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 (LT 4 ) dose as soon as pregnancy is confirmed. However, opinions diverge with respect to adjusting the LT 4 dose before or after reassessing thyroid function. The most widely used tests for monitoring pregnant women in use of LT 4 are TSH and free T 4 (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. Arch Endocrinol Metab. 2016;60(1):16-20
Objective: We aimed to investigate the role of DIO2 polymorphisms rs225014 and rs12885300 in Graves' disease patients, mainly for controlling body weight following treatment. Subjects and 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.
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.
Changes in eating habits and physical activity are the cornerstone of treatment of type 2 diabetes mellitus (T2D). Dietary composition has important effects on the postprandial glucose and insulin response, but little is known about its impact in a real-life context. We analyzed the self-reported daily food composition of 13 individuals with obesity and T2D not on insulin (7F/6M, age 48±9, BMI 33±2, A1C 7±1) with ASA24 (NIH), while wearing continuous glucose monitor (Dexcom G4) for 3±1 days. They also underwent an oral glucose tolerance test to explore correlations with standard indices of insulin secretion and sensitivity. The mean consumption per meal of total calorie was: 534±110Kcal, carbohydrate: 51±19g, total grains: 1.78±0.66g (refined 1.61±0.59g, whole 0.17±0.18g), total fat: 25±6g (10±3.17g monounsaturated fat), and protein: 24±7g. We observed a positive correlation between average intake of total and monounsaturated fat with the insulin secretion index (ρ= 0.630, p=0.02,) and Disposition Index (DI) (p=0.001, ρ=0.821). An inverse relationship between the consumption of total and refined grains was noted with the insulin sensitivity indexes (p=0.01, ρ= -0.663); as well as with whole grains and DI (p=0.03, ρ= -0.601). We documented glycemic variability (GV) related to meal nutrient intake through macro program: CGM peak and nadir analysis, Microsoft Excel. Total and monounsaturated fats correlated with lower GV (p=0.02), while total and refined grains were associated with greater GV (p<0.03). Glucose nadir after a meal and glucose at the time of the meal inversely correlated with insulin secretion indexes and with DI (p<0.05). These data suggest, in a real-life context, the impact of food composition on modulation of GV, with fats being associated with greater insulin secretion and refined grains with decreased insulin sensitivity, reinforcing the importance of the effect of diet on management of diabetes. Disclosure A. Comarella: None. R. Belfort-DeAguiar: Research Support; Fractyl Health, Inc., Silver Palate Kitchens. Funding National Institutes of Health (DK098286-02)
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