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1.
Medicine (Baltimore) ; 99(18): e19737, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32358346

RESUMO

INTRODUCTION: Hypothyroidism, the most common endocrine disease, comprises a deficiency of thyroid hormone, causing coldness, fatigue, and dysmenorrhea. Here, we report the improvement of hypothyroidism symptoms and thyroid hormone level normalization by using Korean herbal medicine and acupuncture therapy. PATIENT CONCERNS: A 30-year-old woman (Case 1) presented at the clinic with continuous seborrheic dermatitis on the scalp, accompanied by dysmenorrhea. A 55-year-old woman (Case 2) presented with symptoms of coldness of the limbs and fatigue. DIAGNOSIS: Both patients were diagnosed with "Yin deficiency and Yang hyperactivity" and hypothyroidism after serum thyroid function tests. INTERVENTIONS: Both patients received herbal medicine decoction, acupuncture, and electroacupuncture therapy. OUTCOMES: Korean medicine improved the symptoms of hypothyroidism and significantly normalized thyroid-stimulating hormone and free-thyroxine levels. CONCLUSION: These outcomes suggest that Korean medicine may be effective for resolution of hypothyroidism; however, further research is needed to confirm these findings.


Assuntos
Terapia por Acupuntura/métodos , Hipotireoidismo/terapia , Medicina Tradicional Coreana/métodos , Fitoterapia/métodos , Adulto , Terapia Combinada , Feminino , Humanos , Hipotireoidismo/sangue , Pessoa de Meia-Idade , República da Coreia , Hormônios Tireóideos/sangue , Resultado do Tratamento
2.
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
3.
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
4.
Medicine (Baltimore) ; 98(52): e18537, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31876751

RESUMO

Thyroid disorders are associated with blood glucose abnormalities. For rendering the patients euthyroid, routine screening and care are essential. Therefore, the aim of this study was to investigate the association between continuity of care (COC) and type 2 diabetes onset among patients with thyroid disorders.We used the national claim data. Our study population was 4099 patients with hyperthyroidism or hypothyroidism. For calculating COC, the Most Frequent Provider Continuity Index (MFPCI), Modified Modified Continuity Index (MMCI), and COC Index (COCI) were used. The dependent variable was type 2 diabetes onset. The Cox proportional hazard regression model was used.Among 4099 patients with thyroid disorders, 25.3% experienced onset of type 2 diabetes. Thyroid patients who had MFPCI and COCI below the median were more likely to experience onset of type 2 diabetes than who had these indices above the median (MFPCI: hazard ratio [HR] = 1.26, 95% confidence interval [CI] = 1.09-1.46; COCI: HR = 1.22, 95% CI = 1.06-1.41). Our subgroup analysis showed that female patients and those 20 to 34 years of age showed a significant association between COC and onset of type 2 diabetes.Patients with thyroid disorders with low COC showed an increased risk of developing type 2 diabetes. Therefore, efforts to enhance COC among patients with thyroid disorders needs to be encouraged.


Assuntos
Continuidade da Assistência ao Paciente , Diabetes Mellitus Tipo 2/etiologia , Doenças da Glândula Tireoide/complicações , Adulto , Fatores Etários , Idoso , Diabetes Mellitus Tipo 2/epidemiologia , Feminino , Humanos , Hipertireoidismo/complicações , Hipertireoidismo/terapia , Hipotireoidismo/complicações , Hipotireoidismo/terapia , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , República da Coreia/epidemiologia , Fatores de Risco , Fatores Sexuais , Doenças da Glândula Tireoide/terapia , Adulto Jovem
5.
Crit Rev Oncol Hematol ; 141: 23-35, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31202955

RESUMO

Recently, tyrosine kinase inhibitors (TKI) and immune checkpoint inhibitors (ICPIs) have emerged as new classes of anticancer therapies. Although generally considered less toxic than cytotoxic chemotherapy, these new drugs can cause significant unanticipated side effects including thyroid dysfunction. This review provides a literature assessment of thyroid dysfunctions induced by TKI and ICPIs. We intend to define for these two classes the frequency of thyroid involvement, the potential mechanisms that result in this toxicity, the clinical-biological impact and the therapeutic management. Detection of thyroid dysfunction requires monitoring of TSH, in combination with free T4 if needed and, depending on the clinical impact and the kinetics of biological abnormalities, starting symptomatic treatment of hyperthyroidism and/or correcting hypothyroidism.


