Professional Documents
Culture Documents
Hipotireoidismo e Hipertireoidismo Uma Breve Revisão Sobre As Disfunçòes Tireoidianas - 2014
Hipotireoidismo e Hipertireoidismo Uma Breve Revisão Sobre As Disfunçòes Tireoidianas - 2014
i to
HIPOTIREOIDISMO E HIPERTIREOIDISMO – UMA BREVE REVISÃO
SOBRE AS DISFUNÇÕES TIREOIDIANAS
Ed
2/,9(,5$9DQHVVD
)DFXOGDGH0XQLFLSDO3URIHVVRU)UDQFR0RQWRUR)03)0
YDQQXWUL#KRWPDLOFRP
F
RESUMO+LSRWLUHRLGLVPRHKLSHUWLUHRLGLVPRVmRGLVIXQo}HVGDJOkQGXODWLUHRLGHTXHFDXVDPGLYHUVDV
DOWHUDo}HVQRRUJDQLVPRKXPDQR(VWHWUDEDOKRWHYHFRPRREMHWLYRUHDOL]DUXPDUHYLVmRGDOLWHUDWXUD
PD
VREUHDVSHFWRVJHUDLVGHVVDVGXDVGLVIXQo}HVWDLVFRPRWLSRVGH¿QLo}HVVLQWRPDVHIHLWRVVREUHR
RUJDQLVPR GLDJQyVWLFRV H WUDWDPHQWR )RL UHDOL]DGD XPD EXVFD GH DUWLJRV FLHQWt¿FRV HP GLIHUHQWHV
EDVHV GH GDGRV FRP WHUPRV DVVRFLDGRV D KLSRWLUHRLGLVPR H KLSHUWLUHRLGLVPR ([LVWH YDVWD OLWHUDWXUD
VREUHRDVVXQWRLQGLFDQGRTXHHVWDVGLVIXQo}HVSRGHPRFRUUHUGHGLIHUHQWHVIRUPDVFRPLPSDFWRV
QRVLVWHPDFDUGLRYDVFXODUSXOPRQDUFpUHEURHWDPEpPGXUDQWHDJHVWDomR2GLDJQyVWLFRpIHLWRDWUD
YpVGDGRVDJHPGRVKRUP{QLRV76+7H74XDQWRjTXHVWmRQXWULFLRQDOSRXFRVWUDEDOKRVIRUDP
HQFRQWUDGRVVREUHRSDSHOGDDOLPHQWDomRWDQWRQRVXUJLPHQWRFRPRQRFRQWUROHGHVWDVGLVIXQo}HV
PALAVRAS-CHAVE+LSRWHLURLGLVPRKLSHUWLUHRLGLVPRGRHQoDGH*UDYHVVLVWHPDFDUGLRYDVFXODUDWL
te r
YLGDGHItVLFD
ABSTRACT: +\SRWK\URLGLVPDQGK\SHUWK\URLGLVPDUHGLVRUGHUVRIWK\URLGJODQGZKLFKFDXVHVHYHUDO
FKDQJHVLQWKHKXPDQERG\7KLVVWXG\DLPHGWRUHYLHZWKHOLWHUDWXUHRQJHQHUDODVSHFWVRIWKHVHWZRGL-
VRUGHUVVXFKDVW\SHVGH¿QLWLRQVV\PSWRPVHIIHFWVRQWKHERG\GLDJQRVLVDQGWUHDWPHQW$VHDUFKRI
as
VFLHQWL¿FDUWLFOHVLQGLIIHUHQWGDWDEDVHVZLWKDVVRFLDWHGK\SRWK\URLGLVPDQGK\SHUWK\URLGLVPWHUPVZDV
SHUIRUPHG7KHUHLVYDVWOLWHUDWXUHRQWKHVXEMHFWLQGLFDWLQJWKDWWKHVHGLVRUGHUVFDQRFFXULQGLIIHUHQW
ZD\VZLWKLPSDFWVRQWKHFDUGLRYDVFXODUV\VWHPOXQJEUDLQDQGDOVRGXULQJSUHJQDQF\7KHGLDJQRVLV
LVPDGHE\WKHGRVDJHRIWKHKRUPRQHV76+7DQG75HJDUGLQJQXWULWLRQDOLVVXHIHZVWXGLHVZHUH
IRXQGDERXWWKHUROHRIIRRGERWKLQDSSHDUDQFHDVLQFRQWUROOLQJWKHVHGLVRUGHUV
KEYWORDS: +\SRWK\URLGLVPK\SHUWK\URLGLVP*UDYHVGLVHDVHFDUGLRYDVFXODUV\VWHPSK\VLFDODF-
nM
WLYLW\
1. INTRODUÇÃO VLDGLIXVDGDWLUHRLGHDVVRFLDGDjGRHQoDGH
*UDYHVEyFLRPXOWLQRGXODUKLSHUIXQFLRQDQ
+LSRWLUHRLGLVPR H KLSHUWLUHRLGLVPR WHHDGHQRPDKLSHUIXQFLRQDQWHGDWLUHRLGH
VmR GXDV GLVIXQo}HV GD JOkQGXOD WLUHRLGH
di
YUHV$VFDXVDVPDLVFRPXQVVmRKLSHUSOD SDUFLDORXWRWDOGDJOkQGXODWLUHRLGHGHSUR
Interciência
36 & Sociedade
,QWHUFLrQFLD 6RFLHGDGH,6619RO1
r
i to
GX]LU RV KRUP{QLRV WLUHRLGLDQRV 0h//(5 EpP VmR UHODWDGRV HP FULDQoDV TXH DSUH
HWDO1RHQWDQWRRKLSRWLUHRLGLVPR VHQWDPKLSRWLUHRLGLVPRFRQJrQLWR7UDEDOKR
SRGHVHDSUHVHQWDUGHRXWUDVPDQHLUDVWDLV UHDOL]DGR FRP FULDQoDV GH D DQRV QR
FRPR KLSRWLUHRLGLVPR FRQJrQLWR FHQWUDO H $FUHHHP5RQG{QLDDSRQWDRXSDUDDWUDVR
VXEFOtQLFR QRLQtFLRGDOLQJXDJHPRUDOWURFDVQDIDOD
Ed
2 KLSRWLUHRLGLVPR FRQJrQLWR +& IDOD LQLQWHOLJtYHO FRPSRUWDPHQWR DJLWDGR H
p D FDXVD PDLV FRPXP GH UHWDUGR PHQWDO FRPSRUWDPHQWR QHUYRVR 9HUL¿FRXVH DOWH
