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HIPOTIREOIDISMO E HIPERTIREOIDISMO UMA BREVE REVISO

SOBRE AS DISFUNES TIREOIDIANAS


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MALDONADO, Rafael Resende


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VREUHDVSHFWRVJHUDLVGHVVDVGXDVGLVIXQo}HVWDLVFRPRWLSRVGHQLo}HVVLQWRPDVHIHLWRVVREUHR
RUJDQLVPR GLDJQyVWLFRV H WUDWDPHQWR )RL UHDOL]DGD XPD EXVFD GH DUWLJRV FLHQWtFRV 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
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KEYWORDS: +\SRWK\URLGLVPK\SHUWK\URLGLVP*UDYHVGLVHDVHFDUGLRYDVFXODUV\VWHPSK\VLFDODFWLYLW\

1. INTRODUO
+LSRWLUHRLGLVPR H KLSHUWLUHRLGLVPR
VmR GXDV GLVIXQo}HV GD JOkQGXOD WLUHRLGH
TXH FDXVDP XPD VpULH GH DOWHUDo}HV QR
RUJDQLVPR KXPDQR 2 KLSRWLUHRLGLVPR p
GHQLGRFRPRXPHVWDGRFOtQLFRUHVXOWDQWH
GH TXDQWLGDGH LQVXFLHQWH 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 GHQLGR
FRPRXPHVWDGRFOtQLFRUHVXOWDQWHGHTXDQ
WLGDGH LQVXFLHQWH RX DXVrQFLD GH KRUP{
QLRVFLUFXODQWHVGDJOkQGXODWLUHRLGHGHQR
PLQDGRV7 WLUR[LQD H7 WULLRGRWLURQLQD 
SDUD VXSULU XPD IXQomR RUJkQLFD QRUPDO
$ IRUPD PDLV SUHYDOHQWH p D GRHQoD WL
UHRLGLDQD SULPiULD GHQRPLQDGD GH KLSRWL
UHRLGLVPR SULPiULR TXH p XPD GHFLrQFLD
KRUPRQDO FDXVDGD GHYLGR j LQFDSDFLGDGH
SDUFLDORXWRWDOGDJOkQGXODWLUHRLGHGHSUR

