Association Between Subclinical Thyroid Dysfunction and Cognitive Decline: Findings From the ELSA-Brasil Study.

BACKGROUND: Thyroid dysfunction has been associated with cognitive decline and dementia. However, the role of subtle thyroid hormone alterations in cognitive function is still debatable. METHODS: Participants without overt thyroid dysfunction aged 35-74 years at baseline were evaluated in 3 study waves (2008-2010, 2012-2014, and 2017-2019). We assessed baseline thyroid-stimulating hormone (TSH), free thyroxine (FT4), and free triiodothyronine (FT3). Cognitive performance was evaluated every 4 years in each wave using 10-word immediate and late recall, word recognition, semantic (animals category) and phonemic (letter f) verbal fluency, and the trail-making B-version tests. A global composite z-score was derived from these tests. The associations of TSH, FT4, and FT3 levels with cognitive decline over time were evaluated using linear mixed-effect models adjusted for sociodemographic, clinical, and lifestyle variables. RESULTS: In 9 524 participants (mean age 51.2 ±â€…8.9 years old, 51% women, 52% White), there was no association between baseline TSH, FT4, and FT3 levels and cognitive decline during the follow-up. However, increase in FT4 levels over time was associated with faster memory (ß = -0.004, 95% CI = -0.007; -0.001, p = .014), verbal fluency (ß = -0.003, 95% CI = -0.007; -0.0005, p = .021), executive function (ß = -0.004, 95% CI = -0.011; -0.003, p < .001), and global cognition decline (ß = -0.003, 95% CI = -0.006; -0.001, p = .001). Decrease in FT4 levels over time was associated with faster verbal fluency (ß = -0.003, 95% CI = -0.007; -0.0004, p = .025) and executive function (ß = -0.004, 95% CI = -0.007; -0.0003, p = .031) decline. CONCLUSIONS: An increase or decrease in FT4 levels over time was associated with faster cognitive decline in middle-aged and older adults without overt thyroid dysfunction during 8 years of follow-up.

Thyroid surgery in children: a single-center experience of 20 years.

OBJECTIVE: Thyroidectomy is a relatively uncommon procedure in pediatric patients. We aimed to review our 20-year experience of thyroid surgery. METHODS: A total of 39 patients who underwent thyroid surgery from 2003 to 2023 were retrospectively evaluated. All patients were followed preoperatively and postoperatively by our institutional multidisciplinary board. Patients were divided into two groups based on their pathologies: benign and malignant. RESULTS: In total, 39 patients (27 girls and 12 boys) underwent 47 thyroid surgeries (total thyroidectomy in 19 patients and subtotal thyroidectomy in 20 patients, with 8 of them having completion thyroidectomy). Notably, 20 (51%) patients had benign and 19 (49%) patients had malignant pathologies. Median age at operation was 157 (9-223) months in the benign group and 182 (1-213) months in the malignant group. In the benign group, 12 (60%) patients had colloidal goiter and 8 (40%) patients had other conditions. In the malignant group, 12 (63%) patients had papillary thyroid carcinoma, 3 (16%) patients had follicular thyroid carcinoma, 2 (11%) had medullary thyroid carcinoma, and 2 patients had other thyroid malignancies. Overall permanent complication rate was 2 out of 39 (5%), which was similar for both groups (1 hypocalcemia in each group). The median follow-up was 38 months (1-179 months) with no local recurrence or distant metastasis. CONCLUSION: Pediatric thyroidectomies are performed on a heterogeneous group of pediatric patients due to a diverse group of pathologies. A multidisciplinary approach is required for proper initial management and surgical strategy with decreased complication rate and event-free survival of these patients in experienced tertiary centers.

Prognostic factors in childhood vitiligo.

BACKGROUND: Vitiligo is a multifactorial disease characterized by the progressive loss of melanocytes. The worldwide prevalence ranges from 0.5% to 2%, and in children from 0% to 2.16%. The objective of this study was to determine the variables associated with progression of vitiligo. METHODS: A retrospective cohort was carried out where a random sample of records of pediatric patients with vitiligo from January 2016 to December 2020 was analyzed. The variables were studied: age at onset, sex, hereditary family history, personal history of thyroid diseases, time of evolution, classification, Köebner phenomena, mucosal vitiligo, halo nevus, premature graying and the presence of other dermatoses. The final state was classified as progression, stability, partial remission and complete remission. RESULTS: 574 children with vitiligo; 290 (50.5%) women, 284 (49.5%) men. Non-segmental vitiligo in 324 (56.4%), segmental vitiligo in 250 (43.6%). Mean age of onset 8.7 years (SD: 4.54). Median evolution time 6 months (25th percentile of 3 months and 75th percentile of 24 months). Family history 27 (4.70%). Thyroid disease 7 (1.21%). Evolution remained stable in 44 (7.7%), 68 (11.8%) had progression, 32 (5.6%) complete remission, 222 (38.7%) partial remission and 208 (36.2%) one consultation. Non-segmental vitiligo was obtained p < 0.028, younger age of onset p < 0.000, and none skin comorbidities p < 0.009. CONCLUSIONS: The variables that were associated with a more progression were non-segmental vitiligo, early ages at the onset of the disease, and not presenting with other skin diseases.

