Thyroid Diseases: Castro JJ

Rodrigues F, Limbert E, Marques AP, Santos AP, Lopes C, Rodrigues E, Borges F, Carrilho F, Castro JJ, Neto J, Salgado L, Oliveira MJ, Anonymous00295. · No affiliation provided · Acta Med Port. · Pubmed #16202330 links to  free full text

Abstract: Differentiated thyroid carcinoma of follicular origin (DTCFO), although not very frequent, has registered a raising incidence in the last decades. In the majority of the cases, DTCFO is a curable disease when treated and monitored by experienced, multidisciplinary teams. These factors contribute to an increasing number of DTCFO survivors requiring life-long monitoring, due to the possibility of occurrence of recurrences many years after the initial treatment. Several aspects of the treatment and management of these patients are still controversial. The present protocol represents the consensus of the members of the Grupo de Estudo da Tiróide of the Sociedade Portuguesa de Endocrinologia, Diabetes e Metabolismo. It aims to define guidelines, in agreement with the current state of the art and contemplating the necessary adaptations to local constrains, that ensure decreased mortality and protection of patients' quality of life, avoiding unnecessarily aggressive or ineffective treatments, optimizing the use of the available resources.

Nobre EL, Jorge Z, Anselmo J, Lopes C, César R, Santos V, Castro JJ. · Serviço de Endocrinologia, Hospital Militar Principal, Lisboa. · Acta Med Port. · Pubmed #16197861 links to  free full text

Abstract: We describe the case of a 22-year old male undergoing a total thyroidectomy for euthyroid multi-nodular goitre (TSH: 1.6 microUI/ml). He was discharged treated with LT4 100 mg id. After discharge, he went into full clinical and laboratorial hypothyroidism (TSH = 396 microUI/mL). We were able to rule out failure to take the medication and concomitant use of drugs. In the evaluation of intestinal absorption, only the D-Xylose test proved to be abnormal. After unsuccessful administration of oral T4 and T3, under close nursing supervision, intramuscular (IM) and subcutaneous (SC) forms of administration of T4 were experimented. While both forms achieved normal levels of thyroid hormones, we opted for IM injection as the patient complained of local pain during SC administration. This seems to be the second case described in which it was necessary to resort to parenteral administration of T4 to achieve clinical and laboratorial euthyroidism.

Vilar H, Carrilho F, Borges F, Limbert E, Rodrigues F, Oliveira MJ, Castro JJ, Anonymous00115. · Sociedade Portuguesa de Endocrinologia, Diabetes e Metabolismo. · Acta Med Port. · Pubmed #16684479 links to  free full text

Abstract: INTRODUCTION: The best diagnostic and treatment strategy for an approach to the nodular thyroid disease continues to be a controversial issue. OBJECTIVES: The aim of this study was to characterise medical practice in the diagnosis and treatment of nodular thyroid disease by endocrinologists and surgeons in Portugal in 2002. METHODS: A questionnaire based on that used by the European Thyroid Association and the American Thyroid Association was drawn up. The questionnaire, based on a well-defined index case, was circulated by the Portuguese Endocrinology Society to endocrinologists and surgeons: 42 year-old woman with solitary thyroid nodule measuring 2 x 3 cm, with no history of malfunction or painful symptoms. Each doctor was asked to reply as to the adopted diagnosis and therapy procedures for the index case. Eleven variations to the original case were proposed in order to evaluate the alterations for each variation. RESULTS: 1492 questionnaires were sent out, 163 to endocrinologists and 1329 to surgeons. A total of 104 were returned. The global response rate was 7%. The response rate for endocrinologists was 27% and 4.5% for surgeons. Of the 104 questionnaires returned, 42% were from endocrinologists and 58% from surgeons. Concerning tests prescribed, surgeons would use more tests than endocrinologists for the index case. The main differences in laboratory terms were the higher number of prescriptions for total T4 and T3 and thyroglobulin by surgeons and more prescriptions for AATPO by endocrinologists. The average number of tests was 4.6, 4.1 for endocrinologists and 5.1 for surgeons. Relative to imaging and cytology, 32% of doctors advocated a scintigraphy to diagnose the index case, with no significant differences between endocrinologists and surgeons. Ultrasonography was used by over 85% of respondents. 90% prescribed a cytology, 83% guided by palpation and 18% ultrasonography-guided. Concerning treatment, 33% of doctors advocated levothyroxin treatment; surgery was advocated by 16.3% of endocrinologists and 36.6% of surgeons. Meanwhile, the majority of doctors (68%) would opt for no treatment and simply maintain the patient under surveillance. CONCLUSIONS: There are important differences in the approach to nodular thyroid disease among the various doctors and specialists, which highlight the difficulty in achieving a diagnostic and therapeutic consensus.

Jorge Z, Nobre EL, Santana A, Castro JJ. · Serviço de Endocrinologia, Diabetes e Metabolismo, Hospital Militar Principal, Lisboa. · Acta Med Port. · Pubmed #16202338 links to  free full text

Abstract: Autoimmune thyroid disease is the most common cause of subclinical thyroid dysfunction (hypo and hyperthyroidism) in the western countries. Autoimmune thyroid diseases with clinical relevance (Graves' disease and autoimmune hypothyroidism) are common and can present with a large clinical and laboratorial spectrum. Hypo and hyperthyroidism can exist in the same patient, on different times. Progression from Graves hyperthyroidism to chronic autoimmune thyroiditis and hypothyroidism is now well-recognized and the inverse might also occur, although being rare. We describe a case report of Graves' disease in a patient with a chronic autoimmune hypothyroidism of long course (diagnosed 21 years ago).