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Hipertireoidismo: Sinais & Sintomas Online (Hyperthyroidism: Signs & Symptoms)

Por Paulo Leite 01/04/2020

Sintomas

– Aumento do apetite

– Aumento da frequência de defecações, diarréia

– Ansiedade, hiperatividade, nervosismo

– Intolerância ao calor

– Dispnéia

– Distúrbios do sono, insônia

– Fadiga, letargia

– Intolerância a exercícios

– Oligomenorréia, amenorréia

– Palpitações

– Perda de peso associada a aumento do apetite

– Perda do libido, disfunção erétil

– Queixas oculares

Sinais

– Arritmia (atriais), taquicardia, fibrilação atrial

– Agitação, psicose

– Aumento da sudorese

– Baqueteamento digital

– Bócio

– Eritema palmar

– Fraqueza musculara proximal

– Ginecomastia

– Insuficiência cardíaca de alto débito

– Oligomenorréia, amenorréia

– Oftalmopatia de Graves

– Paralisia periódica

– Pele quente e úmida

– Perda de cabelo

– Precórdio hiperdinâmico

– Sopro sobre a tireóide

– Tremor fino, hyperreflexia

– Unhas quebradiças

Crise Tireotóxica

– É uma exacerbação dramática, com risco de vida, do hipertireoidismo (tireotoxicose). É o extremo de um continuum de gravidade do hipertireiodismo, que está associado a uma elevada taxa de mortalidade de 20% se não tratado. É um diagnóstico clínico, baseado na gravidade do hipertireoidismo.

■ Hyperthyroidism

Amanda R. Doubleday, Rebecca S. Sippel

Gland Surg. 2020 Feb; 9(1): 124–135

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7082267/

■ A case of unilateral dermopathy possibly related to Grave´s disease

C Rodia, F Menconi, L Mazoni et al

Eur Thyroid J 2020, vol 9 (1): 25-31

https://www.karger.com/Article/FullText/500297

■ National trends in incidence, mortality, and clinical outcomes of patients hospitalized for thyrotoxicosis with and without thyroid storm in the United States, 2004-2013

Rodolfo J. Galindo, Carolina R. Hurtado, Francisco J. Pasquel et al

Thyroid. 2019 Jan 1; 29(1): 36–43.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6916241/

■ Management of thyrotoxicosis in children and adolescents: a Turkish Multi-center experience

İhsan Esen, Elvan Bayramoğlu, Melek Yıldız et al

J Clin Res Pediatr Endocrinol. 2019 Jun; 11(2): 164–172

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6571539/

■ The incidence of childhood thyroxicosis is increasing in both girls and boys in Sweden

Maria Rodanaki, Maria Lodefalk, Katharina Forssell, et al

Horm Res Paediatr. 2019 Jul; 91(3): 195–202

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6690413/

■ Hyperthyroidism in the pregnant woman: maternal and fetal aspects

Mariacarla Moleti, Maria Di Mauro, Giacomo Sturniolo et al

J Clin Transl Endocrinol. 2019 Jun; 16: 100190

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6484219/

■ Association of radioactive iodine treatment with cancer mortality in patients with hyperthyroidism

C M Kitahara, A B de Gonzalez, A Bouville et al

JAMA Intern Med 2019, vol 179 (8): 1034-1042

https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2737319

■ Long-term outcome of thyrotoxicosis in childhood and adolescence in the west of Scotland: the case for long-term antithyroid treatment and the importance of initial counselling

Mariam Kourime, Sheena McGowan, Mabrouka Al Towati, et al

Arch Dis Child. 2018 Jul; 103(7): 637–642

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6047164/

■ Echocardiographic evolution of pulmonary hypertension in female patients with hyperthyroidism

Cristina Tudoran, Mariana Tudoran, Mihaela Vlad, et al

Anatol J Cardiol. 2018 Sep; 20(3): 174–181

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6237944/

■ Hyperthyroidism in a complete molar pregnancy with a mature cystic ovarian teratoma