Assuntos
Antineoplásicos Imunológicos/efeitos adversos , Neoplasias/tratamento farmacológico , Inibidores de Proteínas Quinases/efeitos adversos , Proteínas Tirosina Quinases/antagonistas & inibidores , Doenças da Glândula Tireoide/induzido quimicamente , Antineoplásicos Imunológicos/uso terapêutico , Pontos de Checagem do Ciclo Celular/efeitos dos fármacos , Pontos de Checagem do Ciclo Celular/imunologia , Humanos , Hipotireoidismo/induzido quimicamente , Hipotireoidismo/diagnóstico , Hipotireoidismo/patologia , Hipotireoidismo/terapia , Neoplasias/fisiopatologia , Inibidores de Proteínas Quinases/uso terapêutico , Doenças da Glândula Tireoide/diagnóstico , Doenças da Glândula Tireoide/patologia , Doenças da Glândula Tireoide/terapia , Testes de Função Tireóidea
6.
BMJ Case Rep ; 12(4)2019 Apr 05.
Artigo em Inglês | MEDLINE | ID: mdl-30954956

RESUMO

We report two women who were diagnosed with hypothyroidism due to what was thought to be Hashimoto's thyroiditis 18 and 16 years ago, respectively. They had been euthyroid on stable doses of levothyroxine for many years, and they presented to our clinic with clinically and biochemically overt hyperthyroidism that persisted even after stopping levothyroxine. Immunological and imaging workups were consistent with Graves' disease. Both patients were treated medically and then received definitive treatment. To our knowledge, the intervals for these two conversions are among the longest conversion intervals reported in the medical literature.


Assuntos
Antagonistas Adrenérgicos beta/uso terapêutico , Antitireóideos/uso terapêutico , Doença de Graves/fisiopatologia , Doença de Hashimoto/fisiopatologia , Hipertireoidismo/imunologia , Hipotireoidismo/imunologia , Feminino , Doença de Graves/complicações , Doença de Graves/imunologia , Doença de Graves/terapia , Doença de Hashimoto/complicações , Doença de Hashimoto/imunologia , Doença de Hashimoto/terapia , Humanos , Hipertireoidismo/etiologia , Hipertireoidismo/fisiopatologia , Hipertireoidismo/terapia , Hipotireoidismo/etiologia , Hipotireoidismo/fisiopatologia , Hipotireoidismo/terapia , Metimazol/uso terapêutico , Pessoa de Meia-Idade , Propranolol/uso terapêutico , Tireoidectomia , Tiroxina/efeitos adversos , Tiroxina/uso terapêutico , Resultado do Tratamento
7.
BMC Cardiovasc Disord ; 19(1): 83, 2019 04 04.
Artigo em Inglês | MEDLINE | ID: mdl-30947691

RESUMO

BACKGROUND: Subclinical thyroid dysfunction whose typical patterns include subclinical hypothyroidism and subclinical hyperthyroidism, has been indicated to be associated with an increased risk of heart failure (HF). However, the relationship between subclinical thyroid dysfunction and the clinical outcomes of HF patients is uncertain. This meta-analysis was conducted to assess the association between subclinical thyroid dysfunction and the clinical outcomes of HF patients. METHODS: Pubmed, Embase, Web of Science and Cochrane Central Register of Clinical Trials were searched for eligible studies published up to August 1, 2018 which reported the association between subclinical thyroid dysfunction and the clinical outcomes of HF patients. The pooled hazard ratio (HR) with the corresponding 95% confidence interval (CI) was used to assess the association. RESULTS: Fourteen studies met the eligibility criteria and a total of 21,221 patients with heart failure were included in the meta-analysis. Compared with HF patients with euthyroidism, the pooled HR of subclinical hypothyroidism for all-cause mortality was 1.45 (95% CI 1.26-1.67) in a randomized effects model with mild heterogeneity (I2 = 40.1, P = 0.073). The pooled HR of subclinical hypothyroidism for cardiac death and/or hospitalization was 1.33 (1.17-1.50) in a randomized effects model with moderate heterogeneity (I2 = 69.4, P < 0.001). Subclinical hyperthyroid can increase the risk of all-cause mortality without heterogeneity (HR 1.31, 95% CI 1.10-1.55, I2 = 25.5%, P = 0.225) but have no influence on the risk of cardiac death and/or hospitalization (HR 1.03, 95% CI 0.87-1.23, I2 = 0.0%, P = 0.958). These significant adverse associations were also retained in subgroup analysis. Sensitivity analysis demonstrated the stability of the results of our meta-analysis. CONCLUSIONS: Both subclinical hypothyroidism and subclinical hyperthyroidism are associated with adverse prognosis in patients with HF. Subclinical thyroid dysfunction may be a useful and promising predictor for the long-term prognosis in HF patients.


