Abstract Fecal Immunochemical Test (FIT) followed by a colonoscopy is an efficacious strategy to improve the adenoma detection rate and Colorectal Cancer (CRC). There is no organized national screening program for CRC in Brazil. The aim of this research was to describe the implementation of an organized screening program for CRC through FIT followed by colonoscopy, in an urban low-income community of São Paulo city. The endpoints of the study were: FIT participation rate, FIT positivity rate, colonoscopy compliance rate, Positive Predictive Values (PPV) for adenoma and CRC, and the rate of complications. From May 2016 to October 2019, asymptomatic individuals, 50-75 years old, received a free kit to perform the FIT. Positive FIT (≥ 50 ng/mL) individuals were referred to colonoscopy. 10,057 individuals returned the stool sample for analysis, of which (98.2%) 9,881 were valid. Women represented 64.8% of the participants. 55.3% of individuals did not complete elementary school. Positive FIT was 7.8% (776/9881). The colonoscopy compliance rate was 68.9% (535/776). There were no major colonoscopy complications. Adenoma were detected in 63.2% (332/525) of individuals. Advanced adenomatous lesions were found in 31.4% (165/525). CRC was diagnosed in 5.9% (31/525), characterized as adenocarcinoma: in situ in 3.2% (1/31), intramucosal in 29% (9/31), and invasive in 67.7% (21/31). Endoscopic treatment with curative intent for CRC was performed in 45.2% (14/31) of the cases. Therefore, in an urban low-income community, an organized CRC screening using FIT followed by colonoscopy ensued a high participation rate, and high predictive positive value for both, adenoma and CRC. (FIT . (CRC) Brazil lowincome low income city PPV (PPV complications 201 2019 5075 75 50-7 old ≥ ( 5 ng/mL ngmL ng mL 10057 10 057 10,05 analysis 98.2% 982 98 2 (98.2% 9881 9 881 9,88 valid 648 64 8 64.8 participants 553 55 3 55.3 school 78 7 7.8 776/9881. 7769881 776/9881 776 (776/9881) 689 68 68.9 535/776. 535776 535/776 535 (535/776) 632 63 63.2 332/525 332525 332 525 (332/525 314 31 4 31.4 165/525. 165525 165/525 165 (165/525) 59 5.9 31/525, 31525 31/525 , (31/525) adenocarcinoma 32 3.2 1/31, 131 1/31 1 (1/31) 29 9/31, 931 9/31 (9/31) 677 67 67.7 21/31. 2131 21/31 21 (21/31) 452 45 45.2 14/31 1431 14 (14/31 cases Therefore both (CRC 20 507 50- 1005 05 10,0 98.2 (98.2 988 88 9,8 6 64. 55. 7. 776988 776/988 77 (776/9881 68. 53577 535/77 53 (535/776 63. 332/52 33252 33 52 (332/52 31. 16552 165/52 16 (165/525 5. 3152 31/52 (31/525 3. 13 1/3 (1/31 93 9/3 (9/31 67. 213 21/3 (21/31 45. 14/3 143 (14/3 100 0 10, 98. (98. 9, 77698 776/98 (776/988 5357 535/7 (535/77 332/5 3325 (332/5 1655 165/5 (165/52 315 31/5 (31/52 1/ (1/3 9/ (9/3 21/ (21/3 14/ (14/ (98 7769 776/9 (776/98 535/ (535/7 332/ (332/ 165/ (165/5 31/ (31/5 (1/ (9/ (21/ (14 (9 776/ (776/9 (535/ (332 (165/ (31/ (1 (21 (776/ (535 (33 (165 (31 (2 (776 (53 (3 (16 (77 (5 (7

Objetivo: determinar a secreção de TSH em crianças com síndrome de Down, sem quadro clínico-laboratorial clássico de hipotireoidismo. Métodos: analisou-se 14 crianças com síndrome de Down e idade média de 3,4 (±1,8) anos. Excluiu-se pacientes com sintomas clássicos de hipotireoidismo ou hipertireoidismo, ou que apresentassem anticorpos antitireóide positivos. Os pacientes foram comparados a um grupo controle de 16 pacientes com idade média de 11,8 (±3,8) anos e diagnóstico de baixa estatura familial ou atraso constitucional do crescimento. Foram determinadas as concentrações de TSH, T3, T4, T4L e prolactina no tempo basal e após estímulo com TRH. Pacientes com síndrome de Down, subdivididos quanto ao TSH basal, foram comparados em relação às concentrações basais de T3, T4, T4L e prolactina. Resultados: os valores basais de TSH e de prolactina foram significativamente maiores no grupo com síndrome de Down. Após estímulo com TRH, o pico de TSH foi maior no grupo com síndrome de Down. Tanto o número de pacientes com TSH basal > 5 µU/ml, quanto o número dos que apresentaram hiper-resposta ao estímulo com TRH (pico de TSH > 30 µU/ml), foi maior no grupo com síndrome de Down. Conclusões: freqüentemente, crianças portadoras de síndrome de Down apresentam elevação do TSH basal, mesmo na presença de valores basais normais de hormônios tireoidianos e anticorpos antitireóide negativos. A maioria dessas crianças (65%) apresenta hiper-resposta ao teste de estímulo com TRH. Nossos achados demonstram que nem todas as crianças com síndrome de Down e TSH elevado apresentam quadro clássico de hipotireoidismo, sugerindo nesses pacientes uma secreção anômala de TSH de origem hipotalâmica.

Objective: to determine the thyroid stimulating hormone (TSH) secretion in children with Down syndrome (DS), who do not present clinical and laboratory evidence of classical hypothyroidism and concomitant undetectable antibodies. Methods: fourteen children with DS with a mean age of 3.4 (±1.8) years were studied. Patients with classical hypothyroidism or hyperthyroidism or those with positive antithyroid antibodies were excluded. The DS group was compared to a control group of 16 children with a mean age of 11.8 (±3.8) years, diagnosed as having familial short stature or constitutional growth delay. Both groups underwent hormonal measurements at basal condition to determine serum TSH, T3, T4, free T4 and prolactin concentrations and after stimulation with thyrotropin releasing hormone (TRH). Thyroid hormones concentrations were also compared when children with DS were subdivided into two groups according to their basal TSH levels. Results: basal TSH and prolactin levels were significantly higher in DS group. After stimulation with TRH, TSH peak was higher in the DS group. The number of patients presenting basal TSH levels higher than 5 µU/mL and TSH peaks higher than 30 µU/mL were significantly higher in the DS group. Conclusions: children with Down syndrome present frequent increase in basal TSH concentrations, despite the presence of normal basal thyroid hormones levels and negative antithyroid antibodies. Most of them (65%) show early intense response after TRH stimulation. Our data demonstrate that in spite of the absence of classic hypothyroidism and/or antithyroid antibodies, an abnormal pattern of TSH secretion occurred in patients with Down syndrome, possibly related to hypothalamic dysfunction.