Factores clínicos y bioquímicos asociados con la tirotropina en embarazadas aparentemente sanas / Clinical and biochemical factors associated with thyrotropin in seemingly healthy pregnant women

Introducción: Los valores de tirotropina (TSH) pueden modificarse marcadamente durante el embarazo, en relación con diversos factores clínicos y bioquímicos. Objetivo: Identificar los factores clínicos y bioquímicos asociados con la tirotropina en embarazadas aparentemente sanas. Métodos: Estudio descriptivo, transversal, con 247 gestantes aparentemente sanas del municipio Plaza de la Revolución., en el periodo comprendido de septiembre de 2015 a enero de 2019. Variables analizadas: edad materna y gestacional, trimestre del embarazo, color de la piel, paridad, hábito de fumar, antecedentes familiares de enfermedad tiroidea (APF), consumo de suplementos con yodo, índice de masa corporal (IMC), presencia de bocio al examen físico, TSH, tiroxina total (T4t) y libre (T4l), triyodotironina total (T3t) y libre (T3l), gonadotropina coriónica (hCG), anticuerpos contra la peroxidasa tiroidea (AcTPO) y la tiroglobulina (AcTg) y yoduria. Resultados: La TSH (1,66 ± 0,91mUI/L) tuvo una asociación negativa con la edad materna (r = -0,17; p = 0,008), la paridad (nulíparas 1,80 ± 0,90 mUI/L, multíparas 1,45 ± 0,89 mUI/L; p = 0,003), los APF (positivos 1,56 ± 0,91 mUI/L, negativos 1,81 ± 0,89 mUI/L; p = 0,03), la T4t (r = -0,15; p = 0,02), la T4l (r = -0,23; p = 0,000) y la hCG (r = -0,52; p = 0,001). Mostraron una relación directa la edad gestacional (r = 0,25; p = 0,000) y el uso de suplementos yodados (consumo 1,96 ± 0,72mUI/L, no consumo 1,62 ± 0,93 mUI/L; p = 0,03). Conclusiones: La tirotropina presenta una relación inversa con la edad materna, la paridad, los antecedentes familiares de enfermedad tiroidea, la T4 total y libre, y la gonadotropina coriónica, y una relación directa con la edad gestacional y el consumo de suplementos con yodo(AU)

Introduction: Thyrotropin (TSH) values can be sharply modified during pregnancy, in relation to various clinical and biochemical factors. Objective: Identify clinical and biochemical factors associated with thyrotropin in seemingly healthy pregnant women. Methods: Descriptive, cross-sectional study with 247 seemingly healthy pregnant women from Plaza de la Revolution municipality in the period from September 2015 to January 2019. Variables analyzed: maternal and gestational age, trimester of pregnancy, skin color, pregnancies, smoking habit, family history of thyroid disease (APF), consumption of iodine supplements, body mass index (BMI), presence of goiter to physical examination, TSH, total and free (T4l) thyroxine (T4t), total (T3t) and free (T3l) triiodothyronine, chorionic gonadotropin (hCG), antibodies against thyroid peroxidase (AcTPO) and thyroglobulin (AcTg) and urinary iodine. Results: TSH (1.66 ± 0.91mUI/L) had a negative association with maternal age (r = -0.17; p x 0.008), pregnancy (nulliparas 1.80 ± 0.90 mUI/L, 1.45 ± 0.89 mUI/L; p x 0.003), APF (positive 1.56 ± 0.91 mUI/L, negative 1.81 ± 0.89 mUI/L; p x 0.03), the T4t (r = -0.15; p s 0.02), the T4l (r = -0.23; p x 0.000) and the hCG (r = -0.52; p x 0.001). They showed a direct relationship with gestational age (r x 0.25; p x 0.000) and the use of iodine supplements (consumption 1.96 ± 0.72mUI/L, not consumption 1.62 ± 0.93 mUI/L; p x 0.03). Conclusions: Thyrotropin has an inverse relationship with maternal age, pregnancies, family history of thyroid disease, total and free T4, and chorionic gonadotropin, and a direct relationship with gestational age and consumption of iodine supplements(AU)

Associations between thyroid-stimulating hormone and hypertension according to thyroid cyst status in the general population: a cross-sectional study

