Is it necessary to increase the dose of levothyroxine in patients with hypothyroidism who use omeprazole? É necessário aumentar a dose de levotiroxina em pacientes com hipotireoidismo que usam omeprazol?

ABSTRACT Objective: It is believed that gastric pH interferes in levothyroxine absorption. Omeprazole, which acts by blocking the secretion of gastric acid, might interfere in hypothyroidism control in patients using levothyroxine and this effect could be dose dependent. The present study aimed to investigate this possibility. Subjects and methods: Twenty-one patients with primary hypothyroidism who had been using a stabilized levothyroxine dosage for at least one year were selected and randomly assigned to take omeprazole at the dosage of 40 mg or 20 mg per day. The mean levels of thyroid-stimulating hormone (TSH) before and 3 months after omeprazole usage were compared in the entire sample and in each group. Results: Ten patients concluded the entire treatment protocol in the 20 mg group and nine patients in the 40 mg group. There was no significant difference in TSH levels before and 3 months after omeprazole treatment in the entire patient sample (median levels: 2.28 vs. 2.30 mU/L, respectively: p = 0.56). Analysis of each subgroup (20 and 40 mg) showed no significant variation in TSH levels before and 3 months after omeprazole treatment (median levels: 2.24 vs. 2.42 mU/L, p = 0.62, and 2.28 vs. 2.30 mU/L, p = 0.82, respectively). No significant difference in the absolute (p = 0.93) or relative (p = 0.87) delta were observed between the two subgroups. Conclusion: Omeprazole in the dosage of 20 or 40 mg/day does not interfere in a clinically relevant manner in the treatment of patients with hypothyroidism that was previously under control. Arq Bras Endocrinol Metab. 2014;58(7):731-6 Keywords Hypothyroidism; thyroxine; absorption; omeprazole; proton pump inhibitors RESUMO Objetivo: Acredita-se que o pH gástrico possa interferir na absorção de levotiroxina. O omeprazol, ao inibir a secreção de ácido gástrico, poderia interferir no controle do hipotireoidismo em pacientes em uso de levotiroxina de forma dose-dependente. O presente estudo tem como objetivo investigar essa hipótese. Sujeitos e métodos: Vinte e um pacientes em uso de dose estável de levotiroxina por no mínimo um ano foram incluídos e aleatoriamente selecionados para iniciar o uso de omeprazol na dose de 40 mg ou 20 mg por dia. Foram comparados os níveis médios de hormônio tireoestimulante (TSH) antes e 3 meses após o uso de omeprazol, na amostra total e em cada grupo. Resultados: Dez pacientes concluíram o protocolo de tratamento no grupo de 20 mg e nove, no grupo de 40 mg. Não houve diferença significativa nos níveis de TSH antes e 3 meses após terapia com omeprazol na amostra total de pacientes (média: 2,28 vs. 2,30 mU/L, respectivamente: p = 0,56). A análise de cada subgrupo (20 e 40 mg) não demonstrou variação significativa nos níveis de TSH antes e 3 meses após terapia com omeprazol (média: 2,24 vs. 2,42 mU/L, p = 0,62 e 2,28 vs. 2,30 um/L, p = 0,82, respectivamente). Não houve diferença significativa no delta absoluto (p = 0,93) ou relativo (p = 0,87) entre os dois subgrupos. Conclusão: Omeprazol na dose de 20 ou 40 mg/dia não interfere de forma clinicamente relevante no tratamento de pacientes com hipotireoidismo previamente bem controlados. Arq Bras Endocrinol Metab. 2014;58(7):731-6 Descritore

Set-Out

ABSTRACT Purpose: to estimate the prevalence of oral communication, memory, reading and writing, voice and oral motor skills problems in elderly people. Methods: cross-sectional study with 75 older people registered in a Family Clinic of Rio de Janeiro. It was estimated the prevalence, in all cases and by sex. The presence of differences between the sexes was verified by statistical tests t and chi-square. Results: the problems most frequently related to oral communication and memory were the avoidance to communicate (20.5%), difficulty in remembering recent and past events (34.7% and 26.4% respectively). There was a high prevalence of difficulty in reading and writing. According to hearing, 43.10% reported "watching television and listening to radio too loud." Related to voice perception, 71.2% referred "speak loudly or shouting" and 23.6% to "get hoarse frequently." As far as Myofunctional oral motor skill, 24.7% had "difficulties in chewing in general" and 54.8% "snoring while sleeping." Conclusion: in this study, there was a large proportion of elderly people who referred difficulties related to language, hearing, speech and chewing skills, which are functions related to socialization, welfare and maintenance of functional autonomy and can directly interfere with their quality of life and health. Keywords: Speech and Language Pathology; Health of Elderly; Prevalence RESUMO Objetivo: estimar a prevalência de problemas da comunicação oral, memória, leitura, escrita, voz, audição e motricidade orofacial em idosos. Métodos: estudo transversal, com 75 idosos cadastrados em uma Clínica da Família carioca. Foram estimadas as prevalências por sexos e conjuntamente. Verificou-se a presença de diferenças entre os sexos por meio dos testes t e qui-quadrado. Resultados: os principais problemas de comunicação oral e memória foram "evita se comunicar" (20,5%) e "dificuldades em lembrar fatos recentes e passados" (34,7% e 26,4%, respectivamente). Observou-se elevada prevalência de dificuldade na leitura e escrita. Em relação à audição, 43,1% relataram "ver televisão e ouvir rádio muito alto". Quanto à voz, 71,2% referiam "falar alto ou gritando" e 23,6% "ficar roucos com frequência". Na motricidade orofacial, 24,7% apresentavam "dificuldades na mastigação em geral" e 54,8% "roncavam ao dormir". Conclusão: neste estudo, observou-se uma grande parcela de idosos que referia dificuldades relacionadas às habilidades de linguagem, audição, fonação e mastigação, que são funções relacionadas à socialização, bem-estar e manutenção da autonomia funcional, podendo interferir diretamente na sua qualidade de vida e saúde

