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1.
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
2.
Bull Cancer ; 107(2): 262-271, 2020 Feb.
Artigo em Francês | MEDLINE | ID: mdl-31879018

RESUMO

The immune checkpoint inhibitors (CPI) such as anti-PD(L)1 or anti-CTLA4 had improved long-term patients' outcomes in different malignancies. Thyroid disorders are the most frequent endocrine side effects from CPI reported in clinical trials and in clinical routine practice. The incidence of thyroid dysfunction is variable according to ICP used (more frequent under anti-programmed cell death 1 (PD1) or anti-programmed cell death-ligand 1 (PDL1)). Most thyroid dysfunctions have been reported to occur 2 to 4 courses after CPI initiation. The clinical symptoms are generally nonspecific (asthenia, weight change, rarely cardiac rhythm disorder). These thyroid dysfunctions are commonly painless thyroiditis with a biphasic evolution: thyrotoxicosis followed by a secondary hypothyroidism frequently definitive. Diagnosis is made on a thyroid test (TSH and FT4). In most cases, no further exam is necessary. Beta blockers therapy is recommended in symptomatic thyrotoxicosis with palpitations. Thyroid hormones therapy will be introduced quickly in case of hypothyroidism. Thyroid dysfunctions are not a contra-indication to the continuation of immunotherapy. Due to the high frequency of these complications, close monitoring of the thyroid status is recommended under CPI.


Assuntos
Imunoterapia/efeitos adversos , Neoplasias/terapia , Doenças da Glândula Tireoide/etiologia , Antígeno B7-H1/efeitos adversos , Diagnóstico Diferencial , Humanos , Hipotireoidismo/diagnóstico , Hipotireoidismo/etiologia , Hipotireoidismo/terapia , Doenças da Glândula Tireoide/diagnóstico , Doenças da Glândula Tireoide/terapia , Tireoidite/etiologia , Tireotoxicose/diagnóstico , Tireotoxicose/etiologia , Tireotoxicose/terapia
3.
Pan Afr Med J ; 33: 317, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31692756

RESUMO

Empty sella syndrome is a condition in which the sella turcica is partially or totally filled with cerebrospinal fluid causing a displacement of the pituitary gland. We here report the case of a 49-year old obese patient with progressive headaches, physical asthenia and hypothyroidism. Brain scanner showed empty sella syndrome.


Assuntos
Encéfalo/diagnóstico por imagem , Síndrome da Sela Vazia/diagnóstico , Obesidade/complicações , Astenia/etiologia , Síndrome da Sela Vazia/fisiopatologia , Cefaleia/etiologia , Humanos , Hipotireoidismo/etiologia , Masculino , Pessoa de Meia-Idade
4.
Pan Afr Med J ; 34: 59, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31762924

RESUMO

Several disorders of immunological origin, in particular thyroid disorders have been reported in patients with myasthenia. This relationship has been little elucidated but in patients with myasthenia and Graves' disease was found an immunological cross-reaction between the neuromuscular junction and thyroid components. It is generally accepted that the association between hyperthyroidism and myasthenia is much more common than between myasthenia and hypothyroidism. However, there has been no clear explanation for this difference. We here report the case of a 53-year old patient treated for hypothyroidism due to suspected Hashimoto's disease well balanced under replacement therapy and whose evolution was marked by the detection of myasthenia during the follow up period. Myasthenia responded well to treatment based on neostigmine.


Assuntos
Doença de Hashimoto/complicações , Hipotireoidismo/diagnóstico , Miastenia Gravis/diagnóstico , Inibidores da Colinesterase/administração & dosagem , Feminino , Humanos , Hipotireoidismo/etiologia , Pessoa de Meia-Idade , Miastenia Gravis/tratamento farmacológico , Neostigmina/administração & dosagem
5.
J Med Case Rep ; 13(1): 311, 2019 Oct 18.
Artigo em Inglês | MEDLINE | ID: mdl-31623668

