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1.
Rev Med Suisse ; 16(684): 455-458, 2020 Mar 04.
Artigo em Francês | MEDLINE | ID: mdl-32134225

RESUMO

Subclinical hypothyroidism is frequent and its treatment by thyroid hormones is debated. Current guidelines tend to recommend a treatment for symptomatic adults or for thyrotropin (TSH) levels > 10 mIU/l. Nevertheless, new evidence from systematic review, -including 21 trials and 2192 participants, demonstrated that thyroid hormone replacement has no clinically relevant benefit on patients' symptoms or prognosis. An international and independent panel -including physicians, methodologists and patients issues a strong recommendation (BMJ Rapid Recommendation) against thyroid hormones therapy for adults with subclinical hypothyroidism. This recommendation does not apply to women who are pregnant or trying to conceive or to patients with TSH > 20 mIU/l.


Assuntos
Hipotireoidismo/tratamento farmacológico , Hormônios Tireóideos/uso terapêutico , Humanos , Hipotireoidismo/sangue , Prognóstico , Tireotropina/sangue
2.
3.
JAMA ; 323(11): 1097-1098, 2020 03 17.
Artigo em Inglês | MEDLINE | ID: mdl-32181846
4.
Medicine (Baltimore) ; 99(12): e19650, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32195974

RESUMO

RATIONALE: Mutations of the NKX2-1 gene are associated with brain-lung-thyroid syndrome, which is characterized by benign hereditary chorea, hypothyroidism, and pulmonary disease with variable presentation. Surfactant protein C (SFTPC) gene mutations result in chronic interstitial lung disease in adults or severe neonatal respiratory distress syndrome. PATIENT CONCERNS: Recurrent hypoxemia was observed shortly after birth in a baby at a gestational age of 40 weeks and birth weight of 3150 g. The need for respiratory support gradually increased. He had hypothyroidism and experienced feeding difficulties and irritability. DIAGNOSIS: Genetic examination of the peripheral blood revealed combined mutations of the NKX2-1 and SFTPC genes. INTERVENTIONS: The patient was administered respiratory support, antibiotics, low-dose dexamethasone, supplementary thyroxine, venous nutrition, and other supportive measures. OUTCOMES: The patient's guardian stopped treatment 3 months after commencement of treatment, due to the seriousness of his condition and the patient died. LESSONS: Combined mutations of NKX2-1 and SFTPC genes are very rare. Thus, idiopathic interstitial pneumonia with hypothyroidism and neurological disorders require special attention.


Assuntos
Atetose/genética , Coreia/genética , Hipotireoidismo Congênito/genética , Proteína C/metabolismo , Surfactantes Pulmonares/metabolismo , Síndrome do Desconforto Respiratório do Recém-Nascido/genética , Fator Nuclear 1 de Tireoide/genética , Atetose/sangue , Atetose/diagnóstico , Atetose/terapia , Coreia/sangue , Coreia/diagnóstico , Coreia/terapia , Hipotireoidismo Congênito/sangue , Hipotireoidismo Congênito/diagnóstico , Hipotireoidismo Congênito/terapia , Evolução Fatal , Transtornos da Alimentação e da Ingestão de Alimentos/diagnóstico , Transtornos da Alimentação e da Ingestão de Alimentos/etiologia , Humanos , Hipotireoidismo/diagnóstico , Hipotireoidismo/etiologia , Hipóxia/diagnóstico , Hipóxia/etiologia , Recém-Nascido , Cariotipagem , Doenças Pulmonares Intersticiais/diagnóstico , Doenças Pulmonares Intersticiais/etiologia , Masculino , Mutação , Cuidados Paliativos/métodos , Recidiva , Síndrome do Desconforto Respiratório do Recém-Nascido/sangue , Síndrome do Desconforto Respiratório do Recém-Nascido/diagnóstico , Síndrome do Desconforto Respiratório do Recém-Nascido/etiologia , Síndrome do Desconforto Respiratório do Recém-Nascido/terapia
5.
Medicine (Baltimore) ; 99(11): e19492, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32176089

