High Prevalence of Infertility among Women with Graves’ Disease and Hashimoto’s Thyroiditis

Objectives. To evaluate the prevalence of infertility in women with Graves’ disease (GD) or Hashimoto’s thyroiditis (HT) and associated factors. Material and Methods. This cross-sectional study was conducted at the Endocrinology Clinic for Thyroid Autoimmune Diseases, with 193 women aged 18–50 years with GD and 66 women aged 18–60 years with HT. The women were interviewed to obtain data on their gynecological and obstetric history and family history of autoimmune diseases. Their medical records were reviewed to determine the characteristics of the disease and to confirm association with other autoimmune diseases. Infertility was defined as 12 months of unprotected sexual intercourse without conception. Results. The prevalence of infertility was 52.3% in GD and 47.0% in HT. Mean age at diagnosis was 36.5 years and 39.2 years, in GD and HT, respectively. The mean number of pregnancies was lower in women who were 35 years old or younger at diagnosis and was always lower following diagnosis of the disease, irrespective of age. The only variable associated with infertility was a shorter time of the disease in HT. Conclusions. The prevalence of infertility was high in women with GD and HT and affected the number of pregnancies in young women

Severe Rhabdomyolysis Due To Adipsic Hypernatremia After Craniopharyngioma Surgery.

The association of diabetes insipidus and adipsia after craniopharyngioma surgery has high morbidity. Hypernatremia can be caused by adipsia and be aggravated by diabetes insipidus. Rhabdomyolysis rarely occurs. This is the first report of a diabetic patient with craniopharyngioma who developed diabetes insipidus and adipsia after surgery, evolving with severe hypernatremia that caused considerable rhabdomyolysis. The importance of the evaluation of muscle integrity when under hypernatremic states is pointed out. Although adipsia may have a simple solution through volunteer water ingestion, serious consequences such as repeated severe hypernatremia episodes and intense rhabdomyolysis with high morbidity could occur, if adipsia is not diagnosed.511175-

A logística na cadeia de frio em Portugal: transporte de produtos perecíveis congelados

Trabalho Final de Mestrado para obtenção do grau de Mestre em Engenharia MecânicaEste trabalho é o resultado de uma dissertação de mestrado no âmbito do 2º ano de Mestrado em Energia, Refrigeração e Climatização do Instituto Superior de Engenharia de Lisboa, e vai desenvolver- se numa empresa que comercializa e distribui uma vasta gama de produtos originários do mar, com maior incidência no peixe congelado e marisco. No contexto atual da sociedade e face às exigências do mercado e dos Clientes, o transporte do produto congelado é um tema da atualidade e que reveste de importância crucial, uma vez que deve ser garantido que o produto perecível foi transportado dentro dos padrões legais de conservação e transporte e sem interrupção na cadeia logística. O principal objetivo do projeto foi identificar qual o método mais adequado de transporte rodoviário de produtos perecíveis congelados (peixe), e analisar a importância da minimização da variação da temperatura na gestão do transporte de produtos perecíveis (TPP), integrada na Supply Chain Management (SCM). Apurar quais as causas e as consequências das variações de temperatura e as medidas a implementar para minimizar o seu impacto, numa perspetiva logística. As medições das variações térmicas foram realizadas no interior da caixa isotérmica com o recurso a equipamentos de medição de temperatura, “Data Logger” e o “Termopar”, tendo sido coletados os dados que após análise foram produzidas as respetivas conclusões. De modo a avaliar esta temática foi elaborada uma revisão de literatura qualificada, base da em artigos científicos, livros da especialidade, teses e dissertações. O estudo foi realizado numa Empresa de dimensão média, localizada nos arredores de Lisboa, que realiza o transporte de peixe congelado e marisco. O referido estudo permitiu concluir que existem variações térmicas à medida que se aproxima do ponto de distribuição final e apresentadas soluções para a minimização deste problema.Abstract: This work aims is the resu lt of a master's thesis under the 2nd year of Master in Energy, Refrigeration and Air Conditioning of the Instituto Superior de Engenharia de Lisboa, and will develop a company that markets and distributes a wide range of products originating Sea, focusing on the frozen fish and seafood. In the current context of society and meet the demands of the market and customers, the transport of frozen product is a topical issue and of crucial importance, since it must be ensured that the perishable product has been transported within the legal conservation standards and transportation and rolling in the logistics chain. The main objective of the project was to identify the most appropriate method of road transport frozen perishable products (fish), and analyse the i mportance of minimizing the variation of temperature in the transport of perishables management (TPP), part of the Supply Chain Management (SCM). Which determine the causes and consequences of temperature changes and the measures to be implemented to minimize its impact on a logistics perspective. Measurements were made of the thermal variations within the isothermal box with the use of temperature measuring devices, " Data Logger" and "Thermocouple", the data having been collected which after analysis the respective conclusions were produced. In order to assess this issue was elaborated a qualified literature review based on scientific papers, specialty books, theses and dissertations. The study was performed in a medium- sized company located in the outskirt s of Lisbon, which transports frozen fish and seafood. The study concluded that there are temperature changes as it approaches the final distribution point and presented solutions to minimize this problem