Bryce C. Simes, Alozie A. Mbanaso, Carlos A. Zapata, Chukwuma M. Okoroji

Thyroid Res. 2018; 11: 12

https://thyroidresearchjournal.biomedcentral.com/articles/10.1186/s13044-018-0056-7

■ Severe Mitral Regurgitation by Hyperthyroidism in the Absence of Left Ventricular Dilatation

Jorge, Antonio José Lagoeiro et al

Int. J. Cardiovasc. Sci., Apr 2018, vol.31, no.2, p.190-19

http://www.scielo.br/scielo.php?script=sci_arttext&pid=S2359-56472018000200190&lng=pt&nrm=iso

■ Grave´s hyperthyroidism in pregnancy: a clinical review

Caroline T. Nguyen, Elizabeth B. Sasso, Lorayne Barton, Jorge H. Mestman

Clin Diabetes Endocrinol. 2018; 4: 4.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5831855/

■ ECG changes in patients with primary hyperthyroidism

Ishtiaque Hussain Baladi, Ayesha Aslam Rai, Syed Masroor Ahmed

Pan Afr Med J. 2018; 30: 246

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6307920/

■ 2018 European Thyroid Association guideline for the management of Grave´s hyperthyroidism

George J. Kahaly, Luigi Bartalena, Lazlo Het al

Eur Thyroid J. 2018 Aug; 7(4): 167–186

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6140607/

■ Amiodarone-induced thyrotoxicosis with cardiopulmonary arrest

Kosuke Inoue, Jun Saito, Tetsuo Kondo, et al

Intern Med. 2018 Jan 1; 57(1): 59–63

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5799058/

■ Clinical feasibility of monitoring resting heart rate using a wearable activity tracker in patients with thyrotoxicosis: prospective longitudinal observational study

Jie-Eun Lee, D H Lee, T J Oh et al

JMIR Mhealth Uhealth. 2018 Jul; 6(7): e159

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6064040/

■ Thyrotoxic periodic paralysis: an unusual presentation of hyperthyroidism

M Salih, C M J van Kinschot, R P Peeters et al

The Netherland Journal of Medicine 2017, vol 75 (8)

http://www.njmonline.nl/getpdf.php?id=1893

■ Thyrotoxicosis – investigation and management

Jackie Gilbert

Clin Med (Lond) 2017 Jun; 17(3): 274–277

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6297572/

■ Hyperthyroidism and the heart

Patricia Mejia Osuna, Maja Udovcic, Morali D. Sharma

Methodist Debakey Cardiovasc J. 2017 Apr-Jun; 13(2): 60–63

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5512680/

■ Caracterización de pacientes controlados por enfermedad de Basedow Graves en un hospital universitário

Lanas, Alejandra et al.

Rev. méd. Chile, Abr 2017, vol.145, no.4, p.436-440

https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872017000400003&lng=en&nrm=iso

■ Tiroides ectópica dual hiperfuncionante: Abordaje quirúrgico dual.

Salazar O, Alejandro et al.

Rev. Otorrinolaringol. Cir. Cabeza Cuello, Mar 2018, vol.78, no.1, p.110-120

https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0718-48162018000100110&lng=es&nrm=iso&tlng=es

■ Radioyodo como tratamiento de hipertiroidismo en un paciente en hemodiálisis: Caso clínico.

Hurtado, Claudia et al.

Rev. méd. Chile, Mayo 2017, vol.145, no.5, p.673-677

https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872017000500017&lng=en&nrm=iso

■ Hyperthyroidism

Simone De Leo, Sun Y Lee, Lewis E Braverman

Lancet. 2016 Aug 27; 388(10047): 906–918

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5014602/

■ Managing hyperthyroidism in pregnancy: current perspectives

Stine Linding Andersen, Peter Laurberg

Int J Womens Health. 2016; 8: 497–504

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5034921/

■ Preditores de Recorrência de Fibrilação Atrial em Pacientes com Eutireoidismo e Hipertireoidismo

Gürdoğan, Muhammet et al.

