Does insulin resistance increase thyroid volume in patients with polycystic ovary syndrome?

ABSTRACT Objective To investigate the effect of gonadotropin, sex hormone levels and insulin resistance (IR) on thyroid functions and thyroid volume (TV) in polycystic ovary syndrome (PCOS). Subjects and methods 69 new diagnosed PCOS patients (age 24.82 ± 6.17) and 56 healthy control female (age 26.69 ± 5.25) were involved to the study. Fasting plasma glucose, lipid profile, insulin, thyroid stimulating hormone (TSH), free thyroxine (fT4), estradiol (E2), luteinizing hormone (LH), follicle stimulating hormone levels and urine iodine were measured in all participants. Thyroid and pelvic ultrasound were performed in all participants. Results Insulin, HOMA-IR, LH, E2 and TV were higher in PCOS group (p < 0.05). TV was significantly higher in PCOS patients with IR compared to non-IR PCOS patients (p < 0.001), while TSH, fT4, and urine iodine levels were similar between these groups (p > 0.05). There was a negative correlation between E2 and TSH (p < 0.05) and a positive correlation between TSH and TV (p < 0.05). There was a significant positive correlation between TV and LH, insulin, HOMA-IR (p < 0.05). Conclusion This study showed that TV was increased in patients with insulin resistance but differences in TSH and LH levels may affect TV changes as well.

Alterations in the hypothalamic­pituitary­thyroid axis in animals submitted to early-life trauma

Introduction: Changes in maternal care can affect offspring's thyroid hormone T3 levels. Pups from highly caring mothers have higher levels of thyroid hormone T3. In humans, physical abuse in childhood is related to lower levels of T3 in adolescence. This study aimed at verifying if early-life trauma in rodents is correlated with T3 levels in adulthood. Methods: From the second day of life, litters of Wistar rats were subjected to reduced nesting material (Early­Life Stress-ELS) or standard care (Controls). In adult life, the animals were chronically exposed to standard diet or standard diet + palatable diet and plasma T3 levels were measured before and after the exposition to diet. Results: Thyroid hormone T3 levels in adult life correlated negatively with the licking and grooming (LG) scores in the ELS group. This correlation disappeared when the animals had the opportunity to choose between two diets chronically. Conclusion: The adverse environment affected maternal behavior and caused marks on the metabolism of the intervention group (T3), which were reverted by chronic palatable food consumption (AU)

Reference interval for thyrotropin in a ultrasonography screened Korean population

BACKGROUND/AIMS: The diagnostic accuracy of thyroid dysfunctions is primarily affected by the validity of the reference interval for serum thyroid-stimulating hormone (TSH). Thus, the present study aimed to establish a reference interval for TSH using a normal Korean population. METHODS: This study included 19,465 subjects who were recruited after undergoing routine health check-ups. Subjects with overt thyroid disease, a prior history of thyroid disease, or a family history of thyroid cancer were excluded from the present analyses. The reference range for serum TSH was evaluated in a normal Korean reference population which was defined according to criteria based on the guidelines of the National Academy of Clinical Biochemistry, ultrasound (US) findings, and smoking status. Sex and age were also taken into consideration when evaluating the distribution of serum TSH levels in different groups. RESULTS: In the presence of positive anti-thyroid peroxidase antibodies or abnormal US findings, the central 95 percentile interval of the serum TSH levels was widened. Additionally, the distribution of serum TSH levels shifted toward lower values in the current smokers group. The reference interval for TSH obtained using a normal Korean reference population was 0.73 to 7.06 mIU/L. The serum TSH levels were higher in females than in males in all groups, and there were no age-dependent shifts. CONCLUSIONS: The present findings demonstrate that the serum TSH reference interval in a normal Korean reference population was higher than that in other countries. This result suggests that the upper and lower limits of the TSH reference interval, which was previously defined by studies from Western countries, should be raised for Korean populations.

