RESUMO
PURPOSE: To evaluate liver function improvement and volume gain after percutaneous recanalization of chronic portal vein thrombosis (PVT) in non-cirrhotic patients. MATERIALS AND METHODS: In this retrospective study, five non-cirrhotic participants between 21 and 67 years old with secondary chronic PVT (4-21 years from diagnose) were submitted to percutaneous portal vein recanalization, followed by varices and shunts embolization. RESULTS: After a mean of 12.6 months, all portal veins remained patent and there was complete resolution of portal hypertension (PH) symptoms in all participants. There was a significant increase in liver volume of 39.8 ± 19.0% (p = 0.042), platelets count of 53120 ± 20188/µl (p = 0.042), and a significant decrease in total bilirubin levels from 1.04 ± 0.23 mg/dL to 0.51 ± 0.09 mg/dL (p = 0.043). We also found a non-significant increase in albumin levels from 3.88 ± 0.39 g/dL to 4.38 ± 0.27 g/dL (p = 0.078) and decrease in spleen diameter from 16.88 ± 4.03 cm to 14.15 ± 2.72 cm (p = 0.068). DISCUSSION: In this retrospective study, even with a small number of participants, we were capable of showing a median of 39.8% increase in liver volume, laboratorial liver function improvement, platelets count and resolution of PH symptoms, including gastroesophageal varices disappearance after portal vein recanalization followed by shunt embolization. CONCLUSION: In this small series of cases, recanalization of chronic PVT in non-cirrhotic participants was feasible, successful and safe despite the prolonged time of occlusion. This is a new and promising approaching to an old and still challenging disease.
Assuntos
Aterectomia/métodos , Hipertensão Portal , Fígado/fisiologia , Veia Porta/fisiologia , Derivação Portossistêmica Transjugular Intra-Hepática , Trombose Venosa/terapia , Adulto , Idoso , Humanos , Hipertensão Portal/complicações , Hipertensão Portal/patologia , Fígado/crescimento & desenvolvimento , Pessoa de Meia-Idade , Veia Porta/patologia , Estudos Retrospectivos , Resultado do Tratamento , Trombose Venosa/complicações , Trombose Venosa/diagnóstico por imagem , Adulto JovemRESUMO
BACKGROUND: Endothelial dysfunction may be involved in the pathophysiology of cardiac abnormalities in patients with diabetes mellitus (DM). A correlation between endothelial dysfunction and diastolic dysfunction in patients with type 1 DM has been demonstrated, but this relationship has not been well investigated in type 2 DM. OBJECTIVE: Compare groups of patients with type 2 DM and hypertension with and without diastolic dysfunction using endothelial function indexes, and to assess whether correlations exist between the diastolic function and the endothelial function indexes. METHOD: This was a cross-sectional study of 34 men and women with type 2 DM and hypertension who were aged between 40 and 70 years and were categorized based on assessments of their Doppler echocardiographic parameters as having normal (14 patients) and abnormal (20 patients) diastolic function. Flow-mediated dilatation (FMD) assessments of the brachial artery evaluated the patients' endothelial function. RESULTS: The mean maximum FMD was 7.15 ± 2.80% for the patients with diastolic dysfunction and it was 11.85 ± 4.77% for the patients with normal diastolic function (p = 0.004). Correlations existed between the maximum FMD and the E/e' ratio (p = 0.040, r = -0.354) and the early wave velocity (e') at the lateral mitral annulus (p = 0.002, r = 0.509). CONCLUSION: The endothelial function assessed by FMD was worse in hypertensive diabetic patients with diastolic dysfunction. There were correlations between the diastolic function indexes and the endothelial function indexes in our sample.
