hipotireoidismo e hipertireoidismo – uma breve revisão

HIPOTIREOIDISMO E HIPERTIREOIDISMO – UMA BREVE REVISÃO
SOBRE AS DISFUNÇÕES TIREOIDIANAS
2/,9(,5$9DQHVVD
)DFXOGDGH0XQLFLSDO3URIHVVRU)UDQFR0RQWRUR)03)0
YDQQXWUL#KRWPDLOFRP
MALDONADO, Rafael Resende
)DFXOGDGH0XQLFLSDO3URIHVVRU)UDQFR0RQWRUR)03)0
UDWDIWD#\DKRRFRPEU
RESUMO+LSRWLUHRLGLVPRHKLSHUWLUHRLGLVPRVmRGLVIXQo}HVGDJOkQGXODWLUHRLGHTXHFDXVDPGLYHUVDV
DOWHUDo}HVQRRUJDQLVPRKXPDQR(VWHWUDEDOKRWHYHFRPRREMHWLYRUHDOL]DUXPDUHYLVmRGDOLWHUDWXUD
VREUHDVSHFWRVJHUDLVGHVVDVGXDVGLVIXQo}HVWDLVFRPRWLSRVGH¿QLo}HVVLQWRPDVHIHLWRVVREUHR
RUJDQLVPR GLDJQyVWLFRV H WUDWDPHQWR )RL UHDOL]DGD XPD EXVFD GH DUWLJRV FLHQWt¿FRV HP GLIHUHQWHV
EDVHV GH GDGRV FRP WHUPRV DVVRFLDGRV D KLSRWLUHRLGLVPR H KLSHUWLUHRLGLVPR ([LVWH YDVWD OLWHUDWXUD
VREUHRDVVXQWRLQGLFDQGRTXHHVWDVGLVIXQo}HVSRGHPRFRUUHUGHGLIHUHQWHVIRUPDVFRPLPSDFWRV
QRVLVWHPDFDUGLRYDVFXODUSXOPRQDUFpUHEURHWDPEpPGXUDQWHDJHVWDomR2GLDJQyVWLFRpIHLWRDWUD
YpVGDGRVDJHPGRVKRUP{QLRV76+7H74XDQWRjTXHVWmRQXWULFLRQDOSRXFRVWUDEDOKRVIRUDP
HQFRQWUDGRVVREUHRSDSHOGDDOLPHQWDomRWDQWRQRVXUJLPHQWRFRPRQRFRQWUROHGHVWDVGLVIXQo}HV
PALAVRAS-CHAVE+LSRWHLURLGLVPRKLSHUWLUHRLGLVPRGRHQoDGH*UDYHVVLVWHPDFDUGLRYDVFXODUDWL
YLGDGHItVLFD
ABSTRACT: +\SRWK\URLGLVPDQGK\SHUWK\URLGLVPDUHGLVRUGHUVRIWK\URLGJODQGZKLFKFDXVHVHYHUDO
FKDQJHVLQWKHKXPDQERG\7KLVVWXG\DLPHGWRUHYLHZWKHOLWHUDWXUHRQJHQHUDODVSHFWVRIWKHVHWZRGLVRUGHUVVXFKDVW\SHVGH¿QLWLRQVV\PSWRPVHIIHFWVRQWKHERG\GLDJQRVLVDQGWUHDWPHQW$VHDUFKRI
VFLHQWL¿FDUWLFOHVLQGLIIHUHQWGDWDEDVHVZLWKDVVRFLDWHGK\SRWK\URLGLVPDQGK\SHUWK\URLGLVPWHUPVZDV
SHUIRUPHG7KHUHLVYDVWOLWHUDWXUHRQWKHVXEMHFWLQGLFDWLQJWKDWWKHVHGLVRUGHUVFDQRFFXULQGLIIHUHQW
ZD\VZLWKLPSDFWVRQWKHFDUGLRYDVFXODUV\VWHPOXQJEUDLQDQGDOVRGXULQJSUHJQDQF\7KHGLDJQRVLV
LVPDGHE\WKHGRVDJHRIWKHKRUPRQHV76+7DQG75HJDUGLQJQXWULWLRQDOLVVXHIHZVWXGLHVZHUH
IRXQGDERXWWKHUROHRIIRRGERWKLQDSSHDUDQFHDVLQFRQWUROOLQJWKHVHGLVRUGHUV
KEYWORDS: +\SRWK\URLGLVPK\SHUWK\URLGLVP*UDYHVGLVHDVHFDUGLRYDVFXODUV\VWHPSK\VLFDODFWLYLW\
1. INTRODUÇÃO
+LSRWLUHRLGLVPR H KLSHUWLUHRLGLVPR
VmR GXDV GLVIXQo}HV GD JOkQGXOD WLUHRLGH
TXH FDXVDP XPD VpULH GH DOWHUDo}HV QR
RUJDQLVPR KXPDQR 2 KLSRWLUHRLGLVPR p
GH¿QLGRFRPRXPHVWDGRFOtQLFRUHVXOWDQWH
GH TXDQWLGDGH LQVX¿FLHQWH RX DXVrQFLD GH
KRUP{QLRVFLUFXODQWHVGDJOkQGXODWLUHRLGH
GHQRPLQDGRV 7 WLUR[LQD H 7 WULLRGR
WLURQLQD SDUD VXSULU XPD IXQomR RUJkQLFD
QRUPDO (QTXDQWR TXH R KLSHUWLUHRLGLVPR
FRQVLVWH HP XP HVWDGR KLSHUPHWDEyOLFR
FDXVDGR SHOR DXPHQWR QD IXQomR GD JOkQ
dula tireoide e, consequente, aumento dos
QtYHLVFLUFXODQWHVGRVKRUP{QLRV7H7OL
YUHV$VFDXVDVPDLVFRPXQVVmRKLSHUSOD
36
VLDGLIXVDGDWLUHRLGHDVVRFLDGDjGRHQoDGH
*UDYHVEyFLRPXOWLQRGXODUKLSHUIXQFLRQDQ
WHHDGHQRPDKLSHUIXQFLRQDQWHGDWLUHRLGH
2. HIPOTIREOIDISMO
+LSRWLUHRLGLVPR p GH¿QLGR
FRPRXPHVWDGRFOtQLFRUHVXOWDQWHGHTXDQ
WLGDGH LQVX¿FLHQWH RX DXVrQFLD GH KRUP{
QLRVFLUFXODQWHVGDJOkQGXODWLUHRLGHGHQR
PLQDGRV7WLUR[LQDH7WULLRGRWLURQLQD
SDUD VXSULU XPD IXQomR RUJkQLFD QRUPDO
$ IRUPD PDLV SUHYDOHQWH p D GRHQoD WL
UHRLGLDQD SULPiULD GHQRPLQDGD GH KLSRWL
UHRLGLVPR SULPiULR TXH p XPD GH¿FLrQFLD
KRUPRQDO FDXVDGD GHYLGR j LQFDSDFLGDGH
SDUFLDORXWRWDOGDJOkQGXODWLUHRLGHGHSUR
Interciência
& Sociedade
,QWHUFLrQFLD6RFLHGDGH,6619RO1
GX]LU RV KRUP{QLRV WLUHRLGLDQRV 0h//(5
HWDO1RHQWDQWRRKLSRWLUHRLGLVPR
SRGHVHDSUHVHQWDUGHRXWUDVPDQHLUDVWDLV
FRPR KLSRWLUHRLGLVPR FRQJrQLWR FHQWUDO H
VXEFOtQLFR
2 KLSRWLUHRLGLVPR FRQJrQLWR +&
p D FDXVD PDLV FRPXP GH UHWDUGR PHQWDO
SDVVtYHO GH SUHYHQomR (OH UHVXOWD GD GH
¿FLrQFLD GRV KRUP{QLRV WLUHRLGLDQRV IXQ
damentais na organogênese do sistema
QHUYRVR FHQWUDO DWp RV GRLV DQRV GH YLGD
quando estimulam o crescimento dos den