Role of ultrasound, clinical and scintigraphyc parameters to predict malignancy in thyroid nodule

Background: This study aimed to evaluate clinical, laboratory, ultrasound (US) and scintigraphyc parameters in thyroid nodule and to develop an auxiliary model for clinical application in the diagnosis of malignancy. Methods: We assessed 143 patients who were surgically treated at a single center, 65% (93) benign vs. 35% (50) malignant lesions at final histology (1998-2008). The clinical, laboratory, scintigraphyc and US features were compared and a prediction model was designed after the multivariate analysis. Results: There were no differences in gender, serum TSH and FT4 levels, thyroid auto-antibodies (TAb), thyroid dysfunction and scintigraphyc results (P = 0.33) between benign and malignant nodule groups. The sonographic study showed differences when the presence of suspected characteristics was found in the nodules of the malignant lesions group, such as: microcalcifications, central flow, border irregularity and hypoechogenicity. After the multivariate analysis the model obtained showed age (>39 years), border irregularity, microcalcifications and nodule size over 2 cm as predictive factors of malignancy, featuring 81.7% of accuracy. Conclusions: This study confirmed a significant increase of risk for malignancy in patients of over 39 years and with suspicious features at US

Thyroid imaging reporting and data system score combined with bethesda system for malignancy risk stratification in thyroid nodules with indeterminate results on cytology

The thyroid imaging reporting and data system (TI-RADS) was designed to better select patients who had undergone fine-needle aspiration biopsies (FNABs) with high sensitivity and accuracy. However, the combination of TI-RADS scores and Bethesda system categories in indeterminate thyroid nodules has not been examined extensively. This study aimed to stratify indeterminate thyroid nodules (Bethesda categories III, IV and V) according to risk of malignancy as determined by combining TI-RADS score with Bethesda system classification. Retrospective study. Histopathological, cytological and ultrasound (US) data were available for 242 cases after surgery, including 136 indeterminate nodules. All thyroid cytopathological slides and US reports were reviewed and classified according to Bethesda system and TI-RADS categories. The malignancy rate was determined for each Bethesda category, TI-RADS score and both methods combined of indeterminate nodules. The malignancy rates were 87%, 513% and 675% for Bethesda categories III, IV and V, respectively. Based on histopathological comparison, the accuracy was 667% for TI-RADS greyscale. TI-RADS 3 and 4A scores were observed in 80% of Bethesda III cases, which led to 80% sensitivity and 90% of negative predictive value (NPV). In contrast, for nodules scored as TI-RADS 4B and 5, the combined cytological results of Bethesda IV and V resulted in a higher risk of malignancy (75% and 769%, respectively, P<0001). In view of the high NPV of TI-RADS 3/4A only in Bethesda III category, a surgical approach could be considered for lesions defined as Bethesda III, IV and V when TI-RADS 4B and 5 were concomitant823439444COORDENAÇÃO DE APERFEIÇOAMENTO DE PESSOAL DE NÍVEL SUPERIOR - CAPESFUNDAÇÃO DE AMPARO À PESQUISA DO ESTADO DE SÃO PAULO - FAPESP330030170652008/10183-

High Pre-therapy [99mtc]pertechnetate Thyroid Uptake, Thyroid Size And Thyrostatic Drugs: Predictive Factors Of Failure In [131i]iodide Therapy In Graves' Disease.

Several factors may interfere with the success rate of radioiodine therapy (RIT) in Graves' disease. Our aim was to evaluate, retrospectively, some of these factors in the outcome of RIT. Patient gender, age at diagnosis, ophthalmopathy, disease duration, thyroid size, drug used as clinical treatment, thionamide withdrawal period during RIT preparation, FT4, TSH and [99mTc]pertechnetate thyroid uptake prior to RIT were studied as potential interference factors for RIT success. Eighty-two Graves' disease patients were submitted to RIT after thionamide treatment failure. Prior to RIT, 67 patients were receiving methimazole and 15 propylthiouracil. Thirty-three patients received thionamides during RIT; in 49 patients the medication was withdrawn for 2-30 days. [99mTc]pertechnetate thyroid uptake was determined before RIT. Fixed doses of 370 MBq of [131I]iodide were administered to all patients. Eleven patients became euthyroid; 40 became hypothyroid and 31 remained hyperthyroid. There was no association between outcome and age at diagnosis, gender, ophthalmopathy, pre-RIT FT4, TSH, antithyroid antibodies or thyrostatic drug. Multiple logistic regression showed higher probability of treatment success in patients with thyroid mass <53 g (odds ratio (OR)=8.9), with pre-RIT thyroid uptake <12.5% (OR=4.1) and in patients who withdrew thionamide before RIT (OR=4.9). Fixed doses of 370 MBq of radioiodine seem to be practical and effective for treating Graves' disease patients with [99mTc]pertechnetate uptake <12.5% and thyroid mass <53 g. This treatment is clearly not recommended for patients with large goitre. In contrast to what could be expected, patients with a high pre-RIT thyroid uptake presented a higher rate of RIT failure.26957-6