Rosa Dantas

Objectives: The aim of this study is to develop and validate a novel clinical report form in the format of a structured interview to enable the characterization of the Portuguese population of the Baixo Vouga region with different subtypes of nodular thyroid pathologies (NTyPs). Materials and methods: A structured interview was developed and to the best of our knowledge, this is the first structured interview built and validated for that purpose in Portugal. Results: This structured interview enables the [...] Abstract Objectives: The aim of this study is to develop and validate a novel clinical report form in the format of a structured interview to enable the characterization of the Portuguese population of the Baixo Vouga region with different subtypes of nodular thyroid pathologies (NTyPs). Materials and methods: A structured interview was developed and to the best of our knowledge, this is the first structured interview built and validated for that purpose in Portugal. Results: This structured interview enables the

Controversy exists regarding risk factors in pregnant women that might be associated with a higher probability of failure of lifestyle intervention in the treatment of gestational diabetes (GD). These pregnant women's risk factors may highlight the need for closer surveillance at an early stage of pregnancy. To identify predictors of pharmacological therapy need in early and late GD. This was a retrospective observational study including women with GD diagnosed in the first (group 1) or second trimester (group 2) according to the criteria proposed by the International Association of Diabetes Pregnancy Study Group (IADPSG), singleton pregnancy and follow-up between January 2015 and December 2018, divided according to treatment (lifestyle intervention or pharmacological treatment (metformin and/or insulin)). A total of 278 and 273 women were included in groups 1 and 2, of which 48.6% and 55.3% underwent non-pharmacological treatment, respectively. In group 1, women requiring pharmacological therapy tended to be older and have previous GD or family history of diabetes, higher body mass index (BMI) and higher fasting blood glucose (FBG) levels. In group 2, pharmacological treatment need was associated with multiparity, previous GD, higher BMI, higher fasting glucose value in the oral glucose tolerance test (OGTT), and higher OGTT value at 60 minutes. The independent risk factors identified for pharmacological treatment requirement were maternal age (OR 1.10 (1.05-1.16), p<0.001), previous GD (OR 2.70 (1.10-6.58), p=0.029) and FBG (OR 1.07 (1.00-1.14), p=0.048) in group 1 while BMI (OR 1.07 (1.02-1.13), p=0.012) and fasting glucose value in the OGTT (OR 1.03 (1.01-1.05), p=0.006) were the factors identified in group 2. The cut-off values for FBG and fasting glucose value in the OGTT that predicted the necessity of pharmacological treatment were 95.50 mg/dL and 88.50 mg/dL, respectively. In early GD, closer surveillance is necessary for older women with a previous GD and an FBG ≥ 95.50 mg/dL. In late GD, pre-gestational BMI and a fasting glucose value in the OGTT ≥ 88.50 mg/dL should prevail.

The natural history of subclinical hypothyroidism (SHT) is influenced by the underlying etiology, being the most common Hashimoto's thyroiditis (HT) and isolated hyperthyrotropinemia (IH). Additionally, controversy exists surrounding the need for pharmacological treatment. A retrospective observational study that included patients diagnosed with SHT caused by HT or IH at pediatric age, under levothyroxine therapy and with follow-up at Centro Hospitalar Baixo Vouga between January/2014 and July/2019. Patients with follow-up time <12 months or missing records were excluded. This study aims to compare clinical, analytical and echographic parameters and levothyroxine dose between patients with SHT caused by HT or IH. Sample of 39 patients with 16.5 ± 3.4 years, 22 (56.4%) females. There was a preponderance of females in the HT group and males in the IH (p=0.001). Changes in thyroid ultrasound were more prevalent in the HT group (85.7% vs 16.7%, p<0.001). The median initial and final doses of levothyroxine were higher in the HT group (p=0.016, p=0.011). There was a trend towards a higher levothyroxine discontinuation rate in the IH group (22.2% vs 4.8%, p=0.162). Two positive and statistically significant correlations were found between the level of anti-thyroid peroxidase antibodies (TPOAbs) and both the final levothyroxine dose (ρ=0.544; p=0.004) and the final weight-adjusted levothyroxine dose (ρ=0.434; p=0.027). HT was more common in females and was associated with higher levothyroxine requirements and less likelihood of treatment discontinuation, especially if high TPOAbs levels. These results can be useful in the difficult daily decision of starting therapy, especially in milder forms of SHT.