GULWRVHD[{QLRVDOpPGHFRQWULEXtUHPSDUD
D IRUPDomR GR FyUWH[ FHUHEUDO DQWHULRU KL
SRFDPSR FyUWH[ DXGLWLYR H FHUHEHOR %(
1(9,'(6HWDO
*HUDOPHQWH HVWH WLSR GH KLSHUWL
UHRLGLVPR p GHFRUUHQWH GH GHIHLWRV QD IRU
mação glandular durante a embriogênese e
HYLGrQFLDV VXJHUHP TXH PXWDo}HV QRV ID
WRUHVGHWUDQVFULomR77)77)H3$;
PXLWDVYH]HVVmRRVUHVSRQViYHLVSHODGR
HQoD$IDOWDGHHVWtPXORGR76+KRUP{QLR
HVWLPXODGRUGDWLUHRLGHQDJOkQGXODWLUHRLGH
OHYDDRFRUUrQFLDGDGRHQoDPRWLYDGDSRU
PiIRUPDomRRXGLVIXQomRKLSRIiVLFDRXKL
SRWDOkPLFD2FRUUHJHUDOPHQWHSRUGLVKRU
PRJrQHVHGDJOkQGXODWLUHRLGHSRUGHIHLWR
QR WUDQVSRUWDGRU GH LRGHWR QD PHPEUDQD
EDVDO HRX DSLFDO GHIHLWRV QD VtQWHVH GD
7* RX GHIHLWRV QD RUJDQL¿FDomR GR LRGHWR
3(5521(HWDO$ELRVVtQWHVHGRV
KRUP{QLRV GD WLUHRLGH WHP QD HQ]LPD WLUH
RSHUR[LGDVH 732 XPD IXQomR FKDYH GH
FDWDOLVDULPSRUWDQWHVUHDo}HV0XWDo}HVQR
gene relacionado a esta enzima são consi
GHUDGRVDSULQFLSDOFDXVDGH+&SRUGLVRU
PRQRJrQHVH628=$
'RHQoDV QHXURSVLTXLiWULFDV SR
GHPDSUHVHQWDUP~OWLSORVHQIRTXHVGHQWUH
HOHVUHODomRFRPRVKRUP{QLRVGDWLUHRLGH
Pesquisa realizada com um menino de cin
FRDQRVGHLGDGHFRPKLSRWLUHRLGLVPRFRQ
JrQLWRDVVRFLDGRDSUREOHPDVGRGHVHQYRO
YLPHQWRGHRUGHPLQVWUXPHQWDOHHVWUXWXUDO
UHODWDUHWDUGRQRGHVHQYROYLPHQWRSVLFRPR
WRU SULQFLSDOPHQWH QD IDOD KLSRWRQLD PXV
FXODU H KLSRDFXVLD ELODWHUDO$ HYROXomR GR
FDVRUHODWDGRDSRQWRXPHOKRUDGDVLQWRPD
WRORJLD DVVLP TXH VH REWHYH FRQWUROH GRV
KRUP{QLRV WLUHRLGRV %UDJDWWL:LQFNOHU 5RWWD
3UREOHPDV IRQRXGLROyJLFRV WDP
37
EpP VmR UHODWDGRV HP FULDQoDV TXH DSUH
VHQWDPKLSRWLUHRLGLVPRFRQJrQLWR7UDEDOKR
UHDOL]DGR FRP FULDQoDV GH D DQRV QR
$FUHHHP5RQG{QLDDSRQWDRXSDUDDWUDVR
QRLQtFLRGDOLQJXDJHPRUDOWURFDVQDIDOD
IDOD LQLQWHOLJtYHO FRPSRUWDPHQWR DJLWDGR H
FRPSRUWDPHQWR QHUYRVR 9HUL¿FRXVH DOWH
UDomRQDIDODHPGRJUXSRDYDOLDGRH
DOWHUDomR DXGLWLYD HP 3DUD DTXHOHV
TXHWLYHUDPGLDJQyVWLFRHWUDWDPHQWRPDLV
WDUGLRGRKLSRWLUHRLGLVPRRtQGLFHGHTXHL
[DVIRLPDLRUGRTXHSDUDDTXHOHVFRPGLDJ
QyVWLFR H WUDWDPHQWR PDLV SUHFRFH )(5
5(,5$ HW DO $ LQFLGrQFLD GR +& p
YDULiYHOVHQGRTXHQR%UDVLOHODpGHDSUR
[LPDGDPHQWHFDVRSDUDFDGDQDVFL
GRVYLYRV'(&$59$/+2HWDO
2 KLSRWLUHRLGLVPR SULPiULR +3
SRGH VHU SHUPDQHQWH RX WUDQVLWyULR &HUFD
GHGR+3SHUPDQHQWHpGHFRUUHQWHGH
defeitos na formação glandular durante a
HPEULRJrQHVH H p GHQRPLQDGR GLVJHQHVLD
WLUHRLGLDQD ./(77 3RU RXWUR ODGR
GHIHLWRV JHQpWLFRV QR GHVHQYROYLPHQWR H
IXQomR GD KLSy¿VH SRGHP UHVXOWDU HP Yi
ULDVIRUPDVGHGH¿FLrQFLDFDUDFWHUtVWLFDVGR
KLSRWLUHRLGLVPR FHQWUDO 3(5521( HW DO
2KLSRWLUHRLGLVPRFHQWUDORFRUUHSRU
GH¿FLrQFLD GH KRUP{QLRV WLUHRLGLDQRV SRU
IDOWD GH HVWtPXOR GR76+ KLSR¿ViULR RX GR
75+KRUP{QLROLEHUDGRUGDWLUHRWUR¿QDKL
SRWDOkPLFR
(QTXDQWR LVVR R KLSRWLUHRLGLV
PR VXEFOtQLFR +6 RX GRHQoD WLUHRGLDQD
PtQLPD p GH¿QLGR SHOD HOHYDomR GR QtYHO
VpULFRGR76+DFLPDGROLPLWHVXSHULRUGD
QRUPDOLGDGHDVVRFLDGDDQtYHLVQRUPDLVGH
WLUR[LQDOLYUH7/3,0(17(/+$16(1
7(,;(,5$HWDO2XWURWUDED
OKR UHODWD TXH R KLSRWLUHRLGLVPR VXEFOtQLFR
6+7 p XPD GLVIXQomR FDUDFWHUL]DGD SRU
YDORU VpULFR DXPHQWDGR GR 76+ FRP FRQ
FHQWUDo}HVQRUPDLVGH7H7QDDXVrQ
FLD GH VLQWRPDV FOtQLFRV PDQLIHVWRV (VWD
HQWLGDGH Mi IRL GHQRPLQDGD GH KLSRWLUHRL
GLVPRSUpFOtQLFRGLPLQXLomRGDUHVHUYDGD
WLUHRLGHRXPL[HGHPDSUpFOtQLFR520$/
',1, 6*$5%, )$5$+ $ SUHYD
OrQFLDGR6+7YDULDFRPDLGDGHHRVH[R
GD SRSXODomR VHOHFLRQDGD GH D HTXDQGRDFRPSDQKDGRGHYDORUHVHOHYD
GRVGHDQWLFRUSRVDQWLWLURLGHDQRVRULVFRGH
SURJUHVVmRSDUDKLSRWLUHRLGLVPRFOtQLFDDX
Interciência
& Sociedade
,QWHUFLrQFLD6RFLHGDGH,6619RO1
PHQWDHPDRDQR,QFLGHPDLVQRVH[R
IHPLQLQR H SULQFLSDOPHQWH HP SDFLHQWHV
FRPPDLVGHDQRVGHLGDGHSRGHQGRDO
FDQoDUtQGLFHVGH
2 KLSRWLUHRLGLVPR VXEFOtQLFR SD
UHFH VHU R SULPHLUR VLQDO GH GLVIXQomR GD
