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Abstract(s)
A presente dissertação encontra-se subdivida em dois capítulos, onde descrevo a minha
experiência profissionalizante na vertente de farmácia comunitária e investigação para
obtenção do grau de Mestre em Ciências Farmacêuticas.
O primeiro capítulo corresponde ao projeto de investigação, desenvolvido sob orientação
da Professora Doutora Maria Elisa Cairrão Rodrigues Oliveira e intitulado “Importância
do rastreio de anticorpos tiroideus em pacientes com diabetes mellitus tipo 1: uma revisão
sistemática”.
O segundo capítulo descreve as competências adquiridas e atividades desenvolvidas ao
longo do estágio curricular em Farmácia Comunitária, realizado na Farmácia Grão Vasco,
em Viseu, sob orientação da Doutora Bruna Lopes.
Introdução: A diabetes mellitus (DM) é uma doença metabólica crónica cada vez mais
prevalente na população mundial. Segundo a American Association of Clinical
Endocrinology (AACE), a diabetes mellitus é classificada em 4 grupos distintos: tipo 1 –
onde ocorre destruição autoimune das células beta pancreáticas; tipo 2 – resistência à
insulina e/ou deficiência na sua produção; diabetes gestacional – ocorre no 2º ou 3º
trimestre da gravidez; e, um tipo específico de diabetes devido a outras causas. Focando na
diabetes mellitus tipo 1 (DM1), esta caracteriza-se por ter causa autoimune com
consequente destruição das células beta pancreáticas estando, desta forma, muitas vezes
associada a outras patologias autoimunes, como é o caso das disfunções tiroideias
autoimunes.
Objetivo: Pretendeu-se, através de uma revisão sistemática da literatura, avaliar a
importância do rastreio dos autoanticorpos tiroideus anti-peroxidase (anti-TPO) e antitireoglobulina (anti-TG), bem como a importância de uma monotorização regular da
função tiroideia em pacientes com diabetes mellitus tipo 1 (DM1).
Métodos: Foi realizada uma revisão sistemática e exaustiva da literatura com recurso às
bases de dados PubMed, PubMed PMC e B-on. Para esta pesquisa foram utilizadas as
seguintes palavras-chaves: “autoimmunity”, “type 1 diabetes mellitus”, “thyroid
dysfunction”, “hypothyroidism” e “hashimoto’s thyroiditis”. Foram incluídas todas as
publicações entre janeiro de 2005 e junho de 2021, escritas nas línguas portuguesa,
inglesa e espanhola. Após análise integral dos artigos e segundo critérios específicos de
inclusão e exclusão, obteve-se um total de 13 artigos para análise.
Resultados: Uma vez que as doenças autoimunes são mais prevalentes em pessoas mais
jovens, a maioria dos estudos analisados incidiu numa população pediátrica, em diversos
países. Nos 13 artigos estudados, foi verificada uma prevalência de disfunções tiroideias autoimunes em pacientes do sexo feminino com DM1 e com anticorpos tiroideus anti-TPO
e anti-TG positivos. Além disso, pacientes com anticorpos tiroideus positivos
demonstraram um risco mais elevado de virem a desenvolver disfunções tiroideias
autoimunes nos anos seguintes ao diagnóstico de DM1, em especial, hipotiroidismo
subclínico, consequente de tiroidite de Hashimoto, com possível evolução para
hipotiroidismo clínico.
Conclusão: Em pacientes com DM1, especialmente do sexo feminino, torna-se de
extrema importância o rastreio dos anticorpos tiroideus anti-TPO e anti-TG. Estes
pacientes devem manter um controlo regular da função tiroideia, quer no momento do
diagnóstico de DM1, quer nos anos seguintes a este diagnóstico, devido à forte relação
entre ambas as patologias (disfunção da tiroide e DM1). Pacientes com DM1 apresentam
um risco acrescido de vir a desenvolver outras doenças autoimunes, como disfunções na
glândula tiroideia podendo, desta forma, comprometer a evolução de ambas as patologias,
bem como, a sua qualidade de vida.