RESUMO

BACKGROUND: Levothyroxine is a synthetic thyroxine and is the treatment of choice for hypothyroidism. It is a prohormone with minimal intrinsic activity. The drug is de-iodinated in peripheral tissue to form triiodothyronine, which is the active thyroid hormone. On initiation of treatment, levothyroxine is titrated, and usually it is extremely well tolerated in the vast majority of patients. We report a case of a patient with self-limiting levothyroxine-induced liver injury, a rare adverse effect of this drug. CASE PRESENTATION: We report a case of a 34-year-old Mediterranean woman diagnosed with post-thyroidectomy hypothyroidism. She was commenced on levothyroxine and developed liver injury confirmed by noninvasive liver investigations. Complete recovery of the patient's liver tests occurred upon cessation of the drug. Triiodothyronine was an appropriate treatment alternative. CONCLUSION: Levothyroxine-induced liver injury is a rare, and in the present case report, a self-limiting, adverse effect. The diagnosis of our patient was confirmed via noninvasive diagnostic methods. Knowledge of this rare adverse effect is important in the differential diagnosis of patients who have commenced on levothyroxine and have deranged liver enzymes in the context of hypothyroidism.


Assuntos
Doença Hepática Induzida por Substâncias e Drogas/etiologia , Terapia de Reposição Hormonal/efeitos adversos , Hipotireoidismo/tratamento farmacológico , Tiroxina/efeitos adversos , Adulto , Feminino , Humanos , Hipotireoidismo/etiologia , Tireoidectomia , Tri-Iodotironina/uso terapêutico
7.
Hemoglobin ; 43(3): 218-221, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31373517

RESUMO

Hypothyroidism is one of the common endocrine complications described in patients with ß-thalassemia major (ß-TM). Studies have reported its incidence and severity depending on the region, quality of management and treatment protocols. The reported thyroid dysfunction includes overt hypothyroidism, subclinical hypothyroidism and rarely, central hypothyroidism. The main aims of this study were to identify the incidence of hypothyroidism in 82 patients with ß-TM in Syria, and also to evaluate the effect of compliance with deferoxamine (DFO) therapy on the patients' thyroid function. Out of the 82 patients included in this study, 24 had subclinical hypothyroidism (29.27%) and one patient had overt hypothyroidism (1.22%). It was demonstrated by this study that noncompliance with DFO therapy increases the risk of thyroid dysfunction 6.38-times compared to compliance with DFO [risk ratio (RR) = 6.385; 95% confidence interval (95% CI) 2.40-16.95)]. These results emphasize the importance of compliance with chelation therapy to minimize the burden of thyropathy on patients' quality of life, and also augment the rationale for a routine follow-up and endocrine evaluation for early detection and management of these complications.


Assuntos
Sobrecarga de Ferro/epidemiologia , Sobrecarga de Ferro/etiologia , Adesão à Medicação , Doenças da Glândula Tireoide/epidemiologia , Doenças da Glândula Tireoide/etiologia , Talassemia beta/complicações , Talassemia beta/epidemiologia , Adolescente , Adulto , Biomarcadores , Estudos de Casos e Controles , Criança , Estudos Transversais , Desferroxamina/farmacologia , Desferroxamina/uso terapêutico , Feminino , Humanos , Hipotireoidismo/diagnóstico , Hipotireoidismo/tratamento farmacológico , Hipotireoidismo/epidemiologia , Hipotireoidismo/etiologia , Quelantes de Ferro/farmacologia , Quelantes de Ferro/uso terapêutico , Sobrecarga de Ferro/diagnóstico , Sobrecarga de Ferro/tratamento farmacológico , Masculino , Cooperação do Paciente , Síria/epidemiologia , Doenças da Glândula Tireoide/diagnóstico , Doenças da Glândula Tireoide/tratamento farmacológico , Resultado do Tratamento , Adulto Jovem , Talassemia beta/genética
8.
BMJ Case Rep ; 12(8)2019 Aug 15.
Artigo em Inglês | MEDLINE | ID: mdl-31420436

RESUMO

Fetal goitrous hypothyroidism is a rare entity and is caused mainly by maternal treatment of Graves' disease (GD). We report a case of a 22-year-old woman referred at 12 weeks of gestation due to hyperthyroidism subsequent to recently diagnosed GD. She started treatment with propylthiouracil and, at 21 weeks of gestation, fetal goitre was detected. A cordocentesis confirmed the diagnosis of fetal goitrous hypothyroidism, and intra-amniotic administration of levothyroxine (LT4) was performed and repeated through the pregnancy due to maintenance of fetal goitre. The pregnancy proceeded without further complications and a healthy female infant was born at 37 weeks of gestation, with visible goitre and thyroid function within the normal range at birth. Although there is no consensus on the optimal dose, the number of injections and the interval between them, intra-amniotic LT4 administration is recommended once fetal goitrous hypothyroidism is suspected, in order to prevent long-term complications of fetal hypothyroidism.