WLUHRLGH H SDUHFH HVWDU UHODFLRQDGR FRP
HYHQWRVFDUGLRYDVFXODUHVPRUWDOLGDGHGLV
OLSHGPLDGHSUHVVmRHGp¿FLWFRJQLWLYR(V
WXGRV UHFHQWHV VXJHUHP SRUpP TXH HVWD
VHMD XPD SRVVtYHO FRQGLomR LQHUHQWH DR
HQYHOKHFLPHQWR DWXDQGR FRPR XPD DGDS
WDomR¿VLROyJLFDGHSURWHomRjVH[LJrQFLDV
GH FRQVXPR H[DJHUDGR RX FDWDEROLVPR$
DYDOLDomR GRV KRUP{QLRV WLUHRLGLDQRV HP
LGRVRV p FRPSOH[D GHYLGR j SUHVHQoD GH
doenças concomitantes e uso frequente de
PHGLFDo}HVTXHSRGHPLQÀXHQFLDUDGRVD
JHP GHVWHV KRUP{QLRV H D VLQWRPDWRORJLD
WDPEpP p GLIHUHQWH FRP R DYDQoR GHVWD
LGDGH GH IRUPD TXH WDQWR RV QtYHLV GH UH
IHUrQFLD GRV KRUP{QLRV WLUHRLGLDQRV FRPR
R WUDWDPHQWR DSOLFDGR GHYHP VHU GLIHUHQ
FLDGRV HP IDL[DV HWiULDV PDLV DYDQoDGDV
5$8(1HWDO
8PGRVLPSDFWRVUHODFLRQDGRV DR
6+7GL]UHVSHLWRjSUHVFULomRGHH[HUFtFLRV
ItVLFRV 2V KRUP{QLRV GD WLUHRLGH DWXDP
VREUH R VLVWHPD FDUGLRYDVFXODU UHJXODQGR
D FRQWUDomR H R UHOD[DPHQWR GR P~VFXOR
FDUGtDFRDOpPGHUHJXODURW{QXVYDVFXODU
1R KLSRWLUHRLGLVPR VXEFOtQLFR TXDQGR Ki
QtYHLV DOWHUDGRV GH 7 H 7 RFRUUHP GLV
IXQo}HVFRPRSRUH[HPSORGLPLQXLomRGD
FRQWUDWLOLGDGHHGDIUHTXrQFLDFDUGtDFDGL
PLQXLomRGRGpELWRFDUGtDFRGLPLQXLomRGD
SUHVVmRDUWHULDOHGDYDULDELOLGDGHGDIUHTX
rQFLDFDUGtDFDDOpPGHDXPHQWRQRVQtYHLV
GHFROHVWHUROVpULFRHGLPLQXLomRGDVHQVLEL
OLGDGHjLQVXOLQD8PGRVWUDWDPHQWRVSDUD
UHYHUWHU RV FRPSURPHWLPHQWRV FDUGLRYDV
FXODUHV FDXVDGRV SHOR KLSRWLUHRLGLVPR p D
UHSRVLomRKRUPRQDOFRPOHYRWLUR[LQD$LQGD
KiSRVVLELOLGDGHGDSUiWLFDGHH[HUFtFLRVIt
VLFRV SDUD DMXGDU WDQWR QD SDUWH UHVSLUDWy
ULDTXDQWRQDSDUWHYDVFXODUFDUGLRYDVFXODU
&2(/+2HWDO
9iULRVHVWXGRVDVVRFLDPR6+7D
IDWRUHVGHULVFRGHGRHQoDDUWHURVFOHUyWLFD
PDVSRXFRVFRUUHODFLRQDPHVVHGLVW~UELRj
GLPLQXLomR GD WROHUkQFLD DR HVIRUoR ItVLFR
$UHSRVLomRKRUPRQDOFRP/WLUR[LQDQRWUD
WDPHQWRGRVGRHQWHVSHUPDQHFHFRQWURYHU
38
VD0XOKHUHVSRUWDGRUDVGH6+7QDIDL[DGH
DDQRVFRP76+DFLPDGHP8/
7 OLYUH H 7 QRUPDLV IRUDP DYDOLDGDV HP
WHVWH GH HVIRUoR SURJUHVVLYR FRP DQiOLVH
GDFRQFHQWUDomRGHODFWDWRVDQJXtQHRQRV
SHUtRGRV SUp H SyVWUDWDPHQWR FRP /WLUR
[LQDHREVHUYRXVHPHOKRUDVLJQL¿FDWLYDQD
WROHUkQFLDDRODFWDWRHFRQVHTXHQWHPHQWH
WROHUkQFLD DR HVIRUoR DSyV R WUDWDPHQWR
PRVWUDQGR R SRWHQFLDO GD /WLUR[LQD VyGLFD
SDUDDXPHQWDUDWROHUkQFLDDRHVIRUoRItVLFR
SURJUHVVLYR HP SRUWDGRUDV GH 6+7 GON
d$/9(6HWDO
Em outro trabalho foi feito um le
YDQWDPHQWR GH HVWXGRV SXEOLFDGRV HQWUH
H QD EDVH GH GDGRV 3XE0HG
FRQVLGHUDQGR DUWLJRV TXH DYDOLDUDP D IXQ
omRFDUGLRYDVFXODUGHKLSRWLUHRLGHRVVXEFOt
QLFRV H FOtQLFRV H D LQÀXrQFLD GR H[HUFtFLR
ItVLFR VREUH DV IXQo}HV FDUGLRYDVFXODUHV
DIHWDGDV QHVWD GRHQoD 9HUL¿FRXVH TXH D
FDSDFLGDGH DHUyELD GH KLSRWLUHRLGHRV VXE
FOtQLFRV H FOtQLFRV HVWi UHGX]LGD H TXH D
IXQomR HQGRWHOLDO R HVWUHVVH R[LGDWLYR H D
IXQomRDXWRQ{PLFDHVWmRSUHMXGLFDGRVQHV
WHVVXMHLWRV$SHVDUGHVHUXPDHQIHUPLGD
GH WmR SUHYDOHQWH TXDQWR R GLDEHWHV QmR
H[LVWH XPD UHFRPHQGDomR SDUD SUHVFULomR
GH DWLYLGDGH ItVLFD SDUD RV KLSRWLUHRLGHRV
WDOFRPRKiSDUDREHVRVFDUGLRSDWDVHGLD
EpWLFRV628=$HWDO
8P HVWXGR UHDOL]DGR FRP SDFLHQ
WHVSRUWDGRUHVGHKLSRWLUHRLGLVPRVXEFOtQLFR
DYDOLRX GXUDQWH VHLV PHVHV R WUHLQDPHQWR
DHUyELRVHQGRTXHRVSDFLHQWHVDSUHVHQWD
ram melhoras da função endotelial. O estu
GRDSRQWRXFDUDFWHUtVWLFDVHFRPSRUWDPHQ
WRVIXQFLRQDLVVHPHOKDQWHVDRGHSDFLHQWHV
FDUGtDFRV H SXOPRQDUHV 6HQGR DVVLP D
SUHVFULomR GH H[HUFtFLRV ItVLFRV GHYH OHYDU
HPFRQVLGHUDomRRWLSRDIUHTXrQFLDDGX
UDomR H QtYHO GH KLGUDWDomR GRV SDFLHQWHV
;,$1*HWDO
2XWUD TXHVWmR TXH WHP OHYDQWD
GR LQWHUHVVH p D VLPLODULGDGH GH VLQWRPDV
HQWUH R KLSRWLUHRLGLVPR H D ¿EULRPLDOJLD
$ ¿EURPLDOJLD p GH¿QLGD FRPR XPD VtQ
GURPH GRORURVD P~VFXORHVTXHOpWLFD não
LQÀDPDWyULD GH FDUiWHU FU{QLFR VHQGR DV
SULQFLSDLV PDQLIHVWDo}HV FOtQLFDV DV GH
