HIPOTIREOIDISMO E HIPERTIREOIDISMO UMA BREVE REVISO

SOBRE AS DISFUNES TIREOIDIANAS

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MALDONADO, Rafael Resende

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RESUMO+LSRWLUHRLGLVPRHKLSHUWLUHRLGLVPRVmRGLVIXQo}HVGDJOkQGXODWLUHRLGHTXHFDXVDPGLYHUVDV
DOWHUDo}HVQRRUJDQLVPRKXPDQR(VWHWUDEDOKRWHYHFRPRREMHWLYRUHDOL]DUXPDUHYLVmRGDOLWHUDWXUD
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\VLFDODF-
WLYLW\

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
VLDGLIXVDGDWLUHRLGHDVVRFLDGDjGRHQoDGH
*UDYHVEyFLRPXOWLQRGXODUKLSHUIXQFLRQDQ
WHHDGHQRPDKLSHUIXQFLRQDQWHGDWLUHRLGH
2. HIPOTIREOIDISMO
 +LSRWLUHRLGLVPR p GHQLGR
FRPRXPHVWDGRFOtQLFRUHVXOWDQWHGHTXDQ
WLGDGH LQVXFLHQWH RX DXVrQFLD GH KRUP{
GHQRPLQDGRV 7 WLUR[LQD H 7 WULLRGR QLRVFLUFXODQWHVGDJOkQGXODWLUHRLGHGHQR
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
PLQDGRV7WLUR[LQDH7WULLRGRWLURQLQD
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
36 & Sociedade
 ,QWHUFLrQFLD 6RFLHGDGH,6619RO1

GX]LU RV KRUP{QLRV WLUHRLGLDQRV 0h//(5 EpP VmR UHODWDGRV HP FULDQoDV TXH DSUH
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p D FDXVD PDLV FRPXP GH UHWDUGR PHQWDO
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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
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mao glandular durante a embriognese e SRGH VHU SHUPDQHQWH RX WUDQVLWyULR &HUFD
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EDVDO HRX DSLFDO GHIHLWRV QD VtQWHVH GD IDOWD GH HVWtPXOR GR76+ KLSRViULR RX GR
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gene relacionado a esta enzima so consi VpULFRGR76+DFLPDGROLPLWHVXSHULRUGD
GHUDGRVDSULQFLSDOFDXVDGH+&SRUGLVRU QRUPDOLGDGHDVVRFLDGDDQtYHLVQRUPDLVGH
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HOHVUHODomRFRPRVKRUP{QLRVGDWLUHRLGH
Pesquisa realizada com um menino de cin
FRDQRVGHLGDGHFRPKLSRWLUHRLGLVPRFRQ
JrQLWRDVVRFLDGRDSUREOHPDVGRGHVHQYRO
YLPHQWRGHRUGHPLQVWUXPHQWDOHHVWUXWXUDO
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6+7 p XPD GLVIXQomR FDUDFWHUL]DGD SRU
YDORU VpULFR DXPHQWDGR GR 76+ FRP FRQ
FHQWUDo}HVQRUPDLVGH7H7QDDXVrQ
FLD GH VLQWRPDV FOtQLFRV PDQLIHVWRV (VWD
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FDVRUHODWDGRDSRQWRXPHOKRUDGDVLQWRPD OrQFLDGR6+7YDULDFRPDLGDGHHRVH[R
WRORJLD DVVLP TXH VH REWHYH FRQWUROH GRV GD SRSXODomR VHOHFLRQDGD GH  D 
KRUP{QLRV WLUHRLGRV %UDJDWWL:LQFNOHU  HTXDQGRDFRPSDQKDGRGHYDORUHVHOHYD
5RWWD GRVGHDQWLFRUSRVDQWLWLURLGHDQRVRULVFRGH
3UREOHPDV IRQRXGLROyJLFRV WDP SURJUHVVmRSDUDKLSRWLUHRLGLVPRFOtQLFDDX

Intercincia
37 & Sociedade
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PHQWDHPDRDQR,QFLGHPDLVQRVH[R
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WLUHRLGH H SDUHFH HVWDU UHODFLRQDGR FRP
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HQYHOKHFLPHQWR DWXDQGR FRPR XPD DGDS
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DDQRVFRP76+DFLPDGHP8/
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WHVWH GH HVIRUoR SURJUHVVLYR FRP DQiOLVH
GDFRQFHQWUDomRGHODFWDWRVDQJXtQHRQRV
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SDUDDXPHQWDUDWROHUkQFLDDRHVIRUoRItVLFR
SURJUHVVLYR HP SRUWDGRUDV GH 6+7 GON
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
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YDQWDPHQWR GH HVWXGRV SXEOLFDGRV HQWUH
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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
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ItVLFRV 2V KRUP{QLRV GD WLUHRLGH DWXDP
VREUH R VLVWHPD FDUGLRYDVFXODU UHJXODQGR
D FRQWUDomR H R UHOD[DPHQWR GR P~VFXOR
IXQomRDXWRQ{PLFDHVWmRSUHMXGLFDGRVQHV
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GH WmR SUHYDOHQWH TXDQWR R GLDEHWHV QmR
H[LVWH XPD UHFRPHQGDomR SDUD SUHVFULomR
GH DWLYLGDGH ItVLFD SDUD RV KLSRWLUHRLGHRV
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FDUGtDFRDOpPGHUHJXODURW{QXVYDVFXODU
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QtYHLV DOWHUDGRV GH 7 H 7 RFRUUHP GLV
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FRQWUDWLOLGDGHHGDIUHTXrQFLDFDUGtDFDGL
PLQXLomRGRGpELWRFDUGtDFRGLPLQXLomRGD
SUHVVmRDUWHULDOHGDYDULDELOLGDGHGDIUHTX
rQFLDFDUGtDFDDOpPGHDXPHQWRQRVQtYHLV
GHFROHVWHUROVpULFRHGLPLQXLomRGDVHQVLEL
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UHYHUWHU RV FRPSURPHWLPHQWRV FDUGLRYDV
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EpWLFRV628=$HWDO
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DHUyELRVHQGRTXHRVSDFLHQWHVDSUHVHQWD
ram melhoras da funo endotelial. O estu
GRDSRQWRXFDUDFWHUtVWLFDVHFRPSRUWDPHQ
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9iULRVHVWXGRVDVVRFLDPR6+7D
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do sono. Por outro lado, os sintomas P~V

Intercincia
38 & Sociedade
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FXORHVTXHOpWLFRV WDPEpP WHP VLGR UHODWD SHODV GRVDJHQV GR 76+ 2 76+ p R H[D
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com diferentes sensibilidades, no entanto,
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QRUPDO1RVSDFLHQWHVFRPKLSRWLUHRLGLVPR
SUHYLDPHQWHGLDJQRVWLFDGRDIDGLJDRVRQR
QmRUHVWDXUDGRUHDFHIDOHLDFU{QLFDIRUDP
estatisticamente mais frequentes naqueles
HPTXHIRLIHLWRRGLDJQyVWLFRGHEURPLDO
XP HVWDGR KLSHUPHWDEyOLFR FDXVDGR SHOR
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uma delas a funo tireoidiana. Quando h
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reodismo so: doena autoimune da tireoi
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