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Rosario P.W.,Santa Casa de Belo Horizonte | Batista K.C.S.,Santa Casa de Belo Horizonte | Calsolari M.R.,Servico de Endocrinologia
Archives of Endocrinology and Metabolism | Year: 2016

Objective: The objective of this study, in addition to confirming that therapy with131I causes oxidative stress, was to evaluate the effect of supplementation with vitamins C and E and selenium on this phenomenon by measuring plasma 8-epi-PGF2a, a marker of lipid peroxidation. Subjects and methods: Forty patients with thyroid cancer submitted to thyroidectomy, who received 3.7 GBq131I after levothyroxine withdrawal, were selected; 20 patients did not receive (control group) and 20 patients received (intervention group) daily supplementation consisting of 2000 mg vitamin C, 1000 mg vitamin E and 400 µg selenium for 21 days before131I. Plasma 8-epi-PGF2a was measured immediately before and 2 and 7 days after131I. Results: A significant increase in plasma 8-epi-PGF2a after131I was observed in the two groups. The concentrations of 8-epi-PGF2α were significantly higher in the control group before and 2 and 7 days after131I. The percentage of patients with elevated 8-epi-PGF2α was also significantly higher in the control group before and after131I. Furthermore, the increase (percent) in 8-epi-PGF2α was significantly greater in the control group (average of 112.3% versus 56.3%). Only two patients (10%) reported side effects during supplementation. Conclusions: Ablation with131I causes oxidative stress which can be minimized by the use of antioxidants. © AE&M. All rights reserved.


Furtado M.S.,Santa Casa de Belo Horizonte | Rosario P.W.,Santa Casa de Belo Horizonte | Calsolari M.R.,Servico de Endocrinologia
Archives of Endocrinology and Metabolism | Year: 2015

Objective: Lymph node metastases (LNM) are frequent in patients with papillary thyroid cancer (PTC). The risk of persistent disease (PD) and tumor recurrence (TR) is increased when factors for poor prognosis other than LNM exist, when LNM are numerous, large, detected by preoperative ultrasonography (US), or exhibit extranodal extension. This study evaluated the risk of PD and TR in patients with LNM not exhibiting these characteristics. Subjects and methods: Eighty-six patients with 5 or fewer LNM detected during intraoperative inspection, but not by preoperative US, who had no other factors for poor prognosis [tumors > 4 cm, extensive extrathyroid invasion, vascular invasion, aggressive histological subtype, distant metastases, incomplete tumor resection], were studied. All patients underwent total thyroidectomy followed by radioiodine ablation. PD was defined as metastases on initial post-therapy whole-body scans (RxWBS) or detected by imaging methods up to 12 months after ablation. TR was defined as structural disease diagnosed more than one year after ablation in patients without PD. Results: PD was diagnosed in 3/86 patients (3.5%). TR was observed in 2/83 patients (2.5%) after 62 months of follow-up. There was no case of death due to the disease. A correlation was observed between pre-ablation Tg and PD or TR [1/48 (2%) with Tg ≤ 2 ng/mL versus 2/22 (9%) with Tg > 2 ≤ 10 ng/mL versus 2/7 (28.5%) with Tg ≥ 10 ng/ml)]. It is noteworthy that 38 patients had up to 3 positive LN and pre-ablationTg ≤ 2 ng/ml, and none of them had PD or TR. Conclusions: The frequency of PD and TR was low in patients with PTC with 5 or fewer LNM and without other factors for poor prognosis. Low postoperative stimulated Tg was predictive of the absence of PD and TR in these patients. © AE&M All rights reserved.