TXHL[DV iOJLFDV GLVWULEXtGDV GLIXVDPHQWH
SHORFRUSRVHQVDomRGHIDGLJDHGLVW~UELRV
do sono. Por outro lado, os sintomas P~V
Interciência
& Sociedade
,QWHUFLrQFLD6RFLHGDGH,6619RO1
FXORHVTXHOpWLFRV WDPEpP WHP VLGR UHODWD
GRV QR KLSRWLUHRLGLVPR QD SURSRUomR HQWUH
HGRVFDVRV)5(,5(HWDO
2XWUR HVWXGR WDPEpP DSUHVHQWD FRQFRPL
WkQFLD GH ¿EURPLDOJLD HP SDFLHQWHV SRUWD
GRUHV GH KLSRUWLUHRLGLVPR H DOWHUDo}HV WL
UHRLGLDQDV HP SDFLHQWHV FRP ¿EURPLDOJLD
)RUDPDYDOLDGRVSDFLHQWHVVHQGRTXH
SRVVXtDPKLSRWLUHRLGLVPR2VSDFLHQWHV
IRUDP VXEPHWLGRV jV GRVDJHQV VpULFDV GR
KRUP{QLRHVWLPXODGRUGDWLUHRLGH76+WL
UR[LQD OLYUH 7 OLYUH H DQWLFRUSR DQWLWLUHR
SHUR[LGDVHD732SRUPpWRGRGHTXLPLR
OXPLQHVFrQFLD'HVVHJUXSRSDFLHQWHV
HUDPSRUWDGRUHVGH¿EURPLDOJLDVHQGRTXH
R KLSRWLUHRLGLVPR VXEFOtQLFR IRL HQFRQWUDGR
HPLQGLYtGXRVVHQGRFRPKLSRWLUHRL
GLVPR VXEFOtQLFR FRP SURYiYHO FDXVD GH
WLUHRLGLWH FU{QLFD DXWRLPXQH 76+ HOHYDGR
7 OLYUH QRUPDO H D732 HOHYDGR FRP
KLSRWLUHRLGLVPR VXEFOtQLFR LGLRSiWLFR 76+
GLVFUHWDPHQWHHOHYDGR7OLYUHQRUPDOHD
732QRUPDOFRPKLSRWLUHRLGLVPRFOtQLFR
SRUWLUHRLGLWHFU{QLFDDXWRLPXQH76+HOHYD
GR7OLYUHGLPLQXtGRHD732HOHYDGRH
FRPKLSRWLUHRLGLVPRSRUFDXVDQmRGH¿QLGD
76+ HOHYDGR 7 OLYUH GLPLQXtGR H D732
QRUPDO1RVSDFLHQWHVFRPKLSRWLUHRLGLVPR
SUHYLDPHQWHGLDJQRVWLFDGRDIDGLJDRVRQR
QmRUHVWDXUDGRUHDFHIDOHLDFU{QLFDIRUDP
estatisticamente mais frequentes naqueles
HPTXHIRLIHLWRRGLDJQyVWLFRGH¿EURPLDO
JLD&81+$6È%$5&(/26
(PRXWUDiUHDpLPSRUWDQWHDFRP
SDQKDURIXQFLRQDPHQWRGDJOkQGXODWLUHRLGH
durante a gestação. $JHVWDomRLQGX]GLYHU
VDVDOWHUDo}HV¿VLROyJLFDVPDWHUQDVVHQGR
uma delas a função tireoidiana. Quando há
D SUHVHQoD GH DQWLFRUSRV DQWLWLUHRLGLDQRV
RX LQJHVWmR GH¿FLHQWH GH LRGR DV DOWHUD
o}HVDXPHQWDPDLQGDPDLVUHVXOWDQGRHP
KLSRWLUHRLGLVPR PDWHUQR HRX IHWDO RFDVLR
QDQGR FRPSOLFDo}HV SDUD D PmH H SDUD R
IHWR GXUDQWH D JUDYLGH] (VWXGRV UHODWDP
TXH¿OKRVGHPmHVKLSRWLUHRLGLDQDVQmRWUD
WDGDVGXUDQWHDJUDYLGH]SRGHPDSUHVHQWDU
GH¿FLrQFLDV QR GHVHQYROYLPHQWR GR VLVWH
PDQHUYRVRFHQWUDO61&eDFRQVHOKiYHO
TXHPXOKHUHVTXHSRVVXHPKLSRWLUHRLGLVPR
estabilizem a doença antes da gestação
SDUDDSUHYHQomRGHPDLRUHVFRPSOLFDo}HV
%$57+HWDO
2GLDJQyVWLFRSDVVDQRUPDOPHQWH
39
SHODV GRVDJHQV GR 76+ 2 76+ p R H[D
me de escolha utilizado no rastreamento
SDUD GLVIXQomR WLUHRLGLDQD e SRVVtYHO GH
WHFWDU DOWHUDo}HV PtQLPDV RX VXEFOtQLFDV
GD GH¿FLrQFLD GH KRUP{QLRV WLUHRLGLDQRV
FRP GRVDJHP VpULFD GR 76+ ([LVWHP GL
IHUHQWHV HQVDLRV SDUD GRVDJHP GH 76+
com diferentes sensibilidades, no entanto,
QmRVHGHYHFHQWUDUHVWUDWpJLDGLDJQyVWLFD
DSHQDVQDGRVDJHPGH76+SRUTXHQHVWH
FDVRRHL[RKLSRWiODPRKLSy¿VHWLUHRLGHWH
ULDTXHHVWDUVHPSUHLQWDFWR$UHODomRORJ
OLQHDUHQWUH76+H7OLYUHFRPSURYDTXHR
76+pRPHOKRUH[DPHSDUDGHWHFWDUKLSR
IXQomRWLUHRLGLDQD2PpWRGRXWLOL]DGRDWX
DOPHQWHSDUDGRVDU76+pRLPXQRPpWULFR
QmRLVRWySLFR,0$HGHYHWHUVHQVLELOLGDGH
IXQFLRQDO GH SHOR PHQRV P8/ 12
*8(,5$ HW DO 2V YDORUHV GH UHIH
UrQFLDGH76+SDUDHXWLUHRLGHRVVmRD
P8,/SDUDKLSRWLUHRLGLVPRP8,/
HSDUDKLSHUWLUHRLGLVPRGHDP8,/
0,/+$5$16$62$5(6
3. HIPERTIREOIDISMO
2 KLSHUWLUHRLGLVPR FRQVLVWH HP
XP HVWDGR KLSHUPHWDEyOLFR FDXVDGR SHOR
DXPHQWR QD IXQomR GD JOkQGXOD WLUHRLGH H
FRQVHTXHQWHDXPHQWRGRVQtYHLVFLUFXODQ
WHV GRV KRUP{QLRV 7 H 7 OLYUHV$V FDX
VDV PDLV FRPXQV VmR KLSHUSODVLD GLIXVD
GDWLUHRLGHDVVRFLDGDjGRHQoDGH*UDYHV
EyFLR PXOWLQRGXODU KLSHUIXQFLRQDQWH H DGH
QRPD KLSHUIXQFLRQDQWH GD WLUHRLGH %$5
5262HWDO
$V SULQFLSDLV HWLRORJLDV GR KLSHUWL
reodismo são: doença autoimune da tireoi
GH GH¿FLrQFLD GH LRGR UHGXomR GR WHFLGR
WLUHRGLDQR SRU LRGR UDGLRDWLYR RX SRU FLUXU
JLD SDUD WUDWDPHQWR GD 'RHQoD GH *UDYHV
RX FkQFHU GD WLUHRLGH 1<6 &25'5$<
$VSULQFLSDLVPDQLIHVWDo}HVFOtQLFDV
