Evidencias de doença tireoideana cronica subclinica em portadoras da sindrome de Turner / Evidences for subclinical chronic thyroid disease in patients with Turner Syndrome

RESUMO

O seguimento de pacientes com síndrome de Turner (ST) fteqüentemente revela alterações transitórias, recorrentes e assintomáticas de TSH e(ou) hormônios tireoideanos (HT). O objetivo deste trabalho foi avaliar estrutura e função da tireóide de portadoras da ST com história de alterações subclínicas nas concentrações hormonais. A casuística incluiu 17 pacientes com 5,92 a 22,58 anos (média 14,64). Na primeira avaliação, foram realizadas mensurações das concentrações séricas de TSH, T4 livre,T3 totale anticorpos anti-TPO e anti-Tg, ultra-sonografia (USG) e cintilografia. As pacientes foram seguidas durante dois anos com mensurações semestrais de hormônios e anticorpos e, ainda, nova USG na avaliação final. Doze compareceram às cinco consultas previstas, das quais 11 foram submetidas às duas USG e à cintilografia. Houve alterações de TSH e(ou) HT em 14 casos, em cinco dos quais foi necessário introduzir tratamento para hipotireoidismo (quatro) ou hipertireoidismo (um). Ao final do estudo, dez das 17 pacientes tinham anticorpos presentes naquele momento ou nos exames anteriores. Na avaliação inicial (16 pacientes), só uma paciente teve USG totalmente normal, e todas as demais apresentavam alterações volumétricas (tireomegalia em 14). Na segunda USG (15 casos), quartoze apresentavam alterações volumétricas. Nas duas avaliações, oito pacientes apresentavam outras alterações compatíveis com doença crônica da tireóide, particularmente heterogeneidade do parênquima. A cintilografia foi normal em 13/16 casos. Na primeira e na última avaliação...

ABSTRACT

Ihe folIow up of patients with Iumer syndrome (IS) trequently reveals transient, recurrent and asymptomatic variations of ISH andeor) thyroid hormones (IH). Ihe aim of this work was to evaluate thyroid structure and function in patients with IS who had had episodes of subclinical abnormalities of TSH and(or) TH. Our sample comprised 17 patients aged 5.92 to 22.58 years (mean 14.64). In the first evaluation, serum levels of TSH, free T4, total T3, anti-thyroid peroxidase and anti-thyroglobulin antibodies were determined, and thyroid ultrasound (US) and scintigraphy were done. Ihe patients were followed each six months for two years with measurement of TSH, TH and thyroid antibodies, and another US was done at the end of the study. Iwelve patients attended all five consultations, and 11 were subject to both US and scintigraphy. In 14 cases there were abnormal ISH andeor) IH levels, and five patients had to be treated due to hypothyroidism (four) or hyperthyroidism (one). At the end ofthe study, ten patients had thyroid antibodies at that moment or in clinical history. In the first US (16 patients), only one patient had a totally normal examination, and alI the others had abnormal thyroid volume (thyromegaly in 14 cases). In the second US (15 patients), alI had abnormal thyroid volume. In both examinations, eight patients had other features compatible with chronic thyroid disorder, particularly heterogeneous echogenicity. Scintigraphy was normal in 13/16 cases. In the first and last evaluations, the finding of abnormal TSH and(or) IR levels was independent of age, length of time since the first episode was detected, and thyroid volume, and was also...