Resumo em Inglês:

ABSTRACT Thyroidectomyis the most frequent endocrine surgical treatment for problems such as goiter, thyroid cancer, and Graves’ disease. The global incidence of goiter ranges from 5%-20%, with a notably high frequency in less wealthy countries, and the incidence of thyroid cancer is on the rise due to the greater use of diagnostic imaging. Despite medical options, surgery remains essential. Surgical advancements such as blood vessel sealing technology, intraoperative laryngeal nerve neuromonitoring (IONM), remote access surgery, and parathyroid fluorescence have transformed thyroid surgery. Vessel sealing technologies reduce operative time and blood loss, whereas IONM preserves the laryngeal nerves. Remote access surgery, which includes a variety of techniques, produces results similar to those of open thyroidectomy with a longer operative time. Fluorescence enhances parathyroid detection and lowers the risk of temporary hypoparathyroidism. Economic studies reveal cost discrepancies, with advantages particularly visible in health care systems that depend on surgical time. While these advancements promise better patient outcomes, their accessibility and cost-effectiveness remain issues, particularly in Latin America. Recognizing these concerns, the Latin American Thyroid Society’s Surgical Affairs Committee conducted an extensive review of emerging thyroid surgery technologies to guarantee their proper use in the area.

Resumo em Inglês:

Abstract Doubleor multiple adenomas are rare, and synchronous secretory pituitary adenomas are rarer still. We report a case of a 30-year-old woman with a 6-year history of amenorrhea and occasional galactorrhoea. She presented with headaches, weight gain, subtle acromegalic features, new-onset hypertension and diabetes. Workup confirmed acromegaly and hyperprolactinemia. Preoperative magnetic resonance imaging of the pituitary demonstrated two noncontiguous microadenomas. Two distinct tumors were resected through a transsphenoidal approach. Immunohistochemical analysis of each separated adenoma confirmed the diagnosis of acromegaly and prolactinoma. Postoperatively, she was cured of acromegaly, and her amenorrhea/galactorrhea syndrome resolved. Her growth hormone and insulin-like growth factor-I levels normalized, whereas her prolactin level remained slightly above normal. Therefore, it is critical to consider double or multiple adenomas preoperatively through careful endocrine assessment and review of magnetic resonance imaging. As shown in our case, careful evaluation led to a better surgical outcome.

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Abstract Imatinibis a commonly used antiproliferative agent for treating chronic myelogenous leukemia and gastrointestinal stromal tumors, and it is also thought to be effective in other areas, such as rheumatologic diseases. It has been shown to improve glucose control in diabetic patients by lowering blood sugar, reducing HbA1c levels, and decreasing the need for diabetes medications. However, we present a rare occurrence of severe hyperglycemia and newly elevated HbA1c in a patient on imatinib with no prior history of diabetes. It underscores the need for further research to assess the safety and impact of imatinib on glucose metabolism.

Resumo em Inglês:

Abstract Objective: To explore the association between diabetes and stress-induced hyperglycemia with skeletal muscle expression of key genes related to glucose transport. Methods: This is a cross-sectional study. Skeletal muscle biopsies were taken from the left vastus muscle of critically ill adult patients within 24 hours of intensive care unit admission, and the expression of the genes of interest, namely insulin receptor substrate 1 (IRS1), insulin receptor substrate 2 (IRS2), solute carrier family 2 member 1 (SLC2A1), and solute carrier family 2 member 4 (SLC2A4), was analyzed using quantitative polymerase chain reaction. The primary analysis was planned to compare the gene expression pattern between patients with and without diabetes mellitus. The secondary analyses compared the gene expression in subgroups of patients with different levels of glycemia, glycemic variability, and glycemic gap. Results: A total of 50 consecutive patients (15 with diabetes mellitus and 35 without diabetes mellitus) were included from April 2018 to September 2018. No differences in gene expression were found between patients with or without diabetes mellitus. Individuals with hyperglycemia > 200 mg/dL at intensive care unit admission exhibited a downregulation of IRS1 compared to those without (0.4 [0.1-0.8] versus 1.1 [0.3-2.2], p = 0.04). Similarly, patients with a glycemic gap ≥ 80 mg/dL exhibited a downregulation of IRS1 compared to those with a glycemic gap < 80 mg/dL (0.3 [0.1-0.7] versus 1 [0.4-2] p=0.04). There was no difference in gene expression between patients with glycemic variability higher or lower than 40 mg/dL. Conclusion: No significant changes were found in skeletal muscle expression of IRS1, IRS2, SLC2A1, and SLC2A4 in critically ill patients with or without diabetes mellitus. However, IRS1 was downregulated in patients with stress-induced hyperglycemia.

