No abstract

SummaryAlternating between hyper- and hypo-thyroidism may be explained by the simultaneous presence of both types of TSH receptor autoantibodies (TRAbs) – thyroid stimulating autoantibodies (TSAbs) and TSH blocking autoantibodies (TBAbs). It is a very rare condition, particulary in the pediatric age. The clinical state of these patients is determined by the balance between TSAbs and TBAbs and can change over time. Many mechanisms may be involved in fluctuating thyroid function: hormonal supplementation, antithyroid drugs and levels of TSAbs and TBAbs. Frequent dose adjustments are needed in order to achieve euthyroidism. A definitive therapy may be necessary to avoid switches in thyroid function and frequent need of therapeutic changes. We describe an immune-mediated case of oscillating thyroid function in a 13-year-old adolescent. After a short period of levothyroxine treatment, the patient switched to a hyperthyroid state that was only controlled by adding an antithyroid drug.Learning points Autoimmune alternating hypo- and hyper-thyroidism is a highly uncommon condition in the pediatric age.It may be due to the simultaneous presence of both TSAbs and TBAbs, whose activity may be estimated in vitro through bioassays.The clinical state of these patients is determined by the balance between TSAbs and TBAbs and can change over time.The management of this condition is challenging, and three therapeutic options could be considered: I-131 ablation, thyroidectomy or pharmacological treatment (single or double therapy).Therapeutic decisions should be taken according to clinical manifestations and thyroid function tests, independent of the bioassays results.A definitive treatment might be considered due to the frequent switches in thyroid function and the need for close monitoring of pharmacological treatment. A definitive treatment might be considered due to the frequent switches in thyroid function and the need for close monitoring of pharmacological treatment.

O artigo tem por objetivo analisar algumas das expressões de violência vivenciadas por mulheres do campo e as experiências relacionadas ao acesso à rede de proteção social no Rio Grande do Sul. O estudo foi exploratório, de natureza qualitativa e norteado pelo método dialético-crítico. As narrativas das mulheres do campo, lideranças e trabalhadores da rede foram obtidas a partir de entrevistas semi-estruturadas e analisadas à luz dos estudos de gênero. Os resultados apontam para dificuldades de acesso e/ou inexistência de serviços da rede para as mulheres rurais, além de experiências sociais marcadas pela divisão sexual do trabalho, patriarcalismo e machismo.

Introduction: A new marker that correlates with nutritional recovery in Anorexia Nervosa would be of great value. Our study aimed to analyse the influence of Body Mass Index variations on serum ferritin levels in adolescents with Anorexia Nervosa followed up in a specialised consultation. Methods: We conducted a retrospective, observational, single-centre study in adolescents with Anorexia Nervosa evaluated between 2011 and 2019. Serum ferritin values ​​at baseline and during follow-up were analysed, together with the corresponding Body Mass Index (BMI) and Z-Score values. Further analytical data such as hematological and inflammatory markers were recorded. Results: The study included 53 adolescents with Anorexia Nervosa. Patients were found to have higher initial serum ferritin levels compared to the last, under treatment, assessed values (p<0.001). There was a significant increase in BMI and BMI Z-Score during follow-up (p<0.001), reflecting nutritional recovery. Analysing the variation of these values, we found a negative linear association between the variation of serum ferritin and the variation of BMI Z-Score (ß -0.1; R2 0,39; p<0,001). In analysing the change of BMI Z-Score and serum ferritin as a function of time, a linear regression model was used (ß -0,39; R2 0,12; p <0,001), showing that the quicker the recovery of BMI Z-Score, the faster the decrease in ferritin value. None of the patients presented anaemia, and in most cases, the other inflammatory markers remained normal. Conclusion: Serum ferritin could be of value in the evaluation of patients with Anorexia Nervosa in the absence of other diseases, in particular when other markers of malnutrition are normal.