Arq. Bras. Cardiol., Feb 2016, vol.106, no.2, p.84-91

http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0066-782X2016000200084&lng=en&nrm=iso&tlng=pt (portuguese)

http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0066-782X2016000200084&lng=en&nrm=iso&tlng=en

(english)

■ A combination of tachycardia-mediated heart failure and coronary artery vasospasm-induced silent myocardial infarction in a patient with severe thyrotoxicosis

Serena Sert Kim Khoo, Chong Mow Chu, Yin Khet Fung

Case Rep Cardiol. 2018; 2018: 4827907

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5866855/

■ Clinical and therapeutic controversies on subclinical hyperthyroidism

Salles, Fernanda and Salles, Daniela

MedicalExpress (São Paulo, online), Oct 2014, vol.1, no.5, p.251-256

http://www.scielo.br/scielo.php?script=sci_arttext&pid=S2358-04292014000500251&lng=pt&nrm=iso&tlng=en

■ Consenso brasileiro para o diagnóstico e tratamento do hipertireoidismo: recomendações do Departamento de Tireoide da Sociedade Brasileira de Endocrinologia e Metabologia

Maia, Ana Luiza et al.

Arq Bras Endocrinol Metab, Abr 2013, vol.57, no.3, p.205-232

http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0004-27302013000300006&lng=en&nrm=iso

■ Oftalmopatia de Graves Online (Graves Ophthamopathy)

Arquivo – julho 2019

https://internetmedica.com.br/oftalmopatia-de-graves-online-graves-ophthalmopathy/

■ Doença da Tireóide: Mednews Online (Thyroid Disease: Guidelines)

Arquivo – Agosto 2019

https://internetmedica.com.br/doenca-da-tireoide-mednews-online-thyroid-disease-mednews/

■ Tireoidectomia Online (Thyroidectomy)

Arquivo – novembro 2018

https://internetmedica.com.br/tireoidectomia-online-thyroidectomy/

■ Câncer de Tireóide: Casos Clínicos Online (Thyroid Cancer: Case Reports)

Arquivo – maio 2019

https://internetmedica.com.br/cancer-de-tireoide-casos-clinicos-online-thyroid-cancer-case-reports/

■ Dr Paulo Fernando Leite

Cardiologia/Prevenção Cardiovascular

Estratificação de Risco Cardiovascular

Consultório: Rua Padre Rolim 815/sala 601 – Belo Horizonte/MG/Brasil

Tel: 33245518

CRMMG: 7026

Email: pfleite1873@gmail.com

Data: Abril 2020

Síndrome do Desconforto Respiratório Agudo Online (Acute Respiratory Distress Syndrome)

Por Paulo Leite 31/03/2020

A síndrome do desconforto respiratório agudo (SDRA) é caracterizada por opacidades bilaterais, edema pulmonar não cardiogênico e hipoxemia com pressão parcial de oxigênio/fração inspirada de oxigênio (PaO₂/FIO₂) < 300 com pressão positiva expiratória final (PEEP) ≥ 5cmH₂O, que pode ocorrer em resposta a diferentes insultos, como sepse, trauma, pneumonia ou transfusão maciça. Devido à hipoxemia, os pacientes com SDRA requerem estratégias ventilatórias (ventilação protetora e ventilação em posição prona) que demonstraram ser importantes na redução da mortalidade em curto prazo. O tratamento da síndrome requer balanço hídrico, monitoração hemodinâmica, uso de fármacos (corticosteroides, surfactantes, e outros) e manobras para melhorar a oxigenação.

