Assessment of thyroid disorders in patients with rosacea: a large case-control study

Abstract Background: The frequency of autoimmune diseases and thyroid cancer has been increasingly reported in association with rosacea. However, studies investigating thyroid diseases in rosacea are scarce with conflicting results. Objective: To investigate the relationship between thyroid disorders and rosacea. Methods: A large case-control study on ageand gender-matched 2091 rosacea patients and 9572 controls was conducted. Rosacea patients using the rosacea-specific ICD codes were compiled from the hospital records. Additionally, all participants were evaluated in terms of the presence of hypothyroidism and hyperthyroidism. Conditional logistic regression analysis was used to compute case-control odds ratios (OR) with 95% confidence intervals. Results: The analysis comprehended 2091 rosacea patients (1546 female, 545 male; mean 48.73 ± 14.53 years) and 9572 controls (7009 female, 2563 male; mean 48.73 ± 15.1 years). Whereas the rate of hypothyroidism was significantly higher in rosacea patients (OR = 1.3, 95% CI 1.13-1.49, p < 0.001), there was no significant difference in the rate of hyperthyroidism between the groups (OR = 1.12, 95% CI 0.81-1.53, p = 0.497). Stratification for gender revealed a significant association between hypothyroidism and rosacea in females (OR = 1.27, 95% CI 1.1-1.47, p = 0.002) and males (OR = 1.58, 95% CI 1.04-2.4, p = 0.032). The frequency of hypothyroidism in rosacea patients increased towards the age range of 40-49 and then decreased, parallel with the hypothyroidism frequency of the study population. Study limitations: Different subtypes and severities of rosacea were not distinguished. Conclusions: Hypothyroidism may be a comorbidity of rosacea and investigation for hypothyroidism may be appropriate when evaluating rosacea patients.

Incidence of thyroid diseases: Results from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)

ABSTRACT Objective: To evaluate incidence of subclinical and overt hyperthyroidism and hypothyroidism. Subjects and methods: The Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) is a prospective cohort study of 15,105 civil servants, examined at baseline and over a 4-year follow-up. This analysis included 9,705 participants with normal thyroid function at baseline, follow-up information about thyroid function and with no report of using drugs that may interfere in the thyroid function. Thyroid function was defined by TSH/FT4 levels or routine use of thyroid hormones/anti-thyroid medications. Annual and cumulative (over 4-year) incidence rates were presented as percentages (95% Confidence Intervals). Results: The incidence of all overt and subclinical thyroid disease was 6.7% (1.73%/year): 0.19% for overt hyperthyroidism (0.048%/year), 0.54% for subclinical hyperthyroidism (0.14%/year), 1.98% for overt hypothyroidism (0.51%/year), and 3.99% for subclinical hypothyroidism (1.03%/year). The incidence of all thyroid diseases was higher in women, when compared to men, with a low women:men ratio (1.36). For Blacks the highest incidence was for overt hyperthyroidism, while for Whites, the highest incidence was for overt hypothyroidism. However, the highest incidence of overt hyperthyroidism was detected in Asian descendants. The presence of antithyroperoxidase antibodies at baseline was associated with higher incidence of overt thyroid diseases. Conclusion: These results showed a high incidence of hypothyroidism, which is compatible with a country with a more-than-adequate iodine intake. The low women:men ratio of the incidence of thyroid dysfunction highlights the importance of the diagnosis of thyroid diseases among men in Brazil.

Hipertiroidismo en personas mayores de 65 años: serie de casos de un hospital universitario / Thyrotoxicosis in the elderly: case series report from a university hospital

Introducción: En Chile en las últimas décadas ha aumentado la población de personas mayores de 65 años. La tirotoxicosis en este grupo está asociada a complicaciones como fibrilación auricular (FA), insuficiencia cardiaca (ICC), osteoporosis y aumento de la mortalidad. En algunos casos puede presentarse con síntomas no específicos, cuadro conocido como hipertiroidismo apático. Objetivos: Evaluar las características clínicas de la tirotoxicosis en personas mayores. Método: Serie de casos retrospectiva. Se analizaron fichas clínicas de pacientes mayores de 65 años con el diagnóstico de tirotoxicosis controlados en nuestro centro entre enero de 2012 y mayo de 2018. Resultados: En el periodo estudiado 54 pacientes fueron diagnosticados de tirotoxicosis. Se excluyen 4 por datos incompletos. El 80% corresponden a mujeres. La mediana de edad fue 71 años (rango 65-94), sin diferencias por género (p=0,61). La etiología más frecuente fue enfermedad de Graves (EG) en 64%, seguido por bocio multinodular hiperfuncionante en 20%, adenoma tóxico en 10% y asociada a fármacos en 6%. De los pacientes con EG, 28% presentó orbitopatía distiroidea (OD) clínicamente evidente. Un 30% se diagnosticó en contexto de baja de peso, deterioro cognitivo o patología cardiovascular, sin presentar síntomas clásicos de hipertiroidismo. Un 16% presentó FA, 14% ICC y 6% fractura osteoporótica. El 28% fue diagnosticado durante una hospitalización o requirió ser hospitalizado durante los meses siguientes. Los mayores de 75 años presentan una mayor probabilidad de hipertiroidismo apático (OR 5,1, IC95% 1,15-22,7 p=0,01). Además, las complicaciones aumentan en mayores de 75 años, encontrándose en este grupo todos los casos de FA. Conclusiones: La etiología más común de tirotoxicosis fue la EG, a diferencia de lo reportado en otras poblaciones. Un número importante de pacientes debutó sin síntomas clásicos de hipertiroidismo, principalmente mayores de 75 años, por lo que se debe tener una alta sospecha en este grupo etario.