INTRODUCCIÓN: El vitiligo es una enfermedad multifactorial caracterizada por la pérdida de melanocitos. La prevalencia mundial oscila entre el 0.5% y el 2%, y en niños entre el 0% y el 2.16%. El objetivo de este estudio fue determinar las características clínicas asociadas a la progresión del vitiligo. MÉTODOS: En una cohorte retrospectiva se analizó una muestra aleatoria de expedientes de pacientes con vitiligo de 0-18 años de edad, de enero de 2016 a diciembre de 2020. Se estudiaron la edad de inicio, el sexo, los antecedentes heredofamiliares, el antecedente personal de enfermedades tiroideas, el tiempo de evolución, la clasificación, el fenómeno de Köebner, el vitiligo en mucosas, el halo nevo, el encanecimiento prematuro y la relación con otras dermatosis. El estado final se clasificó en progresión, estabilidad, remisión parcial y remisión completa. RESULTADOS: 574 niños con vitiligo; 290 (50.5%) mujeres y 284 (49.5%) varones. Vitiligo no segmentario en 324 (56.4%), vitiligo segmentario en 250 (43.6%). Edad promedio de aparición 8.7 años (DE: 4.54). Mediana de tiempo de evolución 6 meses (percentil 25 de 3 meses y percentil 75 de 24 meses). Se encontraron antecedentes familiares en 27 (4.70%). Enfermedad tiroidea en 7 (1.21%). En la evolución permanecieron estables 44 (7.7%), progresaron 68 (11.8%), remisión completa 32 (5.6%), remisión parcial 222 (38.7%) y una consulta 208 (36.2%). Se obtuvo p < 0.028 en vitiligo no segmentario, p < 0.000 en menor edad de aparición y p < 0.009 en comorbilidad cutánea. CONCLUSIONES: Las variables que se asociaron a progresión fueron vitiligo no segmentario, edad temprana de inicio y no cursar con otras enfermedades cutáneas.

Association between thyroid disorders and extra-thyroidal cancers, a review.

Thyroid hormone has been shown to have both tumor-promoting and tumor-suppressing actions, which has led to significant debate over its involvement in the development of cancer. Proliferation, apoptosis, invasiveness, and angiogenesis are all aspects of cancer that are affected by the thyroid hormones T3 and T4, according to research conducted in animal models and in vitro experiments. The effects of thyroid hormones on cancer cells are mediated by many non-genomic mechanisms, one of which involves the activation of the plasma membrane receptor integrin αvß3. Typically, abnormal amounts of thyroid hormones are linked to a higher occurrence of cancer. Both benign and malignant thyroid disorders were found to be associated with an increased risk of extra-thyroidal malignancies, specifically colon, breast, prostate, melanoma, and lung cancers. The purpose of this review was to shed light on this link to define which types of cancer are sensitive to thyroid hormones and, as a result, are anticipated to respond favorably to treatment of the thyroid hormone axis.

Encefalitis de Hashimoto. Presentación de un caso / Hashimoto Encephalitis. Case Report

