Screening of celiac disease in patients with autoimmune thyroid disease from Southern Brazil.

OBJECTIVE: The objective of this study was to determine the prevalence of celiac disease (CD) in adults with autoimmune thyroid disease (ATD) from the endocrinology outpatient setting in a university hospital in Southern Brazil. SUBJECTS AND METHODS: From the years 2007 to 2011, 254 patients with ATD were enrolled consecutively, Grave's disease was diagnosed in 143 (56.3%) and Hashimoto's thyroiditis in 111 (43.7%) of them. All patients answered a questionnaire related to symptoms that could be associated with CD and serum samples to screen for IgA anti-endomysial (EmA-IgA) were collected. EmA-IgA-positive patients were offered upper gastrointestinal endoscopy and biopsy of duodenum. RESULTS: A total of 254 patients were included; 222 (87.4%) female, mean age 45.4 ± 13.43 years (18 to 79 years). EmA-IgA was positive in seven patients (2.7%) and five done endoscopy with biopsy. Of these, three diagnosis of CD was confirmed (1.2%). All the three patients with CD had higher EmA-IgA titration, were female and had Hashimoto's thyroiditis. Like other patients with ATD, CD patients had nonspecific gastrointestinal symptoms, such as heartburn and gastric distention. In our study, one in each 85 patients confirmed the diagnosis of CD. CONCLUSION: We found a prevalence of 1.2% (1:85) of confirmed CD among Brazilian patients with ATD. Although some IgA-EmA positive patients had Graves' disease and one was male, all three patients with confirmed CD were female and had Hashimoto's thyroiditis.

Screening of celiac disease in patients with autoimmune thyroid disease from Southern Brazil / Pesquisa de doença celíaca em pacientes com doença autoimune de tireoide do sul do Brasil

Objective: The objective of this study was to determine the prevalence of celiac disease (CD) in adults with autoimmune thyroid disease (ATD) from the endocrinology outpatient setting in a university hospital in Southern Brazil. Subjects and methods: From the years 2007 to 2011, 254 patients with ATD were enrolled consecutively, Grave’s disease was diagnosed in 143 (56.3%) and Hashimoto’s thyroiditis in 111 (43.7%) of them. All patients answered a questionnaire related to symptoms that could be associated with CD and serum samples to screen for IgA anti-endomysial (EmA-IgA) were collected. EmA-IgA-positive patients were offered upper gastrointestinal endoscopy and biopsy of duodenum. Results: A total of 254 patients were included; 222 (87.4%) female, mean age 45.4 ± 13.43 years (18 to 79 years). EmA-IgA was positive in seven patients (2.7%) and five done endoscopy with biopsy. Of these, three diagnosis of CD was confirmed (1.2%). All the three patients with CD had higher EmA-IgA titration, were female and had Hashimoto’s thyroiditis. Like other patients with ATD, CD patients had nonspecific gastrointestinal symptoms, such as heartburn and gastric distention. In our study, one in each 85 patients confirmed the diagnosis of CD. Conclusion: We found a prevalence of 1.2% (1:85) of confirmed CD among Brazilian patients with ATD. Although some IgA-EmA positive patients had Graves’ disease and one was male, all three patients with confirmed CD were female and had Hashimoto’s thyroiditis. Arq Bras Endocrinol Metab. 2014;58(6):625-9 .

Objetivo: O objetivo do presente estudo foi determinar a prevalência de doença celíaca (DC) em adultos com doenças autoimunes de tireoide (DAT) que foram atendidos em um serviço de endocrinologia de um hospital universitário do sul do Brasil. Sujeitos e métodos: Entre os anos de 2007 a 2011, 254 pacientes com DAT foram consecutivamente incluídos, sendo 143 (56,3%) desses diagnosticados com doença de Graves e 111 (43,7%) com doença de Hashimoto. Todos os pacientes responderam a um questionário relatando sintomas que poderiam ser associados com DC, e amostras de soro para a pesquisa de anticorpo antiendomisial (EmA-IgA) foram coletadas. Os pacientes com sorologia positiva foram encaminhados para endoscopia gastrointestinal com biópsia duodenal. Resultados: No total, 254 pacientes foram incluídos, sendo 222 (87,4%) mulheres com média de idade 45,4 ± 13,43 anos (18 a 79 anos). EmA-IgA foi positivo em sete (2,7%) pacientes e cinco fizeram endoscopia com biópsia. Desses, três (1,2%) tiveram o diagnóstico de DC confirmada. Todos os três pacientes com DC apresentaram altos títulos de EmA-IgA, eram mulheres e tinham doença de Hashimoto. Assim como outras pacientes com DAT, os pacientes celíacos tinham sintomas gastrointestinais inespecíficos, como queimação e distensão gástrica. Em nosso estudo, um em cada 85 pacientes com DAT tiveram o diagnóstico de DC confirmado. Conclusão: Em nosso estudo, foi observada prevalência de 1,2% (1:85) de DC confirmada entre os pacientes com DAT, sendo todas mulheres e com doença de Hashimoto. Arq Bras Endocrinol Metab. 2014;58(6):625-9 .