Introduction: Hyperthyroidism in the elderly can produce severe complications such as atrial fibrillation (AF), heart failure (CHF) and osteoporosis. In the elderly, thyrotoxicosis may have only nonspecific symptoms, known as apathetic hyperthyroidism. Objective: To evaluate the clinical characteristics of thyrotoxicosis in the elderly. Methods: Retrospective case series. We reviewed clinical records of patients with thyrotoxicosis older than 65 years, between January 2012 and March 2019. Results: During this period, 54 patients were diagnosed with thyrotoxicosis. Four patients were excluded due to incomplete data. 80% were women. The average age was 73 years (range 65-94), without age difference between gender (p=0,61). The most frequent etiology was Graves' disease in 64%. Hyperfunctioning multinodular goiter was confirmed in 20%, toxic adenoma in 10% and drug-associated in 6%. Twenty eight percent of Graves' disease patients had dysthyroid orbitopathy. Thirty percent presented as apathetic hyperthyroidism. Sixteen percent of the patients presented AF, 14% CHF, and 6% osteoporotic fracture. Twenty-eight percent were diagnosed during hospitalization or required hospitalization in the following months. Those older than 75 years had a greater probability of presenting apathetic hyperthyroidism (OR 5.1, 95% CI 1.15- 22.7 p=0.01). Complications increase in this age group, with all cases of AF. Conclusions: The most common etiology of thyrotoxicosis in this group was GD. This differs from other populations. A significant number of patients presented without classic symptoms of hyperthyroidism, especially in people older than 75 years. Special attention should be paid to atypical symptoms of hyperthyroidism in this group.

Prevalencia de disfunción tiroidea en pacientes con diabetes mellitus tipo 2 / Prevalence of thyroid dysfunction in patients with type 2 diabetes mellitus

La diabetes mellitus (DM) y la disfunción tiroidea (DT) son dos frecuentes desórdenes endocrinos. La DT subclínica no reconocida puede afectar adversamente el control metabólico y aumentar el riesgo cardiovascular. Nuestro objetivo fue determinar la prevalencia de DT en pacientes con diabetes mellitus tipo 2, en un estudio observacional de corte transversal con evaluación clínica y de laboratorio a 205 pacientes consecutivos atendidos en consulta externa del Centro de Endocrinología, Diabetes y Nutrición de la ciudad de Concepción, Tucumán, Argentina. La disfunción tiroidea se clasificó como hipotiroidismo clínico con TSH > 4.20 μUI/ml y T4L < 0.93 ng/dl; hipotiroidismo subclínico con TSH > 4.20 μUI/ml y T4 libre 0.93 a 1.70 ng/dl. hipertiroidismo subclínico con TSH < 0.27 μUI/ml y T4 libre en rango normal (0.93-1.70 ng/dl). Se consideró hipertiroidismo clínico con TSH < 0.27 μUI/ml y T4 libre > 1.70 μUI/ml. Se diagnosticó autoinmunidad con anti-TPO > 34 UI/ml. La prevalencia de DT en los diabéticos tipo 2 fue 48% (n = 92). En aquellos que negaron DT previa, la prevalencia fue 40% (n = 37), 15 presentaron hipotiroidismo subclínico (45%). En el total de la población estudiada la prevalencia de hipotiroidismo subclínico fue 8%. En forma global la prevalencia de DT subclínica fue 9% (n = 17) y la de anticuerpos anti-TPO 13% (n = 25). La detección temprana de disfunción tiroidea en diabetes mellitus tipo 2 debería realizarse rutinariamente, dada la elevada tasa de nuevos casos diagnosticados y el aumento del riesgo cardiovascular asociado a la disfunción tiroidea no diagnosticada oportunamente.