Can Ultrasound Be as a Surrogate Marker for Diagnosing a Papillary Thyroid Cancer? Comparison with BRAF Mutation Analysis

PURPOSE: We investigated the merit of ultrasound (US) features and BRAF(V600E) mutation as an additional study of cytology and compared the diagnostic performances of cytology alone, cytology with US correlation, cytology with BRAF(V600E) mutation, and a combination of cytology, US, and BRAF(V600E) mutation all together. MATERIALS AND METHODS: This study included 185 patients (mean age, 48.4 years; range 20-77 years) with 191 thyroid nodules who underwent US-guided fine-needle aspiration (FNA) with an additional BRAF(V600E) mutation test. Three radiologists highly experienced in thyroid imaging retrospectively reviewed US images and classified each nodule into two categories (positive for malignancy or negative for malignancy). Interobserver variability (IOV) of US assessment between the three readers was estimated using the generalized kappa statistic of Landis and Koch. We also calculated the diagnostic performances of these studies. RESULTS: There were 131 cases of malignancy (131/191, 68.6%) and 60 cases of benign nodules (60/191, 31.4%). In terms of IOV of US assessment, the generalized kappa value was 0.242, indicating fair agreement was reached. The combination of cytology with BRAF(V600E) showed higher specificity (100%) and positive predictive value (PPV) (100%) compared to the combination of cytology, BRAF(V600E), and US (specificity 28.3%, 66.7%, 68.3%; PPV 74.6%, 86.6%, 86.8%, respectively; p<0.001). However, cytology with BRAF(V600E) showed lower sensitivity (84.7%) than cytology with BRAF(V600E) and US (96.2%, 98.5%, 95.4%, respectively; p<0.001). CONCLUSION: Considering the diagnostic performance and low reproducibility of US, the combination of FNA with BRAF(V600E) is the most reliable and objective method for diagnosing thyroid malignancy.

Can Ultrasound Be as a Surrogate Marker for Diagnosing a Papillary Thyroid Cancer? Comparison with BRAF Mutation Analysis

PURPOSE: We investigated the merit of ultrasound (US) features and BRAF(V600E) mutation as an additional study of cytology and compared the diagnostic performances of cytology alone, cytology with US correlation, cytology with BRAF(V600E) mutation, and a combination of cytology, US, and BRAF(V600E) mutation all together. MATERIALS AND METHODS: This study included 185 patients (mean age, 48.4 years; range 20-77 years) with 191 thyroid nodules who underwent US-guided fine-needle aspiration (FNA) with an additional BRAF(V600E) mutation test. Three radiologists highly experienced in thyroid imaging retrospectively reviewed US images and classified each nodule into two categories (positive for malignancy or negative for malignancy). Interobserver variability (IOV) of US assessment between the three readers was estimated using the generalized kappa statistic of Landis and Koch. We also calculated the diagnostic performances of these studies. RESULTS: There were 131 cases of malignancy (131/191, 68.6%) and 60 cases of benign nodules (60/191, 31.4%). In terms of IOV of US assessment, the generalized kappa value was 0.242, indicating fair agreement was reached. The combination of cytology with BRAF(V600E) showed higher specificity (100%) and positive predictive value (PPV) (100%) compared to the combination of cytology, BRAF(V600E), and US (specificity 28.3%, 66.7%, 68.3%; PPV 74.6%, 86.6%, 86.8%, respectively; p<0.001). However, cytology with BRAF(V600E) showed lower sensitivity (84.7%) than cytology with BRAF(V600E) and US (96.2%, 98.5%, 95.4%, respectively; p<0.001). CONCLUSION: Considering the diagnostic performance and low reproducibility of US, the combination of FNA with BRAF(V600E) is the most reliable and objective method for diagnosing thyroid malignancy.

Imaging Mass Spectrometry in Papillary Thyroid Carcinoma for the Identification and Validation of Biomarker Proteins

Direct tissue imaging mass spectrometry (IMS) by matrix-assisted laser desorption ionization and time-of-flight (MALDI-TOF) mass spectrometry has become increasingly important in biology and medicine, because this technology can detect the relative abundance and spatial distribution of interesting proteins in tissues. Five thyroid cancer samples, along with normal tissue, were sliced and transferred onto conductive glass slides. After laser scanning by MALDI-TOF equipped with a smart beam laser, images were created for individual masses and proteins were classified at 200-microm spatial resolution. Based on the spatial distribution, region-specific proteins on a tumor lesion could be identified by protein extraction from tumor tissue and analysis using liquid chromatography with tandem mass spectrometry (LC-MS/MS). Using all the spectral data at each spot, various intensities of a specific peak were detected in the tumor and normal regions of the thyroid. Differences in the molecular weights of expressed proteins between tumor and normal regions were analyzed using unsupervised and supervised clustering. To verify the presence of discovered proteins through IMS, we identified ribosomal protein P2, which is specific for cancer. We have demonstrated the feasibility of IMS as a useful tool for the analysis of tissue sections, and identified the tumor-specific protein ribosomal protein P2.

