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      Hipertiroidismo agudo: um possível caso de síndroma de Marine Lenhart Translated title: Acute hyperthyroidism: a likely marine lenhart syndrome’s case report

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          Abstract

          Resumo Introdução: O hipertiroidismo (HT) é uma patologia que ocorre devido à síntese e secreção excessiva de hormonas tiroideias pela glândula tiroideia, estimando-se que a sua prevalência a nível mundial se situa entre 1,2 e 1,6%. A principal etiologia do HT é a doença de Graves (DG), seguida do bócio multinodular (BMN) tóxico. As manifestações clínicas do HT podem variar, desde o quadro assintomático até ao quadro de tempestade tiroideia, uma situação rara de tirotoxicose aguda grave e potencialmente fatal. O síndroma de Marine Lenhart (SML) consiste num quadro de HT em contexto de coexistência de DG e BMN tóxico, sendo uma situação rara que ocorre em 0,8 a 2,7% dos pacientes com DG. Descrição do caso: Mulher de 50 anos, com antecedentes pessoais de BMN tóxico não medicado, recorre a consulta de doença aguda por quadro caracterizado por fraqueza extrema com impotência funcional para a marcha, insónia grave, labilidade emocional e irritabilidade associada a palpitações. Foi referenciada ao serviço de urgência (SU) onde foi diagnosticada com HT grave por DG, tendo ficado internada. Houve estabilização clínica e laboratorial com melhoria dos sintomas e teve alta com o provável diagnóstico de SML. Comentário: Este caso demonstra a importância da monitorização tiroideia e vigilância sintomática dos doentes com patologia tiroideia de base. O médico de família tem um papel fundamental no controlo destas situações por ter um acompanhamento longitudinal dos seus pacientes. Uma abordagem mais abrangente de cada doente e a articulação entre os cuidados de saúde primários e secundários permite a identificação de problemas clínicos específicos e tratamento precoce dos mesmos.

          Translated abstract

          Abstract Introduction: Hyperthyroidism (HT) is a pathology that occurs due to the synthesis and excessive secretion of thyroid hormones by the thyroid gland and its prevalence worldwide is between 1.2 to 1.6%. The main etiology of HT is Graves’ disease (GD), followed by toxic multinodular goiter (MNG). The clinical manifestations of HT can vary from asymptomatic to a thyroid storm, a rare situation of severe acute and potentially fatal thyrotoxicosis. Marine Lenhart syndrome (MLS) consists of an HT that coexists with a toxic MNG and GD. It is a rare situation that occurs in 0.8 to 2.7% of patients with GD. Case description: A 50-year-old woman, with a personal history of unmedicated toxic, MNG, goes to an appointment due to an extreme weakness with functional impotence for walking, severe insomnia, emotional lability, and irritability associated with palpitations. She was referred to the emergency department where she was diagnosed with severe HT due to GD, having been hospitalized. There was clinical and laboratory stabilization with an improvement of symptoms, and she was discharged from the hospital with the probable diagnosis of MLS. Comments: This case demonstrates the importance of thyroid monitoring and supervision of symptoms in patients with thyroid disease. The family doctor has a fundamental role in controlling these situations because of the longitudinal monitoring of their patients. A broader approach to each patient and the link between primary and secondary health care allow the identification of specific clinical problems and their early treatment.

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          Most cited references19

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          2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer.

          Thyroid nodules are a common clinical problem, and differentiated thyroid cancer is becoming increasingly prevalent. Since the American Thyroid Association's (ATA's) guidelines for the management of these disorders were revised in 2009, significant scientific advances have occurred in the field. The aim of these guidelines is to inform clinicians, patients, researchers, and health policy makers on published evidence relating to the diagnosis and management of thyroid nodules and differentiated thyroid cancer.
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            2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis.

            Thyrotoxicosis has multiple etiologies, manifestations, and potential therapies. Appropriate treatment requires an accurate diagnosis and is influenced by coexisting medical conditions and patient preference. This document describes evidence-based clinical guidelines for the management of thyrotoxicosis that would be useful to generalist and subspecialty physicians and others providing care for patients with this condition.
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              Global epidemiology of hyperthyroidism and hypothyroidism

              Thyroid hormones are essential for growth, neuronal development, reproduction and regulation of energy metabolism. Hypothyroidism and hyperthyroidism are common conditions with potentially devastating health consequences that affect all populations worldwide. Iodine nutrition is a key determinant of thyroid disease risk; however, other factors, such as ageing, smoking status, genetic susceptibility, ethnicity, endocrine disruptors and the advent of novel therapeutics, including immune checkpoint inhibitors, also influence thyroid disease epidemiology. In the developed world, the prevalence of undiagnosed thyroid disease is likely falling owing to widespread thyroid function testing and relatively low thresholds for treatment initiation. However, continued vigilance against iodine deficiency remains essential in developed countries, particularly in Europe. In this report, we review the global incidence and prevalence of hyperthyroidism and hypothyroidism, highlighting geographical differences and the effect of environmental factors, such as iodine supplementation, on these data. We also highlight the pressing need for detailed epidemiological surveys of thyroid dysfunction and iodine status in developing countries.
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                Author and article information

                Journal
                rpmgf
                Revista Portuguesa de Medicina Geral e Familiar
                Rev Port Med Geral Fam
                Associação Portuguesa de Medicina Geral e Familiar (Lisboa, , Portugal )
                2182-5173
                September 2021
                : 37
                : 4
                : 357-361
                Affiliations
                [2] Lisboa orgnameACeS Lisboa Ocidental e Oeiras orgdiv1USF Descobertas Portugal
                [1] Lisboa orgnameUniversidade de Lisboa orgdiv1Faculdade de Medicina Portugal
                Article
                S2182-51732021000400357 S2182-5173(21)03700400357
                10.32385/rpmgf.v37i4.13016
                0d637003-39cf-4c71-951a-cf7c24cc0937

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

                History
                : 25 May 2021
                : 28 October 2020
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 19, Pages: 5
                Product

                SciELO Portugal

                Categories
                Relatos de Casos

                Tirotoxicose,Hipertiroidismo,Graves’ disease,Thyrotoxicosis,Hyperthyroidism,Doença de Graves

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