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2.
Rev. méd. Chile ; 148(6): 740-745, jun. 2020. tab
Article in English | LILACS | ID: biblio-1139366

ABSTRACT

ABSTRACT Background: Hypothyroidism occurs in 1-2% of the general population, is associated with significant morbidity and requires continuous treatment with levothyroxine. Aim: To determine the effectiveness, adherence and safety of levothyroxine therapy in patients with hypothyroidism. Material and Methods: The Morisky-Green adherence test was applied, and effectiveness was determined by measuring thyroid-stimulating hormone (TSH) in 330 patients with with hypothyroidism; the mean age was 64+-15 years and 76% was women. Results: Median TSH was 2.09 mIU/L (interquartile range: 1.16-3.61 mIU/L). Two hundred thirty-five (71%) patients had TSH levels in the euthyroid range, 64 (19%) in the hypothyroid range and 31 (9%) in the hyperthyroid range. Complete, moderate and lack of adherence with levothyroxine was reported in 283 (86%), 29 (9%) and 18 (5%) of patients, respectively. The presence of anemia (odds ratio (OR): 0.37, 95% confidence intervals (CI): 0.15-0.98) or the need of doses over 100 µg/day (OR: 0.47, 95%CI: 0.28-0.80) increased the probability of having an abnormal TSH level. Conclusions: In a large proportion of these patients, TSH levels were controlled, and most patients were adherent to levothyroxine therapy.


Antecedentes: El hipotiroidismo se presenta entre el 1-2% de la población general, genera importante morbilidad y requiere tratamiento con levotiroxina de manera continua. Objetivo: Determinar la efectividad, adherencia y seguridad de la terapia con levotiroxina en pacientes con hipotiroidismo. Material y Métodos: Se aplicó test de adherencia de Morisky-Green y se determinó efectividad mediante medición de TSH en 330 pacientes con edad promedio 63 ± 15 años (76% mujeres). Resultados: La mediana de TSH fue 2,09 mUI/l, (rango intercuartílico: 1,16mUI/l-3,61mUI/l). Un total de 235 (71,2%) tenían cifras de TSH en rango de estado eutiroideo, 64 (19,4%) se catalogaron hipotiroideos y 31 (9,4%) hipertiroideos. El 86% (n = 283) manifestó tener adherencia completa al medicamento, 29 (9%) moderada y 18 (5%) se clasificaron poco adherentes. Tener diagnóstico de anemia (razón de riesgo (RR): 0,37; intervalos de confianza (IC) 95%: 0,15-0,98) o necesitar dosis mayores de 100 µg/día (RR: 0,47; IC95%: 0,28-0,80) elevaron la probabilidad de no controlar el hipotiroidismo. Conclusiones. Una alta proporción de pacientes se encuentran controlados y con mucha frecuencia son adherentes a la terapia con levotiroxina.


Subject(s)
Humans , Female , Middle Aged , Aged , Thyroxine/therapeutic use , Hyperthyroidism , Hyperthyroidism/drug therapy , Thyrotropin , Prescriptions
3.
Rev. Hosp. Ital. B. Aires (2004) ; 39(4): 146-148, dic. 2019. ilus
Article in Spanish | LILACS | ID: biblio-1099838

ABSTRACT

Los anticuerpos monoclonales que inhiben los puntos de control PD-1 y CTLA-4 se usan actualmente en el tratamiento del melanoma y cáncer metastásico de pulmón de células no pequeñas, entre otros. Se refiere el caso de una paciente con cáncer de pulmón en tratamiento con pembrolizumab. La paciente se presentó con edema facial y parálisis facial periférica. En el laboratorio se observó la hormona tirotrofina (TSH) elevada y se llegó al diagnóstico de hipotiroidismo por pembrolizumab. Inició tratamiento con levotiroxina con mejoría clínica. Se presenta este caso por el importante papel del dermatólogo en el manejo multidisciplinario del paciente oncológico. (AU)


Monoclonal antibodies that inhibit PD-1 and CTLA-4 control points are currently used in the treatment of melanoma and metastatic non-small cell lung cancer, among others. The case of a patient, with lung cancer being treated with Pembrolizumab. The patient was presented with facial edema and peripheral facial paralysis and in the laboratory the elevated hormone Tyrotrophin (TSH) was observed, the diagnosis of pembrolizumab hypothyroidism was reached. She started treatment with levothyroxine with clinical improvement. This case is presented by the important role of the dermatologist in the multidisciplinary management of the cancer patient. (AU)


