Estudo da associação entre urticária crônica idiopática e autoimunidade tireóidea: aspectos clínicos, positividade do teste do soro autólogo da pele e expressão gênica do receptor de TSH
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Data
2010-08-20
Autores
Silvares, Maria Regina Cavariani [UNESP]
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Editor
Universidade Estadual Paulista (Unesp)
Resumo
A conexão pele-tireoide tornou-se uma fronteira de interesse da dermatoendocrinologia. Neste contexto, a relação entre urticária crônica idiopática (UCI) e autoimunidade tireóidea tem sido estudada nos seus diferentes aspectos. Além disso, de 30% a 40% dos casos de UCI apresentam etiologia autoimune. A tireoidite de Hashimoto (TH) representa a mais prevalente doença autoimune da tireoide (DAT), acarretando, frequentemente, hipotireoidismo. Os indícios que o quadro de UCI é mais grave e menos responsivo aos tratamentos convencionais quando associado à DAT, sugerem um papel da tireotrofina (TSH) no desenvolvimento das lesões urticariformes. O teste do soro autólogo da pele (TSSA) é um teste intradérmico in vivo utilizado para avaliar a autorreatividade, a presença de autoanticorpos funcionais ou de urticária de etiologia autoimune. Apesar dos indícios de associação entre DAT e UCI, os relatos são controversos. Os objetivos do presente estudo foram avaliar: a associação entre UCI e autoimunidade tireóidea; a frequência de alterações tireóideas em pacientes com UCI, com ênfase nas de origem autoimune; a frequência de angioedema em relação às alterações tireóideas; a associação entre TH, em pacientes com UCI, e positividade do TSSA; a expressão gênica do receptor de TSH (RTSH) na pele sã e na pápula do TSSA, de pacientes com UCI, com e sem TH. O estudo foi dividido em dois capítulos. No Capítulo 1, foi realizada uma análise retrospectiva dos prontuários médicos de 223 pacientes com urticária crônica (UC), acompanhados no ambulatório de alergia dermatológica do Hospital das Clínicas da Faculdade de Medicina de Botucatu. Foram selecionados 115 casos com UCI que dispunham dos resultados das dosagens plasmáticas de TSH, tiroxina livre (T4-L) e anticorpos antitireoperoxidase (antiTPO) e antitireoglobulina (antiTG). Tratava-se de 91 mulheres (79,1%) e...
The thyroid-skin connection has become a hot frontier in dermatoendocrinology. In that context, the relation between chronic idiopathic urticaria (CIU) and thyroid autoimmunity has been studied in its different aspects. Besides, from 30% to 40% of CIU cases present autoimmune etiology. Hashimoto’s thyroiditis (HT) represents the most prevalent autoimmune thyroid disease (ATD), frequently causing hypothyroidism. The signs that the CIU picture is more severe and less responsive to conventional treatments when associated with ATD suggest a role of thyrotropin (TSH) in developing urticariform lesions. The autologous serum skin test (ASST) is an in vivo intradermal test to evaluate autoreactivity, presence of functional antibodies or urticaria from autoimmune etiology. Despite the signs of association between ATD and CIU, reports are controversial. The present study aimed to evaluate: the association between CIU and thyroid autoimmunity; the frequency of thyroid alterations in patients with CIU emphasizing on the autoimmune originated ones; the frequency of angioedema in relation to thyroid alterations; the association between HT, in patients with CIU, and the ASST positivity; the TSH receptor (RTSH) gene expression in healthy skin and in the papules of ASST, of patients with CIU, with or without HT. The study was divided into two chapters. In Chapter 1, a retrospective analysis was performed in the medical report of 223 patients with chronic urticaria (CU), assisted at the outpatient of dermatologic allergy of the Clinic Hospital of the Botucatu Medical School. One hundred fifteen cases with CIU and available results of plasmatic dosage of TSH, free thyroxine (FT4), and antithyroperoxidase (antiTPO) and antithyroglobulin (antiTG) antibodies were selected. There were 91 women (79.1%) and 24 men (20.9%), mean age 36.5 years, who started the follow-up between 1984 and 2006. These case ... (Complete abstract click electronic access below)
The thyroid-skin connection has become a hot frontier in dermatoendocrinology. In that context, the relation between chronic idiopathic urticaria (CIU) and thyroid autoimmunity has been studied in its different aspects. Besides, from 30% to 40% of CIU cases present autoimmune etiology. Hashimoto’s thyroiditis (HT) represents the most prevalent autoimmune thyroid disease (ATD), frequently causing hypothyroidism. The signs that the CIU picture is more severe and less responsive to conventional treatments when associated with ATD suggest a role of thyrotropin (TSH) in developing urticariform lesions. The autologous serum skin test (ASST) is an in vivo intradermal test to evaluate autoreactivity, presence of functional antibodies or urticaria from autoimmune etiology. Despite the signs of association between ATD and CIU, reports are controversial. The present study aimed to evaluate: the association between CIU and thyroid autoimmunity; the frequency of thyroid alterations in patients with CIU emphasizing on the autoimmune originated ones; the frequency of angioedema in relation to thyroid alterations; the association between HT, in patients with CIU, and the ASST positivity; the TSH receptor (RTSH) gene expression in healthy skin and in the papules of ASST, of patients with CIU, with or without HT. The study was divided into two chapters. In Chapter 1, a retrospective analysis was performed in the medical report of 223 patients with chronic urticaria (CU), assisted at the outpatient of dermatologic allergy of the Clinic Hospital of the Botucatu Medical School. One hundred fifteen cases with CIU and available results of plasmatic dosage of TSH, free thyroxine (FT4), and antithyroperoxidase (antiTPO) and antithyroglobulin (antiTG) antibodies were selected. There were 91 women (79.1%) and 24 men (20.9%), mean age 36.5 years, who started the follow-up between 1984 and 2006. These case ... (Complete abstract click electronic access below)
Descrição
Palavras-chave
Tireoide - Doenças, Urticária, Angioedema, Autoimmunity
Como citar
SILVARES, Maria Regina Cavariani. Estudo da associação entre urticária crônica idiopática e autoimunidade tireóidea: aspectos clínicos, positividade do teste do soro autólogo da pele e expressão gênica do receptor de TSH. 2010. 135 f. Tese (doutorado) - Universidade Estadual Paulista, Faculdade de Medicina de Botucatu, 2010.