Navegando por Palavras-chave "Thyrotoxicosis"
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- ItemAcesso aberto (Open Access)Análise retrospectiva do resultado do tratamento com iodo radioativo em 120 pacientes tirotóxicos por doença de Basedow-graves(Sociedade Brasileira de Endocrinologia e Metabologia, 1999-03-01) Di Ninno, Fernanda B. [UNIFESP]; Esteres, Roberto Z. [UNIFESP]; Marone, Marília M.s. [UNIFESP]; Dias-da-Silva, Magnus Régios [UNIFESP]; Matsumura, Luiza Kimiko [UNIFESP]; Hidal, Jairo T. [UNIFESP]; Furlanetto, Reinaldo P. [UNIFESP]; Maciel, Rui Monteiro de Barros [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)We studied retrospectively the outcome of radioactive iodine therapy (RAI) in 120 thyrotoxic patients with Graves' disease (96 F/ 24 M) who were primarily treated with anti-thyroid drugs (ATD). The decision to use RAI was due either to relapse after ATD-induced remission, lack of compliance on ATD, goiter larger than 60g, old age or association with severe diseases. ATD were discontinued one week before RAI administration, calculated by the formula: glandular volume (g) vs. effective radiation (80 mCi/g of tissue) divided by 24h thyroid uptake (%). We reexamined the patients for 48 months after RAI. Medians of age, goiter size and 24h thyroid uptake were 34y (17-69), 54.5g (20-210) and 73% (21-99), respectively. After RAI, patients became gradually hypothyroid on a rate of 15%/ 6mo until the first 18mo, followed by a rate of 2-5%/ 6mo until the end of 48mo. The number of patients in thyrotoxicosis decreased continuously, being 52.2% 6mo after RAI, 25% after 18mo and 6.7% after 48mo; at the end of the study 8 patients were still thyrotoxic. The total of patients without thyrotoxicosis at the end of observation, that is, the sum of those in euthyroidism and hypothyroidism on T4 therapy (cure of thyrotoxicosis) reached 46.8% in 6mo, 63.3% in 12mo, 81.7% in 24mo, 87.5% in 36mo and 93.3% in 48mo. Transient hypothyroidism, that is, elevation of TSH higher than 4.5 mU/L until 12mo after RAI, followed by normalization of TSH was found in 7.5% of patients. The following correlations were found in this study: a) initial T3 values and absence of cure of thyroxicosis (p=0.2); b) total RAI doses in relation to time for cure of thyrotoxicosis (p=0.01); c) dose of 131l/thyroid volume in relation to time for cure of thyrotoxicosis (p=0.02). Adverse effects included exarcebation of thyrotoxicosis in 3 patients and pain in the anterior cervical area in one, all reversible and of short duration. Two patients became pregnant after RAI but both gestations and their outcomes were normal.
- ItemSomente MetadadadosEffects of ghrelin, GH-releasing peptide-6 (GHRP-6) and GHRH on GH, ACTH and cortisol release in hyperthyroidism before and after treatment(Springer, 2010-12-01) Molica, Patricia [UNIFESP]; Nascif, Sergio Oliva [UNIFESP]; Correa-Silva, Silvia Regina [UNIFESP]; Paiva Cunha de Sa, Larissa Bianca [UNIFESP]; Henriques Vieira, Jose Gilberto [UNIFESP]; Lengyel, Ana Maria Judith [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)In thyrotoxicosis GH responses to stimuli are diminished and the hypothalamic-pituitary-adrenal axis is hyperactive. There are no data on ghrelin or GHRP-6-induced GH, ACTH and cortisol release in treated hyperthyroidism. We, therefore, evaluated these responses in 10 thyrotoxic patients before treatment and in 7 of them after treatment. GHRH-induced GH release was also studied. Peak GH (mu g/L; mean +/- A SE) values after ghrelin (22.6 +/- A 3.9), GHRP-6 (13.8 +/- A 2.3) and GHRH (4.9 +/- A 0.9) were lower in hyperthyroidism before treatment compared to controls (ghrelin: 67.6 +/- A 19.3; GHRP-6: 25.4 +/- A 2.7; GHRH: 12.2 +/- A 2.8) and did not change after 6 months of euthyroidism (ghrelin: 32.7 +/- A 4.7; GHRP-6: 15.6 +/- A 3.6; GHRH: 7.4 +/- A 2.3), although GH responses to all peptides increased in similar to 50% of the patients. in thyrotoxicosis before treatment ACTH response to ghrelin was two fold higher (107.4 +/- A 26.3) than those of controls (54.9 +/- A 10.3), although not significantly. ACTH response to GHRP-6 was similar in both groups (hyperthyroid: 44.7 +/- A 9.0; controls: 31.3 +/- A 7.9). There was a trend to a decreased ACTH response to ghrelin after 3 months of euthyroidism (35.6 +/- A 5.3; P = 0.052), but after 6 months this decrease was non-significant (50.7 +/- A 14.0). After 3 months ACTH response to GHRP-6 decreased significantly (20.4 +/- A 4.2), with no further changes. in hyperthyroidism before treatment, peak cortisol (mu g/dL) responses to ghrelin (18.2 +/- A 1.2) and GHRP-6 (15.9 +/- A 1.4) were comparable to controls (ghrelin: 16.4 +/- A 1.6; GHRP-6: 13.5 +/- A 0.9) and no changes were seen after treatment. Our results suggest that the pathways of GH release after ghrelin/GHRP-6 and GHRH are similarly affected by thyroid hormone excess and hypothalamic mechanisms of ACTH release modulated by ghrelin/GHSs may be activated in this situation.
