Role of Estrogen in Thyroid Function and Growth Regulation

Thyroid diseases are more prevalent in women, particularly between puberty and menopause. It is wellknown that estrogen (E) has indirect effects on the thyroid economy. Direct effects of this steroid hormone on thyroid cells have been described more recently; so, the aim of the present paper was to review the evidences of these effects on thyroid function and growth regulation, and its mechanisms. The expression and ratios of the two E receptors, α and β, that mediate the genomic effects of E on normal and abnormal thyroid tissue were also reviewed, as well as nongenomic, distinct molecular pathways. Several evidences support the hypothesis that E has a direct role in thyroid follicular cells; understanding its influence on the growth and function of the thyroid in normal and abnormal conditions can potentially provide new targets for the treatment of thyroid diseases

An unexpected cause of severe and refractory PTH-independent hypercalcemia : case report and literature review

Hypercalcemia is a common condition in the internal medicine practice. Sometimes its cause is not readily apparent, so extensive investigation is appropriate. Here we report an unexpected cause for hypercalcemia in an elderly woman. The case of an 82-years old woman with PTH-independent hypercalcemia, lymphocytosis, normal serum 1,25 (OH)vitamin D levels, and low serum PTHrp levels, is described. Medical history and complementary investigation were unremarkable, except for increased metabolic activity in the glutei regions, as measured by whole body 18F-FDG PET-CT. Reviewing her medical history, her sister recalled that she had been submitted to intramuscular methylmethacrylate injections, for cosmetic purposes, five years before presentation, which was confirmed by muscle biopsy. Low calcium intake, parenteral bisphosphonates, calcitonin, and glucocorticoids were used to control serum calcium levels. Methylmethacrylate injections, used cosmetically, are a new cause for hypercalcemia, even after many years. Hypercalcemia was probably due to calcitriol overproduction in foreign body granulomas. Persistent reactive lymphocytosis could be a clue for this inflammatory cause of hypercalcemia

Prognosis of Thyroid Cancer Related to Pregnancy: A Systematic Review

Differentiated thyroid cancer (DTC) is the second most common cancer in pregnancy. Its management is a challenge for both doctors and patients, and the best timing for surgery is unclear. A systematic review evaluating the prognosis of DTC in pregnant patients was conducted. After reviewing 401 unique citations and 54 full texts, 4 studies that compared the prognosis of patients with DTC related to pregnancy (DTC diagnosed during pregnancy or within 12 months after childbirth) or not were included. In two studies the primary outcome was overall survival, in one study the primary outcomes were recurrent disease and death related to thyroid cancer, and in one study the primary outcome was recurrent or persistent disease. In the first two studies, there was no difference in overall survival in patients with pregnancy-related DTC, when compared with matched controls; in one study, there was no difference in death caused by DTC nor recurrence in DTC related to pregnancy. Nevertheless, in a recent retrospective study, a higher rate of recurrent or persistent DTC was observed in patients with DTC related to pregnancy. There are not many studies on which to base treatment decisions in pregnant patients with DTC

POEMS syndrome manifested as systemic capillary leak syndrome a case report

The authors report a case of an old woman who presented with a history of repetitive dyspnea and inferior limbs edema episodes, up to the point she showed extreme anasarca, hypotension, hypoalbuminemia, hemoconcentration and cachexia, developing unexplained respiratory insufficiency until death, in spite of all interventions. A diagnosis was obtained by autopsia: multicentric Castleman’s disease manifested as capillary leak syndrome and possible POEMS syndrome (polyneuropathy, organomegaly, endocrinopathy, M protein and skin changes), all conditions of rare incidence and of an intriguing association

A short stay unit decreased mean length of stay in a hospital in south Brazil

Introduction Public health services in Brazil are periodically overcrowded. Since reducing the length of stay (LOS) could increase the availability of hospital beds, this study evaluated the impact of a short stay unit (SSU) on LOS, early readmission rates, and intra-hospital mortality rates. Methods Data were evaluated retrospectively in the 12 months before and after the establishment of a multidisciplinary SSU in a tertiary care hospital in south Brazil. All admissions of adult patients through the Emergency Department for causes in nine groups of the World Health Organization International Code of Diseases-10 were included. Results Mean LOS decreased 1.42 days in the first year after the implementation of a SSU with no change in 7-day readmission rates or intra-hospital mortality rates. This decrease may be partially explained by the decrease in the mean LOS in other areas of the hospital, although the amount of hospital-bed days saved in the second year was 5,668 days in the Internal Medicine Division and 1,595 days in all other clinical or surgical areas. Mortality rates after discharge were not evaluated. Conclusions A SSU decreased mean LOS of selected patients admitted through the Emergency Department without increasing 7-day readmission rates or intra-hospital mortality

Hypertension, hyperthermia, productive cough

Resumo não disponíve

Effect of High- versus Low-Fat Meal on Serum 25-Hydroxyvitamin D Levels after a Single Oral Dose of Vitamin D: A Single-Blind, Parallel, Randomized Trial

Background/Aims. Vitamin D3 is liposoluble, so dietary fat could increase its oral absorption. Our aim was to compare serum 25-hydroxyvitamin D [25(OH)D] after the oral intake of cholecalciferol with a high- or low-fat meal. Methods. In a single-blind, parallel clinical trial, 32 healthy physicians were divided into two groups. In the same day, they ingested 50,000 IU (1.25 mg) of vitamin D3 with food: group 1 (G1): lipids: 25.6 g and group 2 (G2) lipids: 1.7 g. Serum 25(OH)D (0, 7, and 14 days), and parathyroid hormone (PTH), and calcium (0 and 14 days) were measured. Results. Baseline mean serum 25(OH)D levels were 42.7 ± 19.0 nmol/L in G1 and 36.4 ± 19.0 nmol/L in G2 (P = 0.38). After cholecalciferol, mean serum 25(OH)D was higher in G1 (P < 0.001): 7 days: G1 = 46.2 (38.4–53.9) nmol/L and G2 = 33.7 (25.4–40.1) nmol/L; 14 days: G1 = 53.7 (45.2–62.1) nmol/L and G2 = 33.7 (25.2–42.2) nmol/L. Serum PTH and 25(OH)D were negatively correlated before and after the intake of vitamin D3, respectively, r = −0.42 (P = 0.02) and r = −0.52 (P = 0.003). Conclusions. A high-fat meal increased the absorption of vitamin D3, as measured by serum 25(OH)D