Follow-up of a case of subacute thyroiditis with uncommon thyroid 99mTc uptake / Acompanhamento de caso de tiroidite subaguda com absorção incomum de 99mTc pela tiroide

Thyroidal 99mTc uptake in the acute thyrotoxic phase of subacute thyroiditis (SAT) is always inhibited. However, a patient with SAT had signs in the right-side thyroid gland with transient thyrotoxicosis and slightly high 99mTc uptake levels in the right lobe, low 99mTc uptake in the left lobe, and normal overall uptake. Histological examination showed cellular destruction and granulomatous inflammatory changes in the right lobe, with marked interstitial fibrosis in the left lobe. The patient was thyrotrophin-receptor antibody (TRAb) positive. After a short course of prednisolone, SAT-like symptoms and signs improved. TRAb-positivity resolved spontaneously after 22 months, and TSH levels were slightly low for 22 months. Levels then kept normal in the following four years. In conclusion, high 99mTc uptake by the right lobe was due to the combined effects of TRAb and left thyroid gland fibrosis.

A absorção tiroidiana de 99mTc no estado tirotóxico agudo da tireoidite subaguda (SAT) é sempre inibida. Entretanto, um paciente com SAT apresentou sinais na tiroide direita, com tirotoxicose transitória e níveis levemente elevados de 99mTc no lobo direito, baixa absorção de 99mTc no lobo esquerdo e absorção geral normal. O exame histológico mostrou destruição celular e alterações inflamatórias granulomatosas no lobo direito, com fibrose intersticial marcada no lobo esquerdo. O paciente foi positivo para anticorpos antirreceptores da tireotropina (TRAb). Após um curto tratamento com prednisolona, os sintomas e sinais da SAT melhoraram. A positividade para TRAb foi resolvida espontaneamente em 22 meses. Os níveis de TSH permaneceram levemente baixos por 22 meses e, depois, se mantiveram normais nos quatro anos seguintes. Concluiu-se que a alta absorção de 99mTc pelo lobo direito foi devida à combinação entre TRAb e fibrose da tiroide esquerda.

Chronic kidney disease; correlation between free thyroxin, thyrotrophin and glomerular filtration rate

Chronic kidney disease [CKD] is defined as kidney damage or glomerular filtration rate <60ml/min/1.73m[2] for 3 months or more, irrespective of cause. To measure glomerular filtration rate, free thyroxin, thyrotrophin in chronic kidney disease patients and to find out the correlation between glomerular filtration rate, free thyroxin and thyrotrphin in these patients. Cross sectional analytical study. Post Graduate Medical Institute [PGMI], Lahore General Hospital [LGH] Lahore. 6 months [Nov 2011 to April 2012]. Sixty five patients were included in the study. Serum Creatinine, TSH and Free T4 were measured; Thyroid function tests TSH, FT4 were measured in these chronic kidney disease patients through enzyme linked immunosorbant assay method. GFR was calculated through Cock-croft-Gualt formula and the relevant data was entered in a predesigned Proforma. In the study total 65 chronic kidney disease patients were taken. Out of which thirty six [55.4%] were male and twenty nine [44.6%] were female. Thirty five [53.8%] CKD patients whose TSH levels were above the normal limit while in the remaining patients the TSH values were in the normal range. Eight patients [12.3%] out of sixty five patients in whom FT4 values were below the normal limit while in the remaining fifty seven patients [87.6%] FT4 values were within the reference range. Those eight patients whose FT4 was below the normal value, their TSH values were above the normal value too. Thirty five patients, whose TSH levels were above the normal 2 limit, their mean age was 50.60 +/- 11.95, mean serum creatinine was 4.73 +/- 2.94 mg/dl, mean GFR was 22.17 +/- 12.48 ml/min/1.73m, mean TSH was 6.68 +/- 0.87 mIU/L and mean FT4 was 0.97 +/- 0.35 ng/dl. The p-value of TSH was < 0.001 and FT4 was < 0.05 in comparing with normal. Glomerular filtrations rate with TSH and FT4 the co-efficient of correlation [r] value for 35 patients to be - 0.713 and 0.47 for TSH and FT4 respectively. Their p- values were 0.000 and 0.004 respectively, and p < 0.001 collectively. This was found to be statistically significant. Linear regression line was obtained between GFR and TSH and GFR and FT4 in CKD patients. From these correlation studies I concluded that the chronic kidney disease is associated with biochemical thyroid dysfunctions causing most commonly subclinical hypothyroidism