Assuntos
Insuficiência Cardíaca/fisiopatologia , Hipertireoidismo/fisiopatologia , Hipotireoidismo/fisiopatologia , Volume Sistólico , Glândula Tireoide/fisiopatologia , Função Ventricular Esquerda , Idoso , Doenças Assintomáticas , Causas de Morte , Feminino , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/mortalidade , Insuficiência Cardíaca/terapia , Humanos , Hipertireoidismo/diagnóstico , Hipertireoidismo/mortalidade , Hipertireoidismo/terapia , Hipotireoidismo/diagnóstico , Hipotireoidismo/mortalidade , Hipotireoidismo/terapia , Masculino , Pessoa de Meia-Idade , Prognóstico , Medição de Risco , Fatores de Risco , Fatores de Tempo
8.
Eur J Endocrinol ; 180(6): 407-416, 2019 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-31035256

RESUMO

Objective To investigate the association between hypothyroidism and cardiovascular disease (CVD) in both treated and untreated hypothyroid patients, and the consequences of over- and under-treatment with respect to cardiovascular risk. Design A registry-based case-control study nested within a population-based cohort of 275 467 individuals with at least one serum thyroid stimulating hormone (TSH) measurement in the period of 1995-2011. Methods Incident cases of CVD were matched with controls according to gender, age and year of birth. Conditional logistic regression analyses were performed to calculate CVD risks associated with exposure to hypothyroidism, with adjustment for 19 pre-existing comorbidities, including cardiovascular disease and diabetes, using the Charlson Comorbidity Index. Results Overall, 20 487 individuals experienced CVD (9.4%, incidence rate 13.1 per 1000 person-years, 95% confidence interval (CI), 13.0-13.3). Risk of CVD was increased in untreated hypothyroidism compared to euthyroidism (odds ratio (OR): 1.83 (95% CI: 1.43-2.35; P < 0.001)). Cardiovascular risk was increased in both treated and untreated hypothyroid individuals per half year of elevated TSH (OR: 1.11 (95% CI: 1.06-1.16; P < 0.001) and OR: 1.15 (95% CI: 1.09-1.23; P = 0.001), respectively). In patients treated with levothyroxine, OR for CVD was 1.12 (95% CI: 1.06-1.18; P < 0.001) for each 6 months of decreased TSH. Conclusion Cardiovascular risk is increased in untreated, but not in treated hypothyroid patients. Among those with treated hypothyroidism, duration of decreased TSH (overtreatment) had a similar impact on cardiovascular risk as duration of elevated TSH (under-treatment), highlighting the importance of initiating treatment and maintaining biochemical euthyroidism in hypothyroid patients in order to reduce the risk of CVD and death.


Assuntos
Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/terapia , Hipotireoidismo/epidemiologia , Hipotireoidismo/terapia , Sobremedicalização/tendências , Adulto , Idoso , Doenças Cardiovasculares/diagnóstico , Estudos de Casos e Controles , Estudos de Coortes , Feminino , Mau Uso de Serviços de Saúde/tendências , Humanos , Hipotireoidismo/diagnóstico , Masculino , Pessoa de Meia-Idade , Sistema de Registros , Fatores de Risco , Fatores de Tempo
9.
J Pharm Pract ; 32(3): 314-326, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30852927

RESUMO

Endocrine emergencies are frequent in critically ill patients and may be the cause of admission or can be secondary to other critical illness. The ability to anticipate endocrine abnormalities such as adrenal excess or , hypothyroidism, can mitigate their duration and severity. Hyperglycemic crisis may trigger hospital and intensive care unit (ICU) admission and may be life threatening. Recognition and safe treatment of severe conditions such as acute adrenal insufficiency, thyroid crisis, and hypoglycemia and hyperglycemic crisis may be lifesaving. Electrolyte abnormalities such as hypercalcemia and hypocalcemia may have underlying endocrine causes, and may be treated differently with recognition of those disorders- electrolyte replacement alone may not be adequate for efficient resolution. Sodium disorders are common in the ICU and are generally related to altered water balance however may be related to pituitary abnormalities in selected patients, and recognition may improve treatment effectiveness and safety.


