Hipotiroidismo en mujeres en la posmenopausia, prevalencia en el Eje Cafetero, Colombia, 2016-2019 / Hypothyroidism in postmenopausal women, prevalence in the Coffee Region, Colombia, 2016-2019 / Hipotiroidismo em mulheres na pós-menopausa, prevalência no Eje Cafetero, Colômbia, 2016-2019

Resumen: El objetivo es determinar la prevalencia de hipotiroidismo en mujeres en la posmenopausia, en el Eje Cafetero. Materiales y métodos: Estudio de corte transversal en 469 participantes. Se ingresaron mujeres mayores de 40 años, en la posmenopausia, que asistieron a la consulta externa para atención por patología ginecológica; entre julio de 2016 y junio de 2019, en tres clínicas privadas de carácter universitario, en el Eje Cafetero, Colombia. Se excluyeron mujeres con diagnóstico previo de hipotiroidismo o que se negaron a participar. Muestreo aleatorio simple. Variables medidas: sociodemográficas, clínicas y quirúrgicas. Se aplicó estadística descriptiva. Resultados: La edad media fue de 56,47 ± 7,14 años. La media de los valores de la TSH en la población global fue de 3,71 ± 1,94 μUI/mL, con tendencia al incremento a medida del aumento de la edad. La prevalencia de hipotiroidismo en mujeres en la posmenopausia fue del 48,61 % (n = 228/469) (IC95 %: 37,83-54,15), en el Eje Cafetero; siendo más elevada en las obesas (54,41 %; IC95 %, 43,29-49,41 %) y en las mayores de 60 (52,35 %; IC95 %: 20,64-31,77). Se detectaron anticuerpos antitiroideos antiperoxidasa (AC-TPO) en el 46,05 % (n = 105/228) y los antitiroglobulina (TgAb) en el 21,05 % (n = 48/228) de las mujeres hipotiroideas, evidenciándose un fenómeno autoinmune en el 3,26 % (n = 153/469) de la población total estudiada. El sobrepeso, el incremento de la edad y la presencia de anticuerpos antitiroideos aumentan significativamente la prevalencia de hipotiroidismo (p < 0,05). Conclusiones: El 48,61 % de las mujeres del Eje Cafetero en la posmenopausia presentan hipotiroidismo.

Abstract: The aim is to determine the prevalence of hypothyroidism in postmenopausal women in the Coffee Region. Materials and methods: Cross-sectional study in 469 participants. Postmenopausal women over 40 years of age who sought outpatient care due to gynecological pathologies between July 2016 and June 2019 in three private university clinics in the Coffee Region, Colombia, were admitted. Women with a previous diagnosis of hypothyroidism or who refused to participate were excluded. Simple random sampling. Measured variables: sociodemographic, clinical, and surgical. Descriptive statistics were applied. Results: The mean age was 56.47 ± 7.14 years. The mean TSH values in the global population were 3.71 ± 1.94 μIU/mL, increasing with age. The prevalence of hypothyroidism in postmenopausal women was 48.61 % (n = 228/469) (95 % CI: 37.83-54.15) in the Coffee Region, being higher in obese women (54.41 %; 95 % CI, 43.29-49.41 %) and those over 60 (52.35 %; 95 % CI: 20.64-31.77). Anti-thyroid peroxidase antibodies (TPoAb) were detected in 46.05% (n = 105/228) and thyroglobulin antibodies (TgAb) in 21.05% (n = 48/228) of hypothyroid women, showing an autoimmune phenomenon in 3.26% (n = 153/469) of the total population studied. Overweight, older age and antithyroid antibodies increase the prevalence of hypothyroidism (p < 0.05). Conclusions: 48.61 % of postmenopausal women from the Coffee Region have hypothyroidism.

