These results show that long-term GH replacement therapy in children with unequivocal GHD significantly decreases serum FT4 and rT3 levels and increases serum T3 levels; that these changes are independent of TSH and result from increased peripheral conversion of T4 to T3 and that GH replacement therapy in GH deficient children does not induce hypothyroidism, but simply reveals previously unrecognized cases whose serum FT4 values fall in the low range during GH replacement.

A prospective study was conducted to evaluate the usefulness and limitations of conservative treatment in patients with pituitary apoplexy. Twelve patients presenting sudden headache, visual impairment, or ophthalmoplegia had the diagnosis of pituitary apoplexy established by computerized tomographic scans. Initially, 11 patients received iv dexamethasone (2.0-16.0 mg/day). Surgery was indicated when dexamethasone failed to improve visual or consciousness impairment. Among the 7 patients who were treated conservatively, ophthalmoplegia recovered completely in 6 and improved in 1. Follow-up computerized tomographic scans showed resolution of the tumor in 4 patients and residual masses in 3 patients who were treated conservatively. Five patients had surgery and experienced improvement of vision and consciousness. Follow-up computerized tomographic scans showed residual masses in all surgical patients. Recurrences were observed in 2 patients, one in each group. The prevalence of pituitary deficiencies in the conservative group (9 of 17) was similar to that of the surgical group (3 of 14), but when only patients whose tumors were resolved by the apoplexy were analyzed, a significantly higher prevalence (8 of 12) was observed (P = 0.02). A retrospective analysis of presenting clinical and computerized tomography data on the basis of the response to dexamethasone showed that visual impairment did not improve during treatment with dexamethasone, whereas the presence of a large hypodense area within the tumor predicted complete tumor resolution. These results support conservative management of pituitary apoplexy in patients who are selected on the basis of clinical and tomographic findings.

Loss of TSH rhythm in Sheehan's syndrome is usually secondary to hormonal deficiency and results from maximally increased secretory activity of a decreased pool of thyrotrophs. The paradox of increased TSH levels and decreased thyroid function in Sheehan's syndrome could result from decreased TSH bioactivity and/or from a critically reduced thyrotroph population that fails to sustain sufficient TSH secretion in the face of rising serum thyroid hormone levels.

Sheehan's syndrome patients have increased total TSH secretion due to increased tonic TSH secretion. A circadian TSH rhythm is still present in these patients, but shows decreased magnitude and markedly displaced acrophase.

We present 2 instances of Ullrich-Turner syndrome with mosaicism 45,X/46,X,idic(Xq)/47, X,idic(Xq),idic(Xq) and X-isochromosomes with 2 C-bands. The mosaicism with the 3 cell lines points to the presence of the isodicentric chromosome in the zygote and a subsequent nondisjunction event.

Objetivo: relato de Carcinoma Papilífero da Tireoide com suspeita diagnóstica a partir de uma abordagem não usual com dosagem de Tireoglobulina em material obtido por punção de linfonodo cervical. Métodos: dados obtidos por meio da revisão de prontuário. Resultados: mulher de 32 anos foi submetida à ultrassonografia cervical (USC) que revelou nódulo de 15 mm no terço inferior do lobo tireoidiano direito. Apresentava também elevação dos níveis séricos de TSH e dos anticorpos anti-tireoglobulina. Iniciada reposição com levotiroxina e realizada biópsia do nódulo, que se mostrou negativa para células neoplásicas (classe II – Bethesda). Após um ano, nova USC revelou nódulo tireoidiano com dimensões e características semelhantes e um linfonodo com componente hipercogênico no nível IV à direita. Punção do linfonodo resultou em citologia oncótica negativa. Solicitada a dosagem de Tireoglobulina em lavado de material da punção desse linfonodo, evidenciando níveis elevados. Com a suspeita de carcinoma diferenciado da tireoide foi realizada tireoidectomia. A análise anatomopatológica confirmou o diagnóstico de Carcinoma Papilífero da Tireoide de variante clássica e linfonodos peritireoidianos com metástase. Conclusão: a dosagem de Tireoglobulina em material de punção de linfonodo cervical suspeito, a despeito da ausência de células neoplásicas, foi determinante para o diagnóstico oncológico.