RESUMEN
OBJECTIVE: We aimed to investigate the role of DIO2 polymorphisms rs225014 and rs12885300 in Graves' disease patients, mainly for controlling body weight following treatment. METHODS: We genotyped 280 GD patients by the time of diagnosis and 297 healthy control individuals using a TaqMan SNP Genotyping technique. We followed up 141 patients for 18.94 ± 6.59 months after treatment. RESULTS: There was no relationship between the investigated polymorphisms with susceptibility to GD and gain or loss of weight after GD treatment. However, the polymorphic inheritance (CC+CT genotype) of DIO2 rs225014 was associated with a lower body weight variation after GD treatment (4.26 ± 6.25 kg) when compared to wild type TT genotype (6.34 ± 7.26 kg; p = 0.0456 adjusted for the follow-up time). This data was confirmed by a multivariate analysis (p = 0.0138) along with a longer follow-up period (p = 0.0228), older age (p = 0.0306), treatment with radioiodine (p-value = 0.0080) and polymorphic inheritance of DIO2 rs12885300 (p = 0.0306). CONCLUSION: We suggest that DIO2 rs225014 genotyping may have an auxiliary role in predicting the post-treatment weight behavior of GD patients.
Asunto(s)
Peso Corporal , Enfermedad de Graves , Yoduro Peroxidasa/genética , Radioisótopos de Yodo , Estudios de Casos y Controles , Frecuencia de los Genes , Predisposición Genética a la Enfermedad , Enfermedad de Graves/genética , Enfermedad de Graves/terapia , Humanos , Patrón de Herencia , Polimorfismo de Nucleótido Simple , Yodotironina Deyodinasa Tipo IIRESUMEN
Objectives Evaluate the management of hypothyroidism in fertile-aged and pregnant women and compare these practices to the recommendations of the Brazilian Society of Endocrinology and Metabolism (SBEM) and the Latin American Thyroid Society, published in 2013. Materials and methods In the first trimester of 2014, SBEM made available to all members an electronic questionnaire based on clinical scenarios in the management of gestational hypothyroidism. The responses of 406 physicians, most of them endocrinologists, were analyzed. Results Eighty-one per cent of the endocrinologists screen all their pregnant patients for thyroid dysfunction, mostly during the pregestational period or after the first prenatal visit. Following screening, 82% of the respondents initiate treatment when TSH levels are > 2.5 mIU/L while 67% monitor their pregnant patients even if TSH was normal on first trimester screening. For hypothyroid women who are planning pregnancy, 96% of the clinicians are aware of the importance of adjusting the levothyroxine (LT4) dose as soon as pregnancy is confirmed. However, opinions diverge with respect to adjusting the LT4 dose before or after reassessing thyroid function. The most widely used tests for monitoring pregnant women in use of LT4 are TSH and free T4 (62%) or TSH alone (21%). Unanimously, the treatment goal is to achieve the target TSH level for each trimester of gestation. Conclusion The recommendations of the consensus statements are incorporated into the respondents’ clinical practice. It is noteworthy that the great majority of the clinicians favor universal screening.