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Abstract Objective: To investigate the clinical characteristics of patients with gestational transient thyrotoxicosis and its possible impacts on pregnancy. Methods: This retrospective study included pregnant women with gestational transient thyrotoxicosis who were admitted to our endocrinology outpatient clinic from June 2020 to March 2023. Patients with other causes of thyrotoxicosis, such as Graves’ disease, toxic nodular goiter, and subacute thyroiditis, were excluded. Results: The study included 50 pregnant women who met the inclusion criteria and whose data could be accessed. Two pregnant women were diagnosed with gestational diabetes, and two pregnancies resulted in abortion. We observed that thyroid-stimulating hormone levels normalized to euthyroid values at a mean gestational age of 18.3 ± 3.7 weeks. The mean gestational age at birth was 38 ± 1.8 weeks. The frequency of preterm labor, defined as delivery before 37 weeks, was 10% (n = 5). Sinus rhythm was observed in 87% of the electrocardiograms obtained during thyrotoxicosis, while sinus tachycardia was detected in four and sinus arrhythmia in two cases. Thyroid nodules were observed in 23 (47.9%) of 48 cases in which ultrasonography was performed during thyrotoxicosis. Discussion: This retrospective study, including 50 pregnant women with gestational transient thyrotoxicosis, found no increase in the rate of serious obstetric complications such as eclampsia/preeclampsia, gestational diabetes, preterm labor, or abortion. Notably, in a detailed examination of electrocardiograms, which has not been done in previous studies, we did not detect any serious, life-threatening arrhythmias, although tachycardia was observed.

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Abstract Objective: To characterize a cohort of pediatric thyroid cancer patients, focusing on clinical features and outcomes stratified by age. Subjects and methods: This retrospective analysis included 63 pediatric differentiated thyroid cancer patients treated at a Portuguese pediatric reference hospital over a period of 20 years. Data extracted from clinical records covered demographics, clinical presentation, family history, tumor characteristics, treatment modalities, complications, disease status, and survival outcomes. Patients younger than 12 years were compared to those aged 12 and older. Results: The mean age at diagnosis of the sample was 14.5 years, with a preponderance of female patients. Clinical presentation varied significantly between age groups; younger patients were more likely to present palpable cervical lymph nodes, while older patients frequently had solitary thyroid nodules. Family history and identifiable risk factors were similar across groups. However, older patients had higher rates of prior neoplasia and radiation exposure. Age also influenced surgical treatment and outcomes, including complications and recurrence rates. Conclusion: Our findings corroborate previous evidence on the predominance of papillary carcinoma and the association between radiation exposure and thyroid cancer. Younger patients demonstrated more aggressive tumor characteristics and higher recurrence rates, underscoring the need for age-specific management strategies. Early detection, comprehensive surgical intervention, and multidisciplinary follow-up are essential for achieving optimal outcomes.

Resumo em Inglês:

ABSTRACT Objective: To assess the efficacy of the triglyceride-glucose (TyG) index in predicting type 2 diabetes mellitus (T2DM) in the general population. Subjects and methods: Baseline data were collected from a community population that underwent physical examination between 2015 and 2020. The TyG index was calculated via the following formula: TyG = Ln [fasting triglyceride (mg/dL) × fasting blood glucose (mg/dL)/2]. Cox regression and stratified analyses were performed to evaluate the ability of the TyG score to predict the occurrence of diabetes. Results: In total, 8 576 subjects were ultimately included and divided into a T2DM group (n = 882) and a non-T2DM group (n = 7,694) according to the results of the 5-year follow-up. Adjustment for all covariates revealed that every 1-unit increase in the TyG index multiplied the risk of T2DM in all the participants (HR: 3.348; 95% CI: 3.004-3.731; P < 0.001). When TyG was divided into three quantiles, the risk of T2DM in the highest quantile was 6.412 times greater than that in the lowest quantile. Subgroup analysis revealed that the correlation was more pronounced in middle-aged and young adults, females, and eutrophic individuals (interaction P value < 0.001). Conclusion: The TyG index can be a strong predictor of T2DM and is more useful for estimating the risk of T2DM in young and middle-aged adults, females, and eutrophic people.

