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1.
Evid. actual. práct. ambul ; 25(1): e2087, 2022.
Article in Spanish | LILACS, BINACIS, UNISALUD | ID: biblio-1367592

ABSTRACT

Un estudio mostró que el aumento de valores de la hormona estimulante de la tiroides se asoció a un aumento de mortalidad por todas las causas, estimando que las enfermedades cardiovasculares mediaban dicha asociación en aproximada-mente el 14 % de los casos. Asimismo se observó que el reemplazo con levotiroxina disminuiría los niveles de colesterol, lo cual podría tener un efecto en la reducción de enfermedades cardiovasculares. Partiendo de una viñeta clínica la autora intenta, a través de una búsqueda bibliográfica y análisis de la evidencia, determinar si el tratamiento del hipotiroidismo subclínico en adultos mayores reduciría la morbimortalidad por eventos cardiovasculares. (AU)


A study showed that increased thyroid-stimulating hormone levels were associated with increased all-cause mortality, with cardiovascular disease estimated to mediate this association in approximately 14 % of cases. Additionally, levothyroxine replacement was found to lower cholesterol levels, which could have an effect in reducing cardiovascular diseases. Basedon a clinical vignette, the author attempts, through a literature search and an analysis of the evidence, to determine whether treatment of subclinical hypothyroidism in older adults would reduce morbidity and mortality from cardiovascular events. (AU)


Subject(s)
Humans , Female , Aged , Thyroxine/therapeutic use , Cardiovascular Diseases/mortality , Cardiovascular Diseases/epidemiology , Hypothyroidism/drug therapy , Indicators of Morbidity and Mortality , Age Factors , Hypothyroidism/blood
4.
Arch. endocrinol. metab. (Online) ; 65(5): 664-668, 2021. tab, graf
Article in English | LILACS | ID: biblio-1345204

ABSTRACT

SUMMARY Treatment-refractory hypothyroidism is a common clinical finding. Substantial causes include poor compliance and intake failure as well as gastrointestinal diseases, such as inflammatory bowel disease and short bowel syndromes. Increasing oral dosage of levothyroxine (LT4) is not always effective. Therefore, alternative routes of administration are necessary. In this report, we evaluate alternative treatment modalities for refractory hypothyroidism and present a 28-year-old woman with intestinal drug malabsorption successfully treated by subcutaneous LT4 administration. In this patient, a parenteral form of LT4, 500 μg/5 ml, was administered subcutaneously in a split dosage regimen. Blood hormone levels returned to normal within a few days and remained stable over an 8-month follow-up period.


Subject(s)
Humans , Female , Adult , Hypothyroidism/drug therapy , Malabsorption Syndromes , Thyroxine
5.
An. bras. dermatol ; 95(6): 721-723, Nov.-Dec. 2020. graf
Article in English | ColecionaSUS, LILACS, ColecionaSUS | ID: biblio-1142123

ABSTRACT

Abstract Thyroid hormone has effects on the skin. Patients with hypothyroidism have changes such as dry, scaly and rough skin. Increase carotene in the dermis becomes a yellowish tone to the skin of the patient with hypothyroidism. There is an increase in capillary cycle (anagen phase) and nail growth and a reduction in eccrine gland secretion. It is a case of primary hypothyroidism with nail manifestations associated with dermatologic disorders and successful treatment with levothyroxine. Receptors for thyroid hormone have already been found in keratinocytes, fibroblasts, hair follicles and sebaceous glands. Genes responsive to thyroid hormones and elements of the hypothalamic-pituitary-thyroid axis were identified on the skin. This report highlights the importance of cutaneous manifestations as markers of thyroid disease.


Subject(s)
Humans , Hypothyroidism/drug therapy , Skin , Thyroid Hormones , Thyroxine , Hair Follicle
6.
Medicina (B.Aires) ; 80(supl.6): 83-93, dic. 2020. graf
Article in English | LILACS | ID: biblio-1250323

ABSTRACT

Abstract The treatment of hypothyroidism is aimed at restoring the euthyroid state. In most cases, the signs and symptoms of thyroid deficiency generally resolve, which is particularly gratifying for the treating physician and mainly, for patients. However, there may be coexisting special situations that can potentially hinder or interfere with a successful treatment, as in the case of the elderly, patients suffering from heart disease, hematological diseases or dyslipidemia, hypothyroid patients who will undergo an emergency surgery, those with chronic kidney failure, or adrenal insufficiency, among others. Besides management of hypothyroidism in time of COVID-19 is also included. Some patients may experience intolerance to treatment and others persistent symptoms of hypothyroidism even under adequate replacement therapy, requiring a special approach. Being aware of these special situations will provide benefits to the patient and will also prevent treatment failure or complications.