Assuntos
Doenças Fetais/tratamento farmacológico , Bócio/tratamento farmacológico , Doença de Graves/tratamento farmacológico , Hipotireoidismo/tratamento farmacológico , Tiroxina/administração & dosagem , Vias de Administração de Medicamentos , Feminino , Bócio/embriologia , Bócio/etiologia , Doença de Graves/complicações , Doença de Graves/embriologia , Humanos , Hipotireoidismo/embriologia , Hipotireoidismo/etiologia
9.
Clin Obes ; 9(5): e12328, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31267667

RESUMO

Hyperthyroidism causes weight loss in the majority, but its effect is variable and 10% of patients gain weight. Its treatment usually leads to weight gain and some studies have reported an excess weight regain. However, there is considerable inter-individual variability and a differential effect on body weight by different treatments, with some studies reporting more weight increase with radioiodine, and perhaps surgery, compared with anti-thyroid drugs. The excess weight regain may relate to treatment-induced hypothyroidism. Furthermore, the transition from hyperthyroidism to euthyroidism may unmask, or exacerbate, the predisposition that some patients have towards obesity. Other risk factors commonly implicated for such weight increase include the severity of thyrotoxicosis at presentation and underlying Graves' disease. Conflicting data exist whether lean body mass or fat mass or both are increased post-therapy and whether such increments occur concurrently or in a sequential manner; this merits clarification. In any case, clinicians need to counsel their patients regarding this issue at presentation. Limited data on the effect of dietary interventions on weight changes with treatment of hyperthyroidism are encouraging in that they cause significantly lesser weight gain compared to standard care. More research is indicated on the impact of the treatment of hyperthyroidism on various anthropometric indices and the predisposing factors for any excessive weight gain. Regarding the impact of dietary management or other weight loss interventions, there is a need for well-designed and, ideally, controlled intervention studies.


Assuntos
Hipertireoidismo/terapia , Ganho de Peso , Antitireóideos/uso terapêutico , Composição Corporal , Dietoterapia , Feminino , Doença de Graves/terapia , Humanos , Hipotireoidismo/etiologia , Hipotireoidismo/fisiopatologia , Radioisótopos do Iodo/uso terapêutico , Masculino , Obesidade/epidemiologia , Obesidade/etiologia , Fatores de Risco , Tireoidectomia , Tireotoxicose/terapia
10.
J UOEH ; 41(2): 249-257, 2019.
Artigo em Japonês | MEDLINE | ID: mdl-31292372

RESUMO

Here we report a case of a 12-year-old girl who was referred to our department because of marked short stature of more than -5 SD below the median. Although her growth failure began suddenly at 6 years of age, she never had an examination because she had no other symptoms. Brain MRI examination suggested a tumor in the suprasellar region, and endocrine examination revealed combined pituitery hormone deficiency due to the tumor. Before surgery, the supplementation with hydrocortisone and levothyroxine was initiated. The pathological diagnosis of the surgically removed tumor was xanthogranuloma. The pattern of her growth curve showed a growth failure with sudden onset, which is a typical pattern of short stature secondary to pituitary disfunction including growth hormone deficiency associated with brain tumors. This case suggests that growth failure could be the only symptom in pediatric cases with brain tumors. Improved awareness regarding the association of growth failure with brain tumors is needed for earlier diagnosis and treatment. Furthermore, the growth curves should be carefully evaluated in regular health examinations at school.