Assuntos
Doenças do Sistema Endócrino/terapia , Unidades de Terapia Intensiva/normas , Insuficiência Adrenal/terapia , Síndrome de Cushing/terapia , Humanos , Hipercalcemia/terapia , Hiperglicemia/terapia , Hipernatremia/terapia , Hipertireoidismo/terapia , Hipocalcemia/terapia , Hipoglicemia/terapia , Hipotireoidismo/terapia
10.
Artigo em Inglês | MEDLINE | ID: mdl-30621568

RESUMO

BACKGROUND AND OBJECTIVE: Cardiovascular disease is the most important cause of morbidity and mortality worldwide, with a significant economic burden, which is expected to increase in the next years. Alongside the management of cardiac manifestations and major risk factors for atherosclerosis, great attention has been paid to the role of comorbidities in initiating and worsening cardiac conditions. DISCUSSION: The cardiovascular impact of a broad spectrum of endocrine disorders has been evaluated, with particular regard to their effects on cardiac function and cardiovascular prognosis in affected patients. Among the different endocrine conditions considered, the association between subclinical hypothyroidism and cardiovascular events is still uncertain. A number of observational studies have linked subclinical hypothyroidism (in particular severe elevation of TSH levels) with incident cardiovascular disease and poor prognosis, however thyroid replacement therapy is still controversial, especially in the elderly, due to the lack of evidence coming from randomized controlled trials. With regards to testosterone deficiency, even though it has been associated with metabolic abnormalities and poor prognosis in patients affected by cardiovascular diseases, the cardiac safety of replacement therapy has still to be completely clarified. Similarly, growth hormone deficiency showed detrimental effects on cardiovascular events and risk factors which seem to be reverted by replacement therapy, even if unequivocal evidence from randomized clinical trials is still lacking Another relevant chapter in cardiovascular disease management is about the cardiovascular outcomes of diabetes medical treatments. In recent years, a growing interest has been developed around the cardiovascular safety of antidiabetic medications which has led to a great number of publications addressing this issue for the different classes of antidiabetic drugs. Interestingly, the recently approved classes, i.e. incretins and SGLT-2 inhibitors, have additionally demonstrated a protective effect against major cardiovascular events, shedding new light on the management of diabetes in patients affected by cardiovascular disease. CONCLUSION: Important controversies still exist regarding the cardiac implications of the therapies adopted in endocrine diseases. Owing the large prevalence of these conditions, particularly in the cardiovascular population, further research is awaited in order to clarify the potential advantage and the possible cardiac risk related to treatment of the endocrine comorbidities.


Assuntos
Doenças Cardiovasculares/terapia , Doenças do Sistema Endócrino/terapia , Endocrinologia/tendências , Terapias em Estudo/tendências , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/etiologia , Sistema Cardiovascular/efeitos dos fármacos , Sistema Cardiovascular/fisiopatologia , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/epidemiologia , Diabetes Mellitus Tipo 2/terapia , Doenças do Sistema Endócrino/complicações , Doenças do Sistema Endócrino/epidemiologia , Endocrinologia/métodos , Humanos , Hipoglicemiantes/uso terapêutico , Hipotireoidismo/complicações , Hipotireoidismo/epidemiologia , Hipotireoidismo/terapia , Fatores de Risco , Terapias em Estudo/métodos
11.
Rev Med Suisse ; 15(N° 632-633): 42-45, 2019 Jan 09.
Artigo em Francês | MEDLINE | ID: mdl-30629367

RESUMO

Hypothyroidism is the most common hormonal disorder, especially in the female population. Advances in clinical research have allowed more precision in the management of this entity, particularly its subclinical form in the elderly and pregnant women.


Assuntos
Hipotireoidismo , Complicações na Gravidez , Idoso , Feminino , Humanos , Hipotireoidismo/terapia , Gravidez , Complicações na Gravidez/terapia
12.
J Gynecol Obstet Hum Reprod ; 48(4): 231-233, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30634005

RESUMO

Fetal thyroid disorders while uncommon in general, have significant morbidity and profound effects in the neonate. Pregnancy provides the opportunity not only for the diagnosis of these conditions but also for therapeutic interventions. In careful balance, these disorders range from hypothyroidism to hyperthyroidism, both may manifest with fetal thyroid goiters as well. The intrauterine therapeutic approach of these must also weight the balance in this range as well as the maternal well being which may also express thyroid dysfunction. In this review we explore the different fetal manifestations of thyroid disease, describe the pathophysiology and therapeutic approaches both in practice and in development.