SDVVtYHO GH SUHYHQomR (OH UHVXOWD GD GH UDomRQDIDODHPGRJUXSRDYDOLDGRH
¿FLrQFLD GRV KRUP{QLRV WLUHRLGLDQRV IXQ DOWHUDomR DXGLWLYD HP 3DUD DTXHOHV
damentais na organogênese do sistema TXHWLYHUDPGLDJQyVWLFRHWUDWDPHQWRPDLV
QHUYRVR FHQWUDO DWp RV GRLV DQRV GH YLGD WDUGLRGRKLSRWLUHRLGLVPRRtQGLFHGHTXHL
quando estimulam o crescimento dos den [DVIRLPDLRUGRTXHSDUDDTXHOHVFRPGLDJ
F
GULWRVHD[{QLRVDOpPGHFRQWULEXtUHPSDUD QyVWLFR H WUDWDPHQWR PDLV SUHFRFH )(5
D IRUPDomR GR FyUWH[ FHUHEUDO DQWHULRU KL 5(,5$ HW DO $ LQFLGrQFLD GR +& p
SRFDPSR FyUWH[ DXGLWLYR H FHUHEHOR %( YDULiYHOVHQGRTXHQR%UDVLOHODpGHDSUR
PD
1(9,'(6HWDO [LPDGDPHQWHFDVRSDUDFDGDQDVFL
*HUDOPHQWH HVWH WLSR GH KLSHUWL GRVYLYRV'(&$59$/+2HWDO
UHRLGLVPR p GHFRUUHQWH GH GHIHLWRV QD IRU 2 KLSRWLUHRLGLVPR SULPiULR +3
mação glandular durante a embriogênese e SRGH VHU SHUPDQHQWH RX WUDQVLWyULR &HUFD
HYLGrQFLDV VXJHUHP TXH PXWDo}HV QRV ID GHGR+3SHUPDQHQWHpGHFRUUHQWHGH
WRUHVGHWUDQVFULomR77)77)H3$; defeitos na formação glandular durante a
PXLWDVYH]HVVmRRVUHVSRQViYHLVSHODGR HPEULRJrQHVH H p GHQRPLQDGR GLVJHQHVLD
HQoD$IDOWDGHHVWtPXORGR76+KRUP{QLR WLUHRLGLDQD ./(77 3RU RXWUR ODGR
te r
HVWLPXODGRUGDWLUHRLGHQDJOkQGXODWLUHRLGH GHIHLWRV JHQpWLFRV QR GHVHQYROYLPHQWR H
OHYDDRFRUUrQFLDGDGRHQoDPRWLYDGDSRU IXQomR GD KLSy¿VH SRGHP UHVXOWDU HP Yi
PiIRUPDomRRXGLVIXQomRKLSRIiVLFDRXKL ULDVIRUPDVGHGH¿FLrQFLDFDUDFWHUtVWLFDVGR
SRWDOkPLFD2FRUUHJHUDOPHQWHSRUGLVKRU KLSRWLUHRLGLVPR FHQWUDO 3(5521( HW DO
PRJrQHVHGDJOkQGXODWLUHRLGHSRUGHIHLWR 2KLSRWLUHRLGLVPRFHQWUDORFRUUHSRU
as
QR WUDQVSRUWDGRU GH LRGHWR QD PHPEUDQD GH¿FLrQFLD GH KRUP{QLRV WLUHRLGLDQRV SRU
EDVDO HRX DSLFDO GHIHLWRV QD VtQWHVH GD IDOWD GH HVWtPXOR GR76+ KLSR¿ViULR RX GR
7* RX GHIHLWRV QD RUJDQL¿FDomR GR LRGHWR 75+KRUP{QLROLEHUDGRUGDWLUHRWUR¿QDKL
3(5521(HWDO$ELRVVtQWHVHGRV SRWDOkPLFR
KRUP{QLRV GD WLUHRLGH WHP QD HQ]LPD WLUH (QTXDQWR LVVR R KLSRWLUHRLGLV
nM
RSHUR[LGDVH 732 XPD IXQomR FKDYH GH PR VXEFOtQLFR +6 RX GRHQoD WLUHRGLDQD
FDWDOLVDULPSRUWDQWHVUHDo}HV0XWDo}HVQR PtQLPD p GH¿QLGR SHOD HOHYDomR GR QtYHO
gene relacionado a esta enzima são consi VpULFRGR76+DFLPDGROLPLWHVXSHULRUGD
GHUDGRVDSULQFLSDOFDXVDGH+&SRUGLVRU QRUPDOLGDGHDVVRFLDGDDQtYHLVQRUPDLVGH
PRQRJrQHVH628=$ WLUR[LQDOLYUH7/3,0(17(/ +$16(1
'RHQoDV QHXURSVLTXLiWULFDV SR 7(,;(,5$HWDO2XWURWUDED
GHPDSUHVHQWDUP~OWLSORVHQIRTXHVGHQWUH OKR UHODWD TXH R KLSRWLUHRLGLVPR VXEFOtQLFR
HOHVUHODomRFRPRVKRUP{QLRVGDWLUHRLGH 6+7 p XPD GLVIXQomR FDUDFWHUL]DGD SRU
di
Pesquisa realizada com um menino de cin YDORU VpULFR DXPHQWDGR GR 76+ FRP FRQ
FRDQRVGHLGDGHFRPKLSRWLUHRLGLVPRFRQ FHQWUDo}HVQRUPDLVGH7H7QDDXVrQ
JrQLWRDVVRFLDGRDSUREOHPDVGRGHVHQYRO FLD GH VLQWRPDV FOtQLFRV PDQLIHVWRV (VWD
YLPHQWRGHRUGHPLQVWUXPHQWDOHHVWUXWXUDO HQWLGDGH Mi IRL GHQRPLQDGD GH KLSRWLUHRL
a te
UHODWDUHWDUGRQRGHVHQYROYLPHQWRSVLFRPR GLVPRSUpFOtQLFRGLPLQXLomRGDUHVHUYDGD
WRU SULQFLSDOPHQWH QD IDOD KLSRWRQLD PXV WLUHRLGHRXPL[HGHPDSUpFOtQLFR520$/
FXODU H KLSRDFXVLD ELODWHUDO$ HYROXomR GR ',1, 6*$5%, )$5$+ $ SUHYD