Diabetes mellitus (DM) and thyroid dysfunction (TD) are two common endocrine disorders. The unrecognized subclinical TD may adversely affect metabolic control and increase cardiovascular risk. Our aim was to investigate the prevalence of TD in patients with type 2 diabetes mellitus in an observational cross-sectional study. Clinical and laboratory evaluation was performed to 205 consecutive outpatients at Endocrinology Diabetes and Nutrition Center in Concepcion City, Tucuman, Argentina. Thyroid dysfunction was classified as clinical hypothyroidism with TSH > 4.20 mUI / ml and FT4 < 0.93 ng / dl, subclinical hypothyroidism with TSH > 4.20 mUI / ml and free T4 0.93 to 1.70 ng / dl. Subclinical hyperthyroidism was considered with TSH < 0.27 mUI / ml and free T4 was in normal range (0.93 to 1.70 ng / dl); and clinical hyperthyroidism with TSH < 0.27 mUI / ml and free T4 >1.70 mUI / ml. Autoimmunity was diagnosed with anti-TPO > 34 IU / ml. TD prevalence in type 2 diabetic patients was 48% (n = 92). In subjects who denied prior TD, the prevalence was 40% (n = 37), 15 with subclinical hypothyroidism (45%). In the whole study population prevalence of subclinical hypothyroidism was 8%. Globally, subclinical DT prevalence was 9% (n = 17) and anti-TPO 13% (n = 25). Early detection of thyroid dysfunction in patients with type 2 diabetes mellitus should be performed routinely, given the high rate of newly diagnosed cases, and increased cardiovascular risk associated with undiagnosed thyroid dysfunction.

Evaluación de la disfunción tiroidea en estudiantes de una institución universitaria / Evaluation of thyroid dysfunction in university students of an institution

RESUMEN Objetivo Determinar la prevalencia de la disfunción tiroidea subclínica en la comunidad estudiantil de la Universidad Católica de Manizales. Materiales y Métodos Se realizó un estudio descriptivo de corte transversal donde participaron 160 estudiantes de la Universidad Católica de Manizales en el período 2012-2013, los cuáles fueron sensibilizados mediante una estrategia publicitaria acerca de la disfunción tiroidea, se les aplicó encuesta y consentimiento informado, posteriormente se realizó valoración médica de nódulos y bocio, toma de muestra sanguínea, procesamiento y determinación de niveles de Hormona estimulante de tiroides (TSH). Resultados El análisis de correspondencias (Escalamiento óptimo) logró establecer que las variables relacionadas como Índice de masa corporal (IMC) promedio 24,12 (normal 18,5-24,99), el género femenino (87,5 %), la raza mestiza (61 %) presentaron una alta correspondencia con los valores normales de hormona estimulante de tiroides (TSH) según valores inserto de la casa comercial (0,39-6,16 µIU/ml), y el rango de edad 20-25 años (50 %) y no se presentó relación con los hallazgos de antecedentes familiares, presencia de bocio y nódulos. Conclusiones La población estudiantil de la Universidad Católica de Manizales no presentó disfunción tiroidea subclínica.(AU)

ABSTRACT Objective To determine the prevalence of subclinical thyroid dysfunction in the student community of Universidad Católica in Manizales. Materials and Methods Descriptive cross-sectional study in which 160 students of Universidad Católica in Manizales participated during 2012 and 2013; these students were educated through an advertising strategy about thyroid dysfunction and then a survey was applied. Informed consent was obtained and medical evaluation of nodules and goiter, blood sampling, processing and determination of thyroid stimulating hormone (TSH) were performed. Results A correspondence analysis (optimal scaling) established that related variables such as average body mass index (BMI) 24.12 (normal 18.5 to 24.99), female gender (87.5 %), and mixed race (61 %) showed high correspondence with the normal values of thyroid stimulating hormone (TSH) according to the values provided by the trading house (0,39-6,16 µIU/ml) and the age range 20-25 years (50 %). No evidence of a relation between family history, presence of goiter and nodules was found. Conclusions Student population Universidad Católica in Manizales did not present subclinical thyroid dysfunction.(AU)

Estudo epidemiológico da evolução de neonatos com hipertireotropinemia no Estado de Minas Gerais: Brasil / Epidemiologic study of the newborns evolution with hyperthyrotropinemia in the State of Minas Gerais: Brazil

Introdução: no exame sérico os valores de TSH acima de 10 ?Ul/mL e de T4 livre (T4L) baixo confirmam o diagnóstico do hipotireoidismo congênito, e as crianças deverão ser tratadas. Contudo, se houver elevação discreta do TSH (5,6 a 10 µUI/mL) e T4L normal, o recém-nascido (RN) apresenta quadro de hipertireotropinemia (HT) neonatal, que pode ser transitório ou permanente, e deve permanecer em acompanhamento clínico rigoroso. Objetivos: verificar a evolução de crianças triadas pelo Programa de Triagem Neonatal de Minas Gerais (PTN-MG) com HT. Métodos: estudo do tipo coorte retrospectivo. Analisaram-se os dados obtidos pelo ?teste do pezinho?, disponibilizados pelo banco de dados do Núcleo deAções e Pesquisa em Apoio Diagnóstico (NUPAD). Resultados: no período de 2000 a 2010,125 RNs apresentaram HT. Desses, 48% normalizaram os níveis de TSH no período médio de 20 meses. Já os outros 52% não normalizaram o TSH no período estudado e por isso foram mantidos em acompanhamento. Conclusões: mesmo que os níveis de TSH tenham se normalizado em 48% dos casos, concedendo alta a esses RNs, o tempo para esse desfecho foi significativo (cerca de 20 meses). Nesse período, pode haver alterações nos exames, muitas vezes com necessidade de tratamento com reposição hormonal, sendo, portanto, fundamentalo seguimento por meio de consultas e dosagens hormonais periódicas.