Intercincia
& Sociedade

,QWHUFLrQFLD 6RFLHGDGH ,661 9RO1

GX]LU RV KRUP{QLRV WLUHRLGLDQRV 0h//(5


HWDO 1RHQWDQWRRKLSRWLUHRLGLVPR
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 organognese 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
mao glandular durante a embriognese e
HYLGrQFLDV VXJHUHP TXH PXWDo}HV QRV ID
WRUHVGHWUDQVFULomR 77)77)H3$; 
PXLWDVYH]HVVmRRVUHVSRQViYHLVSHODGR
HQoD$IDOWDGHHVWtPXORGR76+ KRUP{QLR
HVWLPXODGRUGDWLUHRLGH QDJOkQGXODWLUHRLGH
OHYDDRFRUUrQFLDGDGRHQoDPRWLYDGDSRU
PiIRUPDomRRXGLVIXQomRKLSRIiVLFDRXKL
SRWDOkPLFD2FRUUHJHUDOPHQWHSRUGLVKRU
PRJrQHVHGDJOkQGXODWLUHRLGHSRUGHIHLWR
QR WUDQVSRUWDGRU GH LRGHWR QD PHPEUDQD
EDVDO HRX DSLFDO GHIHLWRV QD VtQWHVH GD
7* RX GHIHLWRV QD RUJDQLFDomR GR LRGHWR
3(5521(HWDO $ELRVVtQWHVHGRV
KRUP{QLRV GD WLUHRLGH WHP QD HQ]LPD WLUH
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FDWDOLVDULPSRUWDQWHVUHDo}HV0XWDo}HVQR
gene relacionado a esta enzima so consi
GHUDGRVDSULQFLSDOFDXVDGH+&SRUGLVRU
PRQRJrQHVH 628=$ 
'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
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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
$FUHHHP5RQG{QLDDSRQWDRXSDUDDWUDVR
QRLQtFLRGDOLQJXDJHPRUDOWURFDVQDIDOD
IDOD LQLQWHOLJtYHO FRPSRUWDPHQWR DJLWDGR H
FRPSRUWDPHQWR QHUYRVR 9HULFRXVH DOWH
UDomRQDIDODHPGRJUXSRDYDOLDGRH
DOWHUDomR DXGLWLYD HP  3DUD DTXHOHV
TXHWLYHUDPGLDJQyVWLFRHWUDWDPHQWRPDLV
WDUGLRGRKLSRWLUHRLGLVPRRtQGLFHGHTXHL
[DVIRLPDLRUGRTXHSDUDDTXHOHVFRPGLDJ
QyVWLFR H WUDWDPHQWR  PDLV SUHFRFH )(5
5(,5$ 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 formao glandular durante a
HPEULRJrQHVH H p GHQRPLQDGR GLVJHQHVLD
WLUHRLGLDQD ./(77   3RU RXWUR ODGR
GHIHLWRV JHQpWLFRV QR GHVHQYROYLPHQWR H
IXQomR GD KLSyVH SRGHP UHVXOWDU HP Yi
ULDVIRUPDVGHGHFLrQFLDFDUDFWHUtVWLFDVGR
KLSRWLUHRLGLVPR FHQWUDO 3(5521( HW DO
 2KLSRWLUHRLGLVPRFHQWUDORFRUUHSRU
GHFLrQFLD GH KRUP{QLRV WLUHRLGLDQRV SRU
IDOWD GH HVWtPXOR GR76+ KLSRViULR RX GR
75+ KRUP{QLROLEHUDGRUGDWLUHRWURQD KL
SRWDOkPLFR
(QTXDQWR LVVR R KLSRWLUHRLGLV
PR VXEFOtQLFR +6  RX GRHQoD WLUHRGLDQD
PtQLPD p GHQLGR SHOD HOHYDomR GR QtYHO
VpULFRGR76+DFLPDGROLPLWHVXSHULRUGD
QRUPDOLGDGHDVVRFLDGDDQtYHLVQRUPDLVGH
WLUR[LQDOLYUH 7/  3,0(17(/ +$16(1
7(,;(,5$HWDO 2XWURWUDED
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[HGHPDSUpFOtQLFR 520$/
',1, 6*$5%,  )$5$+   $ SUHYD
OrQFLDGR6+7YDULDFRPDLGDGHHRVH[R
GD SRSXODomR VHOHFLRQDGD GH  D 
HTXDQGRDFRPSDQKDGRGHYDORUHVHOHYD
GRVGHDQWLFRUSRVDQWLWLURLGHDQRVRULVFRGH
SURJUHVVmRSDUDKLSRWLUHRLGLVPRFOtQLFDDX

