Encefalitis de Hashimoto. Presentación de un caso / Hashimoto Encephalitis. Case Report

INTRODUCCIÓN La Encefalitis de Hashimoto (EH) es una encefalopatía de naturaleza autoinmune, con buena respuesta al tratamiento con corticoides, títulos séricos elevados de anticuerpos antitiroideos y de curso subagudo con recaídas-remisiones. Es una enfermedad poco frecuente, con una presentación clínica variable y fisiopatología aún desconocida. PRESENTACIÓN DEL CASO: Paciente femenina de 76 años con antecedentes de hipotiroidismo primario. Ingresó con un síndrome confusional agudo. Al examen físico vigil, Glasgow 13/15, subfebril (37.8°C) desorientada temporoespacialmente, ecolalia, pupilas isocóricas y reactivas, sin focalidad neurológica. Signos meníngeos negativos. Laboratorio: Hipocalcemia leve (7.8mg/dl), hipopotasemia (K 3,2 mmol/l), PCR 221.9 mg/L. Test rápido para VIH negativo. TC de encéfalo sin alteraciones. Punción lumbar líquido cristal de roca, proteínas 1 g/l, glucosa 0.67 g/l, láctico 1.3, leucocitos 77 células/microL (100% mononucleares). Se interpretó inicialmente como Encefalitis de etiología viral y se le indicó aciclovir. Presentó sensorio alternante, excitación psicomotriz y convulsión tónica clónica generalizada. Debido a deterioro súbito del sensorio, se realizó intubación orotraqueal y se trasladó a Unidad de Terapia Intensiva (UTI). Permaneció bajo asistencia mecánica ventilatoria y con vasopresores. Laboratorio: VDRL, p24 y anticuerpos HIV negativos, TSH 27,82, T4 0,41. PCR de LCR: Virus herpes simple 1 y 2, citomegalovirus y JC negativos. Hemocultivos negativos. Ante sospecha clínica de Encefalitis de Hashimoto, se solicitaron anticuerpos antitiroideo peroxidasa (aTPO), antitiroglobulina (aTG) y Anticuerpos Anti-Receptor de TSH (TRABS), que resultaron positivos. Recibió tratamiento con levotiroxina endovenosa e hidrocortisona. Normaliza valores. Por fallo en el weaning, se realizó traqueostomía. Luego de 21 días de internación en Terapia Intensiva pasó a clínica con posterior alta hospitalaria. Discusión: La EH se puede considerar como diagnóstico, solo después de descartar otras causas. En el caso expuesto se llegó al diagnóstico luego de descartar otras causas posibles, con anticuerpos antitiroideos positivos en altas concentraciones y respuesta al tratamiento con corticoides. Conclusión: Se destaca la necesidad de ampliar el conocimiento de esta patología con el fin de disminuir el subdiagnóstico y promover un inicio precoz del tratamiento, mejorando así su progresión y calidad de vida de los pacientes.

INTRODUCTION: Hashimoto's Encephalitis (HE) is an autoimmune encephalopathy, with a good response to treatment with corticosteroids, high serum titers of antithyroid antibodies and a subacute course with relapses-remissions. It is a rare disease, with a variable clinical presentation and still unknown pathophysiology. CASE REPORT: A 76-year-old female patient with a history of primary hypothyroidism. She was admitted with acute confusional syndrome. On physical examination, she was awake, she was Glasgow 13/15, she was subfebrile (37.8°C), disoriented temporally, echolalia, isochoric and reactive pupils, without neurological focality. Negative meningeal signs. Laboratory: Mild hypocalcemia (7.8 mg/dl), hypokalemia (K 3.2 mmol/l), CRP 221.9 mg/L. Rapid test for HIV negative. Brain CT without alterations. Lumbar puncture rock crystal liquid, proteins 1 g/l, glucose 0.67 g/l, lactic acid 1.3, leukocytes 77 cells/microL (100% mononuclear). It was initially interpreted as Encephalitis of viral etiology and acyclovir was prescribed. He presented alternating sensory, psychomotor excitement, and generalized tonic-clonic seizure. Due to sudden deterioration of the sensorium, orotracheal intubation was performed and he was transferred to the Intensive Care Unit. He remained under mechanical ventilatory assistance and with vasopressors. Laboratory: VDRL, p24 and HIV antibodies negative, TSH 27.82, T4 0.41. CSF PCR: Herpes simplex virus 1 and 2, cytomegalovirus and JC negative. Negative blood cultures. Due to clinical suspicion of Hashimoto's Encephalitis, anti-thyroid peroxidase (aTPO), anti-thyroglobulin (aTG) antibodies and Anti-TSH Receptor Antibodies (TRABS) were requested, which were positive. She was treated with intravenous levothyroxine and hydrocortisone. Normalized values. Due to weaning failure, a tracheostomy was performed. After 21 days of hospitalization in the Intensive Care Unit, she was admitted to the clinic and subsequently discharged from the hospital. Discussion: HD can be considered as a diagnosis, only after ruling out other causes. In the case presented, the diagnosis was made after ruling out other possible causes, with positive antithyroid antibodies in high concentrations and response to treatment with corticosteroids. Conclusion: The need to expand knowledge of this pathology is highlighted in order to reduce underdiagnosis and promote early initiation of treatment, thus improving its progression and quality of life of patients.

Evaluación de la agudeza diagnóstica de la Ecografía Translaríngea Transcutánea (ETLTC) en la valoración de la movilidad de las cuerdas vocales en cirugía de tiroides y paratiroides / Evaluation of the diagnostic acuity of the Transcutaneous Translaryngeal Ultrasound (TCTLUS) in the assessment of the vocal cords mobility in thyroid and parathyroid surgery

Introducción. La evaluación de la movilidad de las cuerdas vocales en cirugía de tiroides y paratiroides hace parte de la adecuada valoración integral. Aunque la laringoscopia directa es prueba de referencia, su uso real no es rutinario por lo que se propone la ecografía translaríngea como alternativa de evaluación. Métodos. Estudio prospectivo de evaluación de una prueba diagnóstica de la movilidad de las cuerdas vocales pre y posoperatoria, comparando la ecografía translaríngea con la video laringoscopia, en pacientes con cirugía de tiroides y paratiroides, de febrero 1° a noviembre 30 de 2022. Se describieron las variables usando frecuencias absolutas y relativas. En el análisis univariado se calcularon Chi cuadrado y T de Student y en el bivariado, regresión logística binaria. La agudeza diagnóstica se determinó con sensibilidad, especificidad y valores predictivos; se consideró la significancia estadística con p < 0,05. Resultados. Se incluyeron 267 pacientes, 219 mujeres y 48 hombres; 196 pacientes (73,4%) tenían malignidad. Se encontró en el preoperatorio, sensibilidad 100 %, especificidad 99,6 %, VPP 83,3 %, VPN 100 %, odds de probabilidad positiva 83 % y Odds de probabilidad negativa 0,004 %. En el posoperatorio, sensibilidad 82,8 %, especificidad 99,2 %, VPP 92,3 % VPN 97,9 %, odds de probabilidad positiva 92 % y odds de probabilidad negativa 0,2 %. Conclusiones. La ecografía translaríngea en nuestro medio tiene alta agudeza diagnóstica. Podría ser usada en el abordaje inicial de la evaluación de la movilidad de las cuerdas vocales y reemplazar la laringoscopia directa, dejando ésta para cuando la visualización ecográfica no sea adecuada, o en casos de afectación o sospecha de invasión, para su confirmación.