RESUMO
Fundamentos: Diabéticos hipertensos apresentam maior probabilidade de desenvolverem hipertrofia ventricular esquerda e fibrilação atrial. Evidências sugerem que bloqueadores do sistema renina-angiotensina-aldosterona devem ser usado neste grupo de pacientes. Objetivo: Avaliar se há diferença entre os efeitos do inibidor da enzima conversora de angiotensina benazepril e do bloqueador de receptor de angiotensina losartana sobre o tamanho atrial esquerdo, a massa ventricular, quando associados ao tratamento de pacientes hipertensos diabéticos em uso de anlodipino. Métodos: Foram randomizados em dois grupos para associação de losartana ou benazepril 34 pacientes hipertensos e diabéticos tipo 2 do serviço de clínica médica da Universidade do Estado do Rio de Janeiro, após período de 6 semanas apenas com anlodipino. Ao início e ao término do tratamento combinado, os pacientes foram submetidos a ecocardiograma para medidas de cavidades, espessuras parietais e fluxos. Resultados: Houve redução da massa ventricular esquerda indexada no grupo losartana de 81,1 ± 23,5 para 76,9 ± 23,8 g/m² (p = 0,044), sem diferença no grupo benazepril (de 81,8 ± 10,8 para 79,7 ± 12,1; p = 0,520). O diâmetro atrial esquerdo foi menor ao final de 12 semanas (p = 0,034) no grupo losartana, no qual variou de 2,12 ± 0,23 para 2,03 ± 0,22 cm/m² (p = 0,103), quando comparado ao grupo benazepril, no qual variou de 2,12 ± 0,30 para 2,23 ± 0,29 cm/m² (p = 0,064). Conclusão: A combinação losartana e anlodipino foi melhor que a combinação benazepril e anlodipino para redução de massa ventricular esquerda e tamanho do átrio esquerdo nesta amostra de hipertensos diabéticos tipo 2
Background: Hypertensive diabetic patients are more likely to develop left ventricular hypertrophy and atrial fibrillation. Evidence suggests that renin-angiotensin-aldosterone system blockers should be used in this group of patients. Objective: To evaluate if there are differences between the effects of angiotensin-converting enzyme benazepril and the angiotensin-receptor blocker losartan on left atrial size and ventricular mass when associated to the treatment of diabetic hypertensive patients using amlodipine. Methods: 34 hypertensive type-2 diabetic outpatients from the Internal Medicine service of Universidade do Estado do Rio de Janeiro were randomized into two groups, after a period of 6 weeks receiving only amlodipine, to receive losartan or benazepril. At the beginning and end of the combined treatment, patients were submitted to echocardiography for cavity assessment, wall thickness and flow measurements. Results: There was reduction in left ventricular mass index in the losartan group (from 81.1 ± 23.5 to 76.9 ± 23.8 g/m²; p = 0.044), with no difference in the benazepril group (from 81.8 ± 10.8 to 79.7 ± 12.1 g/m²; p = 0.520). The left atrial diameter index was lower at 12 weeks (p=0.034) in the losartan group, which ranged from 2.12 ± 0.23 to 2.03 ± 0.22 cm/m² (p = 0.103) when compared to the benazepril group, which ranged from 2.12 ± 0.30 to 2.23 ± 0.29 cm/m² (p = 0.064). Conclusion: The losartan and amlodipine combination was better than the benazepril and amlodipine combination for left ventricular mass and left atrial size reduction in this sample of type 2 diabetic hypertensive patients
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Fibrilação Atrial/fisiopatologia , Diabetes Mellitus/terapia , Hipertensão/complicações , Hipertensão/terapia , Hipertrofia Ventricular Esquerda , Adesão à Medicação , Anlodipino/administração & dosagem , Anti-Hipertensivos/administração & dosagem , Doenças Cardiovasculares/fisiopatologia , Ecocardiografia/métodos , Ventrículos do Coração , Ensaio Clínico Controlado Aleatório , Sistema Renina-Angiotensina , Interpretação Estatística de Dados , Resultado do TratamentoRESUMO
Abstract Background: Studies suggest that statins have pleiotropic effects, such as reduction in blood pressure, and improvement in endothelial function and vascular stiffness. Objective: To analyze if prior statin use influences the effect of renin-angiotensin-aldosterone system inhibitors on blood pressure, endothelial function, and vascular stiffness. Methods: Patients with diabetes and hypertension with office systolic blood pressure ≥ 130 mmHg and/or diastolic blood pressure ≥ 80 mmHg had their antihypertensive medications replaced by amlodipine during 6 weeks. They were then randomized to either benazepril or losartan for 12 additional weeks while continuing on amlodipine. Blood pressure (assessed with ambulatory blood pressure monitoring), endothelial function (brachial artery flow-mediated dilation), and vascular stiffness (pulse wave velocity) were evaluated before and after the combined treatment. In this study, a post hoc analysis was performed to compare patients who were or were not on statins (SU and NSU groups, respectively). Results: The SU group presented a greater reduction in the 24-hour systolic blood pressure (from 134 to 122 mmHg, p = 0.007), and in the brachial artery flow-mediated dilation (from 6.5 to 10.9%, p = 0.003) when compared with the NSU group (from 137 to 128 mmHg, p = 0.362, and from 7.5 to 8.3%, p = 0.820). There was no statistically significant difference in pulse wave velocity (SU group: from 9.95 to 9.90 m/s, p = 0.650; NSU group: from 10.65 to 11.05 m/s, p = 0.586). Conclusion: Combined use of statins, amlodipine, and renin-angiotensin-aldosterone system inhibitors improves the antihypertensive response and endothelial function in patients with hypertension and diabetes.