FDVRUHODWDGRDSRQWRXPHOKRUDGDVLQWRPD OrQFLDGR6+7YDULDFRPDLGDGHHRVH[R
WRORJLD DVVLP TXH VH REWHYH FRQWUROH GRV GD SRSXODomR VHOHFLRQDGD GH D
KRUP{QLRV WLUHRLGRV %UDJDWWL:LQFNOHU HTXDQGRDFRPSDQKDGRGHYDORUHVHOHYD
5RWWD GRVGHDQWLFRUSRVDQWLWLURLGHDQRVRULVFRGH
re
Interciência
37 & Sociedade
,QWHUFLrQFLD 6RFLHGDGH,6619RO1
r
i to
PHQWDHPDRDQR,QFLGHPDLVQRVH[R VD0XOKHUHVSRUWDGRUDVGH6+7QDIDL[DGH
IHPLQLQR H SULQFLSDOPHQWH HP SDFLHQWHV DDQRVFRP76+DFLPDGHP8/
FRPPDLVGHDQRVGHLGDGHSRGHQGRDO 7 OLYUH H 7 QRUPDLV IRUDP DYDOLDGDV HP
FDQoDUtQGLFHVGH WHVWH GH HVIRUoR SURJUHVVLYR FRP DQiOLVH
2 KLSRWLUHRLGLVPR VXEFOtQLFR SD GDFRQFHQWUDomRGHODFWDWRVDQJXtQHRQRV
Ed
UHFH VHU R SULPHLUR VLQDO GH GLVIXQomR GD SHUtRGRV SUp H SyVWUDWDPHQWR FRP /WLUR
WLUHRLGH H SDUHFH HVWDU UHODFLRQDGR FRP [LQDHREVHUYRXVHPHOKRUDVLJQL¿FDWLYDQD
HYHQWRVFDUGLRYDVFXODUHVPRUWDOLGDGHGLV WROHUkQFLDDRODFWDWRHFRQVHTXHQWHPHQWH
OLSHGPLDGHSUHVVmRHGp¿FLWFRJQLWLYR(V WROHUkQFLD DR HVIRUoR DSyV R WUDWDPHQWR
WXGRV UHFHQWHV VXJHUHP SRUpP TXH HVWD PRVWUDQGR R SRWHQFLDO GD /WLUR[LQD VyGLFD
VHMD XPD SRVVtYHO FRQGLomR LQHUHQWH DR SDUDDXPHQWDUDWROHUkQFLDDRHVIRUoRItVLFR
HQYHOKHFLPHQWR DWXDQGR FRPR XPD DGDS SURJUHVVLYR HP SRUWDGRUDV GH 6+7 GON
F
WDomR¿VLROyJLFDGHSURWHomRjVH[LJrQFLDV d$/9(6HWDO
GH FRQVXPR H[DJHUDGR RX FDWDEROLVPR$ Em outro trabalho foi feito um le
DYDOLDomR GRV KRUP{QLRV WLUHRLGLDQRV HP YDQWDPHQWR GH HVWXGRV SXEOLFDGRV HQWUH
PD
LGRVRV p FRPSOH[D GHYLGR j SUHVHQoD GH H QD EDVH GH GDGRV 3XE0HG
doenças concomitantes e uso frequente de FRQVLGHUDQGR DUWLJRV TXH DYDOLDUDP D IXQ
PHGLFDo}HVTXHSRGHPLQÀXHQFLDUDGRVD omRFDUGLRYDVFXODUGHKLSRWLUHRLGHRVVXEFOt
JHP GHVWHV KRUP{QLRV H D VLQWRPDWRORJLD QLFRV H FOtQLFRV H D LQÀXrQFLD GR H[HUFtFLR
WDPEpP p GLIHUHQWH FRP R DYDQoR GHVWD ItVLFR VREUH DV IXQo}HV FDUGLRYDVFXODUHV
LGDGH GH IRUPD TXH WDQWR RV QtYHLV GH UH DIHWDGDV QHVWD GRHQoD 9HUL¿FRXVH TXH D
IHUrQFLD GRV KRUP{QLRV WLUHRLGLDQRV FRPR FDSDFLGDGH DHUyELD GH KLSRWLUHRLGHRV VXE
R WUDWDPHQWR DSOLFDGR GHYHP VHU GLIHUHQ FOtQLFRV H FOtQLFRV HVWi UHGX]LGD H TXH D
te r
FLDGRV HP IDL[DV HWiULDV PDLV DYDQoDGDV IXQomR HQGRWHOLDO R HVWUHVVH R[LGDWLYR H D
5$8(1HWDO IXQomRDXWRQ{PLFDHVWmRSUHMXGLFDGRVQHV
8PGRVLPSDFWRVUHODFLRQDGRV DR WHVVXMHLWRV$SHVDUGHVHUXPDHQIHUPLGD
6+7GL]UHVSHLWRjSUHVFULomRGHH[HUFtFLRV GH WmR SUHYDOHQWH TXDQWR R GLDEHWHV QmR
ItVLFRV 2V KRUP{QLRV GD WLUHRLGH DWXDP H[LVWH XPD UHFRPHQGDomR SDUD SUHVFULomR
as
VREUH R VLVWHPD FDUGLRYDVFXODU UHJXODQGR GH DWLYLGDGH ItVLFD SDUD RV KLSRWLUHRLGHRV
D FRQWUDomR H R UHOD[DPHQWR GR P~VFXOR WDOFRPRKiSDUDREHVRVFDUGLRSDWDVHGLD
FDUGtDFRDOpPGHUHJXODURW{QXVYDVFXODU EpWLFRV628=$HWDO
1R KLSRWLUHRLGLVPR VXEFOtQLFR TXDQGR Ki 8P HVWXGR UHDOL]DGR FRP SDFLHQ
QtYHLV DOWHUDGRV GH 7 H 7 RFRUUHP GLV WHVSRUWDGRUHVGHKLSRWLUHRLGLVPRVXEFOtQLFR
nM
FXODUHV FDXVDGRV SHOR KLSRWLUHRLGLVPR p D UDomR H QtYHO GH KLGUDWDomR GRV SDFLHQWHV
UHSRVLomRKRUPRQDOFRPOHYRWLUR[LQD$LQGD ;,$1*HWDO
KiSRVVLELOLGDGHGDSUiWLFDGHH[HUFtFLRVIt 2XWUD TXHVWmR TXH WHP OHYDQWD