Introduction. The evaluation of the mobility of the vocal cords in thyroid and parathyroid surgery is part of the adequate comprehensive assessment. Altough, direct laryngoscopy is the gold standard, its real use is not routine, so translaryngeal ultrasound approach is proposed as an alternative. Methods. A prospective diagnostic test study was carried out to evaluate the translaryngeal ultrasound compared with video laryngoscopy in visualizing vocal mobility in patients with thyroid and parathyroid surgery from February 1 to November 30, 2022. Patients were described using absolute and relative frequencies. Univariate statistical analysis with Chi-square and Student's t tests. T. Bivariate analysis using binary logistic regression. Diagnostic acuity was calculated with sensitivity, specificity, PPV, NPV. Statistical significance with p< 0.05, 95% confidence interval. Results. 267 patients undergoing thyroid or parathyroid surgery were included, 219 women and 48 men. Malignant: thyroid neoplasm 196 patients (73.4%). The findings were for the preoperative period, 100% sensitivity, 99.6% specificity, PPV 83.33%, NPV 100%, 83% positive probability odds, and 0.004% negative probability odds. For the postoperative period, 82.8% sensitivity, 99.2% specificity, 92.3% PPV, 97.9% NPV, 92% positive probability odds, and 0.2% negative probability odds were found.Conclusions. Translaryngeal ultrasound in our series has high diagnostic acuity. It could be used as the initial approach to evaluate vocal mobility and might replace direct laryngoscopy, leaving it when its visualization is not adequate or in cases of involvement or suspected invasion for confirmation.

Manejo del paciente con Hipertiroidismo en consulta externa de la Unidad Técnica de Endocrinología del Hospital Carlos Andrade Marín / Management of the patient with hyperthyroidism in the outpatient clinic of the Technical Unit of Endocrinology of the Endocrinology Technical Unit of the Carlos Andrade Marín Hospital

El hipertiroidismo es un trastorno caracterizado por el exceso de hormonas tiroideas. El déficit de yodo es un factor clave en dicha patología y en lugares con suficiencia del mismo se asocian a au-toinmunidad tiroidea. La prevalencia de hipertiroidismo mani-fiesto varía del 0,2% al 1,3% en áreas con suficiencia de yodo, sin embargo, esto puede variar en cada país por diferencias en umbrales de diagnóstico, sensibilidad de ensayo y población se-leccionada. Un reporte de The Third National Health and Nutri-tion Examination Survey (NHANES III) mostró que el hiperti-roidismo manifiesto se presenta en 0,7% de la población general e hipertiroidismo subclínico en el 1,7%1,2.En incidencia, la patología se asocia con la suplementación de yodo, con la mayor frecuencia en áreas de deficiencias, por au-mento de nódulos tiroideos en la población anciana, teniendo a regiones de áreas montañosas como América del Sur, África Central y suroeste de Asia dentro de este grupo. Un meta aná-lisis de estudios europeos mostró una incidencia general de 50 casos por 100000 personas/años1. En Ecuador, según los datos del Instituto Nacional de Estadísticas y Censos (INEC) del 2017, se reportaron 157 casos de hipertiroidismo, de los cuales la En-fermedad de Graves (EG) fue la causa más común, seguida por el bocio multinodular tóxico (BMNT) y finalmente el adenoma tóxico (AT) con una incidencia de 61 %, 24 % y 14 % respecti-vamente3.Los pacientes con esta patología tienen aumento de riesgo com-plicaciones cardiovasculares y mortalidad por todas las causas, siendo falla cardíaca uno de sus principales desenlaces, así el diagnóstico precoz evita estos eventos, principalmente en pobla-ción de edad avanzada.El presente protocolo se ha realizado para un correcto trata-miento de esta patología en el Hospital de Especialidades Carlos Andrade Marín (HECAM).

Hyperthyroidism is a disorder characterized by an excess of thyroid hormones. Iodine deficiency is a key factor in this pa-thology and in places with iodine deficiency it is associated with thyroid autoimmunity. The prevalence of overt hyperthyroidism varies from 0,2% to 1,3% in iodine-sufficient areas; however, this may vary from country to country due to differences in diag-nostic thresholds, assay sensitivity, and selected population. A report from The Third National Health and Nutrition Examina-tion Survey (NHANES III) showed that overt hyperthyroidism occurs in 0,7% of the general population and subclinical hyper-thyroidism in 1,7%1,2.In incidence, the pathology is associated with iodine supplemen-tation, with the highest frequency in areas of deficiencies, due to increased thyroid nodules in the elderly population, having regions of mountainous areas such as South America, Central Africa and Southwest Asia within this group. A meta-analysis of European studies showed an overall incidence of 50 cases per 100000 person/years1. In Ecuador, according to data from the National Institute of Statistics and Census (INEC) in 2017, 157 cases of hyperthyroidism were reported, of which, Graves' di-sease (GD) was the most common cause, followed by toxic mul-tinodular goiter (BMNT) and finally toxic adenoma (TA) with an incidence of 61 %, 24 % and 14 % respectively3.Patients with this pathology have an increased risk of cardiovas-cular complications and all-cause mortality, with heart failure being one of the main outcomes, so early diagnosis avoids these events, mainly in the elderly population.The present protocol has been carried out for the correct treat-ment of this pathology at the Carlos Andrade Marín Specialties Hospital (HECAM).