Resumo Fundamentos: Estudos sugerem que as estatinas possuem efeitos pleotrópicos, como melhora da função endotelial, da rigidez vascular e redução da pressão arterial. Objetivo: Analisar se o uso prévio de estatina influenciou o efeito sobre a pressão arterial, a função endotelial e a rigidez vascular de drogas inibidoras do sistema renina-angiotensina-aldosterona. Métodos: Pacientes hipertensos e diabéticos com pressão arterial de consultório sistólica ≥ 130 mmHg e/ou diastólica ≥ 80 mmHg tiveram suas medicações anti-hipertensivas substituídas por anlodipino durante 6 semanas. Em seguida, foram randomizados para associação de benazepril ou losartana por mais 12 semanas. Pressão arterial (através da monitorização ambulatorial da pressão arterial), função endotelial (dilatação mediada por fluxo da artéria braquial) e rigidez vascular (velocidade da onda de pulso) foram avaliados antes e após o tratamento combinado. Neste trabalho, uma análise post-hoc foi realizada para comparar pacientes que vinham (grupo CE) ou não (grupo SE) em uso de estatina. Resultados: O grupo CE apresentou maior redução na pressão arterial sistólica nas 24 horas (134 para 122 mmHg, p = 0,007) e na dilatação mediada por fluxo da artéria braquial (6,5 para 10,9%, p = 0,003) quando comparado com o grupo SE (137 para 128 mmHg, p = 0,362, e 7,5 para 8,3%, p = 0,820). Não houve diferença estatisticamente significante na velocidade de onda de pulso (grupo CE 9,95 para 9,90 m/s, p = 0,650 e grupo SE 10,65 para 11,05 m/s, p = 0,586). Conclusão: O uso combinado de estatinas, anlodipino e inibidores do sistema renina-angiotensina-aldosterona melhora a resposta anti-hipertensiva e a função endotelial em pacientes hipertensos e diabéticos.