Subject(s)
Humans , Female , Middle Aged , M Phase Cell Cycle Checkpoints/drug effects , Immunotherapy/adverse effects , Antibodies, Monoclonal/adverse effects , Thyroxine/therapeutic use , Brain Neoplasms/complications , Brain Neoplasms/drug therapy , Thyrotropin/analysis , Carboplatin/administration & dosage , Carcinoma, Non-Small-Cell Lung/complications , Carcinoma, Non-Small-Cell Lung/drug therapy , Tumor Suppressor Proteins/drug effects , Dermatology , Facial Injuries , Facial Paralysis , CTLA-4 Antigen/drug effects , CTLA-4 Antigen/physiology , Programmed Cell Death 1 Receptor/drug effects , Programmed Cell Death 1 Receptor/physiology , Pemetrexed/administration & dosage , Melanoma/complications , Melanoma/drug therapy , Antibodies, Monoclonal/administration & dosage , Antibodies, Monoclonal/therapeutic use , Neoplasm Metastasis/drug therapy
4.
Rev. cuba. endocrinol ; 30(2): e197, mayo.-ago. 2019. graf
Article in Spanish | LILACS, CUMED | ID: biblio-1126436

ABSTRACT

RESUMEN El síndrome de Van Wyk-Grumbach se caracteriza por hipotiroidismo primario de larga duración asociado a pubertad precoz. Se presenta una paciente de 7 años, mestiza, que acude por sangrado vaginal, acompañado de hiperpigmentación de las areolas sin galactorrea, abdomen globuloso, mixedema, hirsutismo, baja talla, astenia y retraso escolar. La química sanguínea mostró anemia, hipercolesterolemia y hipertransaminasemia; los estudios de imágenes constataron derrame pericárdico, retraso marcado de la edad ósea, incremento de las dimensiones de la silla turca y gran quiste del ovario con aparente criterio quirúrgico. Los estudios hormonales confirmaron la sospecha de hipotiroidismo primario asociado a hiperprolactinemia. El tratamiento sustitutivo con levotiroxina sódica revirtió los signos y síntomas de pubertad precoz, lo que evitó la cirugía del quiste de ovario; la recuperación en el ambiente escolar y social fue indiscutible. Reconocer esta entidad evita tratamientos absolutamente contraindicados, como la extirpación de los quistes o el tratamiento quirúrgico de la hiperplasia hipofisaria(AU)


ABSTRACT Van Wyk-Grumbach syndrome is characterized by long-lasting primary hypothyroidism associated with precocious puberty. A case of a 7-year-old female mestizo patient is reported. She came to consultation for vaginal bleeding, accompanied by hyperpigmentation of the areolas without galactorrhea, globular abdomen, myxedema, hirsutism, short stature, asthenia and school delay. Blood chemistry showed anemia, hypercholesterolemia and hypertransaminasemia. Imaging studies showed pericardial effusion, marked delay in bone age, increased dimensions of Turkish chair and large ovarian cyst with apparent surgical criteria. Hormonal studies confirmed the suspicion of primary hypothyroidism associated with hyperprolactinemia. Substitute treatment with levothyroxine sodium reversed the signs and symptoms of precocious puberty, which prevented ovarian cyst surgery; the recovery in the school and social environment was certain. Recognizing this entity avoids absolutely contraindicated treatments, such as the removal of cysts or the surgical treatment of pituitary hyperplasia(AU)


Subject(s)
Humans , Female , Child , Puberty, Precocious , Thyroxine/therapeutic use , Hypercholesterolemia/etiology , Hypothyroidism/diagnosis , Anemia/etiology
5.
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
6.
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
7.
Arch. endocrinol. metab. (Online) ; 62(6): 641-643, Dec. 2018. tab
Article in English | LILACS | ID: biblio-1038493

ABSTRACT

ABSTRACT Objective: Universal screening for thyroid dysfunction in pregnant women is not recommended by the American Thyroid Association (ATA) or the American Association of Clinical Endocrinologists (AACE). This study evaluated the frequency of pregnant women that would have an indication for levothyroxine (L-T4) according to the new ATA/AACE guidelines among low-risk women without an indication for screening with TSH. Subjects and methods: The sample consisted of 412 pregnant women ranging in age from 18 to 30 years. These women were considered to be at low risk for thyroid dysfunction according to ATA/AACE and would not be candidates for screening with TSH. Anti-thyroid peroxidase antibodies (TPOAb) and TSH were measured. Women who had TSH > 2.5 mIU/L or TPOAb in the first trimester were submitted to subsequent evaluations in the second and third trimester. Results: In the first trimester, none of the pregnant women would have L-T4 therapy "recommended" and treatment would be "considered" in only two. In the second trimester, pregnant women with positive TPOAb or TSH > 2.5 mIU/L in the first trimester (n = 30) were reevaluated. L-T4 treatment would be "recommended" in only one woman and would be "considered" in two others. The 28 women that were not treated in the second trimester were reevaluated in the third trimester, but none of them would have L-T4 "recommended". Conclusion: The findings of the study suggest that selective screening, recommended by ATA/AACE does not result in a significant loss of pregnant women with an indication for L-T4 treatment.