RESUMO

Despite many studies, the molecular mechanisms of hepatocellular carcinoma (HCC) development remain unclear. Thyroid hormone (TH) levels may vary in many chronic diseases including cirrhosis. The aim of this study was to evaluate TH status in patients with cirrhosis and HCC and to investigate the relationship between THs and HCC development.Five hundred seventy-seven patients with cirrhosis who applied to Demiroglu Bilim University, Faculty of Medicine, Gastroenterology Department between 2004 and 2019 were included the study. Three hundred sixty-seven patients who applied to Internal Medicine Unit for general health check-up were included in the study as healthy control group. Demographic, laboratory, and imaging findings of study groups were retrospectively reviewed and recorded from hospital information system.In the cirrhosis group, 252 patients had HCC (43.67%), and 325 patients had non-HCC cirrhosis (56.33%). Free thyroxine (FT4) levels were higher in the control group than in the cirrhotic group but there was no significant difference (P = .501). Thyroid-stimulating hormone (TSH) and FT4 levels were similar between groups, while free triiodothyronine (FT3) levels were significantly different between HCC group, non-HCC cirrhosis group, and control group (P = .299 for TSH, P = .263 for FT4, P < .001 for FT3). FT3 levels were significantly higher in HCC group than non-HCC cirrhosis group, but significantly lower than control group (P < .05).Our study confirmed the presence of hypothyroidism in cirrhosis patients and clearly demonstrated a strong relationship between FT3 levels and HCC development.


Assuntos
Carcinoma Hepatocelular/complicações , Hipotireoidismo/complicações , Cirrose Hepática , Neoplasias Hepáticas/complicações , Hormônios Tireóideos/sangue , Adulto , Alanina Transaminase/sangue , Aspartato Aminotransferases/sangue , Carcinoma Hepatocelular/sangue , Estudos de Casos e Controles , Progressão da Doença , Feminino , Humanos , Hipotireoidismo/sangue , Neoplasias Hepáticas/sangue , Masculino , Pessoa de Meia-Idade , Análise de Regressão , Testes de Função Tireóidea
6.
Medicine (Baltimore) ; 99(8): e19222, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32080117

RESUMO

RATIONALE: Primary hypothyroidism is characterized by loss of thyroxine feedback inhibition and overproduction of thyrotropin-releasing hormone, which might result in reactive pituitary hyperplasia. However, pituitary adenoma secondary to primary hypothyroidism is extremely rare and usually underdiagnosed, and the pathogenic mechanism remains unclear. Herein, we reported two cases with pituitary adenoma secondary to primary hypothyroidism. PATIENT CONCERNS: Case 1: A 35-year-old man presented to the local clinic with a 2-year history of fatigue, puffiness in the bilateral lower extremities and facial region, and coarseness of facial features. Additionally, his relatives also supplemented that he suffered from hypomnesis and hypophrenia.Case 2: A 56-year-old, postmenopausal woman presented to the local clinic with fatigue, dry skin, and sluggishness. DIAGNOSES: The pathological diagnosis of two patients was plurihormonal pituitary adenoma. INTERVENTIONS: A microscopical tumorectomy was performed when the two patients were admitted to our hospital. Thyroid hormone replacement therapy (thyroxine 50 µg/day) was prescribed after microsurgery. OUTCOMES: After 32 months (Case 1) or 43 months (Case 2) follow-up respectively, there was no recurrence, and the symptoms were completely relieved. LESSONS: Pituitary hyperplasia caused by primary hypothyroidism responds well to thyroid hormone replacement therapy. It is worth noting that repeated detection of serum T3, T4, and thyroid-stimulating hormone (TSH) should be performed 3 months after replacement therapy. If the results showed that TSH level decreased partly, while thyroid function did not improve significantly, long-term increased secretion of pituitary TSH adenoma should be considered. And microsurgical resection via a transsphenoidal approach could be ordered. If the optic nerve or optic chiasm were pressed by the adenoma, microsurgery should be performed to relieve the pressure immediately. And then, thyroxine tablet substitute therapy should be performed after surgery.


Assuntos
Adenoma/etiologia , Hipotireoidismo/complicações , Neoplasias Hipofisárias/etiologia , Adenoma/cirurgia , Adulto , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Neoplasias Hipofisárias/cirurgia , Tireotropina/sangue , Tiroxina/sangue
8.
Life Sci ; 245: 117385, 2020 Mar 15.
Artigo em Inglês | MEDLINE | ID: mdl-32014425