INTRODUCCIÓN La Encefalitis de Hashimoto (EH) es una encefalopatía de naturaleza autoinmune, con buena respuesta al tratamiento con corticoides, títulos séricos elevados de anticuerpos antitiroideos y de curso subagudo con recaídas-remisiones. Es una enfermedad poco frecuente, con una presentación clínica variable y fisiopatología aún desconocida. PRESENTACIÓN DEL CASO: Paciente femenina de 76 años con antecedentes de hipotiroidismo primario. Ingresó con un síndrome confusional agudo. Al examen físico vigil, Glasgow 13/15, subfebril (37.8°C) desorientada temporoespacialmente, ecolalia, pupilas isocóricas y reactivas, sin focalidad neurológica. Signos meníngeos negativos. Laboratorio: Hipocalcemia leve (7.8mg/dl), hipopotasemia (K 3,2 mmol/l), PCR 221.9 mg/L. Test rápido para VIH negativo. TC de encéfalo sin alteraciones. Punción lumbar líquido cristal de roca, proteínas 1 g/l, glucosa 0.67 g/l, láctico 1.3, leucocitos 77 células/microL (100% mononucleares). Se interpretó inicialmente como Encefalitis de etiología viral y se le indicó aciclovir. Presentó sensorio alternante, excitación psicomotriz y convulsión tónica clónica generalizada. Debido a deterioro súbito del sensorio, se realizó intubación orotraqueal y se trasladó a Unidad de Terapia Intensiva (UTI). Permaneció bajo asistencia mecánica ventilatoria y con vasopresores. Laboratorio: VDRL, p24 y anticuerpos HIV negativos, TSH 27,82, T4 0,41. PCR de LCR: Virus herpes simple 1 y 2, citomegalovirus y JC negativos. Hemocultivos negativos. Ante sospecha clínica de Encefalitis de Hashimoto, se solicitaron anticuerpos antitiroideo peroxidasa (aTPO), antitiroglobulina (aTG) y Anticuerpos Anti-Receptor de TSH (TRABS), que resultaron positivos. Recibió tratamiento con levotiroxina endovenosa e hidrocortisona. Normaliza valores. Por fallo en el weaning, se realizó traqueostomía. Luego de 21 días de internación en Terapia Intensiva pasó a clínica con posterior alta hospitalaria. Discusión: La EH se puede considerar como diagnóstico, solo después de descartar otras causas. En el caso expuesto se llegó al diagnóstico luego de descartar otras causas posibles, con anticuerpos antitiroideos positivos en altas concentraciones y respuesta al tratamiento con corticoides. Conclusión: Se destaca la necesidad de ampliar el conocimiento de esta patología con el fin de disminuir el subdiagnóstico y promover un inicio precoz del tratamiento, mejorando así su progresión y calidad de vida de los pacientes.

INTRODUCTION: Hashimoto's Encephalitis (HE) is an autoimmune encephalopathy, with a good response to treatment with corticosteroids, high serum titers of antithyroid antibodies and a subacute course with relapses-remissions. It is a rare disease, with a variable clinical presentation and still unknown pathophysiology. CASE REPORT: A 76-year-old female patient with a history of primary hypothyroidism. She was admitted with acute confusional syndrome. On physical examination, she was awake, she was Glasgow 13/15, she was subfebrile (37.8°C), disoriented temporally, echolalia, isochoric and reactive pupils, without neurological focality. Negative meningeal signs. Laboratory: Mild hypocalcemia (7.8 mg/dl), hypokalemia (K 3.2 mmol/l), CRP 221.9 mg/L. Rapid test for HIV negative. Brain CT without alterations. Lumbar puncture rock crystal liquid, proteins 1 g/l, glucose 0.67 g/l, lactic acid 1.3, leukocytes 77 cells/microL (100% mononuclear). It was initially interpreted as Encephalitis of viral etiology and acyclovir was prescribed. He presented alternating sensory, psychomotor excitement, and generalized tonic-clonic seizure. Due to sudden deterioration of the sensorium, orotracheal intubation was performed and he was transferred to the Intensive Care Unit. He remained under mechanical ventilatory assistance and with vasopressors. Laboratory: VDRL, p24 and HIV antibodies negative, TSH 27.82, T4 0.41. CSF PCR: Herpes simplex virus 1 and 2, cytomegalovirus and JC negative. Negative blood cultures. Due to clinical suspicion of Hashimoto's Encephalitis, anti-thyroid peroxidase (aTPO), anti-thyroglobulin (aTG) antibodies and Anti-TSH Receptor Antibodies (TRABS) were requested, which were positive. She was treated with intravenous levothyroxine and hydrocortisone. Normalized values. Due to weaning failure, a tracheostomy was performed. After 21 days of hospitalization in the Intensive Care Unit, she was admitted to the clinic and subsequently discharged from the hospital. Discussion: HD can be considered as a diagnosis, only after ruling out other causes. In the case presented, the diagnosis was made after ruling out other possible causes, with positive antithyroid antibodies in high concentrations and response to treatment with corticosteroids. Conclusion: The need to expand knowledge of this pathology is highlighted in order to reduce underdiagnosis and promote early initiation of treatment, thus improving its progression and quality of life of patients.

Severe hypothyroidism as a trigger for Brugada-type ECG abnormalities: a case report and literature review.