Danilovic D.L.S.,University of Sao Paulo | Lima E.U.,University of Sao Paulo | Domingues R.B.,University of Sao Paulo | Brandao L.G.,University of Sao Paulo | And 2 more authors.
European Journal of Endocrinology | Year: 2014

Objective: The p.V600E BRAF and RAS mutations are found in 30-80% of differentiated thyroid carcinoma (DTC). BRAF mutation has been associated with poor prognosis. This study investigated the role of molecular studies in preoperative diagnosis of DTC and the association of p.V600E mutation with prognostic factors. Design: Prospective study. Methods: A total of 202 patients with cytological diagnosis of Bethesda III-VI underwent preoperative molecular studies and subsequent thyroidectomy. p.V600E and RAS mutations were studied in the cytology smears, using real-time PCR genotyping technique. The BRAF mutation (BRAF+ or BRAF-) was correlated with histological and clinical findings. Results: Molecular study of 172 nodules with Bethesda III-V cytology improved negative predictive value and accuracy of Bethesda III and IV diagnosis. BRAF mutation was present in 65% of 94 DTC and p.Q61R NRAS in one. Except for age, BRAF+ and BRAF- did not differ in sex, tumor size, histological subtype, multifocality, vascular invasion, extrathyroidal extension, or prognostic staging. Among papillary carcinomas, lymph node (LN) metastasis was diagnosed in 23% BRAF+ and 37% BRAF-. Distant metastasis occurred in four BRAF-. Recurrent or persistent disease was more frequent in BRAF- (26.7 vs 3.3% BRAF+, P=0.002) along follow-up of 29.8±10 months. BRAF+ patients without LN metastasis by pre-operative evaluation submitted to thyroidectomy with central neck dissection (CND) had more frequent LN metastasis (45 vs 5% no CND, P=0.002), but no difference in clinical outcome was observed. Conclusions: Pre-operative identification of BRAF mutation improved cytological diagnosis of DTC, but it was not associated with poor prognostic factors. Prophylactic CND did not guarantee better outcome in BRAF+ patients. © 2014 European Society of Endocrinology Printed in Great Britain.


Weinert L.S.,Federal University of Rio Grande do Sul | Mastella L.S.,Federal University of Rio Grande do Sul | Oppermann M.L.R.,Federal University of Rio Grande do Sul | Oppermann M.L.R.,Hospital Of Clinicas Of Porto Alegre Hcpa | And 3 more authors.
Arquivos Brasileiros de Endocrinologia e Metabologia | Year: 2014

Objectives: The aims of this study were to estimate the local rate of postpartum diabetes screening after gestational diabetes mellitus (GDM) pregnancies, and to identify clinical variables associated with retesting rates and with the persistence of decreased glucose tolerance. Subjects and methods: Prospective cohort of GDM women with prenatal delivery at a specialized center, from November 2009 to May 2012. All women were advised to schedule a 6 weeks postpartum 75-g oral glucose tolerance test (OGTT). Results: Of the 209 women included, 108 (51.7%) returned to be tested with fasting plasma glucose (n = 14), OGTT (n = 93) or random glucose (n = 1). Return was associated with lower parity rate (2 vs. 3, p < 0.001) and higher pregnancy 2-h OGTT (165 vs. 155 mg/dL, p = 0.034), but not with socio-demographic characteristics. Four women (3.7%) had diabetes, 22 (20.4%) had impaired fasting glucose or impaired glucose tolerance. Persistent hyperglycemia was associated with a positive family history of diabetes (relative risk - RR 2.41, p = 0.050), diagnostic 2-h OGTT in pregnancy (RR 1.01, p = 0.045), insulin use during pregnancy (RR 2.37, p = 0.014), and cesarean section (RR 2.61, p = 0.015). Conclusions: Even though postpartum abnormalities were frequent in GDM, rates of postpartum diabetes screening were undesirably low. As no specific clinical profile defines who will adhere to postpartum testing, it is essential to encourage all women to reevaluate their glucose status, particularly those with a family history of diabetes and more severe hyperglycemia. © ABE&M todos os direitos reservados.