■ Guidelines on the management of acute respiratory distress syndrome

Mark J D Griffiths, Danny Francis McAuley, Gavin D Perkins et al

BMJ Open Respir Res. 2019; 6(1): e000420

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6561387/

■ Formal guidelines: management of acute respiratory distress syndrome

Laurent Papazian, Cécile Aubron, Laurent Brochard, et al

Ann Intensive Care. 2019; 9: 69.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6565761/

■ Acute respiratory distress syndrome

Michael A. Matthay, Rachel L. Zemans, Guy A. Zimmerman et al

Nat Rev Dis Primers. 2019; 5(1): 18

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6709677/

■ Management of acute respiratory distress syndrome and refractory hypoxemia. A multicenter observational study

E H Duan, N K J Adhikari, F D´Aragon et al

Annals of the American Thoracic Society 2017, vol 14 (12)

https://www.atsjournals.org/doi/full/10.1513/AnnalsATS.201612-1042OC

■ Fluid management in acute respiratory distress syndrome: a narrative review

Jean I. Keddissi, Houssein A. Youness, Kellie R. Jones, Gary T. Kinasewitz

Can J Respir Ther. 2019; 55: 1–8.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6591787/

■ Síndrome do desconforto respiratório agudo: como estão os pacientes após a unidade de terapia intensiva?

Oliveira, Roselaine Pinheiro de, Teixeira, Cassiano and Rosa, Régis Goulart

Rev. bras. ter. intensiva, Dez 2019, vol.31, no.4, p.555-560

http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0103-507X2019000400555&lng=pt&nrm=iso

■ Oxigenação por membrana extracorpórea para síndrome do desconforto respiratório agudo grave em pacientes adultos: revisão sistemática e metanálise

Mendes, Pedro Vitale et al.

Rev. bras. ter. intensiva, Dez 2019, vol.31, no.4, p.548-554

http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0103-507X2019000400548&lng=pt&nrm=iso

■ Associação entre achados eletromiográficos e mortalidade na unidade de terapia intensiva em pacientes com síndrome do desconforto respiratório agudo mecanicamente ventilados sob sedação profunda

Teixeira, Cassiano et al.

Rev. bras. ter. intensiva, Dez 2019, vol.31, no.4, p.497-503

http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0103-507X2019000400497&lng=pt&nrm=iso

■ The current state of pediatric acute respiratory distress syndrome

Kirsten E. Orloff, David A. Turner, Kyle J. Rehde

Pediatr Allergy Immunol Pulmonol. 2019 Jun 1; 32(2): 35–44

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6589490/

■ Biomarkers in pediatric acute respiratory distress syndrome

Erin F. Carlton, Heidi R. Flori

Ann Transl Med. 2019 Oct; 7(19): 505

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6828797/

■ Diagnóstico rápido da síndrome do desconforto respiratório por aspirado bucal em recém-nascidos prematuros

Ribeiro, Manoel Antonio da Silva et al

Pediatr. (Rio J.), Aug 2019, vol.95, no.4, p.489-494

http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0021-75572019000500489&lng=pt&nrm=iso&tlng=pt (portuguese)

http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0021-75572019000500489&lng=pt&nrm=iso&tlng=en (english)

■ Sepsis and pediatric acute respiratory distress syndrome

Nadir Yehya, Neal J. Thomas

J Pediatr Intensive Care. 2019 Mar; 8(1): 32–41.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6506676/

■ Acute respiratory distress syndrome as an organ phenotype of vascular microthrombotic disease: based on hemostatic theory and endotelial molecular pathogenesis

Jae C. Chang

Clin Appl Thromb Hemost. 2019 Jan-Dec; 25: 1076029619887437

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7019416/

■ Biomarkers for acute respiratory distress syndrome and prospects for personalised medicine

Savino Spadaro, Mirae Park, Cecilia Turrini, et al

J Inflamm (Lond) 2019; 16: 1

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6332898/

■ Usefulness of ultrasound in the management of acute respiratory distress syndrome

Anis Chaari, Kamel Bousselmi, Walid Assar et al

Int J Crit Illn Inj Sci. 2019 Jan-Mar; 9(1): 11–15

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6423925/

■ Physiologic analysis and clinical performance of the ventilatory ratio in acute respiratory distress syndrome