Brugada syndrome (BrS) is an inherited disorder that can cause ventricular fibrillation and sudden cardiac death in individuals with otherwise structurally normal hearts. Several provoking factors are known to potentially unmask or exacerbate a typical Brugada ECG pattern in predisposed subjects. Hypothyroidism has been suggested as one of these triggers, but the exact mechanisms underlying this relationship remain poorly understood. Moreover, the severity of thyroid dysfunction beyond which a Brugada-type ECG alteration might be triggered is still unclear. We report the case of a 33-year-old male who displayed a Brugada type 1 ECG pattern and was diagnosed with severe hypothyroidism (TSH > 100 mU/L with undetectable levels of fT4 and fT3). Hormonal replacement therapy with levothyroxine was initiated at increasing doses; serial biochemical and ECG controls were performed, initially every 3 weeks up to 15 weeks and afterward every 3 months. The regression of typical Brugada ECG waveforms could be seen at an early stage, when the patient was still taking a low dose of levothyroxine (37.5 µg/day, i.e., one-fourth of his final requirements of 150 µg/day), and laboratory tests still showed a marked alteration of thyroid hormonal parameters. Hypothyroidism may act as a trigger for Brugada-type ECG abnormalities, but a very severe alteration of the hormonal parameters is necessary to prompt these alterations. In our case, the initiation of replacement therapy with levothyroxine rapidly reversed the ECG modifications, even at a low subtherapeutic dose.

Evaluación de la agudeza diagnóstica de la Ecografía Translaríngea Transcutánea (ETLTC) en la valoración de la movilidad de las cuerdas vocales en cirugía de tiroides y paratiroides / Evaluation of the diagnostic acuity of the Transcutaneous Translaryngeal Ultrasound (TCTLUS) in the assessment of the vocal cords mobility in thyroid and parathyroid surgery

Introducción. La evaluación de la movilidad de las cuerdas vocales en cirugía de tiroides y paratiroides hace parte de la adecuada valoración integral. Aunque la laringoscopia directa es prueba de referencia, su uso real no es rutinario por lo que se propone la ecografía translaríngea como alternativa de evaluación. Métodos. Estudio prospectivo de evaluación de una prueba diagnóstica de la movilidad de las cuerdas vocales pre y posoperatoria, comparando la ecografía translaríngea con la video laringoscopia, en pacientes con cirugía de tiroides y paratiroides, de febrero 1° a noviembre 30 de 2022. Se describieron las variables usando frecuencias absolutas y relativas. En el análisis univariado se calcularon Chi cuadrado y T de Student y en el bivariado, regresión logística binaria. La agudeza diagnóstica se determinó con sensibilidad, especificidad y valores predictivos; se consideró la significancia estadística con p < 0,05. Resultados. Se incluyeron 267 pacientes, 219 mujeres y 48 hombres; 196 pacientes (73,4%) tenían malignidad. Se encontró en el preoperatorio, sensibilidad 100 %, especificidad 99,6 %, VPP 83,3 %, VPN 100 %, odds de probabilidad positiva 83 % y Odds de probabilidad negativa 0,004 %. En el posoperatorio, sensibilidad 82,8 %, especificidad 99,2 %, VPP 92,3 % VPN 97,9 %, odds de probabilidad positiva 92 % y odds de probabilidad negativa 0,2 %. Conclusiones. La ecografía translaríngea en nuestro medio tiene alta agudeza diagnóstica. Podría ser usada en el abordaje inicial de la evaluación de la movilidad de las cuerdas vocales y reemplazar la laringoscopia directa, dejando ésta para cuando la visualización ecográfica no sea adecuada, o en casos de afectación o sospecha de invasión, para su confirmación.

Introduction. The evaluation of the mobility of the vocal cords in thyroid and parathyroid surgery is part of the adequate comprehensive assessment. Altough, direct laryngoscopy is the gold standard, its real use is not routine, so translaryngeal ultrasound approach is proposed as an alternative. Methods. A prospective diagnostic test study was carried out to evaluate the translaryngeal ultrasound compared with video laryngoscopy in visualizing vocal mobility in patients with thyroid and parathyroid surgery from February 1 to November 30, 2022. Patients were described using absolute and relative frequencies. Univariate statistical analysis with Chi-square and Student's t tests. T. Bivariate analysis using binary logistic regression. Diagnostic acuity was calculated with sensitivity, specificity, PPV, NPV. Statistical significance with p< 0.05, 95% confidence interval. Results. 267 patients undergoing thyroid or parathyroid surgery were included, 219 women and 48 men. Malignant: thyroid neoplasm 196 patients (73.4%). The findings were for the preoperative period, 100% sensitivity, 99.6% specificity, PPV 83.33%, NPV 100%, 83% positive probability odds, and 0.004% negative probability odds. For the postoperative period, 82.8% sensitivity, 99.2% specificity, 92.3% PPV, 97.9% NPV, 92% positive probability odds, and 0.2% negative probability odds were found.Conclusions. Translaryngeal ultrasound in our series has high diagnostic acuity. It could be used as the initial approach to evaluate vocal mobility and might replace direct laryngoscopy, leaving it when its visualization is not adequate or in cases of involvement or suspected invasion for confirmation.

