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The thyroid gland is positioned directly below the larynx in the anterior portion of the neck (Kumrow & Dahlen, 2002). The nerves and arteries of the thyroid and larynx are intertwined thus damage to one structure could easily affect the other structure. Thyroid dysfunction may also affect the histology of the larynx thus changing vocal quality (Stemple, 2010). This study measured vocal quality of patients with thyroid disease using the Consensus Auditory Perceptual Evaluation of Voice (CAPE-V). Voice samples from 16 subjects with thyroid disease were compared to an age-matched group of 18 control subjects with no reported history of thyroid dysfunction. An experienced voice clinician rated each sample on the six parameters of the CAPE-V: overall severity, roughness, breathiness, strain, pitch and loudness. Statistical analysis of the results revealed a significant difference between the thyroid disease group and the control group for overall severity of vocal quality and vocal roughness. These results further strengthen the connection between thyroid disease and vocal dysfunction. Further research is warranted to explore the specific thyroid diagnoses that relate to vocal dysfunction, as well as to strengthen the findings on a larger population of participants. / Lori Lombard, Ph.D., CCC-SLP David Stein, Ph. D., CCC-SLP Jill Brady, Ph.D., CCC-SLP

ABSTRACT Thyroid disease is one of the most common endocrine disorders in clinical practice. Critical illness is often associated with alterations in thyroid hormone functions. Thyroid dysfunction is a serious matter if managed inaccurately; it may increase morbidity and mortality. The purpose of this Doctor of Nursing Practice project is to identify the knowledge, attitudes, behaviors and practice of advanced practice nurses (acute care nurse practitioners (ACNP) and adult gerontology acute care nurse practitioners (AGACNP)) on current thyroid dysfunction management in the acute care setting. The DNP project demonstrated that most acute care nurse practitioners believe that TD screening, diagnosis and management is important in the acute care setting. The survey results also indicated that most of the AGACNP/ACNPs would initiate treatment while managing patient in an acute care setting and will likely collaborate with endocrinology for overall management or follow ups to ensure quality and comprehensive care in management of TD. Keywords: thyroid disease, thyroid dysfunction, identify, knowledge, attitudes, behaviors, acute care

Thyroid disease, a chronic illness, affects nearly 200 million people worldwide and is more common among women than in men. Numerous factors make diagnosing and treating thyroid disease in women challenging. The standard blood test for diagnosing thyroid disease and determining treatment effectiveness is inconsistent in its accuracy. Many women with thyroid disease are misdiagnosed or struggle with symptoms even once receiving treatment. Although thyroid disease is highly prevalent among women and the doctor-patient relationship is known to influence treatment outcomes, there is a gap in the literature regarding the treatment experiences of women with thyroid disease and the doctor-patient relationship. The purpose of this phenomenological study was to explore female thyroid patients' experiences of treatment and the doctor-patient relationship. Sixteen female thyroid patients, ages 18 and older and members of an international online support group, were individually interviewed via online chat. Data interpretation was guided by social constructionism and feminist theory and was accomplished via Moustakas's analytic method. Themes related to the doctor-patient relationship were identified, including the culture of the medical profession, diagnostic bias, and gender differences in communication. Emergent themes included patient education level, patient self-advocacy behaviors, and the use of natural thyroid medication. The results of this study may contribute to positive social change by enhancing doctors' understanding of thyroid disease in women and the influence of the doctor-patient relationship in determining positive treatment outcomes, thus equipping doctors with enriched knowledge for providing their female thyroid patients with the highest quality of care.

The objective of this study was to define if there is a mutual influence between the daily dose of levothyroxine, positivity/negativity of thyroid antibody, BMI, waistline, hip measurement and other anthropometric parameters. It was also to analyze if the daily dose of levothyroxine is being influenced by degree of hypothyroidismimportance. Methodology: There were 44 patients examined having hypothyroidism and who have been cured with levothyroxine so that their thyroid function has been normal at the time. I have examined those patients' body height, weight, BMI, waistline and hipline. Under the supervision of the medicine doctor I used records available for each of patients regarding concentration of TSH, TPOAb and TgAb, which were defined with patients' blood by a method of immunoassay. Results: The average daily dose of levothyroxine in all patients sample has showed a positive correlation with BMI (Spearman rho coef. 0,429, P value=0,004) and with waistline of women (Spearman rho coef. 0,332, P value=0,028). The concentration of thyroidantibody did not show a statistical relevance regarding the dependence with the dose of levothyroxine, BMI or other anthropometric parameters.The highest average daily dose of levothyroxine was confirmed for examined patients after total thyroidectomy (median of...

