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1.
J Med Case Rep ; 15(1): 108, 2021 Mar 03.
Artigo em Inglês | MEDLINE | ID: mdl-33653380

RESUMO

BACKGROUND: Hypothyroidism is diagnosed on the basis of laboratory tests because of the lack of specificity of the typical clinical manifestations. There is conflicting evidence on screening for hypothyroidism. CASE PRESENTATION: We report a case of an apparently healthy 19-year-old Kuwaiti woman referred to our clinic with an incidental finding of extremely high thyroid-stimulating hormone (TSH), tested at the patient's insistence as she had a strong family history of hypothyroidism. Despite no stated complaints, the patient presented typical symptoms and signs of hypothyroidism on evaluation. Thyroid function testing was repeated by using different assays, with similar results; ultrasound imaging of the thyroid showed a typical picture of thyroiditis. Treatment with levothyroxine alleviated symptoms and the patient later became biochemically euthyroid on treatment. CONCLUSION: There is controversy regarding screening asymptomatic individuals for hypothyroidism; therefore, it is important to maintain a high index of suspicion when presented with mild signs and symptoms of hypothyroidism especially with certain ethnic groups, as they may be free of the classical symptoms of disease.


Assuntos
Hipotireoidismo/diagnóstico , Tireoidite Autoimune/diagnóstico , Alopecia/fisiopatologia , Apetite , Autoanticorpos/imunologia , Constipação Intestinal/fisiopatologia , Depressão/fisiopatologia , Fadiga/fisiopatologia , Feminino , Humanos , Hipotireoidismo/sangue , Hipotireoidismo/tratamento farmacológico , Hipotireoidismo/fisiopatologia , Achados Incidentais , Iodeto Peroxidase/imunologia , Menorragia/fisiopatologia , Índice de Gravidade de Doença , Glândula Tireoide/diagnóstico por imagem , Tireoidite Autoimune/sangue , Tireoidite Autoimune/imunologia , Tireoidite Autoimune/fisiopatologia , Tireotropina/sangue , Tiroxina/sangue , Tiroxina/uso terapêutico , Ultrassonografia , Ganho de Peso , Adulto Jovem
2.
Eur J Endocrinol ; 184(2): 277-287, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33539318

RESUMO

Background: Tripterygium glycosides (TG) has been used to treat a spectrum of inflammatory and autoimmune diseases. Our preliminary studies have shown that TG is effective in the treatment of active Graves' ophthalmopathy (GO). Objective: We aimed to compare the efficacy and tolerability of TG with intravenous methylprednisolone (iv.MP) in patients with active moderate-to-severe GO. Methods: This study was an observer-masked, single-centre, block-randomised trial. Patients with active moderate-to-severe GO were randomly assigned to receive iv.MP (500 mg once per week for 6 weeks followed by 250 mg per week for 6 weeks) or with TG (20 mg tablet three times per day for 24 weeks). The primary endpoints were the overall response rate and the patients' quality of life at 12 and 24 weeks. Results: In this study, 161 patients were enrolled and randomised from 2015 to 2019. A total of 79 were randomly assigned to receive iv.MP and 82 to receive TG. A greater overall response rate was found in the TG group compared with the iv.MP group at week 24 (90.2% vs 68.4%, P = 0.000). Similarly, the patients' quality of life of the TG group showed a significantly higher response than the iv.MP group at week 24 (89.02% vs 72.15%, P = 0.001). The TG therapy showed a better CAS response than the iv.MP (91.5% vs 70.9% improved, P < 0.05), and up to 91.2% of patients were inactive. Also, the TG group showed a significantly higher improved rate of diplopia, proptosis, visual acuity, soft tissue involved and the decrease of eye muscle motility than the iv.MP group at week 24. Significantly more patients in the iv.MP group than the TG group experienced adverse events. Conclusion: Compared with iv.MP treatment, TG therapy is more effective and safer for patients with active moderate to severe GO.


Assuntos
Glicosídeos/uso terapêutico , Oftalmopatia de Graves/tratamento farmacológico , Extratos Vegetais/uso terapêutico , Tripterygium , Administração Intravenosa , Adulto , Antitireóideos/uso terapêutico , Diplopia/fisiopatologia , Exoftalmia/fisiopatologia , Dor Ocular/fisiopatologia , Feminino , Glucocorticoides/uso terapêutico , Doença de Graves/tratamento farmacológico , Oftalmopatia de Graves/fisiopatologia , Humanos , Hipotireoidismo/tratamento farmacológico , Masculino , Metilprednisolona/uso terapêutico , Pessoa de Meia-Idade , Músculos Oculomotores/fisiopatologia , Índice de Gravidade de Doença , Método Simples-Cego , Tiroxina/uso terapêutico , Resultado do Tratamento , Acuidade Visual/fisiologia
3.
Medicine (Baltimore) ; 100(4): e23866, 2021 Jan 29.
Artigo em Inglês | MEDLINE | ID: mdl-33530180

