RESUMO
PURPOSE: Inconsistencies in the medical management of hypothyroidism have been reported between endocrinologists in different countries. This study aimed to identify the attitudes of Latin America thyroid specialists towards the use of thyroid hormones. METHODS: Online survey of members of the Latin America Thyroid Society. RESULTS: 81/446 (18.2%) completed the questionnaire. Levothyroxine (LT4) was the initial treatment of choice for all respondents. 56.8% would consider LT4 use in biochemically euthyroid patients: infertile women with elevated anti-thyroid antibodies (46.9%), resistant depression (17.3%) and growing goiter (12%). Most respondents preferred tablets (39.5%) over liquid formulations (21.0%) or soft gel capsules (22.2%) and would not consider switching formulations in patients with persistent symptoms. 39.5% would never use LT4 + liothyronine (LT3) combination therapy in symptomatic euthyroid patients, due to low quality evidence for benefit. 60.5% reported that persistence of symptoms despite normal TSH is rare (below 5% of patients) and its prevalence has been stable over the last five years. Psychosocial factors (84.0%), comorbidities (86.4%) and the patient unrealistic expectation (72.8%) were considered the top three explanations for this phenomenon. CONCLUSION: LT4 tablets is the treatment of choice for hypothyroidism. A significant proportion of respondents would use LT4 in some groups of euthyroid individuals, contrasting the recommendations of the major clinical practice guideline indications. LT4 + LT3 combination treatment in euthyroid symptomatic patients was considered by nearly 50%. Practices based on weak or absent evidence included use of thyroid hormones for euthyroid subjects by 56.8% of respondents and use of LT4 + LT3 treatment by 60.5% of respondents for patients with persistent symptoms. In contrast to many European countries, LATS respondents report a low and unchanged proportion of dissatisfied patients over the last five years.
RESUMO
BACKGROUND: Selenium (Se) and iodine (Io) are important micronutrients for the proper functioning of the thyroid gland, as they are crucial for the synthesis and activation of the thyroid hormones (TH) triiodothyronine (T3) and thyroxine (T4). OBJECTIVE: To evaluate the Se and Io nutritional status among schoolchildren. METHODOLOGY: Cross-sectional, descriptive and analytical study conducted in 982 schoolchildren aged 6-14 years from public schools in the state of Bahia, Brazil. Sociodemographic and anthropometric variables, as well as urinary Se (USC) and Io concentrations (UIC) using the inductively coupled plasma mass spectrometry (ICP-MS) method and thyroid-stimulating hormone (TSH) from filter paper blood collection, were evaluated. RESULTS: The median USC and UIC were 38.7 and 210.0 (IQR: 26.8-52.9 and 129.3-334.1 µg/L, respectively). The prevalence of iodine deficiency and excessive UIC were observed in 17.1% and 30.9% of schoolchildren, respectively. Concomitant low USC and IoD was found in 3.9% of schoolchildren. There was a positive correlation between USC and UIC (r = 0.60; p = 0.00). The median TSH was 0.95 (IQR: 0.69-1.30 µUI/L). CONCLUSIONS: This study demonstrates that USC is a good biomarker for assessing Se status, meantime more studies are needed to establish cutoff USC in child population. Despite adequate median intake, a subgroup of schoolchildren had IoD and low USC. The correlation between UIC and USC point at the importance of two micronutrients, raising the question whether measuring Se should be included in monitoring programs that address the prevention of nutritional disturbances.