RESUMO
OBJECTIVE: To investigate the hypothalamus-pituitary-thyroid axis in patients with glycogen storage disease type 1(GSD1). STUDY DESIGN: Ten patients with GSD1a, 7 patients with GSD1b, and 34 sex- and age-matched healthy control subjects were enrolled in the study. RESULTS: The levels of serum-free thyroxine (FT4) were significantly lower in patients with GSD1a and GSD1b (P < .05), whereas thyrotropin was significantly higher compared with control subjects only in patients with GSD1b (P < .005). Thyroglobulin and thyroperoxidase auto-antibodies were significantly higher in patients with GSD1b than in patients with GSD1a and control subjects (P < .005). After thyrotropin-releasing hormone stimulation, an enhanced thyrotropin response was found in patients with GSD1a and patients with GSD1b (P < .005) compared with control subjects. The presence of a subclinical or overt hypothyroidism was found in 4 of 7 patients with GSD1b and in no patient with GSD1a (chi2 = 7.47, P < .005) or control subject (chi2 = 27.2, P < .0001). CONCLUSIONS: Patients with GSD1b have an increased prevalence of thyroid autoimmunity and hypothyroidism, although patients with GSD1a have little evidence of thyroid abnormalities. Concomitant damage at the level of the hypothalamus or pituitary gland might be hypothesized on the basis of the slightly elevated thyrotropin levels, even in patients with overt hypothyroidism.
Assuntos
Doença de Depósito de Glicogênio Tipo I/epidemiologia , Hipotireoidismo/epidemiologia , Tireoidite Autoimune/epidemiologia , Adolescente , Adulto , Distribuição por Idade , Estudos de Casos e Controles , Criança , Comorbidade , Feminino , Doença de Depósito de Glicogênio Tipo I/diagnóstico , Humanos , Hipotireoidismo/diagnóstico , Masculino , Prevalência , Probabilidade , Prognóstico , Estudos Prospectivos , Valores de Referência , Medição de Risco , Distribuição por Sexo , Estatísticas não Paramétricas , Testes de Função Tireóidea , Tireoidite Autoimune/diagnóstico , Tireotropina/sangue , Tiroxina/sangueRESUMO
We present a case of recurrent pulmonary alveolar proteinosis after heart-lung transplantation in a child with lysinuric protein intolerance. The recurrence of the pulmonary disease provides further insight regarding the possible pathogenesis of pulmonary alveolar proteinosis and therapeutic options for this complication.