BACKGROUND@#The absence of thyroid cysts may indicate latent thyroid damage, as demonstrated in our previous study. However, the association between the absence of thyroid cysts and latent functional damage of the thyroid is unknown. At low thyroid hormone productivity, which may be associated with latent functional damage of the thyroid, the association between thyroid-stimulating hormone (TSH) and hypertension might be enhanced. Therefore, we evaluated the association between TSH level and hypertension stratified by thyroid cyst status.@*METHODS@#We conducted a cross-sectional study of 1724 euthyroid Japanese individuals aged 40-74 years who participated in an annual health checkup in 2014.@*RESULTS@#In the study population, 564 and 686 participants had thyroid cysts and hypertension, respectively. A significant positive association was observed between TSH and hypertension in subjects without a thyroid cyst but not in subjects with thyroid cysts. There was a significant positive association between hypertension and TSH in subjects without a thyroid cyst (odds ratio [OR] 1.27; 95% confidence intervals [CI] 1.01, 1.61) but not in subjects with thyroid cysts (OR 0.79; CI 0.57, 1.09) in the model fully adjusted for known confounding factors. The correlation between the TSH and free triiodothyronine (fee T3) levels (simple correlation coefficient [r] = - 0.13, p < 0.01) was stronger in the subjects without thyroid cysts than in those with thyroid cysts (r = - 0.03, p = 0.525).@*CONCLUSIONS@#TSH is positively associated with hypertension only in individuals without thyroid cysts. The correlation between the TSH and free T3 levels was stronger in the subjects without thyroid cysts than in those with thyroid cysts. Therefore, the absence of thyroid cysts could be related to the association between TSH level and hypertension, possibly by indicating that the subjects without thyroid cysts had limited thyroid hormone reserves. Therefore, the absence of thyroid cysts could indicate the latent functional damage of the thyroid.

Efectos endocrinológicos tardíos del tratamiento oncológico en supervivientes de meduloblastoma / Endocrinological late effects of oncologic treatment on survivors of medulloblastoma

INTRODUCCIÓN: La radioterapia, quimioterapia y la cirugía empleada en el tratamiento de los tumores cerebrales tienen efectos en el eje hipotálamo-hipofisario y pueden resultar en disfunción endocrina hasta en el 96% de los casos. PACIENTES Y MÉTODO: Estudio retrospectivo y descriptivo en pacientes diagnos ticados de meduloblastoma sometidos a tratamiento con quimio y radioterapia en los últimos 20 años en un hospital terciario. Se analizan variables edad, sexo, peso, talla, índice de masa corporal (IMC) al final del seguimiento, estadio de maduración sexual, niveles séricos de TSH y T4 libre, ACTH/cortisol e IGF-1, FSH, LH, estradiol, testosterona, perfil lipídico (colesterol total) y prueba de función dinámica de hormona de crecimiento. RESULTADOS: Muestra total de 23 pacientes. El déficit de hormona de crecimiento es la secuela más frecuente (82 %) seguido de disfunción ti roidea (44,8%) y disfunción puberal (24,1%). Solo se diagnosticó un caso de diabetes insípida y 2 casos de déficit de corticotrofina. CONCLUSIONES: El seguimiento a largo plazo de los supervivientes de meduloblastoma tratados con quimio y radioterapia revela una prevalencia muy alta de disfun ción endocrina, particularmente de deficiencia de hormona del crecimiento y de hipotiroidismo. Creemos oportuna la monitorización y el seguimiento a largo plazo de estos pacientes con el fin de garantizar un manejo terapéutico adecuado de aquellas disfunciones tratables.

INTRODUCTION: Radiation therapy, chemotherapy, and surgery used to treat brain tumors have effects on the hy pothalamic-pituitary-adrenal axis and can result in endocrine dysfunction in up to 96% of cases. PATIENTS Y METHOD: Retrospective and descriptive study in patients diagnosed with medulloblasto ma who underwent treatment with chemo and radiotherapy in the last 20 years in a tertiary hospital. The variables analyzed were age, sex, weight, height, body mass index (BMI) at the end of follow-up, sexual maturity stage, serum levels of TSH and free T4, ACTH/cortisol and IGF-1, FSH, LH, estradiol, testosterone, lipid profile (total cholesterol), and growth hormone dynamic function test. RESULTS: Total sample of 23 patients. Growth hormone deficiency is the most frequent sequelae (82%) fo llowed by thyroid dysfunction (44.8%), and disorders of puberty (24.1%). Only one case of diabetes insipidus and two cases of corticotropin deficiency were diagnosed. CONCLUSIONS: Long-term follow- up of medulloblastoma survivors treated with chemo and radiotherapy reveals a very high prevalence of endocrine dysfunction, especially growth hormone deficiency and hypothyroidism. We believe that monitoring and long-term follow-up of these patients is necessary in order to ensure adequate therapeutic management of those treatable dysfunctions.