Assuntos
Doenças Fetais/diagnóstico , Doenças da Glândula Tireoide/embriologia , Antitireóideos/administração & dosagem , Feminino , Doenças Fetais/fisiopatologia , Doenças Fetais/terapia , Idade Gestacional , Bócio/diagnóstico por imagem , Bócio/embriologia , Humanos , Hipertireoidismo/diagnóstico , Hipertireoidismo/embriologia , Hipertireoidismo/terapia , Hipotireoidismo/diagnóstico , Hipotireoidismo/embriologia , Hipotireoidismo/terapia , Recém-Nascido , Triagem Neonatal , Gravidez , Complicações na Gravidez , Diagnóstico Pré-Natal , Propiltiouracila/administração & dosagem , Doenças da Glândula Tireoide/fisiopatologia , Doenças da Glândula Tireoide/terapia , Tiroxina/administração & dosagem , Ultrassonografia Pré-Natal
13.
Endokrynol Pol ; 70(2): 165-171, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30480752

RESUMO

INTRODUCTION: The increasing number of patients with end-stage renal disease (ESRD) requires seeking new opportunities to improve their quality of life, not only because of kidney disease but also due to other disturbances, such as thyroid hormone disorders. The objective of the study was to evaluate the influence of coexisting hypothyroidism and thyroid hormone therapy in patients with ESRD on thyroid hormone conversion ratios and rT3 concentration. MATERIAL AND METHODS: The study involved 85 patients aged 26 to 87 years, with a mean age of 59.62 ± 15.45 years. Four groups of patients were examined: G1 group - 25 persons without RF and hypothyroidism, G2 - 26 patients with ESRD treated with haemodialysis (HD), G3 - 12 patients with ESRD treated with HD and newly diagnosed hypothyroidism, and G4 - 22 HD patients with hypothyroidism treated with thyroid hormones substitution. The concentrations of TSH, T4, T3, fT4, fT3, and rT3 were measured and the fT3/fT4, T3/T4, and rT3/T4 conversion ratios and rT3/T3 ratio were calculated. Concentrations of protein, hsCRP, Hg, and blood gases were also checked; the anion gap was calculated. RESULTS: Patients from group G1 through G2 to G3 were older (ptrend = 0.002), with lower Hb level (ptrend < 0.001), with lower pH (ptrend < 0.001), with increased anion gap (ptrend < 0.013) and CRP concentrations (ptrend < 0.001), and decreased total protein level (ptrend < 0.001). There were increased TSH values (ptrend < 0.001) and lower T4 (ptrend = 0.024), fT3 (ptrend < 0.001), T3 (ptrend < 0.001), and rT3 (ptrend = 0.008) levels. rT3/T3 ratio did not change, the rT3/T4 ratio tended to decrease (ptrend = 0.065) similarly to T3/T4 ratio (ptrend = 0.063), and the fT3/fT4 ratio also decreased (ptrend = 0.005). It seems that the treatment of thyroid disease in patients with renal failure, treated with haemodialysis, is not associated with change of rT3 and conversion factor levels. CONCLUSIONS: The concentration of rT3 in HD patients in relation to healthy persons tends to decrease, and hypothyroidism increases this tendency in these patients. Hormone substitution treatment does not eliminate the influence of RF on inhibition of rT3 production. In patients with ESRD, hypothyroidism additionally reduces the conversion of thyroid hormones examined by fT3/fT4 and to a lesser extent T3/T4 ratios.


Assuntos
Hipotireoidismo/metabolismo , Hipotireoidismo/terapia , Falência Renal Crônica/metabolismo , Falência Renal Crônica/terapia , Hormônios Tireóideos/metabolismo , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Hipotireoidismo/sangue , Hipotireoidismo/complicações , Falência Renal Crônica/sangue , Falência Renal Crônica/complicações , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Diálise Renal , Hormônios Tireóideos/sangue
14.
Thyroid ; 29(2): 174-182, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30501570