Resumo: O objetivo é determinar a prevalência de hipotiroidismo em mulheres na pós-menopausa, no Eje Cafetero (Eixo Cafeeiro). Materiais e métodos: Estudo de corte transversal em 469 participantes. Foram incluídas mulheres maiores de 40 anos, na pós-menopausa, que foram à consulta externa para o atendimento por patologia ginecológica; entre julho de 2016 e junho de 2019, em três hospitais particulares de caráter universitário, no Eje Cafetero, Colômbia. Foram excluídas mulheres com diagnóstico prévio de hipotiroidismo ou que negaram a participar. Amostragem aleatória simples. Variáveis medidas: sociodemográficas, clínicas e cirúrgicas. Foi aplicada estatística descritiva. Resultados: A idade média foi de 56,47 ± 7,14 anos. A média dos valores da TSH na população global foi de 3,71 ± 1,94 μUI/mL, com tendência à elevação à medida que a idade aumentasse. A prevalência de hipotiroidismo em mulheres na pós-menopausa foi de 48,61 % (n = 228/469) (IC95 %: 37,83-54,15), no Eje Cafetero; sendo mais elevada nas obesas (54,41 %; IC95 %, 43,29-49,41 %) e nas maiores de 60 (52,35 %; IC95 %: 20,64-31,77). Foram detectados anticorpos antitiroideus antiperoxidase (AC-TPO) em 46,05 % (n = 105/228) e os antitiroglobulina (TgAb) em 21,05 % (n = 48/228) das mulheres com hipotiroidismo, evidenciando-se um fenómeno autoimune em 3,26 % (n = 153/469) da população total estudada. O sobrepeso, o aumento da idade e a presença de anticorpos antitiroideus aumentam significativamente a prevalência de hipotiroidismo (p < 0,05). Conclusões: 48,61 % das mulheres do Eje Cafetero na pós-menopausa apresentam hipotiroidismo.

Hipotireoidismo subclínico: uma revisão para o médico clínico / Subclinical hypothyroidism: a review for the clinic physician

O hipotireoidismo subclínico é uma alteração frequente, definida como condição oligossintomática ou assintomática, com níveis séricos elevados do hormônio estimulador da tireoidee níveis normais de tiroxina livre. Pode representar o estágio inicial de uma deterioração progressiva da função tireoidiana, sendo que, em alguns casos, esta função pode permanecer inalterada ou mesmo normal. O objetivo deste estudo foi revisara literatura para os aspectos epidemiológicos, diagnósticos, indicações do tratamento e o procedimento terapêutico aplicado ao hipotireoidismo subclínico. Os clínicos generalistas devem ser capazes de diagnosticar, indicar a terapia em situações adequadas e dar seguimento aos casos. Será discutido o conceito de hipotireoidismo subclínico, rastreio e epidemiologia.Serão abordadas evidências presentes em relação às alterações provocadas pelo hipotireoidismo subclínico: na dislipidemia,na resposta cardiovascular ao esforço físico e recuperação, no risco cardiovascular, em distúrbios psiquiátricos e em grupos especiais de idosos e gestantes, descrevendo-se o tratamento. Oh ipotireoidismo subclínico é uma condição frequente nos ambulatórios de clínica médica e por muitas vezes é assintomático ou apresentado por sintomas sutis e inespecíficos tais como: a disfunção sexual, parestesias, fadiga crônica, mialgia, sintomas psiquiátricos e disfunção cognitiva leve. É papel de o médico generalista estar capacitado para diagnosticar, analisar as variáveis que se impõem para decisão quanto ao início do tratamento e realizar acompanhamento periódico destes pacientes.

Subclinical hypothyroidism is a frequent pathology defined as an oligosymptomatic or asymptomatic condition with high serum levels of thyroid stimulating hormone, and normal free thyroxine levels. It can represent the initial stage of a progressive deterioration of thyroid function, and in some cases this function may remain unchanged or even become normal. The objective of this study is to review the literature for the epidemiological aspects, diagnosis, treatment indications and treatment procedure applied to subclinical hypothyroidism. Generalist physicians should be able to diagnose, indicate the therapy in appropriate situations and follow the cases. The concept, screening and epidemiology of subclinical hypothyroidism will be discussed. We will approach the current evidence regarding changes caused by the subclinical hypothyroidism in dyslipidemia, cardiovascular response to physical exercise and recovery, cardiovascular risk, psychiatric disorders, and in the special groups: elderly and pregnant women. The treatment will also be described. The subclinical hypothyroidism is a common condition in the outpatient clinica nd is often asymptomatic or presented with subtle and nonspecific symptoms such as sexual dysfunction, paresthesias, chronic fatigue, myalgia, psychiatric symptoms and mild cognitive impairment. The generalist physician must be able to diagnose, analyze the variables that are needed for decision on the initiation of treatment, and regularly monitor the thyroid function of these patients.