Diffuse Thyroid Uptake Incidentally Found on 18F-Fluorodeoxyglucose Positron Emission Tomography in Subjects without Cancer History

OBJECTIVE: We investigated the clinical significance of incidental diffuse thyroid uptake (DTU) on 18F-FDG PET in subjects without a history of cancer. MATERIALS AND METHODS: This study included 2062 studies from adults who underwent 18F-FDG PET as a cancer screening program. Subjects were divided into the following two groups: with (group I) or without (group II) DTU. The presence of DTU and the thyroid visual grading score were compared with thyroid function tests, serum anti-microsomal antibody (AMA) levels, and the presence of diffuse parenchymal change (DPC) on ultrasonography (USG). RESULTS: DTU was found in 6.6% of the scans (137/2062). Serum thyroid stimulating hormone (TSH) and AMA levels were significantly higher in group I than in group II. Increased AMA level (55.1%) and DPC (48.7%) were more frequently found in group I (p < 0.001). The proportion of subjects with any abnormal results in serum free thyroxine, triiodothyronine, TSH, or AMA levels or DPC on USG was significantly higher in group I than in group II (71.5% vs. 10.6%, p < 0.001), and was significantly and gradually increased according to the visual grading score group (0 vs. 1-2 vs. 3-4 = 10.6% vs. 58.5% vs. 90.9%, p < 0.001). TSH and is AMA levels were significantly increased according to the visual grading score. CONCLUSION: The presence or degree of incidental DTU on 18F-FDG PET is closely correlated with increased serum AMA and TSH levels, and the presence of DPC on USG. Therefore, the most plausible pathological cause of DTU may be cell damage by an autoimmune mechanism.

Evaluation of effect of isoflavone on thyroid economy & autoimmunity in oophorectomised women: A randomised, double-blind, placebo-controlled trial.

Background and objectives: The potential of soy isoflavones to interfere with thyroid function has been reported. However, there are limited data regarding their effect on thyroid function and autoimmunity in surgical menopausal women. The present study aimed to evaluate the effect of isoflavones on thyroid function and autoimmunity, menopausal symptoms, serum follicle stimulating hormone (FSH) and estradiol levels in oophorectomised women. Methods: A randomized, double blind, placebo-controlled trial was conducted in 43 oophorectomised women to evaluate the effect of soy isoflavones (75 mg/day for 12 wk) on serum thyroid profile (free T3 , free T4 , TSH, TBG and anti-TPO antibody titres) assessed at baseline, 6 and 12 wk after randomization. Assessment was also done for menopause symptom score (MSS) three weekly, and FSH and estradiol levels at baseline and at study completion. Results: There was a significant alteration in free T 3 levels in the group receiving isoflavones (4.05 ± 0.36, 4.12 ± 0.69 and 3.76 ± 0.55 pmol/l at baseline, 6 and 12 wk, respectively; P=0.02). However, the mean change in various thyroid parameters at 12 wk from baseline was not significantly different between the two groups. MSS was also significantly decreased at 9 and 12 wk from baseline with isoflavones (12.47 ± 8.15, 9.35 ± 5.23 and 9 ± 5.14 at baseline, 9 and 12 wk respectively; P=0.004) with significant improvement in urogenital symptoms compared to placebo. Isoflavones did not significantly affect other parameters during study period. There were no serious adverse events reported and the proportion of patients experiencing adverse events was similar between the two groups. Interpretation and conclusions: Modest reduction in serum free T3 levels in the isoflavone group in the absence of any effect on other thyroid parameters might be considered clinically unimportant.

