Livro de resumos do 5º Fórum do Movimento Vasco da Gamaстатья из журнала
Аннотация: Background: Immunologic tolerance justifies the favorable evolution of autoimmune thyroid diseases during pregnancy and explains their exacerbation in the postpartum.Postpartum thyroiditis affects 4-10% of women up to 12 months postpartum, presenting as asymptomatic, with symptoms and signs of hypothyroidism or hyperthyroidism.In the later scenario, differential diagnosis with Graves' disease is clinically difficult, so positive anti-TSH receptor antibodies (TRABs) confirm this diagnosis.Maternal thyroid autoimmunity is still related to postpartum depression, a situation that should call for the attention of family doctors while they provide care to newly mothers.Description: 34-year-old female, nuclear family in phase III of Duvall's life cycle, two daughters (5 years and 12 months-old), teacher.Past smoking history, hyperemesis gravidarum in both pregnancies, Graves' disease after the first pregnancy -in remission and without therapy since 2014.Seven months after the second delivery she presented symptomatic hyperthyroidism and thyroid evaluation revealed positive TRAbs, which confirmed the recurrence of Graves' disease.She initiated therapy with thiamazole and propanolol, which was effective in controlling thyroid function about one month later, requiring therapeutic adjustment with levothyroxine.However she maintained marked irritability, sadness, lack of concentration and insomnia, with great impact on her relationship with her husband and daughters.After careful anamnesis we realized that this emotional lability were present since the first delivery, although lightly.She started escitalopram and zolpidem, with little efficacy, and the case was discussed with our psychiatry consultant, who suggested further evaluation in psychiatry consultation -for which the patient is presently waiting.Discussion: Although there is an association between hormonal imbalances of the postpartum period (including thyroid hormones) and affective disorders, in this patient's particular case the causal relationship is not clear.Careful details of her anamnesis suggest that a psychiatric condition has been evolving in the past few years, though aggravated now by her hormonal alterations.At the same time, the recurrence of an autoimmune thyroid disease requires a differentiated support by endocrinology.In these cases, the family physician acts as a liaison and point of continuity of care for the patient, performing a watchful monitoring, early diagnosis and rapid referral.
Год издания: 2018
Авторы: Órgão Oficial, D Associação, Portuguesa De, Medicina Geral, Ana Margarida, Cruz André, N Van Nhieu, Berk Geroğlu, Bruno Heleno, Candan Kendir, Chloé Delacour, Christofer Reichel, Elvira Ensink, Enrique Gómez Álvarez, Charilaos Lygidakis, Ivana Babič Božović, María Joana Gomes, Job Metsemakers, Katarzyna Nessler, Liliana Laranjo, Lucia Ludmila, Resutiková Luís, Monteiro Luís, Pisco Patrick O'donnell, Persijn Honkoop, Raluca Zoitanu, Raquel Gómez Bravo, Rosy Tsopra, Simone Cernesi, Stefano Celotto, Tom Axelrod, Ulrik Bak Kirk, Yusianmar Mariani, Marta Barroca, Diogo Correia, Susana Pacheco, Ana Cláudia, Monteiro Pereira, Cláudia Ho, Sofia Pereira, Ana F. Lopes, Sophia Martins, José Manuel de. Viveiros, Sara Cristina Rodrigues Dinis, Ana Mota, Natalina Rodrigues, Cristina Serra, Miguel Pereira, Eduarda Cerdeira, Joana Queiroz-Machado, Abílio Malheiro, Sara Coelho, José Mendes, C. Gil-Lozano, Ikbal Hümay Akyildiz, Elif Okumuş, Nan Lay, Kader Topçu, Özlem Sarıkaya, Pemra C. Ünalan, Katri Mustonen, Jarmo Kantonen, Timo Kauppila, Nishan Silva, Shaluni Tissera, Pasindu Malaka, Thusitha Bandara, Geethanjana Malsha, Sofia Santos, Ivone Rodrigues, Maria Tomé, E Nina
Источник: Revista Portuguesa de Clínica Geral
Ключевые слова: Galician and Iberian cultural studies
Открытый доступ: hybrid
Том: 34
Выпуск: 7