Sintomas vocais, ansiedade e depressão pré e pós-tireoidectomia / Vocal symptoms, anxiety and depression pre and post thyroidectomy / Síntomas vocales, ansiedad y depresión pre y post tiroidectomía

Introdução: Alterações na tireoide e a tireoidectomia podem levar à sintomatologia vocal e emocional.Objetivo: Correlacionar sintomas vocais e traços de ansiedade e depressão pré e pós-tireoidectomia. Métodos: Estudo observacional, longitudinal. Participaram 20 pacientes submetidos à tireoidectomia, ao exame visual laríngeo e à Escala de Sintomas Vocais (ESV) e Escala Hospitalar de Ansiedade e Depressão (HADS) no pré-operatório, pós 1 semana e pós 3 meses, com média de idade de 54,5 anos, maior prevalência do sexo feminino (85%) e tireoidectomia parcial (70%). Resultados: Os pacientes autorreferiram sintomas vocais em todos os momentos, com maior frequência após uma semana e diferença significativa entre o domínio físico pré e pós 1 semana. Na HADS, observou-se maior escore total no pré-operatório e diferença significante nos três momentos, em todos os domínios, com maior diferença entre pré e pós 1 semana. Houve correlação positiva fraca entre os domínios limitação, emocional e escore total da ESV com a subescala de ansiedade pós 1 semana, entre o escore total da ESV e o escore total da HADS e correlação positiva moderada entre os domínios limitação e emocional da ESV com o escore total da HADS após uma semana. Conclusão: Pacientes submetidos à tireoidectomia autopercebem sintomas vocais e traços de grau leve de ansiedade tanto no pré quanto pós 1 semana e após 3 meses de cirurgia com pior autorreferência após uma semana. Quanto maior a autorreferência de sintomas vocais, mais traços de ansiedade o paciente pode apresentar. (AU)

Introduction: Thyroid alterations and thyroidectomy can lead to vocal and emotional symptoms.Purpose: To correlate vocal symptoms and anxiety and depression traits pre and post-thyroidectomy. Methods: Observational, longitudinal study. Participants were 20 patients who underwent thyroidectomy, laryngeal visual examination and the Voice Symptom Scale (VoiSS) and Hospital Anxiety and Depression Scale (HADS) preoperatively, 1 week and 3 months after, with a mean age of 54.5 years, higher prevalence of female gender (85%) and partial thyroidectomy (70%). Results: The patients self-reported vocal symptoms at all times, more frequently after one week and a significant difference between the physical domain pre and post 1 week. In HADS, there was a higher total score in the preoperative period and a significant difference in the three moments, in all domains, with a greater difference between pre and post 1 week. There was a weak positive correlation between the limitation, emotional and total score of the ESV domains with the anxiety subscale after 1 week, between the total score of the ESV and the total score of the HADS, and a moderate positive correlation between the limitation and emotional domains of the ESV with the HADS total score after one week. Conclusion: Patients undergoing thyroidectomy self-perceived vocal symptoms and mild anxiety traits both before and after 1 week and after 3 months of surgery with worse self-report after one week. The greater the self-report of vocal symptoms, the more traces of anxiety the patient may present. (AU)

Introducción: Cambios en la tiroides y tiroidectomía pueden provocar síntomas vocales y emocionales. Objetivo: Correlacionar síntomas vocales y rasgos de ansiedad y depresión antes y después de tiroidectomía. Metodos: Estudio observacional/longitudinal. Participaron 20 pacientes que se les realizó tiroidectomía, examen visual laríngeo, Escala de Síntomas Vocales (ESV) y Escala Hospitalaria de Ansiedad y Depresión (HADS) en preoperatorio, 1 semana y 3 meses después, con edad media de 54,5 años, prevalencia del género femenino (85%) y tiroidectomía parcial (70%). Resultados: Los pacientes informaron síntomas vocales en todo momento, con mayor frecuencia después de una semana y una diferencia significativa entre el dominio físico antes y después de 1 semana. En HADS, hubo mayor puntaje total en el preoperatorio y diferencia significativa en los tres momentos, con mayor diferencia entre pre y post 1 semana. Hubo una correlación positiva débil entre limitación, emocional y total de los dominios de la ESV con la subescala de ansiedad después de 1 semana, entre el total de la ESV y e total de la HADS, y una correlación positiva moderada entre la puntuación de limitación y dominios emocionales de la ESV con la puntuación total de HADS después de una semana. Conclusión: Los pacientes sometidos a tiroidectomía autopercibieron síntomas vocales y rasgos de ansiedad leve tanto antes como después de 1 semana y después de 3 meses de la cirugía con peor autoinforme después de una semana. Cuanto mayor es el autoinforme de síntomas vocales, más rastros de ansiedad puede presentar el paciente. (AU)

Características clínicas, epidemiológicas y quirúrgicas de pacientes con afecciones nodulares tiroideas / Clinical, Epidemiological and Surgical Characteristics of Patients with Thyroid Nodular Conditions

Introducción: En las últimas décadas la incidencia del cáncer tiroideo en el curso de la enfermedad nodular se ha incrementado debido a las novedosas técnicas de diagnóstico; sin embargo, la tasa de mortalidad se ha mantenido muy baja. Objetivo: Evaluar las características clínicas, epidemiológicas y quirúrgicas de pacientes con afecciones nodulares tiroideas. Métodos: Se realizó un estudio descriptivo observacional de cohorte prospectivo, longitudinal con los pacientes operados de afecciones tiroideas durante el período comprendido entre enero del 2008 y diciembre del 2018. El universo y la muestra quedaron constituidos por 467 pacientes que cumplieron con los criterios de inclusión. Resultados: Predominaron el sexo femenino (89,5 por ciento) y el grupo etario de 45-60 años (29,5 por ciento). Asociaron comorbilidades 338 pacientes y algún factor de riesgo de malignidad (6,2 por ciento). Un total de 174 pacientes manifestaron síntomas y 264 mostraron algún signo. Predominaron los reportes ecográficos (TI-RADS) y citológicos (Bethesda) tipo II (54,3 por ciento) y (55,5 por ciento), respectivamente. La hemitiroidectomía fue el procedimiento más realizado (59,9 por ciento) y la disfonía la complicación más encontrada (1,9 por ciento). Conclusiones: El diagnóstico oportuno del cáncer tiroideo en el curso de una enfermedad nodular contribuye a individualizar todas las decisiones terapéuticas atendiendo a las características de cada paciente y sus circunstancias(AU)