Disfunción tiroidea inducida por amiodarona en pacientes portadores de arritmias / Thyroid dysfunction induced by Amiodarone in patient with arrhythmias

Evaluar la presencia de disfunción tiroidea en pacientes con arritmias cardíacas tratados con Amiodarona (AMD) Métodos: se realizó el estudio en 24 pacientes que presentaron arritmias supraventriculares o ventriculares tratados con AMD, atendidos en el Servicio de Medicina Interna de la Ciudad Hospitalaria "Dr. Enrique Tejera" durante el período julio 2015 ­ abril 2016. Se les determinaron T3L, T4L y TSH a manera de tamizaje previo a la administración de AMD y fueron citados y divididos en 3 grupos de 3, 6 y 12 meses de tratmiento de AMD con determinación del perfil tiroideo en la consulta. Resultados: El hipotiroidismo inducido por AMD (HIA) se presentó en 20,83% (n=5), siendo más frecuente en aquellos pacientes asculinos que tenían 3 meses de tratamiento y que recibían una dosis de 1400 mg/semanal. La tirotoxicosis inducida por AMD (TIA) se presentó en 8,33% (n=2) ambos masculinos con dosis de 1400 mg/semanal. No se encontró asociación entre HIA y TIA con el tiempo, dosis, grupo etario ni género (P>0,05). T3L, T4L y TSH registraron el mayor y menor promedio a los 12 y 3 meses (P < 0,05); 12 y 6 meses; 3 y 12 meses respectivamente. Conclusión: La frecuencia de HIA fue de 20,83 % y TIA de 8,33 %. No hubo asociación estadísticamente significativa entre la HIA o TIA con la duración de consumo, dosis, grupo etario ni género. La TSH presentó el mayor promedio a los 3 meses, la T3L y T4L a los 12 meses (AU)

to evaluate the presence of thyroid dysfunction in patients with cardiac arrhythmia who were treated with Amiodarone (AMD). Methods: the study was done in 24 patients who were treated for supraventricular or ventricular arrhythmia at the Department of Internal Medicine of Hospital "Dr. Enrique Tejera" in Valencia, Venezuela from July 2015 to April 2016. FT3, FT4 and TSH were measured to the administration of AMD. The patients were divided in 3 groups according to time of use of the drug as follows: 3, 6 and 12 months, and their thyroid function was measured at each of these periods. Results: 20.83 % (n=5) presented Amiodarone induced hypothyroidism (AIH), which was more frequent in males at 3 months of treatment and who received 1400 mg weekly. Amiodarone induced thyrotoxicosis (AIT) was found in 8.33% (n=2) also in male patients using 1400mg weekly. There was no association between AIH or AIT and duration, dose of AMD, age or gender. (p>0.05) FT3, FT4 and TSH registered their higher and lower averages on 12 and 3 months (P < 0,05); 12 and 6 months; 3 and 12 months respectively. Conclusion: AIH's frequency was 20.83 % and 8.33% for AIT. There was no statistically significant association between AIH or AIT and duration, dose of AMD, age or gender TSH average measure was higher at 3 months and the FT3 and FT4 at 12 months(AU)

Trastornos respiratorios del sueño en niños con síndrome de Down / Sleep disorder breathing in children with Down syndrome

Respiratory sleep disorders in children with Down syndrome (DS) have a high prevalence and are related to anatomical and functional characteristics of this syndrome. In this children we should have a high index of suspicion of sleep breathing disorders, diagnose and treat them in order to achieve their full potential in terms of physical and cogntive health

Los trastornos respiratorios del sueño (TRS) en niños con síndrome de Down (SD) tienen una alta prevalencia y estan relacionados con características estructurales y funcionales propias de la enfermedad. En el SD se debe mantener un alto índice de sospecha de los TRS, diagnosticarlos y tratarlos con el fin que los pacientes puedan alcanzar su pleno potencial en términos de salud física y cognitiva

Insights into the posttranslational structural heterogeneity of thyroglobulin and its role in the development, diagnosis, and management of benign and malignant thyroid diseases