Assuntos
Estatura , Insuficiência de Crescimento , Transtornos do Crescimento/etiologia , Doenças da Hipófise/complicações , Xantogranuloma Juvenil/complicações , Anormalidades Múltiplas/etiologia , Fatores Etários , Criança , Diagnóstico Precoce , Facies , Feminino , Transtornos do Crescimento/patologia , Transtornos do Crescimento/prevenção & controle , Humanos , Hipotireoidismo/etiologia , Imagem por Ressonância Magnética , Exame Físico , Doenças da Hipófise/diagnóstico por imagem , Doenças da Hipófise/patologia , Doenças da Hipófise/cirurgia , Hormônios Adeno-Hipofisários/deficiência , Instituições Acadêmicas , Índice de Gravidade de Doença , Fator de Transcrição Pit-1/deficiência , Xantogranuloma Juvenil/diagnóstico por imagem , Xantogranuloma Juvenil/patologia , Xantogranuloma Juvenil/cirurgia
11.
Intern Med ; 58(21): 3121-3123, 2019 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-31292406

RESUMO

We herein report a rare case of a 41-year-old woman with painless thyroiditis who was positive for thyrotropin (TSH) receptor-blocking (TBAbs) and receptor-stimulating autoantibodies (TSAbs) in the thyrotoxic phase. Her serum thyroid hormone levels were high, and TSH was undetectable. The low uptake of 99mTc led to the diagnosis of painless thyroiditis. M22-TRAb, TBAb and TSAb were detectable in the thyrotoxic phase. Three months later, she became severely hypothyroid. M22-TRAb and TBAb were still strongly positive, although the TSAb levels had decreased to just above the reference range. In this case, TBAb led to hypothyroidism.


Assuntos
Autoanticorpos/sangue , Receptores da Tireotropina/imunologia , Tireoidite/imunologia , Adulto , Feminino , Humanos , Hipotireoidismo/etiologia , Imunoglobulinas Glândula Tireoide-Estimulantes/sangue , Glândula Tireoide/diagnóstico por imagem , Tireoidite/complicações , Tireotoxicose/etiologia , Tireotropina/sangue , Ultrassonografia
12.
J Surg Res ; 244: 102-106, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31279993

RESUMO

BACKGROUND: After thyroidectomy, patients require Levothyroxine (LT4). It may take years of dose adjustments to achieve euthyroidism. During this time, patients encounter undesirable symptoms associated with hypo- or hyper-thyroidism. Currently, providers adjust LT4 dose by clinical estimation, and no algorithm exists. The objective of this study was to build a decision tree that could estimate LT4 dose adjustments and reduce the time to euthyroidism. METHODS: We performed a retrospective cohort analysis on 320 patients who underwent total or completion thyroidectomy at our institution. All patients required one or more LT4 dose adjustments from their initial postoperative dose before attaining euthyroidism. Using the Classification and Regression Tree algorithm, we built various decision trees from patient characteristics, estimating the dose adjustment to reach euthyroidism. RESULTS: The most accurate decision tree used thyroid-stimulating hormone values at first dose adjustment (mean absolute error = 13.0 µg). In comparison, the expert provider and naïve system had a mean absolute error of 11.7 µg and 17.2 µg, respectively. In the evaluation dataset, the decision tree correctly predicted the dose adjustment within the smallest LT4 dose increment (12.5 µg) 79 of 106 times (75%, confidence interval = 65%-82%). In comparison, expert provider estimation correctly predicted the dose adjustment 76 of 106 times (72%, confidence interval = 62%-80%). CONCLUSIONS: A decision tree predicts the correct LT4 dose adjustment with an accuracy exceeding that of a completely naïve system and comparable to that of an expert provider. It can assist providers inexperienced with LT4 dose adjustment.


Assuntos
Árvores de Decisões , Cálculos da Dosagem de Medicamento , Terapia de Reposição Hormonal/métodos , Tireoidectomia/efeitos adversos , Tiroxina/administração & dosagem , Adulto , Idoso , Feminino , Humanos , Hipertireoxinemia/sangue , Hipertireoxinemia/etiologia , Hipertireoxinemia/prevenção & controle , Hipotireoidismo/sangue , Hipotireoidismo/tratamento farmacológico , Hipotireoidismo/etiologia , Aprendizado de Máquina , Masculino , Pessoa de Meia-Idade , Cuidados Pós-Operatórios/métodos , Estudos Retrospectivos , Tireotropina/sangue , Tiroxina/efeitos adversos
13.
Cancer Radiother ; 23(5): 439-448, 2019 Sep.
Artigo em Francês | MEDLINE | ID: mdl-31358445