VLFRV SDUD DMXGDU WDQWR QD SDUWH UHVSLUDWy GR LQWHUHVVH p D VLPLODULGDGH GH VLQWRPDV
a te
Interciência
38 & Sociedade
,QWHUFLrQFLD 6RFLHGDGH,6619RO1
r
i to
FXORHVTXHOpWLFRV WDPEpP WHP VLGR UHODWD SHODV GRVDJHQV GR 76+ 2 76+ p R H[D
GRV QR KLSRWLUHRLGLVPR QD SURSRUomR HQWUH me de escolha utilizado no rastreamento
HGRVFDVRV)5(,5(HWDO SDUD GLVIXQomR WLUHRLGLDQD e SRVVtYHO GH
2XWUR HVWXGR WDPEpP DSUHVHQWD FRQFRPL WHFWDU DOWHUDo}HV PtQLPDV RX VXEFOtQLFDV
WkQFLD GH ¿EURPLDOJLD HP SDFLHQWHV SRUWD GD GH¿FLrQFLD GH KRUP{QLRV WLUHRLGLDQRV
Ed
GRUHV GH KLSRUWLUHRLGLVPR H DOWHUDo}HV WL FRP GRVDJHP VpULFD GR 76+ ([LVWHP GL
UHRLGLDQDV HP SDFLHQWHV FRP ¿EURPLDOJLD IHUHQWHV HQVDLRV SDUD GRVDJHP GH 76+
)RUDPDYDOLDGRVSDFLHQWHVVHQGRTXH com diferentes sensibilidades, no entanto,
SRVVXtDPKLSRWLUHRLGLVPR2VSDFLHQWHV QmRVHGHYHFHQWUDUHVWUDWpJLDGLDJQyVWLFD
IRUDP VXEPHWLGRV jV GRVDJHQV VpULFDV GR DSHQDVQDGRVDJHPGH76+SRUTXHQHVWH
KRUP{QLRHVWLPXODGRUGDWLUHRLGH76+WL FDVRRHL[RKLSRWiODPRKLSy¿VHWLUHRLGHWH
UR[LQD OLYUH 7 OLYUH H DQWLFRUSR DQWLWLUHR ULDTXHHVWDUVHPSUHLQWDFWR$UHODomRORJ
F
SHUR[LGDVHD732SRUPpWRGRGHTXLPLR OLQHDUHQWUH76+H7OLYUHFRPSURYDTXHR
OXPLQHVFrQFLD'HVVHJUXSRSDFLHQWHV 76+pRPHOKRUH[DPHSDUDGHWHFWDUKLSR
HUDPSRUWDGRUHVGH¿EURPLDOJLDVHQGRTXH IXQomRWLUHRLGLDQD2PpWRGRXWLOL]DGRDWX
PD
R KLSRWLUHRLGLVPR VXEFOtQLFR IRL HQFRQWUDGR DOPHQWHSDUDGRVDU76+pRLPXQRPpWULFR
HPLQGLYtGXRVVHQGRFRPKLSRWLUHRL QmRLVRWySLFR,0$HGHYHWHUVHQVLELOLGDGH
GLVPR VXEFOtQLFR FRP SURYiYHO FDXVD GH IXQFLRQDO GH SHOR PHQRV P8/ 12
WLUHRLGLWH FU{QLFD DXWRLPXQH 76+ HOHYDGR *8(,5$ HW DO 2V YDORUHV GH UHIH
7 OLYUH QRUPDO H D732 HOHYDGR FRP UrQFLDGH76+SDUDHXWLUHRLGHRVVmRD
KLSRWLUHRLGLVPR VXEFOtQLFR LGLRSiWLFR 76+ P8,/SDUDKLSRWLUHRLGLVPRP8,/
GLVFUHWDPHQWHHOHYDGR7OLYUHQRUPDOHD HSDUDKLSHUWLUHRLGLVPRGHDP8,/
732QRUPDOFRPKLSRWLUHRLGLVPRFOtQLFR 0,/+$5$16$ 62$5(6
te r
SRUWLUHRLGLWHFU{QLFDDXWRLPXQH76+HOHYD
GR7OLYUHGLPLQXtGRHD732HOHYDGRH 3. HIPERTIREOIDISMO
FRPKLSRWLUHRLGLVPRSRUFDXVDQmRGH¿QLGD
76+ HOHYDGR 7 OLYUH GLPLQXtGR H D732 2 KLSHUWLUHRLGLVPR FRQVLVWH HP
QRUPDO1RVSDFLHQWHVFRPKLSRWLUHRLGLVPR XP HVWDGR KLSHUPHWDEyOLFR FDXVDGR SHOR
as
Interciência
39 & Sociedade
,QWHUFLrQFLD 6RFLHGDGH,6619RO1
r
i to
de uma doença autoimune, caracterizada GHKRUP{QLRVGDWLUHRLGHDWUDYpVGDDGPL
SRU DQWLFRUSRV FRQWUD R UHFHSWRU GH 76+ QLVWUDomRGHWLRQDPLGDVLRGRUDGLRDWLYRRX
Os sintomas mais frequentes são ansieda FLUXUJLD1(9(6HWDO2XWURHVWXGR
GH WUHPRU IUDTXH]D SDOSLWDomR SHUGD GH DSRQWD TXH R , WHP VLGR FDGD YH] PDLV
SHVR LQWROHUkQFLD DR FDORU GHQWUH RXWUDV XWLOL]DGRFRPRSULPHLUDHVFROKDWHUDSrXWLFD
Ed
9$/(17(HWDO$VRSo}HVWHUDSrX SRUWUDWDUVHGHXPWUDWDPHQWRGH¿QLWLYRGH
WLFDVDWXDOPHQWHGLVSRQtYHLVVmRDVGURJDV IiFLO DGPLQLVWUDomR H VHJXUR $1'5$'(
DQWLWLUHRLGLDQDV '$7 D FLUXUJLD H R LRGR *5266 0$,$
UDGLRDWLYR ,, sendo que nenhuma delas $VVLPFRPRQRFDVRGRKLSRWLUHRL
p FRQVLGHUDGD LGHDO YLVWR TXH QmR DWXDP GLVPR WDPEpP Ki QR FDVR GR KLSHUWLUHRL