Resumen El tratamiento del hipotiroidismo tiene como objetivo restaurar el estado eutiroideo. En la mayoría de los casos los signos y síntomas del déficit tiroideo en general se resuelven, lo cual es muy gratificante para el médico tratante y en especial para los pacientes. Sin embargo, pueden coexistir situaciones especiales que potencialmente dificulten o interfieran con un tratamiento exitoso como en el caso de los pacientes ancianos, aquellos con cardiopatías, enfermedades hematológicas o dislipemia, pacientes hipotiroideos que requieran cirugía de urgencia, aquellos con insuficiencia renal crónica, o insuficiencia adrenal, entre otras. Además, se incluye el manejo del hipotiroidismo en la era del COVID-19. Algunos pacientes pueden manifestar intolerancia al tratamiento y otros, persistencia de síntomas de hipotiroidismo aun bajo un adecuado reemplazo hormonal, lo cual requerirá un abordaje especial. Estar advertido de estas situaciones especiales redundará en el beneficio del paciente y evitará fracasos o complicaciones terapéuticas.


Subject(s)
Humans , Aged , Adrenal Insufficiency/drug therapy , COVID-19 , Hypothyroidism/drug therapy , SARS-CoV-2
7.
Rev. chil. endocrinol. diabetes ; 13(1): 20-23, 2020. tab
Article in English | LILACS | ID: biblio-1048916

ABSTRACT

Se presenta el caso de dos mujeres con hipotiroidismo, con TSH persistentemente elevada, lo que hacía aumentar la dosis de levotiroxina y llegar a un hipertiroidismo clínico con TSH anormalmente alto. Se realizó un seguimiento de los niveles de TSH y T4 libre, durante un período de 20 y 10 meses respectivamente. En ambas situaciones no hubo una respuesta esperable a las dosis de levotiroxina ascendentes. Después de descartar causas posibles que explicaran esta situación, se sospechó y confirmó la presencia de Macro TSH, que es un complejo biológicamente inactivo de TSH e Inmunoglobulina G. Se obtiene como resultado la estabilidad de ambas pacientes siendo su seguimiento prioritariamente clínico y con mediciones de T4L, comprendiendo por qué la TSH persiste elevada. Nos pareció interesante la comunicación de estos casos, que permite recordar causas atípicas de refractariedad al tratamiento con levotiroxina, como es la macro TSH, indispensable pesquisar para el manejo adecuado de estos pacientes.


An inadequate response to levothyroxine treatment in a patient with hypothyroidism suggests lack of intake, lack of absorption, nephrotic syndrome, thyroid hormone resistance among other reasons. We present the case of two women with hypothyroidism and a persistently elevated level of TSH, which required increasing the dose of levothyroxine, resulting in a clinical hyperthyroidism with an abnormally high TSH. A TSH and free T4 follow up was performed during a period of 20 and 10 months respectively, in both situations there was not an adequate response to rising levothyroxine treatment. After ruling out other possible causes that could explain this situation, it was suspected and then confirmed the presence of Macro TSH, which is a biologically inactive complex of TSH and Immunoglobulin G. Therefore, both patients achieved disease stability once controlled by clinical state and free T4 measurements, understanding why THS persited high. We present these interesting cases, because this allows us to remember atypical causes of refractory treatment with levothyroxine, such as the Macro TSH, indispensable to search for the proper management of these patients.


Subject(s)
Humans , Female , Adult , Middle Aged , Thyroid Hormones/blood , Hypothyroidism/diagnosis , Hypothyroidism/blood , Thyroxine/administration & dosage , Immunoglobulin G , Hypothyroidism/drug therapy
9.
Arch. endocrinol. metab. (Online) ; 63(1): 16-21, Jan.-Feb. 2019. tab, graf
Article in English | LILACS | ID: biblio-989293

ABSTRACT

ABSTRACT Objective: In this study, we aimed to evaluate serum irisin and apelin levels in patients with subclinical hypothyroidism (SCH) when they were subclinical hypothyroid and become euthyroid after levothyroxine therapy and association of these adipokines with markers of atherosclerosis such as serum homocysteine levels and carotid intima-media thickness (IMT). Subjects and methods: The study included 160 patients with newly diagnosed subclinical hypothyroidism due to Hashimoto's thyroiditis and 86 euthyroid healty subjects. Serum glucose and lipid profile, insulin, HOMA, TSH, free T3, free T4, anti-thyroperoxidase and anti-thyroglobulin antibodies, homocysteine, apelin and irisin levels were measured in all study subjects. Thyroid and carotid ultrasound examinations were performed. The subclinical hypothyroid group was reevaluated after 12-weeks of levothyroxine therapy when they became euthyroid. Results: Clinical characteristics of the patient and control group were similar. Glucose, insulin and HOMA levels, lipid parameters and free T3 were similar between the two groups.. Serum homocystein was higher and apelin was lower in patients with SCH, but irisin levels were similar between the two groups. While thyroid volume was lower, carotid IMT was significantly greater in patients with SCH (pCarotidIMT:0,01). After 12-weeks of levothyroxine therapy, all the studied parameters remained unchanged except, serum freeT4, TSH, homocystein and apelin. While homocystein decreased (p: 0,001), apelin increased significantly (p = 0,049). In multivariate analysis, low apelin levels significantly contributed to carotid IMT (p = 0,041). Conclusions: Apelin-APJ system may play a role in vascular and cardiac dysfunction in patients with SCH and treatment of this condition may improve the risk of cardiovascular disease.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Young Adult , Fibronectins/blood , Atherosclerosis/etiology , Hashimoto Disease/complications , Apelin/blood , Hypothyroidism/complications , Thyroid Function Tests , Thyroxine/therapeutic use , Biomarkers/blood , Case-Control Studies , Prospective Studies , Atherosclerosis/diagnosis , Atherosclerosis/blood , Hashimoto Disease/drug therapy , Hashimoto Disease/blood , Carotid Intima-Media Thickness , Hypothyroidism/drug therapy , Hypothyroidism/blood
10.
Evid. actual. práct. ambul ; 22(4): e002015, 2019.
Article in Spanish | LILACS | ID: biblio-1052839