Introduction: in the serum exam TSH values above 10 ?Ul / mL and free T4 (FT4) low confirm the diagnosis of congenital hypothyroidism, and children should be treated. However, if mild elevation of TSH (5.6 to 10 ?UI / mL), normal FT4, the newborn (NB) has a hyperthyrotropinemia (HT) frame neonatal, which can be temporary or permanent, and should remain in rigorous clinical monitoring. Objects: to check the progress of children screened by the Newborn Screening Program of Minas Gerais (LWA-MG) withHT. Methods: this is a retrospective cohort study. We analyzed the data obtained by ? heel prick test ? provided by the Core Database Action and Research in Support Diagnostics (NUPAD). Results: from 2000 to 2010, 125 newborns had HT. Of these, 48% had a normal TSH levels in an average period of 20 months. As for the other 52% did not normalizeTSH during the study period and were therefore kept in accompaniment. Conclusions: Even though TSH levels have become normal in 48% of cases providing high for these RNs, this time to endpoint was significantly (about 20 months). During this period there may be changes in the exams, often requiring treatment with hormone replacement, and is therefore essential to follow through periodic consultations and hormone levels.

Características clínicas, demográficas y perfil tiroideo de los pacientes hospitalizados por hipertiroidismo en un hospital general / Clinical and demographic features and thyroid hormone profile in hospitalized patients with hyperthyroidism in a general hospital

Describir las características clínicas y las causas de hospitalización en pacientes con hipertiroidismo en un hospital general de Lima, Perú. Material y métodos: Estudio descriptivo, retrospectivo, tipo serie de casos. La población de estudio estuvo constituida por todos los pacientes hospitalizados con el diagnóstico de hipertiroidismo entre enero de 1989 y diciembre de 2005 en el Hospital Nacional Cayetano Heredia. La fuente de datos fue el libro de interconsultas del Servicio de Endocrinología. Se exploraron las características clínicas y demográficas de los pacientes de acuerdo a su etiología. Resultados: Se identificaron 230 pacientes con diagnóstico de hipertiroidismo y se revisaron 162 historias clínicas. La mediana de la edad fue 36 años, el 79% eran mujeres y la causa más frecuente fue la enfermedad de Graves (EG) (87,65%), seguida por la enfermedad nodular tiroidea (ENT) (12,35%). Las pacientes con EG fueron más jóvenes, habían nacido en la costa; mientras que las pacientes con ENT eran mayores y habían nacido en la sierra. Las causas más frecuentes de hospitalización fueron el compromiso cardiovascular (insuficiencia cardíaca y fibrilación auricular), las infecciones y las complicaciones gineco-obstétricas. La mayoría de pacientes fueron tratadas con tionamidas y beta bloqueadores. La mortalidad fue 1,23%. Conclusiones: De manera similar a otros estudios nacionales, la causa más frecuente de hospitalización por hipertiroidismo fue la EG con compromiso cardiovascular. La mortalidad fue menor al de estudios previos...

To describe the clinical features and causes of hospitalization in patients with hyperthyroidism in a general hospital in Lima, Peru. Methods: A retrospective and descriptive study was carried out. The study population was all patients hospitalized with the diagnosis of hyperthyroidism from January 1989 to December 2005 at Hospital Nacional Cayetano Heredia. Source data was the consultation book-record of the Endocrinology service. Clinical and demographic features were gathered. Results: 230 patients were identified, 162 clinical charts were reviewed. Median age was 36 years of age; 79% of patients were female, and Graves disease (GD) was the most common cause of hyperthyroidism (87.65%), followed by nodular thyroid disease (NTD, 12.35%). Patients with GD were younger and had been borne in the coast, while patients with NTD were older and had been born in the highlands. The most common reasons for hospitalization were cardiovascular involvement (heart failure and atrial fibrillation), infections and gyneco-obstetric complications. Most of the patients were treated with thioamides and beta- blockers. Mortality was 1.2%. Conclusions: As reported in other national studies the most common cause for hospitalization was GD with cardiovascular involvement. Mortality was lower than previously reported...