GLUHWDPHQWH QD SDWRJrQHVH GD GLVIXQomR GLVPR RV FDVRV FRQVLGHUDGRV VXEFOtQLFRV
02027$0,HWDO 6+7$SUHYDOrQFLDGR6+7YDULDFRPLGD
F
8PHVWXGRUHWURVSHFWLYRFRPDQi GHHVH[RGDSRSXODomRHQWUHH
OLVHGHSURQWXiULRVKRVSLWDODUHVDYDOLRX HTXDQGRDFRPSDQKDGRGHYDORUHVHOHYD
SDFLHQWHVPXOKHUHVHKRPHQVFRP GRVGHDQWLFRUSRVDQWLWLURLGHDQRVRULVFRGH
PD
PHGLDQDGHLGDGHGHDQRVFRPSDUDQGR SURJUHVVmRSDUDKLSRWLUHRLGLVPRFOtQLFRDX
JUXSRTXHUHFHEHXWUDWDPHQWRFRPLRGRUD PHQWDHPDRDQR$RFRUUrQFLDpPDLRU
GLRDWLYRSDUDGRHQoDGH*UDYHVHSDFLHQWHV QRVH[RIHPLQLQRHHPSDFLHQWHVFRPPDLV
eutireoidianos SyVWUDWDPHQWR FRP GURJDV GHDQRVSRGHQGRDWLQJLUtQGLFHVGHDWp
DQWLWLUHRLGLDQDV '$7 2EVHUYRXVH XP 6$:,1HWDO
VLJQL¿FDWLYRDXPHQWRGDKLSHUWHQVmRDUWHULDO 1D SUHVHQoD GH KLSHUWLUHRLGLVPR
H GD GLVOLSLGHPLD PDV QmR QD WD[D GH DIXQomRFDUGtDFDSRGHVHDOWHUDUSRUDomR
PRUWDOLGDGHHPSDFLHQWHVWUDWDGRVFRPLRGR GLUHWDGR7RXSRUYDULDo}HVKHPRGLQkPL
te r
UDGLRDWLYR2HVWXGRVXJHUHDQHFHVVLGDGH FDV H YDVFXODUHV 2 H[FHVVR GH KRUP{QLR
GH XP PDLRU DFRPSDQKDPHQWR GRV WLUHRLGLDQR SURYRFD GLIHUHQWHV UHVSRVWDV
SDFLHQWHVWUDWDGRVFRPLRGRUDGLRDWLYRSDUD FDUGLRYDVFXODUHVGHSHQGHQWHVGRWHPSRGH
estabelecer uma melhor correlação entre o H[SRVLomR2VKRUP{QLRVWLUHRLGLDQRVSDU
WUDWDPHQWRDVFRPRUELGDGHVREVHUYDGDVH WLFXODUPHQWHR7PRGXODPDVtQWHVHJHUDO
as
WROHUDGRSDUDSDFLHQWHVFRPUHFLGLYDDSyV (PRXWURHVWXGRWDPEpPFRPUD
remissão com tionamida ou com efeitos co WRV:LVWDUHPVLWXDomRGHKLSHUWLUHRLGLVPR
ODWHUDLVJUDYHVDHVWDGURJDHSDUDSDFLHQ FU{QLFR IRL DYDOLDGR R HIHLWR GD YLWDPLQD (
WHVFRPUHFLGLYDDSyVWUDWDPHQWRFLU~UJLFR VREUHDPRGXODomRGDUHVSRVWDKLSHUWUy¿FD
a te
EHWDEORTXHDGRUHVHQDUHGXomRGDVtQWHVH UDPKLSHUWUR¿DUHGX]LGDFRQFOXLQGRVHTXH
Interciência
40 & Sociedade
,QWHUFLrQFLD 6RFLHGDGH,6619RO1
r
i to
DYLWDPLQD(UHGX]DKLSHUWUR¿DFDUGtDFDHP DQLPDOFRPRFDUQHVOHLWHHVHXVGHULYDGRV
VLWXDomRGHKLSHUWLUHRLGLVPRFU{QLFRSRUUH (VWXGRUHDOL]DGRSURFXURXDYDOLDURHVWDGR
GXomR GR HVWUHVVH R[LGDWLYR '5(+(5 HW QXWULFLRQDOGHSDFLHQWHVFRPKLSHUWLUHRLGLV
DO PR HP UHODomR DR ]LQFR 'H SDFLHQWHV
(VWXGRH[SHULPHQWDODYDOLRXRSHU DYDOLDGRV DSUHVHQWDYDP FRQFHQWUDomR
Ed
¿O OLStGLFR HP UDWRV :LVWDU FRP KLSHUWLUHRL SODVPiWLFDGH]LQFRDEDL[RGRLGHDO(VWXGR
GLVPRLQGX]LGRHPUHSRXVRHDSyVH[HUFtFLR H[SHULPHQWDOHPDQLPDLVREVHUYRXXPDGL
ItVLFRDJXGR1RJUXSRFRPKLSHUWLUHRLGLVPR PLQXLomRVLJQL¿FDWLYDGH]LQFRQRVHULWUyFL
REVHUYRXVHPHQRUSHVRGRWHFLGRDGLSRVR WRVPDVGLPLQXLo}HVQRQtYHOSODVPiWLFRGR
QDV UHJL}HV PHVHQWpULFD UHWURSHULWRQHDO H PLQHUDOQmRKDYLDPVLGRREVHUYDGDVRTXH
VXEFXWkQHDPHQRUHVYDORUHVGHFROHVWHURO RFRUUH VRPHQWH HP FDVRV GH GH¿FLrQFLDV
WRWDO /'/ H +'/ H WDPEpP PHQRUHV FRQ PXLWRJUDYHVGH]LQFRQRRUJDQLVPR2VUH
F
FHQWUDo}HV GH OLStGHRV WRWDLV QR FRUDomR VXOWDGRVLQGLFDPpTXHSRGHVHULPSRUWDQWH
TXDQGR HVWHV HQFRQWUDYDPVH HP UHSRX fazer o monitoramente nutricional de zinco
VR HP FRPSDUDomR FRP JUXSR FRQWUROH HP SDFLHQWHV SRUWDGRUHV GH KLSHUWLUHRLGLV
PD
$SyV VHVVmR DJXGD GH H[HUFtFLRV ItVLFRV PRD¿PGHHYLWDUGH¿FLrQFLDVQHVVHJUXSR
QmR KRXYH DOWHUDomR GR SHU¿O OLStGLFR GRV %$55262HWDO