ABSTRACT

El hipotiroidismo subclínico suele ser identificado como un cuadro que disminuye la capacidad reproductiva de las mujeresy está asociado a un riesgo aumentado de complicaciones perinatales. A partir de un caso clínico real, revisamos laevidencia disponible y encontramos que existen pruebas que contradicen este conocimiento tradicional sobre el pronósticoy la necesidad de tratamiento de este cuadro. (AU)


Subclinical hypothyroidism is usually identified as a condition that decreases the reproductive capacity of women and isassociated with a higher risk of perinatal complications. From a real clinical case, we review the available evidence andfound that there is evidence that contradicts this traditional knowledge about the prognosis and the need for treatment ofthis condition. (AU)


Subject(s)
Humans , Female , Pregnancy , Adolescent , Adult , Young Adult , Reproduction , Hypothyroidism/embryology , Hypothyroidism/drug therapy , Quality of Life , Thyroxine/adverse effects , Thyroxine/therapeutic use , Perinatal Mortality/trends , Reproductive Physiological Phenomena , Patient Preference , Fertility , Hypothyroidism/etiology , Hypothyroidism/genetics
11.
Rev. chil. endocrinol. diabetes ; 12(4): 220-223, 2019. tab
Article in Spanish | LILACS | ID: biblio-1088032

ABSTRACT

Introducción: El hipotiroidismo constituye una patología frecuente, y su tratamiento habitual es el suplemento de levotiroxina (LT4) oral (VO). Sin embargo, existen casos inhabituales donde no es posible corregir esta condición a pesar de la utilización de LT4 en dosis alta. El hipotiroidismo refractario se define como la persistencia del hipotiroidismo a pesar del uso de LT4 > 1,9 ug/kg/día. La prevalencia del hipotiroidismo refractario no ha sido suficientemente documentada hasta ahora. Descripción del caso: Mujer de 53 años con antecedentes de hipotiroidismo, obesidad, dislipidemia, hipertensión arterial e insulinorresistencia. Fue derivada desde APS a nivel terciario por hipotiroidismo persistente a pesar del uso de LT4 800 ug/día y liotironina 80 ug/día. En forma ambulatoria se descartaron distintas causas, como mala adhesión al tratamiento, pseudo-malabsorción, síndromes de malabsorción; interacciones farmacológicas o interacciones alimentarias. Ante esto, y manteniéndose en su condición, se decide hospitalizar. Durante la hospitalización se prueban distintas fórmulas de administración. Finalmente, se logra respuesta adecuada con LT4 por vía rectal 100 ug/día asociado a 100 ug c/12 horas VO. Discusión: A pesar de no contar con herramientas óptimas para enfrentar este caso, se logró aplicar una estrategia sistemática especializada, que permitió un buen manejo de la paciente. Luego de probar distintas formulaciones de hormonas tiroideas, se logró respuesta mediante la administración por vía rectal, lo cual sugiere que esta paciente presentaba algún trastorno celular/bioquímico intestinal alto, que impedía la absorción óptima de LT4 VO. Conclusiones: La principal fortaleza de este trabajo consiste en la demostración de la utilidad práctica, en un contexto de recursos limitados, de una estrategia de estudio y tratamiento sistemático del hipotiroidismo refractario, lo cual ha sido escasamente publicado en la literatura internacional. Además, se recalca la importancia de una intervención especializada oportuna para evitar los riesgos sistémicos asociados a dosis altas de hormonas tiroideas.


Introduction: Hypothyroidism is a common condition, and its usual treatment is the supplement of oral levothyroxine (po). However, there are unusual cases where it is not possible to correct this condition despite the use of high-dose levothyroxine. Refractory hypothyroidism is defined as the persistence of hypothyroidism despite the use of levothyroxine > 1.9 ug/kg/ day. The prevalence of refractory hypothyroidism has not been sufficiently documented so far. Case description: 53 year old woman with a history of hypothyroidism, obesity, dyslipidemia, hypertension and insulin resistance. She was sent from primary care to tertiary level due to persistent hypothyroidism despite the use of 800 ug/day levothyroxine and liothyronine 80 ug/ day. On an outpatient basis, different causes were excluded as poor adherence to treatment, pseudo-malabsorption, malabsorption syndromes; drug interactions or food interactions. Given this, and staying on her condition, it was decided to hospitalize. Different forms of administration were tested during hospitalization. Finally, got adequate response with levothyroxine rectally 100 ug/day associated with 100 ug po bid. Discussion: Despite not having optimum tools to deal with this case, it was succeeded thanks to the implementation of a specialized systematic strategy. After testing different formulations of thyroid hormones, a positive response by rectal administration was achieved, which suggests that this patient presented any high intestinal cell/biochemist disorder that prevented the optimal absorption of levothyroxine po. Conclusions: The main strength of this work consists in demonstrating the practical utility, in a context of limited resources, of a study and systematic treatment strategy of refractory hypothyroidism, which has barely been published in the international literature. It is also highlighted the importance of an early specialized intervention to prevent the systemic risks associated with high doses of thyroid hormones.


