O hipotireoidismo pode ser:
Hipotireoidismo Primário (HTP) (condições que interferem diretamente sobre a tireóide)
- Tireoidite de Hashimoto;
- Tratamento de hipertireoidimo (cirurgia de ressecção ou ablação com iodo radioativo)
O hipotireiodismo primário pode se apresentar com a doençaestabelecida ou hipotireoidismo subclínico
Se TSH > 10 e Anti-TPO + doença tende evoluir para HTP Franco
Central (Deficiência de TSH
(TEEM 2013) Paciente de 32 anos, gestação de 7 semanas, realizou exames de rotina e dosagem sérica de
TSH = 3,5 μU/ml (valor referência 0,4 a 4,0 μU/ml). O exame foi repetido com resultado de TSH
= 3,8 μU/ml e dosagem de anticorpo antitireoperoxidase e antitireoglobulina positivos. Assinale
a alternativa CORRETA:
a) O valor de referência do TSH na gestação deve ser o mesmo utilizado para a população não gestante.
b) O maior declínio nos níveis séricos de TSH ocorre no segundo trimestre.
c) TSH < 0,01 com valores normais de hormônios tireoidianos na gestação pode ter efeitos deletérios
no feto e esta indicado o tratamento com droga antitireoidiana.
d) O tratamento com levotiroxina esta indicado no caso desta paciente.
Alternativa D
A paciente acima citada apresenta um hipotireoidismo subclínico, com menos de 12 semanas de gestação, pois isso, segundo as novas diretrizes o recomendado é manter o TSH abaixo de 2,5 nesta paciente
A 67-year-old man comes to your office complaining of weight gain, lethargy, and cold intolerance. His blood pressure is 155/95 mm Hg. After these findings you began therapy with levothyroxine. Now, 6 months later, the patient returns for further follow-up and reports feeling much more energetic. Provided that he has responded appropriately to the medication and that his TSH normalizes, what effect would you expect to see on his blood pressure and lipid profile?
A. Decreased blood pressure, decreased LDL, and decreased triglycerides
B. Decreased blood pressure, increased LDL, and increased triglycerides
C. Increased blood pressure, decreased LDL, and decreased triglycerides
D. Increased blood pressure, increased LDL, and increased triglycerides
E. No change in blood pressure or lipid profile
The correct answer is A. Hypothyroidism has important effects on the cardiovascular system. Both blood pressure and lipid profile are adversely affected. Paradoxically, low levels of circulating thyroxine will actually elevate blood pressure. The process is mediated through an increase in peripheral vascular resistance. The effect is most pronounced in those with established hypertension. Hypothyroidism also decreases heart rate and myocardial contractility, lowering overall cardiac output. However, the increase in peripheral vascular resistance is more prominent, resulting in an overall increase in mean arterial pressure. A screening TSH to rule out hypothyroidism is a routine part of the workup for secondary causes of hypertension. Hypothyroidism also decreases lipid clearance from the blood by the liver, resulting in elevated serum total, LDL, and triglyceride fractions. In a prospective study, 4.2% of those with hyperlipidemia were found to have hypothyroidism. Only those patients with a serum TSH concentration above 10 mU/L had a significant reduction in the serum cholesterol concentration during thyroid hormone replacement. The effect of thyroid hormone replacement in the setting of subclinical hypothyroidism is usually small and varies considerably. Because of these two effects, both blood pressure and lipid profiles should improve during thyroid hormone replacement. Choices B, C, D, and E all describe cardiovascular changes that would be unexpected.
Hipotireoidismo Primário (HTP) (condições que interferem diretamente sobre a tireóide)
- Tireoidite de Hashimoto;
- Tratamento de hipertireoidimo (cirurgia de ressecção ou ablação com iodo radioativo)
O hipotireiodismo primário pode se apresentar com a doençaestabelecida ou hipotireoidismo subclínico
Se TSH > 10 e Anti-TPO + doença tende evoluir para HTP Franco
Central (Deficiência de TSH
(TEEM 2013) Paciente de 32 anos, gestação de 7 semanas, realizou exames de rotina e dosagem sérica de
TSH = 3,5 μU/ml (valor referência 0,4 a 4,0 μU/ml). O exame foi repetido com resultado de TSH
= 3,8 μU/ml e dosagem de anticorpo antitireoperoxidase e antitireoglobulina positivos. Assinale
a alternativa CORRETA:
a) O valor de referência do TSH na gestação deve ser o mesmo utilizado para a população não gestante.
b) O maior declínio nos níveis séricos de TSH ocorre no segundo trimestre.
c) TSH < 0,01 com valores normais de hormônios tireoidianos na gestação pode ter efeitos deletérios
no feto e esta indicado o tratamento com droga antitireoidiana.
d) O tratamento com levotiroxina esta indicado no caso desta paciente.
Alternativa D
A paciente acima citada apresenta um hipotireoidismo subclínico, com menos de 12 semanas de gestação, pois isso, segundo as novas diretrizes o recomendado é manter o TSH abaixo de 2,5 nesta paciente
A 67-year-old man comes to your office complaining of weight gain, lethargy, and cold intolerance. His blood pressure is 155/95 mm Hg. After these findings you began therapy with levothyroxine. Now, 6 months later, the patient returns for further follow-up and reports feeling much more energetic. Provided that he has responded appropriately to the medication and that his TSH normalizes, what effect would you expect to see on his blood pressure and lipid profile?
A. Decreased blood pressure, decreased LDL, and decreased triglycerides
B. Decreased blood pressure, increased LDL, and increased triglycerides
C. Increased blood pressure, decreased LDL, and decreased triglycerides
D. Increased blood pressure, increased LDL, and increased triglycerides
E. No change in blood pressure or lipid profile
The correct answer is A. Hypothyroidism has important effects on the cardiovascular system. Both blood pressure and lipid profile are adversely affected. Paradoxically, low levels of circulating thyroxine will actually elevate blood pressure. The process is mediated through an increase in peripheral vascular resistance. The effect is most pronounced in those with established hypertension. Hypothyroidism also decreases heart rate and myocardial contractility, lowering overall cardiac output. However, the increase in peripheral vascular resistance is more prominent, resulting in an overall increase in mean arterial pressure. A screening TSH to rule out hypothyroidism is a routine part of the workup for secondary causes of hypertension. Hypothyroidism also decreases lipid clearance from the blood by the liver, resulting in elevated serum total, LDL, and triglyceride fractions. In a prospective study, 4.2% of those with hyperlipidemia were found to have hypothyroidism. Only those patients with a serum TSH concentration above 10 mU/L had a significant reduction in the serum cholesterol concentration during thyroid hormone replacement. The effect of thyroid hormone replacement in the setting of subclinical hypothyroidism is usually small and varies considerably. Because of these two effects, both blood pressure and lipid profiles should improve during thyroid hormone replacement. Choices B, C, D, and E all describe cardiovascular changes that would be unexpected.
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