Assuntos
Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Aminoácidos/farmacologia , Inibidores da Enzima Conversora de Angiotensina/farmacologia , Anti-Hipertensivos/farmacologia , /tratamento farmacológico , Endotélio Vascular/efeitos dos fármacos , Hipertensão/tratamento farmacológico , Sistema Renina-Angiotensina/efeitos dos fármacos , Aminoácidos/uso terapêutico , Anlodipino/farmacologia , Anlodipino/uso terapêutico , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Anti-Hipertensivos/uso terapêutico , Monitorização Ambulatorial da Pressão Arterial , Benzazepinas/farmacologia , Benzazepinas/uso terapêutico , Pressão Sanguínea/efeitos dos fármacos , Artéria Braquial/efeitos dos fármacos , Endotélio Vascular/fisiologia , Losartan/farmacologia , Losartan/uso terapêutico , Análise de Onda de Pulso , Estatísticas não Paramétricas , Fatores de Tempo , Resultado do Tratamento , Rigidez Vascular/efeitos dos fármacosRESUMO
BACKGROUND: Studies suggest that statins have pleiotropic effects, such as reduction in blood pressure, and improvement in endothelial function and vascular stiffness. OBJECTIVE: To analyze if prior statin use influences the effect of renin-angiotensin-aldosterone system inhibitors on blood pressure, endothelial function, and vascular stiffness. METHODS: Patients with diabetes and hypertension with office systolic blood pressure ≥ 130 mmHg and/or diastolic blood pressure ≥ 80 mmHg had their antihypertensive medications replaced by amlodipine during 6 weeks. They were then randomized to either benazepril or losartan for 12 additional weeks while continuing on amlodipine. Blood pressure (assessed with ambulatory blood pressure monitoring), endothelial function (brachial artery flow-mediated dilation), and vascular stiffness (pulse wave velocity) were evaluated before and after the combined treatment. In this study, a post hoc analysis was performed to compare patients who were or were not on statins (SU and NSU groups, respectively). RESULTS: The SU group presented a greater reduction in the 24-hour systolic blood pressure (from 134 to 122 mmHg, p = 0.007), and in the brachial artery flow-mediated dilation (from 6.5 to 10.9%, p = 0.003) when compared with the NSU group (from 137 to 128 mmHg, p = 0.362, and from 7.5 to 8.3%, p = 0.820). There was no statistically significant difference in pulse wave velocity (SU group: from 9.95 to 9.90 m/s, p = 0.650; NSU group: from 10.65 to 11.05 m/s, p = 0.586). CONCLUSION: Combined use of statins, amlodipine, and renin-angiotensin-aldosterone system inhibitors improves the antihypertensive response and endothelial function in patients with hypertension and diabetes.
Assuntos
Aminoácidos/farmacologia , Inibidores da Enzima Conversora de Angiotensina/farmacologia , Anti-Hipertensivos/farmacologia , Diabetes Mellitus Tipo 2/tratamento farmacológico , Endotélio Vascular/efeitos dos fármacos , Hipertensão/tratamento farmacológico , Sistema Renina-Angiotensina/efeitos dos fármacos , Aminoácidos/uso terapêutico , Anlodipino/farmacologia , Anlodipino/uso terapêutico , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Anti-Hipertensivos/uso terapêutico , Benzazepinas/farmacologia , Benzazepinas/uso terapêutico , Pressão Sanguínea/efeitos dos fármacos , Monitorização Ambulatorial da Pressão Arterial , Artéria Braquial/efeitos dos fármacos , Endotélio Vascular/fisiologia , Feminino , Humanos , Losartan/farmacologia , Losartan/uso terapêutico , Masculino , Pessoa de Meia-Idade , Análise de Onda de Pulso , Estatísticas não Paramétricas , Fatores de Tempo , Resultado do Tratamento , Rigidez Vascular/efeitos dos fármacosRESUMO
INTRODUCTION: The purpose of this study was to compare the effects of benazepril and losartan on endothelial function and vascular stiffness, in patients with diabetes mellitus and hypertension. MATERIALS AND METHODS: We included hypertensive diabetic patients with an office systolic blood pressure (BP) ⩾ 130 mmHg and/or diastolic BP ⩾ 80 mmHg. Patients were rolled over to amlodipine for 6 weeks, then we performed C-reactive protein assays, BP measurement and vascular tests; next, patients were randomized to benazepril or losartan. The tests were repeated after 12 weeks. RESULTS: We randomized 14 patients to benazepril and 16 to losartan. There were no differences in systolic (139 versus 134 mmHg, p = 0.618) and diastolic (82 versus 80 mmHg, p = 0.950) BP at the end of the study. C-reactive protein values were lower in the benazepril group (0.38 versus 0.42 mg/dl, p = 0.020). There was a slightly higher flow-mediated vasodilation (FMD) response in the benazepril group (45% increase, p = 0.057) than in the losartan group (19% increase, p = 0.132). Both central systolic BP (129 versus 123 mmHg, p = 0.934) and carotid-femoral pulse wave velocity (cfPWV) (8.5 versus 8.5 m/s, p = 0.280) were the same between groups. CONCLUSIONS: Hypertensive diabetic patients using benazepril had a greater reduction in C-reactive protein, and a slight improvement in FMD, than those taking losartan.