RESUMO

INTRODUCTION: Metastasis of a papillary thyroid microcarcinoma (PTMC) in the lateral neck is characterized primarily by solid lymphadenopathy, although some cases may rarely present with a cervical cystic mass. We report a case of lateral cervical lymph node metastases of PTMC that appeared as a cystic lymphangioma of the lateral neck. PATIENT CONCERNS: A 55-year-old man with a painless egg-sized mass in the right side of the neck that had been present for 1 month underwent physical examination, ultrasonography, computed tomography (CT), fine needle aspiration biopsy (FNAB), and intraoperative fast-frozen pathological examination, which indicated that the cystic masses in the neck were benign. However, the final pathology report identified the lateral neck masses as lymph node metastases of thyroid carcinoma. DIAGNOSIS: The patient was diagnosed with PTMC of the right lobe of the thyroid gland with lateral neck metastases. INTERVENTIONS: The patient underwent right cervical neck dissection together with a right thyroidectomy, followed by levothyroxine therapy and routine follow-up. OUTCOMES: No postoperative complications were reported, and the thyroid-stimulating hormone inhibition target was <0.1 mmol/L; there was no detectable tumor recurrence on routine clinical follow-up for up to 16 months. CONCLUSIONS: This case report emphasizes the need to consider cervical lymph node metastases of thyroid carcinoma in the differential diagnosis for patients with large, multiple, simple cystic neck masses.


Assuntos
Carcinoma Papilar/patologia , Neoplasias de Cabeça e Pescoço/secundário , Linfangioma/patologia , Metástase Linfática , Neoplasias da Glândula Tireoide/patologia , Carcinoma Papilar/tratamento farmacológico , Carcinoma Papilar/cirurgia , Neoplasias de Cabeça e Pescoço/cirurgia , Terapia de Reposição Hormonal , Humanos , Linfangioma/cirurgia , Masculino , Pessoa de Meia-Idade , Esvaziamento Cervical , Neoplasias da Glândula Tireoide/tratamento farmacológico , Neoplasias da Glândula Tireoide/cirurgia , Tireoidectomia , Tiroxina/uso terapêutico
4.
JAMA Netw Open ; 4(2): e2036645, 2021 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-33566107

RESUMO

Importance: Previous trials on the effect of levothyroxine on depressive symptom scores in patients with subclinical hypothyroidism were limited by small sample sizes (N = 57 to 94) and potential biases. Objective: To assess the effect of levothyroxine on the development of depressive symptoms in older adults with subclinical hypothyroidism in the largest trial on this subject and to update a previous meta-analysis including the results from this study. Design, Setting, and Participants: This predefined ancillary study analyzed data from participants in the Thyroid Hormone Replacement for Untreated Older Adults with Subclinical Hypothyroidism (TRUST) trial, a double-blind, randomized, placebo-controlled, parallel-group clinical trial conducted from April 2013 to October 31, 2016. The TRUST trial included adults aged 65 years or older diagnosed with subclinical hypothyroidism, defined as the presence of persistently elevated thyroid-stimulating hormone (TSH) levels (4.6-19.9 mIU/L) with free thyroxine (T4) within the reference range. Participants were identified from clinical and general practitioner laboratory databases and recruited from the community in Switzerland, the Netherlands, Ireland, and the UK. This ancillary study included a subgroup of 472 participants from the Netherlands and Switzerland; after exclusions, a total of 427 participants (211 randomized to levothyroxine and 216 to placebo) were analyzed. This analysis was conducted from December 1, 2019, to September 1, 2020. Interventions: Randomization to either levothyroxine or placebo. Main Outcomes and Measures: Depressive symptom scores after 12 months measured with the Geriatric Depression Scale (GDS-15), with higher scores indicating more depressive symptoms (minimal clinically important difference = 2). Results: A total of 427 participants with subclinical hypothyroidism (mean [SD] age, 74.52 [6.29] years; 239 women [56%]) were included in this analysis. The mean (SD) TSH level was 6.57 (2.22) mIU/L at baseline and decreased after 12 months to 3.83 (2.29) mIU/L in the levothyroxine group; in the placebo group, it decreased from 6.55 (2.04) mIU/L to 5.91 (2.66) mIU/L. At baseline, the mean (SD) GDS-15 score was 1.26 (1.85) in the levothyroxine group and 0.96 (1.58) in the placebo group. The mean (SD) GDS-15 score at 12 months was 1.39 (2.13) in the levothyroxine and 1.07 (1.67) in the placebo group with an adjusted between-group difference of 0.15 for levothyroxine vs placebo (95% CI, -0.15 to 0.46; P = .33). In a subgroup analysis including participants with a GDS-15 of at least 2, the adjusted between-group difference was 0.61 (95% CI, -0.32 to 1.53; P = .20). Results did not differ according to age, sex, or TSH levels. A previous meta-analysis (N = 278) on the association of levothyroxine with depressive symptoms was updated to include these findings, resulting in an overall standardized mean difference of 0.09 (95% CI, -0.05 to 0.22). Conclusions and Relevance: This ancillary study of a randomized clinical trial found that depressive symptoms did not differ after levothyroxine therapy compared with placebo after 12 months; thus, these results do not provide evidence in favor of levothyroxine therapy in older persons with subclinical hypothyroidism to reduce the risk of developing depressive symptoms. Trial Registration: ClinicalTrials.gov Identifier: NCT01853579.