Subject(s)
Humans , Female , Middle Aged , Thyroxine/administration & dosage , Hypothyroidism/complications , Hypothyroidism/drug therapy , Malabsorption Syndromes/complications , Administration, Rectal
12.
Arch. endocrinol. metab. (Online) ; 62(4): 392-398, July-Aug. 2018. tab
Article in English | LILACS | ID: biblio-950084

ABSTRACT

ABSTRACT Objective: Treatment of subclinical hypothyroidism (ScH), especially the mild form of ScH, is controversial because thyroid hormones influence cardiac function. We investigate left ventricular systolic and diastolic function in ScH and evaluate the effect of 5-month levothyroxine treatment. Subjects and methods: Fifty-four patients with newly diagnosed mild ScH (4.2 <TSH < 10.0 mU/L) and 30 euthyroid subjects matched by age were analysed. Laboratory analyses and an echocardiography study were done at the first visit and after 5 months in euthyroid stage in patients with ScH. Results: Compared to healthy controls, patients with ScH had a lower E/A ratio (1.03 ± 0.29 vs. 1.26 ± 0.36, p < 0.01), higher E/e' sep. ratio (762 ± 2.29 vs. 6.04 ± 1.64, p < 0.01), higher myocardial performance index (MPI) (0.47 ± 0.08 vs. 0.43 ± 0.07, p < 0.05), lower global longitudinal strain (GLS) (-19.5 ± 2.3 vs. −20.9 ± 1.7%, p < 0.05), and lower S wave derived by tissue Doppler imaging (0.077 ± 0.013 vs. 0.092 ± 0.011 m/s, p < 0.01). Levothyroxine treatment in patients with ScH contributed to higher EF (62.9 ± 3.9 vs. 61.6 ± 4.4%, p < 0.05), lower E/e' sep. ratio (6.60 ± 2.06 vs. 762 ± 2.29, p < 0.01), lower MPI (0.43 ± 0.07 vs. 0.47 ± 0.08%, p < 0.01), and improved GLS (-20.07 ± 2.7 vs. −19.55 ± 2.3%, p < 0.05) compared to values in ScH patients at baseline. Furthermore, in all study populations (ScH patients before and after levothyroxine therapy and controls), TSH levels significantly negatively correlated with EF (r = −0.15, p < 0.05), E/A (r = −0.14, p < 0.05), GLS (r = −0.26, p < 0.001), and S/TDI (r = −0.22, p < 0.01) and positively correlated with E/e' sep. (r = 0.14, p < 0.05). Conclusion: Patients with subclinical hypothyroidism versus healthy individuals had subtle changes in certain parameters that indicate involvement of systolic and diastolic function of the left ventricle. Although the values of the parameters were in normal range, they were significantly different compared to ScH and the control group at baseline, as well as to the ScH groups before and after treatment.The results of our study suggest that patients with ScH must be followed up during treatment to assess improvement of the disease. Some of the echocardiography obtained parameters were reversible after levothyroxine therapy.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Systole/drug effects , Thyroxine/pharmacology , Ventricular Function, Left/drug effects , Diastole/drug effects , Hypothyroidism/drug therapy , Systole/physiology , Thyroxine/administration & dosage , Thyroxine/blood , Thyroxine/therapeutic use , Triiodothyronine/blood , Thyrotropin/blood , Case-Control Studies , Prospective Studies , Echocardiography, Doppler, Pulsed , Diastole/physiology , Heart Ventricles/physiopathology , Heart Ventricles/diagnostic imaging
13.
Medwave ; 18(8)2018.
Article in English, Spanish | LILACS | ID: biblio-969320

ABSTRACT

INTRODUCCIÓN La suplementación habitual del hipotiroidismo se basa en la monoterapia con levotiroxina, sin embargo, algunos pacientes persisten con síntomas atribuibles al déficit de hormona tiroidea. Debido a esto se ha planteado que el uso de un tratamiento combinado con liotironina y levotiroxina otorgaría un mayor beneficio. MÉTODOS Realizamos una búsqueda en Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante el cribado de múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, analizamos los datos de los estudios primarios, realizamos un metanálisis y preparamos una tabla de resumen de los resultados utilizando el método GRADE. RESULTADOS Y CONCLUSIONES Identificamos tres revisiones sistemáticas que en conjunto incluyeron 12 estudios primarios, todos correspondientes a ensayos aleatorizados. Concluimos que la adición de liotironina al tratamiento del hipotiroidismo tiene un efecto mínimo o nulo sobre fatiga y calidad de vida. Probablemente tampoco mejora estado de ánimo, dolor ni función cognitiva, y no reduciría el peso corporal.