RESUMO

AIM: The influence of thyroid hormones on exocrine pancreas function is poorly understood, and limited to the postnatal development period. Here, we evaluated the effects of hypo- and hyperthyroidism on the morphology and enzyme content of this tissue. MAIN METHODS: To induce hypothyroidism male Wistar rats were subjected to a thyroidectomy (Tx) or sham operated (SO). After 40 days, some of the Tx and SO rats were treated with T3 for 7 days. Following euthanization, the pancreas was removed and evaluated for morphology, as well as amylase, lipase and trypsin content, using histological and immunoreactive techniques analyses, respectively. Serum amylase levels were also evaluated. KEY FINDINGS: The pancreatic acinar cells of Tx rats were smaller, exhibited reduced Haematoxyllin stained areas, and contained lower amylase and lipase levels, indicative of low cell activity. Tx rats also presented higher collagen levels, and high trypsin content in pancreatic extracts. Interestingly, T3 administration reversed the observed acinar cell alterations and restored pancreatic enzyme content, by augmenting amylase and lipase and attenuating trypsin levels, but failed to change collagen content. Increased levels of lipase and decreased trypsin were also observed in T3-treated SO rats. SIGNIFICANCE: Thyroid hormones play an important role in acinar cell morphology and function. In the hypothyroid state there is a decrease in pancreatic enzyme levels that is restored with T3 treatment. In addition to participating in insulin sensitivity and glycemic control, THs also modulate enzyme expression and activity in the exocrine pancreas, consequently, delivering metabolic substrates to specific organs and tissues.


Assuntos
Pâncreas Exócrino/patologia , Hormônios Tireóideos/fisiologia , Amilases/sangue , Animais , Western Blotting , Hipertireoidismo/complicações , Hipertireoidismo/patologia , Hipotireoidismo/complicações , Hipotireoidismo/patologia , Masculino , Pâncreas Exócrino/efeitos dos fármacos , Pâncreas Exócrino/fisiopatologia , Ratos , Ratos Wistar , Tireoidectomia , Tireotropina/sangue , Tri-Iodotironina/farmacologia
9.
Isr Med Assoc J ; 22(2): 100-103, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32043327

RESUMO

BACKGROUND: Autoimmune hepatitis (AIH) may be associated with other autoimmune diseases. Autoantibodies are common in AIH suggesting their potential role in the pathogenesis of the disease. Among these autoantibodies, thyroid autoantibodies have been reported in patients with chronic hepatitis, with greater prevalence in patients with chronic hepatitis C infection. OBJECTIVES: To assess the prevalence of thyroid dysfunction among patients with AIH. METHODS: In this case-control, retrospective study, we examined patients diagnosed with AIH according to both the original and revised international AIH group scoring systems. Patients with other hepatic pathologies were excluded AIH was evaluated as an independent risk factor for thyroid disease by a logistic regression model. Univariate and multivariate regression analyses were conducted using hypothyroidism and hyperthyroidism as the dependent variables. RESULTS: Our cohort comprised 163 patients diagnosed with AIH and 1104 healthy age- and gender-matched controls. Hypothyroidism was more prevalent among those with AIH compared to controls (17.7% vs. 5%, respectively, 95% confidence interval [95%CI] 1.68-2.48, P < 0.001). Hyperthyroidism was more prevalent in AIH patients compared to controls (odds ratio 3.2% and 1.2%, respectively, 95%CI 1.68-2.47, P < 0.001). Using a multivariate logistic analysis, we found an independent association between AIH and hypothyroidism but not with hyperthyroidism. CONCLUSIONS: Thyroid dysfunction is more prevalent in patients with AIH. Whether thyroid dysfunction is the cause or a risk factor for AIH, or vice versa, is still unclear. Screening for thyroid dysfunction is warranted after AIH is diagnosed.


Assuntos
Hepatite Autoimune , Hipotireoidismo , Glândula Tireoide/imunologia , Adulto , Autoanticorpos/análise , Autoimunidade/imunologia , Estudos de Casos e Controles , Feminino , Hepatite C Crônica/diagnóstico , Hepatite C Crônica/epidemiologia , Hepatite C Crônica/imunologia , Hepatite Autoimune/diagnóstico , Hepatite Autoimune/epidemiologia , Hepatite Autoimune/imunologia , Humanos , Hipotireoidismo/diagnóstico , Hipotireoidismo/epidemiologia , Hipotireoidismo/imunologia , Israel/epidemiologia , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Medição de Risco , Testes de Função Tireóidea/métodos , Testes de Função Tireóidea/estatística & dados numéricos
10.
Vnitr Lek ; 65(12): 802-808, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32013524

RESUMO

Thyroid gland function is mediated by thyreoideal hormones, in which iodine is very important structural part. High iodine intake, can initiate thyroid dysfunction. Amiodarone induced hypothyroidism is treated with levothyroxine and amiodarone taking is not interrupted. Amiodarone induced hyperthyroidism is divided into two subtypes, which differ by mechanism of origin and treatment strategy. In patients with cardiovascular disease is higher possibility of getting substances, with high content of iodine in diagnostic-therapeutic examination with contrast or treatment with amiodarone. In this group of patients is necessary to control thyroid function regularly and to hold preventive actions.