Assuntos
Doenças Assintomáticas , Depressão/psicologia , Hipotireoidismo/tratamento farmacológico , Tiroxina/uso terapêutico , Idoso , Idoso de 80 Anos ou mais , Método Duplo-Cego , Feminino , Humanos , Hipotireoidismo/sangue , Hipotireoidismo/psicologia , Masculino , Tireotropina/sangue , Tiroxina/sangue , Resultado do Tratamento
5.
Medicine (Baltimore) ; 100(3): e23947, 2021 Jan 22.
Artigo em Inglês | MEDLINE | ID: mdl-33545971

RESUMO

BACKGROUND: Subclinical hypothyroidism (SCH) can increase the risk of heart failure (HF) clinically. However, thyroxine therapy for patients with HF and SCH has the risk of developing tachyarrhythmias. At present, there is no sufficient evidence-based medical evidence for levothyroxine in the therapy of this situation, and the treatment issue is still controversial. Therefore, our meta-analysis aims to assess the effectiveness and safety of thyroxine therapy for patients with HF and SCH. METHODS: We searched the related randomized controlled trials that have been published in the following 7 electronic databases: PubMed, Cochrane Library, EMBASE, Chongqing VIP, China National Knowledge Infrastructure, Chinese biomedical literature database, and Wan Fang database. The treatment group was treated with routine HF therapy plus thyroxine, while the control group was treated with HF routine therapy. Main outcome measures effective rate and New York Heart Association classification; Secondary outcome measures included: left ventricular ejection fraction, quality of life score, brain natriuretic peptide / N-terminal pro brain natriuretic peptide, 6-minute walk test, and adverse events. After screening studies and extracting data, we will use Cochrane collaborative tools to evaluate the risk of bias to assess the methodological quality of the included randomized controlled trials. We will use STATA 14.0 software for data synthesis and statistical analysis. Both subgroup analysis and sensitivity analysis will be used to detect potential sources of heterogeneity. In addition, we will use sensitivity analysis to test the stability of the outcomes. If possible, we will perform a funnel chart and Eggers test evaluate publication bias. The quality of the evidence will be evaluated through the grades of recommendations assessment, development, and evaluation system. RESULTS: Our findings will be published in peer-reviewed journals. CONCLUSION: This research will provide evidence about the efficacy and safety of thyroxine in the treatment of patients with HF and SCH. Objective to provide evidence-based medicine basis for thyroxine treatment of patients with SCH and HF. REGISTRATION NUMBER: INPLASY2020100062.


Assuntos
Protocolos Clínicos , Insuficiência Cardíaca/tratamento farmacológico , Hipotireoidismo/tratamento farmacológico , Tiroxina/uso terapêutico , Insuficiência Cardíaca/fisiopatologia , Humanos , Hipotireoidismo/fisiopatologia , Metanálise como Assunto , Revisões Sistemáticas como Assunto
6.
Orv Hetil ; 162(7): 262-268, 2021 02 14.
Artigo em Húngaro | MEDLINE | ID: mdl-33582652

RESUMO

Összefoglaló. Bevezetés: A tudományos szakirodalomban számos kérdés fogalmazódik meg a pajzsmirigybetegségeket befolyásoló pszichológiai tényezokrol. Kevés tanulmány készült a pajzsmirigybetegségek és a megküzdési stratégiák kapcsolatáról. Célkituzés: Jelen tanulmányunk célja felmérni a megküzdési stratégiák, a depresszió és a szorongás szintjének változásait a pajzsmirigybetegek (hyperthyreosis és hypothyreosis) esetében a gyógyszeres kezelés (Thyrozol és Euthyrox) hatására. Módszer: A betegeket a szakorvos diagnózisa, illetve a TSH- és fT4-szint alapján hyperthyreosis- (n = 10) és hypothyreosis- (n = 21) csoportba soroltuk. Mindkét csoport tagjait az endokrinológiai kezelés elott és után pszichológiai felmérésnek vetettük alá. A felmérés során a megküzdési stratégiák felméréséhez a következo skálákat alkalmaztuk: Kognitív Érzelem Szabályozás Kérdoív (Cognitive Emotion Regulation Questionnaire - CERQ), Hobfoll-féle Megküzdési Stratégia Kérdoív (Strategic Approach to Coping Scale - SACS). A Beck Depresszió Kérdoívet (Beck Depression Inventory - BDI-II) alkalmaztuk a depresszió felmérésére, az Állapot- és Vonásszorongás Kérdoívet (State-Trait Anxiety Inventory, Form Y - STAI-Y) a szorongás szintjének felmérésére. Eredmények: A két csoport pszichológiai és laboreredményeit összehasonlítottuk a gyógyszeres kezelés elott és után. Mind a hyperthyreosisban, mind a hypothyreosisban szenvedo betegeknél magas volt a depresszió és a szorongás szintje. A hyperthyreosisban szenvedo betegeknél a depresszió magasabb. A gyógyszeres kezelés után a depresszió és a szorongás szintje csökkent mindkét csoportban, a megküzdési stratégiák többnyire változatlanok maradtak. Következtetések: Pajzsmirigybetegeknél a kognitív viselkedésbeli pszichoterápiás beavatkozás a gyógyszeres kezelés kiegészíto alternatívája lehet a szorongás és a depresszió szintjének csökkentése és a diszfunkcionális megküzdési stratégiák módosítása szempontjából. Orv Hetil. 2021; 162(7): 262-268. INTRODUCTION: There is a high interest in the scientific literature in psychological factors that influence the course of thyroid disease. There are a few studies on the link between thyroid disease and coping strategies. OBJECTIVE: In the present study, we aimed to evaluate the manifestation of depression, anxiety and coping strategies in people with thyroid disease and the impact of endocrinological medication on these psychologic items. METHOD: The patients were grouped into two groups, hyperthyroid (n = 10) and hypothyroid (n = 21), according to the diagnosis established by the attending physician, TSH and fT4 level. Patients with hyperthyroidism and hypothyroidism were evaluated before and after endocrinological treatment with the Cognitive Emotion Regulation Questionnaire (CERQ), Strategic Approach to Coping Scale (SACS) for the evaluation of coping strategies, Beck Depression Inventory (BDI-II) for assessing the level of depression, State-Trait Anxiety Inventory, Form Y (STAI-Y) for assessing anxiety. These two groups have been compared. RESULTS: The psychological and laboratory results of the two groups were compared before and after drug treatment. Both patients with hyperthyroidism and with hypothyroidism had high levels of depression and anxiety. In hyperthyroidism, depression is more severe. Following treatment with Thyrozol and Euthyrox, the level of depression and anxiety decreases in patients with hyper- and hypothyroidism; the coping strategies remained almost unchanged. CONCLUSION: Cognitive-behavioral psychotherapeutic intervention could be supplementary to drug treatment in terms of reducing anxiety, depression, and modifying dysfunctional coping strategies for patients with thyroid diseases. Orv Hetil. 2021; 162(7): 262-268.