INTRODUCTION The usual supplementation for hypothyroidism is based on monotherapy with levothyroxine. However, some patients persist with symptoms attributable to the deficit of thyroid hormone. It has been suggested that the a combined treatment with liothyronine and levothyroxine would provide a greater benefit. METHODS We searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. RESULTS AND CONCLUSIONS We identified three systematic reviews including twelve primary studies overall, all of which were randomized trials. We concluded that the addition of liothyronine to the treatment of hypothyroidism has minimal or no effect on fatigue and quality of life. It probably does not improve mood, pain or function cognitive, and it would not reduce body weight.


Subject(s)
Humans , Thyroxine/administration & dosage , Triiodothyronine/administration & dosage , Hypothyroidism/drug therapy , Quality of Life , Body Weight , Randomized Controlled Trials as Topic , Databases, Factual , Treatment Outcome , Drug Therapy, Combination
14.
Rev. argent. endocrinol. metab ; 54(3): 130-135, set. 2017. graf, tab
Article in Spanish | LILACS | ID: biblio-957978

ABSTRACT

Los objetivos del presente trabajo fueron: 1) determinar la frecuencia de hipotiroidismo subclínico (HSC) en pacientes con enfermedad renal crónica (ERC), y 2) evaluar los cambios en la función renal de pacientes con ERC e HSC luego del tratamiento con levotiroxina. Se estudió a 182 pacientes, 99 con ERC y 83 sin ERC (grupo control), entre 20 y 70 años de edad, de ambos sexos, atendidos en centros de salud y consultorios hospitalarios de Posadas, Misiones. La frecuencia de HSC en el grupo con ERC fue del 28,3% y en el grupo control 14,5% (p = 0,025). Los pacientes con ERC e HSC fueron derivados al servicio de endocrinología, donde luego de 3 meses de tratamiento con levotiroxina, se revaluó la función renal, observando en todos los pacientes disminución en los niveles de creatinina sérica y aumento del índice de filtrado glomerular. Sobre la base de estos hallazgos se podría recomendar el estudio de la función tiroidea a todo paciente con ERC de causa desconocida, considerando al HSC entre las posibles causas de deterioro de la función renal.


The objectives of the present study were: 1) to determine the frequency of Subclinical Hypothyroidism (SCH) in patients with Chronic Renal Disease (CKD), and 2) to evaluate the changes in renal function in patients with CKD and SCH after treatment with levothyroxine. A total of 182 patients were studied, 99 with CKD and 83 without CKD (control group), with ages between 20 and 70 years old, of both sexes, attending health centres and hospital clinics in Posadas, Misiones, Argentina. The frequency of SCH was 28.3% in the CKD group, and 14.5% in the control group (P=.025). Patients with CKD and SCH were referred to medical endocrinology, where after three months of treatment with levothyroxine, renal function was evaluated, after which a decrease in serum creatinine levels and an increase in the glomerular filtration rate were observed in all patients. Based on these findings, the study of thyroid function should be recommended for all patients with CKD of unknown cause, considering SCH among the possible causes of impaired renal function.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Renal Insufficiency, Chronic/complications , Hypothyroidism/complications , Thyroxine/therapeutic use , Renal Insufficiency, Chronic/blood , Glomerular Filtration Rate , Hypothyroidism/drug therapy
15.
Arch. endocrinol. metab. (Online) ; 60(6): 562-572, Nov.-Dec. 2016. tab, graf
Article in English | LILACS | ID: biblio-827785

ABSTRACT

ABSTRACT Objective To compare the effects of a unique fixed combination levothyroxine/liothyronine (LT4/LT3) therapy in patients with primary hypothyroidism. Subjects and methods This is a randomized, double-blind, crossover study. Adults with primary hypothyroidism (n = 32, age 42.6 ± 13.3, 30 females) on stable doses of LT4 for ≥ 6 months (125 or 150 μg/day) were randomized to continue LT4 treatment (G1) or to start LT4/LT3 therapy (75/15 μg/day; G2). After 8 weeks, participants switched treatments for 8 more weeks. Thyroid function, lipid profile, plasma glucose, body weight, electrocardiogram, vital signs, and quality of life (QoL) were evaluated at weeks 0, 8 and 16. Results Free T4 levels were significantly lower while on LT4/LT3 (G1: 1.07 ± 0.29 vs. 1.65 ± 0.46; G2: 0.97 ± 0.26 vs. 1.63 ± 0.43 ng/dL; P < 0.001). TSH and T3 levels were not affected by type of therapy. More patients on LT4/LT3 had T3 levels above the upper limit (15% vs. 3%). The combination therapy led to an increase in heart rate, with no significant changes in electrocardiogram or arterial blood pressure. Lipid profile, body weight and QoL remained unchanged. Conclusions The combination therapy yielded significantly lower free T4 levels, with no changes in TSH or T3 levels. More patients on LT4/T3 had elevated T3 levels, with no significant alterations in the evaluated outcomes. No clear clinical benefit of the studied formulation could be observed. Future trials need to evaluate different formulations and the impact of the combined therapy in select populations with genetic polymorphisms.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Thyroxine/therapeutic use , Triiodothyronine/therapeutic use , Hypothyroidism/drug therapy , Quality of Life , Thyroid Function Tests , Thyroxine/blood , Thyroxine/pharmacology , Triiodothyronine/blood , Triiodothyronine/pharmacology , Blood Glucose/analysis , Body Weight/drug effects , Thyrotropin/drug effects , Cholesterol/blood , Double-Blind Method , Cross-Over Studies , Drug Combinations , Hypothyroidism/blood
16.
Rev. chil. cir ; 68(1): 87-93, feb. 2016. tab
Article in Spanish | LILACS | ID: lil-780539

