Passos Ananda Castro Vieira, Barros Fábio de, Damiani Durval, Semer Beatriz, Cespedes Wendy Cira Justiniano, Sannicola Bruna, Tannuri Ana Cristina Aoun, Tannuri Uenis
Serviço de Cirurgia Pediátrica e Transplante Hepático, Laboratório de Investigação em Cirurgia Pediátrica (LIM-30), Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP, Brasil.
Unidade de Endocrinología Pediátrica, Divisão de Pediatria, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP Brasil.
Arch Endocrinol Metab. 2018;62(6):655-660. doi: 10.20945/2359-3997000000093.
Short bowel syndrome (SBS) is the leading cause of intestinal failure in children, a condition of absence of sufficient bowel to meet the nutritional and metabolic needs of a growing individual. The treatment of patients in this situation is based on the association of parenteral and enteral nutrition for prolonged periods of time until intestinal rehabilitation occurs with complete enteral nutrition autonomy. Six consecutive cases of children with SBS (residual intestinal length of 5 cm to 75 cm) were managed with this program and were diagnosed with associated hypothyroidism during the treatment (ages at the diagnosis 5 months to 12 years). All patients were successfully treated with oral hormone reposition therapy and in one patient, the replacement was performed via rectal enemas due to a complete absence of small bowel. Although iodine deficiency associated to long-term parenteral nutrition is a well-known condition, this is the first report in the literature about an expressive number of patients with hypothyroidism detected in patients with SBS during the prolonged treatment for intestinal rehabilitation.
短肠综合征（SBS）是儿童肠道衰竭的主要原因，这种情况是指肠道不足以满足生长中个体的营养和代谢需求。对于处于这种情况的患者，治疗方法是长期联合肠外营养和肠内营养，直到肠道恢复，实现完全的肠内营养自主。连续6例短肠综合征患儿（残余肠长度为5厘米至75厘米）采用该方案进行治疗，在治疗期间被诊断出伴有甲状腺功能减退（诊断时年龄为5个月至12岁）。所有患者均通过口服激素替代疗法成功治疗，其中1例患者因完全没有小肠，通过直肠灌肠进行替代治疗。虽然长期肠外营养相关的碘缺乏是一种众所周知的情况，但这是文献中首次报道在肠道康复的长期治疗过程中，短肠综合征患者中检测出大量甲状腺功能减退患者。
