 59 and 56 years, respectively, while in teleconsultations it was 58 years. Diabetes mellitus was the main reason for consultation (between 32,6% and 34,4% of all consultations), followed by hypothyroidism and nodular thyroid disease. During the pandemic, the proportion of consultations for hypothyroidism was higher in teleconsultations vs. face-to-face consultations (25,3% vs. 18%). Conclusions: During the pandemic, teleconsultations predominated over face-to-face consultation. There were no relevant differences in median age or predominant gender among patients before or during the pandemic. Diabetes mellitus was the main reason for consultation in general and during the pandemic consultations for hypothyroidism were higher in teleconsultation.

Hipotiroidismo subclínico y pérdida de embarazo: una revisión de la literatura / Subclinical Hypothyroidism and Pregnancy Loss: A Literature Review

Existe una alta prevalencia de hipotiroidismo subclínico (SCH) en el embarazo. Está vinculado a una importante morbilidad y mortalidad materna y fetal. Los efectos de SCH sobre el embarazo incluyen mayores riesgos de hipertensión gestacional y ruptura prematura de membranas (PROM). Sus fetos y bebés tenían más probabilidades de sufrir de bajo peso al nacer (LBW) y retraso del crecimiento intrauterino (IUGR). El riesgo de aborto espontáneo se informa alto en varios estudios para SCH no tratado. SCH se asocia directamente con una mayor presencia de anti -cuerpos anti TPO en suero materno. La detección temprana y el tratamiento de SCH han sido testigos de mejores resultados en términos de resultado del embarazo. Esta revisión se centra para establecer la relación de una mayor prevalencia de SCH en los países en desarrollo, así como su asociación con el aumento de los cuerpos anti TPO en suero materna y sacar una conclusión que puede ayudar a reducir las razones y proporcionar una solución. Este estudio concluyó que SCH es más frecuente en los países en desarrollo, ya sea debido a la deficiencia de yodo, una disminución de la conciencia sobre este problema o menos acceso a las instalaciones médicas. Por lo tanto, se sugiere que las hembras con antecedentes de partos prematuros, IUGR anteriores o abortos involuntarios deben someterse a una detección de hipotiroidismo subclínico y niveles de anticuerpos anti TPO durante sus visitas prenatales

There is a high prevalence of subclinical hypothyroidism (SCH) in pregnancy. It is linked to significant maternal and fetal morbidity and mortality. SCH's effects on pregnancy include increased risks of gestational hypertension and premature rupture of membranes (PROM). Their fetuses and infants had been more likely to suffer from low birth weight (LBW) and intrauterine growth retardation (IUGR). The risk of miscarriage is reported high in various studies for untreated SCH. SCH is directly associated with increased presence of anti TPO anti bodies in maternal serum. Early detection and treatment of SCH have witnessed better results in terms of pregnancy outcome. This review focuses to establish the relationship of increased prevalence of SCH in the developing countries as well as its association with increased anti TPO anti bodies in maternal serum and draw a conclusion which can help narrow down the reasons and provide solution. This study concluded that SCH is more prevalent in developing countries, either due to iodine deficiency, decreased awareness about this problem or less access to medical facilities. Therefore, it is suggested that females with history of preterm deliveries, previous IUGRs, or miscarriages should undergo screening for subclinical hypothyroidism and Anti TPO antibody levels during their antenatal visits.