ABSTRACT

Abstract Thyroid disorders and chronic use of corticosteroids are common in the surgical population, so is necessary an appropriate perioperative management of these patients. There is no contraindication for elective surgery in patients with asymptomatic hypothyroidism and good control, it is not necessary to maintain thelevothyroxine dose the day of surgery, due to the pharmacokinetic properties of the drug. If hypothyroidpatients are symptomatic and/or have not reached the euthyroid phase, should be treated and compensatedprior to the elective surgical procedure. Patients with hyperthyroidism should keep their antithyroid treatmentincluding the day of surgery. The symptomatic and/or decompensated hyperthyroidism have an increasedrisk of developing a thyroid storm, so no elective surgery is recommended in these patients, which should beconducted once achieved an euthyroid state. A strict monitoring in the postoperative period is key to preventcomplications. Chronic glucocorticoid use is common. In these patients there is risk of developing acute adrenal insufficiency by surgical stress, so before surgery (elective or emergency) it is necessary to supplementwith exogenous corticosteroid dose dependent on the type of surgical procedure performed.


Resumen Los trastornos tiroideos y el uso crónico de corticoides son frecuentes en la población quirúrgica, por lo que es necesario un manejo perioperatorio adecuado en este tipo de pacientes. No existe contraindicación para una cirugía electiva en pacientes con hipotiroidismo asintomáticos y buen control, no siendo necesario mantener la dosis habitual de levotiroxina el día de la cirugía, debido a las características farmacocinéticas del medicamento. Si los pacientes hipotiroideos se encuentran sintomáticos y/o no han alcanzado la fase eutiroidea, deben ser tratados y compensados previo al procedimiento quirúrgico electivo. Los pacientes hipertiroideos deben mantener su tratamiento antitiroideo incluso el día de la cirugía. En el hipertiroidismo sintomático y/o descompensado existe mayor riesgo de desarrollar una tormenta tiroidea, por lo que no se recomiendacirugía electiva en este tipo de pacientes, la cual debe realizarse una vez logrado un estado eutiroideo. Una estricta monitorización en el período postoperatorio es clave para prevenir complicaciones. El uso crónico degluco corticoides es frecuente. En estos pacientes existe riesgo de desarrollar insuficiencia suprarrenal aguda ante el estrés quirúrgico, por lo que antes de una cirugía (electiva o de urgencia) es necesario suplementar concorticoides exógenos, en dosis dependientes del tipo de procedimiento quirúrgico a realizarse.


Subject(s)
Humans , Surgical Procedures, Operative/methods , Thyroid Diseases/drug therapy , Preoperative Care/methods , Adrenal Cortex Hormones/therapeutic use , Postoperative Complications/prevention & control , Thyroid Diseases/complications , Adrenal Insufficiency/prevention & control , Perioperative Period , Glucocorticoids/therapeutic use , Hyperthyroidism/drug therapy , Hypothyroidism/drug therapy , Intraoperative Complications/prevention & control
17.
Arch. endocrinol. metab. (Online) ; 59(6): 495-500, Dec. 2015. tab
Article in English | LILACS | ID: lil-767930

ABSTRACT

Objective Glycated hemoglobin (HbA1c) may not accurately reflect the level of glycemia in conditions of altered erythrocyte turnover. Hypothyroidism is one condition associated with sluggish erythropoesis. To assess changes in HbA1c, independent of changes in plasma glucose after initiation of thyroxine replacement in patients with overt hypothyroidism. Materials and methods In this prospective longitudinal study carried out in a tertiary care centre, adult non-diabetic patients with overt hypothyroidism recruited between March 2012 to August 2013 were rendered euthyroid on thyroxine. They underwent testing for hemoglobin, HbA1c, reticulocyte count, thyroxine, thyrotropin and a standard oral glucose tolerance test, both before and at 3 months after restoration to the euthyroid state. Main outcome assessed was the change in HbA1c independent of the change in glucose parameters. Results Thirty eight patients (35 female and 3 male) aged 37.8 ± 10.2 years with overt hypothyroidism (thyroxine 12.6 ± 13.4 ng/mL and thyrotropin -98.1 ± 63.7 µIU/mL respectively) were recruited. While HbA1c fell from 5.8 ± 0.7% to 5.6 ± 0.5% (p = 0.009) at 3 months following the correction of hypothyroidism, there were no changes in the fasting and the 2 hr post oral glucose tolerance test glucose (p = 0.67 and 0.56 respectively). The number of patients with dysglycemia diagnosed by HbA1c (i.e HbA1c≥ 5.7%) fell from 25 (65.78%) to 17 (44.7%) after treatment (p = 0.008). There were 7 (18.4%) patients with HbA1c ≥ 6.5% at baseline, but this fell to just 4 (10.5%) (p < 0.001) after 3 months of euthyroidism. Conclusion HbA1c is not a reliable diagnostic test for diabetes in the presence of hypothyroidism.


