Publicação
Hashimoto’s thyroiditis follow up along 10 years
| Resumo: | Introduction: Hypothyroidism occurs in the adult population in 4 to 5 %. Hashimoto’s thyroiditis, an autoimmune disease, is the most common cause of hypothyroidism in areas of iodine sufficiency. Clinically is characterized by variable sized goiter, positive thyroid antibodies and euthyroidism or subclinical hypothyroidism. Patients and methods: The study considered all patients, followed by a single doctor at the outpatient clinic of a tertiary hospital. A specific database was defined with the Statistical Package for the Social Sciences Program (SPSS/IBM 19th version), the database included the gender and age at the first appointment; the results of each analytical evaluation and Levothyroxine prescription. Results: Were evaluated 164 patients; the majority were female 147 (90%), the meanage 48±16 years [12-80 years] and were followed since 2000 with a mean follow-up of 4±3 years [1-10 years]. All analytical parameters considered at each time – T3, T4, TSH, fT4 – presented a normal distribution, except for TPOAb and TgAb, that presented a distribution significantly different from the normal one. More than half of the patients (61%) presented at the first appointment with hypothyroidism, most were already under substitutive therapy, and the remaining presented naïve to therapy beginning therapy immediately at the first appointment. From the remaining naïve patients, 28% presented later with hypothyroidism, at an average rate of 9% per year. The thyroid antibodies variability was demonstrated to be rather elevated, regarding TPOAb values these can increase four times within the range, and at some time both anti-thyroid antibodies are negative while later either one, or both became positive. Levels of TPOAb seem to increase over time, and was demonstrated a direct and significant relation between TPOAb and TSH, showing a functional relevance of the antibody. Discussion and Conclusion: Thyroid antibodies presented a fluctuate evolution over time, and therefore a defective marker of HT, since it can exclude incorrectly the diagnosis; the most common thyroid auto-antibodies are not related between them; more than half of HT patients probably develop hypothyroidism in the early years after the diagnosis; the progressive nature of HT can be followed by TPOAb and T3; in the short term period, thyroid antibodies evolution wasn’t modified by substitutive therapy. |
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| Autores principais: | Vicente, Ana Margarida Gil Marques Borrero |
| Assunto: | Endocrinologia Doença de Hashimoto |
| Ano: | 2014 |
| País: | Portugal |
| Tipo de documento: | dissertação de mestrado |
| Tipo de acesso: | acesso restrito |
| Instituição associada: | Universidade de Lisboa |
| Idioma: | inglês |
| Origem: | Repositório da Universidade de Lisboa |
| Resumo: | Introduction: Hypothyroidism occurs in the adult population in 4 to 5 %. Hashimoto’s thyroiditis, an autoimmune disease, is the most common cause of hypothyroidism in areas of iodine sufficiency. Clinically is characterized by variable sized goiter, positive thyroid antibodies and euthyroidism or subclinical hypothyroidism. Patients and methods: The study considered all patients, followed by a single doctor at the outpatient clinic of a tertiary hospital. A specific database was defined with the Statistical Package for the Social Sciences Program (SPSS/IBM 19th version), the database included the gender and age at the first appointment; the results of each analytical evaluation and Levothyroxine prescription. Results: Were evaluated 164 patients; the majority were female 147 (90%), the meanage 48±16 years [12-80 years] and were followed since 2000 with a mean follow-up of 4±3 years [1-10 years]. All analytical parameters considered at each time – T3, T4, TSH, fT4 – presented a normal distribution, except for TPOAb and TgAb, that presented a distribution significantly different from the normal one. More than half of the patients (61%) presented at the first appointment with hypothyroidism, most were already under substitutive therapy, and the remaining presented naïve to therapy beginning therapy immediately at the first appointment. From the remaining naïve patients, 28% presented later with hypothyroidism, at an average rate of 9% per year. The thyroid antibodies variability was demonstrated to be rather elevated, regarding TPOAb values these can increase four times within the range, and at some time both anti-thyroid antibodies are negative while later either one, or both became positive. Levels of TPOAb seem to increase over time, and was demonstrated a direct and significant relation between TPOAb and TSH, showing a functional relevance of the antibody. Discussion and Conclusion: Thyroid antibodies presented a fluctuate evolution over time, and therefore a defective marker of HT, since it can exclude incorrectly the diagnosis; the most common thyroid auto-antibodies are not related between them; more than half of HT patients probably develop hypothyroidism in the early years after the diagnosis; the progressive nature of HT can be followed by TPOAb and T3; in the short term period, thyroid antibodies evolution wasn’t modified by substitutive therapy. |
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