Subject(s)
Humans , Female , Pregnancy , Adult , Young Adult , Pregnancy Complications/diagnosis , Prenatal Diagnosis/standards , Thyroid Diseases/diagnosis , Thyroid Diseases/drug therapy , Thyroxine/therapeutic use , Practice Guidelines as Topic/standards , Pregnancy Complications/blood , Pregnancy Trimesters , Reference Values , Autoantibodies/blood , Thyroid Diseases/blood , Brazil , Thyrotropin/blood , Risk Factors , Risk Assessment , Guideline Adherence , Withholding Treatment/statistics & numerical data , Iodide Peroxidase/immunology
8.
Rev. argent. endocrinol. metab ; 55(3): 21-30, set. 2018. graf
Article in Spanish | LILACS | ID: biblio-1041741

ABSTRACT

RESUMEN La Endotelina-1 (ET1) y Proteína C Reactiva ultrasensible (PCRus) como marcadores de disfunción endotelial (DE) e inflamación vascular en hipotiroidismo subclínico (HS) han mostrado resultados controvertidos. El rol del estrés oxidativo y defensa antioxidante (TRAP) es motivo de discusión. Objetivos Establecer si el HS y la autoinmunidad tiroidea (AIT), excluyendo otros factores de riesgo cardiovascular, pueden causar DE e inflamación vascular, evaluadas a través de ET1 y PCRus, respectivamente. Establecer si TRAP juega algún rol. Evaluar cambios en ET1 y PCRus luego del tratamiento con levotiroxina (LT4). Material y métodos Se evaluaron prospectivamente 70 pacientes divididos en 3 grupos: HS: 41 pacientes (T4 normal,TSH >4,2 y <10 mUI/L), AIT: 10 pacientes eutiroideos (TSH <4,2 mUI/L) con aTPO y/o aTg (+) y Control: 19 pacientes eutiroideos sin AIT. Se excluyeron otros factores de riesgo cardiovascular. Se midió basalmente ET1, PCRus y TRAP plasmáticos, y en HS bajo LT4 (n = 24): ET1 y PCRus. Resultados No hubo diferencias significativas en edad, IMC, perfil lipídico y TRAP. ET1 y PCRus fueron significativamente mayores en pacientes con HS (media ± DS 1,77 ± 0,85 pg/ml y 1,5 ± 0,6 mg/l vs. controles (0,8 ± 0,3 pg/ml y 0,5 ± 0,2 mg/l) p <0,0001 y <0,008 respectivamente. Del mismo modo en AIT (1,4 ± 0.4 pg/ml y 2,3 ± 1,3 mg/l) vs controles p <0,0001 y <0,034, respectivamente. La TSH fue mayor en el grupo AIT vs. Control 2,57 ± 0,88 vs. 1,64 ± 0,5 mUI/L; p = 0,002. En HS bajo LT4 (8,7 ± 3,8 meses) se observó descenso de ET1 (p <0,001). ET1 correlacionó con TSH (r = 0,5 p <0,0001). El punto de corte de ET1 mediante curva ROC fue 1,32 pg/ml (Sensibilidad 81,6%-Especificidad 75%). Conclusiones ET1 y PCRus resultaron marcadores útiles para evaluar DE e inflamación vascular asociadas a HS. La defensa antioxidante no ejercería un rol en estos mecanismos. El tratamiento con LT4 produjo una significativa caída de ET1, pudiendo necesitarse un período más largo de eutiroidismo para normalizarla. En AIT, niveles de TSH >2,5 mUI/L podrían sugerir un mínimo grado de hipotiroidismo justificando la elevación en ET1 y PCR, sin descartar el rol de la AIT "per se".