Subject(s)
Adult , Female , Humans , Male , Middle Aged , Blood Glucose/analysis , Hormone Replacement Therapy , Glycated Hemoglobin A/drug effects , Hypothyroidism/drug therapy , Thyroxine/therapeutic use , Glucose Tolerance Test , Glycated Hemoglobin A/analysis , Hypothyroidism/blood , Longitudinal Studies , Prospective Studies , Tertiary Care Centers , Thyroxine/pharmacology
18.
Arch. endocrinol. metab. (Online) ; 59(2): 141-147, 04/2015. tab, graf
Article in English | LILACS | ID: lil-746464

ABSTRACT

Objective Investigate the effect of GC-1 on tolerance to exercise in rats with experimental hypothyroidism. Materials and methods Hypothyroidism was induced with methimazole sodium and perchlorate treatment. Six groups with eight animals were studied: control group (C), hypothyroid group without treatment (HYPO); hypothyroidism treated with physiological doses of tetraiodothyronine (T4) or 10 times higher (10×T4); hypothyroidism treated with equal molar doses of GC-1 (GC-1) or 10 times higher (10×GC-1). After eight weeks, each animal underwent an exercise tolerance test by measuring the time (seconds), in which the rats were swimming with a load attached to their tails without being submerging for more than 10 sec. After the test, the animals were killed, and blood samples were collected for biochemical analysis, and the heart and soleus muscle were removed for weighing and morphometric analysis of the cardiomyocyte. Results Hypothyroidism significantly reduced tolerance to exercise and, treatment with GC-1 1× or T4 in physiological doses recover tolerance test to normal parameters. However, high doses of T4 also decreased tolerance to physical exercise. Conversely, ten times higher doses of GC-1 did not impair tolerance to exercise. Interestingly, hypothyroidism, treated or not with T4 in a physiological range, GC-1 or even high doses of GC-1 (10X) did not change cardiomyocyte diameters and relative weight of the soleus muscle. In contrast, higher doses of T4 significantly increased cardiomyocyte diameter and induced atrophy of the soleus muscle. Conclusion Unlike T4, GC-1 in high doses did not modify tolerance to physical exercise in the rats with hypothyroidism. .


Subject(s)
Animals , Acetates/pharmacology , Exercise Tolerance/drug effects , Hypothyroidism/drug therapy , Phenols/pharmacology , Thyroid Hormone Receptors beta/agonists , Exercise Tolerance/physiology , Hypothyroidism/blood , Hypothyroidism/chemically induced , Hypothyroidism/physiopathology , Methimazole , Muscle, Skeletal/drug effects , Myocytes, Cardiac/drug effects , Perchlorates , Rats, Wistar , Sodium Compounds , Swimming , Thyrotropin/blood , Thyroxine/administration & dosage , Thyroxine/blood , Triiodothyronine/blood
19.
Arq. bras. endocrinol. metab ; 58(9): 906-911, 12/2014. tab, graf
Article in English | LILACS | ID: lil-732193

ABSTRACT

Objective To determine how endocrinologists in Latin America deal with clinical case scenarios related to hypothyroidism and pregnancy. Materials and methods In January 2013, we sent an electronic questionnaire on current practice relating to management of hypothyroidism in pregnancy to 856 members of the Latin American Thyroid Society (LATS) who manage pregnant patients with thyroid disease. Subsequently, we have analyzed responses from physician members. Results Two hundred and ninety-three responders represent clinicians from 13 countries. All were directly involved in the management of maternal hypothyroidism and 90.7% were endocrinologists. The recommendation of a starting dose of L-thyoxine for a woman diagnosed with overt hypothyroidism in pregnancy, preconception management of euthyroid women with known thyroid autoimmunity and approach related to ovarian hyperstimulation in women with thyroid peroxidase antibodies were widely variable. For women with known hypothyroidism, 34.6% of responders would increase L-thyroxine dose by 30-50% as soon as pregnancy is confirmed. With regard to screening, 42.7% of responders perform universal evaluation and 70% recommend TSH < 2.5 mUI/L in the first trimester and TSH < 3 mUI/L in the second and third trimester as target results in known hypothyroid pregnant women. Conclusion Deficiencies in diagnosis and management of hypothyroidism during pregnancy were observed in our survey, highlighting the need for improvement of specialist education and quality of care offered to patients with thyroid disease during pregnancy in Latin America. Arq Bras Endocrinol ...