VmR FDQVDoR IDGLJD H[DXVWmR VRQROrQ
FLDSHUGDGHPHPyULDHGHFRQFHQWUDomR
LQWROHUkQFLD DR IULR JDQKR GH SHVR FRQV
WLSDomR GHSUHVVmR PHQVWUXDomR LUUHJXODU
DXPHQWR GH YROXPH GD WLUHRLGH VtQGURPH
GRW~QHOGRFDUSRSHOHVHFDXQKDVTXHEUD
GLoDVGp¿FLWGHDXGLomRHGHPDSDOSHEUDO
EUDGLFDUGLDSUHVVmRDOWDHQWUHRXWUDV
$ GRHQoD GH *UDYHV p D FDXVD
PDLV FRPXP GH KLSHUWLUHRLGLVPR 7UDWDVH
Interciência
& Sociedade
,QWHUFLrQFLD6RFLHGDGH,6619RO1
de uma doença autoimune, caracterizada
SRU DQWLFRUSRV FRQWUD R UHFHSWRU GH 76+
Os sintomas mais frequentes são ansieda
GH WUHPRU IUDTXH]D SDOSLWDomR SHUGD GH
SHVR LQWROHUkQFLD DR FDORU GHQWUH RXWUDV
9$/(17(HWDO$VRSo}HVWHUDSrX
WLFDVDWXDOPHQWHGLVSRQtYHLVVmRDVGURJDV
DQWLWLUHRLGLDQDV '$7 D FLUXUJLD H R LRGR
UDGLRDWLYR ,, sendo que nenhuma delas
p FRQVLGHUDGD LGHDO YLVWR TXH QmR DWXDP
GLUHWDPHQWH QD SDWRJrQHVH GD GLVIXQomR
02027$0,HWDO
8PHVWXGRUHWURVSHFWLYRFRPDQi
OLVHGHSURQWXiULRVKRVSLWDODUHVDYDOLRX
SDFLHQWHVPXOKHUHVHKRPHQVFRP
PHGLDQDGHLGDGHGHDQRVFRPSDUDQGR
JUXSRTXHUHFHEHXWUDWDPHQWRFRPLRGRUD
GLRDWLYRSDUDGRHQoDGH*UDYHVHSDFLHQWHV
eutireoidianos SyVWUDWDPHQWR FRP GURJDV
DQWLWLUHRLGLDQDV '$7 2EVHUYRXVH XP
VLJQL¿FDWLYRDXPHQWRGDKLSHUWHQVmRDUWHULDO
H GD GLVOLSLGHPLD PDV QmR QD WD[D GH
PRUWDOLGDGHHPSDFLHQWHVWUDWDGRVFRPLRGR
UDGLRDWLYR2HVWXGRVXJHUHDQHFHVVLGDGH
GH XP PDLRU DFRPSDQKDPHQWR GRV
SDFLHQWHVWUDWDGRVFRPLRGRUDGLRDWLYRSDUD
estabelecer uma melhor correlação entre o
WUDWDPHQWRDVFRPRUELGDGHVREVHUYDGDVH
DWD[DGHPRUWDOLGDGHHPSDFLHQWHVFRPhi
SHUWLUHRLGLVPR$=(9('2HWDO
2 WUDWDPHQWR LGHDO SDUD R KLSHU
WLUHRLGLVPR GD GRHQoD GH *UDYHV VHULD D
FRUUHomR GRV GLVW~UELRV DXWRLPXQHV SDUD
restaurar a função tiroidiana normal. O tra
WDPHQWR FRP LRGR UDGLRDWLYR , p XPD
GDVRSo}HVGHWUDWDPHQWRGRKLSHUWLUHRLGLV
PRUHODFLRQDGRDGRHQoDGH*UDYHVVHQGR
LQGLFDGR SDUD SDFLHQWHV LGRVRV FRP GRHQ
oDGH*UDYHVSUpWUDWDGRVFRPWLRQDPLGDV
WUDWDPHQWRLQLFLDOSDUDDGXOWRVFRPGRHQoD
GH*UDYHVFRPKLSHUWLUHRLGLVPROHYHHEHP
WROHUDGRSDUDSDFLHQWHVFRPUHFLGLYDDSyV
remissão com tionamida ou com efeitos co
ODWHUDLVJUDYHVDHVWDGURJDHSDUDSDFLHQ
WHVFRPUHFLGLYDDSyVWUDWDPHQWRFLU~UJLFR
É contra indicado durante a gestação e
UHFRPHQGDVH TXH PXOKHUHV HP LGDGH UH
SURGXWLYDHYLWHPDJUDYLGH]QRSHUtRGRGH
DPHVHVDSyVDWHUDSLD/23(6
Outra sugestão de tratamento da
GRHQoDGH*UDYHVFRQVLVWHQDDERUGDJHP
WHUDSrXWLFDGRKLSHUWLUHRLGLVPRFRPXVRGH
EHWDEORTXHDGRUHVHQDUHGXomRGDVtQWHVH
40
GHKRUP{QLRVGDWLUHRLGHDWUDYpVGDDGPL
QLVWUDomRGHWLRQDPLGDVLRGRUDGLRDWLYRRX
FLUXUJLD1(9(6HWDO2XWURHVWXGR
DSRQWD TXH R , WHP VLGR FDGD YH] PDLV
XWLOL]DGRFRPRSULPHLUDHVFROKDWHUDSrXWLFD
SRUWUDWDUVHGHXPWUDWDPHQWRGH¿QLWLYRGH
IiFLO DGPLQLVWUDomR H VHJXUR $1'5$'(
*52660$,$
$VVLPFRPRQRFDVRGRKLSRWLUHRL
GLVPR WDPEpP Ki QR FDVR GR KLSHUWLUHRL
GLVPR RV FDVRV FRQVLGHUDGRV VXEFOtQLFRV
6+7$SUHYDOrQFLDGR6+7YDULDFRPLGD
GHHVH[RGDSRSXODomRHQWUHH
HTXDQGRDFRPSDQKDGRGHYDORUHVHOHYD
GRVGHDQWLFRUSRVDQWLWLURLGHDQRVRULVFRGH
SURJUHVVmRSDUDKLSRWLUHRLGLVPRFOtQLFRDX
PHQWDHPDRDQR$RFRUUrQFLDpPDLRU
QRVH[RIHPLQLQRHHPSDFLHQWHVFRPPDLV
GHDQRVSRGHQGRDWLQJLUtQGLFHVGHDWp
6$:,1HWDO
1D SUHVHQoD GH KLSHUWLUHRLGLVPR
DIXQomRFDUGtDFDSRGHVHDOWHUDUSRUDomR
GLUHWDGR7RXSRUYDULDo}HVKHPRGLQkPL
FDV H YDVFXODUHV 2 H[FHVVR GH KRUP{QLR
WLUHRLGLDQR SURYRFD GLIHUHQWHV UHVSRVWDV
FDUGLRYDVFXODUHVGHSHQGHQWHVGRWHPSRGH
H[SRVLomR2VKRUP{QLRVWLUHRLGLDQRVSDU
WLFXODUPHQWHR7PRGXODPDVtQWHVHJHUDO
GDIRVIRFUHDWLQD3&UDXPHQWDPDWD[DGH
IRVIRULODomRR[LGDWLYDPLWRFRQGULDOUHJXODP
DDWLYLGDGHWRWDOGDFUHDWLQDTXLQDVH&.H
a distribuição de suas isoenzimas. Estudo
HPUDWRV:LVWDUXWLOL]DQGRVHRPRGHORH[
SHULPHQWDO GH KLSHUWLUHRLGLVPR DYDOLRXVH
DDomRGDOHXFLQDQDKLSHUWUR¿DFDUGtDFDH
QD FRQFHQWUDomR GH FUHDWLQD TXLQDVH &.