Introduction: In recent decades, the incidence rates of thyroid cancer in the course of nodular disease has increased due to novel diagnostic techniques; however, the mortality rate has remained very low. Objective: To evaluate the clinical, epidemiological and surgical characteristics of patients with nodular thyroid disease. Methods: A descriptive, observational, of prospective cohort, longitudinal and observational study was conducted with patients operated on for thyroid disorders during the period from January 2008 to December 2018. The study universe and sample consisted of 467 patients who met the inclusion criteria. Results: The female sex (89.5 percent) and the age group 45-60 years (29.5 percent) predominated. Comorbidities were present in 338 patients, as well as some risk factor for malignancy in 6.2 percent. A total of 174 patients manifested symptoms and 264 showed some sign. There was a predominance of echography (TI-RADS) and cytology (Bethesda) type II reports, accounting for 54.3 percent and 55.5 percent, respectively. Hemithyroidectomy was the most performed procedure (59.9 percent), while dysphonia was the most encountered complication (1.9 percent). Conclusions: Timely diagnosis of thyroid cancer in the course of nodular disease contributes to individualizing all therapeutic decisions considering the characteristics of each patient and their circumstances(AU)

Hipotiroidismo y su asociación con otras patologías: una revisión narrativa / Hypothyroidism and its association with other pathologies: a narrative review

Introducción: El hipotiroidismo es la insuficiente producción de hormona tiroidea, para satisfacer las necesidades corporales. Este puede ser primario (con pérdida de la función de la glándula tiroidea) o secundario (por falta de estimulación de la glándula). Dada la alta prevalencia del hipotiroidismo, y frecuentes asociaciones con otras enfermedades, se realizó una revisión que puntualiza aspectos de interés clínico en esta patología, que pueden resultar útiles en la práctica médica. Metodología: Se efectuó una búsqueda bibliográfica en PubMed, PubMed Central, MEDLINE Complete, Epistemonikos, Europe PMC y Scielo. Se buscaron los términos "hipotiroidismo" y "tiroides", y se acortaron los artículos a los últimos 5 años. Resultados: Se incluyeron en total 36 artículos publicados en Inglés y en Español. Se seleccionaron aquellos relacionados al hipotiroidismo que exponen asociaciones con otras patologías. Entre estas patologías se encuentra la diabetes, las dislipidemias, enfermedades cardiovasculares, hepáticas, entre otras. Conclusiones: El hipotiroidismo es una patología prevalente que se asocia de forma frecuente con muchas otras comorbilidades que hay que tener en cuenta a la hora de abordar estos pacientes, y con ello tomar las mejores decisiones diagnósticas y terapéuticas.

Introduction: Hypothyroidism is the insufficient production of thyroid hormone to meet the bodily needs. This can be primary (with loss of function of the thyroid glands) or secondary (due to lack of stimulation of the glands). Given the high prevalence of hypothyroidism, and frequent associations with other diseases, a review was carried out that points out aspects of clinical interest in this pathology, which may be useful in medical practice. Methodology: A bibliographic search was carried out in PubMed, PubMed Central, MEDLINE Complete, Epistemonikos, Europe PMC and Scielo. The terms "hypothyroidism" and "thyroid" were searched, and the articles were shortened to the last 5 years. Results: A total of 36 articles published in English and Spanish were included. Those related to hypothyroidism that exhibit associations with other pathologies were selected. These pathologies include diabetes, dyslipidemia, cardiovascular and liver diseases, among others. Conclusions: Hypothyroidism is a prevalent pathology that is frequently associated with many other comorbidities that must be taken into account when dealing with these patients, and thus make the best diagnostic and therapeutic decisions.

Correlación ultrasonográfica entre volumen tiroideo y ti-rads. Estudio prospectivo / Ultrasonographic correlation between thyroid volume and ti-rads. Prospective study

La comunidad científica se ha preocupado por cuantificar el volumen tiroideo según variables como sexo, edad y deficiencias de yodo asociadas, sin embargo, pese al uso globalizado de TI-RADS para estimación de riesgo de malignidad en la patología tiroidea, no existe suficiente información en relación a si el tamaño de la glándula guarda o no relación con esta escala. Objetivo: comparar el Volumen Tiroideo con TI-RADS en pacientes atendidos en la unidad de ecografía diagnóstica del Centro Clínico Naguanagua en el período enero 2022 - enero 2023. Métodos: estudio observacional-descriptivo de nivel comparativo, con diseño transversal y prospectivo. Muestra no probabilística censal, abarcando la totalidad de los pacientes a los cuales se les efectuó ecografía tiroidea en el período establecido. Se efectuó un registro en cuanto a la cuantificación del volumen de: lóbulo tiroideo derecho, lóbulo tiroideo izquierdo y total de tiroides, TI-RADS, edad y sexo del paciente. Se utilizó el estadístico ANOVA y se empleó el programa Statistical® de licencia libre. Resultados: muestra de 126 pacientes, con edad promedio de 51,71 años ± 1,44, mediana de 53 años. Cuando se comparó el Volumen Total de Tiroides con TI-RADS, se constató que el mayor promedio lo registraron aquellos pacientes clasificados como 4B (p <0,05). Conclusión: aun cuando se registran mayores promedios de volumen total glandular en pacientes con hallazgos nodulares, llama la atención que entre los datos registrados existan pacientes con valores muy similares a lo reportado en la literatura como volúmenes normales en presencia de patología nodular tiroidea(AU)

The scientific community has been concerned with quantifying thyroid volume according to variables such as sex, age, and associated iodine deficiencies; however, despite the global use of TI-RADS to estimate the risk of malignancy in thyroid pathologies, there is not enough information in regarding whether or not the size of the gland is related to this scale. Objective: to compare the Thyroid Volume with TI-RADS in patients treated in the diagnostic ultrasound unit of the Naguanagua Clinical Center in the period January 2022 - January 2023. Methods: observational-descriptive study of a comparative level, with a crosssectional and prospective design. Non-probabilistic census sample, covering all the patients who underwent thyroid ultrasound in the established period. A record was made regarding the quantification of the volume of: right thyroid lobe, left thyroid lobe and total thyroid, TI-RADS, age and sex of the patient. The ANOVA statistic was used and the free license Statistical® program was used. Results: sample of 126 patients, mean age 51.71 ± 1.44 years, median 53 years. When the Total Thyroid Volume was compared with TI-RADS, it was found that the highest mean was registered by those patients classified as 4B (p <0.05). Conclusion: even when higher total glandular volume averages are recorded in patients with nodular findings, it is noteworthy that among the recorded data there are patients with values very similar to those reported in the literature as normal volumes in the presence of thyroid nodular pathology(AU)

Review on ultrasonographic diagnosis of thyroid diseases based on deep learning / 生物医学工程学杂志

In recent years, the incidence of thyroid diseases has increased significantly and ultrasound examination is the first choice for the diagnosis of thyroid diseases. At the same time, the level of medical image analysis based on deep learning has been rapidly improved. Ultrasonic image analysis has made a series of milestone breakthroughs, and deep learning algorithms have shown strong performance in the field of medical image segmentation and classification. This article first elaborates on the application of deep learning algorithms in thyroid ultrasound image segmentation, feature extraction, and classification differentiation. Secondly, it summarizes the algorithms for deep learning processing multimodal ultrasound images. Finally, it points out the problems in thyroid ultrasound image diagnosis at the current stage and looks forward to future development directions. This study can promote the application of deep learning in clinical ultrasound image diagnosis of thyroid, and provide reference for doctors to diagnose thyroid disease.