Objetivo Determinar, na América Latina, como os endocrinologistas lidam com cenários clínicos relacionados ao hipotireoidismo durante a gravidez. Materiais e métodos Em Janeiro de 2013, foi enviado, para 856 membros da Sociedade Latino-Americana de Tireoide (LATS), um questionário eletrônico sobre práticas relacionadas ao manejo do hipotireoidismo durante a gestação. Subsequentemente, as respostas foram analisadas. Resultados Duzentos e noventa e três médicos, de 13 países, responderam ao questionário. Todos estavam diretamente envolvidos no manejo de hipotireoidismo materno e 90,7% eram endocrinologistas. As recomendações de iniciar terapia com levotiroxina para uma mulher com hipotireoidismo franco durante a gravidez e o manejo na fase de pré-concepção de pacientes eutireoidianas com conhecida autoimunidade em hiperestimulação ovariana variaram amplamente. Para mulheres com hipotireoidismo conhecido, apenas 34,6% dos respondedores aumentariam a dose de levotiroxina em 30-50% assim que a gravidez fosse confirmada. Em relação ao rastreamento, 42,7% dos respondedores realizam avaliação universal. Setenta por cento recomendam TSH < 2,5 mUI/L no primeiro trimestre e TSH < 3 mUI/L no terceiro trimestre como alvos. Conclusão Observamos problemas no diagnóstico e manejo do hipotireoidismo durante a gestação, enfatizando a necessidade, na América Latina, de melhoria na educação médica continuada em áreas como tireoiodopatias na gestação. Arq Bras Endocrinol Metab. ...


Subject(s)
Adult , Female , Humans , Pregnancy , Hypothyroidism/diagnosis , Hypothyroidism/drug therapy , Practice Patterns, Physicians'/statistics & numerical data , Pregnancy Complications/diagnosis , Pregnancy Complications/drug therapy , Surveys and Questionnaires , Europe , Latin America , Mass Screening , Practice Guidelines as Topic , Societies, Medical/statistics & numerical data , Thyroid Gland/immunology , Thyrotropin/analysis , Thyroxine/therapeutic use
20.
Arq. bras. endocrinol. metab ; 58(7): 731-736, 10/2014. tab, graf
Article in English | LILACS | ID: lil-726256

ABSTRACT

Objective It is believed that gastric pH interferes in levothyroxine absorption. Omeprazole, which acts by blocking the secretion of gastric acid, might interfere in hypothyroidism control in patients using levothyroxine and this effect could be dose dependent. The present study aimed to investigate this possibility. Subjects and methods Twenty-one patients with primary hypothyroidism who had been using a stabilized levothyroxine dosage for at least one year were selected and randomly assigned to take omeprazole at the dosage of 40 mg or 20 mg per day. The mean levels of thyroid-stimulating hormone (TSH) before and 3 months after omeprazole usage were compared in the entire sample and in each group. Results Ten patients concluded the entire treatment protocol in the 20 mg group and nine patients in the 40 mg group. There was no significant difference in TSH levels before and 3 months after omeprazole treatment in the entire patient sample (median levels: 2.28 vs. 2.30 mU/L, respectively: p = 0.56). Analysis of each subgroup (20 and 40 mg) showed no significant variation in TSH levels before and 3 months after omeprazole treatment (median levels: 2.24 vs. 2.42 mU/L, p = 0.62, and 2.28 vs. 2.30 mU/L, p = 0.82, respectively). No significant difference in the absolute (p = 0.93) or relative (p = 0.87) delta were observed between the two subgroups. Conclusion Omeprazole in the dosage of 20 or 40 mg/day does not interfere in a clinically relevant manner in the treatment of patients with hypothyroidism that was previously under control. .


Objetivo Acredita-se que o pH gástrico possa interferir na absorção de levotiroxina. O omeprazol, ao inibir a secreção de ácido gástrico, poderia interferir no controle do hipotireoidismo em pacientes em uso de levotiroxina de forma dose-dependente. O presente estudo tem como objetivo investigar essa hipótese. Sujeitos e métodos Vinte e um pacientes em uso de dose estável de levotiroxina por no mínimo um ano foram incluídos e aleatoriamente selecionados para iniciar o uso de omeprazol na dose de 40 mg ou 20 mg por dia. Foram comparados os níveis médios de hormônio tireoestimulante (TSH) antes e 3 meses após o uso de omeprazol, na amostra total e em cada grupo. Resultados Dez pacientes concluíram o protocolo de tratamento no grupo de 20 mg e nove, no grupo de 40 mg. Não houve diferença significativa nos níveis de TSH antes e 3 meses após terapia com omeprazol na amostra total de pacientes (média: 2,28 vs. 2,30 mU/L, respectivamente: p = 0,56). A análise de cada subgrupo (20 e 40 mg) não demonstrou variação significativa nos níveis de TSH antes e 3 meses após terapia com omeprazol (média: 2,24 vs. 2,42 mU/L, p = 0,62 e 2,28 vs. 2,30 um/L, p = 0,82, respectivamente). Não houve diferença significativa no delta absoluto (p = 0,93) ou relativo (p = 0,87) entre os dois subgrupos. Conclusão Omeprazol na dose de 20 ou 40 mg/dia não interfere de forma clinicamente relevante no tratamento de pacientes com hipotireoidismo previamente bem controlados. .


Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Anti-Ulcer Agents/administration & dosage , Hormone Replacement Therapy , Hypothyroidism/drug therapy , Omeprazole/administration & dosage , Thyroxine/administration & dosage , Drug Administration Schedule , Drug Interactions , Pilot Projects , Random Allocation , Thyrotropin/blood
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