Assuntos
Adaptação Psicológica , Antitireóideos/uso terapêutico , Ansiedade/etiologia , Depressão/etiologia , Hipertireoidismo/tratamento farmacológico , Hipotireoidismo/tratamento farmacológico , Metimazol/uso terapêutico , Doenças da Glândula Tireoide/psicologia , Tiroxina/uso terapêutico , Ansiedade/psicologia , Humanos , Hipertireoidismo/diagnóstico , Hipertireoidismo/psicologia , Hipotireoidismo/diagnóstico , Hipotireoidismo/psicologia
7.
BMJ Case Rep ; 14(2)2021 Feb 09.
Artigo em Inglês | MEDLINE | ID: mdl-33563696

RESUMO

Hypothyroidism can involve any organ system in the body with the involvement of haematopoietic system seen in about 30% of the cases. Anaemia is the most common haematological involvement with the affection of other cell lines being exceedingly rare and limited to occasional case reports. Here we present a case of a 14-year-old boy who presented with fever and pancytopenia and was later diagnosed to be a case of autoimmune hypothyroidism.


Assuntos
Doença de Hashimoto/complicações , Doença de Hashimoto/diagnóstico , Pancitopenia/etiologia , Tireoidite Autoimune/complicações , Tireoidite Autoimune/diagnóstico , Adolescente , Diagnóstico Diferencial , Doença de Hashimoto/tratamento farmacológico , Humanos , Masculino , Tireoidite Autoimune/tratamento farmacológico , Tiroxina/uso terapêutico
8.
Zhonghua Fu Chan Ke Za Zhi ; 56(1): 58-63, 2021 Jan 25.
Artigo em Chinês | MEDLINE | ID: mdl-33486929

RESUMO

Objective: To conduct a systematic review of the association of levothyroxine treatment with pregnancy outcomes in euthyroid women who are thyroid autoantibody positive. Methods: Medline, Excerpta Medica (EMBASE), Cochrane Library, China National Knowledge Infrastructure (CNKI), China Biology Medicine (CBM), Wanfang data and VIP database were searched from inception until Jan. 28, 2020. All published randomized controlled trials assessing the association of levothyroxine treatment with pregnancy outcomes in euthyroid women with thyroid autoantibody-positive were included. STATA 11.0 and RevMan 5.3 softwares were used to perform this Meta-analysis. Results: A total of 6 studies met the inclusion criteria, with 2 188 women randomized. Meta-analysis showed that there was no significantly association between miscarriage (OR=0.85, 95%CI: 0.65-1.11, P=0.234) and preterm birth (OR=0.79, 95%CI: 0.54-1.16, P=0.224) with levothyroxine treatment. Conclusions: Levothyroxine therapy could not reduce the risk of miscarriage and preterm birth in euthyroid women with thyroid autoantibody-positive. Therefore, levothyroxine should be used with caution for these pregnant women.


Assuntos
Autoanticorpos/sangue , Hipotireoidismo/tratamento farmacológico , Nascimento Prematuro/prevenção & controle , Tireotropina/sangue , Tiroxina/uso terapêutico , Autoanticorpos/fisiologia , China , Feminino , Humanos , Recém-Nascido , Gravidez , Complicações na Gravidez , Resultado da Gravidez , Nascimento Prematuro/sangue , Nascimento Prematuro/epidemiologia , Tiroxina/administração & dosagem , Tiroxina/efeitos adversos , Tiroxina/sangue , Resultado do Tratamento
9.
BMJ Case Rep ; 14(1)2021 Jan 28.
Artigo em Inglês | MEDLINE | ID: mdl-33509858

RESUMO

Bardet-Biedl syndrome (BBS) is a rare autosomal recessive ciliopathy characterised by rod-cone dystrophy, obesity, postaxial polydactyly, cognitive impairment, hypogonadism, renal abnormalities, and rarely, laryngeal webs or bifid epiglottis. Most patients present with obesity. Multiple genes are involved in causation of BBS and there is also evidence of triallelic inheritance. We herein report an Asian boy who had weak cry and stridor since birth, and on evaluation was found to have both laryngeal web and bifid epiglottis. Mutation analysis revealed a homozygous variant in BBS10 gene.