Assuntos
Doenças Cardiovasculares , Hipertireoidismo , Hipotireoidismo , Amiodarona/efeitos adversos , Antiarrítmicos/efeitos adversos , Doenças Cardiovasculares/complicações , Humanos , Hipertireoidismo/complicações , Hipotireoidismo/etiologia , Iodo , Tiroxina
11.
Eur J Endocrinol ; 182(4): C13-C15, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32061161

RESUMO

Endocrine disorders such as Cushing's syndrome and hypothyroidism may cause weight gain and exacerbate metabolic dysfunction in obesity. Other forms of endocrine dysfunction, particularly gonadal dysfunction (predominantly testosterone deficiency in men and polycystic ovarian syndrome in women), and abnormalities of the hypothalamic-pituitary-adrenal axis, the growth hormone-IGF-1 system and vitamin D deficiency are common in obesity. As a result, endocrinologists may be referred people with obesity for endocrine testing and asked to consider treatment with various hormones. A recent systematic review and associated guidance from the European Society of Endocrinology provide a useful evidence summary and clear guidelines on endocrine testing and treatment in people with obesity. With the exception of screening for hypothyroidism, most endocrine testing is not recommended in the absence of clinical features of endocrine syndromes in obesity, and likewise hormone treatment is rarely needed. These guidelines should help reduce unnecessary endocrine testing in those referred for assessment of obesity and encourage clinicians to support patients with their attempts at weight loss, which if successful has a good chance of correcting any endocrine dysfunction.


Assuntos
Doenças do Sistema Endócrino/complicações , Doenças do Sistema Endócrino/diagnóstico , Obesidade/etiologia , Síndrome de Cushing/complicações , Feminino , Glucocorticoides/metabolismo , Hormônios/análise , Hormônios/uso terapêutico , Humanos , Hipogonadismo/complicações , Hipotireoidismo/complicações , Masculino , Síndrome do Ovário Policístico/complicações
12.
Mymensingh Med J ; 29(1): 156-161, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31915352

RESUMO

Sub clinical hypothyroidism (SCH) is common in clinical practice. Autoimmunity is thought to be the most important cause of SCH. In this cross-sectional study, we investigated 120 SCH patients and 100 healthy controls attending the Endocrinology Outpatient Department of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from June 2014 to April 2015 for anti-thyroid antibodies (anti-TPO and anti-Tg). Measurement of serum TSH, FT4, anti-TPO, and anti-Tg antibodies were done by using the chemiluminescent sequential immunometric assay. SCH patients had a higher mean age; the frequencies of female subjects, those having family history of thyroid disease or other autoimmune diseases, and goiter were higher in SCH group than in the control group. Forty-five percent (45%) of SCH patients were positive for anti-thyroid antibodies (23.3% for both anti-TPO and anti-Tg, 16.7% for only anti-TPO, and 5% positive for only anti-Tg) in comparison to only 10% anti-thyroid antibody positive controls (none for both antibodies, 8% for only anti-TPO, and 2% positive for only anti-Tg). The SCH subjects in the lower age group, females and with a TSH >10µIU/mL had the higher frequency of thyroid autoimmunity. Female gender, high socioeconomic condition, the presence of other autoimmune diseases, the presence of goiter and TSH >10µIU/mL were associated with higher odds of anti-thyroid antibody positivity in the SCH group, though none were statistically significant. The frequency of anti-thyroid antibody was higher in SCH and was more prevalent among the females, younger patients and those having a goiter, other autoimmune diseases, and TSH >10µIU/mL.


