Arquivos Brasileiros de Endocrinologia & Metabologiahttps://www.scielo.br/journal/abem/feed/2022-08-06T14:17:38.680000ZVol. 58 No. 9 - 2014WerkzeugBariatric surgery – An update for the
endocrinologist10.1590/0004-27300000034132022-08-06T14:17:38.680000Z2020-08-09T06:48:11.828000ZMancini, Marcio C.
<em>Mancini, Marcio C.</em>;
<br/><br/>
Obesity is a major public health problem, is associated with increased rates of mortality risk and of developing several comorbidities, and lessens life expectancy. Bariatric surgery is the most effective treatment for morbidly obese patients, reducing risk of developing new comorbidities, health care utilization and mortality. The establishment of centers of excellence with interdisciplinary staff in bariatric surgery has been reducing operative mortality in the course of time, improving surgical safety and quality. The endocrinologist is part of the interdisciplinary team. The aim of this review is to provide endocrinologists, physicians and health care providers crucial elements of good clinical practice in the management of morbidly obese bariatric surgical candidates. This information includes formal indications and contraindications for bariatric operations, description of usual bariatric and metabolic operations as well as endoscopic treatments, preoperative assessments including psychological, metabolic and cardiorespiratory evaluation and postoperative dietary staged meal progression and nutritional supplementation follow-up with micronutrient deficiencies monitoring, surgical complications, suspension of medications in type 2 diabetic patients, dumping syndrome and hypoglycemia. Arq Bras Endocrinol Metab. 2014;58(9):875-88Brown adipose tissue: what have we learned since its
recent identification in human adults10.1590/0004-27300000034922022-08-06T14:17:38.680000Z2020-08-09T06:48:11.828000ZHalpern, BrunoMancini, Marcio CorreaHalpern, Alfredo
<em>Halpern, Bruno</em>;
<em>Mancini, Marcio Correa</em>;
<em>Halpern, Alfredo</em>;
<br/><br/>
Brown adipose tissue, an essential organ for thermoregulation in small and hibernating mammals due to its mitochondrial uncoupling capacity, was until recently considered to be present in humans only in newborns. The identification of brown adipose tissue in adult humans since the development and use of positron emission tomography marked with 18-fluorodeoxyglucose (PET-FDG) has raised a series of doubts and questions about its real importance in our metabolism. In this review, we will discuss what we have learnt since its identification in humans as well as both new and old concepts, some of which have been marginalized for decades, such as diet-induced thermogenesis. Arq Bras Endocrinol Metab. 2014;58(9):889-99Estudo do polimorfismo G54D do gene <i>MBL2 </i>no
diabetes melito gestacional10.1590/0004-27300000028192022-08-06T14:17:38.680000Z2020-08-09T06:48:11.828000ZBaggenstoss, RejanePetzhold, Silvia VanderléiaWillemann, Izabela K. MichelsPabis, Francisco SimõesGimenes, PauloSouza, Barbara Vicente deFrança, Paulo Henrique Condeixa deSilva, Jean Carl
<em>Baggenstoss, Rejane</em>;
<em>Petzhold, Silvia Vanderléia</em>;
<em>Willemann, Izabela K. Michels</em>;
<em>Pabis, Francisco Simões</em>;
<em>Gimenes, Paulo</em>;
<em>Souza, Barbara Vicente De</em>;
<em>França, Paulo Henrique Condeixa De</em>;
<em>Silva, Jean Carl</em>;
<br/><br/>