ABSTRACT Thyroglobulin (Tg) is the major glycoprotein produced by the thyroid gland, where it serves as a template for thyroid hormone synthesis and as an intraglandular store of iodine. Measurement of Tg levels in serum is of great practical importance in the follow-up of differentiated thyroid carcinoma (DTC), a setting in which elevated levels after total thyroidectomy are indicative of residual or recurrent disease. The most recent methods for serum Tg measurement are monoclonal antibody-based and are highly sensitive. However, major challenges remain regarding the interpretation of the results obtained with these immunometric methods, particularly in patients with endogenous antithyroglobulin antibodies or in the presence of heterophile antibodies, which may produce falsely low or high Tg values, respectively. The increased prevalence of antithyroglobulin antibodies in patients with DTC, as compared with the general population, raises the very pertinent possibility that tumor Tg may be more immunogenic. This inference makes sense, as the tumor microenvironment (tumor cells plus normal host cells) is characterized by several changes that could induce posttranslational modification of many proteins, including Tg. Attempts to understand the structure of Tg have been made for several decades, but findings have generally been incomplete due to technical hindrances to analysis of such a large protein (660 kDa). This review article will explore the complex structure of Tg and the potential role of its marked heterogeneity in our understanding of normal thyroid biology and neoplastic processes.

Prevalence of thyroid diseases in patients with acromegaly: experience of a Brazilian center / Prevalência das doenças tireoidianas em pacientes com acromegalia: experiência de um centro brasileiro

OBJECTIVES: Acromegaly is frequently associated with thyroid diseases. In this study, we evaluated the frequency of thyroid disorders in a series of acromegalic patients. SUBJECTS AND METHODS: We evaluated 106 acromegalic patients using thyroid ultrasonography (US) and measurements of GH, IGF-I, free T4, TSH and anti-thyroperoxidase antibody levels. IGF-I was expressed in mass units and age-related standard deviation scores (SD-scores). Fine-needle aspiration biopsy (FNAB) was performed on thyroid nodules with a diameter greater than one centimeter or with suspicious characteristics. RESULTS: Thyroid disorders were found in 75 patients. Eleven patients had diffuse goiter, 42 patients had nodular goiter, and 22 patients had unspecific morphological abnormalities. Four patients (3.8%) had thyroid carcinoma. Considering the patients with diffuse or nodular goiter, thyroid volume was greater in patients with active acromegaly, and was positively correlated with GH, IGF-I, and IGF-I SD-score. CONCLUSIONS: Our study confirmed that benign thyroid diseases are frequent in acromegalic patients. The prevalence of thyroid cancer was higher than in the overall population. We suggest that thyroid US should be routinely performed in patients with acromegaly.

OBJETIVOS: Acromegalia está frequentemente associada a doenças tireoidianas. Neste estudo, avaliamos a presença de tireoidopatias em uma série de pacientes acromegálicos. SUJEITOS E MÉTODOS: Foram avaliados 106 pacientes por ultrassonografia (US) e dosagens de GH, IGF-1, T4 livre, TSH e anticorpo antitireoperoxidase. O IGF-I foi expresso em unidades de massa e desvio-padrão (DP-IGF-I). Punção aspirativa por agulha fina (PAAF) foi realizada quando os nódulos eram maiores que um centímetro ou tinham características suspeitas. RESULTADOS: Alterações tireoidianas foram encontradas em 75 pacientes. Onze apresentavam bócio difuso, 42, bócio nodular e 22, alterações morfológicas inespecíficas. Houve quatro casos (3,8%) de câncer diferenciado de tireoide. Considerando os pacientes com bócio difuso ou nodular, o volume tireoidiano foi maior naqueles com acromegalia em atividade e correlacionou-se positivamente com os níveis de GH, IGF-1 e DP-IGF-1. CONCLUSÕES: Nosso estudo confirmou que as doenças tireoidianas benignas são frequentes nos pacientes acromegálicos. A prevalência de câncer diferenciado de tireoide foi maior que na população geral. Sugerimos que US de tireoide seja realizado rotineiramente nos pacientes com acromegalia.

Tasa de tiroidectomías por cáncer y por enfermedades benignas tiroídeas y su posible relación con un déficit de selenio ambiental / Rate of thyroidectomy by cancer and benign thyroid diseases and its possible relation with a deficit of selenium environmental

Recientemente hemos reportado el déficit de selenio ambiental, y el estatus alterado de selenio medido como actividad de Glutatión Peroxidasa en población beneficiaria del Servicio de Salud de Osorno. Estos déficits se asocian a alteraciones funcionales y estructurales del tiroides que se correlacionan con la aparición de enfermedades tiroídeas benignas y cáncer tiroídeo. El objetivo de este trabajo es mostrar la tasa de tiroidectomías por cáncer y por enfermedades benignas que se presentan en las comunas que habitan la población beneficiaria del Servicio de Salud Osorno y llamar la atención sobre su posible asociación con el estatus alterado de selenio y la menor actividad de Glutatión Peroxidasa descrita previamente.