Objective: To evaluate the influence of maternal pre-pregnancy body mass index (BMI) and gestational weight gain (GWG) on blood glucose levels at diagnosis of gestational diabetes mellitus (GDM) and obstetric/neonatal outcomes. Subjects and methods: Retrospective cohort study including 462 women with GDM and singleton pregnancy delivered in our institution between January 2015 and June 2018 and grouped according to BMI/GWG. Results: The diagnosis of GDM was more likely to be established in the 1st trimester (T) in women with [...] ABSTRACT Objective: To evaluate the influence of maternal pre-pregnancy body mass index (BMI) and gestational weight gain (GWG) on blood glucose levels at diagnosis of gestational diabetes mellitus (GDM) and obstetric/neonatal outcomes. Subjects and methods: Retrospective cohort study including 462 women with GDM and singleton pregnancy delivered in our institution between January 2015 and June 2018 and grouped according to BMI/GWG. Results: The diagnosis of GDM was more likely to be established in the 1st trimester (T) in women with

Introduction: Cardiovascular disease is an important cause of morbidity and mortality in individuals with type 1 diabetes (T1D). The American Diabetes Association (ADA) has the ADA risk-assessment tool for cardiovascular risk (CVR) prediction in individuals with T1D. This study aims to evaluate the prevalence of novel and traditional cardiovascular risk factors (CVRF) and the CVR by the ADA risk-assessment tool: 10-year risk for diabetes complications in young adults with T1D. Methods: Cross-sectional observational study of T1D individuals aged 18-40 years and T1D duration ≥1 year. The ADA risk-assessment tool was applied to predict CVR. Results: 75 individuals, 61.3% male, with a median age of 30 (26.0-36.0) and 13.0 (6.0-20.0) years of T1D duration. Hypertension was found in 16% of individuals and dyslipidemia in 75.0%. 21.3% were active smokers, 30.7% sedentary, and 42.7% were at least overweight. Most individuals had a 10-year risk <1% for all complications except myocardial infarction (MI). In individuals who were outside the honeymoon period (T1D duration ≥ 5 years), most had a 10-year risk <1% for all complications except MI and amputation. Non-traditional CVRF homocysteine, apolipoprotein B, apolipoprotein B/apolipoprotein A1 ratio, magnesium, and vitamin D correlated with the ADA risk-assessment tool. 10-year risk for MI ≥1% was significantly more frequent in men. Conclusion: To our knowledge, this is the first study to apply the ADA risk-assessment tool: 10-year risk for diabetes complications in T1D. Young adults with T1D have a worrying prevalence of CVRF and show suboptimal control. Most individuals with T1D duration ≥1 year have an estimated 10-year risk <1% for all complications, except for MI.

Introduction: Many studies have shown an association between decreased serum magnesium (Mg) levels and poor glycemic control and dyslipidemia in individuals with type 1 diabetes (T1D). Few studies evaluated the association between magnesium (Mg) levels and diabetic retinopathy (DR) in individuals with type 1 diabetes (T1D). Methods: Retrospective study of adults with T1D, with an ophthalmological evaluation and a serum Mg level determination. According to Mg levels, the individuals were stratified into two groups: normal Mg levels (1.81-2.60 mg/dL) and low Mg levels (≤1.80 mg/dL). Exclusion criteria were individuals on diuretics or proton-pump inhibitors, malabsorption or diarrhea, oral magnesium supplementation in the recent past, pregnancy, or sepsis. Results: 105 individuals, with median Mg levels of 1.96 (interquartile range 0.23) mg/dL. Hypomagnesemia (≤1.80 mg/dL) was detected in 20.0% individuals and 26.7% had DR. Individuals with hypomagnesemia had higher HbA1c (p = 0.014) and triglycerides (p = 0.024). Mg levels were negatively correlated with systolic blood pressure (r = -0.200, p = 0.041), HbA1c (r = -0.281, p = 0.004) and body mass index (BMI) (r = -0.197, p = 0.041). There was no significant difference between Mg levels or prevalence of hypomagnesemia in individuals with or without DR. Also, there was no significant difference between Mg levels and the severity of DR. Conclusion: Hypomagnesemia is a common problem in adults with T1D, and it was correlated with poor glycemic control, although we did not find a significant association between Mg levels and prevalence or severity of DR.