Objetivo Analisar a influência da associação do polimorfismo G54D (rs1800450) do gene MBL2 no diabetes melito gestacional (DMG) quanto à necessidade de tratamento complementar e ocorrência de recém-nascidos grandes para a idade gestacional. Sujeitos e métodos Cento e cinco pacientes com DMG segundo parâmetro da OMS (Organização Mundial da Saúde) foram avaliadas no período de novembro de 2010 a outubro de 2012. As gestantes foram divididas em dois grupos correspondentes à presença (n = 37) ou à ausência (n = 68) do alelo mutante. As variantes do polimorfismo G54D foram identificadas por meio da técnica de polimorfismos de comprimentos de fragmentos de restrição (RFLP). Parâmetros antropométricos e bioquímicos da mãe e do recém-nascido (RN) e a necessidade de terapia complementar associada à dietoterapia foram avaliados como desfechos primários. Resultados Das pacientes analisadas, 35,2% carregavam pelo menos um alelo mutante do polimorfismo G54D. Os dois grupos não apresentaram diferença significativa quanto a ganho de peso, paridade, idade, índice de massa corporal e idade gestacional de chegada à maternidade. Os grupos de pacientes portadoras ou não do alelo mutante não diferiram quanto à necessidade de tratamento complementar à dietoterapia (16,2% vs. 26,7%) respectivamente e à ocorrência de recém-nascidos grandes para a idade gestacional (24,3% vs. 13,2%). Conclusão Nossos dados demonstraram que o polimorfismo G54D do gene MBL2 não teve efeito sobre a necessidade de tratamento complementar acrescido à dietoterapia e à ocorrência de recém-nascidos grandes para a idade gestacional na população estudada. Arq Bras Endocrinol Metab. 2014;58(9):900-5An international survey of screening and management of
hypothyroidism during pregnancy in Latin America10.1590/0004-27300000033822022-08-06T14:17:38.680000Z2020-08-09T06:48:11.828000ZMedeiros, Mateus Fernandes da SilvaCerqueira, Taise Lima de OliveiraSilva Junior, Joaquim CustódioAmaral, Magali Teresopolis ReisVaidya, BijayPoppe, Kris GustaveCarvalho, Gisah Amaral deGutierrez, SilviaAlcaraz, GracielaAbalovich, MarcosRamos, Helton Estrela,
<em>Medeiros, Mateus Fernandes Da Silva</em>;
<em>Cerqueira, Taise Lima De Oliveira</em>;
<em>Silva Junior, Joaquim Custódio</em>;
<em>Amaral, Magali Teresopolis Reis</em>;
<em>Vaidya, Bijay</em>;
<em>Poppe, Kris Gustave</em>;
<em>Carvalho, Gisah Amaral De</em>;
<em>Gutierrez, Silvia</em>;
<em>Alcaraz, Graciela</em>;
<em>Abalovich, Marcos</em>;
<em>Ramos, Helton Estrela</em>;
<em>,</em>;
<br/><br/>
Objective To determine how endocrinologists in Latin America deal with clinical case scenarios related to hypothyroidism and pregnancy. Materials and methods In January 2013, we sent an electronic questionnaire on current practice relating to management of hypothyroidism in pregnancy to 856 members of the Latin American Thyroid Society (LATS) who manage pregnant patients with thyroid disease. Subsequently, we have analyzed responses from physician members. Results Two hundred and ninety-three responders represent clinicians from 13 countries. All were directly involved in the management of maternal hypothyroidism and 90.7% were endocrinologists. The recommendation of a starting dose of L-thyoxine for a woman diagnosed with overt hypothyroidism in pregnancy, preconception management of euthyroid women with known thyroid autoimmunity and approach related to ovarian hyperstimulation in women with thyroid peroxidase antibodies were widely variable. For women with known hypothyroidism, 34.6% of responders would increase L-thyroxine dose by 30-50% as soon as pregnancy is confirmed. With regard to screening, 42.7% of responders perform universal evaluation and 70% recommend TSH < 2.5 mUI/L in the first trimester and TSH < 3 mUI/L in the second and third trimester as target results in known hypothyroid pregnant women. Conclusion Deficiencies in diagnosis and management of hypothyroidism during pregnancy were observed in our survey, highlighting the need for improvement of specialist education and quality of care offered to patients with thyroid disease during pregnancy in Latin America. Arq Bras Endocrinol Metab. 2014;58(9):906-11Evaluation of percutaneous ethanol injections in benign