PubMed | Servico de Endocrinologia and Programa de Pos Graduacao
Type: Journal Article | Journal: Archives of endocrinology and metabolism | Year: 2016

The objective of this study, in addition to confirming that therapy with 131I causes oxidative stress, was to evaluate the effect of supplementation with vitamins C and E and selenium on this phenomenon by measuring plasma 8-epi-PGF2a, a marker of lipid peroxidation.Forty patients with thyroid cancer submitted to thyroidectomy, who received 3.7 GBq 131I after levothyroxine withdrawal, were selected; 20 patients did not receive (control group) and 20 patients received (intervention group) daily supplementation consisting of 2000 mg vitamin C, 1000 mg vitamin E and 400 g selenium for 21 days before 131I. Plasma 8-epi-PGF2a was measured immediately before and 2 and 7 days after 131I.A significant increase in plasma 8-epi-PGF2a after 131I was observed in the two groups. The concentrations of 8-epi-PGF2 were significantly higher in the control group before and 2 and 7 days after 131I. The percentage of patients with elevated 8-epi-PGF2 was also significantly higher in the control group before and after 131I. Furthermore, the increase (percent) in 8-epi-PGF2 was significantly greater in the control group (average of 112.3% versus 56.3%). Only two patients (10%) reported side effects during supplementation.Ablation with 131I causes oxidative stress which can be minimized by the use of antioxidants.


Rosario P.W.,Laboratorio ANALYS | Purisch S.,Servico de Endocrinologia
Arquivos Brasileiros de Endocrinologia e Metabologia | Year: 2010

Objective: To evaluate the frequency of subclinical acromegaly (in the absence of clinical phenotype but biochemically uncontrolled) in patients with prolactinoma during treatment with dopaminergic agonists. Subjects and methods: One hundred twenty one patients without a phenotype suggestive of acromegaly were studied. Results: Initially, the laboratory diagnosis of acromegaly was unequivocal (elevated IGF-1 for gender and age with nadir GH > 1 μg/L) in two patients, and likely (elevated IGF-1 with nadir GH > cut-off but < 1 μg/L) in another patient. In two other patients, this diagnosis was possible (normal IGF-1 with nadir GH > 1 μg/L). Repetition of the tests 6 months after withdrawal of the dopaminergic agonist confirmed the diagnosis of subclinical acromegaly (elevated IGF-1 for gender and age with nadir GH > 1 μg/L) in these 5 patients. False-positive results were excluded in all cases. Conclusion: In patients with prolactinomas, acromegaly should be investigated not only in cases with a clinical phenotype.


PubMed | Servico de Endocrinologia and University of Coimbra
Type: Clinical Trial | Journal: Acta medica portuguesa | Year: 2014

Diabetes mellitus is an endocrine disease in which are involved the hormones produced by the islets of Langerhans. The diabetes mellitus can affect various functions of the immune system of the individual, predisposing them to chronic inflammation, progressive degradation of tissues and decreased tissue repair. The changes caused by this disease at the level of the oral cavity can highlight xerostomia, dysgeusia, periodontal alterations, increased susceptibility to infection and changes both in the dental pulp and periapical tissues.The aim of this study is to evaluate the influence of diabetes mellitus at the periapical tissues and the success of endodontic treatment in these patients.We analyzed 737 cases treated in consultation Area of Dental Medicine, which were made nonsurgical endodontic treatments, between the years 2003 and 2012. These were selected patients with diabetes mellitus, a total of 32, of whom 23 were willing to come to the consultation and to participate in this study. The data collected were analyzed using the Statistical Package for the Social Sciences, version 19, at a significance level of 5%.A total of 37 teeth in the test group and 25 in the control group. For the analyzed parameters related to the diagnosis pulp, mobility, fistula, pain on percussion horizontal and vertical evaluation of final restoration and the time interval between the query and the final restoration shutter and / or the control visit, there were no differences statistically significant (p > 0.05). Regarding the assessment of the success of endodontic treatment, this was 62% in the test group and 80% in the control group (p > 0.05).The results of this study are inconclusive regarding the increasing prevalence of apical periodontitis in diabetic patients. Regarding the evaluation of the success of endodontic treatments examined it was found that the success rate in diabetic patients is lower, though not statistically significant. For this reason and given the limitations of this study, we cannot state that patients with diabetes mellitus have a greater predisposition to the development of periradicular lesions or that the success of endodontic treatment in these patients is compromised. It is important, however, that further studies are developed to characterize the pulp and periradicular changes and to assess the prevalence of apical periodontitis and progression in patients with diabetes mellitus.