Thyroid abnormality in patients with psoriasis: prevalence and association with severity.

BACKGROUND: Psoriasis is associated with several comorbidities and its association with thyroid abnormality has been hypothesized. OBJECTIVE: To assess the prevalence of thyroid abnormality in Brazilian patients with psoriasis and to analyze its association with severity, presence of psoriatic arthritis and immunobiological treatment. Additionally, to compare results with literature as a control. METHODS: In this observational study, clinical and laboratory data of patients followed from January 2018 to December 2019 were analyzed. Thyroid abnormality was assessed through the current history of thyroid disease and laboratory tests - thyrotropin (TSH), free thyroxine (FT4), antithyroid peroxidase (anti-TPO) and antithyroglobulin (anti-TG) antibodies. Patients were classified according to psoriasis severity - Psoriasis Area and Severity Index (PASI), presence of psoriatic arthritis, and current treatment. Subsequently, the results were compared with a control group selected from the literature review. RESULTS: Of the 250 included patients, 161 were eligible. The prevalence of thyroid abnormality was 28.57% and of hypothyroidism, 14.91%. The mean age was 55 years and the median PASI was 2.2. There was no association between thyroid abnormality and PASI (p=0.8), presence of psoriatic arthritis (p=0.87), or use of immunobiological therapy (p=0.13). The literature control group included 6,227 patients and there was a statistically significant difference for the hypothyroidism variable (p<0.0001). STUDY LIMITATIONS: Absence of a control group from the same center. CONCLUSION: This was one of the first Brazilian studies on the prevalence of thyroid abnormality in patients with psoriasis.

Thyroid dysfunction alters gene expression of proteins related to iron homeostasis and metabolomics in male rats.

Thyroid hormones (THs) are crucial in bodily functions, while iron is essential for processes like oxygen transport. Specialized proteins maintain iron balance, including ferritin, transferrin, ferroportin, and hepcidin. Research suggests that THs can influence iron homeostasis by affecting mRNA and protein expression, such as ferritin and transferrin. Our study focused on male rats to assess mRNA expression of iron homeostasis-related proteins and metabolomics in thyroid dysfunction. We found altered gene expression across various tissues (liver, duodenum, spleen, and kidney) and identified disrupted metabolite patterns in thyroid dysfunction. These findings highlight tissue-specific effects of thyroid dysfunction on essential iron homeostasis proteins and provide insights into associated metabolic changes. Our research contributes to understanding the intricate interplay between thyroid hormones and iron balance. By unveiling tissue-specific gene expression alterations and metabolic disruptions caused by thyroid dysfunction, our work lays a foundation for future investigations to explore underlying mechanisms and develop targeted strategies for managing iron-related complications in thyroid disorders.

Understanding the Relationship between Nonalcoholic Fatty Liver Disease and Thyroid Disease.

The prevalence of hypothyroidism in patients with nonalcoholic fatty liver disease (NAFLD) is high (22.4%). Thyroid hormones (THs) regulate many metabolic activities in the liver by promoting the export and oxidation of lipids, as well as de novo lipogenesis. They also control hepatic insulin sensitivity and suppress hepatic gluconeogenesis. Because of its importance in lipid and carbohydrate metabolism, the involvement of thyroid dysfunction in the pathogenesis of NAFLD seems plausible. The mechanisms implicated in this relationship include high thyroid-stimulating hormone (TSH) levels, low TH levels, and chronic inflammation. The activity of the TH receptor (THR)-ß in response to THs is essential in the pathogenesis of hypothyroidism-induced NAFLD. Therefore, an orally active selective liver THR-ß agonist, Resmetirom (MGL-3196), was developed, and has been shown to reduce liver fat content, and as a secondary end point, to improve nonalcoholic steatohepatitis. The treatment of NAFLD with THR-ß agonists seems quite promising, and other agonists are currently under development and investigation. This review aims to shine a light on the pathophysiological and epidemiological evidence regarding this relationship and the effect that treatment with THs and selective liver THR-ß agonists have on hepatic lipid metabolism.

