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1.
Eur J Endocrinol ; 181(5): 539-544, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31536967

RESUMO

Objective: To investigate the concordance of serologic and sonographic evidence of Hashimoto's thyroiditis with its gold standard histopathologic identification. Design: We performed a retrospective analysis on a cohort of 825 consecutive patients in whom TPOAb and thyroid ultrasound were performed, and in whom thyroid nodule evaluation led to surgical and histopathologic analysis. The presence or absence of Hashimoto's thyroiditis on histopathology was correlated with serologic and sonographic markers. We further assessed the impact of low versus high titers of TPOAb upon this concordance. Results: Of 825 patients, 277 (33.5%) had histologic confirmation of Hashimoto's thyroiditis, 235 patients (28.4%) had elevated serum levels of TPOAb, and 197 (23.8%) had sonographic evidence of diffuse heterogeneity. Of those with histopathologic evidence, only 64% had elevated TPOAb (sensitivity: 63.9%; specificity: 89.4%), while only 49% were sonographically diffusely heterogeneous (sensitivity: 49.1%; specificity: 88.9%). A subset of only 102 of 277 (37%) with histologically proven Hashimoto's thyroiditis was positive for both TPOAb and diffusely heterogeneous. Concordance analysis demonstrated that TPOAb and histopathology had higher agreement (κ = 0.55) than did ultrasound and histopathology (κ = 0.40) for the diagnosis of Hashimoto's thyroiditis. Higher titers of TPOAb correlated with a higher likelihood of Hashimoto's thyroiditis, with a best cutoff of 2.11-fold the upper normal level of TPOAb. Conclusion: Only moderate concordance exists between serological evidence of Hashimoto's thyroiditis and histopathologic findings, though it increases with higher TPOAb concentration. Diffuse heterogeneity on ultrasound is a less-sensitive diagnostic tool than elevated TPOAb.


Assuntos
Doença de Hashimoto/sangue , Doença de Hashimoto/diagnóstico por imagem , Adulto , Idoso , Biomarcadores , Estudos de Coortes , Reações Falso-Positivas , Feminino , Doença de Hashimoto/patologia , Humanos , Iodeto Peroxidase/sangue , Iodeto Peroxidase/imunologia , Masculino , Pessoa de Meia-Idade , Curva ROC , Padrões de Referência , Estudos Retrospectivos , Sensibilidade e Especificidade , Ultrassonografia , Adulto Jovem
2.
J Clin Pharm Ther ; 44(5): 742-749, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31183891

RESUMO

WHAT IS KNOWN AND OBJECTIVE: Thyroid autoimmune diseases occur much more frequently in women than men. Unfortunately, no previous study has determined whether sex hormones produce any effect on thyroid antibody titres. The primary study aim was to assess whether exogenous testosterone affects thyroid autoimmunity in men with Hashimoto's thyroiditis and low testosterone levels. METHODS: The study population consisted of 34 euthyroid men with autoimmune thyroiditis and testosterone deficiency. On the basis of patient preference, these patients were either treated with oral testosterone undecanoate (120 mg daily; n = 16) or remained untreated (n = 18). Circulating levels of thyrotropin, free thyroxine, free triiodothyronine, prolactin and total testosterone, as well as serum titres of thyroid peroxidase and thyroglobulin antibodies, were measured at the beginning of the study and 6 months later. The structure parameters of thyroid homeostasis (Jostel's thyrotropin index, SPINA-GT and SPINA-GD) were also calculated. Moreover, semen analyses were performed in eight patients in each group. RESULTS AND DISCUSSION: In testosterone-naïve men, serum hormone levels and antibody titres remained at the similar levels throughout the study. Apart from increasing serum testosterone levels, testosterone undecanoate reduced titres of thyroid peroxidase and thyroglobulin antibodies and increased SPINA-GT. The drug produced a neutral effect on circulating levels of thyrotropin, free thyroid hormones, prolactin and testosterone, Jostel's thyrotropin index, SPINA-GD and semen parameters. Testosterone-induced changes in antibody titres correlated with the effect of treatment on SPINA-GT and with serum testosterone levels. WHAT IS NEW AND CONCLUSION: This study is the first one to have shown that exogenous testosterone may have a protective effect on thyroid autoimmunity in men with Hashimoto's thyroiditis and testosterone deficiency.


Assuntos
Autoanticorpos/uso terapêutico , Autoimunidade/efeitos dos fármacos , Doença de Hashimoto/tratamento farmacológico , Testosterona/sangue , Testosterona/uso terapêutico , Glândula Tireoide/efeitos dos fármacos , Feminino , Doença de Hashimoto/sangue , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Iodeto Peroxidase/sangue , Masculino , Pessoa de Meia-Idade , Testosterona/análogos & derivados , Tireoglobulina/sangue , Hormônios Tireóideos/sangue , Tireotropina/sangue
3.
Arch Endocrinol Metab ; 63(4): 351-357, 2019 Apr 25.
Artigo em Inglês | MEDLINE | ID: mdl-31038589