Treating primary hypothyroidism with weekly doses of levothyroxine: a randomized, single-blind, crossover study.

OBJECTIVE: Compliance to levothyroxine treatment in hypothyroidism is compromised by daily schedule, and a weekly dose may be an alternative. SUBJECTS AND METHODS: This was a randomized, crossover study. Fourteen females were assigned to daily or weekly doses of LT4. After six weeks, they switched regimens. Thyroid parameters were measured at baseline, and after 42 and 84 days. Echocardiogram and hyperthyroidism symptoms were evaluated before and four hours after LT4 intake. RESULTS: In the weekly dose treatment, fT4 levels were higher after taking LT4, and lower seven days after the last dose; by the 6(th) week there was a small decrease in T3 levels. TSH remained unchanged and there were no hyperthyroidism symptoms or echocardiographic manifestations. CONCLUSION: Weekly dose leads to transient increases in fT4, without hyperthyroidism or cardiac symptoms. That approach seems to be a safe alternative for the treatment of hypothyroidism.

Treating primary hypothyroidism with weekly doses of levothyroxine: a randomized, single-blind, crossover study / Tratamento de hipotiroidismo primário com doses semanais de levotiroxina: um estudo randomizado, unicego, crossover

OBJECTIVE: Compliance to levothyroxine treatment in hypothyroidism is compromised by daily schedule, and a weekly dose may be an alternative. SUBJECTS AND METHODS: This was a randomized, crossover study. Fourteen females were assigned to daily or weekly doses of LT4. After six weeks, they switched regimens. Thyroid parameters were measured at baseline, and after 42 and 84 days. Echocardiogram and hyperthyroidism symptoms were evaluated before and four hours after LT4 intake. RESULTS: In the weekly dose treatment, fT4 levels were higher after taking LT4, and lower seven days after the last dose; by the 6th week there was a small decrease in T3 levels. TSH remained unchanged and there were no hyperthyroidism symptoms or echocardiographic manifestations. CONCLUSION: Weekly dose leads to transient increases in fT4, without hyperthyroidism or cardiac symptoms. That approach seems to be a safe alternative for the treatment of hypothyroidism.

OBJETIVO: Aderência ao tratamento do hipotiroidismo é comprometido pelo uso diário de levotiroxina, e doses semanais poderiam ser uma alternativa. SUJEITOS E MÉTODOS: Este é um estudo randomizado, crossover. Quatorze mulheres foram selecionadas para receber LT4 diariamente ou semanalmente. Após seis semanas, houve inversão do regime de tratamento. Avaliações tireoideanas foram realizadas antes, após 42 e 84 dias. Avaliação de sintomas de hipertireoidismo e ecocardiograma foi realizada antes e após quatro horas de LT4. RESULTADOS: Com dose semanal, os níveis de fT4 foram mais elevados logo após a dose de LT4, e menores após sete dias; após seis semanas, houve diminuição de T3. TSH permaneceu inalterado e não houve manifestações ecocardiográficas ou de hipertireodismo. CONCLUSÃO: Dose semanal de LT4 leva à elevação de fT4, sem manifestações de hipertireoidismo, e parece ser uma alternativa segura para o tratamento do hipotireoidismo.

O uso de carbonato de lítio no tratamento da tireotoxicose induzida por amiodarona / Use of lithium carbonate for the treatment of amiodarone-induced thyrotoxicosis

Dentre as disfunções tireoidianas induzidas por amiodarona, a tireotoxicose é a mais grave e associada a maior morbi-mortalidade. O tratamento consiste no emprego de altas doses de drogas antitireoidianas e corticoesteróides, de forma isolada ou combinada. Outras terapias associadas foram propostas para o tratamento dos casos refratários. Relatamos o caso de um paciente de 40 anos com história de miocardiopatia dilatada idiopática que desenvolveu um quadro grave de tireoidite induzida por amiodarona após transplante cardíaco. Este paciente não respondeu à terapia inicial com doses altas de droga antitireoidiana e corticoesteróides, sendo, então, associado o carbonato de lítio em baixas doses e por curto período de tempo, o que resultou na normalização da função tireoidiana. Neste caso, o emprego do carbonato de lítio mostrou-se como uma terapia adjuvante eficaz e segura no controle da tireotoxicose induzida por amiodarona.