HRVUHVXOWDGRVDSRQWDUDPSDUDXPDDomR
GDOHXFLQDQRVHQWLGRGHLQLELUDKLSHUWUR¿D
FDUGtDFDLQGX]LGDQRKLSHUWLUHRLGLVPRDOpP
GHUHGX]LUDVFRQFHQWUDo}HVVpULFDVGHFUH
DWLQDTXLQDVH),'$/(HWDO
(PRXWURHVWXGRWDPEpPFRPUD
WRV:LVWDUHPVLWXDomRGHKLSHUWLUHRLGLVPR
FU{QLFR IRL DYDOLDGR R HIHLWR GD YLWDPLQD (
VREUHDPRGXODomRGDUHVSRVWDKLSHUWUy¿FD
FDUGtDFD)RUDPIHLWRVJUXSRVVHQGRXP
WUDWDGRFRPYLWDPLQD(XPKLSHUWLUHyLGHR
XPKLSHUWLUHyLGHRWUDWDGRFRPYLWDPLQD(H
XP JUXSR FRQWUROH 2V UHVXOWDGRV DSRQWD
UDP SDUD XP JUDQGH DXPHQWR GR FRUDomR
QRJUXSRGRVKLSHUWLUHyLGHRVHQTXDQWRTXH
DTXHOHVWUDWDGRVFRPYLWDPLQD(DSUHVHQWD
UDPKLSHUWUR¿DUHGX]LGDFRQFOXLQGRVHTXH
Interciência
& Sociedade
,QWHUFLrQFLD6RFLHGDGH,6619RO1
DYLWDPLQD(UHGX]DKLSHUWUR¿DFDUGtDFDHP
VLWXDomRGHKLSHUWLUHRLGLVPRFU{QLFRSRUUH
GXomR GR HVWUHVVH R[LGDWLYR '5(+(5 HW
DO
(VWXGRH[SHULPHQWDODYDOLRXRSHU
¿O OLStGLFR HP UDWRV :LVWDU FRP KLSHUWLUHRL
GLVPRLQGX]LGRHPUHSRXVRHDSyVH[HUFtFLR
ItVLFRDJXGR1RJUXSRFRPKLSHUWLUHRLGLVPR
REVHUYRXVHPHQRUSHVRGRWHFLGRDGLSRVR
QDV UHJL}HV PHVHQWpULFD UHWURSHULWRQHDO H
VXEFXWkQHDPHQRUHVYDORUHVGHFROHVWHURO
WRWDO /'/ H +'/ H WDPEpP PHQRUHV FRQ
FHQWUDo}HV GH OLStGHRV WRWDLV QR FRUDomR
TXDQGR HVWHV HQFRQWUDYDPVH HP UHSRX
VR HP FRPSDUDomR FRP JUXSR FRQWUROH
$SyV VHVVmR DJXGD GH H[HUFtFLRV ItVLFRV
QmR KRXYH DOWHUDomR GR SHU¿O OLStGLFR GRV
DQLPDLV FRP KLSHUWLUHRLGLVPR H[FHWR SHOR
DXPHQWRGHOLStGHRVWRWDLVGRFRUDomR2V
UHVXOWDGRVVmRXPLQGLFDWLYRGDFRUUHODomR
HQWUHKLSHUWLUHRLGLVPRHSHU¿OOLStGLFRRTXH
pLPSRUWDQWHSDUDDYDOLDUUHODomRGDGRHQoD
FRPSRVVtYHLVSUREOHPDVFDUGLRYDVFXODUHV
&$0%5, HW DO (P RXWUR HVWXGR
HPFRQGLo}HVVLPLODUHVIRUDPHQFRQWUDGDV
DOWHUDo}HVQRSHVRFRUSRUDOHHPYDULiYHLV
SODVPiWLFDV TXDQGR FRPSDUDGRV DQLPDLV
FRP KLSHUWLUHRLGLVPR VRE UHSRXVR H DSyV
H[HUFtFLRDJXGRLQGLFDQGRTXHRH[HUFtFLR
ItVLFRDJXGRSRGHDOWHUDUDGLQkPLFDPHWD
EyOLFDJOLFtGLFDHSURWpLFDSODVPiWLFDHWHFL
GXDOHPUDWRVFRPKLSHUWLUHRLGLVPR%(&.
HWDO
2XWUD TXHVWmR TXH YHP VHQGR
DERUGDGDHPHVWXGRVUHFHQWHVpDUHODomR
HQWUHKLSHUWHQVmRDUWHULDOSXOPRQDU+$3H
WLUHRLGRSDWLDVKLSRWLUHRLGLVPRHKLSHUWLUHRL
GLVPR (VWD KLSyWHVH WHP VLGR OHYDQWDGD
SRUTXH R DXPHQWR GD +$3 p OHYH H UHYHU
VtYHO FRP R WUDWDPHQWR GH WLUHRLGRSDWLD 2
PHFDQLVPRH[DWRHQYROYLGRQDSDWRJrQHVH
desta associação não está estabelecido e a
LQÀXrQFLD GLUHWD GRV KRUP{QLRV GD WLUHRLGH
e autoimunidade são consideradas como
KLSyWHVHV'HYLGRjDOWDSUHYDOrQFLDGHGR
HQoDV GD WLUHRLGH HP SDFLHQWHV FRP +$3
WHVWHVGHIXQomRWLUHRLGLDQDGHYHPVHUFRQ
VLGHUDGRVQDLQYHVWLJDomRGHWRGRSDFLHQWH
FRP+$36,/9$HWDO
2 ]LQFR =Q p XP tRQ LQWUDFHOXODU
H p XP GRV HOHPHQWRVWUDoR H HVWi QR RU
JDQLVPRHPFHUFDGHDJ$VSULQFLSDLV
fontes de zinco são alimentos de origem
41
DQLPDOFRPRFDUQHVOHLWHHVHXVGHULYDGRV
(VWXGRUHDOL]DGRSURFXURXDYDOLDURHVWDGR
QXWULFLRQDOGHSDFLHQWHVFRPKLSHUWLUHRLGLV
PR HP UHODomR DR ]LQFR 'H SDFLHQWHV
DYDOLDGRV DSUHVHQWDYDP FRQFHQWUDomR
SODVPiWLFDGH]LQFRDEDL[RGRLGHDO(VWXGR
H[SHULPHQWDOHPDQLPDLVREVHUYRXXPDGL
PLQXLomRVLJQL¿FDWLYDGH]LQFRQRVHULWUyFL
WRVPDVGLPLQXLo}HVQRQtYHOSODVPiWLFRGR
PLQHUDOQmRKDYLDPVLGRREVHUYDGDVRTXH
RFRUUH VRPHQWH HP FDVRV GH GH¿FLrQFLDV
PXLWRJUDYHVGH]LQFRQRRUJDQLVPR2VUH
VXOWDGRVLQGLFDPpTXHSRGHVHULPSRUWDQWH
fazer o monitoramente nutricional de zinco
HP SDFLHQWHV SRUWDGRUHV GH KLSHUWLUHRLGLV
PRD¿PGHHYLWDUGH¿FLrQFLDVQHVVHJUXSR
%$55262HWDO
7DPEpP VmR IUHTXHQWHV PDQLIHV
WDo}HV FRPSRUWDPHQWDLV DVVRFLDGDV DR
KLSHUWLUHRLGLVPR FRPR SRU H[HPSOR KL
SHUFLQHVLD QHUYRVLVPR LUULWDELOLGDGH H[FL
WDELOLGDGH GL¿FXOGDGH GH DSUHQGL]DJHP H
GLVW~UELRVGRVRQR8PHVWXGRGHVFULWLYRGH
FDVRVFRPDGROHVFHQWHVFRPKLSHUWLUHRLGLV
PR IRL UHDOL]DGR FRP QRYH DGROHVFHQWHV
FRP SUHGRPtQLR GR VH[R IHPLQLQR H LGDGH
PpGLD GH DQRV 2V SULQFLSDLV VLQWRPDV
UHODWDGRVIRUDPSHUGDGHSHVRLQV{QLDKL
SHUDWLYLVPRSDOSLWDo}HVQHUYRVLVPRHWUH
PRUHVFRPWHPSRGHPDQLIHVWDomRFOtQLFD
GDGRHQoDGHDSUR[LPDGDPHQWHDQRV
(PRXWURHVWXGRGHVFULWLYRDGROHV
FHQWHVFRPKLSHUWLUHRLGLVPRGHLGDGHHQWUH
HDQRVIRUDPVXEPHWLGRVjDYDOLDomR
FOtQLFD H ODERUDWRULDO H WHVWDJHP SVLFRPp
WULFD$PpGLDGRFRH¿FLHQWHGHLQWHOLJrQFLD
4,WRWDOIRLGHGR4,9HUEDOGH
HGR4,GH([HFXomRGH6HWHLQGLYt
GXRVDSUHVHQWDUDPFRPSRUWDPHQWRVFRQGL
]HQWHV FRP WUDQVWRUQRV QHXURSVLFROyJLFRV
HVSHFt¿FRV 2V UHVXOWDGRV LQGLFDUDP XPD
LQÀXrQFLD GR KLSHUWLUHRLGLVPR VREUH R GH
VHQYROYLPHQWR FRJQLWLYR GRV DGROHVFHQWHV
DYDOLDGRV6e5*,2HWDO
4. CONSIDERAÇÕES FINAIS
$ SDUWLU GRV DUWLJRV DQDOLVDGRV IRL
SRVVtYHO GHVFUHYHU RV SULQFLSDLV WLSRV GH
KLSRWLUHRLGLVPR H KLSHUWLUHRLGLVPR FDXVDV
VLQWRPDVIRUPDVGHGLDJQyVWLFRHWLSRVGH
WUDWDPHQWRVGLVSRQtYHLV(PUHODomRDRKL
SRWLUHRLGLVPR p LPSRUWDQWH GHVWDFDU D UH
Interciência
& Sociedade
,QWHUFLrQFLD6RFLHGDGH,6619RO1
ODomR GHVWH FRP R VLVWHPD FDUGLRYDVFXODU
FRPRXPIDWRUTXHDXPHQWDRULVFRGHDSD
UHFLPHQWRGHGRHQoDVFDUGtDFDVHGHYHVH
WHU DWHQomR DR WLSR GH H[HUFtFLR ItVLFR TXH
GHYH VHU SUHVFULWR HP IXQomR GDV DOWHUD
o}HV QR VLVWHPD FDUGLRYDVFXODU 1R FDVR
GRKLSRWLUHRLGLVPRFRQJrQLWRHVWHHVWiUH
ODFLRQDGR SULQFLSDOPHQWH FRP SUREOHPDV
GH UHWDUGR QR GHVHQYROYLPHQWR PHQWDO H
FRJQLWLYRGHFULDQoDVTXDQGRQmRVmRGH
YLGDPHQWH GLDJQRVWLFDGDV 2 KLSRWLUHRLGLV
PR DLQGD DSUHVHQWD XPD VHPHOKDQoD GH
VLQWRPDVFRPD¿EURPLDOJLDHDVDOWHUDo}HV
¿VLROyJLFDVGXUDQWHDJUDYLGH]SRGHPOHYDU
ao surgimento dessa disfunção tireoidiana.