Intercincia
& Sociedade

,QWHUFLrQFLD 6RFLHGDGH ,661 9RO1

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
OLSHGPLDGHSUHVVmRHGpFLWFRJQLWLYR(V
WXGRV UHFHQWHV VXJHUHP SRUpP TXH HVWD
VHMD XPD SRVVtYHO FRQGLomR LQHUHQWH DR
HQYHOKHFLPHQWR DWXDQGR FRPR XPD DGDS
WDomRVLROyJLFDGHSURWHomRjVH[LJrQFLDV
GH FRQVXPR H[DJHUDGR RX FDWDEROLVPR$
DYDOLDomR GRV KRUP{QLRV WLUHRLGLDQRV HP
LGRVRV p FRPSOH[D GHYLGR j SUHVHQoD GH
doenas concomitantes e uso frequente de
PHGLFDo}HVTXHSRGHPLQXHQFLDUDGRVD
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
[LQDHREVHUYRXVHPHOKRUDVLJQLFDWLYDQD
WROHUkQFLDDRODFWDWRHFRQVHTXHQWHPHQWH
WROHUkQFLD DR HVIRUoR DSyV R WUDWDPHQWR
PRVWUDQGR R SRWHQFLDO GD /WLUR[LQD VyGLFD
SDUDDXPHQWDUDWROHUkQFLDDRHVIRUoRItVLFR
SURJUHVVLYR HP SRUWDGRUDV GH 6+7 GON
d$/9(6HWDO 
Em outro trabalho foi feito um le
YDQWDPHQWR GH HVWXGRV SXEOLFDGRV HQWUH
 H  QD EDVH GH GDGRV 3XE0HG
FRQVLGHUDQGR DUWLJRV TXH DYDOLDUDP D IXQ
omRFDUGLRYDVFXODUGHKLSRWLUHRLGHRVVXEFOt
QLFRV H FOtQLFRV H D LQXrQFLD GR H[HUFtFLR
ItVLFR VREUH DV IXQo}HV FDUGLRYDVFXODUHV
DIHWDGDV QHVWD GRHQoD 9HULFRXVH TXH D
FDSDFLGDGH DHUyELD GH KLSRWLUHRLGHRV VXE
FOtQLFRV H FOtQLFRV HVWi UHGX]LGD H TXH D
IXQomR HQGRWHOLDO R HVWUHVVH R[LGDWLYR H D
IXQomRDXWRQ{PLFDHVWmRSUHMXGLFDGRVQHV
WHVVXMHLWRV$SHVDUGHVHUXPDHQIHUPLGD
GH WmR SUHYDOHQWH TXDQWR R GLDEHWHV QmR
H[LVWH XPD UHFRPHQGDomR SDUD SUHVFULomR
GH DWLYLGDGH ItVLFD SDUD RV KLSRWLUHRLGHRV
WDOFRPRKiSDUDREHVRVFDUGLRSDWDVHGLD
EpWLFRV 628=$HWDO 
8P HVWXGR UHDOL]DGR FRP SDFLHQ
WHVSRUWDGRUHVGHKLSRWLUHRLGLVPRVXEFOtQLFR
DYDOLRX GXUDQWH VHLV PHVHV R WUHLQDPHQWR
DHUyELRVHQGRTXHRVSDFLHQWHVDSUHVHQWD
ram melhoras da funo 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 GHQLGD FRPR XPD VtQ
GURPH GRORURVD P~VFXORHVTXHOpWLFD no
LQDPDWyULD 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

Intercincia
& Sociedade

,QWHUFLrQFLD 6RFLHGDGH ,661 9RO1

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{QLRHVWLPXODGRUGDWLUHRLGH 76+ WL
UR[LQD OLYUH 7 OLYUH  H DQWLFRUSR DQWLWLUHR
SHUR[LGDVH D732 SRUPpWRGRGHTXLPLR
OXPLQHVFrQFLD'HVVHJUXSRSDFLHQWHV
HUDPSRUWDGRUHVGHEURPLDOJLDVHQGRTXH
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
732QRUPDO FRPKLSRWLUHRLGLVPRFOtQLFR
SRUWLUHRLGLWHFU{QLFDDXWRLPXQH 76+HOHYD
GR7OLYUHGLPLQXtGRHD732HOHYDGR H
FRPKLSRWLUHRLGLVPRSRUFDXVDQmRGHQLGD
76+ HOHYDGR 7 OLYUH GLPLQXtGR H D732
QRUPDO 1RVSDFLHQWHVFRPKLSRWLUHRLGLVPR
SUHYLDPHQWHGLDJQRVWLFDGRDIDGLJDRVRQR
QmRUHVWDXUDGRUHDFHIDOHLDFU{QLFDIRUDP
estatisticamente mais frequentes naqueles
HPTXHIRLIHLWRRGLDJQyVWLFRGHEURPLDO
JLD &81+$6 %$5&(/26 
(PRXWUDiUHDpLPSRUWDQWHDFRP
SDQKDURIXQFLRQDPHQWRGDJOkQGXODWLUHRLGH
durante a gestao. $JHVWDomRLQGX]GLYHU
VDVDOWHUDo}HVVLROyJLFDVPDWHUQDVVHQGR
uma delas a funo tireoidiana. Quando h
D SUHVHQoD GH DQWLFRUSRV DQWLWLUHRLGLDQRV
RX LQJHVWmR GHFLHQWH 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
TXHOKRVGHPmHVKLSRWLUHRLGLDQDVQmRWUD
WDGDVGXUDQWHDJUDYLGH]SRGHPDSUHVHQWDU
GHFLrQFLDV QR GHVHQYROYLPHQWR GR VLVWH
PDQHUYRVRFHQWUDO 61& eDFRQVHOKiYHO
TXHPXOKHUHVTXHSRVVXHPKLSRWLUHRLGLVPR
estabilizem a doena antes da gestao
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 GHFLrQFLD 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[RKLSRWiODPRKLSyVHWLUHRLGHWH
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
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