Thyroid cancer’s incidence has increased in the last decades, and its diagnosis can be a challenge. Further and complementary testing based in biochemical alterations may be important to correctly identify thyroid cancer and prevent unnecessary surgery. Fourier-transform infrared (FTIR) spectroscopy is a metabolomic technique that has already shown promising results in cancer metabolome analysis of neoplastic thyroid tissue, in the identification and classification of prostate tumor tissues and of breast carcinoma, among others. This work aims to gather and discuss published information on the ability of FTIR spectroscopy to be used in metabolomic studies of the thyroid, including discriminating between benign and malignant thyroid samples and grading and classifying different types of thyroid tumors.

Background: Many studies have shown an association between decreased serum magnesium (Mg) levels and poor glycemic control and dyslipidemia in patients with type 1 diabetes (T1DM). However, few studies have evaluated the association between reduced Mg levels and the diabetes complications in these patients and, in particular with diabetic retinopathy (DR), found divergent results. Aims: To evaluate the status of serum Mg levels in adults with T1DM and to assess the association between Mg levels and glycemic control, lipid profile and prevalence of DR. Methods: Retrospective study of adults with T1DM, with an ophthalmological evaluation and a serum Mg level determination. According to Mg levels, the patients were stratified into two groups: normomagnesemic (1.81–2.60 mg/dl) and hypomagnesemic (≤1.80 mg/dl) patients. Exclusion criteria were: patients on diuretics or proton-pump inhibitors, malabsorption or diarrhea, oral magnesium supplementation in recent past, pregnancy or sepsis. Results: Included 105 patients (56.2% male) with median age of 36.0 (interquartile range 16.0) years and median T1DM duration of 16.0 (12.0) years. Median HbA1c was 7.6 (1.5)% and median Mg levels was 1.96 (0.23) mg/dl. Hypomagnesemia (≤1.80 mg/dl) was detected in 20.0% (n=21) patients and 26.7% (n=28) had DR. Hypomagnesemic patients had higher HbA1c [8.2 (1.6) vs 7.5 (1.3)%, p=0.014]. There was no statistical difference in age, sex, T1DM duration or DR between the groups stratified by Mg levels. Mg levels was negatively and weakly correlated with systolic blood pressure (r=-0.200, p=0.041), HbA1c (r=-0.281, p=0.004) and BMI (r=-0.197, p=0.041). There was no correlation between Mg levels and total cholesterol, LDL-C, HDL-C or triglycerides. In multivariate logistic regression analysis, HbA1c was the only predictor of hypomagnesemia [OR=1.541 (1.027–2.312), p=0.037], after the adjustments for age, T1DM duration and BMI. There was no significant difference between patients with or without DR in relation to Mg levels [1.96 (0.28) vs 1.96 (0.19) mg/dL, p=0.986]. Also, there was no statistically significant association between Mg levels and the severity of DR or T1DM duration. In multivariate analysis, T1DM duration, male and estimated glomerular filtration rate >60mL/min/1.73m² had independently significant association with DR after adjusting for age, glycemic control, hypertension, dyslipidemia, 25-hydroxyvitamin D and Mg levels [OR=1.194 (1.088–1.310), p=<0.001; OR=6.980 (1.654–29.450), p=0.008, and OR=0.780 (0.008–0.751), p=0.028, respectively]. Discussion: Hypomagnesemia is a common problem in adults with T1DM and it was correlated with glycemic control, although we did not find significant association between Mg levels and lipid profile or prevalence of DR. Future longitudinal studies may elucidate the causality between reduced Mg levels and the prevalence of diabetes complications.

Obesity is a public health problem and a risk factor for pathologies such type 2 diabetes mellitus, cardiovascular diseases and non-alcoholic fatty liver disease. Given these clinical implications, there is a growing interest to understand the pathophysiological mechanism of obesity. Changes in lipid metabolism have been associated with obesity and obesity-related complications. However, changes in the lipid profile of obese children have been overlooked. In the present work, we analysed the serum phospholipidome of overweight and obese children by HILIC-MS/MS and GC-MS. Using this approach, we have identified 165 lipid species belonging to the classes PC, PE, PS, PG, PI, LPC and SM. The phospholipidome of overweight (OW) and obese (OB) children was significantly different from normal-weight children (control). Main differences were observed in the PI class that was less abundant in OW and OB children and some PS, PE, SM and PC lipid specie are upregulated in obesity and overweight. Although further studies are needed to clarify some association between phospholipid alterations and metabolic changes, our results highlight the alteration that occurs in the serum phospholipid profile in obesity in children.