Rosario P.W.,Servico de Endocrinologia | Carvalho M.,Servico de Endocrinologia | Calsolari M.R.,Servico de Endocrinologia
Archives of Endocrinology and Metabolism | Year: 2016

Objective: To define the normal range of TSH in the first trimester of gestation and to evaluate the correlation between maternal TSH and obstetric and neonatal outcomes. Subjects and methods: Prospective study. Women without known or clinically suspected thyroid disease and without risk factors for thyroid dysfunction, who became pregnant spontaneously and were initially evaluated up to week 12 of gestation, were included. Women with positive anti-thyroperoxidase antibodies, twin pregnancy, hyperemesis gravidarum, and trophoblastic disease were excluded. Results: In the 660 pregnant women, the mean, median, and 2.5th and 97.5th percentiles of TSH were 0.9, 0.96, 0.04 and 2.68 mIU/L, respectively. TSH was undetectable in 2%, < 0.5 mIU/L in 17.4%, > 2 mIU/L in 9.7%, > 2.5 mIU/L in 4.7%, and > 3 mIU/L in 1%. None of the women received levothyroxine or antithyroid drugs during pregnancy. In addition, there was no difference in obstetric or neonatal outcomes when women with TSH ≤ 0.1, between 0.1 and 2.5, and between 2.5 and 4 mIU/L were compared. Conclusion: In the population studied, the TSH value corresponding to the 97.5th percentile was 2.68 mIU/L in the first trimester of gestation. © AE&M. All rights reserved.


PubMed | Servico de Endocrinologia
Type: Journal Article | Journal: Acta medica portuguesa | Year: 2012

The aim of the present study was to evaluate iodine intake in portuguese school children in order to inform health authorities of eventual measures to be implemented.Iodine is the key element for thyroid hormone synthesis and its deficiency even mild, as found in other European countries, may have deleterious effects in pregnancy resulting in cognitive problems of offsprings. In Portugal there are no recent data on iodine intake in schoolchildren.3680 children aged 6-12 years of both sexes, from 78 different schools were studied. Iodine intake was evaluated trough urine iodine (UI) determinations using a colorimetic method.The global median UI value was 105.5 g/L; the percentage of children with UI <100 g/L was 47.1%, corresponding to 41% of the studied schools. The percentage of values <50 g/L was 11.8%. The male gender, the south region of the country and the distribution of milk in school were significantly linked with a higher iodine elimination.Our global results point to a borderline/ mildly insufficient iodine intake in the portuguese school population. However 47% of the children had UI under 100 g /L. The comparison of our results with the available data from 30 years ago, point to a considerable improvement, due to silent prophylaxis. Male gender, geographical area and milk distribution influenced positively iodine intake.The importance of milk has been referred in numerous papers.The study of UI in the Portuguese school population points to a borderline iodine intake. However, in 47% of children iodine intake was inadequate. Compared with data from the eighties, a considerable increase in iodine elimination was found. Taking into account the potencial deleterious effects of inadequate iodine intake, a global prophylaxis with salt iodization has to be considered.


PubMed | Servico de Endocrinologia
Type: Journal Article | Journal: Acta medica portuguesa | Year: 2013

In the last years there was an increasing concern about driving and some medical conditions. Diabetes is one of the diseases associated with road traffic accidents. This increased risk is associated with hypoglycemia and diabetes complications such as: retinopathy, cataracts and neuropathy. In order to avoid car crashes patients must follow some rules like carrying some sugar source in their vehicle, always measure blood glycemia before start driving, never begin an extended drive with blood glucose less than 90 mg/dl without prophylactic carbohydrate consumption, stop the vehicle as soon any of the symptoms of low blood glucose are experienced and measure and treat the blood glucose level. In Portugal there are new rules for diabetic drivers since January 2013. Group 1 drivers are considerer unfit to drive if they have severe or recurrent hypoglycemia. Group 2 drivers need to present a medical report certificating they have good diabetes control, have not had any severe or recurrent hypoglycemia in the last twelve months and there arent any other diabetes complications.

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