RESUMO

OBJECTIVE: In this study, we aimed to describe the prevalence and distribution of positive antithyroperoxidase antibodies (TPOAb) according to sex, age strata, and presence of thyroid dysfunction using baseline data from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). MATERIALS AND METHODS: Thyroid hormone tests were obtained from each study participant at baseline. Levels of thyroid-stimulating hormone (TSH) and free thyroxine (FT4) were measured using a third-generation immunoenzymatic assay. Antithyroperoxidase antibodies were measured by electrochemiluminescence and were considered to be positive when ≥ 34 IU/mL. RESULTS: The prevalence of TPOAb among 13,503 study participants was 12%. Of participants with positive TPOAb, 69% were women. Almost 60% of the individuals with positive TPOAb were white. The presence of positive TPOAb was associated with the entire spectrum of thyroid diseases among women, but only with overt hyperthyroidism and overt hypothyroidism in men. CONCLUSION: The distribution of positive TPOAb across sex, race, age, and thyroid function in the ELSA-Brasil study is aligned with the worldwide prevalence of positive TPOAb reported in iodine-sufficient areas. In women, the presence of TPOAb was related to the entire spectrum of thyroid dysfunction, while in men, it was only related to the occurrence of overt thyroid disease.


Assuntos
Anticorpos/sangue , Iodeto Peroxidase/sangue , Doenças da Glândula Tireoide/epidemiologia , Adulto , Distribuição por Idade , Idoso , Índice de Massa Corporal , Brasil/epidemiologia , Brasil/etnologia , Estudos Transversais , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Distribuição por Sexo , Doenças da Glândula Tireoide/sangue , Tireotropina/sangue , Tiroxina/sangue
4.
Acta Biochim Pol ; 66(2)2019 Apr 12.
Artigo em Inglês | MEDLINE | ID: mdl-30978267

RESUMO

BACKGROUNDS: Deiodinase type 2 (DIO2) is a selenoenzyme involved in the synthesis of thyroid hormones. Chemerin is a newly investigated adipokine known also as novel chemokine. Both molecules have been recently expected and found to play an important role in inflammation and immunity. DIO2, for example, is upregulated during acute and chronic inflammation. In addition, inflammation-induced expression of DIO2 in macrophages has been confirmed, while chemerin modulates the activation and chemotaxis of immune cells. It is widely known that chronic obstructive pulmonary disease (COPD) - the most common lung disease in the world - is accompanied by an inflammatory process and immune activation. There are no studies demonstrating an association between DIO2, chemerin and COPD. The aim of this study was to estimate DIO2 and chemerin concentration in serum collected from patients suffering from COPD and to compare it with healthy subjects, as well as to correlate with basic and clinical characteristics. METHODS: The study group included 50 patients with COPD and 30 healthy subjects. DIO2 and chemerin serum levels as well as c-reactive protein levels were determined in all the subjects using commercial enzyme-linked immunosorbent assay kits. The association between serum DIO2 and chemerin with sociodemographic and clinical variables was assessed. RESULTS: DIO2 serum levels were significantly higher in the patients with COPD as compared to the control group (50.3±23.2 U/L vs. 13.3±13.1; p<0.00001). No differences were observed in serum chemerin levels between the patients and controls (107.559±86.695.6 vs. 100.701±53.805; p=0.54). Furthermore, there was no association between DIO2 and chemerin levels and other variables, and no correlation between both molecules. CONCLUSIONS: This study demonstrated that DIO2 levels were higher in the patients with COPD than in the control subjects. The examined molecules should be further investigated if they are intended to be considered markers of processes involved in COPD mechanisms.


Assuntos
Iodeto Peroxidase/sangue , Doença Pulmonar Obstrutiva Crônica/sangue , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Índice de Massa Corporal , Proteína C-Reativa/análise , Quimiocinas/sangue , Distribuição de Qui-Quadrado , Feminino , Hospitais Universitários , Humanos , Inflamação/sangue , Masculino , Pessoa de Meia-Idade , Polônia , Estatísticas não Paramétricas , Hormônios Tireóideos/sangue
5.
Pharmacol Rep ; 71(2): 367-373, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30844687

RESUMO

BACKGROUND: Both exogenous vitamin D and selenium reduce thyroid antibody titers. The aim of the study was to investigate whether the impact of vitamin D on thyroid autoimmunity is affected by selenium intake. METHODS: The study included 47 euthyroid women with Hashimoto's thyroiditis and low vitamin D status, 23 of whom had been treated with selenomethionine (200 µg daily) for at least 12 months before the beginning of the study. During the study, all patients were treated with vitamin D preparations (4000 IU daily). Serum titers of thyroid peroxidase and thyroglobulin antibodies, as well as circulating levels of thyrotropin, free thyroid hormones and 25-hydroxyvitamin D were measured before vitamin D supplementation and 6 months later. Moreover, at the beginning and at the end of the study, we calculated Jostel's thyrotropin index, the SPINA-GT index and the SPINA-GD index. RESULTS: With the exception of the free triiodothyronine/free thyroxine ratio and the SPINA-GD index, there were no differences between the study groups. In both groups, vitamin D increased 25-hydroxyvitamin D levels, reduced thyroid peroxidase and thyroglobulin antibody titers, as well as increased the SPINA-GT index. The effects on antibody titers and the SPINA-GT index were more pronounced in women receiving selenomethionine. Neither in selenomethionine-treated nor in selenomethionine-naïve women vitamin D affected serum hormone levels, Jostel's index and the SPINA-GD index. CONCLUSIONS: The results of the study suggest that selenium intake enhances the effect of vitamin D on thyroid autoimmunity.