DQLPDLV FRP KLSHUWLUHRLGLVPR H[FHWR SHOR 7DPEpP VmR IUHTXHQWHV PDQLIHV
DXPHQWRGHOLStGHRVWRWDLVGRFRUDomR2V WDo}HV FRPSRUWDPHQWDLV DVVRFLDGDV DR
UHVXOWDGRVVmRXPLQGLFDWLYRGDFRUUHODomR KLSHUWLUHRLGLVPR FRPR SRU H[HPSOR KL
HQWUHKLSHUWLUHRLGLVPRHSHU¿OOLStGLFRRTXH SHUFLQHVLD QHUYRVLVPR LUULWDELOLGDGH H[FL
pLPSRUWDQWHSDUDDYDOLDUUHODomRGDGRHQoD WDELOLGDGH GL¿FXOGDGH GH DSUHQGL]DJHP H
FRPSRVVtYHLVSUREOHPDVFDUGLRYDVFXODUHV GLVW~UELRVGRVRQR8PHVWXGRGHVFULWLYRGH
te r
&$0%5, HW DO (P RXWUR HVWXGR FDVRVFRPDGROHVFHQWHVFRPKLSHUWLUHRLGLV
HPFRQGLo}HVVLPLODUHVIRUDPHQFRQWUDGDV PR IRL UHDOL]DGR FRP QRYH DGROHVFHQWHV
DOWHUDo}HVQRSHVRFRUSRUDOHHPYDULiYHLV FRP SUHGRPtQLR GR VH[R IHPLQLQR H LGDGH
SODVPiWLFDV TXDQGR FRPSDUDGRV DQLPDLV PpGLD GH DQRV 2V SULQFLSDLV VLQWRPDV
FRP KLSHUWLUHRLGLVPR VRE UHSRXVR H DSyV UHODWDGRVIRUDPSHUGDGHSHVRLQV{QLDKL
as
H[HUFtFLRDJXGRLQGLFDQGRTXHRH[HUFtFLR SHUDWLYLVPRSDOSLWDo}HVQHUYRVLVPRHWUH
ItVLFRDJXGRSRGHDOWHUDUDGLQkPLFDPHWD PRUHVFRPWHPSRGHPDQLIHVWDomRFOtQLFD
EyOLFDJOLFtGLFDHSURWpLFDSODVPiWLFDHWHFL GDGRHQoDGHDSUR[LPDGDPHQWHDQRV
GXDOHPUDWRVFRPKLSHUWLUHRLGLVPR%(&. (PRXWURHVWXGRGHVFULWLYRDGROHV
HWDO FHQWHVFRPKLSHUWLUHRLGLVPRGHLGDGHHQWUH
nM
desta associação não está estabelecido e a LQÀXrQFLD GR KLSHUWLUHRLGLVPR VREUH R GH
LQÀXrQFLD GLUHWD GRV KRUP{QLRV GD WLUHRLGH VHQYROYLPHQWR FRJQLWLYR GRV DGROHVFHQWHV
e autoimunidade são consideradas como DYDOLDGRV6e5*,2HWDO
KLSyWHVHV'HYLGRjDOWDSUHYDOrQFLDGHGR
a te
Interciência
41 & Sociedade
,QWHUFLrQFLD 6RFLHGDGH,6619RO1
r
i to
ODomR GHVWH FRP R VLVWHPD FDUGLRYDVFXODU S
FRPRXPIDWRUTXHDXPHQWDRULVFRGHDSD
%(&. :5$1'5$'( /3 &$5,7È 5$& <$
UHFLPHQWRGHGRHQoDVFDUGtDFDVHGHYHVH 0$'$$. '$/,$ 5$ /(0( -$&$ 0(//2
WHU DWHQomR DR WLSR GH H[HUFtFLR ItVLFR TXH 0$5 /8&,$12 ( ,QÀXrQFLD GR H[HUFtFLR DJXGR
GHYH VHU SUHVFULWR HP IXQomR GDV DOWHUD QR PHWDEROLVPR GH UDWRV FRP KLSHUWLUHRLGLVPR Re-
Ed
o}HV QR VLVWHPD FDUGLRYDVFXODU 1R FDVR vista Brasileira de Ciência e MovimentoYQ
GRKLSRWLUHRLGLVPRFRQJrQLWRHVWHHVWiUH
ODFLRQDGR SULQFLSDOPHQWH FRP SUREOHPDV %HQHYLGHV$0/LPD&+95RFKD&$&RUUrD
GH UHWDUGR QR GHVHQYROYLPHQWR PHQWDO H 55 (O +XVQ\$6 )HUQDQGHV&DOGDWR 0& 3HU
FRJQLWLYRGHFULDQoDVTXDQGRQmRVmRGH ¿O (SLGHPLROyJLFR GH 3RUWDGRUHV GH +LSRWLUHRLGLVPR
YLGDPHQWH GLDJQRVWLFDGDV 2 KLSRWLUHRLGLV congênito. Revista Paraense de Medicina Y
QS
PR DLQGD DSUHVHQWD XPD VHPHOKDQoD GH
F
VLQWRPDVFRPD¿EURPLDOJLDHDVDOWHUDo}HV %UDJDWWL:LQFNOHU 0, 5RWWD 17 +RUP{QLRV WLUHRL
¿VLROyJLFDVGXUDQWHDJUDYLGH]SRGHPOHYDU GHRV QD VLQWRPDWRORJLD GH GRHQoDV QHXURSVLTXLiWUL
ao surgimento dessa disfunção tireoidiana. cas. Arquivos de neuropsiquiatriaYQS
PD
(P UHODomR DR KLSHUWLUHRLGLVPR D GRHQoD
GH *UDYHV GRHQoD DXWRLPXQH p D SULQFL &$0%5, /7 9,7$/707(,;(,5$ &9/ -$0
SDO FDXVD GR VXUJLPHQWR GHVWD GLVIXQomR %$66,),/+2-&'$/,$5$/8&,$12(3HU
$VVLP FRPR QR KLSRWLUHRLGLVPR D IXQomR ¿O /LStGLFR GH 5DWRV FRP +LSHUWLUHRLGLVPR ,QGX]LGR
FDUGtDFD p DOWHUDGD HP IXQomR GDV DOWHUD (IHLWRGR([HUFtFLR)tVLFR$JXGRRevista Brasileira