RESUMO

Intensity-modulated radiation therapy (IMRT) is presently the recommended technique for the treatment of locally advanced head and neck carcinomas. Proton therapy would allow to reduce the volume of irradiated normal tissue and, thus, to decrease the risk of late dysphagia, xerostomia, dysgeusia and hypothyroidism. An exhaustive research was performed with the search engine PubMed by focusing on the papers about the physical difficulties that slow down use of proton therapy for head and neck carcinomas. Range uncertainties in proton therapy (±3 %) paradoxically limit the use of the steep dose gradient in distality. Calibration uncertainties can be important in the treatment of head and neck cancer in the presence of materials of uncertain stoichiometric composition (such as with metal implants, dental filling, etc.) and complex heterogeneities. Dental management for example may be different with IMRT or proton therapy. Some uncertainties can be somewhat minimized at the time of optimization. Inter- and intrafractional variations and uncertainties in Hounsfield units/stopping power can be integrated in a robust optimization process. Additional changes in patient's anatomy (tumour shrinkage, changes in skin folds in the beam patch, large weight loss or gain) require rescanning. Dosimetric and small clinical studies comparing photon and proton therapy have well shown the interest of proton therapy for head and neck cancers. Intensity-modulated proton therapy is a promising treatment as it can reduce the substantial toxicity burden of patients with head and neck squamous cell carcinoma compared to IMRT. Robust optimization will allow to perform an optimal treatment and to use proton therapy in current clinical practice.


Assuntos
Neoplasias de Cabeça e Pescoço/radioterapia , Física Sanitária , Terapia com Prótons , Lesões por Radiação/prevenção & controle , Radioterapia (Especialidade) , Carcinoma de Células Escamosas de Cabeça e Pescoço/radioterapia , Pesquisa Médica Translacional , Transtornos de Deglutição/etiologia , Transtornos de Deglutição/prevenção & controle , Disgeusia/etiologia , Disgeusia/prevenção & controle , Humanos , Hipotireoidismo/etiologia , Hipotireoidismo/prevenção & controle , Modelos Teóricos , Órgãos em Risco , Lesões por Radiação/etiologia , Dosagem Radioterapêutica , Planejamento da Radioterapia Assistida por Computador , Radioterapia Guiada por Imagem , Radioterapia de Intensidade Modulada/efeitos adversos , Incerteza , Xerostomia/etiologia , Xerostomia/prevenção & controle
14.
World Neurosurg ; 131: e81-e87, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31306837

RESUMO

BACKGROUND: Pituitary stalk sectioning is only essential in cases of craniopharyngioma originating from the stalk or metastatic tumor to the stalk. Some patients can discontinue postoperative antidiuretic hormone (ADH) supplementation with special conditions. METHODS: Sixty-three patients with craniopharyngiomas who were treated by surgery with pituitary stalk sectioning were included in this study. Great care was taken to preserve the fine arteries running along the lateral walls of the third ventricle. Removal rates, change of endocrinologic status, and magnetic resonance imaging (MRI) findings were investigated. RESULTS: Total removal was achieved in 52 of 54 patients in initial surgery (96.3%), and in 5 of 9 patients in retreatment (55.6%). ADH supplementation was required in all patients from the day of surgery, but was discontinued in 29 of 54 patients among the initial surgery group (53.7%) and in 2 of 9 patients among the retreatment group (22.2%). Preservation of thyroid hormone secretion was observed in 24 of 31 patients who could discontinue ADH (77.4%), but only in 12 of 32 patients who could not discontinue ADH (37.5%). Recovery from diabetes insipidus (DI) was significantly associated with preservation of thyroid function (P < 0.01). Postoperative MRI showed that part of the hypothalamus was enhanced in patients with recovery from DI. CONCLUSIONS: Total removal was achieved in 91% of all cases. Half of the patients could discontinue ADH supplementation, which was associated with preservation of thyroid function. The findings of hypothalamic enhancement on postoperative MRI may be associated with recovery from DI.