Assuntos
Autoimunidade/efeitos dos fármacos , Doença de Hashimoto/tratamento farmacológico , Selenometionina/farmacologia , Vitamina D/administração & dosagem , Adulto , Autoanticorpos/sangue , Autoantígenos/sangue , Autoimunidade/imunologia , Feminino , Doença de Hashimoto/sangue , Doença de Hashimoto/imunologia , Humanos , Iodeto Peroxidase/sangue , Proteínas de Ligação ao Ferro/sangue , Pessoa de Meia-Idade , Tireoglobulina/sangue , Hormônios Tireóideos/sangue , Vitamina D/análogos & derivados , Vitamina D/sangue , Adulto Jovem
6.
Pharmacol Rep ; 71(2): 243-247, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30818086

RESUMO

BACKGROUND: Both selenium and vitamin D were found to reduce thyroid antibody titers in women with Hashimoto's thyroiditis. METHODS: The study enrolled 37 young drug-naïve euthyroid men with autoimmune thyroiditis, who were treated for 6 months with either exogenous vitamin D (group A, n = 20) or selenomethionine (group B, n = 17). Serum titers of thyroid peroxidase and thyroglobulin antibodies, serum levels of thyrotropin and free thyroid hormones, serum levels of 25-hydroxyvitamin D, as well Jostel's thyrotropin, the SPINA-GT and the SPINA-GD indices were determined at the beginning and at the end of the study. RESULTS: At baseline, there were no differences between the study groups. Both vitamin D and selenomethionine reduced antibody titers and increased the SPINA-GT index. Only selenomethionine affected the SPINA-GD index, while only vitamin D increased 25-hydroxyvitamin D levels. Neither selenomethionine nor vitamin D significantly affected thyrotropin and free thyroid hormone levels. The effect of vitamin D on antibody titers correlated with baseline and treatment-induced changes in serum levels of 25-hydroxivitamin D. CONCLUSIONS: Both vitamin D and selenomethionine have a beneficial effect on thyroid autoimmunity in drug-naïve men with Hashimoto's thyroiditis.


Assuntos
Doença de Hashimoto/sangue , Selenometionina/administração & dosagem , Hormônios Tireóideos/sangue , Vitamina D/administração & dosagem , Adulto , Autoanticorpos/sangue , Autoantígenos/sangue , Autoimunidade/imunologia , Suplementos Nutricionais , Doença de Hashimoto/imunologia , Humanos , Sistema Hipotálamo-Hipofisário/metabolismo , Iodeto Peroxidase/sangue , Proteínas de Ligação ao Ferro/sangue , Masculino , Projetos Piloto , Hipófise/metabolismo , Selenometionina/farmacologia , Testes de Função Tireóidea , Tireotropina/sangue , Vitamina D/análogos & derivados , Vitamina D/sangue
7.
Endokrynol Pol ; 70(2): 143-150, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30648728

RESUMO

INTRODUCTION: The aim of the study was to determine the frequency of occurrence of antibodies participating in the development of endocrine diseases in patients with autoimmune haematopoietic disease, thus documenting the potential suitability of specific diagnostic and screening tests. MATERIAL AND METHODS: The study group consisted of 124 persons (men and women) with newly diagnosed pernicious anaemia (PA) and a control group (C) of 41 healthy people. Antibodies against: intrinsic factor (IFAb), gastric parietal cells (APCA), thyroid peroxidase (TPOAb), thyroglobulin (TgAb), adrenal cortex (AdrenalAb), and pituitary anterior lobe (PituitaryAb) were determined in the blood. RESULTS: 1. The risk of the presence of antibodies against endocrine glands in patients with PA can be classified in order: TPOAb and/or TgAb - 41.1%, TPOAb - 36.3%, TgAb - 25.0%, TPOAb and TgAb - 20.2%, AdrenalAb - 1.6%, PituitaryAb - 0.8%. 2. TPOAb and/or TgAb (mainly TPOAb) are more frequently present in patients with PA, who have IFAb and/or APCA. This correlation is most evident in patients with simultaneous occurrence of IFAb and APCA. 3. Among patients with PA, the simultaneous presence of antibodies IFAb and/or APCA with TPOAb and/or TgAb antibodies is most likely in women over 45 years of age. 4. In group C, 12% had at least one of two antithyroid antibodies (TgAb twice as often as TPOAb), and 2.4% had both. AdrenalAb and PituitaryAb are not found in healthy persons. CONCLUSIONS: In patients with PA, a screening for autoimmune thyroid disease is justified, which should first involve the determination of TPOAb (further TgAb) in the blood. The assessment of antithyroid antibodies should be recommended primarily to patients with PA, who have IFAb and/or APCA, and in particular those with concurrent IFAb and APCA.