de Ciência e MovimentoYQ
o}HVKRUPRQDLVGDWLUHRLGH(PUHODomRDRV
DVSHFWRVQXWULFLRQDLVGHQWUHRVDUWLJRVDYD &2(/+2():(51(&.)=0$,1(17050
OLDGRVSRXFRWHPVLGRFLWDGRVREUHRSDSHO
te r
2/,9(,5$)39$,60$10,QWROHUkQFLDDRHVIRUoR
da alimentação no surgimento e no controle QRKLSRWLUHRLGLVPRVXEFOtQLFRLPSOLFDo}HVSDUDSUHV
FULomR GH H[HUFtFLRV ItVLFRV Fiep:Bulletin On-line,
GHVWDV GLVIXQo}HV VHQGR R DVSHFWR PDLV
Y
UHOHYDQWH HQFRQWUDGR R GH TXH D YLWDPLQD
(OHYDDGLPLQXLomRGDKLSHUWUR¿DFDUGtDFD &81+$ , 6È ' %$5&(/26 $ Fibromialgia: A
HP SDFLHQWHV FRP KLSHUWLUHRLGLVPR 6HQGR outra face da dor. Acta Reumatológica Portuguesa,
as
5. REFERÊNCIAS BIBLIOGRÁFICAS
'UHKHU*-%HFNHU&8$UDXMR$6'51X
QHV & )7 5LEHLUR 0 ) 6FKHQNHO 3 & )HU
$QGUDGH9$*URVV-/0DLD$/,RGRUDGLRDWLYR
QDQGHV 7 5 * +LSHUWUR¿D &DUGtDFD ,QGX]LGD SHOR
QRPDQHMRGRKLSHUWLUHRLGLVPRGDGRHQoDGH*UDYHV
+LSHUWLUHRLGLVPR3DSHOGR'HVEDODQoR5HGR[QD0R
Arquivos Brasileiros de Endocrinologia e Metabo-
GXODomRGH9LDVGH&UHVFLPHQWRH0RUWH&HOXODU,Q
logiaYQ
6DOmRGH,QLFLDomR&LHQWt¿FD3RUWR$OHJUHLivro de
ResumosS
$=(9('2 )95 %/277$ )*6 *2,5*(77$
-012e59$,60$10$YDOLDomRGRVXUJLPHQ
di
Interciência
42 & Sociedade
,QWHUFLrQFLD 6RFLHGDGH,6619RO1
r
i to
UHV GH KLSRWLUHRLGLVPR H GH DOWHUDo}HV WLUHRLGHDQDV
HPSDFLHQWHVFRP¿EURPLDOJLDRevista Brasileira de
ReumatologiaYQS 5$8(1*:$&++2/=$*5$)+3,1720-
$ERUGDJHP GR KLSRWLUHRLGLVPR VXEFOtQLFR QR LGRVR
*RQoDOYHV $ )HUQDQGHV 0 / /DPRXQLHU 5 Revista Brasileira de Clínica Médica Y Q S
3 &RVWD $ 5HVHQWH ( (IHLWR GD /WLUR[LQD MXODJR
Ed
VyGLFD QD WROHUkQFLD DR HVIRUoR HP PXOKHUHV FRP
KLSRWLUHRLGLVPR VXEFOtQLFR Brasília médica Y 5RPDOGLQL-+6JDUEL-$)DUDK&6'LVIXQo}HV
Q 0tQLPDV GD 7LUyLGH +LSRWLURLGLVPR VXEFOtQLFR H +L
SHUWLURLGLVPR VXEFOtQLFR Arquivo Brasileiro de En-
.OHWW0(SLGHPLRORJ\RIFRQJHQLWDOK\SRWK\URLGLVP docrinologia e MetabologiaYQ
Experimental and Clinical Endocrinology Diabe-
tesYS 6DZLQ &7 &DVWHOOL :3 +HUVKPDQ -0 0F1DPDUD
3%DFKDUDFK37KHDJLQJWK\URLG7K\URLGGH¿FLHQF\
/RSHV 0+& 7HUDSLD FRP , SDUD UHVROXomR GR
F
in the Framingham Study. Archieve Internacional
KLSHUWLURLGLVPR GRHQoD GH JUDYHV VHOHomR GD GRVH Medicine, YS
Arquivos Brasileiros de Endocrinologia e Metabo-
logiaYQ 6,/9$'5*$==$1$0%-2+1$%6,48(,
PD
5$'50$,$$/6%$55(72660+LSHUWHQ
0LOKDUDQVD 3 6RDUHV 5 +RUP{QLR GH HVWLPXODomR VmR DUWHULDO SXOPRQDU H GRHQoDV GD WLUHRLGH Jour-
GDWLUHRLGH76+HFRUUHODo}HVODERUDWRULDLVRBAC, nal Brasilian of PneumologyQYS
YQS
0XOOHU$)%HUJKRXW$:LHUVLQJD:0.RR\$ 6RX]D$$'/LPD$+5'$1yEUHJD76
6PLWV-:+HUPXV$57K\URLGIXQFWLRQGLVRUGHUV '6LOYD$6,QÀXrQFLDGRH[HUFtFLRItVLFRQDVDOWH
±*XLGHOLQHVRIWKH1HWKHUODQGV$VVRFLDWLRQRI,QWHUQDO UDo}HVFDUGLRYDVFXODUHVLQGX]LGDVSHORKLSRWLUHRLGLV
Medicine. Journal MedicineYS mo. Revista Brasileira de Atividade Física & Saú-
deQYS
as
1HYHV&$OYHV0'HOJDGR-/0HGLQD-/'R
HQoDGH*UDYHVArquivos de MedicinaYQ Souza, R.da S. Prospecção de mutações éxons1,
S 2, 3, 4, 5 e 8a do gene da tireoperoxidase (TPO) em
pacientes com hipotireoidismo congênito (HC).