This masters thesis is divided into two chapters, where I describe my professional experience in the field of community pharmacy and research to complement the Master's degree in Pharmaceutical Sciences. The first chapter is about the research study, developed under the guidance of the project Professor Maria Elisa Cairrão Rodrigues Oliveira and entitled “Importance of screening for thyroid antibodies in patients with type 1 diabetes mellitus: systematic review”. The second chapter describes competences and activities developed during the curricular internship at Farmácia Grão Vasco in Viseu, under the guidance of Dr. ª Bruna Lopes. Introduction: The “diabetes mellitus” (DM) is a chronic metabolic disease increasingly prevalent in the world population. According to the “American Association of Clinical Endocrinology” (AACE), the DM is classified into 4 distinct groups: type 1 – where autoimmune destruction of pancreatic beta cells occurs; type 2 – insulin resistance and/or deficiency in its production; gestational diabetes – occurs in the 2nd or 3rd trimester of pregnancy; and, a specific kind of diabetes due to other factors. Focusing in the diabetes mellitus type 1 (DM1), this is characterized by having an autoimmune cause with consequent destruction of pancreatic beta cells and, therefore, is often associated with other autoimmune pathologies, such as autoimmune thyroid dysfunctions. Objective: Through a systematic review of the literature, the aim was to assess the importance of screening for anti-peroxidase (anti TPO) and anti-thyroglobulin (anti TG) thyroid autoantibodies, as well as the importance of regular monitoring of thyroid function in patients with DM1. Methodology: A systematic and exhaustive review of the literature was carried out using the PubMed, PubMed PMC and B-on databases. For this research, the following keywords were used: “autoimmunity”, “type 1 diabetes mellitus”, “thyroid dysfunction”, “hypothyroidism” and “hashimoto’s thyroiditis”. All publications between January 2005 and June 2021, written in Portuguese, English and Spanish, were included. After full analysis of the articles and according to specific inclusion and exclusion criteria, a total of 13 articles were obtained for analysis. Results: Since autoimmune diseases are more prevalent in younger people, most of the studies analyzed focused on a pediatric population in several countries. In the 13 articles studied, a prevalence of autoimmune thyroid disorders was observed in female patients with DM1 and with positive anti-TPO and anti-TG thyroid antibodies. In addition, patients with positive thyroid antibodies showed a higher risk of developing autoimmune thyroid disorders in the years following the diagnosis of DM1, especially subclinical hypothyroidism, resulting from Hashimoto's thyroiditis, with possible evolution to clinical hypothyroidism. Conclusion: In patients with DM1, especially females, screening for anti-TPO and antiTG thyroid antibodies is extremely important. These patients must maintain a regular control of thyroid function, either at the time of the diagnosis of DM1, or in the years following this diagnosis, due to the strong relationship between both pathologies (thyroid dysfunction and DM1). Patients with DM1 have an increased risk of developing other autoimmune diseases, such as thyroid gland dysfunctions, which may, in this way, compromise the evolution of both pathologies, as well as their quality of life.
This masters thesis is divided into two chapters, where I describe my professional experience in the field of community pharmacy and research to complement the Master's degree in Pharmaceutical Sciences. The first chapter is about the research study, developed under the guidance of the project Professor Maria Elisa Cairrão Rodrigues Oliveira and entitled “Importance of screening for thyroid antibodies in patients with type 1 diabetes mellitus: systematic review”. The second chapter describes competences and activities developed during the curricular internship at Farmácia Grão Vasco in Viseu, under the guidance of Dr. ª Bruna Lopes. Introduction: The “diabetes mellitus” (DM) is a chronic metabolic disease increasingly prevalent in the world population. According to the “American Association of Clinical Endocrinology” (AACE), the DM is classified into 4 distinct groups: type 1 – where autoimmune destruction of pancreatic beta cells occurs; type 2 – insulin resistance and/or deficiency in its production; gestational diabetes – occurs in the 2nd or 3rd trimester of pregnancy; and, a specific kind of diabetes due to other factors. Focusing in the diabetes mellitus type 1 (DM1), this is characterized by having an autoimmune cause with consequent destruction of pancreatic beta cells and, therefore, is often associated with other autoimmune pathologies, such as autoimmune thyroid dysfunctions. Objective: Through a systematic review of the literature, the aim was to assess the importance of screening for anti-peroxidase (anti TPO) and anti-thyroglobulin (anti TG) thyroid autoantibodies, as well as the importance of regular monitoring of thyroid function in patients with DM1. Methodology: A systematic and exhaustive review of the literature was carried out using the PubMed, PubMed PMC and B-on databases. For this research, the following keywords were used: “autoimmunity”, “type 1 diabetes mellitus”, “thyroid dysfunction”, “hypothyroidism” and “hashimoto’s thyroiditis”. All publications between January 2005 and June 2021, written in Portuguese, English and Spanish, were included. After full analysis of the articles and according to specific inclusion and exclusion criteria, a total of 13 articles were obtained for analysis. Results: Since autoimmune diseases are more prevalent in younger people, most of the studies analyzed focused on a pediatric population in several countries. In the 13 articles studied, a prevalence of autoimmune thyroid disorders was observed in female patients with DM1 and with positive anti-TPO and anti-TG thyroid antibodies. In addition, patients with positive thyroid antibodies showed a higher risk of developing autoimmune thyroid disorders in the years following the diagnosis of DM1, especially subclinical hypothyroidism, resulting from Hashimoto's thyroiditis, with possible evolution to clinical hypothyroidism. Conclusion: In patients with DM1, especially females, screening for anti-TPO and antiTG thyroid antibodies is extremely important. These patients must maintain a regular control of thyroid function, either at the time of the diagnosis of DM1, or in the years following this diagnosis, due to the strong relationship between both pathologies (thyroid dysfunction and DM1). Patients with DM1 have an increased risk of developing other autoimmune diseases, such as thyroid gland dysfunctions, which may, in this way, compromise the evolution of both pathologies, as well as their quality of life.
Description
Keywords
Autoimunidade Diabetes Mellitus Tipo 1 Disfunção Tiroideia Hipotiroidismo e Tiroidite de Hashimoto