Assuntos
Anemia Perniciosa/sangue , Anemia Perniciosa/imunologia , Anticorpos/sangue , Adulto , Fatores Etários , Anemia Perniciosa/diagnóstico , Autoanticorpos/sangue , Estudos de Casos e Controles , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Fator Intrínseco/sangue , Iodeto Peroxidase/sangue , Masculino , Pessoa de Meia-Idade , Células Parietais Gástricas/imunologia , Tireoglobulina/sangue
8.
Artigo em Inglês | MEDLINE | ID: mdl-30068285

RESUMO

BACKGROUND: The prevalence of thyroid dysfunction and autoimmunity in the Portuguese population has not yet been estimated. However, the national prevalence of the metabolic syndrome remains high. The association of thyroid pathology with cardiovascular risk has been addressed but is still unclear. Our study aimed to evaluate the prevalence of thyroid dysfunction and autoimmunity and to assess the associations of thyroid-stimulating hormone and thyroid hormones and antibodies with metabolic syndrome, its components, and other possible determinants in a national sample. MATERIAL AND METHODS: The present study included a subsample of 486 randomly selected participants from a nationwide cross-sectional study sample of 4095 adults. A structured questionnaire was administered on past medical history and socio-demographic and behavioural characteristics. Blood pressure and anthropometric measurements were collected, and the serum lipid profile, glucose, insulin, hs- CRP, TSH, FT4, FT3 and thyroid antibodies were measured. RESULTS: In our sample, the prevalence of hypothyroidism, hyperthyroidism and undiagnosed dysfunction was 4.9%, 2.5% and 72.2%, respectively. Overall, the prevalence of positivity for the thyroid peroxidase and thyroglobulin antibodies was 11.9% and 15.0%, respectively. A positive association was found between free triiodothyronine and metabolic syndrome (OR: 2.019; 95% CI: 1.196, 3.410). Additionally, thyroid peroxidase antibodies had a negative association with metabolic syndrome (OR: 0.465; 95% CI: 0.236, 0.917) and its triglyceride component (OR: 0.321; 95% CI: 0.124, 0.836). CONCLUSION: The prevalence of undiagnosed thyroid dysfunction and autoimmunity was high. Thyroid peroxidase antibodies were negatively associated with metabolic syndrome and its triglyceride component, whereas the free triiodothyronine level was positively associated with metabolic syndrome.


Assuntos
Doenças Autoimunes/complicações , Doenças Autoimunes/epidemiologia , Síndrome Metabólica/complicações , Síndrome Metabólica/epidemiologia , Doenças da Glândula Tireoide/complicações , Doenças da Glândula Tireoide/epidemiologia , Adulto , Idoso , Pressão Sanguínea , Estudos Transversais , Feminino , Humanos , Resistência à Insulina , Iodeto Peroxidase/sangue , Masculino , Pessoa de Meia-Idade , Portugal/epidemiologia , Prevalência , Fatores Socioeconômicos , Hormônios Tireóideos/sangue , Tireotropina/sangue , Tri-Iodotironina/sangue
9.
PLoS One ; 13(11): e0207446, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30427925

RESUMO

BACKGROUND: Although a wide range of genetic influences on thyroid-stimulating hormone (TSH) and free thyroxine (fT4) levels have been reported, sex differences in the genetic influences have not been well described. METHODS: We assessed TSH and fT4 levels in 2,250 subjects without thyroid peroxidase antibody, with data obtained from the Korea National Health and Nutrition Examination Surveys (KNHANES) conducted from 2013 to 2015. Using variance decomposition methods, the variation of TSH and fT4 levels was divided into genetic and environmental components common to both sexes, and to males and females separately. The genetic correlation between TSH and fT4 levels was also assessed in both sexes, and in males and females separately. RESULTS: Narrow-sense heritability for TSH and fT4 were 54% and 56%, respectively. Sex-specific heritability for TSH levels was significantly higher in females than in males (75% and 41%, respectively; p = 0.037). Heritability for fT4 levels was not significantly different between males and females (62% and 52%, respectively; p = 0.335). TSH and fT4 levels showed a negative genetic correlation in females (ρg = -0.347, p = 0.040) after regressing out the influences of environmental covariates, but this correlation was not present in males (ρg = -0.160, p = 0.391). CONCLUSIONS: The genetic influences on individual TSH levels were more prominent in females than in males. In addition, female-specific pleiotropy between TSH and fT4 might be a clue that this stronger genetic influences in females would mainly affect thyroid function per se, rather than other TSH-related factors that do not primarily trigger the negative feedback loop between TSH and fT4.


Assuntos
Iodeto Peroxidase/genética , Glândula Tireoide/metabolismo , Tireotropina/sangue , Tiroxina/sangue , Adulto , Feminino , Humanos , Iodeto Peroxidase/sangue , Masculino , Pessoa de Meia-Idade , Valores de Referência , República da Coreia , Caracteres Sexuais , Testes de Função Tireóidea
10.
J Clin Exp Hematop ; 58(4): 166-170, 2018 Dec 13.
Artigo em Inglês | MEDLINE | ID: mdl-30416171

RESUMO

Acquired amegakaryocytic thrombocytopenia (AATP) is a rare disease characterized by thrombocytopenia and the disappearance of marrow megakaryocytes. A 43-year-old man was admitted because of thrombocytopenia of 1.0×109/L. Bone marrow aspirate demonstrated normal hematopoiesis lacking megakaryocytes, and AATP was diagnosed. The serum concentration of thrombopoietin (TPO) was high (7.72 fmol/mL). Prednisolone (PSL) at 60 mg/day was started and the platelet count recovered to 1,335×109/L; however, excessive megakaryocytopoiesis and subsequent decline in platelet count were noted 14 days later. At the peak platelet count, the TPO remained at 3.79 fmol/mL and returned to a normal level of 0.40 fmol/mL during the period of normal platelet count after PSL tapering. The marked thrombocytosis in response to prednisolone may have been caused by the high TPO after the resolution of suppressed megakaryopoiesis. Marked rebound thrombocytosis beyond 1,000×109/L after successful PSL treatment for AATP has not been previously reported.