Surgical management of goiter with intrathoracic extension at the Philippine General Hospital Department of Otolaryngology Head and Neck Surgery

Objective@#To describe the demographic and clinical characteristics of patients diagnosed with intrathoracic thyroid masses managed surgically in our institution, determine associated factors affecting eventual operative approaches for these patients, and assess postoperative outcomes and complications associated with surgical intervention.@*Methods@#Design: Retrospective descriptive case series. Setting:Tertiary National University Hospital. Participants: 24 patients.@*Results@#The mean age of patients diagnosed with intrathoracic goiters was 55.71 years old, with a 1:1.4 male to female ratio; with most having an intrathoracic extent of Huins Grade 1 (67%) compared to others having Huins Grade 2-3. Majority of patients pre-operatively had a Fine Needle Aspiration (FNA) Bethesda Thyroid Nodule Classification of Category II (benign); 79% of total patients underwent excision of thyroid mass utilizing a transcervical approach alone. As Intrathoracic Extension (ITE) grade increased, additional transthoracic approaches were performed; duration of operation, average estimated blood loss, length of hospital stay was also noted to increase. Majority of post operative surgical histopathology results revealed malignant thyroid masses, in contrast to pre-operative FNA. Post-operative transient hypocalcemia was the most reported immediate complication. @*Conclusions@#Management of intrathoracic goiter is often multidisciplinary. Referral to the thoracic vascular service is warranted for access to the thoracic inlet. Classification by grade of intrathoracic goiters is helpful to determine the most appropriate operative approach and may be predictive of intraoperative and postoperative outcomes. Postoperative histopathology across all ITE grades mostly yield malignant results; hence, preoperative FNA results should be used with caution.

Enfermedad de cambios mínimos cortico-resistente e hipotiroidismo. Reporte de caso / Steroid-resistant minimal change disease and hypothyroidism: Case report

Introducción: La enfermedad de cambios mínimos es una causa rara de síndrome nefrótico en el adulto, y su relación con el hipotiroidismo es más rara aún. Se considera que esta patología renal responde favorablemente al manejo con glucocorticoides y tiene una baja frecuencia de resistencia. Su abordaje hoy en día es objeto de investigación. Objetivo: Describir una rara etiología de síndrome nefrótico en el adulto con presentación, tratamiento y desenlace infrecuentes. Presentación del caso: Paciente femenino de 53 años quien inicia con síndrome nefrótico por enfermedad de cambios mínimos cortico-resistente y su asociación con un hipotiroidismo descontrolado, quien requiere manejo con rituximab y control de la enfermedad endocrinológica asociada, como enfermedad de base. Conclusiones: En este caso clínico se muestra como las enfermedades citadas pueden coexistir y el tratamiento en conjunto es necesario. El establecimiento de nuevas terapias en la población adulta como el rituximab podría mostrar beneficio, como en este caso. Sin embargo, aún existe la necesidad de estudios de mayor evidencia que validen firmemente la efectividad de los diferentes tratamientos en este tipo de pacientes.

Introduction: Minimal change disease is a rare cause of nephrotic syndrome in adults, and its association with hypothyroidism is even more exceptional. This renal pathology is considered to respond favorably to glucocorticoid management and has a low resistance frequency. How to approach this disease is currently under investigation. Objective: To describe a rare etiology of adult nephrotic syndrome with unusual presentation, treatment, and outcome. Case presentation: A 53 years-old female patient who initially experienced nephrotic syndrome due to steroid-resistant minimal change disease, which was also associated with uncontrolled hypothyroidism. She required management with rituximab and control of the associated endocrinological disease, which was considered as the underlying disease. Conclusions: This clinical case shows (i) how the two aforementioned diseases can coexist and (ii) that a joint treatment is necessary. Establishing new therapies may be beneficial for adult populations, such as the benefits seen in this case with the use of rituximab. However, further studies are needed to strongly validate the effectiveness of the different treatments for these types of patients.

Factores clínicos y ambientales asociados a la tiroiditis de Hashimoto / Clinical and environmental factors associated with Hashimoto's thyroiditis

Introducción: La tiroiditis de Hashimoto es una enfermedad tiroidea autoinmune poligénica y multifactorial resultante de una interacción compleja de factores genéticos y ambientales. Objetivo: Determinar la posible asociación de los factores clínicos y ambientales con los niveles de anticuerpos antitiroideos y las pruebas de función tiroidea en la tiroiditis de Hashimoto. Métodos: Estudio observacional, descriptivo y transversal con 120 personas con diagnóstico de tiroiditis de Hashimoto. Variables estudiadas: edad, sexo, color de la piel, estado nutricional, paridad, hábito de fumar, consumo de alcohol, preparados estrogénicos, antecedentes familiares de enfermedad autoinmune tiroidea y personales de otras enfermedades autoinmunes. Se realizaron determinaciones de anticuerpos AbTPO, TSH, T3 y T4. Resultados: Predominio del sexo femenino (92,5 por ciento), de pacientes de piel blanca (50,8 por ciento) y con sobrepeso corporal (40 por ciento). El 73 por ciento no consumían preparados estrogénicos. El 20 por ciento tenían antecedentes familiares de enfermedad tiroidea y personales de diabetes mellitus tipo 1 (7,5 por ciento). La media del anticuerpo en pacientes con antecedentes de infecciones virales fue superior a los que no tuvieron este antecedente (732,6 vs. 624,6). El resto de las variables no mostraron diferencias entre las medias del anticuerpo. Ninguno de los factores estudiados mostró asociación con el estado de la función tiroidea. (p>0,05). Conclusiones: No existió asociación entre los factores clínicos y ambientales en relación a los niveles de Ac TPO y el estado de la función tiroidea, con predominio del hipotiroidismo manifiesto al diagnóstico de la TH(AU)