RESUMO

BACKGROUND: Recent reports suggest that prescriptions for thyroid hormones have increased. Recent trends in and determinants of the prevalence of treated hypothyroidism across the United Kingdom were therefore analyzed. METHODS: Data covering the whole of the United Kingdom held by the National Health Service and the Office of National Statistics were examined. The main outcome measured was trends in the prevalence of treated hypothyroidism between 2005 and 2014. In addition, linear trend forecasting was performed to estimate projected trends in the prevalence of treated hypothyroidism up to the year 2025. Furthermore, determinants of variation of treated hypothyroidism prevalence across each of the 237 health areas in the United Kingdom in 2014 and its association with other health conditions were explored by multivariate linear regression analyses. RESULTS: The prevalence of treated hypothyroidism increased from 2.3% (1.4 million) to 3.5% (2.2 million) of the total British population between the years 2005 and 2014 and is projected to rise further to 4.2% (2.9 million) by 2025. There was large geographical variation of treated hypothyroidism across the United Kingdom, with London having the lowest (1.4%) and the Western Isles of Scotland having the highest (6.3%) prevalence. This variation was attenuated, but did not completely disappear, after some potential determinants were accounted for. The prevalence of treated hypothyroidism was independently related to health areas, with a higher proportion of individuals who were female, white, and obese, and negatively associated with prevalent cigarette smoking. The prevalence of treated hypothyroidism was significantly associated with the frequency of prevalent atrial fibrillation but not with other major health conditions, including ischemic heart disease and osteoporosis. CONCLUSIONS: Between 2005 and 2014, the prevalence of treated hypothyroidism increased across the United Kingdom, has wide geographical variation, and is likely to increase further for the foreseeable future. Clinical effects and cost-effectiveness of the trend in increasing treatment of hypothyroidism remains to be evaluated.


Assuntos
Hipotireoidismo/epidemiologia , Hipotireoidismo/terapia , Hormônios Tireóideos/uso terapêutico , Fibrilação Atrial/complicações , Endocrinologia/tendências , Grupos Étnicos , Feminino , Geografia , Humanos , Masculino , Análise Multivariada , Obesidade/complicações , Prevalência , Fatores de Risco , Fumar , Reino Unido/epidemiologia
15.
Thyroid ; 29(1): 142-152, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30375266

RESUMO

BACKGROUND: Hypothyroidism is a common hormone deficiency condition. Regenerative medicine approaches, such as a bioengineered thyroid, have been proposed as potential therapeutic alternatives for patients with hypothyroidism. This study demonstrates a novel approach to generate thyroid grafts using decellularized rat thyroid matrix. METHODS: Isolated rat thyroid glands were perfused with 1% sodium dodecyl sulfate to generate a decellularized thyroid scaffold. The rat thyroid scaffold was then recellularized with rat thyroid cell line to reconstruct the thyroid by perfusion seeding technique. As a pilot study, the decellularized rat thyroid scaffold was perfused with human-derived thyrocytes and parathyroid cells. RESULTS: The decellularization process retained the intricate three-dimensional microarchitecture with a perfusable vascular network and native extracellular matrix components, allowing efficient reseeding of the thyroid matrix with the FRTL-5 rat thyroid cell line generating three-dimensional follicular structures in vitro. In addition, the recellularized thyroid showed successful cellular engraftment and thyroid-specific function, including synthesis of thyroglobulin and thyroid peroxidase. Moreover, the decellularized rat thyroid scaffold could further be recellularized with human-derived thyroid cells and parathyroid cells to reconstruct a humanized bioartificial endocrine organ, which maintained expression of critical genes such as thyroglobulin, thyroid peroxidase, and parathyroid hormone. CONCLUSION: These findings demonstrate the utility of a decellularized thyroid extracellular matrix scaffold system for the development of functional, bioengineered thyroid tissue, which could potentially be used to treat hypothyroidism.


Assuntos
Hipotireoidismo/patologia , Hipotireoidismo/terapia , Regeneração/fisiologia , Células Epiteliais da Tireoide/citologia , Glândula Tireoide/citologia , Engenharia Tecidual , Animais , Matriz Extracelular , Ratos
16.
Auris Nasus Larynx ; 46(4): 605-608, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30454972

RESUMO

OBJECTIVE: Myxedema coma is a serious complication of hypothyroidism that can be precipitated by major surgery. It is extremely rare, with only a few reports in the literature. This study aims to present a relatively large case series of post-surgical myxedema coma and to analyze medical and surgical risk factors. METHODS: Analysis of the patients' surgical records and medical charts. RESULTS: Four patients developed postoperative myxedema coma and were evaluated for risk factors. Three had known hypothyroidism. Two had undergone large head and neck composite resections necessitating a free flap repair for malignant disease. One had undergone coronary artery bypass graft for ischemic heart disease, and another had undergone endoscopic cholecystectomy for complicated cholecystitis. All four patients required prolonged hospitalization, including treatment in the intensive care unit. One patient had undergone full cardiopulmonary resuscitation directly related to the myxedema coma state. CONCLUSION: We present a series of four patients who developed myxedema coma following major surgery. We recommend that patients with known hypothyroidism who are scheduled for major surgery should be tested for thyroid function status and assessed for postoperative risk of hypothyroidism. Those who develop complications following major surgery, should be immediately tested for thyroid function to rule out myxedema coma.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Colecistectomia Laparoscópica , Coma/fisiopatologia , Mixedema/fisiopatologia , Procedimentos Cirúrgicos Otorrinolaringológicos , Complicações Pós-Operatórias/fisiopatologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Coma/sangue , Coma/terapia , Feminino , Humanos , Hipotireoidismo/sangue , Hipotireoidismo/fisiopatologia , Hipotireoidismo/terapia , Masculino , Pessoa de Meia-Idade , Mixedema/sangue , Mixedema/terapia , Complicações Pós-Operatórias/sangue , Complicações Pós-Operatórias/terapia , Medição de Risco , Tireotropina/sangue , Tiroxina/sangue , Tiroxina/uso terapêutico , Tri-Iodotironina/sangue
17.
Mult Scler Relat Disord ; 28: 125-128, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30593981