thyroid nodules10.1590/0004-27300000034442022-08-06T14:17:38.680000Z2020-08-09T06:48:11.828000ZPerez, Camila Luhm SilvaFighera, Tayane MunizMiasaki, FabiolaMesa Junior, Cleo OtavianoPaz Filho, Gilberto Jorge daGraf, HansCarvalho, Gisah Amaral de
<em>Perez, Camila Luhm Silva</em>;
<em>Fighera, Tayane Muniz</em>;
<em>Miasaki, Fabiola</em>;
<em>Mesa Junior, Cleo Otaviano</em>;
<em>Paz Filho, Gilberto Jorge Da</em>;
<em>Graf, Hans</em>;
<em>Carvalho, Gisah Amaral De</em>;
<br/><br/>
Objective The objective of this study was to evaluate the efficacy and safety of percutaneous ethanol injection (PEI) in the treatment of benign thyroid nodules. Subjects and methods We evaluated 120 patients with benign thyroid nodules. Patients underwent evaluation of serum TSH and free T4, cervical ultrasound, and thyroid scintigraphy (in those with suppressed TSH levels). The application of sterile ethanol 99% was guided by ultrasound, with the injected volume amounting to one-third of the nodule volume. Response was considered complete (reduction of 90%); partial (reduction between 50 and 90%); or none (reduction of < 50%). Autonomous nodules were evaluated for normalization of TSH levels. Results Among the nodules studied, 30.8% were solid, 56.7% were mixed, 12.5% were cystic, and 21.6% were hyperfunctioning. The initial volume of the treated nodules ranged from 0.9 to 74.8 mL (mean 13.1 ± 12.4 mL). We performed 1-8 sessions of PEI, applying an average of 6.2 mL of ethanol for patient. After 2 years of follow-up, 17% of patients achieved a complete response (94% reduction); 53%, a partial response (70% reduction); and 30%, no response. A reduction in the volume of autonomous nodules was noted in 70% of cases, and 54% had a normalized value of TSH. The main side effect is local pain, lasting less than 24 hours in most cases. Conclusion This study showed that PEI is a safe and effective procedure for treatment of benign, solid or mixed thyroid nodules. Most cases resulted in significant reduction in nodule volume, with normalization of thyroid function. Arq Bras Endocrinol Metab. 2014;58(9):912-7The TCF7L2 rs7903146 (C/T) polymorphism is associated
with risk to type 2 diabetes mellitus in Southern-Brazil10.1590/0004-27300000035102022-08-06T14:17:38.680000Z2020-08-09T06:48:11.828000ZAssmann, Taís S.Duarte, Guilherme C. K.Rheinheimer, JakelineCruz, Lavínia A.Canani, Luís H.Crispim, Daisy
<em>Assmann, Taís S.</em>;
<em>Duarte, Guilherme C. K.</em>;
<em>Rheinheimer, Jakeline</em>;
<em>Cruz, Lavínia A.</em>;
<em>Canani, Luís H.</em>;
<em>Crispim, Daisy</em>;
<br/><br/>