Introduction: Hashimoto's thyroiditis is a polygenic and multifactorial autoimmune thyroid disease, resulting from a complex interaction of genetic and environmental factors. Objective: To determine the possible association of clinical and environmental factors with antithyroid antibody levels and thyroid function tests in HT. Methods: An observational, descriptive, cross-sectional study was carried out with 120 subjects diagnosed with Hashimoto's thyroiditis. We studied variables such as age, sex, skin color, nutritional status, parity, smoking, alcohol consumption, estrogen preparations, family history of autoimmune thyroid disease and personal history of other autoimmune diseases. Additionally, AbTPO, TSH, T3 and T4 antibody determinations were made. Results: Predominance of the female sex (92.5 percent), white skin (50.8 percent) and body overweight (40 percent). 73 percent did not consume estrogenic preparations. Twenty percent had family history of thyroid disease and personal history of type 1 diabetes mellitus (7.5 percent). The mean antibody in patients with history of viral infections was higher than those without this history (732.6 vs. 624.6). The rest of the variables did not show differences between the means of the antibody. None of the factors studied showed association with the state of thyroid function. (p > 0.05). Conclusions: There was no association between clinical and environmental factors in relation to Ac TPO levels and the state of thyroid function, with a predominance of overt hypothyroidism at diagnosis of HT(AU)

Frequency of oral Lichen Planus among hypothyroid patients / Frequência de Líquen Plano oral em pacientes com hipotireoidismo

Objective: Recent investigations have suggested a correlation between thyroid diseases, particularly hypothyroidism (HT), and oral lichen planus (OLP). Objective: This study aimed to assess the frequency of OLP in HT patients. Material and Methods: This analytical descriptive study evaluated 100 HT patients including 94 females and 6 males, who were selected by convenience sampling. The subjects were clinically examined for OLP. The mean age of patients was 42.49±1.29 years. Also, 100 age- and sex-matched healthy controls were examined. The data were analyzed using chi-square test and Fisher's exact test via SPSS. Results: Of all, 14 (14%) HT patients (12 females and 2 males) had OLP while only one case of OLP was found in the control group. The difference between the two groups in the frequency of OLP was significant (P=0.001). The odds ratio (OR) of developing OLP was calculated to be 16.11 in HT patients. Reticular form was the most common type of OLP in patients (50%). The buccal mucosa was the most common site of involvement (92.85%). The mean age of patients with OLP was 42.93±1.29 years with a median of 46±1.29 years in HT group. Conclusion: The frequency of OLP was significantly higher in HT patients such that HT patients had higher odds of developing OLP by 16 folds. (AU)

Objetivo: Investigações recentes sugeriram uma correlação entre doenças da tireoide, particularmente hipotireoidismo (HT), e líquen plano oral (LPO). Objetivo: Este estudo teve como objetivo avaliar a frequência de LPO em pacientes com HT. Material e Métodos: Este estudo descritivo analítico avaliou 100 pacientes com HT, incluindo 94 mulheres e 6 homens, selecionados por amostragem por conveniência. Os indivíduos foram examinados clinicamente para LPO. A média de idade dos pacientes foi de 42,49 ± 1,29 anos. Além disso, foram examinados 100 controles saudáveis pareados por idade e gênero. Os dados foram analisados usando o teste do qui-quadrado e o teste exato de Fisher via SPSS. Resultados: De todos, 14 (14%) pacientes com HT (12 mulheres e 2 homens) tiveram LPO, enquanto apenas um caso de LPO foi encontrado no grupo controle. A diferença entre os dois grupos na frequência de LPO foi significativa (P = 0,001). A razão de probabilidade de desenvolvimento de LPO foi calculado em 16,11 em pacientes com HT. A forma reticular foi o tipo mais comum de LPO nos pacientes (50%). A mucosa bucal foi o local de acometimento mais comum (92,85%). A média de idade dos pacientes com LPO foi de 42,93 ± 1,29 anos, com mediana de 46 ± 1,29 anos no grupo HT. Conclusão: A frequência de LPO foi significativamente maior em pacientes com HT, de modo que os pacientes com HT tinham maior chance de desenvolver LPO em 16 vezes. (AU)

Función tiroidea y embarazo / Thyroid function and pregnancy

La enfermedad tiroidea, junto con la diabetes mellitus, son las dos endocrinopatías más frecuentes en el embarazo. El hipotiroidismo primario en mujeres en edad gestacional tiene una prevalencia del 2%, convirtiendo en un reto su diagnóstico, tratamiento y seguimiento en la práctica clínica

Thyroid disease, along with diabetes mellitus, are the two most common endocrinopathies in pregnancy. Primary hypothyroidism in women of gestational age has a prevalence of 2%, making its diagnosis, treatment and follow-up a challenge in clinical practice

Experiencia de ocho años en tiroidectomías en el Hospital General Docente "Dr. Enrique Cabrera Cossío" / Experience of Eight Years Performing Thyroidectomies at Dr. Enrique Cabrera Cossío General Teaching Hospital

Introducción: Las enfermedades tiroideas son relativamente frecuentes que puede tener carácter benigno o maligno. El algoritmo para el diagnóstico de los nódulos tiroideos se dirige principalmente a definir la presencia o no de un carcinoma de la glándula. El tratamiento quirúrgico puede incluir técnicas convencionales, parciales y totales, y mínimamente invasivas. Objetivo: Describir los resultados del tratamiento quirúrgico de las enfermedades tiroideas en el Hospital General Docente "Enrique Cabrera" entre enero 2013 y diciembre de 2020. Métodos: Se realizó un estudio descriptivo ambispectivo, en el mencionado centro, entre el 1ro de enero de 2013 hasta el 31 de diciembre de 2020. El universo se conformó por todos los pacientes con enfermedades de tiroides que fueron tratados quirúrgicamente. La muestra quedó constituida por 96 pacientes. Resultados: La edad media fue 48,1 años. Predominó el sexo femenino (83,3 por ciento). El diagnóstico más frecuente fue el bocio con síntomas compresivos (39,6 por ciento), seguido del carcinoma tiroideo (25 por ciento), en este último el más observado fue el carcinoma papilar (66,6 por ciento). Se realizó tiroidectomía total en 40,6 por ciento, con pocas complicaciones posoperatorias (7,3 por ciento), siendo la parálisis recurrencial la más frecuente de ellas. Conclusiones: El tratamiento quirúrgico de las enfermedades tiroideas en el Hospital General Docente "Dr. Enrique Cabrera" tuvo buenos resultados, tanto en enfermedades benignas como en el cáncer tiroideo(AU)

