The TCF7L2 rs7903146 (C/T) polymorphism is associated with risk to type 2 diabetes mellitus in Southern-Brazil

Objective The aim of this study was to investigate the association between the rs7903146 (C/T) polymorphism in the TCF7L2 gene and type 2 diabetes mellitus, in a Southern-Brazilian population. Materials and methods The TCF7L2 rs7903146 polymorphism was genotyped in 953 type 2 diabetic patients and 535 non-diabetic subjects. All subjects were white. The polymorphism was genotyped by Real-Time PCR using TaqMan MGB probes (Life Technologies). Odds ratios (OR) and 95% confidence intervals (CI) were calculated for additive, recessive and dominant inheritance models. Results Genotype and allele frequencies of the rs7903146 polymorphism differed significantly between type 2 diabetic patients and non-diabetic subjects (P = 0.001 and P = 0.0001, respectively). The frequency of the minor allele was 38% in type 2 diabetes group and 31% in non-diabetic subjects, and this allele was significantly associated with type 2 diabetes risk (OR = 1.42, 95% CI 1.15 – 1.76 for the dominant model of inheritance). Moreover, the T/T genotype was associated with a higher risk for type 2 diabetes (OR = 1.83, 95% CI 1.3-2.5) than the presence of only one copy of the T allele (OR = 1.31, 95% CI 1.1-1.6). Both results were adjusted for age and gender. Conclusions Our results confirm the association between the TCF7L2 rs7903146 polymorphism and increase risk for type 2 diabetes in Southern-Brazil. Arq Bras Endocrinol Metab. 2014;58(9):918-25

An international survey of screening and management of hypothyroidism during pregnancy in Latin America

Objective To determine how endocrinologists in Latin America deal with clinical case scenarios related to hypothyroidism and pregnancy. Materials and methods In January 2013, we sent an electronic questionnaire on current practice relating to management of hypothyroidism in pregnancy to 856 members of the Latin American Thyroid Society (LATS) who manage pregnant patients with thyroid disease. Subsequently, we have analyzed responses from physician members. Results Two hundred and ninety-three responders represent clinicians from 13 countries. All were directly involved in the management of maternal hypothyroidism and 90.7% were endocrinologists. The recommendation of a starting dose of L-thyoxine for a woman diagnosed with overt hypothyroidism in pregnancy, preconception management of euthyroid women with known thyroid autoimmunity and approach related to ovarian hyperstimulation in women with thyroid peroxidase antibodies were widely variable. For women with known hypothyroidism, 34.6% of responders would increase L-thyroxine dose by 30-50% as soon as pregnancy is confirmed. With regard to screening, 42.7% of responders perform universal evaluation and 70% recommend TSH < 2.5 mUI/L in the first trimester and TSH < 3 mUI/L in the second and third trimester as target results in known hypothyroid pregnant women. Conclusion Deficiencies in diagnosis and management of hypothyroidism during pregnancy were observed in our survey, highlighting the need for improvement of specialist education and quality of care offered to patients with thyroid disease during pregnancy in Latin America. Arq Bras Endocrinol Metab. 2014;58(9):906-11

Brown adipose tissue: what have we learned since its recent identification in human adults

Brown adipose tissue, an essential organ for thermoregulation in small and hibernating mammals due to its mitochondrial uncoupling capacity, was until recently considered to be present in humans only in newborns. The identification of brown adipose tissue in adult humans since the development and use of positron emission tomography marked with 18-fluorodeoxyglucose (PET-FDG) has raised a series of doubts and questions about its real importance in our metabolism. In this review, we will discuss what we have learnt since its identification in humans as well as both new and old concepts, some of which have been marginalized for decades, such as diet-induced thermogenesis. Arq Bras Endocrinol Metab. 2014;58(9):889-99

Estudo do polimorfismo G54D do gene MBL2 no diabetes melito gestacional

Objetivo Analisar a influência da associação do polimorfismo G54D (rs1800450) do gene MBL2 no diabetes melito gestacional (DMG) quanto à necessidade de tratamento complementar e ocorrência de recém-nascidos grandes para a idade gestacional. Sujeitos e métodos Cento e cinco pacientes com DMG segundo parâmetro da OMS (Organização Mundial da Saúde) foram avaliadas no período de novembro de 2010 a outubro de 2012. As gestantes foram divididas em dois grupos correspondentes à presença (n = 37) ou à ausência (n = 68) do alelo mutante. As variantes do polimorfismo G54D foram identificadas por meio da técnica de polimorfismos de comprimentos de fragmentos de restrição (RFLP). Parâmetros antropométricos e bioquímicos da mãe e do recém-nascido (RN) e a necessidade de terapia complementar associada à dietoterapia foram avaliados como desfechos primários. Resultados Das pacientes analisadas, 35,2% carregavam pelo menos um alelo mutante do polimorfismo G54D. Os dois grupos não apresentaram diferença significativa quanto a ganho de peso, paridade, idade, índice de massa corporal e idade gestacional de chegada à maternidade. Os grupos de pacientes portadoras ou não do alelo mutante não diferiram quanto à necessidade de tratamento complementar à dietoterapia (16,2% vs. 26,7%) respectivamente e à ocorrência de recém-nascidos grandes para a idade gestacional (24,3% vs. 13,2%). Conclusão Nossos dados demonstraram que o polimorfismo G54D do gene MBL2 não teve efeito sobre a necessidade de tratamento complementar acrescido à dietoterapia e à ocorrência de recém-nascidos grandes para a idade gestacional na população estudada. Arq Bras Endocrinol Metab. 2014;58(9):900-5