Assuntos
Anticorpos/sangue , Autoanticorpos/sangue , Hipotireoidismo/diagnóstico , Hipotireoidismo/imunologia , Adulto , Autoantígenos , Bangladesh/epidemiologia , Biomarcadores/sangue , Estudos Transversais , Feminino , Humanos , Hipotireoidismo/epidemiologia , Iodeto Peroxidase , Proteínas de Ligação ao Ferro , Prevalência , Tireoglobulina/sangue , Tireotropina/sangue , Tiroxina/sangue , Tri-Iodotironina/sangue
14.
Endocrinol. diabetes nutr. (Ed. impr.) ; 67(1): 28-35, ene. 2020. tab
Artigo em Inglês | IBECS | ID: ibc-186144

RESUMO

Objective: The purpose of this prospective study was to assess the effects of selenium supplementation on TSH and interferon-γ inducible chemokines (CXCL9, CXCL10 and CXCL11) levels in patients with subclinical hypothyroidism due to Hashimoto's thyroiditis. Patients and methods: Patients with subclinical hypothyroidism due to Hashimoto thyroiditis were prospectively enrolled in the SETI study. They received 83mcg of selenomethionine/day orally in a soft gel capsule for 4 months with water after a meal. No further treatment was given. All patients were measured thyroid hormone, TPOAb, CXCL9, CXCL10, CXCL11, iodine, and selenium levels at baseline and at study end. Results: 50 patients (43/7 female/male, median age 43.9 ± 11.8 years) were enrolled, of which five withdrew from the study. At the end of the study, euthyroidism was restored in 22/45 (48.9%) participants (responders), while 23 patients remained hypothyroid (non-responders). There were no significant changes in TPOAb, CXCL9, CXCL10, CXCL11, and iodine levels from baseline to the end of the study in both responders and non-responders. TSH levels were re-tested six months after selenomethionine withdrawal: 83.3% of responding patients remained euthyroid, while only 14.2% of non-responders became euthyroid. Conclusions: The SETI study shows that short-course supplementation with selenomethionine is associated to a normalization of serum TSH levels which is maintained 6 months after selenium withdrawal in 50% of patients with subclinical hypothyroidism due to chronic autoimmune thyroiditis. This TSH-lowering effect of selenium supplementation is unlikely to be related to changes in humoral markers of autoimmunity and/or circulating CXCL9


Objetivo: El objetivo de este estudio prospectivo es evaluar los efectos de los suplementos de selenio sobre las concentraciones de TSH y de quimiocinas inducibles por interferón γ (CXCL9, CXCL10 y CXCL11) en pacientes con hipotiroidismo subclínico, debido a tiroiditis de Hashimoto. Pacientes y métodos: Se incluyó prospectivamente en el estudio SETI a pacientes con hipotiroidismo subclínico, debido a tiroiditis de Hashimoto. Recibieron 83μg de selenometionina al día por vía oral en una cápsula de gel blanda durante 4 meses con agua después de una comida. No se administró más tratamiento. Se sometió a todos los pacientes a evaluaciones del perfil hormonal tiroideo, anticuerpos anti-TPO, CXCL9, CXCL10, CXCL11, yodo y selenio en el momento del reclutamiento y al final del estudio. Resultados: Se reclutó a 50 pacientes (43/7 mujeres/varones, mediana de edad de 43,9 ± 11,8 años); 5 se retiraron del ensayo. Al final del estudio, 22/45 (48,9%) participantes recuperaron el eutiroidismo (respondedores) y 23 se mantuvieron hipotiroideos (no respondedores). No se observaron diferencias significativas en los valores de anticuerpos anti-TPO, CXCL9, CXCL10 y CXCL11 y yodo entre el momento basal y el final del estudio en los pacientes con y sin respuesta. La TSH se volvió a analizar 6 meses después de la retirada de la selenometionina: el 83,3% de los sujetos con respuesta seguían siendo eutiroideos, mientras que solo el 14,2% de los que no habían respondido se convirtieron en eutiroideos. Conclusión: El estudio SETI muestra que la suplementación de corta duración con selenometionina se asocia con una normalización de las concentraciones séricas de TSH que se mantiene 6 meses después de la retirada del selenio en el 50% de los pacientes con hipotiroidismo subclínico debido a tiroiditis autoinmunitaria crónica. Es improbable que esta acción reductora de la TSH de los suplementos de selenio esté relacionada con cambios de los marcadores humorales de autoinmunidad o del CXCL9 circulante


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Hipotireoidismo/dietoterapia , Tireoidite Autoimune/complicações , Compostos de Selênio/uso terapêutico , Quimiocinas/uso terapêutico , Suplementos Nutricionais , Selenometionina/uso terapêutico , Estudos Prospectivos , Síndromes do Eutireóideo Doente/dietoterapia
15.
Endocrinol. diabetes nutr. (Ed. impr.) ; 67(1): 36-42, ene. 2020. tab
Artigo em Inglês | IBECS | ID: ibc-186145