ResumoA síndrome de Turner (ST) é uma das cromossomopatias mais frequentes nas mulheres. Vários estudos revelaram associação entre ST e aumento da prevalência de diabetes mellitus (DM). Na consulta de endocrinologia do centro onde foi desenvolvido este trabalho foram seguidas 60 mulheres com ST até à data. Aqui, as doentes foram vigiadas considerando o seu risco aumentado de desenvolvimento de doenças metabólicas, nomeadamente as alterações do metabolismo dos hidratos de carbono. O principal objetivo deste artigo é realizar uma revisão da literatura acerca da associação entre DM e ST, tendo como ponto de partida as 4 doentes reportadas.Os primeiros 3 casos correspondem a doentes com ST que desenvolveram DM tipo 2 (DM2). O diagnóstico de ST suspeitou‐se por infertilidade, baixa estatura (BE) associada a amenorreia primária e amenorreia primária, tendo os cariótipos sido 45,X/46,X,i(Xq), 45,X e 45,X[18]/47,XXX[10]/46,XX[2], respetivamente. O diagnóstico de DM2 estabeleceu‐se após prova de tolerância à glucose oral (PTGO), aos 40 e 47 anos, nas 2 primeiras doentes e após glicemias de jejum consecutivamente >126mg/dl, aos 34 anos, no terceiro caso. Foram medicadas com metformina, apresentando bom controlo metabólico. A quarta doente foi diagnosticada com ST aos 2 anos por BE, com cariótipo 45,X/46,X,i(Xq). Aos 10 anos foi‐lhe diagnosticada DM1 e, posteriormente, tiroidite autoimune e doença celíaca. Esta doente tem apresentado insatisfatório controlo, tendo sido detetada, aos 32 anos, retinopatia diabética.Os casos apresentados de DM2 foram facilmente controlados, apresentando‐se em idades jovens, como previamente descrito. Contudo, é reconhecido que a mortalidade, sobretudo cardiovascular, é elevada nesta síndrome. Sabe‐se também que a autoimunidade está aumentada na ST, o que contribui para o desenvolvimento de DM1. Foi demonstrada associação entre determinadas alterações citogenéticas e DM. São essenciais: o reconhecimento deste risco e estabelecimento de vigilância adequada, em equipa especializada e multidisciplinar.AbstractTurner syndrome (TS) is one of the most common chromosomal abnormalities in women. Several studies have shown an association between ST and increased prevalence of diabetes mellitus (DM). Sixty ST patients have been followed in the Endocrine clinics of the centre where this work was developed. These patients were regularly monitored considering their increased risk of developing metabolic disorders, in particular, changes in carbohydrates’ metabolism. The aim of this article is to perform a review of literature on DM and ST, taking as its starting point the four reported cases.The first three women developed type 2 diabetes (T2DM). The diagnosis of TS was suspected by infertility, short stature (SS) associated with primary amenorrhea and primary amenorrhea, and the karyotype was 45,X/46,X,i(Xq), 45,X and 45X[18]/47,XXX[10]/46,XX[2], respectively. T2DM was established after oral glucose tolerance test, at the age of 40 and 47, respectively, in the first two cases, and after consecutive fasting glucose levels >126mg/dl, at 34, in the third case. They were all medicated with metformin, achieving good metabolic control. The fourth patient was diagnosed with ST at the age of 2 due to SS, with karyotype 45,X/46,X,i(Xq). At 10 she was diagnosed with T1DM, and subsequently with autoimmune thyroiditis and celiac disease. This patient has presented an unsatisfactory control, and she was diagnosed with diabetic retinopathy at the age of 42.T2DM cases were easily controlled and were diagnosed at young ages, as previously described. However, it's recognized that mortality, especially cardiovascular, is augmented in this syndrome. It's also known that autoimmunity is increased in TS, which contributes to the development of T1DM. It was demonstrated association between certain cytogenetic alterations and DM. The recognition of this risk and the establishment of an adequate follow‐up in a specialized and multidisciplinary team are essential