Thyroid hormone is a master regulator of growth and development in all vertebrates. Thus, disruption of its synthesis and activity can lead to profound consequences. Past decade studies on thyroid function tests have established an efficient guideline for monitoring thyroid diseases, yet a significant proportion of healthcare providers do not defer to it in their practice. The aim of this study is to assess provider practices in the diagnosis and treatment of primary hypothyroidism due to autoimmunity at Boston Children's Hospital (CHB) for a primarily pediatric patient population. Commonly known as Hashimoto's thyroiditis (HT), this is the most common thyroid disease in the world as well as the most common manifestation of human autoimmune endocrine disease. Through CHB's bioinformatics institute, a rich data set was collected to assess the manner in which healthcare providers utilized relevant thyroid function tests (TFTs). This work assessed and confirmed the superior sensitivity of thyroid peroxidase autoantibodies (TPO) relative to thyroglobulin antibodies (TgAb) for diagnosing HT in children. We also verified proper utilization of thyroid stimulating hormone tests to monitor HT but concluded that there is a low utilization efficiency with regards to measurements of thyroid hormones (thyroxine and triiodothyronine). Based upon the observation of unnecessary monetary loss caused by improper TFTs utilization, it can be concluded that reflex testing at CHB may improve provider practices' efficiency for HT monitoring.

Submitted by Divisão de Documentação/BC Biblioteca Central (ddbc@ufam.edu.br) on 2018-03-16T14:51:26Z No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Reprodução Não Autorizada.pdf: 47716 bytes, checksum: 0353d988c60b584cfc9978721c498a11 (MD5) / Approved for entry into archive by Divisão de Documentação/BC Biblioteca Central (ddbc@ufam.edu.br) on 2018-03-16T14:51:39Z (GMT) No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Reprodução Não Autorizada.pdf: 47716 bytes, checksum: 0353d988c60b584cfc9978721c498a11 (MD5) / Made available in DSpace on 2018-03-16T14:51:39Z (GMT). No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Reprodução Não Autorizada.pdf: 47716 bytes, checksum: 0353d988c60b584cfc9978721c498a11 (MD5) Previous issue date: 2017-11-25 / Introduction: The colloid goiter (CG) is a heterogeneous disorder and represents the main cause of benign thyroid nodule. Prevalent in geographical areas with iodine deficiency, in most cases carried out expectant conduct or surgically. Classified according to the morphological and functional characteristics, it may present as diffuse or nodular, toxic or nontoxic (with or without functional autonomy). Can reach large volume and compression of neck structures or even turn into malignant disease. Dependent on environmental and genetic factors, with iodine deficiency being the main determinant for the impact on incidence, other environmental and hereditary factors are listed, but little is known about the molecular pathogenesis. Objectives: To map the Epigenetic alterations of the five different surgical parts of CG from patients submitted to total thyroidectomy in Manaus, Amazonas, to analyze, compare and describe the specific pattern for this population. Methods: Five specimens of CG with histopathological confirmation were obtained from the “Normal Thyroid Tissue Bank and with Goiter” from the UFAM. Were used to identify the global methylation patterns of DNA and histone 3 in trimethylated lysine 4, 9 and 27 (H3K4me3, H3K9me3 and H3K27me3). Was used an ELISA type specific immunoassay method, with the results compared between the patients, between the different region of the gland in the same individual and between the individuals. Results: there was no evidence there were significant differences (5%) in the mean global DNA methylation patterns between the patients (p = 0.114) or between the thyroid regions (p = 0.843) considered similar. The mean pan-methylation patterns of histones H3K4me3, H3K9me3 and H3K27me3 are significantly different among patients (p <1%), although there were no significant differences between parts in the same individual (p> 5%). Conclusion: The results of the analyzes of this study revealed that CG parts obeyed a pattern of distribution of significant DNA hypermethylation between patients and parts of CG, differing only among patients the pattern of histone methylation. As these findings are more common in cancer, we may suggest that at the epigenetic level CG may have some common etiologic factor that leads to this tissue response or that responds by phenotypic