Resumo em Inglês:

ABSTRACT Objective: To characterize, via a predictive model using real-world data, patients with diabetes with a heightened probability of hospitalization. Methods: At the Endocrinology Unit of a tertiary public hospital in Rio Grande do Sul, Brazil, a retrospective cohort study analyzed initial consultations from January 1, 2015, to December 31, 2017, focusing on 617 patients with diabetes. Within this group, 82.98% (512 patients) did not require hospitalization, while 17.02% (105 patients) were hospitalized at least once. Multiple machine learning algorithms were tested, and the combination of XGBoost and Instance Hardness Threshold models displayed the best predictive performance. The SHapley Additive exPlanations method was used for result interpretation. Results: The most optimal performance was observed by combining the XGBoost and Instance Hardness Threshold models, resulting in the highest sensitivity (0.93) in accurately classifying hospitalization events, with an acceptable area under the curve of 0.72. Key predictive features included the number of outpatient visits, amplitude of estimated glomerular filtration rate, and age (individuals below 24 years old and between 65 to 70 years old had higher hospitalization likelihood). Conclusion: The proposed model demonstrated high predictive capability and may help to identify patients with diabetes who should be more closely monitored to reduce their risk of hospitalization.

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ABSTRACT Objective: To investigate the association between the rs3844492/ARHGAP22 and rs741301/ELMO1 polymorphisms and diabetic kidney disease in patients with type 2 diabetes mellitus. Methods: The sample consisted of 740 patients with type 2 diabetes mellitus and diabetic kidney disease (cases) and 303 patients with type 2 diabetes mellitus, but no diabetic kidney disease (controls). The genotyping of the polymorphisms was conducted using real-time polymerase chain reaction with Taqman probes. Results: The frequency of the rs3844492/ARHGAP22 G/G genotype was 16.8% in the control group and 15.7% in cases (p = 0.069). After adjusting for covariables, the presence of the G allele was associated with risk for diabetic kidney disease (OR = 1.435, 95% CI 1.023 – 2.011; p = 0.036), as well as with a decreased estimated glomerular filtration rate (p = 0.012) and elevated creatinine levels (p = 0.009). No difference was observed in the rs741301/ELMO1 genotype frequencies between groups (p = 0.800). However, the presence of the C allele appears to be associated with higher creatinine levels in patients with type 2 diabetes mellitus (p = 0.064). Conclusion: The rs3844492/ARHGAP22 and rs741301/ELMO1 polymorphisms are associated with alterations in renal function markers among patients with type 2 diabetes mellitus.

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ABSTRACT Objective: This study investigated the effects of selenium, which is known for its antioxidant and immune-supporting properties, on serum levels of thyroid function markers, selenoproteins, and proinflammatory cytokines in a model of hyperthyroidism. Materials and methods: A total of 48 Wistar albino rats were distributed into 6 groups: a control group; a hyperthyroid group (HT group); a group fed 0.5 mg/kg sodium selenite (Se 1 group); a group fed 1 mg/kg sodium selenite (Se 2 group); a hyperthyroid group fed 0.5 mg/kg sodium selenite (HT + Se 1 group); and a hyperthyroid group fed 1 mg/kg sodium selenite (HT + Se 2 group) added to standard fodder. Serum levels of interleukin (IL)-1β, IL-6, IL-18, tumour necrosis factor alpha (TNF-α), selenoprotein P (SelP), and glutathione peroxidase 1 (GPx1) were measured using ELISAs. Results: IL-Iβ, IL-6, IL-18, and TNF-α levels were increased, but selenium, GPx1, and SelP levels were decreased in the hyperthyroid group compared with those in the control group. Selenium and GPx1 levels were increased, but TNF-α levels were decreased in the HT + Se 1 group compared with those in the HT group. Selenium, SelP, and GPx1 levels were increased, but TNF-α, IL-6, and IL-18 levels were decreased in the HT + Se 2 group compared with those in the HT group. Conclusion: Our results suggest that appropriate doses of selenium may be effective at preventing inflammation and providing protection against oxidative stress in hyperthyroid rats.