RESUMO

Introduction: There is no agreement on the procedures to be used for diagnosis and treatment of gestational thyroid dysfunction. Controversy still exists on the normal range of thyroid-stimulating hormone (TSH) levels and use of gestational hypothyroidism (GH) screening. The aim of this study was to assess diagnosis and treatment of thyroid dysfunction during pregnancy in a group of Spanish hospitals. Study design: This was a retrospective, multicenter study in pregnant females with GH attending Spanish healthcare centers from March 2013 to July 2014. Variables analyzed included diagnosis criteria for GH (availability of universal screening for gestational thyroid disorders and TSH reference values (RVs) by trimester of pregnancy): risk factors for GH, iodine intake from food or supplementation, gestational age (at diagnosis/treatment) and l-thyroxine treatment. Results: Fourteen centers participated in the study. Universal screening was performed in only half of the centers, and only 14% had their own TSH RVs. Overall, 257 pregnant women were enrolled, 53.7% with hypothyroidism (HT) diagnosed before pregnancy (pre-GH) and 46.3% with HT diagnosed during pregnancy (intra-GH). A comparison of intra-GH and pre-GH women showed that intra-GH women made their first visit later (59.7% vs. 75.4% respectively before week 12, p = 0.007) and had more frequently high TSH levels (>2.5 μIU/ml) during the first trimester (94.4% vs. 67.0% respectively, p < 0.001). Conclusions: Our results suggest that GH may be underdiagnosed or inadequately diagnosed in most healthcare centers. These findings suggest the need of improving the current practice in Spain


Introducción: Los procedimientos a seguir para el diagnóstico y tratamiento de la disfunción tiroidea en la gestación no están del todo consensuados. Aún se discute el rango de normalidad de los valores de la hormona estimulante del tiroides (TSH) y el uso de screening para detectar hipotiroidismo gestacional (HG). El objetivo de este estudio es evaluar la forma de diagnóstico y tratamiento de la disfunción tiroidea durante la gestación en un grupo de hospitales de España. Diseño del estudio: Estudio retrospectivo, multicéntrico en mujeres embarazadas con HG atendidas en instituciones sanitarias españolas entre marzo de 2013 y julio de 2014. Las variables analizadas incluyeron criterios diagnósticos de HG (disponibilidad de screening universal para trastornos tiroideos gestacionales y valores de referencia de TSH según el trimestre gestacional); factores de riesgo de HG, ingesta de yodo mediante alimentos o suplementos, edad gestacional (al diagnóstico/tratamiento) y tratamiento con L-tiroxina. Resultados: Participaron un total de 14 centros. Únicamente la mitad de los centros empleaba el screening universal, y solo el 14% tenía valores de referencia de TSH propios. Se incluyeron un total de 257 embarazadas, 53,7% con diagnóstico de hipotiroidismo previo al embarazo (pre-HG) y 46,3% con hipotiroidismo diagnosticado durante el embarazo (intra-HG). Comparando los casos de pre-HG e intra-HG, las mujeres con intra-HG realizaban la primera visita más tarde (antes de la semana 12; 59,7% vs. 75,4% respectivamente, p = 0,007) y tenían más frecuentemente valores elevados de TSH (> 2,5 μUI/ml) durante el primer trimestre (94,4% vs. 67,0% respectivamente, p < 0,001). Conclusiones: Nuestros resultados sugieren que el HG puede estar infradiagnosticado o diagnosticado indebidamente en la mayoría de los centros sanitarios. Estos hallazgos sugieren la necesidad de mejorar la práctica actual en España


Assuntos
Humanos , Feminino , Gravidez , Hipotireoidismo/diagnóstico , Hipotireoidismo/terapia , Complicações na Gravidez/terapia , Fatores de Risco , Hipotireoidismo/complicações , Estudos Retrospectivos , Iodo/uso terapêutico , Suplementos Nutricionais , Idade Gestacional , Tiroxina/uso terapêutico
16.
Endocr Pract ; 26(1): 82-96, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31557082

