Does a three-degree hypoechogenicity grading improve ultrasound thyroid nodule risk stratification and affect the TI-RADS 4 category? A retrospective observational study

ABSTRACT Objective: The aim of this study was to determine whether classifying hypoechogenicity in three degrees (mild, moderate, and marked) could improve the distinction between benign and malignant nodules and whether such an approach could influence Category 4 of the Thyroid Imaging Reporting and Data System (TI-RADS). Materials and methods: In total, 2,574 nodules submitted to fine needle aspiration, classified by the Bethesda System, were retrospectively assessed. Further, a subanalysis considering solid nodules without any additional suspicious findings (n = 565) was performed with the purpose of evaluating mainly TI-RADS 4 nodules. Results: Mild hypoechogenicity was significantly less related to malignancy (odds ratio [OR]: 1.409; CI: 1.086-1.829; p = 0.01), compared to moderate (OR: 4.775; CI: 3.700-6.163; p < 0.001) and marked hypoechogenicity (OR: 8.540; CI: 6.355-11.445; p < 0.001). In addition, mild hypoechogenicity (20.7%) and iso-hyperechogenicity (20.5%) presented a similar rate in the malignant sample. Regarding the subanalysis, no significant association was found between mildly hypoechoic solid nodules and cancer. Conclusion: Stratifying hypoechogenicity into three degrees influences the confidence in the assessment of the rate of malignancy, indicating that mild hypoechogenicity has a unique low-risk biological behavior that resembles iso-hyperechogenicity, but with minor malignant potential when compared to moderate and marked hypoechogenicity, with special influence on the TI-RADS 4 category

Palliative Care in Oncology: Nurses’ Experience in Caring for Children in The Final Stages of Life / Cuidados Paliativos em Oncologia: Vivência de Enfermeiros ao Cuidar de Crianças em Fase Final da Vida

Objetivo: Investigar a vivência de enfermeiros ao cuidar de crianças com câncer sob cuidados paliativos. Método: Estudo exploratório com abordagem qualitativa, realizado com doze enfermeiros através de entrevista semiestruturada e submetido à análise de conteúdo. Resultados: Emergiram três categorias temáticas: Percepção de enfermeiros acerca da assistência a crianças com câncer em Cuidados Paliativos e apoio aos familiares, destacando a assistência voltada ao bem-estar e ao conforto; práticas de cuidado utilizadas por enfermeiros à criança com câncer em Cuidados Paliativos, com abordagem voltada para o alívio da dor e de outros sintomas; comunicação de más notícias e valorização da espiritualidade na assistência à criança em Cuidados Paliativos, no contexto da terminalidade. Conclusão: Os entrevistados demonstraram vivenciar assistência voltada à qualidade de vida da criança com câncer em cuidados paliativos e de seus familiares. Sugere-se maior investimento na formação acadêmica em relação à temática.

Palliative Care in Oncology: Nurses’ Experience in Caring for Children in The Final Stages of Life / Cuidados Paliativos em Oncologia: Vivência de Enfermeiros ao Cuidar de Crianças em Fase Final da Vida

Objetivo: Investigar a vivência de enfermeiros ao cuidar de crianças com câncer sob cuidados paliativos. Método: Estudo exploratório com abordagem qualitativa, realizado com doze enfermeiros através de entrevista semiestruturada e submetido à análise de conteúdo. Resultados: Emergiram três categorias temáticas: Percepção de enfermeiros acerca da assistência a crianças com câncer em Cuidados Paliativos e apoio aos familiares, destacando a assistência voltada ao bem-estar e ao conforto; práticas de cuidado utilizadas por enfermeiros à criança com câncer em Cuidados Paliativos, com abordagem voltada para o alívio da dor e de outros sintomas; comunicação de más notícias e valorização da espiritualidade na assistência à criança em Cuidados Paliativos, no contexto da terminalidade. Conclusão: Os entrevistados demonstraram vivenciar assistência voltada à qualidade de vida da criança com câncer em cuidados paliativos e de seus familiares. Sugere-se maior investimento na formação acadêmica em relação à temática.