Evaluation of thyroid function and autoimmunity in HIV-infected women / Avaliação da função tiroidiana e autoimunidade em mulheres infectadas pelo HIV

Autoimmune thyroid diseases (AITD) are the main causes of thyroid dysfunction and the most common autoimmune diseases in the world. An association between AITD and infections with the human immunodeficiency virus (HIV), in combination with the effects of highly active anti-retroviral therapy (HAART), has been suggested by several research groups. The aim of the present study was to evaluate the frequency of thyroid dysfunction and AITD in women > 35 years of age infected with HIV, and to identify factors associated with the emergence of these thyroid abnormalities. HIV-infected women (n = 153) selected from the infectious disease outpatient clinic at a University Hospital in Rio de Janeiro were characterized based on their circulating CD4+ lymphocytes levels, viral loads, serum TSH levels, and the presence of FT4 and anti-thyroperoxidase antibodies (TPO-Ab). A total of 129 participants were on HAART and 24 were not. The frequency of thyroid disorders was 7.8% (12/153 patients) and all were on HAART at the time of diagnosis, yielding a prevalence of 9.3% in patients receiving HAART compared with 0% in patients not on HAART. AITD, hyper, and hypothyroidism were detected in 4.6%, 3.1%, and 4.1% of HAART patients. It was not detected any thyroid dysfunction or autoimmunity in HIV-infected women not on HAART. This study demonstrated an association between HAART and the development of AITD. In addition AITD only developed in HAART patients also presenting with undetectable viral loads and slightly elevated CD4+ T cell counts.

Doenças tiroidianas autoimunes (DTAI) são a maior causa de disfunção tiroidiana e são as doenças autoimunes mais comuns no mundo. A associação entre DTAI e infecções com o vírus da imunodeficiência humana (HIV), em combinação com a terapia antirretroviral altamente ativa (HAART), foi sugerida por vários grupos de pesquisadores. O objetivo do presente estudo foi avaliar a fre-quência de disfunção tiroidiana e DTAI em mulheres com mais 35 anos de idade infectadas com o HIV e identificar fatores associados com a emergência dessas anormalidades tiroidianas. As mulheres infectadas com HIV (n = 153), selecionadas do ambulatório de doenças infecciosas de um hospital universitário do Rio de Janeiro, foram caracterizadas com base no nível de linfócitos CD4+ circulantes, carga viral, níveis de TSH sérico e presença de anticorpos FT4 e antitiroperoxidase (TPO-Ab). Um total de 129 participantes se tratava com HAART e 24 não. A frequência de desordens da tiroide foi 7,8% (12/153 pacientes) e todas estavam em tratamento com HAART no momento do diagnóstico, levando a uma prevalência 9,3% em pacientes recebendo HAART, em comparação com 0% em pacientes não tratadas com HAART. DTAI, hipertireoidismo e hipotireoidismo foram detectados em 4,6%, 3,1% e 4,1% das pacientes tratadas com HAART. Não foram detectadas disfunção tiroidiana ou autoimunidade em mulheres infectadas com HIV e não tratadas com HAART. Este estudo demonstrou uma associação entre a HAART e o desenvolvimento de DTAI. Além disso, a DTAI apenas se desenvolveu em pacientes tratadas com HAART e que apresentavam cargas virais indetectáveis e contagens de células CD4+ T levemente elevadas.

Prospective Observation of 5-Year Clinical Course of Subclinical Hypothyroidism in Korean Population

Subclinical hypothyroidism (SCH) is a common clinical condition, whereas it's natural course has not been identified distinctly. We evaluated the natural history of 169 SCH patients over 5-yr and the prognostic factors including thyroid autoantibodies and thyroid ultrasonographic (USG) findings related to develop overt hypothyroidism. After 5 yr, 47.3% of patients showed normalization of TSH, while 36.7% of patients remained persistence of high level of TSH, and overt hypothyroidism developed in 11.2% of patients. There were painless thyroiditis (2.9%) and hyperthyroidism (1.7%) during 5 yr follow-up. The thyroid nodule was seen in 48.6% of patients. Most of patients had 1 to 2 nodules whereas only 3% of patients with thyroid nodule had more than 6 nodules. Overt hypothyroidism patients had more heterogenous echogenecity in USG compared to patients with normalization or persistent SCH (76.5% vs 50.0% vs 35.0%, P = 0.048) and higher prevalence positive anti-thyroid peroxidase (anti-TPO Ab) and anti-thyroglobulin antibody (anti-Tg Ab) and titer of anti-TPO Ab than other two groups. The cut off values for prediction of overt hypothyroidism were TSH > 7.45 microIU/mL, free T4 560 IU/mL. SCH has various courses and initial TSH, free T4, presence of thyroid autoantibody, titer of thyroid autoantibody; and thyroid USG findings can serve as a prognostic factor for progression of overt hypothyroidism. These parameters suggest consideration to initiate thyroid hormone treatment in SCH.

Perfil epidemiológico dos pacientes com vitiligo e sua associação com doenças da tireoide / Vitiligo epidemiological profile and the association with thyroid disease