We have recently reported the lack of environmental selenium and the altered selenium status measured as deficient glutathione peroxidase (GPx) activity in the population affiliated to the Osorno Health Service. These deficits are associated to functional and structural abnormalities of the thyroid gland that correlates with the appearance of benign thyroid pathologies and thyroid cancer. The aim of this investigation is to show the rate of thyroidectomy associated with malign and benign disease in the communities associated to the Osorno Health Service and warn about their possible link with the poor amount of selenium in the environment and the altered function of the GPx enzyme, previously described.

Subclinical autoimmune thyroid disorders in Egyptian patients with untreated chronic hepatitis C virus infection

The frequency of anti-thyroid antibodies and subclinical thyroid disorders in Egyptian patients with untreated chronic hepatitis type C was estimated. In addition, it determines the correlation between the seropositivity of anti-thyroid antibodies and serum thyroid stimulating hormone level in chronic HCV positive patients. Also, the impact of hepatic decompensation in inducing thyroid autoimmunity in such patients was evaluated. This study included 56 untreated chronic hepatitis C patients and 28 healthy subjects of the same local population as a control group. The results showed that the mean thyroid stimulating hormone levels were significantly higher in patients with chronic hepatitis C than in controls. Patients with decompensated chronic hepatitis C had insignificantly higher subsequent autoimmune hypothyroidism than the compensated patients. A significant positive correlation between the level of thyroid stimulating hormone and anti-thyroglobulin, but not with anti-thyroperoxidase, was found. Therefore, there is an association between chronic hepatitis C virus infection and subclinical autoimmune thyroid disorders. Thyroid stimulating hormone and anti-thyroglobulin antibodies screening for all chronic HCV patients, even if antiviral treatment will not be initiated, should be done

Endocrine Complications after Hematopoietic Stem Cell Transplantation during Childhood and Adolescence

Long-term survivors of hematopoietic stem cell transplantation (HSCT) during childhood and adolescence are at risk of developing endocrine complications. The purpose of this study was to evaluate the long-term endocrine complications and their associated risk factors among such patients. We reviewed the data from 111 patients (59 males and 52 females) who underwent HSCT at the mean age of 8.3+/-4.1 yr. Thirty patients (27.0%) had growth impairment, and seven (21.2%) out of 33 patients who attained final height reached final height below 2 standard deviation (SD). The final height SD score of the patients conditioned with total body irradiation (TBI) was significantly lower than that of the patients conditioned without TBI (-1.18+/-1.14 vs. -0.19+/-0.78, P=0.011). Thirteen patients (11.7%) developed hypothyroidism (11 subclinical, 2 central) 3.8+/-1.8 (range 1.6-6.2) yr after HSCT. Nineteen (65.5%) out of 29 females had evidence of gonadal dysfunction, and 18 (64.3%) out of 28 males had evidence of gonadal dysfunction. The risk for gonadal dysfunction was significantly higher in females conditioned with busulfan/cyclophosphamide (P=0.003). These results suggest that the majority of patients treated with HSCT during childhood and adolescence have one or more endocrine complications. Therefore, multiple endocrine functions should be monitored periodically after HSCT until they reach adult age.

Effects of combined interferon alpha and ribavirin therapy on thyroid functions in patients with chronic hepatitis C

To determine the frequency of thyroid dysfunction in patients of chronic hepatitis C during treatment with interferon alpha-2b and ribavirin therapy. A cohort study. Army Medical College and Military Hospital, Rawalpindi, from February 2006 to January 2007. One hundred and sixty seven non-cirrhotic chronic hepatitis C patients were grouped into treatment group [n=107] and control group [n=60] awaiting treatment. Baseline serum[s.] Alanine Transferase [ALT] and S. Aspartate Transferase [AST] were measured by IFCC method. Serum Thyroid Stimulating Hormone [S. TSH], serum free thyroxine [S. Free T4] and serum total triiodothyronine [S.T3] level were determined by chemiluminescence. Study group patients underwent 24 weeks IFN and ribavirin therapy and were followed-up for thyroid dysfunction at weeks 0, 12 and 24. Control group patients underwent the same tests at weeks 0, 12 and 24. Statistical analysis was done on SPSS 15. Out of 107 patients of treatment group, 20 patients [18.69%] developed thyroid dysfunction. Females were at higher risk with Relative Risk [RR] of 11.25 and Attributable Risk [AR] of 91%. Hypothyroidism was more common than hyperthyroidism. Interferon-alpha and ribavirin therapy induces thyroid dysfunction in chronic hepatitis C patients. Hypothyroidism was more common. Females are at a higher risk of developing thyroid dysfunction

