Objective: Although hypothyroidism has been linked to oxidative stress, data regarding the relationship between thyroid hormone levels and oxidative stress is still inconsistent. This study was designed to evaluate the effect of levothyroxine replacement on oxidative stress in women with primary hypothyroidism.Design: A total of 25 female patients with primary hypothyroidism were included. Oxidative stress markers were measured before and after levothyroxine replacement treatment in all patients.Methods: Oxidative stress was evaluated through the measurement of oxidants (thiobarbituric acid reactive substances [TBARS] and nitrite/nitrate levels), and antioxidants (superoxide dismutase and catalase activity).Results: Antioxidant catalase activity (63.77 ± 23.8 vs. 50.12 ±12.75 atv/min; p = 0.03) was significantly increased and the levels of TBARS (3.02 ± 0.86 vs. 3.55 ± 0.87 μM; p = 0.03) were significantly decreased in the state of euthyroidism after levothyroxine replacement compared to the hypothyroidism before levothyroxine treatment. No significant change in neither nitrite/nitrate concentration (p = 0.18) nor in superoxide dismutase activity (p = 0.93) after L-T4 adjustment was found.Conclusions: Our data demonstrate that levothyroxine replacement improved oxidative status in patients with primary hypothyroidism, indexed by the significantly decreased levels of malonaldehyde (MDA) and increased catalase (CAT) activity.

Objective: To report the clinical and molecular aspects of a patient with a diagnosis of Resistance to Thyroid Hormone (RTH) harboring the E449X mutation associated with autoimmune thyroid disease and severe neuropsychomotor retardation. Methods: We present a case report including clinical and laboratory fi ndings, and molecular analysis of a Brazilian patient with RTH. Results: A 23-year old male presented hyperactivity disorder, attention defi cit, delayed neuropsychomotor development, and goiter. Since the age of 1 year and 8 months, his mother had sought medical care for her son for the investigation of delayed neuropsychomotor development associated with irritability, aggressiveness, recurrent headache, profuse sudoresis, intermittent diarrhea, polyphagia, goiter, and low weight. Laboratory tests revealed normal TSH, increased T 3, T 4 , antithyroglobulin and antimicrosomal antibody titers. Increasing doses of levothyroxine were prescribed, reaching 200 µg/day, without signifi cant changes in his clinical-laboratory picture. Increasing doses of tiratricol were introduced, with a clear clinical improvement of aggressiveness, hyperactivity, tremor of the extremities, and greater weight gain. Molecular study revealed a nonsense mutation in exon 10, in which a substitution of a guanine to tyrosine in nucleotide 1345 (codon 449) generates the stop codon TAA, confi rming the diagnosis of RTH. Conclusion: This patient has severe neuropsychomotor retardation not observed in a single previous report with the same mutation. This may refl ect the lack of a genotype-phenotype correlation in affected cases with this syndrome, suggesting that genetic variability of factors other than β receptor of thyroid hormone (TRβ) might modulate the phenotype of RTH. RESUMOMutação E449X no Receptor β do Hormônio Tireoidiano Associada com Doença Tireoidiana Auto-Imune e Retardo Neuropscicomotor Grave. Objetivos: Descrever aspectos clínicos e moleculares de um paciente com resistência ao hormônio tireoidiano (RHT) portador da mutação E449X associada a doença tireoideana auto-imune e retardo neuropscicomotor grave. Métodos: Relatamos um caso incluindo achados clínicos, laboratoriais e aná-lise molecular de um paciente brasileiro com RHT. Resultados: Paciente masculino, 23 anos de idade, apresentou-se com distúrbio de hiperatividade, défi cit de atenção, retardo no desenvolvimento neuropsicomotor e bócio. Desde 1 ano e 8 meses de idade, sua mãe procurou assistência médica para investigação do retardo do desenvolvimento neuropsicomotor associado com irritabilidade, agressividade, cefaléia recorrente, sudorese profusa, diarréia intermitente, polifagia, bócio e perda de peso. Avaliação laboratorial evidenciou TSH normal e aumento do T3, T4 e anticorpos antimicrossomal e