Assuntos
Benzazepinas/uso terapêutico , Diabetes Mellitus Tipo 2/tratamento farmacológico , Endotélio Vascular/fisiopatologia , Hipertensão/tratamento farmacológico , Hipertensão/fisiopatologia , Losartan/uso terapêutico , Rigidez Vascular/efeitos dos fármacos , Aorta/efeitos dos fármacos , Aorta/fisiopatologia , Benzazepinas/efeitos adversos , Benzazepinas/farmacologia , Pressão Sanguínea/efeitos dos fármacos , Proteína C-Reativa , Estudos de Coortes , Diabetes Mellitus Tipo 2/fisiopatologia , Endotélio Vascular/efeitos dos fármacos , Feminino , Humanos , Losartan/efeitos adversos , Losartan/farmacologia , Masculino , Pessoa de Meia-Idade , Análise de Onda de PulsoRESUMO
BACKGROUND: Antihypertensive drugs are used to control blood pressure (BP) and reduce macro- and microvascular complications in hypertensive patients with diabetes. OBJECTIVES: The present study aimed to compare the functional vascular changes in hypertensive patients with type 2 diabetes mellitus after 6 weeks of treatment with amlodipine or losartan. METHODS: Patients with a previous diagnosis of hypertension and type 2 diabetes mellitus were randomly divided into 2 groups and evaluated after 6 weeks of treatment with amlodipine (5 mg/day) or losartan (100 mg/day). Patient evaluation included BP measurement, ambulatory BP monitoring, and assessment of vascular parameters using applanation tonometry, pulse wave velocity (PWV), and flow-mediated dilation (FMD) of the brachial artery. RESULTS: A total of 42 patients were evaluated (21 in each group), with a predominance of women (71%) in both groups. The mean age of the patients in both groups was similar (amlodipine group: 54.9 ± 4.5 years; losartan group: 54.0 ± 6.9 years), with no significant difference in the mean BP [amlodipine group: 145 ± 14 mmHg (systolic) and 84 ± 8 mmHg (diastolic); losartan group: 153 ± 19 mmHg (systolic) and 90 ± 9 mmHg (diastolic)]. The augmentation index (30% ± 9% and 36% ± 8%, p = 0.025) and augmentation pressure (16 ± 6 mmHg and 20 ± 8 mmHg, p = 0.045) were lower in the amlodipine group when compared with the losartan group. PWV and FMD were similar in both groups. CONCLUSIONS: Hypertensive patients with type 2 diabetes mellitus treated with amlodipine exhibited an improved pattern of pulse wave reflection in comparison with those treated with losartan. However, the use of losartan may be associated with independent vascular reactivity to the pressor effect.
Assuntos
Anlodipino/farmacologia , Anti-Hipertensivos/farmacologia , Pressão Sanguínea/efeitos dos fármacos , Diabetes Mellitus Tipo 2/fisiopatologia , Hipertensão/tratamento farmacológico , Losartan/farmacologia , Adulto , Idoso , Pressão Sanguínea/fisiologia , Monitorização Ambulatorial da Pressão Arterial , Artéria Braquial/fisiologia , Estudos Transversais , Feminino , Humanos , Hipertensão/fisiopatologia , Masculino , Manometria , Pessoa de Meia-Idade , Análise de Onda de Pulso/métodosRESUMO
Background: Antihypertensive drugs are used to control blood pressure (BP) and reduce macro- and microvascular complications in hypertensive patients with diabetes. Objectives: The present study aimed to compare the functional vascular changes in hypertensive patients with type 2 diabetes mellitus after 6 weeks of treatment with amlodipine or losartan. Methods: Patients with a previous diagnosis of hypertension and type 2 diabetes mellitus were randomly divided into 2 groups and evaluated after 6 weeks of treatment with amlodipine (5 mg/day) or losartan (100 mg/day). Patient evaluation included BP measurement, ambulatory BP monitoring, and assessment of vascular parameters using applanation tonometry, pulse wave velocity (PWV), and flow-mediated dilation (FMD) of the brachial artery. Results: A total of 42 patients were evaluated (21 in each group), with a predominance of women (71%) in both groups. The mean age of the patients in both groups was similar (amlodipine group: 54.9 ± 4.5 years; losartan group: 54.0 ± 6.9 years), with no significant difference in the mean BP [amlodipine group: 145 ± 14 mmHg (systolic) and 84 ± 8 mmHg (diastolic); losartan group: 153 ± 19 mmHg (systolic) and 90 ± 9 mmHg (diastolic)]. The augmentation index (30% ± 9% and 36% ± 8%, p = 0.025) and augmentation pressure (16 ± 6 mmHg and 20 ± 8 mmHg, p = 0.045) were lower in the amlodipine group when compared with the losartan group. PWV and FMD were similar in both groups. Conclusions: Hypertensive patients with type 2 diabetes mellitus treated with amlodipine exhibited an improved pattern of pulse wave reflection in comparison with those treated with losartan. However, the use of losartan may be associated with independent vascular reactivity to the pressor effect. .