expressions and malignant transformation. There are now no efficient markers that accurately detect the risk of CG malignancy, much less the possibility of defining its tissue progression, it is very likely that multiple genes will participate in this process. Therefore, the findings found in these patients may make way for the future application of the CG epigenetic study, which may imply the viability of new therapeutic or preventive forms of progression, since the methylation status can be reversed, but other studies in the population are needed to understand better those finding. / Introdução: O bócio coloide (BC) constitui numa desordem heterogênea e representa a principal causa de nódulo benigno da tireoide. Prevalente em áreas geográficas com deficiência de iodo, sendo, na maioria dos casos, conduzido de forma expectante ou cirúrgica. Classificado de acordo com as características morfológicas e funcionais, pode se apresentar difuso ou nodular, tóxico ou atóxico (com ou sem autonomia funcional), podendo alcançar grandes volumes e ocasionar compressão de estruturas do pescoço, ou, não muito raramente, sofrer transformação maligna. Dependente de fatores ambientais e genéticos, com a deficiência de iodo sendo o principal fator determinante para o impacto na incidência, outros fatores ambientais e hereditários são arrolados, porém pouco se conhece da patogênese molecular. Objetivos: mapear as alterações epigenéticas de diferentes regiões de 05 espécies cirúrgicas de BC de pacientes submetidos a tireoidectomia total em Manaus, Amazonas, com o objetivo de analisar, comparar e descrever o padrão específico para esta população. Metodologia: Foram utilizados 05 espécimes de BC com confirmação histopatológica, provenientes do “Banco de Tecidos de Tireoide Normal e com Bócio” da UFAM, e para identificar os padrões de metilação global do DNA e da histona 3 na lisina trimetiladas 4, 9 e 27 (H3K4me3, H3K9me3 e H3K27me3) foram utilizados método de imunoensaio específico do tipo ELISA, com os resultados comparados entre as pacientes, entre as diferentes regiões da glândula num mesmo indivíduo e entre os indivíduos. Resultados: não houveram evidências de que existam diferenças significativas (ao nível de 5%) dos padrões médios de metilação global do DNA entre os pacientes (p = 0,114), ou entre as regiões da tireoide (p = 0,843), sendo, portanto, consideradas similares. Os padrões médios de pan-metilação das histonas H3K4me3, H3K9me3 e H3K27me3 são significativamente diferentes entre os pacientes (p < 1%), apesar de não apresentar diferenças significativas entre as regiões num mesmo indivíduo, (p > 5%). Conclusão: Os resultados das análises deste estudo, revelou que os espécimes de BC obedeceram a um padrão de distribuição de hipermetilação do DNA significativa entre os pacientes e as regiões do BC, diferindo somente entre os pacientes o padrão de metilação das histonas. Como estes achados são mais comuns no câncer, podemos sugerir que em nível epigenético, o BC possa ter algum fator etiológico comum que leve a esta resposta tecidual ou que responda pelas expressões fenotípicas e transformação maligna. Como, até o momento, não existem marcadores eficientes que detecte com precisão a existência de risco de malignização do BC, muito menos a possibilidade de definir sua progressão tecidual, é muito provável que participem múltiplos genes neste processo. Portanto, os achados encontrados nestas pacientes podem abrir caminho na aplicação futura do estudo epigenético do BC, podendo implicar na viabilização de novas formas terapêuticas ou preventivas da progressão, uma vez que, o status de metilação pode ser revertido, porém outros estudos ampliados na população em questão são necessários para entender melhor estes achados.

INTRODUÇÂO: O funcionamento da tireóide fetal se inicia em torno de dez semanas de vida embrionária, e está intimamente relacionado ao funcionamento tireoidiano materno. Em gestantes com doenças tireodianas (principalmente hipertireoidismo), a passagem de anticorpos e medicações maternas pode provocar o mau funcionamento da tireóide fetal, acarretando bócio fetal. Além disso, algumas doenças fetais podem cursar com bócio antenatal. O funcionamento inadequado da tireóide fetal pode ter conseqüências severas (restrição de crescimento intra-uterino, craniosinostose, alterações na produção de líquido intra-âmniótico, insuficiência cardíaca ou até óbito fetal). Além disso, o bócio fetal avançado pode funcionar como obstrução à via de parto, podendo acarretar problemas na evolução do parto. A ultra-sonografia da tireóide fetal vem sendo descrita como um bom método para