RESUMO

Objective: Autoimmune thyroid disease, including Graves disease (GD) and Hashimoto thyroiditis (HT), is one of the most common endocrine diseases. GD and HT are the main etiologies for hyperthyroidism and hypothyroidism, respectively. This study aimed to provide a metabolomic analysis of GD patients with hyperthyroidism and HT patients with hypothyroidism. Methods: This study investigated serum metabolomics in 43 GD patients with hyperthyroidism, 45 HT patients with hypothyroidism, and 52 age- and sex-matched healthy controls. The metabolomic data were analyzed by performing multivariate statistical analysis. Results: The 186 metabolites including amino acids, bile acids, free fatty acids, and lipids were identified in all participants. Multivariate models indicated systematic differences in the hyperthyroidism, hypothyroidism, and control groups. Compared to healthy controls, the 22 metabolites in the hyperthyroidism group and the 17 metabolites in the hypothyroidism group were significantly changed. Pathway analysis showed that hyperthyroidism had a significant impact on arginine and proline metabolism and aminoacyl-transfer ribonucleic acid biosynthesis, while hypothyroidism had a significant impact on alanine, aspartate, and glutamate metabolism. Conclusion: The serum metabolomic pattern changes in patients with autoimmune thyroid dysfunction. Abbreviations: BMI = body mass index; CA = cholic acid; CDCA = chenodeoxycholic acid; DCA = deoxycholic acid; FBG = fasting plasma glucose; FINS = fasting plasma insulin; FT3 = free triiodothyronine; FT4 = free thyroxine; GD = Graves disease; GDCA = glycodeoxycholic acid; HDL-C = high-density lipoprotein cholesterol; HOMA-IR = homeostasis model assessment of insulin resistance; HT = Hashimoto thyroiditis; LDL-C = low-density lipoprotein cholesterol; PC = phosphatidylcholine; PCA = principal component analysis; PLS-DA = partial least squares discriminant analysis; SM = sphingomyelin; TBA = total bile acid; TC = total cholesterol; TG = triglyceride; TSH = thyrotropin; VIP = variable influences on projection.


Assuntos
Doença de Hashimoto , Hipotireoidismo , Doenças da Glândula Tireoide , Humanos , Metabolômica , Tireotropina , Tiroxina , Tri-Iodotironina
17.
Int J Vitam Nutr Res ; 90(1-2): 156-168, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31017555

RESUMO

Protective effects of vitamin E (Vit E) on long term potentiation (LTP) impairment, neuronal apoptosis and increase of nitric oxide (NO) metabolites in the hippocampus of juvenile rats were examined. The rats were grouped (n=13) as: (1) control; (2) hypothyroid (Hypo) and (3) Hypo-Vit E. Propylthiouracil (PTU) was given in drinking water (0.05%) during 6 weeks. Vit E (20 mg/ kg) was daily injected (IP). To evaluate synaptic plasticity, LTP from the CA1 area of the hippocampus followed by high frequency stimulation to the ipsilateral Schafer collateral pathway was carried out. The cortical and hippocampal tissues were then removed to measure NO metabolites. The brains of 5 animals in each group were removed for apoptosis study. The hypothyroidism status decreased the slope, 10-90% slope and amplitude of field excitatory post synaptic potential (fEPSP) compared to the control group (P<0.01-P<0.001). Injection of Vit E increased the slope, 10-90% slope and amplitude of the fEPSP in the Hypo-Vit E group in comparison to the Hypo group (P<0.05-P<0.01). TUNEL positive neurons and NO metabolites were higher in the hippocampus of the Hypo rats, as compared to those in the hippocampus of the control ones (P<0.001). Treatment of the Hypo rats by Vit E decreased apoptotic neurons (P<0.01-P<0.001) and NO metabolites (P<0.001) in the hippocampus compared to the Hypo rats. The results of the present study showed that Vit E prevented the LTP impairment and neuronal apoptosis in the hippocampus of juvenile hypothyroid rats.


Assuntos
Hipocampo/efeitos dos fármacos , Hipotireoidismo , Potenciação de Longa Duração , Vitamina E/farmacologia , Animais , Hipotireoidismo/tratamento farmacológico , Ratos , Ratos Wistar , Vitamina E/química
18.
Int J Vitam Nutr Res ; 90(1-2): 84-94, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30789800

RESUMO

Background: The effects of Vit C on liver and renal function and the tissues oxidative damage was investigated in hypothyroid rats. Materials and methods: The pregnant rats were divided into 5 groups (n=6): (1) Control; (2) Propylthiouracil (PTU; 0.005%), (3-5) PTU plus 10, 100 or 500 mg/kg b.w. Vit C. The drugs were added to the drinking water of the dams and their pups during lactation period and then continued for the offspring through the first 8 weeks of their life. Finally, 7 male offspring from each group were randomly selected. Results: Thyroxine, protein and albumin concentrations in the serum and thiol content and superoxide dismutase (SOD) and catalase (CAT) activities in renal and liver tissues of hypothyroid group was lower (all P<0.001) while, aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALK-P), creatinine and blood urea nitrogen (BUN) concentrations in the serum and malondialdehyde (MDA) in the liver and renal tissues were higher than the control (all P<0.001). All doses of Vit C increased thyroxine, protein and albumin and thiol content in in renal and liver tissues while, decreased AST, ALT and ALK-P concentration and MDA in liver and renal tissues compared to PTU group (P<0.05-P<0.001). Creatinine, BUN and SOD and CAT were improved by both 100 and 500 mg/kg of Vit C in the renal (P<0.05-P<0.001) and by 100 mg/kg in the liver (P<0.05-P<0.001). Conclusion: Vit C improved liver and renal function of hypothyroid rats which might be due to its protective effects against tissues oxidative damage.