Fundamento: A escolha dos fármacos anti-hipertensivos no tratamento de hipertensos diabéticos tem como objetivos o controle da pressão arterial (PA) e a redução das complicações macro/microvasculares. Objetivos: O objetivo deste estudo foi comparar as alterações vasculares funcionais em pacientes hipertensos e diabéticos tipo 2 após seis semanas de anlodipina ou losartana. Métodos: Pacientes com diagnóstico prévio de hipertensão arterial e diabetes melito tipo 2 foram randomizados e divididos em dois grupos, sendo avaliados na sexta semana de uso de losartana 100 mg/dia ou anlodipina 5 mg/dia, com medida da PA, realização de monitoração ambulatorial da pressão arterial e testes para avaliação de parâmetros vasculares, como tonometria de aplanação, velocidade de onda de pulso (VOP) e dilatação mediada por fluxo (DMF) da artéria braquial. Resultados: Foram incluídos 42 pacientes, 21 em cada grupo, com predominância do sexo feminino (71%) nos dois grupos. Os grupos anlodipina e losartana apresentaram média de idade semelhante (54,9 ± 4,5 e 54,0 ± 6,9 anos, respectivamente) e sem diferença estatística na média da PA (145 ± 14/84 ± 8 e 153 ± 19/90 ± 9 mmHg). O augmentation index (30 ± 9% × 36 ± 8%, p = 0,025), assim como a augmentation pressure (16 ± 6 mmHg × 20 ± 8 mmHg, p = 0,045) foram menores no grupo anlodipina que no grupo losartana. Os valores obtidos para VOP e DMF foram semelhantes nos dois grupos. Conclusões: Em hipertensos e diabéticos tipo 2, o uso de anlodipina demonstrou um padrão de reflexão da onda de pulso mais favorável nesse grupo, mas o uso de losartana pode estar associado com ações vasculares independentes do efeito pressórico. .
Assuntos
Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Anlodipino/farmacologia , Anti-Hipertensivos/farmacologia , Pressão Sanguínea/efeitos dos fármacos , /fisiopatologia , Hipertensão/tratamento farmacológico , Losartan/farmacologia , Monitorização Ambulatorial da Pressão Arterial , Pressão Sanguínea/fisiologia , Artéria Braquial/fisiologia , Estudos Transversais , Hipertensão/fisiopatologia , Manometria , Análise de Onda de Pulso/métodosRESUMO
A 31-year-old man admitted with abdominal pain, nauseas, vomiting, jaundice and fever that had began 2 weeks before. He had a history of hyperthyroidism and an irregular treatment with propylthiouracil (PTU) for 2 years. He had stopped PTU when the current symptoms started. The patient presented diffuse goiter, about 120g, FT4 22.7 ng/dL (N: 0.8 - 1.9 ng/dL); THS < 0.002 microUI/mL (N 0.4-5 microUI/mL). Transaminases, serum total and direct bilirubins were increased. He was kept without PTU and propranolol was started and increased until the dose of 480 mg/day. Abdominal ultrasonography was normal and serologic markers for hepatitis A, B and C pointed to acute virus B hepatitis. The patient presented a worse of hepatic function and elevated thyroid hormones levels. To avoid the future need of antithyroid drugs, to get a fast normalization of thyroid hormones levels and because of the goiter size thyroidectomy was recommended. The patient underwent one therapeutic plasmapheresis session just before the surgery. A total thyroidectomy was performed without complications. At the 5th day after surgery the patient presented improvement of hepatic function and low FT4 serum levels. We concluded that preexisting hyperthyroidism may aggravate or perpetuate a hepatic failure caused for acute viral hepatitis and plasmapheresis is a rapid, reliable and effective way to lower thyroid hormones serum levels, allowing a successful thyroidectomy in patients with severe thyrotoxicosis.
