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ABSTRACT: The World Health Organization considers iodine deficiency as a major worldwide cause of mental and development diseases, estimating that about 13% of the world population is affected by diseases caused by iodine deficiency. Iodine is a trace element necessary for the synthesis of thyroid hormones which, since it cannot be formed by the organism, must be taken regularly with food. Fish and shellfish are generally a good source, because the ocean contains a considerable amount of iodine. On the contrary, plants which grow in iodine-deficient soils are poor in this element, as well as meat and other animal products fed in plants low in iodine. Salt is the best way for iodine supplementation. Cooking the food with iodized salt is a desirable practice because it guarantees the presence of this element. There are also other methods to provide iodine to the general population, such as adding iodine to drinking water or taking supplements of iodine. In pregnancy is recommended iodine supplementation, except in patients with known thyroid disorders. Iodine is an essential component of thyroid hormones (T4 and T3). Inadequate iodine intake leads to inadequate thyroid hormone production. The most important consequences of iodine deficiency, in the general population are goiter and hypothyroidism, and in the severe cases, mental retardation, cretinism and increased neo-natal and infant mortality. The International Council for the Control of Iodine Deficiency Disorders (ICCIDD) formed in 1985, with the only aim of achieving optimal iodine nutrition in the world, in cooperation with UNICEF and WHO. In Portugal, recent studies show significant deficiencies in pregnancy and The Portuguese Society of Endocrinology Diabetes and Metabolism, in partnership with General Directorate of Health, proposed an iodine supplementation during pregnancy with 150-200µg/day.
Acta medica portuguesa 05/2012; 25(3):174-8. · 0.09 Impact Factor
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ABSTRACT: Diabetes mellitus is a progressive disease and the rapid growth of this global prevalence has been a worldwide concern. About a third of Portuguese population has type 2 diabetes or pre-diabetes. 2 DM is associated with significant morbidity and mortality, although the treatment so far available it is a high percentage of patients who do not achieve the proposed objectives. Vildagliptin is an inhibitor of oral DPP-4, the most studied of this new class. Inhibiting the rapid degradation of incretins, the vildagliptin increases levels of GLP-1, getting this hormone available to modulate the function of a and ß cells.
This study aims to characterize the first patients with DM2 treated with vildagliptin in the Department of Endocrinology, Diabetes and Metabolism at the Military Hospital.
Retrospective study with the first 70 patients treated with vildagliptin, between October and December 2008. The information collected was demographic data, disease duration, associated diseases and their medication, metabolic control in the beginning of the disease (values HbA1c) and criteria for use of vildagliptin.
Among the patients included in the study, 55, 7% were male, with the average age of 63, 3 years. These patients had a average duration of diabetes of 11, 7 years. Hypertension was the most frequent associated pathology (85.7% of patients), although dyslipidemia and obesity have a high percentage, 80% and 51% respectively. All patients were overweight (BMI =25 Kg/m(2)). More than half of the patients (55,7%) were on monotherapy until the introduction of vildagliptin, having been associated with other oral antidiabetic agents in all patients.
Most of patients showed risk factors, for witch they were medicated. Vildagliptin has been added mostly in patients medicated with metformin. It is suggested that the therapeutic approach in type 2 diabetes is more and more early, effective and secure.
Acta medica portuguesa 07/2011; 24(4):555-60. · 0.09 Impact Factor
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Thyroid: official journal of the American Thyroid Association 02/2010; 20(2):235-6. · 2.60 Impact Factor
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João Jácome de Castro,
Teresa Dias,
Paula Chambel,
Manuela Carvalheiro,
Luís Gardette Correia,
Liliana Guerreiro,
Olinda Marques,
José Luís Medina,
Ema Nobre,
José Silva Nunes,
Maria Carlos Pereiraa,
Jorge Polónia,
Jorge Portugal,
Anabela Raimundo,
Almeida Ruas,
Pedro Marques da Silva,
Carlos Vasconcelos,
José Lima Reis,
Alberto Galvão Teles
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ABSTRACT: Obesity is a chronic disease and a serious health problem that leads to increased prevalence of diabetes, hypertension, dyslipidemia and gallbladder disease.
To evaluate the efficacy of orlistat for weight loss and improved lipid profile compared to placebo in obese patients with hypercholesterolemia, treated over a period of 6 months.
In a 6-month, multicenter (10 centers in Portugal), double-blind, parallel, placebo-controlled study, 166 patients, aged 18-65 years, body mass index (BMI) > or = 27 kg/m2, LDL cholesterol > 155 mg/dl, were randomized to a reduced calorie diet (600 kcal/day deficit) plus orlistat three times a day or placebo. Exclusion criteria included triglycerides > 400 mg/dl, severe cardiovascular disease, uncontrolled hypertension, type 1 or 2 diabetes under pharmacological treatment, and gastrointestinal or pancreatic disease.
The mean difference in weight from baseline was 5.9% (5.6 kg) in the orlistat group vs. 2.3% (2.2 kg) in the placebo group. In the orlistat group 49% of patients achieved 5-10% weight loss and 8.8% achieved > 10%. The orlistat group showed a significant reduction in total and LDL cholesterol, with similar changes for HDL in both treatment groups. The frequency of gastrointestinal adverse events was slightly higher in the orlistat group than in the placebo group, leading to discontinuation in 7 patients.
Treatment with orlistat plus a reduced calorie diet for 6 months achieved significant reductions in weight, BMI and lipid parameters.