Alterations in TSH and thyroid hormones following mobile phone use

In recent years, the widespread use of mobile phones has lead to a public debate about possible detrimental effects on human health. In spite of years of research, there is still a great controversy regarding the possibility of induction of any significant physiological effects in humans by microwave radiations emitted by mobile phones. This study aims to investigate the effects of electromagnetic fields induced by the Global System for Mobile communications [GSM] mobile phones on the Thyroid Stimulating Hormone [TSH] and thyroid hormones in humans. 77 healthy university students participated in this study. The levels of T3, T4 and TSH were measured by using appropriate enzyme-linked immunosorbent assay [ELISA] kits [Human, Germany]. The average levels of T3,T4 and TSH in students who moderately used mobile phones were 1.25 +/- 0.27 ng/ ml, 7.76 +/- 1.73 micro g/dl and 4.25 +/- 2.12 micro u/l respectively. The levels in the students who severely used mobile phones were 1.18 +/- 0.30, 7.75 +/- 1.14 and 3.75 +/- 2.05 respectively. In non-users, the levels were 1.15 +/- 0.27, 8.42 +/- 2.72 and 2.70 +/- 1.75, respectively. The difference among the levels of TSH in these 3 groups was statistically significant [P<0.05]. As far as the study is concerned, this is the first human study to assess the association between mobile phone use and alterations in the levels of TSH and thyroid hormones. Based on the findings, a higher than normal TSH level, low mean T4 and normal T3 concentrations in mobile users were observed. It seems that minor degrees of thyroid dysfunction with a compensatory rise in TSH may occur following excessive use of mobile phones. It may be concluded that possible deleterious effects of mobile microwaves on hypothalamic-pituitary-thyroid axis affects the levels of these hormones

Enfermedad tiroidea autoinmune: estudio clínico epidemiológico / Autoimmune thyroid disease: clinical-epidemiology study

Este estudio prospectivo sobre los aspectos clínico-epidemiológicos de la enfermedad tiroidea autoinmune en una muestra venezolana de 1000 pacientes, estableció en 9,9 % la prevalencia de enfermedad tiroidea; a su vez, la enfermedad tiroidea autoinmune fue la enfermedad tiroidea más común con una frecuencia relativa de 42% de todos los casos de enfermedad tiroidea y una prevalencia de 4,2%. Se observaron 42 casos de enfermedad tiroidea autoinmune: 27 de tiroiditis crónica autoinmune, 4 de tiroiditis silente y postpartum, uno de hipertiroidismo inducido por amiodarona y 11 de enfermedad de Graves. Una anciana con tiroiditis crónica autoinmune había presentado enfermedad de Graves 40 años antes, siendo esta una posibilidad evolutiva de la enfermedad tiroidea autoinmune. La enfermedad tiroidea fue más frecuente en las mujeres, especialmente en las tiroiditis autoinmunes, cuya relación hembra: varón fue 9,7: 1. Las hembras que constituyeron el 55 % de los 1000 casos, resultaron el 88% de los casos de enfermedad tiroidea autoinmune, diferencia también encontrada entre las ancianas de ambas muestras. En los mil pacientes, una de cada 22 mujeres presentó tiroiditis crónica autoinmune, clínica o subclínica. En los casos de enfermedad tiroidea autoinmune, 40% refirió enfermedad tiroidea familiar, particularmente autoinmune, 3 casos tenían historia familiar de enfermedad autoinmune sistémica y 17% se asoció con otra enfermedad autoinmune endocrina o sistémica. La positividad de los anticuerpos antitiroideos séricos, prueba suficiente para el diagnóstico de tiroiditis crónica autoinmune, se encontró en 89% de nuestros casos. El hipotiroidismo permanente es la secuela funcional más importante de tiroiditis crónica autoinmune, especialmente en las ancianas, tal como ocurrió en 55,5 % de 27 casos, 22,2 % como hipotiroidismo clínico y 33,3% como hipotiroidismo subclínico. En 12 casos con función tiroidea normal el promedio de la edad fue 46,75 ± 17,06. años...

