Prevalencia de hipotiroidismo subclínico en pacientes con síndrome coronario agudo / Prevalence of subclinical hypothyroidism in patients with acute coronary syndrome

INTRODUCTION: Subclinical hypothyroidism (SH) is characterized by elevation of thyroid stimulating hormone (TSH) with normal free thyroxine (FT4). SH has been associated with cardiovascular risk factors (CVRF) such as increased blood pressure, lipid level and atherosclerosis; however, its association with coronary heart disease is controversial. OBJECTIVES: The primary objective was to know the prevalence of SH in patients with acute coronary syndrome (ACS) in 3 hospitals of the Viña del Mar-Quillota Health Service. The secondary objective was to know the prevalence of CVRF in patients with SH and euthyroidism. MATERIAL AND METHOD: A cross-sectional study that included patients admitted for ACS. CVRF and thyroid hormone levels were recorded. RESULTS: Of the 81 patients recruited, 11 (13.6 percent) had SH. AHT was present in 68.3 percent of euthyroid and 90.9 percent of SH (p = 0.16). 55 percent of euthyroid and 63.6 percent of SH had dyslipidemia (p = 0.74). Overweight or obesity was found in 76.6 percent of euthyroid and 54.5 percent of SH (p = 0.15). The median CVRF was 3 (IQR 2-4) in euthyroid and 3 (IQR 3-4) in SH (p = 0.78). CONCLUSIONS: The prevalence of SH in patients with ACS was not higher than that reported in the general population and there were no differences in CVRF between SH and euthyroid. We require prospective cohort studies with a larger sample size to establish incidence and risk of adverse cardiovascular outcomes in SH.

Tiroiditis subaguda con ausencia de captación cintigráfica unilateral inicial / Subacute thyroiditis with initial unilateralabsence of scintigraphic uptake

Subacute thyroiditis is a transient inflammatory process of the thyroid gland and the most common cause of painful thyroiditis. It usually involves the whole thyroid. We present a clinical case of a 45 years old woman developing tachycardia, fever and painful sensation in the left anterior cervical region after an upper respiratory tract infection. In addition the patient presented an enlarged and painful left thyroid lobe. Laboratory analysis demonstrated elevated acute phase reactants, high T4 levels and suppressed thyrotropin with absence of antithyroid antibodies. Thyroid scintigram showed an absent left radioactive iodine uptake. One month later the patient started with malaise, fatigue with an enlarged painful right thyroid lobe. A new scintigram showed complete absence of radioactive iodine uptake. A course of prednisone was initiated with excellent clinical response. Four months later the patient was asymptomatic with normal thyroid function.