Assuntos
Células da Medula Óssea , Megacariócitos , Mielopoese/efeitos dos fármacos , Prednisolona/efeitos adversos , Trombocitopenia , Trombocitose , Adulto , Autoantígenos/sangue , Células da Medula Óssea/metabolismo , Células da Medula Óssea/patologia , Humanos , Iodeto Peroxidase/sangue , Proteínas de Ligação ao Ferro/sangue , Masculino , Megacariócitos/metabolismo , Megacariócitos/patologia , Contagem de Plaquetas , Prednisolona/administração & dosagem , Trombocitopenia/sangue , Trombocitopenia/tratamento farmacológico , Trombocitopenia/patologia , Trombocitose/sangue , Trombocitose/induzido quimicamente , Trombocitose/patologia
11.
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/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
12.
Arch Endocrinol Metab ; 62(4): 386-391, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30304102

RESUMO

OBJECTIVES: American Thyroid Association (ATA)'s new guidelines recommend use of population-based trimester-specific reference range (RR) for thyrotropin (TSH) in pregnancy. The aim of this study was to determine first trimester TSH RR for a population of pregnant women in Rio de Janeiro State. SUBJECTS AND METHODS: Two hundred and seventy pregnant women without thyroid illness, defined by National Academy of Clinical Biochemistry, and normal iodine status were included in this sectional study. This reference group (RG) had normal median urinary iodine concentration (UIC = 219 µg/L) and negative anti-thyroperoxidase antibodies (TPOAb). Twin pregnancy, trophoblastic disease and use of drugs or supplements that influence thyroid function were excluded. In a second step, we defined a more selective reference group (SRG, n = 170) by excluding patients with thyroiditis pattern on thyroid ultrasound and positive anti-thyroglobulin antibodies. This group also had normal median UIC. At a final step, a more selective reference group (MSRG, n = 130) was defined by excluding any pregnant women with UIC < 150 µg/L. RESULTS: In the RG, median, 2.5th and 97.5th percentiles of TSH were 1.3, 0.1, and 4.4 mIU/L, respectively. The mean age was 270 ± 5.0 and the mean body mass index was 25.6 ± 5.2 kg/m2. In the SRG and MSRG, 2.5th and 975th percentiles were 0.06 and 4.0 (SRG) and 0.1 and 3.6 mIU/L (MSRG), respectively. CONCLUSIONS: In the population studied,TSH upper limit in the first trimester of pregnancy was above 2.5 mIU/L. The value of 3.6 mIU/L, found when iodine deficiency and thyroiditis (defined by antibodies and ultrasound characteristics) were excluded, matches recent ATA guidelines.


Assuntos
Guias de Prática Clínica como Assunto/normas , Primeiro Trimestre da Gravidez/sangue , Glândula Tireoide/diagnóstico por imagem , Tireotropina/sangue , Adulto , Autoanticorpos/sangue , Autoantígenos/sangue , Brasil , Estudos Transversais , Feminino , Humanos , Iodeto Peroxidase/sangue , Iodo/urina , Proteínas de Ligação ao Ferro/sangue , Gravidez , Valores de Referência , Testes de Função Tireóidea/normas , Tireotropina/normas , Ultrassonografia , Adulto Jovem
13.
J Nerv Ment Dis ; 206(11): 859-864, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30256331

RESUMO

Thyroid hormone plays a pivotal role in the developing brain and may affect the development of attention deficit hyperactivity disorder (ADHD). This study aimed to examine the role of maternal thyroid function during pregnancy on offspring ADHD. A total of 2912 mother-child pairs were included from the Avon Longitudinal Study of Parents and Children. Thyroid parameters were assessed during the first trimester of pregnancy. Offspring ADHD was assessed using the Development and Well-Being Assessment at the ages of 7.5 and 15 years. The odds of presenting with ADHD were estimated using generalized estimating equations. Levels of thyroid-stimulating hormone (odds ratio [OR], 0.92; 95% confidence interval [CI], 0.48-1.75), free thyroxine (OR, 1.07; 95% CI, 0.87-1.32), and thyroid peroxidase antibodies (OR, 1.00; 95% CI, 0.80-1.25) were not associated with ADHD in children aged 7.5 and 15 years. This study showed no association between maternal thyroid function and offspring ADHD.


