Uma mulher de 49 anos, em tratamento de hipotireoidismo com levotiroxina, após diagnóstico de tireoidite de Hashimoto e tireoidectomia total para bócio multinodular atóxico, foi avaliada devido a hipotireoidismo persistente apesar do uso de altas doses de levotiroxina (600µg/dia). Clinicamente, a paciente apresentava sinais e sintomas de hipotireoidismo, e os exames laboratoriais mostravam tiroxina livre de 0,20ng/dL; hormônio tireoestimulante de 351µUI/mL; triiodotironina total de 27ng/dL. Foi confirmada a não aderência ao tratamento e considerados os diagnósticos de sindrome de Munchausen e transtorno factício, levando ao quadro de pseudomalabsorção de levotiroxina.

A 49-year-old woman who had been treated with sodium levothyroxine because of hypothyroidism after diagnosis of Hashimoto thyroidits and total thyroidectomy for multinodular atoxic goiter was evaluated for persistent hypothyroidism despite the use of large doses of levothyroxine (600µg/day). The patient showed signs and symptoms of hypothyroidism and her laboratory tests were: TSH of 351µUI/mL, free thyroxine of 0.20ng/dL, and total triiodothyronine of 27ng/dL. She was submitted, under medical supervision, to a levothyroxine overload test with no evidence of malabsorption of the thyroid hormone. Diagnosis of factitious disorder and Munchausen syndrome leading to the pseudomalabsorption of levothyroxine was considered.

OBJECTIVE: To evaluate the immediate results of percutaneous mechanical mitral commissurotomy. METHODS: Thirty patients underwent percutaneous mechanical mitral commissurotomy performed with a Cribier's metallic valvulotome from 8/11/99 to 2/4/00. Mean age was 30.7 years, and 73.3% were women. With regards to functional class, 63.3% were class III, and 36.7% were class IV. The echocardiographic score had a mean value of 7.5± 1.8. RESULTS: The mitral valve area increased from 0.97±0.15cm² to 2.16±0.50cm² (p>0.0001). The mean diastolic gradient decreased from 17.9±5.0mmHg to 3.2±1.4mmHg. The mean left atrial pressure decreased from 23.6±5.4mmHg to 8.6±3.1mmHg, (p>0.0001). Systolic pressure in the pulmonary artery decreased from 52.7±18.3mmHg to 32.2±7.4mmHg. Twenty-nine cases were successful. One patient developed severe mitral regurgitation. Interatrial septal defect was observed and one patient. One patient had cardiac tamponade due to left ventricular perforation. No deaths occurred. CONCLUSION: This method has proven to be safe and efficient in the treatment of rheumatic mitral stenosis. The potential advantage is that it can be used multiple times after sterilization, which decreases procedural costs significantly.