Assuntos
Antidiuréticos/uso terapêutico , Craniofaringioma/cirurgia , Diabetes Insípido/tratamento farmacológico , Sistema Hipotálamo-Hipofisário/metabolismo , Procedimentos Neurocirúrgicos/métodos , Neoplasias Hipofisárias/cirurgia , Complicações Pós-Operatórias/tratamento farmacológico , Recuperação de Função Fisiológica , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Desamino Arginina Vasopressina/uso terapêutico , Diabetes Insípido/etiologia , Feminino , Glucocorticoides/deficiência , Glucocorticoides/uso terapêutico , Terapia de Reposição Hormonal , Humanos , Hipopituitarismo/tratamento farmacológico , Hipopituitarismo/etiologia , Sistema Hipotálamo-Hipofisário/diagnóstico por imagem , Hipotireoidismo/tratamento farmacológico , Hipotireoidismo/etiologia , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/efeitos adversos , Hipófise/cirurgia , Complicações Pós-Operatórias/etiologia , Prognóstico , Hormônios Tireóideos/uso terapêutico , Adulto Jovem
15.
Pan Afr Med J ; 32: 186, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31312298

RESUMO

Graves' disease and Hashimoto's thyroiditis are autoimmune thyroid disorders with distinct pathological and histopathological features. The conversion from Hashimoto's thyroiditis to Graves' disease has been rarely reported throughout the world with no reports in the African race to our knowledge. We here report an African lady who was initially diagnosed with primary hypothyroidism following Hashimoto's disease but later became thyrotoxic due to Graves' disease.


Assuntos
Doença de Graves/diagnóstico , Doença de Hashimoto/complicações , Hipotireoidismo/diagnóstico , Grupo com Ancestrais do Continente Africano , Feminino , Doença de Graves/etiologia , Humanos , Hipotireoidismo/etiologia , Pessoa de Meia-Idade
16.
Eur Arch Otorhinolaryngol ; 276(9): 2559-2564, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31250085

RESUMO

PURPOSE: As the lack of consensus in the initial levothyroxine (LT4) dose titration following total thyroidectomy exists, the aim of this study was to identify and quantify predictive factors for LT4 dose replacement. METHODS: A retrospective analysis of a prospectively gathered data of 234 patients who underwent total-thyroidectomy at two institutions between November 9, 2009 and January 1, 2016 was conducted. Outcome variable was the clinically observed optimal LT4 dose. Linear and polynomial regression methods were used for prediction. Continuous variables were tested for mean differences using Student's t-test and association using Pearson's correlation. RESULTS: We identified Body Surface Area (BSA) as the most significant predictor. We propose a model that titrates LT4 dose based on BSA (1.4 µg /kg/day for BSA > 1.79 m2 vs. 1.7 µg /kg/day for BSA ≤ 1.79 m2; P = 0.00). Men required higher doses than women and no differences were noted based on DM status or pathological diagnosis. CONCLUSIONS: Our analysis shows BSA as an independent predictor of LT4 dose post total thyroidectomy. Despite the possibility of generating different equations for predicting LT4 post total-thyroidectomy, finding a practical and clinically relevant prediction model is yet of limited efficiency.


Assuntos
Terapia de Reposição Hormonal/métodos , Hipotireoidismo , Complicações Pós-Operatórias , Tireoidectomia , Tiroxina/administração & dosagem , Adulto , Idoso , Algoritmos , Relação Dose-Resposta a Droga , Cálculos da Dosagem de Medicamento , Feminino , Humanos , Hipotireoidismo/sangue , Hipotireoidismo/tratamento farmacológico , Hipotireoidismo/etiologia , Masculino , Pessoa de Meia-Idade , Cuidados Pós-Operatórios/métodos , Complicações Pós-Operatórias/sangue , Complicações Pós-Operatórias/tratamento farmacológico , Estudos Retrospectivos , Tireoidectomia/efeitos adversos , Tireoidectomia/métodos , Tiroxina/sangue
17.
J Mol Neurosci ; 68(4): 647-657, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31069661