Transient cytotoxicity of 131I beta radiation in hyperthyroid patients treated with radioactive iodine.

Background & objectives: Radioiodine (131I) or radioactive iodine in low doses is used worldwide as the first line of management in the treatment of hyperthyroidism. Information is available on the extent and severity of cell damage after a high dose radioiodine (131I) therapy for thyroid cancer, but information is scanty on its cellular effects, its extent and severity of cell damage after a low dose 131I therapy. The present investigation was aimed to study the cytotoxic effects of a low dose 131I therapy in varying doses as is normally being used in routine clinical practice in the treatment of various forms of hyperthyroidism. Methods: Peripheral blood lymphocytes were analyzed in 32 hyperthyroid patients. All of them received 131I in the form of sodium iodide solution orally. Blood lymphocytes were studied for the presence of chromosomal aberrations (CA) and micro nucleus (MN) using micronucleus assay. Blood samples of these patients were drawn prior to the treatment, on 7 thand 30 thdays after the treatment. Results: The results indicated a positive relationship between 131I dose, CA and MN frequency. A statistically significant increase in CA and MN frequency in day 7 post- therapy and a decrease in mean levels of CA and MN on day 30 post-therapy were observed when compared to pre-therapy. Interpretation & conclusions: This study showed that the cytogenetic damage induced by 131I in low doses i.e., less than 555MBq was minimal and reversible. Patients can be motivated to undertake this safe and easy procedure as a first line of therapy in the treatment of hyperthyroidism.

Efeitos da dieta rica em linhaça na lactação sobre a composição corporal e função tireóidea da prole na idade adulta / Effects of maternal flaxseed diet during lactation on body composition and thyroid function in adult animals

A Linhaça (Linum Usitatissimum) apresenta diversas substâncias com alegados efeitos benéficos que favorecem a diminuição da adiposidade, glicemia e melhoram o perfil lipidêmico e o sistema cardiovascular. Neste trabalho, investigamos na prole 21 e 180 dias de vida o efeito do consumo materno da semente de linhaça durante a lactação sobre os parâmetros associados a composição corporal, a homeostase glicêmica, lipídica e protéica, a leptinemia, adiponectinemia e insulinemia, a função tireoideana e a via de sinalização da leptina no eixo hipotálamo-hipófise-tireóide. As ratas lactantes foram separadas em dois grupos: controle (C) - recebendo ração a base de caseína (20%) e linhaça (L) - recebendo ração adicionada de 25% da semente de linhaça, contendo 18,9% de proteína (sendo 13,9% de caseína e 5% de linhaça) durante a lactação. O sacrifício das proles ocorreu aos 21 e 180 dias de idade, para determinação de: glicemia, albuminemia, proteínas totais, hematócrito, hemoglobina, colesterol total e triglicerídeos, insulina, leptina, adiponectina, TSH, T4 livre e T3 total. Os animais foram completamente eviscerados para obtenção da carcaça e análise da composição corporal. O consumo alimentar e a massa corporal (MC) foram aferidos diariamente durante a lactação e de 4 em 4 dias após a lactação até a idade adulta. As ratas lactantes do grupo L não apresentaram diferença na massa corporal e consumo alimentar. Durante a lactação a prole L apresentou maior ganho de peso corporal e após ao desmame observamos um aumento transitório de massa corporal até a idade adulta. Aos 21 dias, observamos na prole do grupo L menor gordura total e subcutanea, colesterol total, triblicerideo, albumina, insulina, T3 total e atividade de D1 no fígado; e aumento da área dos adipocitos no tecido subcutaneo, leptina, TSH e expressão de Ob-R, STAT3 e p-STAT3 na hipofise (p<0,05). Aos 180 dias, o grupo L apresentou menor glicemia, adiponectina, T4 livre, atividade de D1 e D2 na tireóide...