(P UHODomR DR KLSHUWLUHRLGLVPR D GRHQoD
GH *UDYHV GRHQoD DXWRLPXQH p D SULQFL
SDO FDXVD GR VXUJLPHQWR GHVWD GLVIXQomR
$VVLP FRPR QR KLSRWLUHRLGLVPR D IXQomR
FDUGtDFD p DOWHUDGD HP IXQomR GDV DOWHUD
o}HVKRUPRQDLVGDWLUHRLGH(PUHODomRDRV
DVSHFWRVQXWULFLRQDLVGHQWUHRVDUWLJRVDYD
OLDGRVSRXFRWHPVLGRFLWDGRVREUHRSDSHO
da alimentação no surgimento e no controle
GHVWDV GLVIXQo}HV VHQGR R DVSHFWR PDLV
UHOHYDQWH HQFRQWUDGR R GH TXH D YLWDPLQD
(OHYDDGLPLQXLomRGDKLSHUWUR¿DFDUGtDFD
HP SDFLHQWHV FRP KLSHUWLUHRLGLVPR 6HQGR
DVVLP QR FDPSR QXWULFLRQLDO DLQGD p SUH
FLVRLQYHVWLJDUPDLVRSDSHOGDDOLPHQWDomR
VREUHHVWDVGXDVGLVIXQo}HV
5. REFERÊNCIAS BIBLIOGRÁFICAS
$QGUDGH9$*URVV-/0DLD$/,RGRUDGLRDWLYR
QRPDQHMRGRKLSHUWLUHRLGLVPRGDGRHQoDGH*UDYHV
Arquivos Brasileiros de Endocrinologia e MetabologiaYQ
$=(9('2 )95 %/277$ )*6 *2,5*(77$
-012e59$,60$10$YDOLDomRGRVXUJLPHQ
WR GH FRPRUELGDGHV HP SDFLHQWHV com doença de
*UDYHVWUDWDGRVFRPLRGRUDGLRDWLYRHPDFRPSDQKD
PHQWR SRU PDLV GH DQRV Arquivo Brasileiro de
Endocrinologia e Metabologia Y Q S
%DUURVR &) 6DQWRV$))GRV 3HVVRD 33 6DQ
WRV/%3LUHV/9&DVWUR/03LPHQWHO$0DQ
FLQL)LOKR-&R]]ROLQR60)0DLD&6&(VWDGR
1XWULFLRQDO 5HODWLYR DR =LQFR HP 3DFLHQWHV FRP +L
SHUWLUHRLGLVPRNutrireYQVXSOS
%$57+ 1 '$ &267$ %3 6/21*2 ). 1$6
&,0(172 0& /$5$ *0$YDOLDomR GRV HIHLWRV
GRKLSRWLUHRLGLVPRQDJHVWDomRRBACYROQ
42
S
%(&. :5$1'5$'( /3 &$5,7È 5$& <$
0$'$$. '$/,$ 5$ /(0( -$&$ 0(//2
0$5 /8&,$12 ( ,QÀXrQFLD GR H[HUFtFLR DJXGR
QR PHWDEROLVPR GH UDWRV FRP KLSHUWLUHRLGLVPR Revista Brasileira de Ciência e MovimentoYQ
%HQHYLGHV$0/LPD&+95RFKD&$&RUUrD
55 (O +XVQ\$6 )HUQDQGHV&DOGDWR 0& 3HU
¿O (SLGHPLROyJLFR GH 3RUWDGRUHV GH +LSRWLUHRLGLVPR
congênito. Revista Paraense de Medicina Y QS
%UDJDWWL:LQFNOHU 0, 5RWWD 17 +RUP{QLRV WLUHRL
GHRV QD VLQWRPDWRORJLD GH GRHQoDV QHXURSVLTXLiWUL
cas. Arquivos de neuropsiquiatriaYQS
&$0%5, /7 9,7$/707(,;(,5$ &9/ -$0
%$66,),/+2-&'$/,$5$/8&,$12(3HU
¿O /LStGLFR GH 5DWRV FRP +LSHUWLUHRLGLVPR ,QGX]LGR
(IHLWRGR([HUFtFLR)tVLFR$JXGRRevista Brasileira
de Ciência e MovimentoYQ
&2(/+2():(51(&.)=0$,1(17050
2/,9(,5$)39$,60$10,QWROHUkQFLDDRHVIRUoR
QRKLSRWLUHRLGLVPRVXEFOtQLFRLPSOLFDo}HVSDUDSUHV
FULomR GH H[HUFtFLRV ItVLFRV Fiep:Bulletin On-line,
Y
&81+$ , 6È ' %$5&(/26 $ Fibromialgia: A
outra face da dor. Acta Reumatológica Portuguesa,
YVXSOS
'H&DUYDOKR70GRV6DQWRV+3GRV6DQWRV,&
9DUJDV353HGURVD-1HZERUQVFUHHQLQJDQDWLR
QDOSXEOLFKHDOWKSURJUDPPHLQ%UD]LOJournal Inherited Metabolic DiseaseYQS
'UHKHU*-%HFNHU&8$UDXMR$6'51X
QHV & )7 5LEHLUR 0 ) 6FKHQNHO 3 & )HU
QDQGHV 7 5 * +LSHUWUR¿D &DUGtDFD ,QGX]LGD SHOR
+LSHUWLUHRLGLVPR3DSHOGR'HVEDODQoR5HGR[QD0R
GXODomRGH9LDVGH&UHVFLPHQWRH0RUWH&HOXODU,Q
6DOmRGH,QLFLDomR&LHQWt¿FD3RUWR$OHJUHLivro de
ResumosS
)HUUHLUD /2 5HOYDV 5& 5DPDOKR 066&
5RQFKL &06* 3HULOOR 9&$ 5RGULJXHV /&%
0DQLIHVWDo}HVIRQRDXGLROyJLFDVUHODWDGDVSRUSDLVGH
FULDQoDV FRP KLSRWLUHRLGLVPR FRQJrQLWR Revista da
Sociedade Brasileira de FonoaudiologiaYQ
S
)LGDOH70*RQoDOYHV$/RSHV/73$OYHV35
6RX]D )5' 1XQHV -(' 5HVHQGH (6 (IIHFW
RIOHXFLQHLQFDUGLDFK\SHUWURSK\DQGVHUXPFUHDWLQH
NLQDVHLQUDWVLQH[SHULPHQWDOK\SHUWK\URLGLVPBioscience JournalYQ
)5(,5( 0 7(2'252 5% 2/,9(,5$ /%
&81+$ 6)& )(55(,5$ %3 %25*(6 0')
&RQFRPLWkQFLDGD¿EURPLDOJLDHPSDFLHQWHVSRUWDGR
Interciência
& Sociedade
,QWHUFLrQFLD6RFLHGDGH,6619RO1
UHV GH KLSRWLUHRLGLVPR H GH DOWHUDo}HV WLUHRLGHDQDV
HPSDFLHQWHVFRP¿EURPLDOJLDRevista Brasileira de
ReumatologiaYQS
*RQoDOYHV $ )HUQDQGHV 0 / /DPRXQLHU 5
3 &RVWD $ 5HVHQWH ( (IHLWR GD /WLUR[LQD
VyGLFD QD WROHUkQFLD DR HVIRUoR HP PXOKHUHV FRP
KLSRWLUHRLGLVPR VXEFOtQLFR Brasília médica Y
Q
.OHWW0(SLGHPLRORJ\RIFRQJHQLWDOK\SRWK\URLGLVP
Experimental and Clinical Endocrinology DiabetesYS
/RSHV 0+& 7HUDSLD FRP , SDUD UHVROXomR GR