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Abstract Objective: To investigate the association between weekend catch-up sleep (WCS) and the risk of diabetic kidney disease (DKD). Subjects and methods: Data from 1,621 adults aged 18 years or older from the National Health and Nutrition Examination Survey 2017-2020 were obtained for this cross-sectional study. WCS was calculated as the mean weekend sleep duration minus the mean weekday sleep duration. The outcomes were DKD, a reduced estimated glomerular filtration rate (eGFR), and proteinuria. The associations between WCS and DKD, the reduced eGFR or proteinuria were evaluated via a weighted multivariate logistic regression model. Subgroup analyses were performed for different sexes and participants with or without hypertension. Results: A total of 583 diabetic patients had DKD, of whom 198 patients displayed reduced eGFRs and 499 patients had proteinuria. After adjusting for all confounding factors, Group 4 (weekend CUS ≥ 2 and < 3 hours) still had lower odds of DKD [odds ratio (OR) = 0.51, 95% confidence interval (CI): 0.28-0.93] and proteinuria (OR = 0.51, 95% CI: 0.27-0.96). Additionally, subgroup analyses stratified by sex and hypertension consistently revealed connections in female diabetic patients (OR = 0.40, 95% CI: 0.20-0.78 for DKD; OR = 0.47, 95% CI: 0.22-0.97 for proteinuria) and in diabetic patients with hypertension (OR = 0.39, 95% CI: 0.18-0.81 for DKD; OR = 0.38, 95% CI: 0.19-0.77 for proteinuria). However, the fully adjusted model revealed no such association between WCS and a reduced eGFR. Conclusion: WCS was found to decrease the likelihood of developing DKD and proteinuria among American adult patients diagnosed with diabetes, particularly among female patients or those with hypertension.

Resumo em Inglês:

Abstract Objective: To evaluate the association between diabetic retinopathy, diabetic kidney disease, and the 10-year risk of atherosclerotic cardiovascular disease in patients with diabetes. Subjects and methods: A cross-sectional study was performed involving patients diagnosed with either type 1 or type 2 diabetes mellitus. Participants were classified into four groups: DM (patients without diabetes-related complications), DR (patients with diabetic retinopathy only), DKD (patients with diabetic kidney disease only), and DR + DKD (patients with both diabetic retinopathy and diabetic kidney disease). The primary outcome was the 10-year risk assessment for cardiovascular events, calculated using the American Heart Association’s atherosclerotic cardiovascular disease score. Results: A total of 571 patients were selected including 128 with type 1 diabetes (average age of 39.4 ± 15.1 years; 48.4% female) and 443 with type 2 diabetes (average age of 59.5 ± 11.9 years; 66.4% female). Among the participants with type 2 diabetes, the cardiovascular risk was 15.2 ± 14.6% for the DM group, 15.7 ± 10.7% for the DR group, 22.5 ± 16.7% for the DKD group, and 21.5 ± 15.1% for the DR + DKD group, reflecting a significantly higher cardiovascular risk in the groups with renal involvement (P <0.001). For those with type 1 diabetes, the DM group had a risk of 6.1 ± 8.9%, the DR group 8.9 ±11.8%, the DKD group 5.4 ± 8.8%, and the DR + DKD group 6.1 ± 9.5%. The mean difference in risk between the groups was not statistically significant. Conclusion: In patients with type 2 diabetes, those with diabetic kidney disease appeared to have a higher theoretical risk of cardiovascular disease compared to those with only diabetic retinopathy.