Objective The aim of this study was to investigate the association between the rs7903146 (C/T) polymorphism in the TCF7L2 gene and type 2 diabetes mellitus, in a Southern-Brazilian population. Materials and methods The TCF7L2 rs7903146 polymorphism was genotyped in 953 type 2 diabetic patients and 535 non-diabetic subjects. All subjects were white. The polymorphism was genotyped by Real-Time PCR using TaqMan MGB probes (Life Technologies). Odds ratios (OR) and 95% confidence intervals (CI) were calculated for additive, recessive and dominant inheritance models. Results Genotype and allele frequencies of the rs7903146 polymorphism differed significantly between type 2 diabetic patients and non-diabetic subjects (P = 0.001 and P = 0.0001, respectively). The frequency of the minor allele was 38% in type 2 diabetes group and 31% in non-diabetic subjects, and this allele was significantly associated with type 2 diabetes risk (OR = 1.42, 95% CI 1.15 – 1.76 for the dominant model of inheritance). Moreover, the T/T genotype was associated with a higher risk for type 2 diabetes (OR = 1.83, 95% CI 1.3-2.5) than the presence of only one copy of the T allele (OR = 1.31, 95% CI 1.1-1.6). Both results were adjusted for age and gender. Conclusions Our results confirm the association between the TCF7L2 rs7903146 polymorphism and increase risk for type 2 diabetes in Southern-Brazil. Arq Bras Endocrinol Metab. 2014;58(9):918-25The prevalence of the metabolic syndrome increases through the
quartiles of thyroid stimulating hormone in a population-based sample of euthyroid
subjects10.1590/0004-27300000035382022-08-06T14:17:38.680000Z2020-08-09T06:48:11.828000ZShinkov, AlexanderBorissova, Anna-MariaKovatcheva, RoussankaAtanassova, IlianaVlahov, JordanDakovska, Lilia
<em>Shinkov, Alexander</em>;
<em>Borissova, Anna-Maria</em>;
<em>Kovatcheva, Roussanka</em>;
<em>Atanassova, Iliana</em>;
<em>Vlahov, Jordan</em>;
<em>Dakovska, Lilia</em>;
<br/><br/>
Objective The aim of the study was to assess the prevalence and characteristics of metabolic syndrome (MetS) and its elements in relation to TSH in euthyroid subjects. Materials and methods In the cross-sectional study, 2,153 euthyroid adults, 47.2 ± 14.5 years (20-94) with no current antithyroid or thyroid replacement therapy were enrolled. All participants filled a questionnaire on past and current morbidities, medication and smoking. Body weight, height, waist circumference, serum TSH, glucose and lipids were measured. The subjects were stratified by quartiles of TSH (QTSH) and the prevalence of the MetS elements was calculated. MetS was determined by the IDF 2005 criteria. Results Overweight prevalence was 37.2% (35.2-39.2), obesity in 25.1% (23.3-26.9), abdominal obesity – 61.4% (59.3-63.5), hypertension – 42.1% (38.9-43.1), diabetes/increased fasting glucose – 13.6% (12.1-15), low HDL-cholesterol – 27.6% (25.7-29.5), hypertriglyceridemia – 24.1% (22.3-25.9), MetS – 32.2% (30.2-34.2). MetS was more prevalent in the highest QTSH (34.9%, 30.9-38.9) than the lowest (27%, 23.3-30.9), p < 0.001, as were low HDL-C (32%, 28-35.9 vs. 25%, 21.3-28.7, p < 0.001) and hypertriglyceridemia (26.8%, 23-30.5 vs. 20.4%, 17-23.8, p = 0.015). Each QTSH increased the risk of MetS by 14%, p < 0.001, of hypertriglyceridemia by 20%, p = 0.001 and of low LDL-C by 9%, p = 0.042. Other significant factors for MetS were age, male gender and obesity. Conclusion The prevalence of MetS increased with higher QTSH within the euthyroid range, mostly by an increase in the dyslipidemia. Arq Bras Endocrinol Metab. 2014;58(9):926-32Thyroid nodules and thyroid cancer in Graves’
disease10.1590/0004-27300000035692022-08-06T14:17:38.680000Z2020-08-09T06:48:11.828000ZTam, Abbas AliKaya, CaferKılıç, Fevzi Balkan MehmetErsoy, ReyhanÇakır, Bekir
<em>Tam, Abbas Ali</em>;
<em>Kaya, Cafer</em>;
<em>Kılıç, Fevzi Balkan Mehmet</em>;
<em>Ersoy, Reyhan</em>;
<em>Çakır, Bekir</em>;
<br/><br/>
