ABSTRACT
O hipotireoidismo resulta de uma menor produção ou ação dos hormônios tireoidianos, levando a uma lentidão generalizada dos processos metabólicos. Pode ocorrer em qualquer idade, acometendo desde o recém-nascido até idosos. O tratamento do hipotireoidismo clínico ou manifesto é consenso absoluto; controvérsias permanecem, entretanto, quanto à necessidade do tratamento de pacientes com hipotireoidismo subclínico. Nestes casos, existe indicação mais consistente, ainda que não formal, de tratamento em pacientes com tireotrofina (TSH) acima de 10mUI/L, em especial se associada à presença de anticorpos antitireoidianos, bócio, dislipidemis ou sintomas de hipotireoidismo.
Hypothyroidism is the result of insufficient production or action of the thyroid hormone causing the speed reduction of the metabolic processes. It may occur at all ages affecting from newborns to elderly. Treatment of clinical hypothyroidism is absolute consensus; however controversy remains about the need for treating patients with subclinical hypothyroidism. In these cases, there is a more consistent treatment indication, even though not formal, in patients with the presence of thyroid antibodies, goiter, dyslipidemia or hypothyroidism symptoms.
Subject(s)
Humans , Male , Female , Hypothyroidism/classification , Hypothyroidism/physiopathology , Hypothyroidism/therapy , Thyroid Hormones/therapeutic useABSTRACT
BACKGROUND: Down syndrome is associated with various forms of thyroid dysfunction, hypothyroidism being the most common. The additive effects of both co-morbid conditions lead to further amplification of the clinical problems in these children with Down syndrome. OBJECTIVE: The purpose of this prospective study was to know the prevalence of thyroid dysfunction in Down Syndrome children below the age of 14 years and to correlate the features of Down Syndrome with those of thyroid dysfunction. METHODS: In all 32 Down syndrome children were grouped as euthyroid, compensated and uncompensated hypothyroidism on the basis of their T3, T4 and TSH levels and the features of were compared using the student's t-test. RESULTS: Hypothyroidism was seen in 5 out of 32 cases (15.6%) of which 1 (3.1%) had uncompensated while the other 4 (12.5%) had a compensated hypothyroidism. Hyperthyroidism was not observed in any of the cases. The prevalence of hypothyroidism of 16.7% on the age group 0-1 year could well be a reflection of congenital hypothyroidism while 20% prevalence in the age group 9-12 could imply acquired hypothyroidism. The mean values of the developmental quotient (D.Q.) and the Rao's index in Down syndrome cases with hypothyroidism was 49 5.1 and 0.15 0.06 respectively while that of euthyroid Down syndrome patients were 52 5.54 and 0.17 0.04 respectively ('p' value > 0.05), the differences though obvious yet not statistically significant. CONCLUSION: It thus seems necessary to screen all Down syndrome children for thyroid dysfunction.
Subject(s)
Age Distribution , Child , Child, Preschool , Down Syndrome/complications , Female , Humans , Hypothyroidism/classification , Infant , Infant, Newborn , Male , Prospective Studies , Thyroid Hormones/bloodABSTRACT
A análise retrospectiva de 125 pacientes portadores de hipotireoidismo definitivo demonstrou que a tireoidite crônica auto-imune (Tireoidite de Hashimoto e Hipotrofia Tireoidiana) foi a causa mais comum de hipotireoidismo em nosso meio (52,8 por cento). A tireoidite de Hashimoto apresentou-se frequentemente como doença subclínica (64,3 por cento) e a Hipotrofia Tireoidiana como manifesta (94,7 por cento). Determinou-se a frequência relativa das outras causas de hipotireoidismo: Iatrogênicas 24,8 por cento (Pós-tireoidectomia 17,6 por cento, Pós-radioiodo 7,2 por cento), Congênitas 11,2 por cento e hipotálamo-hipofisárias 11,2 por cento. Todos os pacientes com hipotireoidismo congênito apresentaram-se com mixedema e retardamento mental, o que demonstra a necessidade de rastreamento neonatal, diagnóstico e tratamento mais precoces.
Subject(s)
Humans , Thyroiditis, Autoimmune , Hypothyroidism/etiology , Brazil , Thyrotropin , Retrospective Studies , Goiter , Hypothyroidism/classification , Hypothyroidism/diagnosisABSTRACT
La hiperplasia hipofisiaria originada por falla primaria de un órgano endocrino no es rara. Se han informado casos de hipotiroidismo primario en niños y adultos como etiología de hipertrofia de la hipófisis (1-8). En ocasiones se han observado casos de adenomas y microadenomas hipofisiarios causados por esta alteración, tanto en humanos como en animales de experimentación (2, 6, 9, 10); otras entidades en las cuales se ha documentado aumento del tamaño de la hipófisis incluyen falla gonadal primaria y en pacientes con adrenalectomía total (1, 5). Los primeros casos informados se remontan a 1851 (5); en 1960 Van Wyck y Grumbach describieron un síndrome en niños caracterizado por pubertad precoz, galactorrea, hipotiroidismo primario y aumento del tamaño de la silla turca (!!); a partir de este momento los informes en la literatura demuestran la asociación entre estos dos hallazgos, que pueden llevar a notables confusiones diagnósticas y terapéuticas, debido a las alteraciones endocrinológicas y neurológicas asociadas; un diagnóstico adecuado permitirá un tratamiento oportuno de acuerdo a la patología de base. Las principales alteraciones neurológicas asociadas se producen por compresión de la vía visual por la hiperplasia de la hipófisis, ocasionando desde cambios leves en los campos visuales, papiledema, hasta ceguera (2, 6). Nosotros describimos el caso de una niña con pubertad precoz, talla baja y aumento del tamaño de la hipófisis, demostrado por estudios neurorradiológicos, en quien disminuyó el tamaño hipofisiario luego del tratamiento de sustitución hormonal.