Assuntos
Síndrome de Bardet-Biedl/diagnóstico , Epiglote/anormalidades , Hipotireoidismo/diagnóstico , Laringe/anormalidades , Síndrome de Bardet-Biedl/complicações , Síndrome de Bardet-Biedl/genética , Síndrome de Bardet-Biedl/fisiopatologia , Broncoscopia , Chaperoninas/genética , Dedos/anormalidades , Dedos/fisiopatologia , Mutação da Fase de Leitura , Humanos , Hipotireoidismo/complicações , Hipotireoidismo/tratamento farmacológico , Lactente , Laringe/cirurgia , Masculino , Obesidade Pediátrica/fisiopatologia , Polidactilia/fisiopatologia , Tiroxina/uso terapêutico , Dedos do Pé/anormalidades , Dedos do Pé/fisiopatologia
10.
BMJ Case Rep ; 14(1)2021 Jan 28.
Artigo em Inglês | MEDLINE | ID: mdl-33509867

RESUMO

A man in his early 60s with a medical history of granulomatosis with polyangiitis (GPA) in remission for two decades without maintenance therapy presented with non-specific complaints of profound fatigue and 40-pound weight loss. He was seronegative for antinuclear antibodies and cytoplasmic antineutrophilic antibodies, but erythrocyte sedimentation rate and C reactive protein levels were elevated. Endocrinological testing revealed adrenal insufficiency, hypogonadism, hypothyroidism and diabetes insipidus. An MRI of the head revealed extensive sinonasal inflammation eroding through the floor of the sella turcica and into the pituitary gland and stalk. Biopsy of the sinonasal tissues was inconclusive. On review of his case, a multidisciplinary team diagnosed him with panhypopituitarism secondary to a recurrence of GPA. He responded well to glucocorticoids and methotrexate with marked reduction of pituitary enhancement on imaging and resolution of diabetes insipidus. He will require lifelong testosterone, levothyroxine and glucocorticoids for hormone replacement therapy.


Assuntos
Insuficiência Adrenal/diagnóstico , Diabetes Insípido/diagnóstico , Granulomatose com Poliangiite/diagnóstico por imagem , Hipogonadismo/diagnóstico , Hipopituitarismo/diagnóstico , Hipotireoidismo/diagnóstico , Rinite/diagnóstico por imagem , Sinusite/diagnóstico por imagem , Insuficiência Adrenal/tratamento farmacológico , Insuficiência Adrenal/etiologia , Androgênios/uso terapêutico , Diabetes Insípido/etiologia , Fadiga/etiologia , Glucocorticoides/uso terapêutico , Granulomatose com Poliangiite/complicações , Granulomatose com Poliangiite/tratamento farmacológico , Granulomatose com Poliangiite/patologia , Terapia de Reposição Hormonal , Humanos , Hipogonadismo/tratamento farmacológico , Hipogonadismo/etiologia , Hipopituitarismo/tratamento farmacológico , Hipopituitarismo/etiologia , Hipotireoidismo/tratamento farmacológico , Hipotireoidismo/etiologia , Imunossupressores/uso terapêutico , Imagem por Ressonância Magnética , Masculino , Metotrexato/uso terapêutico , Pessoa de Meia-Idade , Doenças da Hipófise , Hipófise/diagnóstico por imagem , Recidiva , Rinite/patologia , Sela Túrcica/diagnóstico por imagem , Sinusite/patologia , Testosterona/uso terapêutico , Tiroxina/uso terapêutico , Perda de Peso
11.
BMJ Case Rep ; 14(1)2021 Jan 28.
Artigo em Inglês | MEDLINE | ID: mdl-33509872

RESUMO

We report an interesting case of a 38-year-old woman presenting with reverse Takotsubo syndrome (TTS) secondary to an Addisonian crisis, her second such episode. A few years prior, she had presented with typical TTS in the setting of Addisonian crisis; diagnostic work-up revealing Auto-Immune Polyglandular Syndrome Type II (APS II). We believe this to be the first case report of typical and variant phenotypes of TTS in a patient with APS II. The pathogenic link between these two conditions is explored. In patients presenting with Addisonian crises and refractory shock, the possibility of concurrent TTS should be considered. TTS muddies the diagnostic waters and poses therapeutic challenges as outlined.


Assuntos
Doença de Addison/tratamento farmacológico , Hidrocortisona/uso terapêutico , Adesão à Medicação , Poliendocrinopatias Autoimunes/tratamento farmacológico , Cardiomiopatia de Takotsubo/fisiopatologia , Doença de Addison/complicações , Adulto , Progressão da Doença , Ecocardiografia , Feminino , Humanos , Hipotireoidismo/complicações , Hipotireoidismo/tratamento farmacológico , Poliendocrinopatias Autoimunes/complicações , Recidiva , Infecções Respiratórias/complicações , Cardiomiopatia de Takotsubo/diagnóstico , Cardiomiopatia de Takotsubo/etiologia , Tiroxina/uso terapêutico
12.
Adv Ther ; 38(2): 1185-1201, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33355908