avaliação de tireóide fetal, porém existem poucas curvas de normalidade da tireóide fetal descritas atualmente, nenhuma em população brasileira. O objetivo desse estudo é construir curvas de normalidade do perímetro, área e diâmetro transverso da tireóide fetal em população brasileira através da utilização da ultra-sonografia bidimensional. MÉTODOS: Foram avaliadas 239 gestantes sem doenças sistêmicas e sem história de doença tireoidiana do pré-natal do Hospital das Clínicas da Universidade de São Paulo. Todas as gestantes realizaram dosagem de TSH durante a gestação para descartar doença tireoidiana. A idade gestacional foi calculada pela data da última menstruação, e confirmada por ultrasonografia de primeiro ou segundo trimestre. Foram construídas curvas de normalidade do perímetro, área e diâmetro transverso da tireóide fetal. Das 239 pacientes inicialmente avaliadas, 43 (18%) foram excluídas. A prevalência de hipotireoidismo subclínico entre as gestantes foi de 0,9%, e a de hipotireoidismo franco de 2,2%. Em 5,4% das pacientes não foi possível a visualização adequada da tireóide fetal. Foram incluídas 196 pacientes. A avaliação foi realizada por dois operadores independentes. Foram realizadas três medidas de cada parâmetro, e considerada a média dos valores para a construção das curvas. Para o cálculo da variação intra-observador, foram avaliadas 159 pacientes e realizadas três medidas subseqüentes de cada parâmetro. Para o cálculo da variação inter-observador foram avaliadas 34 pacientes, nas quais cada operador realizou uma medida de cada parâmetro. RESULTADOS: Foram construídas curvas de normalidade do perímetro (P), área (A) e diâmetro transverso (DT) da tireóide fetal em relação à idade gestacional (IG) em nossa população de gestantes. As equações que melhor representaram a média esperada por idade gestacional foram equações lineares: P = 0,146 x IG; A = -1,289 + 0,085 x IG; DT = 0,054 x IG. / INTRODUCTION: The functioning of fetal thyroid initiates around ten weeks of embryonic life, and is intimately related to maternal thyroid functioning. In pregnant women with thyroid disease (especially hyperthyroidism), maternal antibodies and medications provoke malfunctioning of the fetal thyroid gland, causing fetal goiter. Moreover, primary fetal anomalies may course with antenatal goiter (i.e.: congenital fetal hypothyroidism). The inadequate functioning of fetal thyroid causes severe consequences such as intrauterine growth restriction, craniosinostosis, altered production of intra-amniotic liquid, cardiac insufficiency and even fetal death. Moreover, large fetal goiters may cause a mass effect, causing difficulties during vaginal delivery. Ultrasound evaluation of fetal thyroid has recently been described as a sensible method for fetal screening of thyroid anomalies. Few normality curves have been described until now, none of them in Brazilian fetuses. The aim of this study was to build normality curves of fetal thyroid perimeter, area and transverse diameter through the use of bidimensional ultrasonography. METHODS: 239 pregnant women without systemic disease and without previous thyroid disease were evaluated in the prenatal care unity of the Hospital of the Clinics of the University of São Paulo. All women had TSH measured during pregnancy in order to exclude thyroid disease. Gestational age was calculated by the date of the last menses, and confirmed by first or second trimester ultrasonography. Normality curves of fetal thyroid perimeter, area and transverse diameter were constructed. From the 239 patients initially evaluated, 43 (18%) were excluded. The prevalence of thyroid hormone disorders was 0.9% for subclinical hypothyroidism, and 2.2% for hypothyroidism. One patient had a TSH value below normal. In 5.4% of patients the adequate visualization of fetal thyroid was not possible. The evaluation was carried out in 196 patients by two independent operators. Three different measures of each parameter were performed. The average values were used to build the curves. Intra-observer variation analysis was made using 159 patients in whom three measures were made for each parameter. For the inter-observer variation, 34 patients were evaluated. RESULTS: Normality curves of the perimeter (P), area (A) and transverse diameter (TD) were constructed in relation to gestational age (GA) in our population. The 95% confidence interval was calculated. The equations that better represented the average value expected for each gestational age were linear regressions: P = 0,146 x GA; A= -1,289 + 0,085 x GA; TD = 0,054 x GA. The method was considered to be reproductive.