Objective The frequency of thyroid nodules accompanying Graves’ disease and the risk of thyroid cancer in presence of accompanying nodules are controversial. The aim of this study was to evaluate the frequency of thyroid nodules and the risk of thyroid cancer in patients operated because of graves’ disease. Subjects and methods Five hundred and twenty-six patients in whom thyroidectomy was performed because of Graves’ disease between 2006 and 2013 were evaluated retrospectively. Patients who had received radioactive iodine treatment and external irradiation treatment in the neck region and who had had thyroid surgery previously were not included in the study. Results While accompanying thyroid nodule was present in 177 (33.6%) of 526 Graves’ patients, thyroid nodule was absent in 349 (66.4%) patients. Forty-two (8%) patients had thyroid cancer. The rate of thyroid cancer was 5.4% (n = 19) in the Graves’ patients who had no nodule, whereas it was 13% (n = 23) in the patients who had nodule. The risk of thyroid cancer increased significantly in presence of nodule (p = 0.003). Three patients had recurrence. No patient had distant metastasis. No patient died during the follow-up period. Conclusions Especially Graves’ patients who have been decided to be followed up should be evaluated carefully during the follow-up in terms of thyroid cancer which may accompany. Arq Bras Endocrinol Metab. 2014;58(9):933-8Evaluation of cytopathological findings in thyroid nodules with
macrocalcification: macrocalcification is not innocent as it seems10.1590/0004-27300000036022022-08-06T14:17:38.680000Z2020-08-09T06:48:11.828000ZArpaci, DilekOzdemir, DidemCuhaci, NeslihanDirikoc, AhmetKilicyazgan, AylinGuler, GulnurErsoy, ReyhanCakir, Bekir
<em>Arpaci, Dilek</em>;
<em>Ozdemir, Didem</em>;
<em>Cuhaci, Neslihan</em>;
<em>Dirikoc, Ahmet</em>;
<em>Kilicyazgan, Aylin</em>;
<em>Guler, Gulnur</em>;
<em>Ersoy, Reyhan</em>;
<em>Cakir, Bekir</em>;
<br/><br/>
Objective Microcalcification is strongly correlated with papillary thyroid cancer. It is not clear whether macrocalcification is associated with malignancy. In this study, we aimed to assess the result of fine needle aspiration biopsies (FNAB) of thyroid nodules with macrocalcifications. Subjects and methods We retrospectively evaluated 269 patients (907 nodules). Macrocalcifications were classified as eggshell and parenchymal macrocalcification. FNAB results were divided into four groups: benign, malignant, suspicious for malignancy, and non-diagnostic. Results There were 79.9% female and 20.1% male and mean age was 56.9 years. Macrocalcification was detected in 46.3% nodules and 53.7% nodules had no macrocalcification. Parenchymal and eggshell macrocalcification were observed in 40.5% and 5.8% nodules, respectively. Cytologically, malignant and suspicious for malignancy rates were higher in nodules with macrocalcification compared to nodules without macrocalcification (p = 0.004 and p = 0.003, respectively). Benign and non-diagnostic cytology results were similar in two groups (p > 0.05). Nodules with eggshell calcification had higher rate of suspicious for malignancy and nodules with parenchymal macrocalcification had higher rates of malignant and suspicious for malignancy compared to those without macrocalcification (p = 0.01, p = 0.003 and p = 0.007, respectively). Conclusions Our findings suggest that macrocalcifications are not always benign and are not associated with increased nondiagnostic FNAB results. Macrocalcification, particularly the parenchymal type should be taken into consideration. Arq Bras Endocrinol Metab. 2014;58(9):939-45Redução da mobilidade funcional e da capacidade cognitiva no