RESUMO

INTRODUCTION: Chronic kidney disease (CKD) may be associated with overt or subclinical hypothyroidism [SCH; defined as elevated serum thyroid-stimulating hormone (TSH) despite normal free thyroxine levels). Although some studies have demonstrated that thyroid replacement therapy may improve renal function in overt hypothyroidism, there is no consensus on its benefits in SCH. Clinical and limited economic outcomes were evaluated in levothyroxine-treated US veterans with CKD + SCH. METHODS: Veterans Health Administration claims data from April 2013 to March 2018 for levothyroxine-treated versus nontreated CKD + SCH patients were compared. Eligible patients with CKD + SCH (≥ 2 elevated TSH values recorded; ≥ 2 normal thyroxine values recorded) had ≥ 1 TSH values recorded during 24-month follow-up, and ≥ 1 estimated glomerular filtration rate (eGFR) measurement during baseline and follow-up. Continuous levothyroxine use (treatment cohort) was required during follow-up. The primary endpoint was eGFR at 6, 12, 18, and 24 months; secondary endpoints included eGFR change from baseline, CKD progression, and length of hospital stay (LOS). Propensity score matching (PSM) was performed. RESULTS: Of 453 eligible patients, 157 remained in each cohort after PSM. Most were male (96%) and white (88%); mean age was 75 years. No significant differences were observed between cohorts at any time point for eGFR, eGFR change from baseline, or CKD progression. Treated patients had numerically higher mean eGFR at 6 and 12 months, lower proportions of progression to higher CKD stages at 12, 18, and 24 months, and shorter mean all-cause LOS versus nontreated patients (1.92 vs. 3.30 days; P = 0.3483) within the 24-month follow-up period. A significantly shorter mean CKD-related LOS was observed versus nontreated patients (0.11 vs. 1.38 days; P < 0.0001) during the 24-month follow-up. CONCLUSION: Levothyroxine use was associated with economic and clinical benefit in some patients with CKD + SCH, despite an absence of overall benefit on eGFR; confirmatory research is needed.


Assuntos
Hipotireoidismo , Insuficiência Renal Crônica , Veteranos , Idoso , Estudos de Coortes , Humanos , Hipotireoidismo/complicações , Hipotireoidismo/tratamento farmacológico , Rim , Masculino , Insuficiência Renal Crônica/complicações , Insuficiência Renal Crônica/tratamento farmacológico , Estudos Retrospectivos , Tireotropina , Tiroxina/uso terapêutico
13.
Eur J Endocrinol ; 183(5): K1-K5, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32805706

RESUMO

Background: Among patients with congenital hypothyroidism, 35% have dyshormonogenesis (DH) with thyroid gland in situ with or without goiter. The majority of DH cases are due to mutations in genes involved in thyroid hormone production as TG, TPO, SLC5A5/NIS, SLC26A4/PDS, IYD/DEHAL1, DUOX2, and DUOXA2, and are usually inherited on an autosomal recessive basis. Most previously reported cases of fetal hypothyroidism and goiter were related to TG or TPO mutations and recently DUOXA2. Patient: In a male patient with antenatal goiter treated with intraamniotic levothyroxine injections, whose long-term follow-up is described in detail, two novel NIS mutations were detected. Mutations of NIS were located in exon 1 (c.52G>A, p.G18R) and exon 13 (c.1546C>T, p.R516X), each mutation was inherited from parents, who are healthy carriers. The p.G18R mutation affecting the first transmembrane domain of the protein can be responsible for deficient iodide uptake. However, the second is a nonsense mutation leading probably to mRNA degradation. In addition, the patient has undergone a thyroidectomy and we have studied the thyroid tissue. The thyroid histology showed heterogeneity with large follicles, epithelial hyperplasia and many areas of fibrosis. Immunohistochemistry with NIS specific antibody showed NIS staining at the basolateral plasma membrane of the thyrocytes. Conclusions: We report the first case of fetal goitrous hypothyroidism due to two novel NIS mutations with access to thyroid tissue of the patient, specific histology studies and long-term follow-up. This case expands our knowledge and provides further insights on molecular causes of fetal goiter in humans.


Assuntos
Hipotireoidismo Congênito/genética , Bócio/genética , Mutação , Simportadores/genética , Adolescente , Criança , Pré-Escolar , Hipotireoidismo Congênito/tratamento farmacológico , Bócio/tratamento farmacológico , Humanos , Lactente , Recém-Nascido , Masculino , Diagnóstico Pré-Natal , Tiroxina/uso terapêutico , Resultado do Tratamento , Adulto Jovem
14.
Endocrine ; 70(1): 1-5, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32754886

RESUMO

The recent coronavirus infectious disease (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is placing health systems in serious challenges worldwide. Shocking statistics each day has prompted the World Health Organization to officially declare the COVID-19 outbreak as a pandemic in March 2020. Preliminary studies have shown increased mortality in patients with solid cancers and infection by SARS-CoV-2. Until now, the evidence on the behavior of COVID-19 in patients with a history of thyroid cancer remains scarce, and most of the recommendations given are based on common sense. Therefore, in this viewpoint, we present a brief review of several challenges we are frequently facing during this pandemic and a series of recommendations based on what we have implemented in our clinical practice at a university hospital currently mostly dedicated to COVID-19.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Neoplasias da Glândula Tireoide/epidemiologia , Biópsia por Agulha Fina/efeitos adversos , Comorbidade , Infecções por Coronavirus/imunologia , Humanos , Sistema Imunitário , Radioisótopos do Iodo/efeitos adversos , Radioisótopos do Iodo/uso terapêutico , Pandemias , Pneumonia Viral/imunologia , Inibidores de Proteínas Quinases/efeitos adversos , Radioterapia/efeitos adversos , Fatores de Risco , Neoplasias da Glândula Tireoide/imunologia , Neoplasias da Glândula Tireoide/terapia , Tiroxina/uso terapêutico , Organização Mundial da Saúde
15.
Brasília; CONITEC; ago. 2020.
Não convencional em Português | BRISA/RedTESA | ID: biblio-1145413