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ABSTRACT Objective: To describe the follow-up of girls with peripheral precocious puberty (PPP) due to McCune-Albright syndrome (MAS). Subjects and methods: Data from 18 females, including anthropometric and reproductive outcomes, were evaluated. Genetic analysis was performed on DNA from peripheral leukocytes via digital PCR. Results: Clinical manifestations of PPP were isolated thelarche, thelarche plus vaginal bleeding, or isolated vaginal bleeding in 44.5%, 33.3%, and 22.2%, respectively, at an early age (3.3 ± 1.6 years). At diagnosis, basal LH and FSH levels were suppressed in 100% and 72.2% of cases, respectively, and estradiol ranged from prepubertal to high levels. The mean bone age advancement was 2.3 ± 1.9 years. Treatment included medroxyprogesterone acetate, tamoxifen, aromatase inhibitors, and ketoconazole, individually or in combination for 5 ± 2.14 years, with partial or complete control of puberty. Secondary central precocious puberty was diagnosed in 57.1% (8/14) of the patients. Fibrous dysplasia was diagnosed in 11 patients and managed with bisphosphonates for those with bone pain. The mean adult height was 155.1 ± 8.7 cm (-1.17 SDS) in 10 patients. Menarche occurred at a mean age of 12.2 ± 1.04 years, 70% reported regular menstrual cycles and only one female desired pregnancy. Genetic diagnosis was established in 52.9% (9/17) of the patients. Conclusion: Medical treatment of PPP was effective in girls with MAS and led to preservation of adult height potential, and reproductive function was normal when patients reached adulthood

Resumo em Inglês:

ABSTRACT Puberty is a biological maturation process that involves genetic, nutritional, environmental, ethnic, and lifestyle factors. During the coronavirus 2019 (COVID-19) pandemic, an increase in referrals for central precocious puberty (CPP) assessment was observed in clinical practice. The aim of this review was to evaluate the incidence of CPP in different countries before and during the COVID-19 pandemic. A PRISMA-ScR-compliant scoping review was performed in the MEDLINE and Embase databases using “puberty” and “COVID-19” as search terms. Exclusion criteria were an identifiable organic cause of CPP, genetic disorders or peripheral precocious puberty. The study was registered in OSF. A total of 26 studies with participants from 11 countries were included. Twenty-five studies found a 1.3- to 5-fold increase in the incidence of CPP in girls. In boys, 4 studies found no significant difference in the number of cases, 3 studies found a 2.8- to 3.4-fold increase, and 1 study detected a 75% decrease. Twelve studies reported an increase in the use of electronic devices, sedentary lifestyles, higher Z-scores for weight and body mass index, increased sleep disturbances, and a lower age at the onset of puberty. Seven studies found no significant differences in clinical and laboratory parameters between the pandemic and pre-pandemic periods. There was an increase in the incidence of precocious puberty among girls during the COVID-19 pandemic. This finding was not consistently observed in boys. Increased screen time, reduced physical activity, psychological stress, changes in diet and sleep habits, and the direct effects of SARS-CoV-2 may have caused these results.

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ABSTRACT Theaim of this review is to determine the proportion of awareness, treatment, and control of diabetes in the South American region. A comprehensive search was conducted using PubMed, EMBASE, SCOPUS, and LILACS databases from January 1, 2014, to March 23, 2024. We included observational, population-based studies that assessed the rates of awareness, treatment, and control of diabetes. The risk of bias was evaluated as proposed by Hoy and cols. A meta-analysis was performed using the random effects model, and heterogeneity was assessed using the I2 statistic. Additionally, a metaregression analysis was conducted to further explore heterogeneity. Fourteen studies met our eligibility criteria. The disease awareness meta-analysis, which included six studies, revealed that 71.7% (95% CI: 65.2%-77.8%, I2: 94.2%) of participants had a previous diagnosis of diabetes. The disease treatment meta-analysis, which included five studies, indicated that 64.6% (95% CI: 52.9%-75.3%, I2: 98.7%) of participants were receiving some form of treatment for diabetes, and 42.4% (95% CI: 36.0%-49.1%, I2: 96.3%) had their glycemic values within target ranges. All included studies were assessed to have a low risk of bias. In South America, the limited available evidence suggests a significant portion of individuals with diabetes remain untreated and uncontrolled. Numerous countries lack critical information on the diabetes care cascade necessary to inform health policies.