Flaxseed (Linum usitatissimum) presents high number of substances with alleged beneficial effects that decrease the adiposity, glocuse levels and improved lipid profile and cardiovascular system. In this study, we investigated in the offspring at 21 and 180 days old the effect of maternal consumption of flaxseed during lactation on the parameters associated with body composition, glucose homeostasis, lipid and protein, leptinemia, adiponectinemia and insulinemia, thyroid function, and leptin signaling pathway in the hypothalamus-pituitary-thyroid axis in the offspring at 21 and 180 days old. Lactating rats were divided into: (1) Controls (C), diet containing 20% casein; (2) FLaxseed (F), diet with additional 25% of flaxseed, containing 18.9% protein (13.9% from casein and 5% from flaxseed). The offspring were sacrificed at 21 and 180 days of age to determinate: glycemia, albumin, leptin, adiponectin, TSH, free T4 and total T3. The animals were completely eviscerated to obtain the carcass by body composition analysis. The maternal food intake and body mass were measured daily during the lactation, and after weaning were monitored once every 4 days until they were 180 days old. The dams of F group presented no changes in body mass and food intake. During the lactation the F offspring showed higher body mass and after weaning they presented a higher transitory body mass until 180 days old. At 21 days old, F group showed lower total and subcutaneous fat mass, total cholesterol, triacylglycerol, albumin, insulin, total T3 and D1 liver activity; and higher subcutaneous adipocytes area, leptin, TSH and Ob-R, STAT3 and p-STAT expression in pituitary (p<0,05). At 180 days old, F group presented lower glycemia, adiponectin, free T4 and D1 and D2 activity in thyroid; and higher visceral and subcutaneous adipocytes area, insuli, Ob-R expression in thyroid and D2 activity in brown adipose tissue (p<0,05). In conclusion, maternal flaxseed diet during lactation...

Role of Ki-67 as a proliferative marker in lesions of thyroid.

Background: Specific criteria are used to diagnose thyroid neoplasms; however, the distinction between certain neoplasms, such as follicular adenoma and carcinoma, could be difficult. Thus, additional diagnostic features that can assist in this distinction would have great clinical usefulness. Aims: To evaluate the role of the proliferative marker Ki-67 in nonneoplastic and neoplastic lesions of the thyroid, with a special emphasis on the distinction between follicular adenoma and follicular carcinoma. Settings and Design: A retrospective study from a tertiary care center. Materials and Methods: One hundred cases of thyroid lesions, including 50 nonneoplastic and 50 neoplastic lesions, were retrieved from the archives of the Department of Pathology, Pt. BD Sharma PGIMS, Rohtak, Ki-67 immunostaining was performed by peroxidase-antiperoxidase method and compared with mitotic counts. Results: Ki-67 labeling index (LI) showed a progressive rise from multinodular goiter to benign to malignant neoplasms. A statistically significant difference was observed in Ki-67 counts between multinodular goiter vs papillary carcinoma (P < 0.05) and follicular adenoma vs follicular carcinoma (P < 0.05). The correlation between mitotic counts and Ki-67 LI was found to be significant. Conclusions: In the present study, Ki-67 was found to be useful in differentiating between follicular adenoma and follicular carcinoma, but since the sample size of our study was small, larger studies are needed to confirm this observation as well as to assign a cutoff value for differentiating benign from malignant tumors.

Alterations in the thyroid axis in critical illness: a brief review

Disturbance of the hypothalamo pituitary-thyroid axis and alteration of circulating thyroid hormones levels are common in non-thyroidal illness [NTI] including infection, burns, and trauma. The commonest abnormality is the low T3 syndrome due to reduced activity of 5-deiodinase. In acute illness this is associated with an increase in reverse T3 but in more chronic illness reverse T3 is not usually raised. Serum T3 shows a negative correlation with serum concentrations of soluble receptors for TNF and IL-2. Low T3 syndrome may be an appropriate energy-saving adaptation. In critical illness the low T4 syndrome is common. Both total T4 and T3 levels are low. Serum total T4 inversely correlates with mortality. fT4 measurement in critical illness is problematic because of marked method-dependence of results. Direct measurement yields normal/high values but two-step immunoassays used clinically show low values. Falls in the levels of serum thyroid hormone binding proteins and alteration to the affinity of hormone binding due to exogenous and endogenous inhibitors of binding generated in illness further complicate in vivo and in vitro assessment. T4 clearance by deiodination is impaired but non-deiodinative pathways are accelerated. Cellular uptake of free hormone is impaired but expression of nuclear thyroid hormone receptors is increased in critical illness. Serum TSH is normal in the low T3 syndrome but can be low in the low T4 syndrome. Low TSH can be a hypothalamo-pituitary manifestation of illness due to the effect of cytokines on TRH release and TSH synthesis, but TSH is also suppressed by dopamine or gluco-corticoid therapy. After drug cessation or in recovery, TSH can transiently increase above the normal range. TSH in critical illness is less glycosylated and less bio-active. Limited trials of T4 and T3 therapy in critical illness have not shown benefit on mortality. No adequate large-scale trial has been conducted