Diagnóstico y tratamiento de los trastornos tiroideos durante el embarazo: un enfoque para el cuidado integral del binomio madre-hijo / Diagnosis and management of thyroid disorders during pregnancy: an approach to comprehensive care of mother and child

Los trastornos tiroideos son frecuentes en mujeres en edad reproductiva. Sin embargo, a menudo no se diagnostican porque su sintomatología se confunde con el estado hipermetabólico característico del embarazo. A los cambios fisiológicos en el embarazo de índole cardiovascular, pulmonar, hematológica, inmunológica, etc., se añaden las modificaciones en el eje tiroideo que a lo largo de la gestación presenta diferentes estados, lo que hace aún más difícil el diagnóstico y tratamiento correctos en los casos patológicos. Los trastornos del eje tiroideo tienen repercusiones negativas sobre la madre y el feto, entre otras: preeclampsia, aborto, parto prematuro y trastornos del sistema nervioso central del feto. El tratamiento se debe dirigir a contrarrestar los efectos del aumento o la disminución del funcionamiento de la glándula teniendo en cuenta las diferencias en cuanto a requerimientos y seguridad de los fármacos en el feto. Actualmente es motivo de controversia la tamización de rutina en gestantes para trastornos tiroideos, pues hasta el momento se destinan las pruebas a mujeres embarazadas de alto riesgo.

Thyroid disorders are frequent in women of reproductive age. However, they are often overlooked because their manifestations may be confused with those of the hypermetabolic state that is characteristic of pregnancy. To the physiological changes that occur during pregnancy –cardiovascular, pulmonary, hematological, immunological, etc., it is necessary to add modifications in the thyroid axis that presents different situations during pregnancy; those variations make it difficult to correctly diagnose and treat pathological situations. Disorders of thyroid axis have negative consequences on both mother and fetus, among them: preeclampsia, abortion, premature delivery and disorders of the fetal central nervous system. Treatment must be oriented to counteract the effects of either increased or diminished thyroid function; for that purpose, differences concerning requirements and safety of medicines must be taken into account. Presently there is controversy concerning routine screening of pregnant women for thyroid disorders; so far, the available tests are usually performed only in high-risk women.

The Relationship between Expression of the Sodium/iodide Symporter Gene and the Status of Hormonal Receptors in Human Breast Cancer Tissue / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: It has been reported that the sodium/iodide symporter (NIS) gene is expressed in several breast cancer tissues, suggesting the possibility of radionuclide imaging and therapy. However, the regulatory mechanism of NIS gene expression in breast cancer is not yet understood. To assess the relationship between the hormonal status and the NIS expression in breast cancer tissue, we investigated the NIS expression and correlated it to the expression of the thyrotropin receptor (thyroid stimulating hormone receptor, TSH-R), the estrogen receptor (ER) and the progesterone receptor (PR) in human breast cancer tissues. MATERIALS AND METHODS: Breast cancer tissues were obtained from 44 patients. Pathological examination showed 2 cases of Grade I, 17 of Grade II, 22 of Grade III, and 3 of unknown grade. We measured the expression of NIS and TSH-R genes by using RT-PCR and we measured the status of ER and PR by using immunohisto-chemistry. RESULTS: The NIS gene was expressed in 15 (34%) of the 44 breast cancer tissues. The NIS gene was expressed in 32% of the cases with TSH-R gene expression. The NIS gene was expressed in 40% of the breast cancer tissues with a positive PR and in 31% with a negative PR (p>0.05). It was positive for PR in 18% of the cases and negative for PR in 39% of the cases (p>0.05). CONCLUSION: The NIS gene is expressed in approximately one-third of the human breast cancer tissues. Its expression was not related to the presence of the TSH-R gene or hormonal receptors, ER and PR.