Carcinoma indiferenciado de tireóide / Anaplastic thyroid carcinoma

O carcinoma diferenciado de tireóide, papilífero ou folicular, usualmente tem um curso relativo benigno após a tireoidectomia total e ablação de remanescentes tireoideanos com 131I. Em contraste, o carcinoma anaplásico de tireóide ou carcinoma indiferenciado de tireóide, também derivado do epitélio folicular tireoideano, é uma das neoplasias humanas mais agressivas, que perdeu a maioria ou todas as características do tecido de origem. Crescimento tumoral rápido é um presságio de mortalidade precoce a menos que se institua tratamento combinado agressivo. Não dispomos ainda de um tratamento que leva à cura definitiva para a maioria dos pacientes. A melhor conduta se constitui de um tratamento cirúrgico agressivo associado com a combinação de novos agentes quimioterápicos e radioterapia externa.

[Use of lithium carbonate for the treatment of amiodarone-induced thyrotoxicosis]. / O uso de carbonato de lítio no tratamento da tireotoxicose induzida por amiodarona.

Among the amiodarone-induced thyroid dysfunctions, thyrotoxicosis is the most troublesome and with the highest rate of morbidity and mortality. Treatment consists in the use of a high dose of anti-thyroid drugs and steroids in an isolated form or in combination. Association of several other drugs have been proposed for the treatment of refractory cases. In this study we report the case of a 40 y.o. patient, with a history of idiopatic dilated miocardiopathy, who developed severe amioradone-induced thyrotoxicosis after heart transplantation. Since the patient did not respond to an initial treatment consisting of a high dose of anti-thyroid drugs combined with steroids, a low dose of lithium carbonate was added for a short period of time, which resulted in normalization of the thyroid function. In this case, the addition of lithium carbonate to the two other drugs resulted in a successful and safety therapy in controlling amiodarone-induced thyrotoxicosis.

[Anaplastic thyroid carcinoma]. / Carcinoma indiferenciado de tireóide.

Well-differentiated thyroid carcinoma (TC), as papillary and follicular carcinoma, usually follows a relatively benign course after total thyroidectomy and thyroid remnant ablation with 131I. In contrast, anaplastic TC or undifferentiated TC, also derived from the thyroid follicular epithelium, refers to one of the more aggressive human malignancies, which have lost most or all characteristics of the tissue from which it originated. Rapid tumor growth presages early mortality unless combined therapy is aggressively pursued. Definitive curative approach does not exist for most patients. The best approach is still aggressive surgery combined with the associated use of new chemotherapies associated with local external beam radiotherapy.

[Thyroid hormone resistance syndrome]. / Síndrome de resistência ao hormônio tireoidiano.

Resistance to thyroid hormone (RTH) is a syndrome characterized by elevated serum thyroid hormone (TH) levels and elevated or inappropriately normal thyrotropin levels. In general, patients exhibit TH resistance in the pituitary and peripheral tissues. The phenotype of RTH is variable; the affected individuals are clinically euthyroid or even hypothyroid depending on the severity of the mutation, the variable hyposensitivity to TH among individuals as well as in different tissues. In almost all cases the genetic basis of RTH lies in mutation of the carboxyl-terminus of the ss-thyroid hormone receptor. RTH is a dominant disorder, except in one family; most individuals are heterozygous for the mutant allele. New standard techniques and genetically engineered mouse model systems have increased our understanding on TH receptor action, in particular, how mutant thyroid receptors from RTH patients can block wild-type thyroid receptor function (dominant negative activity), and how the mutant receptors can differently affect various tissues and individuals.

Síndrome de resistência ao hormônio tireoidiano / Thyroid hormone resistance syndrome

A resistência ao hormônio tireoidiano (RHT) é uma síndrome que se caracteriza pela presença de níveis séricos elevados de hormônios tireoidianos (HT) e níveis séricos elevados, ou inapropriadamente normais, de hormônio estimulante da tireóide. Em geral, os pacientes apresentam resistência ao HT tanto em nível hipofisário como em tecidos periféricos. Os indivíduos afetados apresentam fenótipo variável, dependendo da severidade da mutação, da diversidade da resposta tecido-específica e outros fatores não relacionados à mutação. Na maioria dos casos, a RHT é secundária a mutações no domínio carboxiterminal do receptor ß do hormônio tireoidiano. A RHT é uma doença autossômica dominante, exceto em uma família descrita, na qual a maioria dos indivíduos é heterozigota para o alelo mutado. Novas técnicas e estudos em modelos animais têm possibilitado uma maior compreensão sobre a ação do receptor de HT; em particular, como os receptores de HT mutantes de pacientes com RHT podem bloquear a função de receptores normais (atividade dominante negativa) e como produzem efeitos diversos nos vários tecidos e entre indivíduos.