ABSTRACT The measurement of endothelin-1 (ET1) and high sensitivity C-reactive protein (hsCRP) as markers of endothelial dysfunction (ED) and vascular inflammation in subclinical hypothyroidism (SH) has shown controversial results. The role of oxidative stress and antioxidant defense (TRAP) is a matter of discussion. Objectives To establish if SH and thyroid autoimmunity (TAI), excluding other cardiovascular risk factors, may cause ED and vascular inflammation, evaluated through the measurement of ET1 and hsCRP respectively. To determine if TRAP could have some role. Additionally, changes in these parameters after treatment with levothyroxine (LT4) will be evaluated. Material and methods: 70 patients were prospectively evaluated. They were classified into: SH Group: 41 patients (normal T4, TSH> 4.2 and <10 mIU/L), TAI Group: 10 euthyroid patients (TSH <4.2 mUI/L) with positive aTPO and/or aTg and Control Group: 19 euthyroid patients without TAI. Other cardiovascular risk factors were excluded in patients and controls. Plasma ET1, hsCRP and TRAP were measured basally, and ET1 and hsCRP under LT4 therapy in the HS Group. Results There were no significant differences between the 3 groups in age, BMI, lipids and TRAP. ET1 and hsCRP were significantly higher in patients with SH (mean ± SD 1.77 ± 0.85 pg/ml and 1.5 ± 0.6 mg/l) vs. controls (0.8 ± 0.3 pg/ml y 0.5 ± 0.2 mg/l) p <0.0001 y <0.008 respectively. Similarly, in TAI patients (1.4 ± 0.4 pg/ml y 2.3 ± 1.3 mg/l) vs controls, p <0.0001 and <0.034, respectively. TSH was higher in the TAI patients versus control group (2.5 ± 0.88 versus 1.64 ± 0.5 mIU/L, p = 0.002). Twenty-four patients with SH showed a significant decrease in ET1 (p <0.001) under treatment with LT4 (8.7 ± 3.8 months). ET1 had a highly significant correlation (p <0.0001) with TSH (r = 0.5). The cut-off level of ET1 established by ROC curve was 1.32 pg/ml (Sensitivity 81.6%-Specificity 75%). Conclusions ET1 and hsCRP were useful markers to evaluate ED and vascular inflammation associated with SH. There were no differences in TRAP levels between patients and controls, so it does not appear that oxidative stress would have played any role. Treatment with LT4 produced a significant drop in ET1. Probably, a longer period of euthyroidism might be necessary to normalize ET1 levels. In TAI Group, TSH levels >2.5 mUI/L could suggest a "minimal degree" of hypothyroidism justifying the elevation in ET1 and hs CRP. The role of the TAI "per se" couldn't be completely ruled out.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , C-Reactive Protein/drug effects , Endothelin-1/drug effects , Hypothyroidism/complications , Thyroxine/therapeutic use , C-Reactive Protein/analysis , Autoimmunity/drug effects , Case-Control Studies , Endothelin-1/analysis , Antioxidants/metabolism
9.
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
10.
Porto Alegre; Universidade Federal do Rio Grande do Sul. Telessaúde; 2018.
Non-conventional in Portuguese | LILACS | ID: biblio-995581

ABSTRACT

É uma condição comum, encontrada em 5% das mulheres e 1% dos homens. Se avaliada por ecografia, a prevalência aumenta para 19% a 68%. A principal preocupação com nódulos de tireoide é a possibilidade de neoplasia maligna de tireoide. Apesar disso, a frequência de câncer de tireoide é baixa (7% a 15 % do total de nódulos) e a maioria dos pacientes com esse diagnóstico costuma ter um bom prognóstico (mais de 90% das neoplasias são papilares ou foliculares). Esta guia apresenta informação que orienta a conduta para casos de nódulo de tireoide no contexto da Atenção Primária à Saúde, incluindo: Manifestação Clínica, Diagnóstico, Avaliação Inicial, Indicação de PAAF, Acompanhamento ecográfico de nódulo não puncionado, Conduta após PAAF, Tireoide com múltiplos nódulos, Tratamento, Encaminhamento para serviço especializado.