Assuntos
Hepatite B/complicações , Hipertireoidismo/complicações , Falência Hepática Aguda/etiologia , Adulto , Bócio Nodular/complicações , Bócio Nodular/terapia , Humanos , Hipertireoidismo/terapia , Falência Hepática Aguda/terapia , Masculino , Plasmaferese , TireoidectomiaRESUMO
Paciente masculino, 31 anos, internado com quadro de dor abdominal, náuseas, vômitos, icterícia e febre, iniciado há duas semanas. História de hipertireoidismo e tratamento irregular com propiltiuracil há dois anos, interrompeu a medicação quando iniciou o quadro atual. Apresentava bócio difuso, cerca de 120 g, T4L 22,7 ng/dL (VN 0,8-1,9 ng/dL); TSH < 0,002 µUI/mL (VN 0,4-5 µUI/mL). Transaminases, bilirrubinas total e direta séricas elevadas. Foi mantido sem antitireoidiano e iniciado propranolol até a dose de 480 mg/dia. Ultra-sonografia de abdome foi normal e sorologias para hepatites A, B e C indicaram infecção aguda por vírus B. Ocorreu piora da função hepática e manutenção de níveis elevados de hormônios tireoidianos. Visando evitar necessidade futura de antitireoidiano, obter rápida normalização dos níveis de hormônios tireoidianos e em virtude do tamanho do bócio foi indicado tireoidectomia. O paciente foi submetido a uma sessão de plasmaférese terapêutica, imediatamente antes da cirurgia, e tireoidectomia subtotal sem intercorrências. No quinto dia após a cirurgia, o paciente apresentava melhora da função hepática e baixos níveis séricos de T4 livre. Concluímos que o hipertireoidismo prévio pode exacerbar e perpetuar a disfunção hepática causada por hepatite viral aguda e que a plasmaférese é um meio rápido, seguro e eficaz de reduzir os níveis de hormônio tireoidiano, permitindo uma tireoidectomia bem-sucedida em pacientes com tireotoxicose grave.
A 31-year-old man admitted with abdominal pain, nauseas, vomiting, jaundice and fever that had began 2 weeks before. He had a history of hyperthyroidism and an irregular treatment with propylthiouracil (PTU) for 2 years. He had stopped PTU when the current symptoms started. The patient presented diffuse goiter, about 120g, FT4 22.7 ng/dL (N: 0.8 - 1.9 ng/dL); THS < 0.002 µUI/mL (N 0.4-5 µUI/mL). Transaminases, serum total and direct bilirubins were increased. He was kept without PTU and propranolol was started and increased until the dose of 480 mg/day. Abdominal ultrassonography was normal and serologic markers for hepatitis A, B and C pointed to acute virus B hepatitis. The patient presented a worse of hepatic function and elevated thyroid hormones levels. To avoid the future need of antithyroid drugs, to get a fast normalization of thyroid hormones levels and because of the goiter size thyroidectomy was recommended. The patient underwent one therapeutic plasmapheresis session just before the surgery. A total thyroidectomy was performed without complications. At the 5th day after surgery the patient presented improvement of hepatic function and low FT4 serum levels. We concluded that preexisting hyperthyroidism may aggravate or perpetuate a hepatic failure caused for acute viral hepatitis and plasmapheresis is a rapid, reliable and effective way to lower thyroid hormones serum levels, allowing a successful thyroidectomy in patients with severe thyrotoxicosis.