RESUMO

The expression of homosynaptic long-term depression (LTD) governs the subsequent induction of long-term potentiation (LTP) at hippocampal synapses. This process, called metaplasticity, is associated with a transient increase in the levels of several kinases, such as extracellular signal-regulated protein kinases 1/2 (ERK1/2), c-Jun N-terminal kinase (JNK), and Akt kinase. It has been increasingly realized that the chemical changes in the hippocampus caused by hypothyroidism may be the key underlying causes of the learning deficits, memory loss, and impaired LTP associated with this disease. However, the functional role of thyroid hormones in the "plasticity of synaptic plasticity" has only begun to be elucidated. To address this issue, we sought to determine whether the administration of 6-n-propyl-2-thiouracil (PTU) alters the relationship between priming and the induction of subsequent LTP and related signaling molecules. The activation of ERK1/2, JNK, and Akt was measured in the hippocampus at least 95 min after priming onset. We found that priming stimulation at 5 Hz for 3 s negatively impacted the induction of LTP by subsequent tetanic stimulation in hypothyroid animals, as manifested by a more rapid decrease in the fEPSP slope and population spike amplitude. This phenomenon was accompanied by lower levels of phosphorylated Akt in the surgically removed hippocampus of the hypothyroid rats compared to the euthyroid rats. The metaplastic response and the expression of these proteins in the 1-Hz-primed hippocampus were not different between the two groups. These observations suggest that decreased PI3K/Akt signaling may be involved in the compromised metaplastic regulation of LTP observed in hypothyroidism, which may account for the learning difficulties/cognitive impairments associated with this condition.


Assuntos
Hipotireoidismo/metabolismo , Sistema de Sinalização das MAP Quinases , Plasticidade Neuronal , Animais , Potenciais Pós-Sinápticos Excitadores , Hipocampo/metabolismo , Hipocampo/fisiopatologia , Hipotireoidismo/etiologia , Hipotireoidismo/fisiopatologia , MAP Quinase Quinase 4/metabolismo , Masculino , Proteína Quinase 1 Ativada por Mitógeno/metabolismo , Proteína Quinase 3 Ativada por Mitógeno/metabolismo , Propiltiouracila/toxicidade , Proteínas Proto-Oncogênicas c-akt/metabolismo , Ratos , Ratos Wistar
18.
J Surg Res ; 242: 166-171, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31078901

RESUMO

BACKGROUND: Levothyroxine (LT4) is one of the most prescribed drugs in the United States; however, many patients started on LT4 after thyroidectomy suffer from symptoms of hyper- or hypo-thyroidism before achieving euthyroidism. This study aims to describe the time required for dose adjustment before achieving euthyroidism and identify predictors of prolonged dose adjustment (PDA+) after thyroidectomy. METHODS: This is a single institution retrospective cohort study of patients who achieved euthyroidism with LT4 therapy between 2008 and 2017 after total or completion thyroidectomy for benign disease. Patients who needed at least three dose adjustments (top quartile) were considered PDA+. Binomial logistic regression was used to identify predictors of PDA+. RESULTS: The 605 patients in this study achieved euthyroidism in a median of 116 d (standard deviation 124.9) and one dose adjustment (standard deviation 1.3). The 508 PDA- patients achieved euthyroidism in a median of 101 d and one dose adjustment. The 97 PDA+ patients achieved euthyroidism in a median of 271 d and three dose adjustments. Iron supplementation (odds ratio = 4.4, 95% confidence interval = 1.4-13.5, P = 0.010) and multivitamin with mineral supplementation (odds ratio = 2.4, 95% confidence interval = 1.3-4.3, P = 0.004) were independently associated with PDA+. Age, gender, preoperative thyroid disease, and comorbidities did not independently predict PDA+. CONCLUSIONS: After thyroidectomy, achieving euthyroidism can take nearly 4 mo. Iron and mineral supplementation are associated with PDA+. This information can inform the preoperative counseling of patients and suggests that this may expedite achieving euthyroidism.


Assuntos
Terapia de Reposição Hormonal/métodos , Hipertireoidismo/induzido quimicamente , Hipotireoidismo/tratamento farmacológico , Tireoidectomia/efeitos adversos , Tiroxina/administração & dosagem , Adulto , Idoso , Suplementos Nutricionais/efeitos adversos , Relação Dose-Resposta a Droga , Feminino , Terapia de Reposição Hormonal/efeitos adversos , Terapia de Reposição Hormonal/estatística & dados numéricos , Humanos , Hipertireoidismo/sangue , Hipotireoidismo/sangue , Hipotireoidismo/etiologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Estudos Retrospectivos , Tiroxina/efeitos adversos , Tiroxina/sangue , Fatores de Tempo
19.
BMC Cancer ; 19(1): 461, 2019 May 16.
Artigo em Inglês | MEDLINE | ID: mdl-31096939