Large thyroid cyst in a patient with congenital hypothyroidism

Thyroid hormone biosynthetic defects are rare causes of congenital hypothyroidism. Although, initial presentations are usually diffuse goiter and hypothyroidism, subsequently they may develop thyroid nodules and or thyroid cancer. We describe a case of hypothyroidism due to dyshormonogenesis whose one of the previously solid nodules degenerates into a large cyst. A 22-year-old male was referred to our clinic for evaluation of enlarging thyroid nodule. Hypothyroidism was diagnosed in infancy, however due to poor compliance to treatment TSH values were elevated most of the times. When he was fifteen the first nodule was detected which was a solid cold nodule. Fine needle aspiration was in favor of benign follicular nodule. Seven years later we found a large multi nodular thyroid with a predominant large cyst corresponding to the previously detected solid nodule. 21cc straw colored fluid was aspirated. Cytology was reported as benign cystic nodule. The patient underwent thyroidectomy and pathology confirmed a benign thyroid cyst. Although underreported thyroid dyshormonogenesis may progress to cystic degeneration. Taking into account the risk of malignancy and eventually cyst formation, we recommend more frequent evaluation in the face of nodule formation in these patients. Arq Bras Endocrinol Metab. 2014;58(9):958-61

Redução da mobilidade funcional e da capacidade cognitiva no diabetes melito tipo 2

Objetivos Avaliar a mobilidade funcional e sua relação com a capacidade cognitiva em pacientes com diabetes tipo 2 (DM2) entre 50 e 65 anos de idade, e com menos de 10 anos de diagnóstico. Materiais e métodos Estudo observacional, analítico e transversal envolvendo indivíduos não diabéticos e pacientes com DM2 com controle glicêmico inadequado, selecionados por amostra de conveniência. Em ambos os grupos, foram aplicados questionário estruturado, avaliação cognitiva com Miniexame do Estado Mental (MEEM) e teste do relógio (TDR), além da avaliação de mobilidade funcional pelo teste Timed Up & GO (TUG). Resultados No TUG os pacientes com DM2 apresentaram tempo médio de 11,27 segundos versus 9,52 segundos nos controles (p = 0,013). A associação entre declínio cognitivo e dismobilidade foi positiva nos indivíduos com DM2 (p = 0,037). No subgrupo que apresentou dismobilidade e declínio cognitivo associados, 18% eram portadores de DM2 e 1,6% era do grupo sem DM2 (p < 0,01). Conclusões Pacientes com DM2 apresentaram pior mobilidade funcional e desempenho cognitivo, favorecendo a hipótese de que o DM2 influencia a mobilidade funcional e capacidade cognitiva antes do aparecimento de complicações vasculares ou neuropáticas. Esses dados sugerem que a hiperglicemia é um fator agravante no desempenho de atividades que exijam funções mentais como atenção, orientação e memória de trabalho. Arq Bras Endocrinol Metab. 2014;58(9):946-52

Thyroid nodules and thyroid cancer in Graves’ disease

Objective The frequency of thyroid nodules accompanying Graves’ disease and the risk of thyroid cancer in presence of accompanying nodules are controversial. The aim of this study was to evaluate the frequency of thyroid nodules and the risk of thyroid cancer in patients operated because of graves’ disease. Subjects and methods Five hundred and twenty-six patients in whom thyroidectomy was performed because of Graves’ disease between 2006 and 2013 were evaluated retrospectively. Patients who had received radioactive iodine treatment and external irradiation treatment in the neck region and who had had thyroid surgery previously were not included in the study. Results While accompanying thyroid nodule was present in 177 (33.6%) of 526 Graves’ patients, thyroid nodule was absent in 349 (66.4%) patients. Forty-two (8%) patients had thyroid cancer. The rate of thyroid cancer was 5.4% (n = 19) in the Graves’ patients who had no nodule, whereas it was 13% (n = 23) in the patients who had nodule. The risk of thyroid cancer increased significantly in presence of nodule (p = 0.003). Three patients had recurrence. No patient had distant metastasis. No patient died during the follow-up period. Conclusions Especially Graves’ patients who have been decided to be followed up should be evaluated carefully during the follow-up in terms of thyroid cancer which may accompany. Arq Bras Endocrinol Metab. 2014;58(9):933-8