Assuntos
Antioxidantes/uso terapêutico , Ácido Ascórbico , Hipotireoidismo , Fígado/efeitos dos fármacos , Estresse Oxidativo/efeitos dos fármacos , Animais , Ácido Ascórbico/uso terapêutico , Feminino , Hipotireoidismo/fisiopatologia , Masculino , Gravidez , Ratos , Ratos Wistar
19.
J Oncol Pharm Pract ; 26(1): 224-227, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30880569

RESUMO

PURPOSE: Nivolumab is a fully human IgG4 programmed death 1 immune checkpoint inhibitor (ICI) antibody that has anti-tumor activity by selectively blocking the interaction of the programmed death 1 receptor with its two known programmed death ligands PD-L1 and PD-L2. In doing so, this immune checkpoint inhibitor removes the negative signal stifling T cell activation and proliferation within the tumor microenvironment and demonstrates favorable antitumor activity. CASE REPORT: We report an interesting case of immune checkpoint inhibitor-induced primary hypothyroidism with associated hypothyroid myopathy in a young patient with surgically resected stage IIIB melanoma receiving adjuvant nivolumab. He presented 12 weeks into therapy with severe myalgias, arthralgias, and intermittent disequilibrium of unclear etiology. Laboratory evaluation demonstrated a significant elevation in thyroid stimulating hormone and creatine kinase with an undetectable free T4 with standard laboratory measurement. With thyroid hormone replacement therapy alone, he had rapid improvement in his musculoskeletal symptoms and laboratory parameters over a three-week period. DISCUSSION: This case emphasizes the serious nature of endocrine immune-related adverse events in patients receiving immune checkpoint inhibitors. Additionally, it highlights that unlike most other immune-related adverse events, endocrine immune-related adverse events can generally be managed with adequate hormone replacement alone with swift improvements in symptoms. This allows patients to continue immune checkpoint inhibitors safely without immunosuppression which may dampen the anti-tumor activity of these agents. CONCLUSION: This case highlights the importance of early recognition and the appropriate management of endocrine immune-related adverse events to maximize patient safety and good outcomes.


Assuntos
Antineoplásicos Imunológicos/efeitos adversos , Hipotireoidismo/induzido quimicamente , Doenças Musculares/induzido quimicamente , Nivolumabe/efeitos adversos , Adulto , Humanos , Masculino , Melanoma/tratamento farmacológico
20.
Eur J Endocrinol ; 182(1): G1-G32, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31855556

RESUMO

Obesity is an emerging condition, with a prevalence of ~20%. Although the simple measurement of BMI is likely a simplistic approach to obesity, BMI is easily calculated, and there are currently no data showing that more sophisticated methods are more useful to guide the endocrine work-up in obesity. An increased BMI leads to a number of hormonal changes. Additionally, concomitant hormonal diseases can be present in obesity and have to be properly diagnosed - which in turn might be more difficult due to alterations caused by body fatness itself. The present European Society of Endocrinology Clinical Guideline on the Endocrine Work-up in Obesity acknowledges the increased prevalence of many endocrine conditions in obesity. It is recommended to test all patients with obesity for thyroid function, given the high prevalence of hypothyroidism in obesity. For hypercortisolism, male hypogonadism and female gonadal dysfunction, hormonal testing is only recommended if case of clinical suspicion of an underlying endocrine disorder. The guideline underlines that weight loss in obesity should be emphasized as key to restoration of hormonal imbalances and that treatment and that the effect of treating endocrine disorders on weight loss is only modest.


Assuntos
Índice de Massa Corporal , Hipotireoidismo/diagnóstico , Obesidade/diagnóstico , Comorbidade , Endocrinologia , Humanos , Hipotireoidismo/epidemiologia , Obesidade/epidemiologia , Prevalência , Testes de Função Tireóidea
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