RESUMO

Neuromyelitis optica spectrum disorder (NMOSD) is an autoimmune syndrome characterized by optic nerve and spinal cord inflammation. In recent years, there has been increasing awareness of NMOSD presenting concurrently with other autoimmune diseases, including myasthenia gravis (MG), systemic lupus erythematosus (SLE), Sjögren's syndrome, and sarcoidosis, among others. Whether these diseases coexist in patients due to shared susceptibility to multiple autoimmune conditions as a result of a genetic tendency toward humoral autoimmunity, or whether systemic rheumatologic diseases facilitate some aspect of NMOSD pathogenesis remains an open question. Here, we describe two cases of NMOSD presenting with concurrent autoimmune disease, and highlight the clinical features and diagnostic challenges of each case. Our first patient had aquaporin-4 antibody-positive NMOSD with concurrent hypothyroidism, SLE, and muscle specific kinase antibody-positive MG. Our second patient had seronegative NMOSD with concurrent acetylcholine receptor antibody-positive MG. Practitioners should be aware of the potential for patients to present with a combination of NMOSD and one or more concurrent autoimmune diseases to ensure timely diagnosis and appropriate treatment.


Assuntos
Hipotireoidismo/complicações , Lúpus Eritematoso Sistêmico/complicações , Miastenia Gravis/complicações , Neuromielite Óptica/complicações , Adulto , Aquaporina 4/imunologia , Autoanticorpos/imunologia , Feminino , Humanos , Hipotireoidismo/diagnóstico , Hipotireoidismo/imunologia , Hipotireoidismo/terapia , Lúpus Eritematoso Sistêmico/diagnóstico , Lúpus Eritematoso Sistêmico/imunologia , Lúpus Eritematoso Sistêmico/terapia , Miastenia Gravis/diagnóstico , Miastenia Gravis/imunologia , Miastenia Gravis/terapia , Neuromielite Óptica/diagnóstico , Neuromielite Óptica/imunologia , Neuromielite Óptica/terapia , Receptores Colinérgicos/imunologia
18.
Arch Gynecol Obstet ; 299(2): 327-338, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30569344

RESUMO

PURPOSE: To review the literature on thyroid function and thyroid disorders during pregnancy. METHODS: A detailed literature research on MEDLINE, Cochrane library, EMBASE, NLH, ClinicalTrials.gov, and Google Scholar databases was done up to January 2018 with restriction to English language about articles regarding thyroid diseases and pregnancy. RESULTS: Thyroid hormone deficiencies are known to be detrimental for the development of the fetus. In particular, the function of the central nervous system might be impaired, causing low intelligence quotient, and mental retardation. Overt and subclinical dysfunctions of the thyroid disease should be treated appropriately in pregnancy, aiming to maintain euthyroidism. Thyroxine (T4) replacement therapy should reduce thyrotropin (TSH) concentration to the recently suggested fixed upper limits of 2.5 mU/l (first and second trimester) and 3.0 mU/l (third trimester). Overt hyperthyroidism during pregnancy is relatively uncommon but needs prompt treatment due to the increased risk of preterm delivery, congenital malformations, and fetal death. The use of antithyroid drug (methimazole, propylthiouracil, carbimazole) is the first choice for treating overt hyperthyroidism, although they are not free of side effects. Subclinical hyperthyroidism tends to be asymptomatic and no pharmacological treatment is usually needed. Gestational transient hyperthyroidism is a self-limited non-autoimmune form of hyperthyroidism with negative antibody against TSH receptors, that is related to hCG-induced thyroid hormone secretion. The vast majority of these patients does not require antithyroid therapy, although administration of low doses of ß-blocker may by useful in very symptomatic patients. CONCLUSIONS: Normal maternal thyroid function is essential in pregnancy to avoid adverse maternal and fetal outcomes.