Assuntos
Transtorno do Deficit de Atenção com Hiperatividade/etiologia , Iodeto Peroxidase/sangue , Gravidez/sangue , Efeitos Tardios da Exposição Pré-Natal/psicologia , Tireotropina/sangue , Tiroxina/sangue , Adolescente , Adulto , Criança , Feminino , Humanos , Iodeto Peroxidase/imunologia , Estudos Longitudinais , Masculino , Efeitos Tardios da Exposição Pré-Natal/etiologia , Fatores de Risco
14.
Ann Surg ; 268(3): 506-512, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-30004926

RESUMO

OBJECTIVE: The aim of this study was to determine the prevalence of undiagnosed and untreated hyperthyroidism among patients with suppressed thyroid-stimulating hormone (TSH). BACKGROUND: Hyperthyroidism can significantly diminish patient quality of life and increase the financial burden on patients and health systems. We hypothesized that many patients with hyperthyroidism remain undiagnosed because physicians fail to recognize and evaluate suppressed TSH as the first indication of disease. METHODS: We reviewed administrative data on 174011 patients with TSH measured at a tertiary referral center between 2011 and 2017 to identify individuals with hyperthyroidism (TSH <0.05 mU/L) and their subsequent outcomes: evaluation (measurement of T4, T3, radioactive iodine (RAI) uptake scan, thyroid-stimulating immunoglobulin, thyroid peroxidase antibodies) diagnosis, referral and treatment. We used Kaplan-Meier methods and multivariable time-related parametric hazard modeling to measure our outcomes. RESULTS: We found 3336 patients with hyperthyroidism. The mean age of our cohort was 52 ±â€Š17 years, with 79% females and 59% whites. Only 1088 patients (33%) received any appropriate evaluation and hyperthyroidism remained undiagnosed in 37% of patients who had the appropriate workup. Among those diagnosed with hyperthyroidism, only 21% were referred for surgery and 34% received RAI. Predictors for hyperthyroidism diagnosis include lower TSH (0.01u/L), younger age, African-American race, private commercial insurance, being seen in an outpatient setting, absence of medical comorbidities, presentation with ophthalmopathy, or weight loss. CONCLUSIONS: Hyperthyroidism is frequently unrecognized and untreated, which can lead to adverse outcomes and increased costs. Improved systems for detection and treatment of hyperthyroidism are needed to address this gap in care.


Assuntos
Hipertireoidismo/sangue , Hipertireoidismo/epidemiologia , Tireotropina/sangue , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Efeitos Psicossociais da Doença , Feminino , Humanos , Hipertireoidismo/diagnóstico por imagem , Imunoglobulinas Glândula Tireoide-Estimulantes/sangue , Iodeto Peroxidase/sangue , Masculino , Pessoa de Meia-Idade , Prevalência , Qualidade de Vida , Fatores de Risco
15.
Int J Cancer ; 143(11): 2659-2667, 2018 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-29923180

RESUMO

While enhanced platelet activation may drive cancer progression and metastases, less is known about its role in early cancer development. Thus, we evaluated whether pre-diagnostic biomarkers of platelet activation and coagulation are related to the risks of common cancers in the prospective EPIC-Heidelberg Study using a case-cohort design. Levels of fibrinogen, soluble glycoprotein (sGP) IIb/IIIa, soluble P-selectin (sP-selectin), soluble thrombomodulin (sTM), and thrombopoietin (TPO) were measured in baseline plasma samples of a random subcohort (n = 2,480) and incident cases of breast (n = 605), prostate (n = 543), and colorectal cancer (n = 249). Multivariable Cox regression models revealed no statistically significant associations between biomarker concentrations and any of the cancer endpoints. Subgroup analyses showed a significant inverse relationship between TPO and colorectal cancer among men, with a hazard ratio (HR, highest vs. lowest quartile) of 0.60 (95% confidence interval: 0.37,0.95), whereas no significant association was observed among women. With regard to fibrinogen levels and breast cancer risk, there was a significant positive association among nulliparous women (HR: 2.53 [95% CI: 1.21, 5.30]), but not among parous women. Overall, our data suggest that enhanced platelet activation and a pro-coagulative state may not be related to increased risks of common cancers, although studies on other potential biomarkers of platelet activation and further cancer types are needed. Findings from our subgroup analyses require further investigation, as potential underlying mechanisms are not known.


Assuntos
Biomarcadores Tumorais/sangue , Neoplasias da Mama/epidemiologia , Neoplasias Colorretais/epidemiologia , Neoplasias da Próstata/epidemiologia , Adulto , Autoantígenos/sangue , Neoplasias da Mama/sangue , Neoplasias da Mama/diagnóstico , Antígenos CD36/sangue , Neoplasias Colorretais/sangue , Neoplasias Colorretais/diagnóstico , Feminino , Fibrinogênio/metabolismo , Humanos , Iodeto Peroxidase/sangue , Proteínas de Ligação ao Ferro/sangue , Masculino , Pessoa de Meia-Idade , Selectina-P/sangue , Estudos Prospectivos , Neoplasias da Próstata/sangue , Neoplasias da Próstata/diagnóstico , Fatores de Risco , Trombomodulina/sangue
16.
Thyroid ; 28(6): 773-779, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29737233