KLSHUWLURLGLVPR GRHQoD GH JUDYHV VHOHomR GD GRVH
Arquivos Brasileiros de Endocrinologia e MetabologiaYQ
5$8(1*:$&++2/=$*5$)+3,1720-
$ERUGDJHP GR KLSRWLUHRLGLVPR VXEFOtQLFR QR LGRVR
Revista Brasileira de Clínica Médica Y Q S
MXODJR
5RPDOGLQL-+6JDUEL-$)DUDK&6'LVIXQo}HV
0tQLPDV GD 7LUyLGH +LSRWLURLGLVPR VXEFOtQLFR H +L
SHUWLURLGLVPR VXEFOtQLFR Arquivo Brasileiro de Endocrinologia e MetabologiaYQ
6DZLQ &7 &DVWHOOL :3 +HUVKPDQ -0 0F1DPDUD
3%DFKDUDFK37KHDJLQJWK\URLG7K\URLGGH¿FLHQF\
in the Framingham Study. Archieve Internacional
Medicine, YS
0LOKDUDQVD 3 6RDUHV 5 +RUP{QLR GH HVWLPXODomR
GDWLUHRLGH76+HFRUUHODo}HVODERUDWRULDLVRBAC,
YQS
6,/9$'5*$==$1$0%-2+1$%6,48(,
5$'50$,$$/6%$55(72660+LSHUWHQ
VmR DUWHULDO SXOPRQDU H GRHQoDV GD WLUHRLGH Journal Brasilian of PneumologyQYS
0RPRWDQL11RK-<,VLNDZD1,WR.(IIHFWVRISUR
S\OWKLRXUDFLODQGPHWKLPD]ROHRQIHWDOWK\URLGVWDWXVLQ
PRWKHUVZLWK*UDYHVK\SHUWK\URLGLVPJournal Clinical Endocrinology and Metabolic Y S
6pUJLR - $GDQ / /XFHQD 5& 6LOYD $&&
7DYDUHV/HLWH / 3HU¿O &RJQLWLYR GH $GROHVFHQWHV
FRP +LSHUWLUHRLGLVPR HP 6DOYDGRU %DKLD%UDVLO
Revista Brasileira de Ciências da Saúde Y
QS
0XOOHU$)%HUJKRXW$:LHUVLQJD:0.RR\$
6PLWV-:+HUPXV$57K\URLGIXQFWLRQGLVRUGHUV
±*XLGHOLQHVRIWKH1HWKHUODQGV$VVRFLDWLRQRI,QWHUQDO
Medicine. Journal MedicineYS
6RX]D$$'/LPD$+5'$1yEUHJD76
'6LOYD$6,QÀXrQFLDGRH[HUFtFLRItVLFRQDVDOWH
UDo}HVFDUGLRYDVFXODUHVLQGX]LGDVSHORKLSRWLUHRLGLV
mo. Revista Brasileira de Atividade Física & SaúdeQYS
1HYHV&$OYHV0'HOJDGR-/0HGLQD-/'R
HQoDGH*UDYHVArquivos de MedicinaYQ
S
12*8(,5$&5.,085$(7&$59$/+2*$
6*$5%,-$:$5'/60$&,(//0='LDVGD
6LOYD056WHLQ$7:DJQHU+/+HWHP/$%
$QGUDGD 1& +LSRWLUHRLGLVPR 'LDJQyVWLFR Sociedade Brasileira de Endocrinologia e Metabolismo.
S
1\V 3 &RUGUD\ -3 (WLRORJLF GLVFXVVLRQ DQG FOLQL
FDOUHOHYDQFHRIWK\URLGXOWUDVVRQRJUDSK\LQVXEFOLQL
FDOK\SRWK\URLGLVP$UHWURVSHFWLYHVWXG\LQSD
tients. Ann EndocrinolYS
3HU5RQH'7HL[HLUD66&ODUD6$GRV6DQWRV
'&1RJXHLUD&5$VSHFWRV*HQpWLFRVGR+LSRWLUH
odismo Congênito. Arquivo Brasileiro de Endocrinologia e MetabologiaYQS±
3LPHQWHO / +DQVHQ .: 7K\URLG GLVHDVH LQ WKH
HPHUJHQF\ GHSDUWPHQW D FOLQLFDO DQG ODERUDWRU\ UH
YLHZJournal of Emergency MedicineYS
43
Souza, R.da S. Prospecção de mutações éxons1,
2, 3, 4, 5 e 8a do gene da tireoperoxidase (TPO) em
pacientes com hipotireoidismo congênito (HC).
I7UDEDOKRGH&RQFOXVmRGH&XUVR&LrQFLDV%LROyJL
FDV ± 8QLYHUVLGDGH (VWDGXDO GD 3DUDtED &DPSLQD
*UDQGH
7HL[HLUD 3)6 5HXWHUV 96$OPHLGD &3 )HUUHL
UD00:DJPDQ0%5HLV)$$&RVWD$-/
9DLVPDQ0$YDOLDomR&OtQLFDHGH6LQWRPDV3VLTXL
iWULFRVQR+LSRWLUHRLGLVPRVXEFOtQLFRRevista da Associação Médica Brasileira Y Q S 9DOHQWH20DUWLQV$09DOHQWH)$WDOODK$+L
SHUWLUHRGLVPRRevista Brasileira de MedicinaY
QS
;LDQJ*'3X-6XQ+=KDR/<XH/+RX-
5HJXODUDHURELFH[HUFLVHWUDLQLQJLPSURYHVHQGRWKH
OLXPGHSHQGHQW DUWHULDO GLODWLRQ LQ SDWLHQWV ZLWK VXE
FOLQLFDOK\SRWK\URLGLVPEuropean Journal EndocrinologyYQS
Interciência
& Sociedade
,QWHUFLrQFLD6RFLHGDGH,6619RO1
Vanessa Oliveira pJUDGXDGDHP1XWULomRSHOD)DFXOGDGH0XQLFLSDO3URIHVVRU)UDQFR0RQWRUR
Rafael Resende Maldonado p JUDGXDGR HP (QJHQKDULD GH $OLPHQWRV 81,&$03 H 4XtPLFD 81,
&$03 SRVVXL 0HVWUDGR HP (QJHQKDULD GH$OLPHQWRV 81,&$03 H GRXWRUDGR HP (QJHQKDULD GH
$OLPHQWRV81,&$03$WXDFRPRSURIHVVRUXQLYHUVLWiULRGHVGHHSURIHVVRUGHHQVLQRWpFQLFRGHVGH
$WXDOPHQWHOHFLRQDQD)DFXOGDGH0XQLFLSDO3URIHVVRU)UDQFR0RQWRUR0RJL*XDoXQRVFXUVRVGH1XWULomR
H(QJHQKDULD4XtPLFDQDV)DFXOGDGHV,QWHJUDGDV0DULD,PDFXODGD0RJL*XDoXQRFXUVRGH4XtPLFD,QGXVWULDO
QD(VFROD6XSHULRUGH$GPLQLVWUDomRH0DUNHWLQJ&DPSLQDVQRFXUVRGH(QJHQKDULD4XtPLFDHQD8QLYHUVLGDGH
(VWDGXDOGH&DPSLQDV&DPSLQDVQRFXUVRWpFQLFRGH$OLPHQWRV6HXVLQWHUHVVHVGHSHVTXLVDDEUDQJHPiUHDV
GH1XWULomR$OLPHQWRV4XtPLFDH(QJHQKDULD4XtPLFD(Q]LPRORJLDH%LRFRPEXVWtYHLV
44
Interciência
& Sociedade