Revisiones bibliográficas. Documentación científica en Ortopedia y Traumatología, medicina deportiva, artroscopia, artroplastia y de todas las patologías del sistema Músculo-Esquelético
Embarazo ectópico abdominal secundario a perforación uterina por interrupción voluntaria del embarazo: presentación de caso
Jónathan Hernández Núñez, Alexander Abreu Díaz, Ndivhuwo Michael Ndwambi, Fermín Luis Martínez (Sudáfrica, Argelia) Medwave 2017 Jul;17(6):e7000
COMENTARIOS
Evidencia e información en medicina
Miguel Hugo Kottow Lang (Chile) Medwave 2017 Jul;17(6):7004
Enfrentando el suicidio de un paciente: el impacto sobre los médicos
Marcelo Arancibia, Juan Carlos Martínez-Aguayo, Eva Madrid (Chile) Medwave 2017 Jul;17(6):e6986
Enfermedades tiroideas. Enfoque en el hipertiroidismo
Thyroid Disorders - Focus on Hyperthyroidism
Edited by Gonzalo Diaz Soto, ISBN 978-953-51-1384-3, 278 pages, Publisher: InTech, Chapters published May 21, 2014 under CC BY 3.0 license DOI: 10.5772/57001 Edited Volume The thyroid disorders are one of the most common and exciting areas of endocrinology. Hypothyroidism, multinodular goiter, hyperthyroidism and thyroid cancer are only few of the several implications that the thyroid disorders have in health. In fact, thyroid hormones regulate not only metabolism process, but also many other molecular and physiological systems. From this point of view, hyperthyroidism complications are a good example of the significance of thyroid hormone actions. This book aims to provide a general view of thyroid disorders, and a deeper explanation of hyperthyroidism and its complications and impact in health.
Edited by Drahomira Springer, ISBN 978-953-51-0020-1, 266 pages, Publisher: InTech, Chapters published February 17, 2012 under CC BY 3.0 license DOI: 10.5772/1215 Edited Volume Hypothyroidism is the most common thyroid disorder. It can cause a variety of changes in women's menstrual periods, reduce their chances of becoming pregnant, as well as affect both the course of pregnancy and the neuropsychological development of babies. During pregnancy there is a substantially increased need for thyroid hormones and a substantial risk that a previously unnoticed, subclinical or latent hypothyroidism will turn into overt hypothyroidism. The thyroid inflammation caused by the patient's own immune system may form autoimmune thyroiditis (Hashimoto's thyroiditis). Congenital hypothyroidism (CH) occurs in approximately 1:2,000 to 1:4,000 newborns. Nearly all of the developed world countries currently practice newborn screening to detect and treat congenital hypothyroidism in the first weeks of life. "A New Look at Hypothyroidism" contains many important specifications and innovations for endocrine practice.
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OBJECTIVE: An anaesthetic approach and surgery are important treatment strategies in patients with thyroid dysfunction due to potential complications. We investigated the prevalence of thyroid disorders, the significance of thyroid function tests (TFTs) with respect to anaesthesia in the preoperative period and the need for routine examinations. METHODS: A total of 10,600 patients who were admitted to the anaesthesiology outpatient clinic for surgery were retrospectively screened and enrolled between 2011 and 2013. Evident hypothyroidism was defined as free tetra-iodothyronine (fT4) <0.7 ng dL(-1) and thyroid-stimulating hormone (TSH) >4 mIU mL(-1), and subclinical hypothyroidism was defined as TSH >4 mIU mL(-1) with normal free hormone levels. Evident hyperthyroidism was defined as fT4 >1.7 ng dL(-1) and TSH <0.1 mIU mL(-1), and subclinical hyperthyroidism was defined as TSH <0.1 mIU mL(-1) with normal free hormone levels. Statistical analysis was conducted using the Statistical Package for the Social Sciences (SPSS) version 17.0. Independent samples t-test and one-way analysis of variance were used to compare the difference between groups. RESULTS: Of the participants, 8.5% were found to have hypothyroidism, 2.5% had hyperthyroidism, 3.5% received treatment and 2.5% had their treatment postponed. The likelihood of hypothyroidism was greater among females, and no difference was found between genders with respect to hyperthyroidism. CONCLUSION:
We believe that TFTs are important because of regional factors. However, given the high cost of TFTs and because thyroid dysfunction risk increases with age, we concluded that routine TFTs in young patients with normal physical examination findings are not mandatory.
KEYWORDS: Thyroid function tests; hyperthyroidism; hypothyroidism; iodine
Hyperthyroidism is a common disease of the endocrine system and it is known that additional propofol anaesthesia is required during surgery for patients with hyperthyroidism compared with those with normal thyroid function. The aim of the present study was to determine the mechanism through which thyroid hormones (THs) inhibit the effect of propofol anaesthesia. Immunofluorescence techniques were used to verify the difference between the expression quantities of γ-aminobutyric acid type A (GABAA) receptor subunits α2 and β2 in the dorsal root ganglions (DRGs) of rats with hyperthyroidism and those in normal rats. Perforated patch clamp recordings in the whole-cell mode were performed to detect the GABA-activated current in acutely isolated rat DRG neurons from rats with hyperthyroidism and normal rats. This method was also used to evaluate the change in the GABA-activated currents following the pre-perfusion of propofol with and without 3,3',5-L-triiodothyronine (T3). Compared with normal rats, rats with hyperthyroidism expressed same quantities of GABAA receptor α2 and β2 subunits in DRGs. In addition, no difference in GABA-activated currents in the acutely isolated DRG neurons from the two types of rat was observed (P>0.05). T3 inhibits or minimises the augmentation effect of propofol on the GABA-activated currents (P<0.05). The inhibitory effect of T3 on propofol was minimised by increasing the propofol concentration (P<0.05). The inhibitory effect of T3 on the anaesthetic effect of propofol is achieved through the inhibition of the function of GABAA receptors through the non-genomic actions of the THs, rather than by changing the number of GABAA receptors. This inhibitory effect can be mitigated by increasing the propofol concentration. In conclusion, rats with hyperthyroidism require a larger dose of propofol to induce anaesthesia since the non-genomic actions of THs suppress GABA receptors, which in turn inhibits the anaesthetic action of propofol.