RESUMO

BACKGROUND: Iodine is an important element for the synthesis of thyroid hormone, and its deficiency or excessive intake is associated with various thyroid diseases. Little is known about the association between iodine status and thyroid function among children and adolescents living in iodine-rich areas. Therefore, this study analyzed this association using data from a nationwide survey. METHODS: From the Korea National Health and Nutrition Examination Surveys VI (2013-2015) data, 1288 subjects (711 male) aged 6-19 years who underwent a urinary iodine concentration (UIC) test and 1000 subjects (564 male) aged 10-19 years who underwent a thyroid function test were included in this study. Serum levels of thyrotropin (TSH), free thyroxine (fT4), and thyroperoxidase antibodies (TPOAb) were analyzed. Subclinical hypothyroidism (SCH) was defined as TSH >5.5 µIU/mL with a normal fT4 level. Median daily iodine intake was calculated from the UIC. Daily sodium intake was derived from the nutritional survey data of 1181 subjects. RESULTS: The median UIC was 449 µg/L (range 15-21,905 µg/L), and the prevalence rates of UIC ≥300 µg/L and ≥1000 µg/L were 64.9% and 25.0%, respectively. The prevalence rates of a sodium intake >2000 mg/day and iodine intake >2400 µg/day were 75.0% (885/1181) and 12.7% (164/1288), respectively. The prevalence rates of SCH and TPOAb >34 IU/mL were 7.2% (72/1000) and 2.3% (23/1000), respectively. The prevalence of SCH was significantly higher in the iodine deficient and iodine excess groups compared to those in the UIC 100-299.9 µg/L group (p = 0.038). Therefore, there was a U-shaped and inverted U-shaped correlation between serum levels of TSH and fT4 with UIC, respectively. These correlations were especially prominent when UIC was >1000 µg/L. There was no definite correlation between TPOAb and UIC. CONCLUSIONS: Excess iodine was prevalent in Korean children and adolescents, and it may be associated with SCH. Therefore, monitoring the iodine status and education on adequate intake are needed in iodine-rich areas.


Assuntos
Dieta , Hipotireoidismo/epidemiologia , Iodo/efeitos adversos , Inquéritos Nutricionais , Doenças da Glândula Tireoide/epidemiologia , Adolescente , Anticorpos/sangue , Criança , Feminino , Humanos , Iodeto Peroxidase/sangue , Iodo/urina , Masculino , Estado Nutricional , Prevalência , Valores de Referência , República da Coreia , Tireoglobulina/sangue , Testes de Função Tireóidea , Glândula Tireoide/fisiopatologia , Tireotropina/sangue , Tiroxina/sangue , Adulto Jovem
17.
Br J Haematol ; 182(3): 423-426, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29808904

RESUMO

Immune Thrombocytopenia (ITP) is diagnosed by exclusion of other causes for thrombocytopenia. Reliable detection of platelet autoantibodies would support the clinical diagnosis of ITP and prevent misdiagnosis. We optimized our diagnostic algorithm for suspected ITP using the direct monoclonal antibody immobilization of platelet antigens assay (MAIPA), which evaluates the presence of platelet autoantibodies on the glycoproteins (GP) IIb/IIIa, Ib/IX and V bound on the patient platelets. The direct MAIPA was shown to be a valuable technique for the detection of platelet autoantibodies and could possibly become a guide for optimizing therapy towards a more personalized treatment of ITP.


Assuntos
Autoanticorpos/análise , Plaquetas/imunologia , Púrpura Trombocitopênica Idiopática/diagnóstico , Algoritmos , Anticorpos Monoclonais , Complexo Antígeno-Anticorpo/análise , Antígenos de Plaquetas Humanas/análise , Autoantígenos/sangue , Glicoproteínas/imunologia , Humanos , Iodeto Peroxidase/sangue , Proteínas de Ligação ao Ferro/sangue
18.
Pharmacol Rep ; 70(1): 133-138, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29367100

RESUMO

BACKGROUND: Thyroid hormones (TH) are involved in modulation of the immune system and inflammation. TH dysregulation is associated with depressive disorders. The iodothyronine deiodinases (DIOs), the key enzymes for TH synthesis, can be affected and induced by pro-inflammatory cytokines. We aimed to investigate the levels of and correlation between type 2 DIO (DIO2) and interferon-gamma (IFN-É£) in patients with recurrent depressive disorders (rDD). METHODS: Data from 91 rDD patients and 105 healthy controls were analyzed. The diagnoses are based on the ICD-10 criteria (F33.0-F33.8). Expression levels of DIO2 and IFN-É£ were estimated using the method based on the polymerase chain reaction and the enzyme-linked immunosorbent assay (ELISA). RESULTS: The DIO2 expression on mRNA/protein levels in rDD patients (both female and males) was reduced as compared with the control subjects. No correlation between DIO2 and IFN-É£ expression was observed. CONCLUSION: This is the first study to reveal that one may cautiously suggest that DIO2 may be involved in the development and/or progression of rDD. The mechanisms of TH regulation on depression, however, need further investigation.