This prospective clinical-epidemiologic study about autoimmune thyroid disease, in a Venezuelan sample of 1000 patients, established in 9.9% the prevalence of thyroid diseases; autoimmune thyroid disease was the most common thyroid disease with a relative frequency of 42% of all thyroid diseases cases and with prevalence of 4.2%. Forty two cases of autoimmune thyroid disease were observed: 27 with chronic autoimmune thyroiditis, 4 with silent and postpartum thyroiditis, one with amiodarone-induce thyrotoxicosis and 11 with Graves’ disease. One female initially with Graves’ disease was observed after 40 years with chronic autoimmune thyroiditis, an alternative in autoimmune thyroid disease evolution. In our study, all thyroid diseases were more frequent in women, especially in autoimmune thyroiditis, which female: male ratio was 9.7: 1. Females that represented 55% of 1000 cases were 88% of autoimmune thyroid disease cases, and this difference was found also between elderly females of both samples. In the 1000 patients, one of each 22 females presented clinical or subclinical chronic autoimmune thyroiditis. Forty percent of autoimmune thyroid disease cases referred familiar thyroid disease, particularly autoimmune, 3 cases had family history of systemic autoimmune disease and 17% was associated with other autoimmune endocrine or systemic disease. Antithyroid antibody confirmation is sufficient proof for diagnosis, as was observed in 89% of our cases. Permanent hypothyroidism is the most important functional consequence of chronic autoimmune thyroiditis, especially in older females, such as occurred in 55.5% of 27 cases, 22.2% as clinic hypothyroidism and 33.3% as subclinic hypothyroidism. In 12 cases with normal thyroid function the mean age was 46.75 ± 17,06 years, in 9 cases of subclinical hypothyroidism was 49,00 ± 18,97 years and in 6 cases of clinical hypothyroidism 53,50 ± 20,57 years. In chronic autoimmune thyroiditis, this progressive decline...

Thyroid functions in children with Down's syndrome.

OBJECTIVE: To evaluate thyroid function in children with Down's syndrome, and to ascertain the presence of a relationship between overt thyroid diseases and congenital anomalies. MATERIAL AND METHOD: One hundred and forty Down's syndrome patients, aged from 3 days to 13 years 9 months, were evaluated for karyotype, thyroid functions and the coexistence of congenital anomalies. RESULTS: Trisomy 21 was found in the majority of cases (95.7%). Fifty-six patients (40%) had abnormal thyroid functions: 53 (37.9%) hypothyroidism and 3 (2.1%) hyperthyroidism. Ten patients (7.1%) were diagnosed with overt thyroid disease: congenital hypothyroidism 3.6%, acquired hypothyroidism associated autoimmune thyroiditis 1.4% and hyperthyroidism 2.1%. None of the patients with congenital hypothyroidism had athyreosis or ectopic thyroid gland. Sub-clinical hypothyroidism accounted for 32.9% of all cases; 10.7% showed a spontaneous decrease to normal TSH levels and 13.6% had persistently elevated TSH levels with the median follow-up time of 6 and 12 months, respectively. Congenital heart disease, gastrointestinal anomalies and hematological disease were found in 73.6, 10 and 3.6 percent of patients, respectively. There was no statistical correlation between the coexistence of cardiovascular or gastrointestinal disease in Down's syndrome patients with overt thyroid diseases or sub-clinical hypothyroidism to those having normal thyroid functions. CONCLUSION: Sub-clinical hypothyroidism was the most common thyroid abnormality in children with Down's syndrome. A longitudinal and timely-scheduled evaluation of thyroid function is needed to establish the natural course of this abnormality and the proper management guideline.

Extensive gastrointestinal tract and thyroid involvement with Wegeners granulomatosis.

Wegeners granulomatosis (WG) is a pauci-immune systemic vasculitis involving small to medium sized blood vessels of the respiratory tract and renal vasculature. We report a 34-year-old lady with extensive gastrointestinal tract, pancreas and thyroid involvement. Literature review revealed only two prior reports of esophageal involvement, two reports of pancreatic involvement and few cases of thyroid involvement.