Subject(s)
Humans , Thyroid Nodule/diagnosis , Thyroid Nodule/therapy , Primary Health Care , Referral and Consultation , Thyroxine/therapeutic use
11.
J. pediatr. (Rio J.) ; 93(6): 649-654, Nov.-Dec. 2017. tab, graf
Article in English | LILACS | ID: biblio-894066

ABSTRACT

Abstract Objectives: To determine the prevalence of congenital hypothyroidism in children with filter-paper blood-spot TSH (b-TSH) between 5 and 10 µIU/mL in the neonatal screening. Methods: This was a retrospective study including children screened from 2003 to 2010, with b-TSH levels between 5 and 10 µIU/mL, who were followed-up during the first two years of life when there was no serum TSH normalization. The diagnosis of congenital hypothyroidism was defined as serum TSH ≥10 µIU/mL and start of levothyroxine treatment up to 2 years of age. Results: Of the 380,741 live births, 3713 (1.04%) had filter paper TSH levels between 5 and 10 µIU/mL and, of these, 339 (9.13%) had congenital hypothyroidism. Of these, 76.11% of the cases were diagnosed in the first three months of life and 7.96% between 1 and 2 years of age. Conclusion: The study showed that 9.13% of the children with b-TSH levels between 5 and 10 µIU/mL developed hypothyroidism and that in approximately one-quarter of them, the diagnosis was confirmed only after the third month of life. Based on these findings, the authors suggest the use of a 5 µIU/mL cutoff for b-TSH levels and long-term follow-up of infants whose serum TSH has not normalized to rule out congenital hypothyroidism.


Resumo Objetivos: Determinar a prevalência de hipotireoidismo congênito em crianças com TSH em papel filtro (TSH-f) entre 5 e 10 µUI/mL na triagem neonatal. Métodos: Estudo retrospectivo que incluiu crianças triadas de 2003 a 2010, com TSH-f entre 5 e 10 µUI/mL, acompanhadas nos dois primeiros anos de vida quando não houve normalização do TSH sérico. O diagnóstico de hipotireoidismo congênito foi definido como TSH sérico igual ou superior a 10 µUI/mL e início de tratamento com levotiroxina até os dois anos. Resultados: Dos 380.741 nascidos vivos triados, 3.713 (1,04%) apresentaram TSH-f entre 5 e 10 µUI/mL e, desses, 339 (9,13%) tinham hipotireoidismo congênito. Desses, 76,11% dos casos foram diagnosticados nos primeiros três meses de vida e 7,96% entre um e dois anos. Conclusão: O estudo mostra que 9,13% das crianças com TSH-f entre 5 e 10 µUI/mL desenvolveram hipotireoidismo e que em cerca de um quarto delas o diagnóstico só se confirmou após o terceiro mês de vida. Com base nesses achados, sugere-se, para descartar o hipotireoidismo congênito, o uso do ponto de corte de TSH-f de 5 µUI/mL e o acompanhamento em longo prazo dos lactentes cujo TSH sérico não tenha se normalizado.


Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Neonatal Screening , Congenital Hypothyroidism/diagnosis , Paper , Thyroxine/therapeutic use , Brazil/epidemiology , Blood Specimen Collection/methods , Prevalence , Retrospective Studies , Congenital Hypothyroidism/drug therapy , Congenital Hypothyroidism/epidemiology
12.
Arch. endocrinol. metab. (Online) ; 61(5): 432-437, Sept.-Oct. 2017. tab, graf
Article in English | LILACS | ID: biblio-887585

ABSTRACT

ABSTRACT Objectives To describe the findings of thyroid ultrasonography (T-US), its contribution to diagnose congenital hypothyroidism (CH) and the best time to perform it. Subjects and methods Forty-four patients with CH were invited to undergo T-US and 41 accepted. Age ranged from 2 months to 45 years; 23 patients were females. All were treated with L-thyroxine; 16 had previously undergone scintigraphy and 30 had previous T-US, which were compared to current ones. Results At the current T-US, the thyroid gland was not visualized in its normal topography in 10 patients (24.5%); 31 T-US showed topic thyroid, 17 with normal or increased volume due to probable dyshormonogenesis, 13 cases of hypoplasia and one case of left-lobe hemiagenesis. One patient had decreased volume due to central hypothyroidism. Scintigraphy scans performed 3-4 years earlier showed 100% agreement with current results. Comparisons with previous T-US showed concordant results regarding thyroid location, but a decrease in current volume was observed in eight due to the use of L-thyroxine, calling the diagnosis of hypoplasia into question. Conclusions The role of T-US goes beyond complementing scintigraphy results. It allows inferring the etiology of CH, but it must be performed in the first months of life. An accurate diagnosis of CH will be attained with molecular study and the T-US can guide this early assessment, without therapy withdrawal.


Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , Adult , Middle Aged , Young Adult , Thyroid Gland/diagnostic imaging , Congenital Hypothyroidism/diagnostic imaging , Thyroxine/therapeutic use , Time Factors , Ultrasonography , Sensitivity and Specificity , Congenital Hypothyroidism/etiology , Congenital Hypothyroidism/drug therapy
13.
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
14.
Pakistan Journal of Medical Sciences. 2017; 33 (4): 818-822
in English | IMEMR | ID: emr-188593

ABSTRACT

Objective: To determine the frequency, modes of clinical presentation and indications for replacement therapy in a cohort of patients with subclinical hypothyroidism [SCH]


Methods: This study was conducted at the Endocrine and Diabetes Unit of Jinnah Postgraduate Medical Centre from September 2007 - October 2015. This was a retrospective chart analysis of prospectively collected data in which the medical records of 4448 patients who had presented to the Endocrine Clinic from 2007 to 2015 were reviewed. A total of 2760 [62.05%] patients were diagnosed with thyroid disorders, whereas 260 [9.42%] patients had SCH. The SCH patients were between the age of 12 to 70 years; TSH was >4mlU/l with normal levels of FT3 and FT4. Patients were enrolled using a predesigned structured proforma. Those having chronic systemic diseases were excluded from this study. SPSS 13 was used to evaluate the data


Results: Female patients comprised 93.8% [244 patients] of those with SCH, whereas only 6.2% [16 patients] were male. Common presenting symptoms were, lethargy in 146 patients [56.2%]; increase in weight in 102 patients [39.2%] and menstrual irregularities in 90 patients [34.6%]


TSH level of < 10mlU/l [4-10] was seen in 177 patients [68.1%] and 83 patients [31.9%] had TSH > 10mU/l. Thyroxine was given to 183 [70.4%] of these patients. Common treatment indications were TSH of > 10, which was seen in 83 patients [31.9%], subfertility in 32 patients [12.3%], troublesome symptoms suggestive of hypothyroidism in 31 patients [11.9%] and high titers of antibodies in 23 patients [8.8%]


Conclusion: SCH is frequently seen in our population, with most patients complaining of lethargy. The most common treatment indications were a TSH > 10mlU/l, whereas troublesome symptoms of hypothyroidism and subfertility were the common treatment indications in patients who had a TSH of < 10mlU/l


Subject(s)
Humans , Female , Male , Child , Adolescent , Adult , Middle Aged , Aged , Asymptomatic Infections , Thyroid Diseases , Retrospective Studies , Thyroxine/therapeutic use , Infertility/etiology , Immunoglobulins, Thyroid-Stimulating
15.
Porto Alegre; Universidade Federal do Rio Grande do Sul. Telessaúde; 2017.
Non-conventional in Portuguese | LILACS | ID: biblio-995632

ABSTRACT

É a doença tireoidiana mais comum, com prevalência de 2% na população geral e 15% em pessoas com mais de 60 anos. A doença acomete oito vezes mais mulheres do que homens. A principal forma de apresentação do hipotireoidismo (95% dos casos) é decorrente à alterações primárias na glândula tireoide (hipotireoidismo primário), podendo também ocorrer secundário a medicamentos (antitireoidianos, amiodarona, lítio, interferon, talidomida e rifampicina) e disfunções hipofisárias (hipotireoidismo secundário) ou hipotalâmicas (hipotireoidismo terciário). Não há indicação para solicitar TSH como rastreamento populacional em pacientes assintomáticos ou em gestantes. O TSH só deve ser solicitado para pacientes com suspeita de disfunção tireoidiana. Da mesma forma, ecografia de tireoide não deve ser solicitada para pacientes com suspeita ou diagnóstico de hipotireoidismo, mas sim para pacientes com alterações na palpação cervical. Esta guia apresenta informação que orienta a conduta para casos de hipotireoidismo no contexto da Atenção Primária à Saúde, incluindo: Sinais e Sintomas, Diagnóstico, Tratamento, Acompanhamento, Hipotireoidismo na gestação, Encaminhamento para serviço especializado.


Subject(s)
Humans , Hypothyroidism/diagnosis , Hypothyroidism/therapy , Primary Health Care , Referral and Consultation , Thyroxine/therapeutic use
16.
Rev. chil. cardiol ; 36(2): 132-135, 2017. ilus
Article in Spanish | LILACS | ID: biblio-899578

ABSTRACT

Dilated cardiomyopathy is usually not reversible. In a few cases diverse etiologies can be treated and cardiomyopathy may disappear or improve significantly. The case of a young man with hypothyroidism and dilated cardiomyopathy is presented. After thyroid hormone replacement, a severe left ventricular dysfunction became reverted.