O selênio e a glândula tireóide: um estudo em pacientes portadores de disfunções tireoidianas nos estados de Ceará e São Paulo / The selenium and thyroid gland: a study in patients with thyroid dysfunction in the states of Ceara and Sao Paulo

Introdução: O Selênio é um mineral fundamental para o homem, participa dos mecanismos antioxidantes, influencia o sistema imune e participa ativamente da homeostase da glândula tireóide.Objetivo: Avaliar o estado nutricional relativo ao selênio de pacientes adultos portadores de hipotireoidismo e hipertireoidismo em atendimento ambulatorial no Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo e no Hospital Universitário Walter Cantídio da Universidade Federal do Ceará. Metodologia: Foram avaliados quatro grupos de pacientes com doença de Graves (Graves), Bócio Multinodular Tóxico (BMNT), Hipotireoidismo pós-tireoidectomia (Hipotireoidismo) e tireoidite de Hashimoto (Hashimoto) em dois estados, São Paulo e Ceará e paralelamente dois grupos controle (São Paulo e Ceará). Foram realizadas caracterização antropométrica e clínica. O Se foi analisado no plasma e eritrócitos, foi medida a atividade da GSH-Px, iodúria, MDA plasmático e dosagens de hormônios tireoidianos e Anti-TPO. O consumo alimentar foi estimado utilizando-se a técnica de recordatório 24 horas...

Tireóide e gravidez / Thyroid and pregnancy

A gravidez está associada com a necessidade aumentada de secreção hormonal pela tireóide desde as primeiras semanas após a concepção. Para que esta maior demanda ocorra, a gestação induz uma série de alterações fisiológicas que afetam a função tireoidiana e, portanto, os testes de avaliação da função glandular. Para as mulheres grávidas normais que vivem em áreas suficientes em iodo, este desafio em ajustar a liberação de hormônios tireoidianos para o novo estado de equilíbrio e manter até o término da gestação, geralmente, ocorre sem dificuldades. Entretanto, em mulheres com a capacidade funcional da tireóide prejudicada por alguma doença tireoidiana ou naquelas que residem em áreas de insuficiência iódica, isso não ocorre. O manejo de disfunções tireoidianas durante a gestação requer considerações especiais, pois tanto o hipotireoidismo quanto o hipertireoidismo podem levar a complicações maternas e fetais. Além disso, nódulos tireoidianos são detectados, com certa freqüência, em gestantes, o que pode gerar a necessidade do diagnóstico diferencial entre benignos e malignos ainda durante a gestação.

Pregnancy is associated with an increased requirement of hormone secretion by the thyroid, within the first weeks after conception. To this greater demand to occurs, pregnancy induces a series of physiological changes that affect thyroid function and, consequently, the tests of glandular function. For normal pregnant women living in areas with a sufficient supply of iodine, this challenge regarding the adjustment of thyroid hormone releases to this new state of equilibrium and its maintenance until the end of pregnancy it meets no difficulties. However, among women with impaired thyroid function due to some thyroid disease or among women residing in areas with an insufficient iodine supply, this does not occur. The management of thyroid dysfunction during gestation requires special considerations, since both hypothyroidism and hyperthyroidism can lead to maternal and fetal complications. In addition, thyroid nodules are detected at reasonable frequency among pregnant women, a fact that requires a differential diagnosis between benign and malignant growths during the pregnancy itself.