12*8(,5$&5.,085$(7&$59$/+2*$ I7UDEDOKRGH&RQFOXVmRGH&XUVR&LrQFLDV%LROyJL
6*$5%,-$:$5'/60$&,(//0='LDVGD FDV ± 8QLYHUVLGDGH (VWDGXDO GD 3DUDtED &DPSLQD
nM
6LOYD056WHLQ$7:DJQHU+/+HWHP/$% *UDQGH
$QGUDGD 1& +LSRWLUHRLGLVPR 'LDJQyVWLFR Socie-
dade Brasileira de Endocrinologia e Metabolismo. 7HL[HLUD 3)6 5HXWHUV 96$OPHLGD &3 )HUUHL
S UD00:DJPDQ0%5HLV)$$&RVWD$-/
9DLVPDQ0$YDOLDomR&OtQLFDHGH6LQWRPDV3VLTXL
1\V 3 &RUGUD\ -3 (WLRORJLF GLVFXVVLRQ DQG FOLQL iWULFRVQR+LSRWLUHRLGLVPRVXEFOtQLFRRevista da As-
FDOUHOHYDQFHRIWK\URLGXOWUDVVRQRJUDSK\LQVXEFOLQL sociação Médica Brasileira Y Q S
FDOK\SRWK\URLGLVP$UHWURVSHFWLYHVWXG\LQSD
tients. Ann EndocrinolYS
di
9DOHQWH20DUWLQV$09DOHQWH)$WDOODK$+L
3HU5RQH'7HL[HLUD66&ODUD6$GRV6DQWRV SHUWLUHRGLVPRRevista Brasileira de MedicinaY
'&1RJXHLUD&5$VSHFWRV*HQpWLFRVGR+LSRWLUH QS
odismo Congênito. Arquivo Brasileiro de Endocri-
nologia e MetabologiaYQS± ;LDQJ*'3X-6XQ+=KDR/<XH/+RX-
5HJXODUDHURELFH[HUFLVHWUDLQLQJLPSURYHVHQGRWKH
a te
3LPHQWHO / +DQVHQ .: 7K\URLG GLVHDVH LQ WKH OLXPGHSHQGHQW DUWHULDO GLODWLRQ LQ SDWLHQWV ZLWK VXE
HPHUJHQF\ GHSDUWPHQW D FOLQLFDO DQG ODERUDWRU\ UH FOLQLFDOK\SRWK\URLGLVPEuropean Journal Endocri-
YLHZJournal of Emergency MedicineYS nologyYQS
re
Interciência
43 & Sociedade
,QWHUFLrQFLD 6RFLHGDGH,6619RO1
r
i to
Vanessa Oliveira pJUDGXDGDHP1XWULomRSHOD)DFXOGDGH0XQLFLSDO3URIHVVRU)UDQFR0RQWRUR
Ed
Rafael Resende Maldonado p JUDGXDGR HP (QJHQKDULD GH $OLPHQWRV 81,&$03 H 4XtPLFD 81,
&$03 SRVVXL 0HVWUDGR HP (QJHQKDULD GH$OLPHQWRV 81,&$03 H GRXWRUDGR HP (QJHQKDULD GH
$OLPHQWRV81,&$03$WXDFRPRSURIHVVRUXQLYHUVLWiULRGHVGHHSURIHVVRUGHHQVLQRWpFQLFRGHVGH
$WXDOPHQWHOHFLRQDQD)DFXOGDGH0XQLFLSDO3URIHVVRU)UDQFR0RQWRUR0RJL*XDoXQRVFXUVRVGH1XWULomR
H(QJHQKDULD4XtPLFDQDV)DFXOGDGHV,QWHJUDGDV0DULD,PDFXODGD0RJL*XDoXQRFXUVRGH4XtPLFD,QGXVWULDO
QD(VFROD6XSHULRUGH$GPLQLVWUDomRH0DUNHWLQJ&DPSLQDVQRFXUVRGH(QJHQKDULD4XtPLFDHQD8QLYHUVLGDGH
(VWDGXDOGH&DPSLQDV&DPSLQDVQRFXUVRWpFQLFRGH$OLPHQWRV6HXVLQWHUHVVHVGHSHVTXLVDDEUDQJHPiUHDV
F
GH1XWULomR$OLPHQWRV4XtPLFDH(QJHQKDULD4XtPLFD(Q]LPRORJLDH%LRFRPEXVWtYHLV
PD
te r
as
nM
di
a te
re
Interciência
44 & Sociedade