diabetes melito tipo 210.1590/0004-27300000030972022-08-06T14:17:38.680000Z2020-08-09T06:48:11.828000ZFerreira, Mari CassolTozatti, JoanaFachin, Silvia MariaOliveira, Patricia Pereira deSantos, Rosa Ferreira dosSilva, Maria Elisabeth Rossi da
<em>Ferreira, Mari Cassol</em>;
<em>Tozatti, Joana</em>;
<em>Fachin, Silvia Maria</em>;
<em>Oliveira, Patricia Pereira De</em>;
<em>Santos, Rosa Ferreira Dos</em>;
<em>Silva, Maria Elisabeth Rossi Da</em>;
<br/><br/>
Objetivos Avaliar a mobilidade funcional e sua relação com a capacidade cognitiva em pacientes com diabetes tipo 2 (DM2) entre 50 e 65 anos de idade, e com menos de 10 anos de diagnóstico. Materiais e métodos Estudo observacional, analítico e transversal envolvendo indivíduos não diabéticos e pacientes com DM2 com controle glicêmico inadequado, selecionados por amostra de conveniência. Em ambos os grupos, foram aplicados questionário estruturado, avaliação cognitiva com Miniexame do Estado Mental (MEEM) e teste do relógio (TDR), além da avaliação de mobilidade funcional pelo teste Timed Up & GO (TUG). Resultados No TUG os pacientes com DM2 apresentaram tempo médio de 11,27 segundos versus 9,52 segundos nos controles (p = 0,013). A associação entre declínio cognitivo e dismobilidade foi positiva nos indivíduos com DM2 (p = 0,037). No subgrupo que apresentou dismobilidade e declínio cognitivo associados, 18% eram portadores de DM2 e 1,6% era do grupo sem DM2 (p < 0,01). Conclusões Pacientes com DM2 apresentaram pior mobilidade funcional e desempenho cognitivo, favorecendo a hipótese de que o DM2 influencia a mobilidade funcional e capacidade cognitiva antes do aparecimento de complicações vasculares ou neuropáticas. Esses dados sugerem que a hiperglicemia é um fator agravante no desempenho de atividades que exijam funções mentais como atenção, orientação e memória de trabalho. Arq Bras Endocrinol Metab. 2014;58(9):946-52Marrow hypoplasia: a rare complication of untreated Grave’s
disease10.1590/0004-27300000032162022-08-06T14:17:38.680000Z2020-08-09T06:48:11.828000ZGarcia, JulianaFrança, Larissa deEllinger, VivianWolff, Mônica
<em>Garcia, Juliana</em>;
<em>França, Larissa De</em>;
<em>Ellinger, Vivian</em>;
<em>Wolff, Mônica</em>;
<br/><br/>
Atypical presentation forms of hyperthyroidism are always a challenge to the clinician. We present a female patient with the typical symptoms of thyrotoxicosis, without any thionamides treatment before, associated with pancytopenia, which recovered after euthyroidism state was achieved. Although the major cases of pancytopenia in Grave’s disease are seen as a complication of antithyroid drugs (thioamides), in this case report the alteration in blood tests was associated with untreated hyperthyroidism. In the literature review, we found 19 case reports between 1981 to 2012, but it has been related to a hypercellular bone marrow with periferic destruction. Our case, however, is about a hypocellular bone marrow without fibrosis or fat tissue replacement, which proceeded with a periferic improvement following thyroid treatment. Although rare, pancytopenia, when present, may develop as an unusual and severe manifestation in untreated subjects.Large thyroid cyst in a patient with congenital
hypothyroidism10.1590/0004-27300000032872022-08-06T14:17:38.680000Z2020-08-09T06:48:11.828000ZKaykhaei, Mahmoud AliHeidari, ZahraMehrazin, Ahmad
<em>Kaykhaei, Mahmoud Ali</em>;
<em>Heidari, Zahra</em>;