Assuntos
Antitireóideos/uso terapêutico , Doenças da Glândula Tireoide/tratamento farmacológico , Testes de Função Tireóidea/métodos , Feminino , Humanos , Hipotireoidismo/terapia , Gravidez
19.
Cancer Med ; 7(12): 5870-5878, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30453389

RESUMO

BACKGROUND/AIMS: Hypothyroidism has been associated with hepatocellular carcinoma (HCC) incidence; however, the relationship between hypothyroidism and HCC patient outcomes is unclear. We investigated the impact of hypothyroidism on outcomes after liver transplantation for HCC. MATERIALS AND METHODS: We retrospectively studied HCC patients transplanted between January 2000 and December 2015. Hypothyroidism was defined as a thyroid-stimulating hormone (TSH) level continuously greater than 5 mIU/L, a documented history of hypothyroidism, or treatment with thyroid hormone replacement therapy. Multivariate Cox regression was used to assess the impact of hypothyroidism on overall survival (OS) and recurrence-free survival (RFS) adjusting for potential confounders. Subgroup analyses and interaction tests were conducted to compare the impact of hypothyroidism in different subgroups and assess for possible synergistic effects. Sensitivity analyses were performed among different cohorts to verify the stability of the results. RESULTS: A total of 343 HCC patients who underwent liver transplantation were included in the analysis. The primary analysis was conducted among 288 patients diagnosed with HCC prior to transplantation. Hypothyroidism was independently associated with worse OS and RFS, as was elevated TSH. The adjusted hazard ratio (AHR) of hypothyroidism was 2.45 (95% confidence interval [CI], 1.44-4.18) for OS and 5.54 (2.36, 13.01) for RFS. The AHR of TSH for OS was 1.05 (1.02, 1.09) and 1.08 (1.03, 1.13) for RFS. No interaction was found among different subgroups categorized by etiology and comorbidity. The results were stable to sensitivity analyses. CONCLUSION: Hypothyroidism is associated with poorer overall and recurrence-free survival of HCC patients receiving liver transplantation. These results require validation.


Assuntos
Carcinoma Hepatocelular/terapia , Hipotireoidismo/terapia , Neoplasias Hepáticas/terapia , Transplante de Fígado , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Resultado do Tratamento
20.
Arch Endocrinol Metab ; 62(5): 530-536, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30462806

RESUMO

OBJECTIVE: The aim was to evaluate the quality of life (HRQoL) in women with subclinical hypothyroidism (sHT) after 16 weeks of endurance training. SUBJECTS AND METHODS: In the first phase, a cross-sectional study was conducted in which 22 women with sHT (median age: 41.5 (interquartile range: 175) years, body mass index: 26.2 (8.7) kg/m2, thyroid stimulating hormone > 4.94 mIU/L and free thyroxine between 0.8 and 1.3 ng/dL were compared to a group of 33 euthyroid women concerned to HRQoL. In the second phase, a randomized clinical trial was conducted where only women with sHT were randomly divided into two groups: sHT-Tr (n = 10) - participants that performed an exercise program - and sHT-Sed (n = 10) - controls. Exercise training consisted of 60 minutes of aerobic activities (bike and treadmill), three times a week, for 16 weeks. The HRQoL was assessed by the SF-36 questionnaire in the early and at the end of four months. RESULTS: Women with sHT had lower scores on functional capacity domain in relation to the euthyroid ones (770 ± 23.0 vs. 88.8 ± 14.6; p = 0.020). The sHT-Tr group improved functional capacity, general health, emotional aspects, mental and physical component of HRQoL after training period, while the sHT-Sed group showed no significant changes. CONCLUSION: After 16 weeks of aerobic exercise training, there were remarkable improvements in HRQoL in women with sHT.


Assuntos
Terapia por Exercício/métodos , Exercício Físico/fisiologia , Hipotireoidismo/terapia , Qualidade de Vida , Adulto , Análise de Variância , Autoanticorpos/sangue , Estudos Transversais , Feminino , Humanos , Hipotireoidismo/fisiopatologia , Iodeto Peroxidase/sangue , Iodeto Peroxidase/imunologia , Medições Luminescentes/métodos , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Inquéritos e Questionários , Tireotropina/sangue , Tiroxina/sangue , Fatores de Tempo , Resultado do Tratamento
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