FUNDAMENTO: O vitiligo é considerado a hipomelanose adquirida mais frequente. Apesar de sua etiopatogenia ser incerta, acredita-se que a etiologia autoimune seja a mais plausível, teoria que se fundamenta na concomitância de vitiligo com doenças autoimunes. OBJETIVOS: Traçar o perfil epidemiológico dos pacientes com vitiligo e estimar a prevalência da associação de vitiligo com doenças autoimunes da tireoide. MÉTODOS: Efetuou-se um estudo transversal, analisando-se prontuários dos pacientes com diagnóstico de vitiligo atendidos no Ambulatório de Dermatologia AME-Unisul e do HU-UFSC. Avaliaram-se as características clínicas e laboratoriais desses pacientes. RESULTADOS: Foram avaliados 85 prontuários, sendo 56 do sexo feminino, com idade média de 37,14 anos e idade média de início de 25,25 anos. O vitiligo vulgar ocorreu em 70,6 por cento dos casos. As doenças autoimunes da tireoide foram encontradas em 22,4 por cento dos casos. Outras doenças autoimunes foram identificadas em 5,9 por cento dos casos. Os pacientes com anticorpos antitireoidianos positivos revelaram uma probabilidade elevada de extensão do vitiligo maior que 25 por cento. Não houve diferença estatística quanto às características clínicas do vitiligo em portadores ou não de tireoidite autoimune com alteração hormonal. CONCLUSÃO: Os resultados deste estudo são similares aos de outros autores, mostrando que as doenças autoimunes da tireoide são mais frequentes nos pacientes com vitiligo.

BACKGROUND: Vitiligo is considered the most frequent acquired hypomelanosis. Although its pathogenesis is uncertain, it is believed that autoimmune etiology is the most plausible. This theory is based on the coexistence of vitiligo with autoimmune diseases. OBJECTIVES: To describe the epidemiological profile of vitiligo patients and to estimate the prevalence of the association of vitiligo with autoimmune thyroid diseases. METHODS: A cross-sectional study was conducted through analysis of the medical records of patients diagnosed with vitiligo in the AME-UNISUL Outpatient Clinic of Dermatology and at HU-UFSC. The clinical and laboratorial characteristics of these patients were assessed. RESULTS: 85 medical records were evaluated; 56 patients were female, with a mean age of 37.14 years and mean onset age of 25.25 years. Vitiligo vulgaris occurred in 70.6 percent. Autoimmune thyroid diseases were found in 22.4 percent. Other autoimmune diseases were identified in 5.9 percent. Patients with positive thyroid autoantibodies showed a probability of extension of vitiligo greater than 25 percent. There was no statistical difference with regard to the clinical characteristics of vitiligo in patients with or without autoimmune thyroiditis with hormonal change. CONCLUSION: The findings of this study are similar to those obtained by other authors, showing that autoimmune thyroid diseases are more common in patients with vitiligo.

Prevalence of thyroid disorders among older people: results from the São Paulo ageing & health study / Prevalência de doenças da tireóide em idosos: resultados do São Paulo ageing & health study

This study aimed to estimate prevalence of thyroid disorders in the São Paulo Ageing & Health Study, an epidemiological study addressing several health-adverse outcomes among elderly people living in a poor area of São Paulo, Brazil. All participants answered a questionnaire and had a blood sample collected to assess levels of tireotropic hormone and free-thyroxine. Among 1,373 people (60.8 percent women), prevalence rates (95 percent confidence interval) for thyroid dysfunction ( percent) were: overt hyperthyroidism, 0.7 percent (0.2-1.1)[women: 0.8 percent (0.2-1.5); men: 0.4 percent (0.01-0.9)]; overt hypothyroidism, 5.7 percent (4.5-6.9) [women: 5.9 percent (4.3-7.5); men: 5.4 percent (3.5-7.3)]; subclinical hyperthyroidism, 2.4 percent (1.6-3.2) [women: 2.8 percent (1.6-3.9); men: 1.9 percent (0.7-3.0)]; and subclinical hypothyroidism, 6.5 percent (5.2-7.8) [women: 6.7 percent (5.0-8.4); men: 6.1 percent (4.1-8.2)]. There was no difference in prevalence rates according to gender, but almost 40 percent of women were diagnosed and under treatment compared to 9 percent of men. The burden of thyroid disorders in this sample is high and most participants were not aware of them.

O objetivo da pesquisa foi avaliar a prevalência de doenças da tireóide no São Paulo Ageing & Health Study, estudo epidemiológico focado em desfechos de saúde adversos em amostra de idosos moradores de São Paulo, Brasil. Todos os participantes responderam a questionário e colheram sangue para dosagem de hormônio tireotrópico e tiroxina-livre. Entre os 1.373 participantes (60,8 por cento mulheres), a prevalência (intervalo de 95 por cento de confiança) de hipertireoidismo clínico foi de 0,7 por cento (0.2-1,1) [mulheres: 0,8 por cento (0,2-1,5); homens: 0,4 por cento (0,01-0,9)]; hipotireoidismo clínico, 5,7 por cento (4,5-6,9) [mulheres: 5,9 por cento (4,3-7,5); homens: 5,4 por cento (3,5-7,3)]; hipertireoidismo subclínico, 2,4 por cento (1,6-3,2) [mulheres: 2,8 por cento (1,6-3,9); homens: 1,9 por cento (0,7-3,0)]; e hipotireoidismo subclínico, 6,5 por cento (5,2-7,8) [mulheres: 6,7 por cento (5,0-8,4); homens: 6,1 por cento (4,1-8,2)]. Não houve diferença na prevalência de doenças da tireóide por sexo. Quarenta por cento das mulheres tinham diagnóstico e estavam tratando, comparadas a 9 por cento dos homens. A prevalência de disfunção tireoidiana foi elevada e a maioria dos participantes desconhecia o diagnóstico.

