RESUMO
SUMMARY Acute suppurative thyroiditis is an uncommon disorder caused by a bacterial infection, usually presenting with normal thyroid function. It is a serious condition that requires a prompt diagnosis and treatment with antibiotics and supportive measures. A 62 years-old female presented with a painful cervical induration and odynophagia a week after a fish bone had been removed from her pharynx. She was febrile, and tachycardic and, on physical examination, a painful thyroid mass was detected. High inflammatory parameters and thyrotoxicosis were confirmed: thyroid stimulating hormone (TSH) < 0.01 mIU/L (normal range [NR] 0.27-4.2); free thyroxine (FT4) 3.86 ng/dL (NR 0.9-1.7) and anti-TSH receptor antibodies (TRABs) 5.3 U/L (NR < 1.5). Thyroid scintigraphy showed a diffuse uptake of the thyroid parenchyma suggesting Graves disease. Cervical ultrasonography revealed an abscess of the left thyroid lobe of 36 × 36 mm and fine needle aspiration biopsy (FNAB) with partial drainage was performed. Staphylococcus aureus and Streptococcus viridans were isolated, and directed antibiotic therapy was started. Clinical improvement was observed as well as a decrease of inflammatory parameters and the patient was discharged after 9 days of hospitalization. Eighteen days after discharge, thiamazole was initiated due to persistent thyrotoxicosis. Complete resolution of the abscess was documented within 6 months and the patient became euthyroid under thiamazole one year after initial presentation. To our knowledge, this is the third case reporting an association between acute thyroiditis and Graves disease. Furthermore, this is the first case detailing the simultaneous diagnosis of acute suppurative thyroiditis caused by a foreign body and Graves disease.
RESUMO
Objetivo: Analisar o estado atual da cobertura vacinal (CV) de crianças menores de três anos no município de Fortaleza, CE, e sua relação com a condição socioeconômica das famílias. Métodos: Pesquisa transversal de base populacional com amostragem aleatória. As informações foram obtidas por meio da aplicação de questionários e conferência de Cadernetas de Saúde quanto ao estado vacinal, bem como de dados ecológicos de desenvolvimento humano. A CV foi estimada em crianças na faixa etária de 19 a 36 meses. Resultados: Observou-se que 45,2% das crianças estudadas apresentavam-se com a CV recomendada pelo Ministério da Saúde (MS). Além disto, verificou-se fatores socioeconômicos determinantes de cobertura vacinal e que áreas descobertas de Agentes Comunitários de Saúde apresentaram pior cobertura. Conclusão: O presente estudo revela que é necessário fortalecer as ações que aumentem as cobertura vacinais no município.
Objective: To analyze the current state of the vaccination coverage (VC) of children under three years old in the city of Fortaleza, CE, and its relation with the socioeconomic status of the families. Methods: A population-based cross-sectional survey with random sampling, information was obtained through questionnaires applied and Health Booklets conferred to the vaccination status, as well as ecological human development data. VC was estimated in children between the ages of 19 and 36 months. Results: It was observed that 45.2% of studied children presented a VC recommended by the Ministry of Health. In addition, socioeconomic factors which are determinants of vaccine coverage were identified and that areas not covered by community health agents have worse coverage. Conclusion: The present study reveals that it is necessary to strengthen actions that increase VC in the municipality.
Objetivo: Analizar el estado actual de la cobertura vacunal (CV) de niños menores de tres años en el municipio de Fortaleza y su relación con la condición socioeconómica de las familias. Métodos: Investigación transversal de base poblacional con muestreo aleatorio, se obtuvo información a través de cuestionarios aplicados y Cuadernos de Salud conferidos al estado vacunal, así como datos ecológicos de desarrollo humano. La CV fue estimada en niños en el grupo de edad de 19 a 36 meses. Resultados: Se observó que el 45,2% de los niños estudiados se presentaban con la CV recomendada por el Ministerio de Salud. Además, que factores socioeconómicos son determinantes de cobertura vacunal y que áreas descubiertas de agentes comunitarios de salud presentan peor cobertura. Conclusión: El presente estudio revela que es necesario fortalecer las acciones que aumenten las CV en el municipio.