Asunto(s)
Femenino , Humanos , Embarazo , Manejo de la Enfermedad , Hipotiroidismo/diagnóstico , Hipotiroidismo/terapia , Atención Preconceptiva , Complicaciones del Embarazo/diagnóstico , Tiroxina/sangre , Brasil , Toma de Decisiones Clínicas , Endocrinología/estadística & datos numéricos , Medicina General/estadística & datos numéricos , Ginecología/estadística & datos numéricos , Hipotiroidismo/sangre , Obstetricia/estadística & datos numéricos , Guías de Práctica Clínica como Asunto , Complicaciones del Embarazo/sangre , Encuestas y Cuestionarios , Tiroxina/uso terapéuticoRESUMEN
OBJECTIVES: Evaluate the management of hypothyroidism in fertile-aged and pregnant women and compare these practices to the recommendations of the Brazilian Society of Endocrinology and Metabolism (SBEM) and the Latin American Thyroid Society, published in 2013. MATERIALS AND METHODS: In the first trimester of 2014, SBEM made available to all members an electronic questionnaire based on clinical scenarios in the management of gestational hypothyroidism. The responses of 406 physicians, most of them endocrinologists, were analyzed. RESULTS: Eighty-one per cent of the endocrinologists screen all their pregnant patients for thyroid dysfunction, mostly during the pregestational period or after the first prenatal visit. Following screening, 82% of the respondents initiate treatment when TSH levels are > 2.5 mIU/L while 67% monitor their pregnant patients even if TSH was normal on first trimester screening. For hypothyroid women who are planning pregnancy, 96% of the clinicians are aware of the importance of adjusting the levothyroxine (LT4) dose as soon as pregnancy is confirmed. However, opinions diverge with respect to adjusting the LT4 dose before or after reassessing thyroid function. The most widely used tests for monitoring pregnant women in use of LT4 are TSH and free T4 (62%) or TSH alone (21%). Unanimously, the treatment goal is to achieve the target TSH level for each trimester of gestation. CONCLUSION: The recommendations of the consensus statements are incorporated into the respondents' clinical practice. It is noteworthy that the great majority of the clinicians favor universal screening.
Asunto(s)
Manejo de la Enfermedad , Hipotiroidismo/diagnóstico , Hipotiroidismo/terapia , Atención Preconceptiva , Complicaciones del Embarazo/diagnóstico , Tiroxina/sangre , Brasil , Toma de Decisiones Clínicas , Endocrinología/estadística & datos numéricos , Femenino , Medicina General/estadística & datos numéricos , Ginecología/estadística & datos numéricos , Humanos , Hipotiroidismo/sangre , Obstetricia/estadística & datos numéricos , Guías de Práctica Clínica como Asunto , Embarazo , Complicaciones del Embarazo/sangre , Encuestas y Cuestionarios , Tiroxina/uso terapéuticoRESUMEN
Thyrotoxicosis is a rare clinical syndrome resulting from an exacerbation of hyperthyroidism, with various etiology and triggering factors. Its approach may be accomplished by blocking the synthesis of hormones, their secretion and/or inhibition of their peripheral action, besides treating the triggering factors. However, in refractory cases, plasmapheresis appears as an important option for treatment. We report a patient with Graves' disease who was admitted with thyrotoxicosis and signs of severe hepatotoxicity induced by propylthiouracil. Plasmapheresis was indicated, with the aim of rapidly reducing thyroid hormones in the preparation for total thyroidectomy.
Asunto(s)
Antitiroideos/efectos adversos , Enfermedad de Graves/tratamiento farmacológico , Hígado/efectos de los fármacos , Plasmaféresis/métodos , Propiltiouracilo/efectos adversos , Tiroidectomía , Tirotoxicosis/inducido químicamente , Adulto , Humanos , Masculino , Cuidados Preoperatorios/métodos , Tiroxina/sangre , Resultado del TratamientoRESUMEN
A tireotoxicose é uma rara síndrome clínica decorrente da exacerbação do hipertireoidismo, de etiologia e fatores desencadeantes diversos. A abordagem terapêutica pode ser realizada por meio de medicamentos para bloqueio da síntese, secreção e/ou inibição da ação periférica hormonal, além de terapia dirigida aos fatores desencadeantes. Entretanto, em casos refratários, a plasmaférese surge como importante opção de tratamento. Relatamos o caso de um paciente com doença de Graves, internado com quadro de hepatotoxicidade grave por propiltiouracil, que evoluiu com tireotoxicose, sendo indicada plasmaférese para rápida redução dos hormônios tireoidianos, em preparo para a tireoidectomia total.
Thyrotoxicosis is a rare clinical syndrome resulting from an exacerbation of hyperthyroidism, with various etiology and triggering factors. Its approach may be accomplished by blocking the synthesis of hormones, their secretion and/or inhibition of their peripheral action, besides treating the triggering factors. However, in refractory cases, plasmapheresis appears as an important option for treatment. We report a patient with Graves' disease who was admitted with thyrotoxicosis and signs of severe hepatotoxicity induced by propylthiouracil. Plasmapheresis was indicated, with the aim of rapidly reducing thyroid hormones in the preparation for total thyroidectomy.