Investigação das alterações cardiovasculares e microcirculatórias em um modelo de hipertireoidismo experimental / Investigation of cardiovascular and microcirculatory changes in a model of experimental hyperthyroidism

Os sintomas cardiovasculares constituem uma das manifestações clínicas mais comuns e, por vezes, predominantes no hipertiroidismo. No entanto, os efeitos do hipertiroidismo sobre a microcirculação miocárdia e muscular esquelética são controversos neste modelo experimental. Objetivos: Foram investigadas a densidade capilar funcional (DCF) através de videomicroscopia intravital por epi-iluminação e fluorescência após a injeção intravenosa de fluoresceína-isotiocianato (FITC) – dextram e a densidade capilar estrutural (DCE) no ventrículo esquerdo através de análise histoquímica com uma lectina de Griffonia simplicifolia (GSI) conjugada a FITC, assim como os efeitos dos tratamentos crônicos ou com um bloqueador dos canais de cálcio (diltiazem), ou com um antagonista dos receptores AT1 (losartan), ou com um β- bloqueador não-seletivo (propanolol) sobre a hipertrofia cardíaca e densidade capilar estrutural miocárdia em ratos hipertireóideos. Métodos: Um grupo de animais foi submetido à injeção intraperitoneal de L-tiroxina (600mig/kg/dia) durante 14 e 35 dias. Em uma segunda etapa no 14º dia os animais que receberam tiroxina foram divididos em 4 grupos experimentais. A partir dessa divisão, além da continuação da administração de tiroxina, os diferentes grupos de animais receberam ou salina ou losartana ou diltiazem ou propanolol por via oral durante 21 dias, totalizando 35 dias. Após o término do tratamento avaliou-se a densidade capilar funcional através da microscopia intravitral por epi-iluminação com fluorescência, e a densidade capilar estrutural através de histoquímica. Resultados: A administração por 14 dias de tiroxina induziu a hipertrofia e fibrose cardíaca, rarefação capilar funcional muscular e rarefação capilar estrutural miocárdica, assim como uma diminuição na expressão dos receptores AT1 cardíacos no hipertiroidismo. Os tratamentos crônicos ou com o losartan, ou com diltiazem, ou com o propanolol, foram capazes de reverter à hipertrofia e remodelamento cardíaco, além da rarefação microvascular presente no VE de ratos hipertireóideos. Conclusões: O modelo de hipertiroidismo experimental produziu uma série de alterações cardiovasculares, como taquicardia, hipertensão arterial, hipertrofia e fibrose cardíaca, e alterações microcirculatórias musculares esqueléticas e cardíacas. Além da abordagem terapêutica atitireoidiana convencional, deve ser a terapia adjuvante com bloqueadores dos canais de Ca2+, além de antagonistas dos receptores beta-adrenérgicos, e antagonistas dos receptores AT1 da angiotensina II, no hipertiroidismo.

Frequency of subclinical thyroid dysfunction and risk factors for cardiovascular disease among women at a workplace / Frequência das doenças subclínicas da tireóide e de fatores de risco para doença cardiovascular em mulheres em um local de trabalho

CONTEXT AND OBJECTIVE: Subclinical thyroid dysfunction is very common in clinical practice and there is some evidence that it may be associated with cardiovascular disease. The aim here was to evaluate the frequencies of subclinical thyroid disease and risk factors for cardiovascular disease among women at a workplace, and to evaluate the association between subclinical thyroid disease and cardiovascular risk factors among them. DESIGN AND SETTING: Cross-sectional study on 314 women aged 40 years or over who were working at Universidade de São Paulo (USP). METHODS: All the women answered a questionnaire on sociodemographic characteristics and risk factors for cardiovascular disease and the Rose angina questionnaire. Anthropometric variables were measured and blood samples were analyzed for blood glucose, total cholesterol and fractions, high-sensitivity C-reactive protein, thyroid-stimulating hormone (TSH), free thyroxine (free-T4) and anti-thyroperoxidase antibodies (anti-TPO). RESULTS: The frequencies of subclinical hypothyroidism and hyperthyroidism were, respectively, 7.3 percent and 5.1 percent. Women with subclinical thyroid disease presented higher levels of anti-TPO than did women with normal thyroid function (P = 0.01). There were no differences in sociodemographic factors and cardiovascular risk factors according to thyroid function status, except for greater sedentarism among the women with subclinical hypothyroidism. Restricting the comparison to women with subclinical hypothyroidism (TSH > 10 mIU/l) did not change the results. CONCLUSION: In this sample of women, there was no association between poor profile of cardiovascular risk factors and presence of subclinical thyroid disease that would justify screening at the workplace.