Teratoma quístico maduro de tiroides: a propósito de un caso / Mature cystic teratoma of thyroid: a purpose of a case

Los Teratomas son tumores que están compuestos de tejidos derivados de las tres capas germinales. La localización más común en los niños son las sacrococcígeas (40 por ciento), mientras que los ubicados en cabeza y cuello, solo representan el 3,5 por ciento. Desde el punto de vista clínico, los pacientes consultan por la presencia de una masa en el cuello. Los estudios incluyen radiografía simple, ultrasonido, scan de la glándula tiroides, medición de AFP y ß-HCG. La extirpación quirúrgica es el tratamiento de elección. El presente caso clínico trata de un lactante mayor masculino de 12 meses de edad, quien presenta desde el nacimiento, aumento de volumen en la cara antero-lateral izquierda del cuello. Se solicita ecograma cervical reportando: Tumoración ecomixta latero cervical izquierda y ganmagrama tiroideo evidenciándose: bocio multinodular. A los 7 meses de edad se aprecia un aumento mayor de la tumoración y se indica nuevo ecograma: Lóbulo tiroideo izquierdo de tamaño aumentado, con gran imagen nodular, ecomixta. Por lo que se indica Cintilograma tiroideo con I131: Glándula deformada, con una zona hipocaptante que se relaciona con nódulo tiroideo. Se realiza Tiroidectomía ezquierda total con istmectomía. Encontrando hallazgos compatibles con TERATOMA QUÍSTICO MADURO. Los Teratomas de tiroides son tumores muy raros. La mayor incidencia se aprecia en recién nacidos hasta los 2 años de edad. Los pacientes con diagnóstico de malignidad, son tratados con quimioterapia, radioterapia o ambos. Actualmente el niño tiene 10 meses de haber sido intervenido y se encuentra clínicamente estable y sin recidivas.

Resultado del tratamiento quirúrgico del bocio endotorácico / Result of the surgical treatment of the goiter endotorácico

Se realizó un estudio retrospectivo y prospectivo de 30 pacientes estudiados y tratados por bocio endotorácico, seleccionados de un universo de 450 pacientes operados por nosotros a causa de diversas enfermedades tiroideas en el período comprendido entre 1994 y 2004. El sexo predominante fue el femenino (83,3 por ciento) y la edad promedio, de 52 años. El aumento de volumen (86,6 por ciento) y la disfagia (16,6 por ciento) fueron los síntomas más frecuentes. Se utilizó el ultrasonido y la radiografía de tórax en todos los casos, mientras que la biopsia por aspiración con aguja fina (BAAF) se empleó en el 96,6 por ciento de los pacientes. El bocio coloide difuso, con 19 casos (63,3 por ciento), fue el tipo histológico más observado. La hemitiroidectomía más la exéresis de la prolongación endotorácica (12 casos; 40 por ciento) fue la intervención quirúrgica más realizada. No presentó complicaciones el 93,3 por ciento de los pacientes y se presentó un caso con granuloma de la herida y otro con hipoparatiroidismo transitorio, lo cual constituyó el 3,3 por ciento. En nuestros casos no encontramos degeneración maligna del bocio(AU)

He/she was carried out a retrospective and prospective study of 30 studied patients and tried by goiter endotorácico, selected of an universe of 450 patients operated by us because of diverse thyroid illnesses in the period understood between 1994 and 2004. The predominant sex was the feminine one (83,3 percent) and the age average, 52 years old. The increase of volume (86,6 percent) and the disfagia (16,6 percent) they were the most frequent symptoms. It was used the ultrasonido and the thorax x-ray in all the cases, while the biopsy for aspiration with fine needle (BAAF) it was used by 96,6 percent of the patients. The goiter diffuse colloid, with 19 cases (63,3 percent), it was the type more observed histológico. The more hemitiroidectomía the exéresis of the continuation endotorácica (12 cases; 40 percent) it was the carried out surgical intervention. It didn't present complications 93,3 percent of the patients and a case was presented with granuloma of the wound and another with transitory hipoparatiroidismo, that which constituted 3,3 percent. In our cases we don't find wicked degeneration of the goiter(AU)

A Case of McCune-Albright Syndrome with Associated Multiple Endocrinopathies

McCune-Albright syndrome (MAS) is a rare disorder that develops from an activating mutation in the Gs gene. It is characterized by an association with Polyostotic fibrous dysplasia, and precocious puberty, Caf-au-lait pigmentation, and other endocrinopathies that result from the hyperactivity of a variety of endocrine glands. Recently we encountered a patient with MAS with fibrous dysplasia, skin pigmentation, acromegaly, hyperprolactinemia and a thyroid nodule. A 23-year-old male presented for an evaluation of a change in his facial structures. Fibrous dysplasia was diagnosed by a bone biopsy and radiographic studies. The GH level increased paradoxically after an oral glucose load. The plasma prolactin, IGF-1 and alkaline phosphatase were high. Thyroid ultrasonography revealed multiple nodules. The brain MRI demonstrated a mass in the left pituitary gland. Genetic analysis identified a change from Arg (CGT) at codon 201 to Cys (TGT).