RESUMO

CONTEXTO: O hipotireoidismo congênito (HC) é a doença congênita mais comum do sistema endócrino e a principal causa de deficiência mental passível de prevenção no mundo. No Brasil, a incidência do HC é de aproximadamente um caso para cada 2.595 a 4.795 nascidos vivos. O prognóstico depende, fundamentalmente, do tempo decorrido para instituição do tratamento, da severidade do hipotireoidismo e da manutenção dos níveis hormonais dentro da normalidade. O tratamento é realizado com o medicamento levotiroxina e deve ser instituído o mais breve possível para evitar prejuízos no desenvolvimento mental e no crescimento da criança. JUSTIFICATIVA DA DEMANDA: As apresentações de levotiroxina sódica disponíveis na Rename e indicados no PCDT para o tratamento do HC são os comprimidos de 25, 50 e 100 mcg. A necessidade de ajustes posológicos de acordo com o crescimento da criança e dos níveis de TSH e T4 livre ou total tornam necessários ajustes posológicos frequentes. A utilização de apresentações intermediárias como de 12,5 mcg e 37,5 mcg reduzem a necessidade de utilização de comprimidos partidos para complementação das doses, minimizando erros de administração, ajustes de doses mais fidedignos a necessidade e o desperdício dos comprimidos. Em reunião de escopo para revisão do PCDT da HC realizada em 11/09/2019, na qual estavam presentes metodologistas, especialistas em endocrinologia e membros do DGITIS, foi sugerida a avaliação da incorporação das apresentações de 12,5 e 37,5 mcg de levotiroxina sódica para os pacientes com HC. DELIBERAÇÃO FINAL: Diante do exposto, a Conitec, em sua 88ª reunião ordinária, realizada no dia 8 de julho de 2020, deliberou por unanimidade recomendar a incorporação das apresentações de 12,5 e 37,5 mcg de levotiroxina sódica para o tratamento do Hipotireoidismo congênito no Sistema Único de Saúde. Assim, foi assinado o registro de deliberação nº 536/2020. DECISÃO: Incorporar as apresentações de 12,5 e 37,5 mcg de levotiroxina sódica para o tratamento de pacientes com hipotireoidismo congênito, conforme protocolo do Ministério da Saúde, no âmbito do Sistema Único de Saúde ­ SUS, conforme Portaria n° 38, publicada no Diário Oficial da União n° 181, seção 1, página 235, em 21 de setembro de 2020.


Assuntos
Tiroxina/uso terapêutico , Hipotireoidismo Congênito/tratamento farmacológico , Avaliação da Tecnologia Biomédica , Sistema Único de Saúde , Brasil , Análise Custo-Benefício
16.
Rev Cardiovasc Med ; 21(2): 297-301, 2020 Jun 30.
Artigo em Inglês | MEDLINE | ID: mdl-32706217

RESUMO

Myxedema coma occurs mostly in patients with long-standing untreated or undertreated hypothyroidism. Bradycardia is a well-known cardiac manifestation for myxedema coma; however, not all bradycardia with hypothyroidism are sinus bradycardia. Sick sinus syndrome is a group of arrhythmias caused by the malfunction of the natural pacemaker of the heart. Tachy-Brady syndrome is considered to be a type of sick sinus syndrome, where the heart alternates between tachycardia and bradycardia, and it is usually treated with pacemaker implantation along with rate slowing medical therapy. Here we report a case of an 83-year-old female who presented with myxedema coma and atrial fibrillation with tachycardia and intermittent slow ventricular response. We attempt to review the relationship between these two diseases and conclude that appropriate diagnosis of myxedema coma, may be beneficial in reducing the need for pacemaker implantation.


Assuntos
Bradicardia/etiologia , Coma/etiologia , Frequência Cardíaca , Hipotireoidismo/complicações , Mixedema/etiologia , Idoso de 80 Anos ou mais , Bradicardia/diagnóstico , Bradicardia/fisiopatologia , Bradicardia/terapia , Estimulação Cardíaca Artificial , Coma/diagnóstico , Coma/tratamento farmacológico , Coma/fisiopatologia , Feminino , Frequência Cardíaca/efeitos dos fármacos , Terapia de Reposição Hormonal , Humanos , Hipotireoidismo/diagnóstico , Hipotireoidismo/tratamento farmacológico , Hipotireoidismo/fisiopatologia , Mixedema/diagnóstico , Mixedema/tratamento farmacológico , Mixedema/fisiopatologia , Índice de Gravidade de Doença , Tiroxina/uso terapêutico , Resultado do Tratamento
17.
Ann Intern Med ; 173(1): ITC1-ITC16, 2020 07 07.
Artigo em Inglês | MEDLINE | ID: mdl-32628881

RESUMO

Hypothyroidism is a common condition in which the thyroid gland provides insufficient amounts of thyroid hormone for the needs of peripheral tissues. The most common cause in adults is chronic lymphocytic thyroiditis (Hashimoto thyroiditis), but there are many other causes. Because most of the clinical features of hypothyroidism are nonspecific, the diagnosis requires laboratory testing. Serum thyroid-stimulating hormone (TSH) measurement is the best diagnostic test; an elevated TSH level almost always signals primary hypothyroidism. Serum free thyroxine levels may be below the reference range (overt hypothyroidism) or within the reference range (subclinical hypothyroidism). All patients with overt hypothyroidism should be treated, but those with subclinical hypothyroidism do not always benefit from treatment, especially elderly patients and those with baseline TSH levels below 10 mU/L. Oral L-thyroxine is the treatment of choice because of its well-demonstrated efficacy, safety, and ease of use. Therapy goals are symptom relief and maintenance of serum TSH levels within the reference range. Myxedema coma is a life-threatening form of decompensated hypothyroidism that must be treated with aggressive L-thyroxine replacement and other supportive measures in the inpatient setting.