Introduction: Thyroid diseases are relatively frequent and can be benign or malignant. The algorithm for the diagnosis of thyroid nodules is mainly aimed at defining the presence or absence of a carcinoma in the gland. Surgical treatment can include conventional, partial or total, as well as minimally invasive, techniques. Objective: To describe the outcomes of surgical treatment for thyroid diseases at Enrique Cabrera General Teaching Hospital between 2013 and 2020. Methods: An ambispective and descriptive study was carried out, between January 1, 2013 and December 31, 2020, in the aforementioned center. The universe was made up of all patients with thyroid diseases treated surgically. The sample consisted of 96 patients. Results: The mean age was 48.1 years. The female sex predominated (83.3 percent). The most frequent diagnosis was goiter with compressive symptoms (39.6 percent), followed by thyroid carcinoma (25 percent); among the latter, the most observed was papillary carcinoma (66.6 percent). Total thyroidectomy was performed in 40.6 percent, with few postoperative complications (7.3 percent), recurrent paralysis being the most frequent of them. Conclusions: The surgical treatment for thyroid diseases at Dr. Enrique Cabrera General Teaching Hospital had good outcomes, both in benign diseases and in thyroid cancer(AU)

Comportamiento de la enfermedad nodular tiroidea en la provincia de Cienfuegos / Characterization of Nodular Thyroid Disease in Cienfuegos Province

Introducción: La enfermedad nodular tiroidea es frecuente motivo de consulta médica, para lo que se emplea como pilar de tratamiento la intervención quirúrgica. Objetivo: Caracterizar el comportamiento de los pacientes con afecciones quirúrgicas del tiroides, en la provincia de Cienfuegos. Métodos: Se realizó un estudio descriptivo, retrospectivo de 193 pacientes con afecciones quirúrgicas del tiroides en el Servicio de Cirugía del Hospital General Universitario "Dr. Gustavo Aldereguía Lima", durante un periodo de 3 años, comprendidos desde el 1 de enero del 2018 al 31 de diciembre del 2020. Las variables analizadas fueron: edad, sexo, afecciones tiroideas, procedimiento quirúrgico empleado y complicaciones posquirúrgicas. Se empleó modelo recolector de datos con las variables de interés y se presentaron en tablas de frecuencia, números y porciento. Resultados: Predominaron las féminas (83,9 por ciento) y el grupo etario 41 - 50 años (31,1 por ciento). Prevaleció el carcinoma papilar (13,0 por ciento) y globalmente de las afecciones benignas (74,6 por ciento). La hemitiroidectomía fue el procedimiento quirúrgico más empleado (50,8 por ciento) y la disfonía transitoria (6,2 por ciento) como complicación más frecuente. Conclusiones: Las afecciones tiroideas predominaron en las féminas entre 41 y 50 años, fueron diagnosticadas mediante estudios histológicos. Predominó el carcinoma papilar y de forma global las afecciones benignas, se recurrió a la hemitiroidectomía y la disfonía transitoria fue la complicación más frecuente(AU)

Introduction: Nodular thyroid disease is a frequent reason for medical consultation. In such cases, surgical intervention is used as mainstay of treatment. Objective: To characterize patients with thyroid surgical conditions in Cienfuegos Province. Methods: A descriptive and retrospective study was carried out in the surgery service of Dr. Gustavo Aldereguía Lima General University Hospital with 193 patients who presented thyroid surgical conditions over a period of three years (from January 1, 2018 to December 31, 2020). The following variables were analyzed: age, sex, thyroid conditions, surgical procedure used and postoperative complications. A data collector model including the variables of interest was used. They data were presented in tables of frequency, numbers and percentage. Results: The was a predominance of females (83.9 percent) and the age group 41-50 years (31.1 percent). There was a prevalence of papillary carcinoma (13.0 percent) and, globally, of benign conditions (74.6 percent). Hemithyroidectomy was the most used surgical procedure (50.8 percent) and transient dysphonia (6.2 percent) was the most frequent complication. Conclusions: Thyroid affections predominated among females between 41 and 50 years old, diagnosed by histological studies. Papillary carcinoma predominated, as well as benign conditions globally. Hemithyroidectomy was used and transient dysphonia was the most frequent complication(AU)

Potential targets for the hepatitis C virus-mediated autoimmune thyroiditis

2021.174934ABSTRACTIntroduction: The mechanisms by which hepatitis C virus (HCV) infection induces autoimmune thyroiditis (AIT) have been studied, and it was suggested that inflammatory cytokines during HCV infection would change the thy-roperoxidase (TPO) signaling cascade and thyroglobulin (Tg) determining autoimmune thyroid disease.Objective: To show the signaling pathway, of TPO and Tg, and their potential targets mediated HCV in individuals with hepatitis C.Methods: The mapping of the signaling pathway was based on a review study approach and performed using the automatic annotation server of the Kyoto and Genome Encyclopedia (KEGG). PathVisio is free software for analysis and design of open source routes, and was used for the graphic representation of the signaling pathway.Results: The contigs were extracted from the KEGG database and their mapped transcription represents the signa-ling pathway of the main biomolecules that triggers the AIT. The action of HCV, or its treatment can trigger AIT that is characterized by the presence of autoantibodies against TPO and Tg. In AIT, autoreactive CD4 + T lymphocytes recruit B cells and CD8 + T cells in the thyroid. The progression of the disease leads to the death of thyroid cells and hypothyroidism. Conclusion: HCV or its treatment activates several signaling pathways with thyroid cells damage resulting in AIT and secondary hypothyroidism to cellular apoptosis. (AU)

RESUMOIntrodução: Os mecanismos pelos quais a infecção com o vírus da hepatite C (HCV) induz à tireoidite autoimune (TAI) têm sido alvo de estudos. Tem sido sugerido que citocinas inflamatórias, como a elevação das interleucinas na inflamação causadas pelo HCV, alterariam a cascata de sinalização da tireoperoxidase (TPO) e tireoglobulina (Tg) determinando um quadro de doença autoimune da tireóide.Objetivo: Demonstrar a via de sinalização da TPO e da Tg e seus potenciais alvos para a TAI mediados pelo HCV em indivíduos com hepatite C.Método: O mapeamento da via de sinalização foi realizado usando o servidor de anotação automática da Enciclopé-dia Quioto de Genes e Genomas (KEGG). O PathVisio, um software gratuito de análise e desenho de vias de código aberto, foi utilizado para a representação gráfica da via de sinalização.Resultado: As sequências foram retiradas do banco de dados KEGG e sua transcrição mapeada representa a via de . sinalização das principais biomoléculas que desencadeia a TAI. A ação do HCV, ou seu tratamento pode desen-cadear a TAI que é caracterizada pela presença de autoanticorpos contra a TPO e Tg. Na TAI os linfócitos T CD4+ auto-reativos recrutam células B e células T CD8+ na tireóide. A progressão da doença leva à morte de células da tireóide e hipotireoidismo.Conclusão: O HCV ou o seu tratamento ativa várias vias de sinalização com dano na célula tireoidiana, tendo como resultado TAI e hipotireoidismo secundário a apoptose celular. (AU)

