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Hipotireoidismo (TSH/ T4)
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Sociedade Brasileira de Endocrinologia e MetabolismoSociedade Brasileira de Medicina de Família e Comunidade QUANDO SUSPEITAR DE HIPOTIREIODISMO?
Devem ser investigados bioquimicamente para hipotireoidismo todos os pacientes
que apresentam isoladamente ou em combinação as manifestações citadas no quadro
clínico, além de mulheres com distúrbios menstruais e de infertilidade e portadores de
hipercolesterolemia.
Manifestações Clínicas no Hipotireoidismo
Cansaço/Fadiga/Exaustão
Sonolência
Perda de concentração/memória
Intolerância ao frio
Constipação
Depressão
Ganho de Peso
Aumento de volume da tireóide
Menstruação Irregular
Síndrome do tunel do carpo
Déficit de audição
Pele seca
Unhas quebradiças
Edema palpebral/ pretibial não compressivo
Bradicardia
Pressão alta
Alteração do Reflexo de Aquiles
HIPOTIREOIDISMO PRIMÁRIO E GALACTORRÉIA
Pacientes que apresentam galactorréia, principalmente em mulheres, devem ser investigados
Para a possibilidade de hipotireoidismo primário. Se confirmado a correlação, não
há necessidade de tratamento específico da galactorréia, somente do hipotireodismo.
COMO PREDIZER SE O HIPOTIREOIDISMO SUBCLÍNICO IRÁ PROGREDIR
PARA O HIPOTIREOIDISMO?
A taxa de risco de progressão do hipotireoidismo subclínico ao hipotireoidismo aumenta
com a idade, sexo feminino, e na presença de anticorpos antitireoidianos positivos. O único
fator independente que se associa à progressão para hipotireoidismo foi a concentração sérica
inicial do TSH, com maiores taxas quando o TSH inicial for acima de 10 mIU/L.
O TSH É O EXAME INDICADO PARA O DIAGNÓSTICO DE HIPOTIREOIDISMO?
Fazer a dosagem de TSH pelo método de ensaio imunométrico não isotópico (IMA). O valor
da normalidade hoje está na faixa de 0,2 – 4,5 mlU/L.
TODO PACIENTE COM SUSPEITA DE HIPOTIREOIDISMO NECESSITA
FAZER DOSAGEM DE AUTOANTICORPOS? QUAL SOLICITAR E QUAL A SUA
IMPORTÂNCIA?
O autoanticorpo antiperoxidase (ATPO) deve ser solicitado após segunda dosagem de TSH
> 4 mlU/L e a sua presença estabelece diagnóstico de doença autoimune como causa do
hipotireoidismo
primário. Nos casos de hipotireoidismo subclínico, a presença de ATPO aumenta
a taxa de evolução para hipotireoidismo clinico.
O ATPO deve ser solicitado para os pacientes com Síndrome de Down, e nos pacientes
com doenças autoimunes não tireoidianas, independentes do nível de TSH.
A ULTRASSONOGRAFIA DEVE FAZER PARTE DOS EXAMES DIAGNÓSTICOS
DE HIPOTIREIODISMO ?
Recomenda-se o acompanhamento com US e/ou US/Doppler, pois este exame é útil na detecção
de pacientes com maior risco de desenvolver hipotireoidismo após as tireoidites.
Recomenda-se para paciente portador de hipotireoidismo o acompanhamento com US e/
ou US/Doppler pela associação deste com doença nodular da tireóide e câncer diferenciado da
tireóide.
COMO FAZER O DIAGNÓSTICO DE HIPOTIREOIDISMO CENTRAL?
Para fazer diagnóstico de hipotireoidismo central deve-se dosar o T4L, na presença de um
achado de TSH sem elevação, em paciente com quadro clínico suspeito de hipotireoidismo.
Paciente deve ser tratado com reposição de hormônio da tireóide e seguido somente com dosagens
de T4L , sem necessidade de solicitar o TSH no acompanhamento.
HÁ ASSOCIAÇÃO DO USO DE LÍTIO COM HIPOTIREOIDISMO?
O uso de lítio facilita o aparecimento de hipotireoidismo, principalmente em mulheres,
pacientes onde há história familiar de doenças de tireóide e em indivíduos que possuam anticorpos
antitireoidianos. Há necessidade de controle destes pacientes, pois diagnosticando
hipotireoidismo, ele necessita ser tratado.
QUANDO A SÍNDROME DO EUTIREOIDISMO DOENTE OCORRE E QUANDO
DEVE SER PESQUISADA?
Investigar a Síndrome do Eutireoidismo Doente diante de pacientes com quadros clínico
grave, em pós-operatórios e nos quadros de jejum prolongado. Encontram-se alterações
dos níveis de T3 e/ou T4, com TSH normal. Esta síndrome tem valor prognóstico para piora da
evolução clínica.
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