RESUMO
OBJECTIVES: To identify possible clinical factors associated with hyperthyroidism at presentation and to assess post-evacuation thyroid function in women with complete hydatidiform mole (CHM). METHODS: This observational study included women with CHM attending a specialized Brazilian center in 2002-2018. Clinical and laboratory data (serum hCG, TSH, fT4) were collected at presentation. Factors associated with hyperthyroidism were assessed by logistic regression. Receiver-operating characteristic curves were built to determine the hCG cutoff for predicting hyperthyroidism at CHM presentation. Post-molar evacuation follow-up included clinical assessment and close thyroid function monitoring. RESULTS: Of 137 CHM patients, 69 (50.3%) had hyperthyroidism of any type (43.5% subclinical, 56.5% overt) at presentation. Uterine fundal height > 16 cm or > gestational age (GA), and theca lutein cysts >6 cm were significantly associated with both subclinical and overt hyperthyroidism. The optimal hCG cutoff for predicting hyperthyroidism was 430,559 IU/L (sensitivity 85.5%, specificity 83.8%). Post-evacuation hyperthyroidism/transient hypothyroidism conversion was observed in 13% of the women with hyperthyroidism at presentation. Among the patients not showing conversion to hypothyroidism, median time for TSH normalization was 2 and 3 weeks for subclinical and overt hyperthyroidism, respectively. In the women with overt hyperthyroidism, fT4 was normalized at 2 weeks. CONCLUSIONS: Uterine fundal height > 16 cm, uterine fundal height > GA, theca lutein cysts >6 cm, and hCG >400,000 IU/L at presentation are associated with greater risk of hyperthyroidism and its complications. Close monitoring thyroid function during postmolar follow-up showed that, as thyroid hormones are normalized within 2-3 weeks post-evacuation, the use of beta-blockers or antithyroid drugs can be rapidly discontinued.
Assuntos
Cistos , Mola Hidatiforme , Hipertireoidismo , Hipotireoidismo , Neoplasias Uterinas , Gonadotropina Coriônica , Cistos/complicações , Feminino , Humanos , Hipotireoidismo/complicações , Luteína , Gravidez , Tireotropina , Neoplasias Uterinas/complicaçõesRESUMO
BACKGROUND: The red-handed howler monkey (Alouatta belzebul) is one of 116 imperiled Brazilian primate species. We aimed to determine the serum biochemical profile of free-ranging red-handed howler monkeys in a highly disturbed area of the eastern Amazon. METHODS: We obtained serum samples from 26 monkeys, in which we analyzed 20 biochemical variables. RESULTS AND CONCLUSIONS: Calcium concentration was significantly lower in adult males (1.82 ± 0.25 mmol/L) than in adult females (2.10 ± 0.50 mmol/L). Both adults (males = 89 ± 85 UI/L, females = 62 ± 23 UI/L) had lower alkaline phosphatase serum activity than juvenile females (178 ± 120 UI/L). Adult male had higher levels of the direct bilirubin (13.9 ± 8.2 µmol/L) and creatinine (74.3 ± 19.4 µmol/L) than juvenile females (5.1 ± 1.4 µmol/L and 38.9 ± 15.0 µmol/L, respectively). This detailed biochemical profile may be useful for the management of red-handed howler monkeys in the wild and to support further studies at ex situ facilities.