Subject(s)
Humans , Male , Adult , Thyroxine/therapeutic use , Cardiomyopathy, Dilated/etiology , Cardiomyopathy, Dilated/drug therapy , Hypothyroidism/complications , Echocardiography , Cardiomyopathy, Dilated/diagnostic imaging
17.
Arch. endocrinol. metab. (Online) ; 60(6): 601-604, Nov.-Dec. 2016. tab, graf
Article in English | LILACS | ID: biblio-827794

ABSTRACT

SUMMARY Resistance to thyroid hormone (RTH) coexisting with ectopic thyroid is rare. Here we report a case of RTH with ectopic thyroid. A ten-year-old girl had been misdiagnosed as congenital hypothyroidism and treated with levothyroxine since she was born. Ten-year follow-up showed that the elevated thyrotropin was never suppressed by levothyroxine and no signs indicating hyperthyroidism or hypothyroidism despite elevated FT3 and FT4 levels. Therefore the girl developed no defects in physical and cognitive development. Pituitary adenoma was excluded by magnetic resonance imaging. Ultrasonography did not find the thyroid gland in the normal place, while the thyroid scan found a large lingual thyroid gland. The octreotide inhibition test showed a reduction in thyrotropin by 41.98%. No mutation was detected in the thyroid hormone receptor (THR) β, THRα, thyrotropin receptor (TSHR), and GNAS1 genes. To our knowledge, it is an interesting RTH case coexisting with lingual thyroid.


Subject(s)
Humans , Female , Child , Receptors, Thyroid Hormone/genetics , Thyroid Hormone Resistance Syndrome/complications , Thyroid Dysgenesis/complications , Thyroxine/therapeutic use , Time Factors , Tongue Diseases/diagnostic imaging , DNA/isolation & purification , Thyrotropin/analysis , DNA Mutational Analysis , Follow-Up Studies , Thyroid Hormone Resistance Syndrome/genetics , Congenital Hypothyroidism/diagnosis , Diagnostic Errors , Thyroid Dysgenesis/genetics , Thyroid Dysgenesis/diagnostic imaging
18.
Arch. endocrinol. metab. (Online) ; 60(6): 582-586, Nov.-Dec. 2016. tab, graf
Article in English | LILACS | ID: biblio-827786

ABSTRACT

ABSTRACT Objective The current study was aimed at analyzing sarcoplasmic reticulum Ca2+ ATPase (Serca2) and ryanodine receptor type 2 (Ryr2) gene expression in rats subjected to surgery that induced HF and were subsequently treated with T4 using physiological doses. Materials and methods HF was induced in 18 male Wistar rats by clipping the ascending thoracic aorta to generate aortic stenosis (HFS group), while the control group (9-sham) underwent thoracotomy. After 21 weeks, the HFS group was subdivided into two subgroups. One group (9 Wistar rats) with HF received 1.0 µg of T4/100 g of body weight for five consecutive days (HFS/T4); the other group (9 Wistar rats) received isotonic saline solution (HFS/S). The animals were sacrificed after this treatment and examined for signs of HF. Samples from the left ventricles of these animals were analyzed by RT-qPCR for the expression of Serca2 and Ryr2 genes. Results Rats with HF developed euthyroid sick syndrome (ESS) and treatment with T4 restored the T3 values to the Sham level and increased Serca2 and Ryr2 gene expression, thereby demonstrating a possible benefit of T4 treatment for heart function in ESS associated with HF. Conclusion The T4 treatment can potentially normalize the levels of T3 as well elevated Serca2 and Ryr2 gene expression in the myocardium in heart failure rats with euthyroid sick syndrome.


Subject(s)
Animals , Male , Thyroxine/administration & dosage , Euthyroid Sick Syndromes/drug therapy , Ryanodine Receptor Calcium Release Channel/drug effects , Aortic Valve Stenosis/complications , Thyroxine/therapeutic use , Triiodothyronine/drug effects , Euthyroid Sick Syndromes/complications , Euthyroid Sick Syndromes/genetics , RNA, Messenger/metabolism , Gene Expression/drug effects , Rats, Wistar , Ryanodine Receptor Calcium Release Channel/genetics , Models, Animal , Sarcoplasmic Reticulum Calcium-Transporting ATPases/drug effects , Sarcoplasmic Reticulum Calcium-Transporting ATPases/genetics , Heart Failure/complications
19.
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
20.
Lima; s.n; jun. 2016.
Non-conventional in Spanish | LILACS, BRISA | ID: biblio-848559