Pratik Sinha, Carolyn S. Calfee, Jeremy R. Beitler et al

Am J Respir Crit Care Med. 2019 Feb 1; 199(3): 333–34

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6363976/

■ Utility of point-of-care lung ultrasound for initial assessment of acute respiratory distress syndrome patients in the emergency department

Sanjan, S. Vimal Krishnan, Siju V. Abraham, Babu Urumese Palatty

J Emerg Trauma Shock. 2019 Oct-Dec; 12(4): 248–253

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6883501/

■ What links ventilator driving pressure with survival in the acute respiratory distress syndrome? A computational study

Anup Das, Luigi Camporota, Jonathan G. Hardman, Declan G. Bates

Respir Res. 2019; 20: 29.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6371576/

■ Misdiagnosis: acute chest syndrome that evolved into acute respiratory distress syndrome in a patient without a documented history of hemoglobinopathy

Christoph Sossou, Ogechukwu Chika-Nwosuh, Christopher Nnaoma et al

Case Rep Med. 2019; 2019: 2893056

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6378019/

■ Use of neuromuacular blocking agents in acute respiratory distress syndrome

Tsai-Nguyen, Ariel M. Modrykamien

Proc (Bayl Univ Med Cent) 2018 Apr; 31(2): 177–179

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5914437/

■ Acute exacerbation of idiopathic pulmonar fibrosis: lessons learned from acute respiratory distress syndrome?

Alessandro Marchioni, Roberto Tonelli, Lorenzo Ball et al

Crit Care. 2018; 22: 80

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5865285/

■ Pulmonary mechanics and gas Exchange characteristics in uncommon etiologies of acute respiratory distress syndrome

Richard H. Kallet, Kelly Ho, Michael S. Lipnick, Michael A. Matthay

J Thorac Dis. 2018 Aug; 10(8): 5030–5038

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6129894/

■ Beyond low tidal volume ventilation: treatment adjuncts for severe respiratory failure in acute respiratory distress syndrome

Vikram Fielding-Singh, Michael A. Matthay, Carolyn S. Calfee

Crit Care Med. 2018 Nov; 46(11): 1820–1831

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6277052/

■ O que todo intensivista deve saber a respeito da síndrome do desconforto respiratório agudo e dano alveolar difuso?

Rios, Fernando, Iscar, Teresa and Cardinal-Fernández, Pablo

Rev. bras. ter. intensiva, Set 2017, vol.29, no.3, p.354-363

http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0103-507X2017000300354&lng=pt&nrm=iso

■ Respiratory support in patients with acute respiratory distress syndrome: an expert opinion

Davide Chiumello, Laurent Brochard, John J. Marini,et al

Crit Care. 2017; 21: 240.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5596474/

■ Definition and epidemiology of acute respiratory distress syndrome

Emanuele Rezoagli, Roberto Fumagalli, Giacomo Bellani

Ann Transl Med. 2017 Jul; 5(14): 282

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5537110/

■ What every intensivist should know about acute respiratory distress syndrome and diffuse alveolar damage

Fernando Rios, Teresa Iscar, Pablo Cardinal-Fernández

Rev Bras Ter Intensiva. 2017 Jul-Sep; 29(3): 354–363

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5632979/

■ Oxigenação por membrana extracorpórea na síndrome do desconforto respiratório agudo devido à pneumonia por influenza A (H1N1) pdm09. Experiência em um único centro durante a temporada de 2013-2014

Menon, Nithya et al.

Rev. bras. ter. intensiva, Set 2017, vol.29, no.3, p.271-278

http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0103-507X2017000300271&lng=pt&nrm=iso

■ Estratégia ventilatória protetora e manobra de recrutamento alveolar em paciente com síndrome do desconforto respiratório agudo por leptospirose.

Gomes, Natália Paula, Menescal, Zilaís Linhares Carneiro and Holanda, Marcelo Alcântara