RESUMOObjetivo: a síndrome de Turner afeta aproximadamente 1:2.500 meninas nascidas vivas e decorre da ausência completa ou parcial do segundo cromossomo X. Embora o hipogonadismo e a infertilidade sejam os achados mais frequentes, 2-5 % das mulheres podem engravidar naturalmente. O objetivo deste trabalho é relatar o desfecho de uma gravidez espontânea em portadora de síndrome de Turner e apresentar uma revisão sobre o manejo dessa associação incomum. Relato do caso: paciente com síndrome de Turner diagnosticada aos 8 anos, cariótipo 45,X(4%)/46,XX(96%), apresentou desenvolvimento puberal espontâneo e menarca placentomegalia e polidramnia. A gestação evoluiu para trabalho de parto prematuro, com óbito do recém-nascido após 3 horas de vida. A paciente desenvolveu sintomas de depressão pós-parto, sendo encaminhada para acompanhamento psicológico. Conclusão: a gestação espontânea em uma mulher com síndrome de Turner é um evento raro. Há aumento de risco de malformações fetais, abortos espontâneos e natimortos, uma frequência elevada de complicações maternas e alta taxa de mortalidade. Complicações maternas mais comuns são diabetes gestacional, hipotireoidismo, hipertensão, pré-eclâmpsia, eclâmpsia e risco de dissecção/ ruptura da aorta, sendo fundamental acompanhamento multidisciplinar pré-concepcional e pré-natal.Palavras-chave: Síndrome de Turner. Gravidez de alto risco. Complicações na gravidez. ABSTRACTObjectives: Turner syndrome affects approximately one in 2500 live-born females and results from the complete or partial absence of the second sex chromosome. Although hypogonadism and infertility are the most frequent features, 2-5% may present spontaneous pregnancy. The purpose of this paper is to report the outcome of a spontaneous pregnancy in a patient with Turner syndrome and to review management of this unusual association. Case report: the patient diagnosed with Turner syndrome at 8 years old, with 45,X(4%)/46,XX(96%) karyotype, had spontaneous pubertal development and menarche at 15 years old. Spontaneous pregnancy occurred at age 28 and at the 32nd week of gestation ultrasound evaluation revealed hydrops fetalis, placentomegaly and polyhydramnios. The patient developed complications, including preterm birth and newborn death after three hours. Later she presented with postpartum depression. Conclusion: spontaneous pregnancy in woman with Turner syndrome is a rare event. There is an increased risk of chromosomal abnormalities, miscarriages and stillbirths, as well as an increased frequency of complications during pregnancy and higher mortality. The most common complications are gestational diabetes, hypothyroidism, hypertension, preeclampsia, eclampsia and increased risk of aortic dissection/rupture. These life-threatening conditions warrant multidisciplinary counseling prior to conception and during the prenatal period.

A hiperglicemia é uma complicação frequente, cuja prevalência ocorre em até 38% dos pacientes internados. Tal condição pode ser decorrente do diabetes previamente conhecido, de estresse responsivo a doenças ou tratamentos associados ou devido ao diabetes somente diagnosticado durante a internação. A presença de hiperglicemia nosocomial associa-se ao prolongamento do tempo de internação, ao aumento da demanda de recursos humanos e custos hospitalares e na piora do desfecho clínico. Diante das dificuldades de manejo da hiperglicemia de pacientes internados, as unidades hospitalares, seguindo as recomendações das sociedades e diretrizes internacionais e nacionais que trata da hiperglicemia do paciente internado, têm desenvolvido protocolos de controle glicêmico hospitalar e criado comissões interdisciplinares para tal fim. O Hospital Universitário Walter Cantídio (HUWC-UFC), baseado nas principais diretrizes internacionais e nacionais de tratamento ao diabetes, apresenta o seu protocolo de controle da hiperglicemia numa abordagem multi e interdisciplinar de cuidados ao paciente internado.