Manejo del paciente con Hipertiroidismo en consulta externa de la Unidad Técnica de Endocrinología del Hospital Carlos Andrade Marín / Management of the patient with hyperthyroidism in the outpatient clinic of the Technical Unit of Endocrinology of the Endocrinology Technical Unit of the Carlos Andrade Marín Hospital

El hipertiroidismo es un trastorno caracterizado por el exceso de hormonas tiroideas. El déficit de yodo es un factor clave en dicha patología y en lugares con suficiencia del mismo se asocian a au-toinmunidad tiroidea. La prevalencia de hipertiroidismo mani-fiesto varía del 0,2% al 1,3% en áreas con suficiencia de yodo, sin embargo, esto puede variar en cada país por diferencias en umbrales de diagnóstico, sensibilidad de ensayo y población se-leccionada. Un reporte de The Third National Health and Nutri-tion Examination Survey (NHANES III) mostró que el hiperti-roidismo manifiesto se presenta en 0,7% de la población general e hipertiroidismo subclínico en el 1,7%1,2.En incidencia, la patología se asocia con la suplementación de yodo, con la mayor frecuencia en áreas de deficiencias, por au-mento de nódulos tiroideos en la población anciana, teniendo a regiones de áreas montañosas como América del Sur, África Central y suroeste de Asia dentro de este grupo. Un meta aná-lisis de estudios europeos mostró una incidencia general de 50 casos por 100000 personas/años1. En Ecuador, según los datos del Instituto Nacional de Estadísticas y Censos (INEC) del 2017, se reportaron 157 casos de hipertiroidismo, de los cuales la En-fermedad de Graves (EG) fue la causa más común, seguida por el bocio multinodular tóxico (BMNT) y finalmente el adenoma tóxico (AT) con una incidencia de 61 %, 24 % y 14 % respecti-vamente3.Los pacientes con esta patología tienen aumento de riesgo com-plicaciones cardiovasculares y mortalidad por todas las causas, siendo falla cardíaca uno de sus principales desenlaces, así el diagnóstico precoz evita estos eventos, principalmente en pobla-ción de edad avanzada.El presente protocolo se ha realizado para un correcto trata-miento de esta patología en el Hospital de Especialidades Carlos Andrade Marín (HECAM).

Hyperthyroidism is a disorder characterized by an excess of thyroid hormones. Iodine deficiency is a key factor in this pa-thology and in places with iodine deficiency it is associated with thyroid autoimmunity. The prevalence of overt hyperthyroidism varies from 0,2% to 1,3% in iodine-sufficient areas; however, this may vary from country to country due to differences in diag-nostic thresholds, assay sensitivity, and selected population. A report from The Third National Health and Nutrition Examina-tion Survey (NHANES III) showed that overt hyperthyroidism occurs in 0,7% of the general population and subclinical hyper-thyroidism in 1,7%1,2.In incidence, the pathology is associated with iodine supplemen-tation, with the highest frequency in areas of deficiencies, due to increased thyroid nodules in the elderly population, having regions of mountainous areas such as South America, Central Africa and Southwest Asia within this group. A meta-analysis of European studies showed an overall incidence of 50 cases per 100000 person/years1. In Ecuador, according to data from the National Institute of Statistics and Census (INEC) in 2017, 157 cases of hyperthyroidism were reported, of which, Graves' di-sease (GD) was the most common cause, followed by toxic mul-tinodular goiter (BMNT) and finally toxic adenoma (TA) with an incidence of 61 %, 24 % and 14 % respectively3.Patients with this pathology have an increased risk of cardiovas-cular complications and all-cause mortality, with heart failure being one of the main outcomes, so early diagnosis avoids these events, mainly in the elderly population.The present protocol has been carried out for the correct treat-ment of this pathology at the Carlos Andrade Marín Specialties Hospital (HECAM).

Sintomas vocais, ansiedade e depressão pré e pós-tireoidectomia / Vocal symptoms, anxiety and depression pre and post thyroidectomy / Síntomas vocales, ansiedad y depresión pre y post tiroidectomía