Assuntos
Hipotireoidismo/diagnóstico , Hipotireoidismo/terapia , Diagnóstico Diferencial , Quimioterapia Combinada , Feminino , Terapia de Reposição Hormonal , Hospitalização , Humanos , Mixedema/etiologia , Mixedema/terapia , Exame Físico , Guias de Prática Clínica como Assunto , Gravidez , Complicações na Gravidez/diagnóstico , Valores de Referência , Encaminhamento e Consulta , Tireotropina/sangue , Tiroxina/sangue , Tiroxina/uso terapêutico , Tri-Iodotironina/sangue , Tri-Iodotironina/uso terapêutico
18.
Eur J Endocrinol ; 183(4): E7-E9, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32688333

RESUMO

The validity of clinical research is potentially threatened by missing data. Any variable measured in a study can have missing values, including the exposure, the outcome, and confounders. When missing values are ignored in the analysis, only those subjects with complete records will be included in the analysis. This may lead to biased results and loss of power. We explain why missing data may lead to bias and discuss a commonly used classification of missing data.


Assuntos
Viés , Reprodutibilidade dos Testes , Projetos de Pesquisa/normas , Idade de Início , Idoso , Idoso de 80 Anos ou mais , Doenças Assintomáticas , Terapia de Reposição Hormonal , Humanos , Hipotireoidismo/tratamento farmacológico , Hipotireoidismo/epidemiologia , Modelos Logísticos , Razão de Chances , Avaliação de Resultados em Cuidados de Saúde , Placebos , Ensaios Clínicos Controlados Aleatórios como Assunto/normas , Ensaios Clínicos Controlados Aleatórios como Assunto/estatística & dados numéricos , Tamanho da Amostra , Tiroxina/uso terapêutico
19.
Eur J Endocrinol ; 183(2): R13-R28, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32580145

RESUMO

Subclinical hypothyroidism (SH) is biochemically defined as serum TSH levels above the upper limit of the reference range in the presence of normal free T4 (FT4) concentrations. While there is a general agreement to treat subjects with serum TSH levels above 10 mU/L, the management of mild form (TSH concentrations between 4.5 and 10 mU/L) is still a matter of debate. In children, mild SH is often a benign and remitting condition and the risk of progression to overt thyroid dysfunction depends on the underlying condition, being higher in the autoimmune forms. The major concern is to establish whether SH in children should always be considered an expression of mild thyroid dysfunction and may deserve treatment. Current data indicate that children with mild SH have normal linear growth, bone health and intellectual outcome. However, slight metabolic abnormalities and subtle deficits in specific cognitive domains have been reported in children with modest elevation of TSH concentration. Although these findings are not sufficient to recommend levothyroxine treatment for all children with mild SH, they indicate the need for regular monitoring to ensure early identification of children who may benefit from treatment. In the meanwhile, the decision to initiate therapy in children with mild SH should be based on individual factors.


Assuntos
Hipotireoidismo/sangue , Tireotropina/sangue , Adolescente , Criança , Pré-Escolar , Reações Falso-Positivas , Doença de Hashimoto/sangue , Humanos , Hipotireoidismo/tratamento farmacológico , Hipotireoidismo/etiologia , Lactente , Recém-Nascido , Iodo/efeitos adversos , Iodo/deficiência , Triagem Neonatal , Inquéritos Nutricionais , Obesidade Pediátrica/complicações , PubMed , Doenças da Glândula Tireoide/genética , Tiroxina/sangue , Tiroxina/uso terapêutico
20.
Artigo em Inglês | MEDLINE | ID: mdl-32560383

RESUMO

Background: Levothyroxine is the most common treatment to normalize thyroid hormones levels and to reduce primary hypothyroidism symptoms. Aim: To assess sexual function in women with levothyroxine-treated hypothyroidism and women without hypothyroidism. Methods: A case-control study was performed with 152 women with levothyroxine-treated hypothyroidism and 238 women without hypothyroidism. An online survey was used to collect socio-demographic data and the answers to the Women Sexual Function (WSF) questionnaire. Results: Women with levothyroxine-treated hypothyroidism showed a higher prevalence of sexual dysfunction than women in the control group (31.60% vs. 16.40%), furthermore the presence of hypothyroidism increased the risk of sexual dysfunction (p = 0.002, OR: 2.29 (1.36-3.88)). The most affected domains were 'desire' (p < 0.001), 'arousal' (p = 0.003) and 'penetration pain' (p = 0.020). In hypothyroid women, age increased the risk of sexual dysfunctions (p = 0.009, OR: 1.07 (1.01-1.12)), however when age was adjusted (ANCOVA) the sexual dysfunction remained in women with hypothyroidism in all domains. Conclusions: Hypothyroidism is associated with an increase in the prevalence of sexual dysfunction even if treated with levothyroxine and thyroid-stimulating hormone (TSH) levels are normalized. Relevance to clinical practice: Sexual function in hypothyroid women should be assessed before and after starting the treatment.


Assuntos
Hipotireoidismo , Disfunções Sexuais Fisiológicas , Hormônios Tireóideos , Tiroxina , Adulto , Estudos de Casos e Controles , Feminino , Humanos , Hipotireoidismo/tratamento farmacológico , Pessoa de Meia-Idade , Disfunções Sexuais Fisiológicas/complicações , Hormônios Tireóideos/uso terapêutico , Tireotropina , Tiroxina/uso terapêutico
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