Skeletal Muscle Dysfunction in Patients with Subclinical Hypothyroidism

The main objective of this study is to evaluate skeletal muscle dysfunction in sHT. 31 outpatients from HUCFF-UFRJ (29 women and 2 men aging between 18 and 75 years old) with 2 elevated TSH determinations were included. All of them were classified according to Billewicz’s score modified by Zulewski. Manual muscle testing was performed for a variety of muscle groups and quadriceps isometric strength was measured by an electromechanic chair dynamometer. The inspiratory force was estimated by the maximum inspiratory pressure register in a manovacuometer. Clinical score &lt; 3 (normal) was found in 11 patients 35,52%, between 3 and 5 (subclinical dysfunction) in 14 (45,1%) and more than 5 (hypothyroidism) in 6 participants (19,4%). Fatigue was a complaint in 45% and showed positive association with score greater than 2. Shoulder abductors muscles strength was impaired in 14%. Severe reduction in inspiratory force (&lt;60%) was present in 51,6%. No more significant correlation between the variables studied was found. &nbsp;The reduction in inspiratory and peripheral muscular force in these patients may play a main role in fatigue. The lack of statistical significance found will probably be better understood with the increase in the number of patients, with the inclusion of a healthy sex-and-age matched control group and performing a prospective placebo-controlled thyroxine treatment trial.O presente trabalho objetiva verificar a presença de alterações músculo-esqueléticas em pacientes com HS.&nbsp; Avaliados 31 pacientes acompanhados no ambulatório de endocrinologia do HUCFFUFRJ (27 mulheres e 2 homens com idade entre 18 e 75 anos) com pelo menos duas dosagens elevadas de TSH. Todos receberam uma pontuação (score) baseada na escala de Billewicz modificada por Zulewski. Foram aplicados testes musculares manuais (TMM) para as cinturas escapular e pelvica; medida a força muscular de quadríceps em dinamômetro de cadeira eletromecânico; e estimada a força dos músculos inspiratórios através do registro da pressão inspiratória máxima com manovacuômetro. Score &lt; 3 (normal) foi observado em 11 pacientes (35,5%); entre 3 e 5 (disfunção subclínica) em 14 (45,1%) e superior a 5 (hipotireoidismo) em 6 (19,4%). Fadiga foi uma queixa freqüente (45%) e apresentou associação positiva com score maior que 2. O comprometimento da força muscular periférica (alteração no TMM) foi encontrado em 14% dos pacientes. Diminuição grave da força inspiratória (&lt; 60% do previsto) estava presente em 28 participantes (51,6%). Nenhuma das demais alterações encontradas mostraram associação com o escore ou níveis de TSH. A redução da força muscular inspiratória e proximal pode contribuir para a referida fadiga. A ausência de associação estatística entre essas variáveis deverá ser melhor esclarecida com o aumento da amostra e com a inclusão de um grupo controle pareado além do desenvolvimento de um estudo prospectivo com utilização de levotiroxina e placebo

Amiodarona e tireotoxicose: relatos de casos

Relata-se que a disfunção tireoidiana induzida pela amiodarona afeta de 2 a 24% dos usuários. Embora seja fácil tratar o hipotireoidismo induzido pela amiodarona, o desenvolvimento da tireotoxicose leva a uma abordagem difícil na maioria dos casos. O objetivo deste estudo é descrever três casos diferentes de pacientes com tireotoxicose induzida por amiodarona e discutir os aspectos clínicos e laboratoriais, e as diferentes abordagens para esses casos. É essencial avaliar cuidadosamente os pacientes antes e durante o tratamento com amiodarona, tendo em vista que o diagnóstico e o tratamento imediato dessa condição são cruciais em pacientes com alto risco cardiovascular

Heart rate response to graded exercise test of elderly subjects in different ranges of TSH levels