Introdução: Alterações na tireoide e a tireoidectomia podem levar à sintomatologia vocal e emocional.Objetivo: Correlacionar sintomas vocais e traços de ansiedade e depressão pré e pós-tireoidectomia. Métodos: Estudo observacional, longitudinal. Participaram 20 pacientes submetidos à tireoidectomia, ao exame visual laríngeo e à Escala de Sintomas Vocais (ESV) e Escala Hospitalar de Ansiedade e Depressão (HADS) no pré-operatório, pós 1 semana e pós 3 meses, com média de idade de 54,5 anos, maior prevalência do sexo feminino (85%) e tireoidectomia parcial (70%). Resultados: Os pacientes autorreferiram sintomas vocais em todos os momentos, com maior frequência após uma semana e diferença significativa entre o domínio físico pré e pós 1 semana. Na HADS, observou-se maior escore total no pré-operatório e diferença significante nos três momentos, em todos os domínios, com maior diferença entre pré e pós 1 semana. Houve correlação positiva fraca entre os domínios limitação, emocional e escore total da ESV com a subescala de ansiedade pós 1 semana, entre o escore total da ESV e o escore total da HADS e correlação positiva moderada entre os domínios limitação e emocional da ESV com o escore total da HADS após uma semana. Conclusão: Pacientes submetidos à tireoidectomia autopercebem sintomas vocais e traços de grau leve de ansiedade tanto no pré quanto pós 1 semana e após 3 meses de cirurgia com pior autorreferência após uma semana. Quanto maior a autorreferência de sintomas vocais, mais traços de ansiedade o paciente pode apresentar. (AU)

Introduction: Thyroid alterations and thyroidectomy can lead to vocal and emotional symptoms.Purpose: To correlate vocal symptoms and anxiety and depression traits pre and post-thyroidectomy. Methods: Observational, longitudinal study. Participants were 20 patients who underwent thyroidectomy, laryngeal visual examination and the Voice Symptom Scale (VoiSS) and Hospital Anxiety and Depression Scale (HADS) preoperatively, 1 week and 3 months after, with a mean age of 54.5 years, higher prevalence of female gender (85%) and partial thyroidectomy (70%). Results: The patients self-reported vocal symptoms at all times, more frequently after one week and a significant difference between the physical domain pre and post 1 week. In HADS, there was a higher total score in the preoperative period and a significant difference in the three moments, in all domains, with a greater difference between pre and post 1 week. There was a weak positive correlation between the limitation, emotional and total score of the ESV domains with the anxiety subscale after 1 week, between the total score of the ESV and the total score of the HADS, and a moderate positive correlation between the limitation and emotional domains of the ESV with the HADS total score after one week. Conclusion: Patients undergoing thyroidectomy self-perceived vocal symptoms and mild anxiety traits both before and after 1 week and after 3 months of surgery with worse self-report after one week. The greater the self-report of vocal symptoms, the more traces of anxiety the patient may present. (AU)

Introducción: Cambios en la tiroides y tiroidectomía pueden provocar síntomas vocales y emocionales. Objetivo: Correlacionar síntomas vocales y rasgos de ansiedad y depresión antes y después de tiroidectomía. Metodos: Estudio observacional/longitudinal. Participaron 20 pacientes que se les realizó tiroidectomía, examen visual laríngeo, Escala de Síntomas Vocales (ESV) y Escala Hospitalaria de Ansiedad y Depresión (HADS) en preoperatorio, 1 semana y 3 meses después, con edad media de 54,5 años, prevalencia del género femenino (85%) y tiroidectomía parcial (70%). Resultados: Los pacientes informaron síntomas vocales en todo momento, con mayor frecuencia después de una semana y una diferencia significativa entre el dominio físico antes y después de 1 semana. En HADS, hubo mayor puntaje total en el preoperatorio y diferencia significativa en los tres momentos, con mayor diferencia entre pre y post 1 semana. Hubo una correlación positiva débil entre limitación, emocional y total de los dominios de la ESV con la subescala de ansiedad después de 1 semana, entre el total de la ESV y e total de la HADS, y una correlación positiva moderada entre la puntuación de limitación y dominios emocionales de la ESV con la puntuación total de HADS después de una semana. Conclusión: Los pacientes sometidos a tiroidectomía autopercibieron síntomas vocales y rasgos de ansiedad leve tanto antes como después de 1 semana y después de 3 meses de la cirugía con peor autoinforme después de una semana. Cuanto mayor es el autoinforme de síntomas vocales, más rastros de ansiedad puede presentar el paciente. (AU)

Molecular Mechanisms in Autoimmune Thyroid Disease.

The most common cause of acquired thyroid dysfunction is autoimmune thyroid disease, which is an organ-specific autoimmune disease with two presentation phenotypes: hyperthyroidism (Graves-Basedow disease) and hypothyroidism (Hashimoto's thyroiditis). Hashimoto's thyroiditis is distinguished by the presence of autoantibodies against thyroid peroxidase and thyroglobulin. Meanwhile, autoantibodies against the TSH receptor have been found in Graves-Basedow disease. Numerous susceptibility genes, as well as epigenetic and environmental factors, contribute to the pathogenesis of both diseases. This review summarizes the most common genetic, epigenetic, and environmental mechanisms involved in autoimmune thyroid disease.

