The change in the clinical presentation of Graves disease: a 30 years retrospective survey in an academic Brazilian tertiary center

ABSTRACT Objective Graves' disease (GD) is the main cause of hyperthyroidism among adults. It is an autoimmune condition classically marked by the Merserburg Triad (goiter, thyrotoxicosis, and orbitopathy), but the change in presentation of GD over time has rarely been studied. To determine changes in the clinical presentation of patients with GD in the last 30 years. Subjects and methods The study evaluated 475 patients diagnosed with GD between 1986 and 2016 in a single center. Patients were evaluated regarding epidemiological aspects, thyroid function, inflammatory activity of the eyes evaluated by the Clinical Activity Score; CAS, severity evaluated by NOSPECS classification and thyroid volume estimated by ultrasonography. Results Patients assessment identified an increase in the mean age of diagnosis of GD (p < 0.02), a reduction in thyroid volume (p < 0.001) and less intense orbital involvement from 2007-2016 compared to 1986-2006 (p = 0.04). The number of smoking patients was smaller from 2007 to 2016 (28.7%) than 1986 to 2006 (42.8% p = 0.001). The TSH and TRAb values did not had significant changes. Conclusion GD presentation appears to be changed in the last years compared to the typical initial presentation. There is a less frequent inflammatory involvement of orbital tissue, smaller goiters, a lower number of smokers and diagnosis at older age.

Síndrome dos ovários policísticos: a importância da avaliação endócrino-metabólica / Polycystic ovary syndrome: the importance of endocrino-metabolic evaluation

A fisiopatologia multifatorial da síndrome dos ovários policísticos (SOP) encontra-se estabelecida, assim como sua associação com a resistência insulina (RI) e, conseqüentemente, com a síndrome metabólica (SM). Entretanto, a avaliação da SM e do risco cardiovascular (RCV) inerente a este estado tem sido dificultado pela multiplicidade de critérios que definem a SM e pela dificuldade de diagnóstico laboratorial da RI incluso nos critérios. O objetivo deste artigo é revisar, de forma acessível à prática clínica, os critérios diagnósticos atuais para a SOP, associada ou não à SM, possibilitando o embasamento para opções terapêuticas que permitam não apenas tratar a anovulação crônica, como também reduzir o risco cardiovascular das mulheres com SOP.

The multifactorial pathophysiology of the Polycystic Ovary Syndrome is established, as well as its association with insulin resistance and consequently with the Metabolic Syndrome. On the other hand, the evaluation of the Metabolic Syndrome and Cardiovascular risk (CV), inherent to this illness, has been made difficult due to the multiplicity of criteria that define the Metabolic Syndrome and the difficulty of the insulin resistance laboratorial diagnosis, which is included in those criteria. The purpose of this article is to review, in an accessible form the clinic practice, the current diagnosis criteria of the Polycystic Ovary Syndrome, whether associated or not with the Metabolic Syndrome, making possible to set the basis for the therapeutical options that allows not only the chronic anovulation treatment, but also to reduce the cardiovascular risk for women with polycystic ovary syndrome.