INTRODUÇÂO: O funcionamento da tireóide fetal se inicia em torno de dez semanas de vida embrionária, e está intimamente relacionado ao funcionamento tireoidiano materno. Em gestantes com doenças tireodianas (principalmente hipertireoidismo), a passagem de anticorpos e medicações maternas pode provocar o mau funcionamento da tireóide fetal, acarretando bócio fetal. Além disso, algumas doenças fetais podem cursar com bócio antenatal. O funcionamento inadequado da tireóide fetal pode ter conseqüências severas (restrição de crescimento intra-uterino, craniosinostose, alterações na produção de líquido intra-âmniótico, insuficiência cardíaca ou até óbito fetal). Além disso, o bócio fetal avançado pode funcionar como obstrução à via de parto, podendo acarretar problemas na evolução do parto. A ultra-sonografia da tireóide fetal vem sendo descrita como um bom método para avaliação de tireóide fetal, porém existem poucas curvas de normalidade da tireóide fetal descritas atualmente, nenhuma em população brasileira. O objetivo desse estudo é construir curvas de normalidade do perímetro, área e diâmetro transverso da tireóide fetal em população brasileira através da utilização da ultra-sonografia bidimensional. MÉTODOS: Foram avaliadas 239 gestantes sem doenças sistêmicas e sem história de doença tireoidiana do pré-natal do Hospital das Clínicas da Universidade de São Paulo. Todas as gestantes realizaram dosagem de TSH durante a gestação para descartar doença tireoidiana. A idade gestacional foi calculada pela data da última menstruação, e confirmada por ultrasonografia de primeiro ou segundo trimestre. Foram construídas curvas de normalidade do perímetro, área e diâmetro transverso da tireóide fetal. Das 239 pacientes inicialmente avaliadas, 43 (18%) foram excluídas. A prevalência de hipotireoidismo subclínico entre as gestantes foi de 0,9%, e a de hipotireoidismo franco de 2,2%. Em 5,4% das pacientes não foi possível a visualização adequada da tireóide fetal. Foram incluídas 196 pacientes. A avaliação foi realizada por dois operadores independentes. Foram realizadas três medidas de cada parâmetro, e considerada a média dos valores para a construção das curvas. Para o cálculo da variação intra-observador, foram avaliadas 159 pacientes e realizadas três medidas subseqüentes de cada parâmetro. Para o cálculo da variação inter-observador foram avaliadas 34 pacientes, nas quais cada operador realizou uma medida de cada parâmetro. RESULTADOS: Foram construídas curvas de normalidade do perímetro (P), área (A) e diâmetro transverso (DT) da tireóide fetal em relação à idade gestacional (IG) em nossa população de gestantes. As equações que melhor representaram a média esperada por idade gestacional foram equações lineares: P = 0,146 x IG; A = -1,289 + 0,085 x IG; DT = 0,054 x IG. / INTRODUCTION: The functioning of fetal thyroid initiates around ten weeks of embryonic life, and is intimately related to maternal thyroid functioning. In pregnant women with thyroid disease (especially hyperthyroidism), maternal antibodies and medications provoke malfunctioning of the fetal thyroid gland, causing fetal goiter. Moreover, primary fetal anomalies may course with antenatal goiter (i.e.: congenital fetal hypothyroidism). The inadequate functioning of fetal thyroid causes severe consequences such as intrauterine growth restriction, craniosinostosis, altered production of intra-amniotic liquid, cardiac insufficiency and even fetal death. Moreover, large fetal goiters may cause a mass effect, causing difficulties during vaginal delivery. Ultrasound evaluation of fetal thyroid has recently been described as a sensible method for fetal screening of thyroid anomalies. Few normality curves have been described until now, none of them in Brazilian fetuses. The aim of this study was to build normality curves of fetal thyroid perimeter, area and transverse diameter through the use of bidimensional ultrasonography. METHODS: 239 pregnant women without systemic disease and without previous thyroid disease were evaluated in the prenatal care unity of the Hospital of the Clinics of the University of São Paulo. All women had TSH measured during pregnancy in order to exclude thyroid disease. Gestational age was calculated by the date of the last menses, and confirmed by first or second trimester ultrasonography. Normality curves of fetal thyroid perimeter, area and transverse diameter were constructed. From the 239 patients initially evaluated, 43 (18%) were excluded. The prevalence of thyroid hormone disorders was 0.9% for subclinical hypothyroidism, and 2.2% for hypothyroidism. One patient had a TSH value below normal. In 5.4% of patients the adequate visualization of fetal thyroid was not possible. The evaluation was carried out in 196 patients by two independent operators. Three different measures of each parameter were performed. The average values were used to build the curves. Intra-observer variation analysis was made using 159 patients in whom three measures were made for each parameter. For the inter-observer variation, 34 patients were evaluated. RESULTS: Normality curves of the perimeter (P), area (A) and transverse diameter (TD) were constructed in relation to gestational age (GA) in our population. The 95% confidence interval was calculated. The equations that better represented the average value expected for each gestational age were linear regressions: P = 0,146 x GA; A= -1,289 + 0,085 x GA; TD = 0,054 x GA. The method was considered to be reproductive.