- ItemSomente MetadadadosGhrelin and GHRP-6-induced ACTH and cortisol release in thyrotoxicosis(Springer, 2009-12-01) Nascif, Sergio Oliva [UNIFESP]; Molica, Patricia [UNIFESP]; Correa-Silva, Silvia Regina [UNIFESP]; Silva, Marcos Roberto [UNIFESP]; Lengyel, Ana-Maria Judith [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Thyrotoxicosis might alter the hypothalamic-pituitary-adrenal (HPA) axis. We evaluated the effects of ghrelin and GHRP-6 on the HPA axis in 20 hyperthyroid patients and in 9 controls. Mean basal cortisol (mu g/dl) and ACTH (pg/ml) levels were higher in hyperthyroidism (cortisol: 10.7 +/- A 0.7; ACTH: 21.5 +/- A 2.9) compared to controls (cortisol: 8.1 +/- A 0.7; ACTH: 13.5 +/- A 1.8). in thyrotoxicosis a dagger AUC cortisol values (mu g/dl.90 min) after ghrelin (484 +/- A 80) and GHRP-6 (115 +/- A 63) were similar to controls (ghrelin: 524 +/- A 107; GHRP-6: 192 +/- A 73). A significant increase in a dagger AUC ACTH (pg/ml.90 min) after ghrelin was observed in thyrotoxicosis (4,189 +/- A 1,202) compared to controls (1,499 +/- A 338). a dagger AUC ACTH values after GHRP-6 were also higher, although not significantly (patients: 927 +/- A 330; controls: 539 +/- A 237). in summary, our results suggest that ghrelin-mediated pathways of ACTH release might be activated by thyroid hormone excess, but adrenocortical reserve is maintained.
- ItemAcesso aberto (Open Access)Injeção percutânea de etanol no tratamento de nódulos tiroidianos sólidos, císticos e autônomos(Sociedade Brasileira de Endocrinologia e Metabologia, 2003-10-01) Bianchini, Elizabeth X. [UNIFESP]; Ikejiri, Elza S. [UNIFESP]; Mamone, Maria Conceição [UNIFESP]; Paiva, Elias R. [UNIFESP]; Maciel, Rui Monteiro de Barros [UNIFESP]; Furlanetto, Reinaldo P. [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Percutaneous ethanol injection (PEI) guided by ultrasound has been used for the treatment of cystic, solid and autonomous thyroid nodules. We present our experience in the treatment of 50 patients with thyroid nodules: 26 solid, 17 cystic and 7 autonomous (AN). Patients were evaluated 1 week, 1, 3, and 6 months and 1 year after PEI. After one year, solid nodules showed a mean 74% volume reduction, and cysts a volume reduction of 92%, with no recurrences. After one year, 5 patients with AN reached clinical and laboratory euthyroidism; the other 2 also became euthyroid, but with subnormal TSH. Recurrence of thyrotoxicosis was not observed and mean nodular reduction was 66%. The procedure was well tolerated by all patients. The results confirm that PEI is a good therapeutic alternative for reduction of solid and cystic thyroid nodules and for the treatment of autonomous nodules.