Características clínicas, epidemiológicas y quirúrgicas de pacientes con afecciones nodulares tiroideas / Clinical, Epidemiological and Surgical Characteristics of Patients with Thyroid Nodular Conditions

Introducción: En las últimas décadas la incidencia del cáncer tiroideo en el curso de la enfermedad nodular se ha incrementado debido a las novedosas técnicas de diagnóstico; sin embargo, la tasa de mortalidad se ha mantenido muy baja. Objetivo: Evaluar las características clínicas, epidemiológicas y quirúrgicas de pacientes con afecciones nodulares tiroideas. Métodos: Se realizó un estudio descriptivo observacional de cohorte prospectivo, longitudinal con los pacientes operados de afecciones tiroideas durante el período comprendido entre enero del 2008 y diciembre del 2018. El universo y la muestra quedaron constituidos por 467 pacientes que cumplieron con los criterios de inclusión. Resultados: Predominaron el sexo femenino (89,5 por ciento) y el grupo etario de 45-60 años (29,5 por ciento). Asociaron comorbilidades 338 pacientes y algún factor de riesgo de malignidad (6,2 por ciento). Un total de 174 pacientes manifestaron síntomas y 264 mostraron algún signo. Predominaron los reportes ecográficos (TI-RADS) y citológicos (Bethesda) tipo II (54,3 por ciento) y (55,5 por ciento), respectivamente. La hemitiroidectomía fue el procedimiento más realizado (59,9 por ciento) y la disfonía la complicación más encontrada (1,9 por ciento). Conclusiones: El diagnóstico oportuno del cáncer tiroideo en el curso de una enfermedad nodular contribuye a individualizar todas las decisiones terapéuticas atendiendo a las características de cada paciente y sus circunstancias(AU)

Introduction: In recent decades, the incidence rates of thyroid cancer in the course of nodular disease has increased due to novel diagnostic techniques; however, the mortality rate has remained very low. Objective: To evaluate the clinical, epidemiological and surgical characteristics of patients with nodular thyroid disease. Methods: A descriptive, observational, of prospective cohort, longitudinal and observational study was conducted with patients operated on for thyroid disorders during the period from January 2008 to December 2018. The study universe and sample consisted of 467 patients who met the inclusion criteria. Results: The female sex (89.5 percent) and the age group 45-60 years (29.5 percent) predominated. Comorbidities were present in 338 patients, as well as some risk factor for malignancy in 6.2 percent. A total of 174 patients manifested symptoms and 264 showed some sign. There was a predominance of echography (TI-RADS) and cytology (Bethesda) type II reports, accounting for 54.3 percent and 55.5 percent, respectively. Hemithyroidectomy was the most performed procedure (59.9 percent), while dysphonia was the most encountered complication (1.9 percent). Conclusions: Timely diagnosis of thyroid cancer in the course of nodular disease contributes to individualizing all therapeutic decisions considering the characteristics of each patient and their circumstances(AU)

Prevalence of Excessive Iodine Intake in Pregnancy and Its Health Consequences: Systematic Review and Meta-analysis.

The objective was to estimate the prevalence of excessive iodine intake in pregnant women and to investigate the consequences for maternal-fetal health. The systematic review was based on PRISMA. The search was conducted in September 2021 in LILACS, PubMed/MEDLINE, Science Direct, and SCOPUS databases. Observational studies that assessed excessive nutritional iodine status in pregnancy diagnosed by urinary iodine concentration and associated it with biomarkers of thyroid health function were included. Study selection, data extraction, and risk of biased evaluation were performed independently. Meta-analysis was calculated using a fixed and random effect model, and heterogeneity was assessed by the chi-square test. Meta-regressions were performed to identify the causes of heterogeneity using the Knapp and Hartung test. Nine studies were included in the systematic review, and eight in the meta-analysis. The prevalence of excessive iodine intake in 10,736 pregnant women in different regions of the world was 52%. The main implications for pregnant women were hypothyroxinemia, hypothyroidism, and hyperthyroidism. For the newborn, macrosomia and thyroid dysfunction. In addition, drinking water with high iodine intake contributed to excessive iodine intake. Therefore, the prevalence of iodine excess was 52%, with high heterogeneity among studies, explained by trimester of gestation and FT4 level; therefore, the farther the trimester of gestation and the lower the FT4, the higher the prevalence of iodine excess. PROSPERO Registration: CRD420206467 ( https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=206467 ).