<em>Mehrazin, Ahmad</em>;
<br/><br/>
Thyroid hormone biosynthetic defects are rare causes of congenital hypothyroidism. Although, initial presentations are usually diffuse goiter and hypothyroidism, subsequently they may develop thyroid nodules and or thyroid cancer. We describe a case of hypothyroidism due to dyshormonogenesis whose one of the previously solid nodules degenerates into a large cyst. A 22-year-old male was referred to our clinic for evaluation of enlarging thyroid nodule. Hypothyroidism was diagnosed in infancy, however due to poor compliance to treatment TSH values were elevated most of the times. When he was fifteen the first nodule was detected which was a solid cold nodule. Fine needle aspiration was in favor of benign follicular nodule. Seven years later we found a large multi nodular thyroid with a predominant large cyst corresponding to the previously detected solid nodule. 21cc straw colored fluid was aspirated. Cytology was reported as benign cystic nodule. The patient underwent thyroidectomy and pathology confirmed a benign thyroid cyst. Although underreported thyroid dyshormonogenesis may progress to cystic degeneration. Taking into account the risk of malignancy and eventually cyst formation, we recommend more frequent evaluation in the face of nodule formation in these patients. Arq Bras Endocrinol Metab. 2014;58(9):958-61A case of thyroid hormone resistance: a rare
mutation10.1590/0004-27300000032972022-08-06T14:17:38.680000Z2020-08-09T06:48:11.828000ZGonçalves, Ana PiresAragüés, José MariaNobre, EmaBarbosa, Ana PaulaMascarenhas, Mario
<em>Gonçalves, Ana Pires</em>;
<em>Aragüés, José Maria</em>;
<em>Nobre, Ema</em>;
<em>Barbosa, Ana Paula</em>;
<em>Mascarenhas, Mario</em>;
<br/><br/>
Reduced sensitivity to thyroid hormones (RSTH) is a rare disease that affects about 3,000 individuals, belonging to about 1,000 families. It results from reduced intracellular action of thyroid hormones (TH) genetically determined and manifests as persistent hyperthyroxinemia with non-suppressed thyroid-stimulating hormone (TSH). We describe a 67-years old, Caucasian woman, with past history of subtotal thyroidectomy due to diffuse goiter, who presents with a recurrence of goiter. Although she is clinically euthyroid, laboratory evaluation shows persistent hyperthyroxinemia with non-suppressed TSH. Response to thyrotropin releasing hormone (TRH) test was normal and TSH concentrations were not suppressed during oral administration of suprafisiologic doses of levothyroxine (L-T4). Peripheral blood DNA was extracted from the patient and a mutation was found localized in cluster one, at codon 346 of the ligand binding domain of the THRB gene. The patient’s son underwent thyroid function testing (TFT) and genetic study, both negative, suggesting a sporadic mutation. RSTH should be considered in all hyperthyroxinemic patients who are clinically euthyroid. Mutations interfering with three major steps required for TH action on target tissues have been, so far, identified (TR-β, TR-α, MCT8, SPB2). Each mutation is associated with a distinctive syndrome. Goal of management is to maintain a normal serum TSH level and a eumetabolic state and offer appropriate genetic counselling and prenatal diagnosis. Inappropriate treatment of eumetabolic patients results in hypothyroidism and need for TH replacement.Metástase gigante de carcinoma papilífero10.1590/0004-27300000033872022-08-06T14:17:38.680000Z2020-08-09T06:48:11.828000ZMenezes, Marcelo BeneditoBertelli, Antonio Augusto TupinambáSaieg, Mauro AjajCamargo, Tales Maciel deGonçalves, Antonio José
