RESUMO
Membranous nephropathy (MN) is a form of kidney disease that is idiopathic in 70%-80% of cases. Glomerular involvement in autoimmune thyroiditis can occur in 10%-30% of patients, and MN manifests in association with Hashimoto thyroiditis in up to 20% of the cases with glomerular involvement. Reports of MN associated with Graves' disease (GD) are extremely rare in the current literature. Herein, we report the case of a 46-year-old man admitted to the hospital with nephrotic syndrome and symptomatic hyperthyroidism due to GD. Kidney biopsy revealed a secondary MN pattern. Immunohistochemical staining for PLA2R was negative, and thyroglobulin showed weak and segmental staining along the glomerular capillary. Anti-thyroid peroxidase (TPO) antibody test was not performed. The patient was treated for GD with methimazole and prednisone, and despite reaching clinical improvement after 8 months, proteinuria remained close to nephrotic levels. In this scenario, the patient was submitted to radioactive iodine, and there was a dramatic reduction in proteinuria levels after treatment. In conclusion, GD association with MN is rare, and when present, diagnosis using PLA2R and immunohistochemistry can be useful in determining association. In addition, radioactive iodine therapy can be an effective treatment modality when preceded with immunosuppressive corticosteroid therapy.
Assuntos
Glomerulonefrite Membranosa , Doença de Graves , Neoplasias da Glândula Tireoide , Glomerulonefrite Membranosa/diagnóstico , Glomerulonefrite Membranosa/tratamento farmacológico , Glomerulonefrite Membranosa/etiologia , Doença de Graves/complicações , Doença de Graves/diagnóstico , Doença de Graves/tratamento farmacológico , Humanos , Radioisótopos do Iodo/uso terapêutico , Masculino , Pessoa de Meia-Idade , ProteinúriaRESUMO
OBJETIVO: Avaliar se o aumento de iodo na dieta seria o fator desencadeante de tireopatias autoimunes na cidade de Santo André, SP. MÉTODOS: Determinou-se a iodúria em amostra isolada de 58 pacientes, divididos em quatro grupos e de 13 indivíduos normais (controles). RESULTADOS: Iodúria: grupo 1 - hipertireoidismo = 203,5 ± 152,71 µg/L (média ± DP); grupo 2 hipotireoidismo = 258,31 ± 148,2 µg/L; grupo 3 - tireodite crônica autoimune = 244,29 ± 191,6 µg/L; grupo 4 - amiodarona = 1.157,5 ± 261,8 µg/L; grupo 5 - controles = 262,31 ± 146,2 µg/L. Comparadas as médias da iodúria entre os cinco grupos, dos grupos 1, 2, 3 e 5 não apresentaram diferenças significantes (p > 0,05) e todos diferiram do grupo 4 (p < 0,05). A iodúria dos grupos 1, 2, 3 e 5, obtida em 2002 e 2003, não diferiram dos valores determinados em 1994 em escolares em Santo André. CONCLUSÃO: Este estudo evidencia que o iodo não deve ser considerado o agente responsável pelas tireopatias autoimunes em Santo André, e outros fatores ambientais devem ser investigados.
OBJECTIVE: Evaluate whether the increase of iodine in the diet would be the triggering factor for auto-immune thyropathies in the city of Santo André, SP. METHODS: Urinary iodine was determined in samples isolated from 58 patients, divided in 4 Groups, and in 13 normal individuals (controls). RESULTS: Urinary Iodine: Group 1 - hyperthyroidism = 203.5±152.71 µg/ L(mean±sd); Group 2 - hypothyroidism = 258.31±148,2 µg/L; Group 3 - chronic auto-immune thyroiditis = 244.29±191.6 µg/L; group 4 (Amiodarone) = 1157.5±261.8 µg/L; Group 5 - Controls = 262.31±146.2 µg/L. On comparing the means of urinary iodine among the groups, the means for groups 1, 2, 3, and 5 did not present significant differences (p>0.05), and all differed from group 4 (p<0.05). Urinary iodine obtained in groups 1, 2, 3 and 5, obtained in 2002-03, is not different from the values determined in students in 1994 in Santo André. CONCLUSION: This study shows evidence that iodine should not be considered as the responsible agent for auto-immune thyropathies in Santo André, and other environmental factors should be investigated.