RESUMO
We present 4 patients with Graves' disease who developed spontaneous hypothyroidism during follow-up. The two most plausible physiopathologic mechanisms for this development were progressive autoimmune-mediated destruction of the thyroid follicular epithelium and a predominance of blocking antibodies to the thyroid-stimulating hormone (TSH) receptor at the expense of stimulating antibodies in the same patient. Description of these patients not only illustrates the heterogeneous nature of this disease, but also the interrelation among its distinct clinical forms.
Assuntos
Doença de Graves/complicações , Hipotireoidismo/etiologia , Adulto , Idoso , Autoanticorpos/sangue , Autoanticorpos/imunologia , Progressão da Doença , Feminino , Bócio/etiologia , Doença de Graves/sangue , Doença de Graves/tratamento farmacológico , Doença de Graves/imunologia , Doença de Graves/fisiopatologia , Humanos , Hipotireoidismo/sangue , Hipotireoidismo/tratamento farmacológico , Hipotireoidismo/imunologia , Hipotireoidismo/fisiopatologia , Imunoglobulinas Estimuladoras da Glândula Tireoide/sangue , Imunoglobulinas Estimuladoras da Glândula Tireoide/imunologia , Masculino , Metimazol/uso terapêutico , Pessoa de Meia-Idade , Receptores da Tireotropina/imunologia , Hormônios Tireóideos/sangue , Tireotoxicose/etiologia , Tiroxina/uso terapêuticoRESUMO
Presentamos los casos de 4 pacientes con enfermedad de Graves- Basedow que, durante el curso de su proceso patológico, sufrieron hipotiroidismo espontáneo. Los dos mecanismos fisiopatológicos más probables para explicar esta evolución son la destrucción autoinmunitaria progresiva del epitelio folicular tiroideo y la predominancia de anticuerpos inhibidores de los receptores de tirotropina (TSH) frente a anticuerpos estimulantes en un mismo paciente con enfermedad de Graves-Basedow. La exposición de estos 4 casos ilustra la heterogeneidad de esta enfermedad, así como la interrelación de las distintas formas clínicas de la enfermedad tiroidea autoinmunitaria (AU)
We present 4 patients with Graves disease who developed spontaneous hypothyroidism during follow-up. The two most plausible physiopathologic mechanisms for this development were progressive autoimmune-mediated destruction of the thyroid follicular epithelium and a predominance of blocking antibodies to the thyroidstimulating hormone (TSH) receptor at the expense of stimulating antibodies in the same patient. Description of these patients not only illustrates the heterogeneous nature of this disease, but also the interrelation among its distinct clinical forms (AU)
Assuntos
Humanos , Hipotireoidismo/complicações , Doença de Graves/complicações , Receptores da Tireotropina/antagonistas & inibidores , Tireoidite Autoimune/metabolismo , Testes de Função TireóideaRESUMO
La alteraciones neurológicas en situaciones de hiperglucemia aguda están favorecidas por la hiperosmolaridad plasmática. Presentamos el caso de una paciente de 32 años con diabetes mellitus tipo 1 (DM1) de 23 años de evolución, mal control metabólico habitual e insuficiencia renal crónica (aclaramiento de creatinina, 35 ml/min), que ingresó en el servicio de urgencias con deterioro cognitivo y hemiparesia izquierda durante un episodio de cetoacidosis diabética e hiperosmolaridad. La aparición de hiperosmolaridad en un paciente con DM1 es poco frecuente, más aún si tiene insuficiencia renal que conlleva disminución de la diuresis osmótica y, por lo tanto, el desarrollo de hiperosmolaridad (AU)
Plasma hyperosmolarity increases the likelihood of neurological symptoms in acute hyperglycemia. We report the case of a 32-year-old woman with type 1 diabetes for 23 years, poor metabolic control and chronic kidney disease (creatinine clearance rate: 35 ml/min) who presented to the emergency department with depressed sensorium and left-sided hemiparesis during an acute episode of diabetic ketoacidosis and hyperosmolarity. Hyperosmolar coma in type 1 diabetic patients is uncommon, especially if there is renal impairment leading to reduced osmotic diuresis and the development of hyperosmolarity (AU)