ABSTRACT

INTRODUCCIÓN: Antecedentes: El presente dictamen expone la evaluación de tecnología del uso de la tirotropina alfa o tirotropina recombinante humana (rhTSH, por su nombre en inglés) como preparación para realizar un rastreo corporal total (RCT) con radioyodo. Esta evaluación específica para pacientes con sospecha de recidiva de cáncer de tiroides diferenciado, en los que el retiro del tratamiento con levotiroxina no es tolerado. Aspectos Generales: El cáncer de tiroides es el tipo más común de cáncer endocrino y representa menos del 1% de todos los tumores humanos. La incidencia anula de este cáncer varia considerablemente por área geográfica, edad y sexo. Tecnología Sanitaria de Interés: En pacientes en seguimiento posterior al tratamiento de cáncer diferenciado de tiroides y en los que se sospecha recidiva del mismo se sugiere la realización pruebas diagnósticas como el RCT con radioyodo. Para realizar esta prueba en los pacientes mencionados es necesario lograr una elevación de la TSH sérica y promover la captación del marcador en el tejido facilitando su identificación. La tirotropina alfa o rhTSH es una glicoproteína heterodimérica con propriedades bioquíimicas comparables al TSH pituiario humano. La unión de esta sustancia con receptores de TSH en las células epiteliales tiroideas o en tejido tiroideo canceroso diferenciado estimula en éstas la captación de yodo y organización, así como la síntesis y secreción de Tg. METODOLOGÍA: Estrategia de Búsqueda: Se realizó una estrategia de búsqueda sistemática de la evidencia científica con respecto al uso del rhTSH para realizar un rastreo corporal total (RCT) con radioyodo para la detección de cáncer diferenciado de tiroides, intolerante la suspensión de levotiroxina, con sospecha de recurrencia. Se ralizó una búsqueda de estudios en humanos que mostraron evidencia científica en relación a los puntos desarrollados en la pregunta PICO. Se dio preferencia a estudios de tipo meta-análisis, revisiones sistemáticas de ensayos clínicos aleatorizados y ensayos clínicos aleatorizados; así como a guías de práctica clínica de grupos o instituciones relevantes al tema analizado. la bibliografia usada en los artículos seleccionados, así como la inforamación disponible por entes reguladores y normativos como la Food and Drug Administration ( Administración de Drogas y Alimentos, o FDA por sus siglas en inglés) de los Estados Unidos y, a nivel nacional, la DIGEMID. RESULTADOS: Sinopsis de la Evidencia: Se realizó la búsqueda y revisión de la evidencia científica actual para la evaluación del rhTSH para realizar un rastreo corporal total (RCT) con radioyodo para la detección de cáncer diferenciado de tiroides, itolerante la suspensión de levotiroxina, con sospecha de recurrencia. Se presenta la información encontrada de acuerdo al tipo de evidencia revisada. CONCLUSIONES: La evidencia encontrada a la fecha (mayo 2016) indica que el rhTSH puede ser utilizado como una opción alternativa a la suspensión de tratamiento reemplazo hormonal tiroideo como preparación para un RCT con radioyodo en los pacientes descritos. Esta opción no ha demostrado un benefício en la precisión diagnóstica del RCT, presentado solo un benefício de corto plazo al disminuir los efectos adversos asociados a la realización de la prueba. Así, si bien la evidencia no es contundente con respecto al uso la rhTSH como una primera opción para la preparación para un rastreo corporal total con radioyodo en los pacientes descritos, esta es útil y corresponde a la única alternativa disponible actualmente como prueba diagnóstica en el caso de los pacientes que no puedan suspender el tratamiento hormonal por falta de tolerancia, definida por el médico tratante, u obras causas médicas que contraindioquen el estado hipotiroideo. El Instituto de Evaluación de Tecnologías en Salud e Investigación, aprueba el uso de la tirotropina recombinante humana (rhTSH) como preparación para un rastreo corporal total con radioyodo en pacientes con cáncer diferenciado de tiroides posterior al tratamiento, en los que se sospecha recurrencia y que no puedan suspender el tratamiento hormonal por falta de tolerancia, definida por el médico tratante, u otras causas médicas que contraindiquen el estado hipotiroideo.


Subject(s)
Humans , Thyroxine/therapeutic use , Thyroid Neoplasms/drug therapy , Thyrotropin/administration & dosage , Iodine Radioisotopes/analysis , Neoplasm Recurrence, Local , Treatment Outcome , Cost-Benefit Analysis
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