[Superior vena cava syndrome and intrathoracic goiter: an unusual presentation in the 21st century]. / Bócio mergulhante e síndroma da veia cava superior: uma apresentação rara no século XXI.

We present a rare case of retrosternal goiter complicated with superior vena cava síndrome (SVCS) with impressive clinical signs. After clinical and imagiologic confirmation, total thyroidectomy was performed with complete remission of compressive signs.

The relationship between body mass index and educational level in young Portuguese males: 1995 and 1999 cohorts.

INTRODUCTION: Over the last decades, a progressive increase in height and weight has been observed throughout Europe. Increase in weight has been more marked however, with a resulting increase in overweight and obesity prevalence. RESULTS published have analyzed the relationship between body mass index (BMI) and educational level. Most studies indicate an inverse relationship between BMI and educational level in developed countries. OBJECTIVE: This study's main objective was to evaluate the relationship between BMI and educational level (years of schooling) in young Portuguese males in 1995 and 1999. METHODS: Transverse study of data (BMI and years of schooling) from the military inspection records of virtually the entire Portuguese male population with an average age of 20 years, examined in 1995 and 1999, totaling 81 363 and 71 254, respectively. Four classes of BMI (<20, 20-24.9, 25-29.9 and > or =30 kg/m2) and four schooling levels (<5, 5-9, 10-12, and >12 years) were considered. We applied the chi2 test for associations between BMI and educational level and the odds ratio to quantify categorical variables. The significance level was 5%. RESULTS: In 1995, 15.2% were overweight (BMI> or =25 years), increasing to 20.8% in 1999. The percentage of obesity (BMI> or =30 years) was 1.4% in 1995 and 2.2% in 1999. The percentage of overweight and obesity increased directly in line with the increase in educational level, both in 1995 and 1999. In 1995, the percentage of subjects with obesity according to years of schooling was as follows: <5 years--1.4%; 5-9 years--1.4%; 10-12 years--1.5% and >12 years--1.7%. In 1999, the results were as follows: <5 years--1.4%; 5-9 years--2.2%; 10-12 years--2.8% and >12 years--3.2%. CONCLUSIONS: We can conclude that the prevalence of overweight and obesity in young male Portuguese increased in the last decade and that, unlike most developed countries, the higher the level of education, the greater the percentage of overweight and obesity, both in 1995 and 1999.

Relationship between the number and impact of stressful life events and the onset of Graves' disease and toxic nodular goitre.

BACKGROUND: In the last few decades, several studies have suggested a possible association between Stressful Life Events (SLEs) and the onset of Graves' Disease (GD). However, others have criticised this association and it has not yet been possible to prove it unequivocally. At present, we are not aware of studies correlating SLE and non autoimmune thyrotoxicosis. OBJECTIVE: To assess possible associations between SLEs, the onset of GD and the onset of non autoimmune thyrotoxicosis (toxic nodular goitre, TNG). DESIGN: A case-control retrospective study. PATIENTS: This study included 93 subjects, divided into three groups of 31 each: GD, TNG and control (CG). The GD and TNG patients had thyroid disease diagnosed within the last 12 months, with clinical and biochemical confirmation. In the CG, psychopathological and endocrine disturbances had been ruled out. All three groups consisted of nine males (29%) and 22 females (71%). The mean age was 38.4 +/- 10.9 years in the GD group, 48.3 +/- 11.1 years in the TNG group and 41.1 +/- 11.8 years in the CG group. SLEs were evaluated (number and impact) for the 12 months preceding the onset of symptoms of thyroid disease. MEASUREMENTS: SLE occurrences and their impact on each group of cases were measured. To assess SLEs, we used the Life Experiences Survey (LES). Our statistical analysis included descriptive techniques and parametric and/or nonparametric comparative tests. P < 0.01 was considered statistically significant. Odds ratios were also calculated. RESULTS: Patients with GD had a significantly greater number of SLEs compared to the TNG group and the CG (P < 0.001). The number and impact of negative SLEs were significantly higher in GD compared to TNG and CG (P < 0.001). The difference between TNG and CG was not significant (P > 0.01). GD had a higher impact of positive SLEs than TNG (P = 0.004), and no significant differences were found between the GD group and CG. Neutral SLEs were similar in the three groups. CONCLUSIONS: These results suggest that SLEs are a precipitating factor of the onset of GD. We also demonstrated that SLEs do not seem to have any conclusive relationship with the onset of TNG.