Is radioactive iodine- 131 treatment related to the occurrence of non-synchronous second primary malignancy in patients with differentiated thyroid cancer?

ABSTRACT Objective: Much controversy relates to the risk of non-synchronous second primary malignancies (NSSPM) after radioactive iodine treatment (RAI-131) in differentiated thyroid cancer (DTC) patients. This study evaluated the relationship between RAI-131 and NSSPM in DTC survivors with long-term follow-up. Materials and methods: Retrospective analysis of 413 DTC cases was performed; 252 received RAI-131 and 161 were treated with thyroidectomy alone. Exclusion criteria were: prior or synchronous non-thyroidal malignancies (within the first year), familial syndromes associated to multiple neoplasms, ionizing radiation exposure or second tumors with unknown histopathology. Results: During a mean follow-up of 11.0 ± 7.5 years, 17 (4.1%) patients developed solid NSSPM. Patients with NSSPM were older than those without (p = 0.02). RAI-131 and I-131 cumulative activity were similar in patients with and without NSSPM (p = 0.18 and p = 0.78, respectively). Incidence of NSSPM was 5.2% in patients with RAI-131 treatment and 2.5% in those without RAI-131 (p = 0.18). Using multivariate analysis, RAI-131 was not significantly associated with NSSPM occurrence (p = 0.35); age was the only independent predictor (p = 0.04). Under log rank statistical analysis, after 10 years of follow-up, it was observed a tendency of lower NSSPM-free survival among patients that received RAI-131 treatment (0.96 vs. 0.87; p = 0.06), what was not affected by age at DTC diagnosis. Conclusion: In our cohort of DTC survivors, with a long-term follow-up period, RAI-131 treatment and I-131 cumulative dose were not significantly associated with NSSPM occurrence. A tendency of premature NSSPM occurrence among patients treated with RAI-131 was observed, suggesting an anticipating oncogenic effect by interaction with other risk factors. Arch Endocrinol Metab. 2016;60(1):9-1

Is radioactive iodine- 131 treatment related to the occurrence of non-synchronous second primary malignancy in patients with differentiated thyroid cancer?

ABSTRACT Objective: Much controversy relates to the risk of non-synchronous second primary malignancies (NSSPM) after radioactive iodine treatment (RAI-131) in differentiated thyroid cancer (DTC) patients. This study evaluated the relationship between RAI-131 and NSSPM in DTC survivors with long-term follow-up. Materials and methods: Retrospective analysis of 413 DTC cases was performed; 252 received RAI-131 and 161 were treated with thyroidectomy alone. Exclusion criteria were: prior or synchronous non-thyroidal malignancies (within the first year), familial syndromes associated to multiple neoplasms, ionizing radiation exposure or second tumors with unknown histopathology. Results: During a mean follow-up of 11.0 ± 7.5 years, 17 (4.1%) patients developed solid NSSPM. Patients with NSSPM were older than those without (p = 0.02). RAI-131 and I-131 cumulative activity were similar in patients with and without NSSPM (p = 0.18 and p = 0.78, respectively). Incidence of NSSPM was 5.2% in patients with RAI-131 treatment and 2.5% in those without RAI-131 (p = 0.18). Using multivariate analysis, RAI-131 was not significantly associated with NSSPM occurrence (p = 0.35); age was the only independent predictor (p = 0.04). Under log rank statistical analysis, after 10 years of follow-up, it was observed a tendency of lower NSSPM-free survival among patients that received p = 0.06), what was not affected by age at DTC diagnosis. Conclusion: In our cohort of DTC survivors, with a long-term follow-up period, RAI-131 treatment and I-131 cumulative dose were not significantly associated with NSSPM occurrence. A tendency of premature NSSPM occurrence among patients treated with RAI-131 was observed, suggesting an anticipating oncogenic effect by interaction with other risk factors

Redalyc.Rubiaceae in Brazilian Atlantic Forest remnants: floristic similarity and implications for conservation

Abstract: Brazil holds most of the Atlantic Forest Domain and is also one of the Rubiacea