Revista portuguesa de cardiologia: orgao oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology: an official journal of the Portuguese Society of Cardiology 12/2009; 28(12):1361-74.
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ABSTRACT: INTRODUCTION: In January 2005, during the annual meeting of the Portuguese Society of Endocrinology, Diabetes and Metabolism, a questionnaire on the treatment and follow-up of differentiated thyroid carcinoma (DTC) was given to attendants. The aim of this study was to present the survey's results. METHODS: The questionnaire addressed the following issues: the surgical treatment of the gland and cervical lymph nodes, whole body scan and ablation with (131)I, suppression with levothyroxine, and treatment of recurrence and metastases. Fifty-four completed questionnaires were obtained (79% from clinical endocrinologists). RESULTS: When DTC is diagnosed, 67% of respondents reported that total thyroidectomy is always performed. When the diagnosis is made postsurgically, completion of thyroidectomy is recommended by 70% of respondents for papillary carcinoma, by 67% for papillary microcarcinoma and by 44% for minimally invasive follicular carcinoma. Most respondents recommend lymph node dissection if the nodes are involved; 61% systematically perform whole body scan with (131)I after surgery. Twenty-eight percent routinely perform ablation of the thyroid, and 59% request adjuvant radioiodine ablation of the thyroid bed if there is (131)I uptake, if thyroglobulin is increased, or if risk factors are present. The most commonly used ablation dose is 100 mCi. Consensus on the degree of TSH suppression is lacking. Twenty-two percent of the respondents recommend surgery as the first therapeutic option in recurrence and metastases, while 57% prefer (131)I for the treatment of local recurrence. When thyroglobulin levels remain high and the results of (131)I scanning are negative, 50% choose computed tomography scan for the diagnosis of disease recurrence. CONCLUSIONS: The wide variability of responses in this survey and the significant percentage (11 to 41%) of non-responders demonstrates the lack of uniformity in the treatment protocols for DCT in Portugal. According to the published guidelines and the responses to a similar survey performed in Spain, the widest differences are mainly found in lymph node dissection and the treatment of disease recurrence.
Endocrinología y Nutrición 08/2008; 55(7):283-288.
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ABSTRACT: The best diagnostic and treatment strategy for an approach to the nodular thyroid disease continues to be a controversial issue.
The aim of this study was to characterise medical practice in the diagnosis and treatment of nodular thyroid disease by endocrinologists and surgeons in Portugal in 2002.
A questionnaire based on that used by the European Thyroid Association and the American Thyroid Association was drawn up. The questionnaire, based on a well-defined index case, was circulated by the Portuguese Endocrinology Society to endocrinologists and surgeons: 42 year-old woman with solitary thyroid nodule measuring 2 x 3 cm, with no history of malfunction or painful symptoms. Each doctor was asked to reply as to the adopted diagnosis and therapy procedures for the index case. Eleven variations to the original case were proposed in order to evaluate the alterations for each variation.
1492 questionnaires were sent out, 163 to endocrinologists and 1329 to surgeons. A total of 104 were returned. The global response rate was 7%. The response rate for endocrinologists was 27% and 4.5% for surgeons. Of the 104 questionnaires returned, 42% were from endocrinologists and 58% from surgeons. Concerning tests prescribed, surgeons would use more tests than endocrinologists for the index case. The main differences in laboratory terms were the higher number of prescriptions for total T4 and T3 and thyroglobulin by surgeons and more prescriptions for AATPO by endocrinologists. The average number of tests was 4.6, 4.1 for endocrinologists and 5.1 for surgeons. Relative to imaging and cytology, 32% of doctors advocated a scintigraphy to diagnose the index case, with no significant differences between endocrinologists and surgeons. Ultrasonography was used by over 85% of respondents. 90% prescribed a cytology, 83% guided by palpation and 18% ultrasonography-guided. Concerning treatment, 33% of doctors advocated levothyroxin treatment; surgery was advocated by 16.3% of endocrinologists and 36.6% of surgeons. Meanwhile, the majority of doctors (68%) would opt for no treatment and simply maintain the patient under surveillance.
There are important differences in the approach to nodular thyroid disease among the various doctors and specialists, which highlight the difficulty in achieving a diagnostic and therapeutic consensus.
Acta medica portuguesa 18(6):403-8. · 0.09 Impact Factor
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Fernando Rodrigues,
Edward Limbert,
Ana Paula Marques,
Ana Paula Santos,
Carlos Lopes,
Elizabete Rodrigues,
Fátima Borges,
Francisco Carrilho, João Jácome de Castro,
João Neto,
Lucília Salgado,
Maria João Oliveira
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ABSTRACT: Differentiated thyroid carcinoma of follicular origin (DTCFO), although not very frequent, has registered a raising incidence in the last decades. In the majority of the cases, DTCFO is a curable disease when treated and monitored by experienced, multidisciplinary teams. These factors contribute to an increasing number of DTCFO survivors requiring life-long monitoring, due to the possibility of occurrence of recurrences many years after the initial treatment. Several aspects of the treatment and management of these patients are still controversial. The present protocol represents the consensus of the members of the Grupo de Estudo da Tiróide of the Sociedade Portuguesa de Endocrinologia, Diabetes e Metabolismo. It aims to define guidelines, in agreement with the current state of the art and contemplating the necessary adaptations to local constrains, that ensure decreased mortality and protection of patients' quality of life, avoiding unnecessarily aggressive or ineffective treatments, optimizing the use of the available resources.
Acta medica portuguesa 18(1):2-16. · 0.09 Impact Factor