[Asymptomatic hepatitis induced by propylthiouracil]. / Hepatite assintomática induzida pelo propiltiouracilo.

Propylthiouracil (PTU) is widely used to treat patients with hyperthyroidism. In rare cases this drug has been found to have toxic effects on the liver. We describe the second assymptomatic case, reported in the literature, of PTU induced hepatotoxicity. Sixteen cases have been published so far, all with clinical manifestations. A 20-year-old female patient developed an elevation of AST, ALT and GGT levels after 5 months of PTU (50 mg tid) therapy for Graves disease with hyperthyroidism. The patient showed normal levels of liver aminotransferases before starting PTU. She had no risk factors for or clinical evidence of pre-existing liver disease. She didn't take any regular medication. After stopping PTU, the plasma levels of hepatic enzymes normalised within 6 weeks. Thirteen days after the reinstitution of PTU (150 mg tid), because of the recurrence of hyperthyroidism, another episode of assymptomatic hepatotoxicity was documented. AST, ALT, GGT and AP levels rose again, but bilirrubin levels remained normal, which represents a very unusual laboratory constellation in this kind of patient. The serology for hepatitis A, B, C and for EBV and CMV was negative. After stopping PTU, methimazole (MMI) was started and the liver enzymes normalised within two weeks. After 12 months of MMI therapy, the patient is assymptomatic, with normal liver enzyme levels and normal thyroid function tests. This case is the second to be described where the diagnosis was confirmed by the rechallenge of PTU, being this a major diagnostic criteria. Despite its rarity the disease should be suspected in any patient receiving PTU in whom clinical or laboratorial evidence of hepatocellular injury develops. The drug should be discontinued immediately when the hepatic injury is detected. Recovery is usually complete after the withdrawal of the drug, but there were al least, three fatalities among the 17 cases described.

[Relationship between obesity and educational level in Portuguese young males in 1990]. / Relação entre a obesidade e o nível educacional nos mancebos portugueses do sexo masculino em 1990.

OBJECTIVE: To evaluate the relationship between the educational level, weight and obesity of young Portuguese males, aged 20 years. DESIGN: Cross-sectional study, based on the national military census files of 1990, provided by the military selection centres of Portugal (north, centre, south--including Azores and Madeira islands). SUBJECTS AND METHODS: In Portugal, all males aged 20 must present themselves to the military authorities to be submitted to a health exam in order to be screened for the armed forces. The data of 70,858 young Portuguese males aged 20 were gathered. Height and weight were measured by skilled teams. The educational level was confirmed by the presentation of educational attainment certificates. The population was divided into deciles of body mass index (BMI). The whole group was classified as obese or non-obese, according to a cut-off point of 27.8 Kg/sqm. The educational level was classified in four groups: group A--less than 5 years of schooling; group B--5 to 6 years; group C--7 to 9 years; group D--> or = 10 years. The level of education in each decile of BMI was determined and the percentage of obese subjects was calculated for each level of schooling. The odds of obesity associated with each group of schooling was determined as well as their 95% confidence intervals. Statistical significance was considered to exist when p < 0.05. RESULTS: The average BMI in the study population was 22.5 Kg/sqm. A slight increase in schooling was noticed from the lowest to the highest decile of BMI. The same result was obtained when we analysed the upper extreme of the BMI distribution in greater detail. According to our criteria for obesity, the percentages of obesity in each level of schooling were as follows: group A--4.2%; group B--5%; group C--5.1%; and group D--5.4%. The odds ratio (OR) of obesity according to each education level was higher in those with a higher level of education. In fact, those with 10 or more years of schooling presented an OR = 1.05(0.94;1.17) which was not statistically significant (ns) when compared to those with 7-9 years; while an OR = 1.08(0.97;1.21), was also ns when compared to those with 5-6 years, and, finally, an OR = 1.29(1.14;1.47) was statistically significant (p < 0.001) in comparison to those with only 0-4 years of schooling. CONCLUSIONS: As major conclusions one can say that the prevalence of obesity is low among young Portuguese males (4.9%), only 2.1% with a BMI > 30 Kg/sqm. Furthermore, our results show that, in Portugal, contrary to the results found mostly in western European countries, males aged 20 years with higher levels of education are slightly more prone to be obese than others with lower levels of schooling.