ABSTRACT Objective: Life expectancy is increasing worldwide and studies have been demonstrating that elevated serum thyroid stimulating hormone (TSH) concentration in elderly is associated with some better health outcomes. This elevation is somewhat physiological as aging. The aim of this study was to investigate the heart rate (HR) response during a graded exercise test and its recovery in healthy elderly, comparing subjects within serum TSH in the lower limit of reference range to those within the TSH in the upper limit. Subjects and methods: A cross-sectional study was conducted with 86 healthy elderly aged 71.5 ± 5.1 years, with serum TSH between 0.4 – 4.0 mUl/mL. The participants were divided into two groups according to TSH level: < 1.0 mUl/mL (n = 13) and ≥ 1.0 µUI/mL (n = 73). All participants performed an ergometric test on a treadmill. The HR was recorded and analyzed at rest, during exercise and during the three minutes immediately after exercise. Results: No differences were observed in relation to HR at peak of exercise (TSH < 1.0 µUI/mL: 133.9 ± 22.5 bpm vs. TSH ≥ 1.0 µUI/mL: 132.4 ± 21.3 bpm; p = 0.70) and during the first minute of recovery phase (TSH < 1.0 µUI/mL: 122.3 ± 23.1 bpm vs. TSH ≥ 1.0 µUI/mL: 115.7 ± 18.4 bpm p = 0.33). The groups also presented similar chronotropic index (TSH < 1.0 µUI/mL: 78.1 ± 30.6 vs. TSH ≥ 1.0 µUI/mL: 79.5 ± 26.4; p = 0.74). Conclusion: In this sample studied, there were no difference between lower and upper TSH level concerning HR response during rest, peak of exercise and exercise recovery

Serum TSH levels are associated with cardiovascular risk factors in overweight and obese adolescents

Abstract Objective: To investigate the relationship between serum thyrotropin (TSH), insulin resistance (IR), and cardiovascular risk factors (CRF) in a sample of overweight and obese Brazilian adolescents. Methods: A retrospective, longitudinal analysis of 199 overweight and obese pubescent adolescents was performed. The TSH and free T4 (fT4) levels, anthropometric measurements, and laboratory test results of these patients were analyzed. Results: 27 individuals (13.56%) presented with TSH levels above the normal level (subclinical hypothyroidism [SCH]). Their waist circumference (WC) was significantly higher than those of euthyroid individuals. Serum TSH was positively correlated with the homeostasis model assessment of insulin resistance (HOMA-IR) index, triglycerides (TG) and high-density lipoprotein cholesterol (HDL-C). Using TSH and BMI as independent variables, TSH levels were shown to be independently related to HOMA-IR (p = 0.001) and TG (p = 0.007). Among euthyroid subjects, individuals with TSH values <2.5 mIU/mL exhibited statistically significant decreases in waist-to-hip ratio, HDL-C levels, and HOMA-IR scores and a tendency toward lower WC values. Conclusion: SCH in overweight and obese adolescents appears to be associated with excess weight, especially visceral weight. In euthyroid adolescents, there appears to be a direct relationship between TSH and some CRF. In conclusion, in the present sample of overweight and obese adolescents, TSH levels appear to be associated with IR and CRF

Serum TSH levels are associated with cardiovascular risk factors in overweight and obese adolescents

Abstract Objective: To investigate the relationship between serum thyrotropin (TSH), insulin resistance (IR), and cardiovascular risk factors (CRF) in a sample of overweight and obese Brazilian adolescents. Methods: A retrospective, longitudinal analysis of 199 overweight and obese pubescent adolescents was performed. The TSH and free T4 (fT4) levels, anthropometric measurements, and laboratory test results of these patients were analyzed. Results: 27 individuals (13.56%) presented with TSH levels above the normal level (subclinical hypothyroidism [SCH]). Their waist circumference (WC) was significantly higher than those of euthyroid individuals. Serum TSH was positively correlated with the homeostasis model assessment of insulin resistance (HOMA-IR) index, triglycerides (TG) and high-density lipoprotein cholesterol (HDL-C). Using TSH and BMI as independent variables, TSH levels were shown to be independently related to HOMA-IR (p = 0.001) and TG (p = 0.007). Among euthyroid subjects, individuals with TSH values <2.5 mIU/mL exhibited statistically significant decreases in waist-to-hip ratio, HDL-C levels, and HOMA-IR scores and a tendency toward lower WC values. Conclusion: SCH in overweight and obese adolescents appears to be associated with excess weight, especially visceral weight. In euthyroid adolescents, there appears to be a direct relationship between TSH and some CRF. In conclusion, in the present sample of overweight and obese adolescents, TSH levels appear to be associated with IR and CRF

Pulmonary oxygen uptake kinetics during exercise in subclinical hypothyroidism.

Patients with subclinical hypothyroidism (SCH) have lower exercise tolerance, but the impact on oxygen uptake (VO2) kinetics is unknown. This study evaluated VO2 kinetics during and after a constant load submaximal exercise in SCH