<em>Menezes, Marcelo Benedito</em>;
<em>Bertelli, Antonio Augusto Tupinambá</em>;
<em>Saieg, Mauro Ajaj</em>;
<em>Camargo, Tales Maciel De</em>;
<em>Gonçalves, Antonio José</em>;
<br/><br/>
O carcinoma papilífero da tireoide, o mais comum deste órgão, geralmente se apresenta como lesões parenquimatosas pequenas e, eventualmente, com metástases cervicais numerosas, raramente volumosas. É descrito um caso raro de uma paciente do gênero feminino, 44 anos, com um tumor cervical anterior, nodular e volumoso há nove anos. Após o tratamento cirúrgico, o anatomopatológico mostrou tratar-se de metástases linfonodais de carcinoma papilífero. O objetivo deste estudo é relatar um caso clínico de apresentação incomum de carcinoma papilífero da tireoide, de diagnóstico inicial difícil e apresentando-se com metástases linfonodais volumosas. Arq Bras Endocrinol Metab. 2014;58(9):967-9 Papillary thyroid carcinoma, the most common type of thyroid cancer is usually presented as small parenchymatous lesions and, eventually, with cervical lymph node metastasis, rarely voluminous. Here we describe a rare case of a 44-year-old woman presenting a visible anterior cervical tumor, nodullary and voluminous, for nine years. After surgical treatment, the anatomical pathology sample revealed that the mass was composed of several cervical lymph node metastatic lesions of a papillary thyroid carcinoma. We report the discovery of an uncommon papillary thyroid carcinoma manifestation, with a difficult initial diagnosis and presenting voluminous lymph node metastases.Angiotensin-II induced insulin resistance10.1590/0004-27300000032602022-08-06T14:17:38.680000Z2020-08-09T06:48:11.828000ZOnal, Eda DemirIsik, SerhatBerker, DilekGuler, Serdar
<em>Onal, Eda Demir</em>;
<em>Isik, Serhat</em>;
<em>Berker, Dilek</em>;
<em>Guler, Serdar</em>;
<br/><br/>
Response to the letter: Angiotensin-II induced insulin
resistance10.1590/0004-27300000036492022-08-06T14:17:38.680000Z2020-08-09T06:48:11.828000ZLima-Martínez, Marcos M.López-Mendez, GabrielOdreman, RodolfoDonis, José H.Paoli, Mariela
<em>Lima-Martínez, Marcos M.</em>;
<em>López-Mendez, Gabriel</em>;
<em>Odreman, Rodolfo</em>;
<em>Donis, José H.</em>;
<em>Paoli, Mariela</em>;
<br/><br/>
Red cell distribution width in subclinical
hypothyroidism10.1590/0004-27300000034522022-08-06T14:17:38.680000Z2020-08-09T06:48:11.828000ZBalta, SevketAparci, MustafaOzturk, CengizDemirkol, SaitCelik, TurgayIyisoy, Atila
<em>Balta, Sevket</em>;
<em>Aparci, Mustafa</em>;
<em>Ozturk, Cengiz</em>;
<em>Demirkol, Sait</em>;
<em>Celik, Turgay</em>;
<em>Iyisoy, Atila</em>;
<br/><br/>
Response to the letter: Red cell distribution width in
subclinical hypothyroidism10.1590/0004-27300000035522022-08-06T14:17:38.680000Z2020-08-09T06:48:11.828000ZYu, Hea MinPark, Kang SeoLee, Jae Min
<em>Yu, Hea Min</em>;
<em>Park, Kang Seo</em>;
<em>Lee, Jae Min</em>;
<br/><br/>
PTPN2, a potential therapeutic target for type 1
diabetes?10.1590/0004-27300000035612022-08-06T14:17:38.680000Z2020-08-09T06:48:11.828000ZLiu, Shan-ShanJi-Quan, LouYe, Ding
<em>Liu, Shan-Shan</em>;
<em>Ji-Quan, Lou</em>;
<em>Ye, Ding</em>;
<br/><br/>
PTPN2 gene polymorphisms are associated with type 1 diabetes
mellitus in Brazilian subjects?10.1590/0004-27300000036642022-08-06T14:17:38.680000Z2020-08-09T06:48:11.828000ZRheinheimer, JakelineCanani, Luis HenriqueCrispim, Daisy
<em>Rheinheimer, Jakeline</em>;
<em>Canani, Luis Henrique</em>;
<em>Crispim, Daisy</em>;
<br/><br/>