Apoptose, proliferação e histomorfometria do baço de ratas adultas com hipofunção tireoidiana e ovariana / Apoptosis, proliferation and spleen histomorphometry of adult female rats with thyroid and ovarian hypofunction

Apoptose, proliferação e histomorfometria do baço foram investigados em ratas Wistar adultas ovariectomizadas e não-ovariectomizadas, mantidas em hipotireoidismo induzido pela administração diária de propiltiouracil (PTU) por 120 dias. Dois grupos eutireóideos ovariectomizados e não-ovariectomizados serviram como controle. Foi colhido o plasma para dosagem de T4 livre e o baço para análise da histomorfometria, do índice apoptótico e da expressão imunohistoquímica de caspase 3 e CDC47. Valores de T4 livre foram menores nas ratas tratadas com PTU (p < 0,05). Nos grupos hipotireóideos houve redução do peso do baço, do número e do tamanho dos folículos linfóides e aumento do índice apoptótico e da expressão de caspase 3 (p < 0,05). Porém, o baço de ratas hipotireóideas ovariectomizadas apresentou aumento menos acentuado do índice apoptótico e da expressão de caspase 3 do que o baço de ratas hipotireóideas não-ovariectomizadas (p < 0,05). O grupo eutireóideo ovariectomizado apresentou hiperplasia da polpa branca em relação ao grupo eutireóideo não-ovariectomizado. Não houve diferença na expressão de CDC47 entre os grupos. Conclui-se que a hipofunção tireoidiana e gonadal apresentam efeitos distintos no baço e que na associação hipotireoidismo-hipogonadismo há aumento menos acentuado do índice apoptótico e da expressão de caspase-3 esplênica do que no hipotireoidismo isolado.

Apoptosis, proliferation and histomorphometry of spleen were investigated in ovariectomized and non-ovariectomized adult Wistar rats maintained in hypothyroidism induced by daily administration of propylthiouracil (PTU) during 120 days. Two groups ovariectomized euthyroid and non-ovariectomized euthyroid were used as controls. Plasma was collected for free T4 dosage and the spleen for histomorphometry analysis, apoptosis index and the immunohistochemistry expression of caspase 3 and CDC47. Values of free T4 were lower in rats treated with PTU (p<0.05). In the hypothyroid groups there was some decrease in the spleen weight as well as the number and size of lymphoid follicles and there was some increase in the apoptotic index and the caspase 3 expression (p<0.05). However, the increase in the apoptosis index and the expression of caspase 3 in ovariectomized hypothyroid rats spleen was less accentuated than non-ovariectomized hypothyroid ones (p<0.05). The ovariectomized euthyroid group presented white pulp hyperplasia in comparison to the non-ovariectomized euthyroid group. There was no difference in the CDC47 expression between groups. It was concluded that the thyroid and ovarian hypofunction have distinct effects on the spleen and that in the hypothyroidism-hypogonadism association, the increase in the apoptosis index and in the expression of splenic caspase 3 is not as much as in isolated hypothyroidism.

Impacto do tratamento com GH sobre as funções tireoidiana e adrenal: [revisão] / hGH treatment impact on adrenal and thyroid functions: [review]

O estado somatotrófico é modulador importante dos eixos tirotrófico e corticotrófico. Enquanto a reposição somatotrófica em pacientes com deficiência de GH aumenta a conversão do hormônio inativo (T4) na sua forma ativa (T3), aumentando dessa forma a ação biológica do hormônio tireoidiano, a mesma reposição induz no eixo corticotrófico a conversão de cortisol, hormonalmente ativo, em cortisona, que é biologicamente inativa. Nessa revisão, foram discutidos os efeitos do GH nesses dois eixos hormonais, os possíveis mecanismos e as implicações clínicas no manejo dos pacientes com hipopituitarismo.

Somatotrophic status is a major determinant of both thyrotrophic and corticotrophic axis. In growth hormone deficient patients, somatotrophic replacement increases the conversion rate of the inactive form of the thyroid hormone (T4) to its active form (T3), whereas the same replacement induces the conversion of cortisol, which is hormonally active, in cortisone, its inactive form. This review details the effects of GH on these two hormonal axis, possible mechanisms and clinical implications for the management of hypopituitary patients.