Assessment of thyroid disorders in patients with rosacea: a large case-control study

Abstract Background: The frequency of autoimmune diseases and thyroid cancer has been increasingly reported in association with rosacea. However, studies investigating thyroid diseases in rosacea are scarce with conflicting results. Objective: To investigate the relationship between thyroid disorders and rosacea. Methods: A large case-control study on ageand gender-matched 2091 rosacea patients and 9572 controls was conducted. Rosacea patients using the rosacea-specific ICD codes were compiled from the hospital records. Additionally, all participants were evaluated in terms of the presence of hypothyroidism and hyperthyroidism. Conditional logistic regression analysis was used to compute case-control odds ratios (OR) with 95% confidence intervals. Results: The analysis comprehended 2091 rosacea patients (1546 female, 545 male; mean 48.73 ± 14.53 years) and 9572 controls (7009 female, 2563 male; mean 48.73 ± 15.1 years). Whereas the rate of hypothyroidism was significantly higher in rosacea patients (OR = 1.3, 95% CI 1.13-1.49, p < 0.001), there was no significant difference in the rate of hyperthyroidism between the groups (OR = 1.12, 95% CI 0.81-1.53, p = 0.497). Stratification for gender revealed a significant association between hypothyroidism and rosacea in females (OR = 1.27, 95% CI 1.1-1.47, p = 0.002) and males (OR = 1.58, 95% CI 1.04-2.4, p = 0.032). The frequency of hypothyroidism in rosacea patients increased towards the age range of 40-49 and then decreased, parallel with the hypothyroidism frequency of the study population. Study limitations: Different subtypes and severities of rosacea were not distinguished. Conclusions: Hypothyroidism may be a comorbidity of rosacea and investigation for hypothyroidism may be appropriate when evaluating rosacea patients.

Disfunción tiroidea y diabetes mellitus tipo 1 / Thyroid dysfunction and type 1 diabetes mellitus

Introducción: La diabetes mellitus tipo 1 es una enfermedad autoinmunitaria que se relaciona con alteraciones tiroideas. Objetivo: Describir la relación que existe entre diabetes mellitus tipo 1 y enfermedad tiroidea autoinmune. Métodos: Se realizó una revisión de la literatura nacional e internacional de los últimos 15 años en bases de datos, en español y en inglés. Se utilizaron las siguientes palabras clave: diabetes mellitus tipo 1, autoinmunidad, enfermad tiroidea autoinmune, disfunción tiroidea y anticuerpos antitiroideos. Análisis e integración de la información: La alteración más frecuente es el hipotiroidismo subclínico y se presenta con mayor frecuencia en el sexo femenino, por lo que se sugiere realizar periódicamente el perfil tiroideo a estos pacientes. Conclusiones: Se debe tener en cuenta en la práctica clínica estas implicaciones para brindar un tratamiento oportuno, mejorar complicaciones derivadas como las enfermedades cardiovasculares y disminuir las cifras de morbilidad y mortalidad(AU)

Introduction: Type 1 diabetes mellitus is an autoimmune disease that is related to thyroid abnormalities. Objective: Describe the relationship between type 1 diabetes mellitus and autoimmune thyroid disease. Methods: A review of the national and international literature of the last 15 years was carried out in databases, in Spanish and in English. The following keywords were used: type 1 diabetes mellitus, autoimmune, autoimmune thyroid disease, thyroid dysfunction and antithyroid antibodies. Analysis and integration of information: The most common alteration is subclinical hypothyroidism and it occurs most often in the female sex, so it is suggested to periodically perform the thyroid profile to these patients. Conclusions: These implications should be taken into account in clinical practice to provide timely treatment, improve complications such as cardiovascular disease and reduce morbidity and mortality figures(AU)

A trial for improving thyroid gland dysfunction in rats by using a marine organism extract / Tentativa para melhorar a disfunção da glândula tireoide em ratos usando um extrato de organismo marinho

Abstract Understanding the relation between the environmental stress factors and the hypothalamus-pituitary-thyroid (HPT) axis efficiency can reduce the susceptibility to thyroid diseases. In our study, thyroid dysfunction was induced in female rats by administration of 40 mg Na F/kg.bd.wt/day for a month. Co-administration of the water extract of Arca noae (300 mg/kg. bw) was tested as a treatment for Na F induced thyroid dysfunction. A group of rats injected Arca noae extract only (300 mg/kg.bd.wt) was performed to observe the impact of the extract on the (HPT) axis in addition to the normal control group. Results showed that there was a significant decrease in serum triglycerides, total protein and albumin levels in the fluoride supplemented group in addition to abnormal levels of TSH, (T4) and (T3) compared to the control group. In the treated group there was an improvement in the proteins level and lipid profile but pseudo-corrected serum (T4) and (T3) levels were observed in addition to a continuous increase in TSH level. Histological findings confirmed the harmful effect of fluoride on both the non treated and the treated groups. Consequently, fluoride supplementation must be considered as a harmful stress that may affect permanently the HPT axis.

Resumo Compreender a relação entre os fatores de estresse ambiental e o eixo hipotálamo-hipófise-tireoide (HPT) pode reduzir a suscetibilidade a doenças da tireoide. Em nosso estudo, a disfunção tireoidiana foi induzida em ratos fêmeas pela administração de 40 mg Na F/kg.bw/dia durante um mês. A administração concomitante do extrato aquoso de Arca noae (300 mg/kg.Pc) foi testada como tratamento para a disfunção tireoidiana induzida por Na F. Um grupo de ratos injetados apenas com extrato de Arca noae (300 mg/kg. Pc) foi pré-formado com o intuito de observar o impacto do extrato no eixo (HPT), além do grupo controle normal. Os resultados mostraram que houve uma diminuição significativa nos níveis séricos de triglicerídeos, proteína total e albumina no grupo suplementado com fluoreto, além de níveis anormais de TSH, (T4) e (T3) em comparação ao grupo controle. No grupo tratado, houve uma melhora no nível de proteínas e perfil lipídico. Os níveis séricos pseudocorrigidos (T4) e (T3) foram observados, além de um aumento contínuo no nível de TSH. Os achados histológicos confirmaram o efeito prejudicial do flúor nos grupos não tratado e tratado. Consequentemente, a suplementação de flúor é considerada um estresse prejudicial que pode afetar permanentemente o eixo HPT.