Thyroid Diseases: Lopes C

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, Nobre EL, Jorge Z, Lopes C, André S, Salgado L, Macedo A, De Castro JJ. · Serviço de Endocrinologia, Hospital Militar Principal, Lisboa, Portugal. · Acta Med Port. · Pubmed #17328846 links to  free full text

Abstract: INTRODUCTION: Thyroid diseases are an area of particular interest to this Department, constituting 30% of the 3561 patients observed over the last 5 years (when group consultations were set up and outpatient data computerised). OBJECTIVES: To determine the prevalence and aetiologies of Hyperthyroidism (HT) in outpatient clinic and characterise diagnostic and therapy practice. METHODOLOGY: All files of patients diagnosed with HT treated in the department over the last 5 years were reviewed. Of a total of 105 files, 96 were analysed. The data analysed included: demographic data, aetiology of disease, complementary diagnostic test reported, treatment options and follow-up. The data was analysed independently depending on whether 1st consultation occurred before or after 1999. The variables were analysed using descriptive statistical methods, namely frequency and contingency tables for categoric variables and mean, standard deviation, maximum and minimum values for continuous variables. RESULTS: Of the patients evaluated, 72% were female and 28% male, with an average age of 50. 49.0% had Graves' Disease (GD); 14.6% toxic multinodular goitre (TMNG); 11.5% autoimmune HT; 10.4% iatrogenic HT; 7.3% subacute thyroiditis and 7.3% toxic adenoma (TA). Medical treatment was 1st option for 92% of patients with GD (40.4% of cases combined with levothyroxine); 5% received 131Iodine treatment and 3% underwent surgery. In this group, 6 months after suspension of medical treatment, 30.4% had suffered a relapse. Of the patients who suffered a relapse, 42% underwent surgery and 28% received 131Iodine treatment. The remaining 30% made a second attempt with synthetic antithyroid drugs. For patients with TMNG, surgery was the 1st treatment option for the majority of patients (78.5%), followed by 131Iodine (14.2%). 70% of patients with toxic adenoma underwent surgery and 30% 131Iodine treatment. For other pathologies, namely autoimmune HT, iatrogenic HT and subacute thyroiditis, the option was medical treatment. CONCLUSIONS: Hyperthyroidism was diagnosed in 3.5% of patients observed as outpatients in this Department. GD was the most prevalent form of HT (49%). Medical treatment is the first treatment option (92%) for GD. 6 months after suspension of medical treatment, 30% of patients had suffered a relapse of GD. For these patients, surgery was the 1st option. For both TMNG and TA, surgery was the first treatment option. Complications: The adverse effects that occurred with ATDs (antithyroid drugs) were detected in 4,1% patients; one case of agranulocytosis with propylthiouracil, 2 cases of allergic reactions--rash (one due to the use of methimazole and the other to propylthiouracil), and one case of minor hepatocellular toxicity. In all patients there was improvement after stopping medical treatment.

Marques L, Lopes C. · Serviço de Endocrinologia, Diabetes e Metabolismo, Hospital de S. João, Porto. · Acta Med Port. · Pubmed #14750282 No free full text.

Abstract: The authors refer particular aetiological features, prognostic e different types of thyroid carcinoma treatment on pregnant women. There are also other kind of tumours occurring during this time, although not so frequent. There are some protocols in discussion to treat these kind of thyroid carcinoma, considering that the problem must be specified according to the type of tumour, stadium, pregnancy time and the patient psychological state.