RESUMO

BACKGROUND: We investigated the risk of thyroid disorders, namely hypothyroidism, thyrotoxicosis and thyroiditis, in head and neck cancer patients undergoing multimodal treatment. METHODS: A cohort study design using Taiwan's National Health Insurance Research Database was used to assess head and neck cancer patients over 20 years old. The cohort was divided into one group who underwent primary tumor excision only (PTE) and another with additional neck dissection (PTE + ND). The tumor sites were stratified to estimate the tumor-site-specific risk of thyroid disorders. The effect of subsequent resurgery, radiotherapy (RT), chemotherapy (CT), and concomitant (CCRT) or sequential chemoradiation therapy (sequential CT+ RT) on the risk of thyroid disorders was explored. RESULTS: For 1999-2012, 7460 patients who underwent PTE + ND and 3730 who underwent PTE were enrolled and followed-up until the end of 2013. There were 122 and 50 patients in the two groups, respectively, who developed thyroid disorders, with no statistical difference between the groups. Patients with hypopharyngeal, oropharyngeal, or laryngeal cancer in the PTE + ND group had a higher risk of thyroid disorders (adjusted HR: 1.50, 95% CI: 0.67-3.38) than those in the PTE group when adjusted for covariates and mortality. Patients who underwent subsequent RT (adjusted HR: 3.64, 95% CI: 1.05-2.77) and CCRT (adjusted HR: 1.70, 95% CI: 1.05-2.77) after PTE + ND had a significantly higher risk of thyroid disorders. CONCLUSION: RT results in a major risk of subsequent thyroid disorders, and ND may exacerbate this effect. Physicians should monitor thyroid function from two years after treatment initiation, especially in patients who undergo ND and subsequent RT.


Assuntos
Terapia Combinada/efeitos adversos , Neoplasias de Cabeça e Pescoço/terapia , Sistema de Registros , Doenças da Glândula Tireoide/etiologia , Adulto , Estudos de Coortes , Feminino , Neoplasias de Cabeça e Pescoço/cirurgia , Humanos , Hipotireoidismo/etiologia , Masculino , Pessoa de Meia-Idade , Taiwan , Tireoidectomia/efeitos adversos , Tireoidite/etiologia , Tireotoxicose/etiologia , Adulto Jovem
20.
World Neurosurg ; 128: e522-e530, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31048050

RESUMO

OBJECTIVE: Rathke's cleft cysts (RCCs) may have various anatomic, clinical, and radiologic characteristics, which may be related to their differences in texture or consistency. The purpose of the study was to investigate RCCs based on consistency. METHODS: We retrospectively reviewed 25 cases of patients with RCCs who underwent endoscopic endonasal transsphenoidal surgery between 2008 and 2018. Cases were divided into 3 types based on cyst consistency: fluid (serous) or type A (n = 4); semi-fluid (mucoid) or type B (n = 17); and non-fluid (caseous) or type C (n = 4). Demographic, clinical, radiologic, and surgical characteristics for each group were analyzed. RESULTS: All type A RCCs (100%) had visual impairment. The mean age (42.8 ± 13 years) and cyst volume (2442.5 ± 533.6 mm3) were higher in these patients. T1-weighted images were hypointense and T2-weighted images were hyperintense on magnetic resonance imaging. Type B RCCs were more frequently encountered (68%). Although headache was the most common (82.3%) symptom, endocrine disorders were also prevalent (52.9%). T1-weighted images were typically isointense or hyperintense on magnetic resonance imaging. Type C RCCs had the youngest patient population (30.3 ± 10.2 years) and T2-weighted images were predominantly hypointense in this group. CONCLUSIONS: The proposed novel consistency classification of RCCs will provide a practical tool for more accurately estimating the nature of the pathology, because each type has its own specific characteristics. Furthermore, the new classification of RCCs may aid in planning a consistency-specific surgery.


Assuntos
Cistos do Sistema Nervoso Central/diagnóstico por imagem , Cistos do Sistema Nervoso Central/patologia , Adolescente , Adulto , Idoso , Cistos do Sistema Nervoso Central/classificação , Cistos do Sistema Nervoso Central/complicações , Feminino , Cefaleia/etiologia , Humanos , Hidrocortisona/deficiência , Hiperprolactinemia/etiologia , Hipogonadismo/etiologia , Hipotireoidismo/etiologia , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Transtornos da Visão/etiologia , Adulto Jovem
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