Assuntos
Transtorno Depressivo/sangue , Interferon gama/sangue , Iodeto Peroxidase/sangue , Adulto , Biomarcadores/sangue , Estudos de Casos e Controles , Transtorno Depressivo/diagnóstico , Transtorno Depressivo/genética , Transtorno Depressivo/psicologia , Feminino , Humanos , Interferon gama/genética , Iodeto Peroxidase/genética , Masculino , Pessoa de Meia-Idade , RNA Mensageiro/genética , Recidiva
19.
J Pediatr Gastroenterol Nutr ; 67(1): 64-68, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29373441

RESUMO

OBJECTIVES: Celiac disease (CD) is associated with thyroid autoimmunity and other autoimmune diseases. Data are, however, lacking regarding the relationship between thyroid autoimmunity and thyroid function, especially in regard to CD. Our aim was to investigate the impact of thyroid autoimmunity on thyroid function in 12-year-old children with CD compared to their healthy peers. METHODS: A case-referent study was conducted as part of a CD screening of 12-year-olds. Our study included 335 children with CD and 1695 randomly selected referents. Thyroid autoimmunity was assessed with antibodies against thyroid peroxidase (TPOAb). Thyroid function was assessed with thyroid-stimulating hormone and free thyroxine. RESULTS: TPOAb positivity significantly increased the risk of developing hypothyroidism in all children. The odds ratios (with 95% confidence intervals) were 5.3 (2.7-11) in healthy 12-year-olds, 10 (3.2-32) in screening-detected CD cases, 19 (2.6-135) in previously diagnosed CD cases, and 12 (4.4-32) in all CD cases together. Among children with TPOAb positivity, hypothyroidism was significantly more common (odds ratio 3.1; 95% CI 1.03-9.6) in children with CD (10/19) than in children without CD (12/46). CONCLUSIONS: The risk of thyroid dysfunction due to thyroid autoimmunity is larger for those with CD than their healthy peers. Our study indicates that a gluten-free diet does not reduce the risk of thyroid dysfunction. Further studies are required for improved understanding of the role of the gluten-free diet for the risk of autoimmune diseases in children with CD.


Assuntos
Autoimunidade , Doença Celíaca/complicações , Hipotireoidismo/etiologia , Glândula Tireoide/fisiopatologia , Estudos de Casos e Controles , Doença Celíaca/dietoterapia , Doença Celíaca/imunologia , Criança , Estudos Transversais , Dieta Livre de Glúten , Feminino , Humanos , Iodeto Peroxidase/sangue , Masculino , Fatores de Risco , Testes de Função Tireóidea/métodos
20.
Exp Clin Endocrinol Diabetes ; 126(5): 321-326, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29117614

RESUMO

BACKGROUND: Levothyroxine and selenomethionine were found to reduce thyroid antibody titers in patients with Hashimoto's thyroiditis. The same effect was produced by intensive statin therapy. The aim of the present study was to assess whether hypolipidemic agents modulate the impact of thyroid hormone supplementation and selenomethionine on thyroid autoimmunity. METHODS: The study included 62 women with Hashimoto's thyroiditis treated for at least 6 months with levothyroxine and selenomethionine. On the basis of plasma lipids, women were divided into three groups: women with isolated hypercholesterolemia (group A; n=20), women with isolated hypertriglyceridemia (group B; n=17), and women with normal plasma lipids (group C; n=25). Group A were then treated with atorvastatin (20 mg daily), while group B received micronized fenofibrate (200 mg daily). Serum titers of thyroid peroxidase and thyroglobulin antibodies, as well as serum levels of thyrotropin, free thyroxine and free triiodothyronine were measured at the beginning of the study and 6 months later. RESULTS: Fenofibrate decreased triglycerides and increased HDL cholesterol, while simvastatin decreased total and LDL cholesterol. Fenofibrate reduced titers of thyroid peroxidase and, to a lesser extent, thyroglobulin antibodies. Atorvastatin tended to increase thyroid peroxidase antibodies. No changes in thyrotropin, free thyroxine and free triiodothyronine were observed in any treatment group. Fenofibrate-induced changes in thyroid antibody titers correlated with baseline antibody titers, as well as with treatment-induced changes in HDL cholesterol and insulin sensitivity. CONCLUSIONS: The obtained results indicate that only fibrates may potentiate the effect of selenomethionine and levothyroxine on thyroid autoimmunity in women.


Assuntos
Autoanticorpos , Autoimunidade/efeitos dos fármacos , Fenofibrato/farmacologia , Doença de Hashimoto , Inibidores de Hidroximetilglutaril-CoA Redutases/farmacologia , Hipercolesterolemia , Hipertrigliceridemia , Hipolipemiantes/farmacologia , Iodeto Peroxidase , Selenometionina/farmacologia , Tireoglobulina , Tiroxina/farmacologia , Adulto , Autoanticorpos/sangue , Autoanticorpos/efeitos dos fármacos , Feminino , Fenofibrato/administração & dosagem , Doença de Hashimoto/sangue , Doença de Hashimoto/tratamento farmacológico , Doença de Hashimoto/imunologia , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/administração & dosagem , Hipercolesterolemia/sangue , Hipercolesterolemia/tratamento farmacológico , Hipertrigliceridemia/sangue , Hipertrigliceridemia/tratamento farmacológico , Hipolipemiantes/administração & dosagem , Iodeto Peroxidase/sangue , Iodeto Peroxidase/efeitos dos fármacos , Iodeto Peroxidase/imunologia , Pessoa de Meia-Idade , Selenometionina/administração & dosagem , Tireoglobulina/sangue , Tireoglobulina/efeitos dos fármacos , Tireoglobulina/imunologia , Tiroxina/administração & dosagem , Adulto Jovem
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