CONTEXTO E OBJETIVO: A doença tireoidiana subclínica é muito frequente na prática clínica e há evidências que sugerem associação com doença cardiovascular. O objetivo foi estabelecer a frequência das doenças subclínicas da tireóide e de fatores de risco para doença cardiovascular em mulheres no local de trabalho, bem como avaliar a associação da doença tireoidiana subclínica com fatores de risco para doença cardiovascular nessas mulheres. TIPO DE ESTUDO E LOCAL: Estudo transversal em 314 mulheres com 40 ou mais anos de idade que trabalham na Universidade de São Paulo. MÉTODOS: Todas as mulheres responderam a questionário sobre características sócio-demográficas, fatores de risco para doença cardiovascular, questionário de angina de Rose, e foram realizadas medidas antropométricas e colhido sangue para dosagem de glicemia, colesterol total e frações, proteína C ultra-sensível, hormônio tireotrópico (TSH), tiroxina-livre (TS-livre) e anticorpos anti-tireoperoxidase. RESULTADOS: As frequências de hipotireoidismo subclínico e de hipertireoidismo subclínico foram respectivamente de 7,3 por cento e 5,1 por cento. Os níveis de anticorpos antiperoxidase foram mais elevados nas mulheres com doença subclínica da tireoide comparadas às mulheres com função tireoidiana normal (P = 0,01). Não houve nenhuma diferença estatisticamente significativa entre os fatores sociodemográficos e de risco para doença cardiovascular entre os grupos exceto pela maior presença de sedentarismo entre as mulheres com hipotireoidismo subclínico. Restringir a comparação somente às mulheres com hipotireoidismo subclínico (TSH > 10 mIU/l) não mudou os resultados. CONCLUSÃO: Nesta amostra de mulheres, não houve nenhuma associação entre um perfil inadequado dos fatores de risco para doença cardiovascular e a presença de doença subclínica da tireóide que justificasse o rastreamento no local de trabalho.

[ incidence of subclinical thyroid dysfunction and it's natural course in the Tehranian adults]

The aim of this study was to determine the incidence of thyroid dysfunction and the natural course of subclinical thyroid disorders in the Tehranian community. All individual >/= 20 years, who participated during the first to third phases [6 years, 7 months], of the [Tehran Lipid and Glucose Study] and provided the relevant data were included in this study. Both Tpo-Ab and TSH were measured. In 808 TPO-Ab negative individuals who were not taking any thyroid and anti-thyroid drugs and without a history of thyroid disease, thyroid surgery, goiter and thyroid nodules, mean, median, 2.5, 5, 95, 97.5 percentile TSH were determined. On the basis of 2.5 and 97.5 percentile, normal reference range for TSH was 0.4- 5.8 micro u/mL. In those, whose TSH fell outside the reference range, T3, T4 and T3 uptake were measured and FTI was calculated. In the first stage, 1065 women and 693 men had normal thyroid tests. After 6.7 years the incidence of clinical hypothyroidism was 0.28 in 1000 women and 0.21 in 1000 men, subclinical hypothyroidism was 11.59 in 1000 women and 4.69 in 1000 men, clinical hyperthyroidism was 1.4 in 1000 women and 0.21 in 1000 men, subclinical hyperthyroidism was 5.72 in 1000 women and 3.62 in 1000 men. In this period, increasing positivity of TPO-Ab from 15.9 to 17.7% in women was significant. [P=0.06] In the first stage 8 women had subclinical hypothyroidism, 5 still did on follow-up, one was normal, and one was diagnosed with clinical hypothyroidism. The remaining one was hyperthyroid on levothyroxin. Two women with subclinical hyperthyroidism in the first stage were normal in follow-up, without any treatment. In the first stage 2 men had subclinical hypothyroidism, and in follow-up, one was same, while the other was diagnosed with clinical hypothyroidism. Normal range of TSH was 0.4-5.8 micro u/mL in the Tehranian community. There was significant increase of the frequency of subclinical thyroid disorders in both genders and frequency of clinical hyperthyroidism and TPO-Ab positive in women. Compared to clinical thyroid disorders, the incidence of subclinical thyroid disorders, was more significant

Hipertiroidismo subclínico / Subclinical hyperthyroidism

El hipertiroidismo subclínico se define por la presencia de niveles disminuidos o no detectables de tirotropina, asociados a concentración de tetrayodotironina y triyodotironina libres dentro de parßmetros normales. Su prevalencia en la población varía entre un 0,5 y un 16 por ciento aproximadamente, y es el tratamiento con levotiroxina sódica la causa mas frecuente. No siempre resulta tan asintomático, y las afectaciones principales ocurren sobre el sistema cardiovascular y óseo. Esta condición médica puede ser reversible espontáneamente. Por lo controversial del tema, el presente trabajo trata los aspectos clínicos más relevantes y la conducta a seguir(AU)

Subclinical hyperthyroidism is defined by presence of decreased o non-detected levels of thyrotropin, associated with free concentrations of tetraiodothyronine and triiodothyromime within normal parameters. Its prevalence in population differs between 0,5 percent and 16 percent approximately, and the sodium Levothyroxine treatment is the more frequent cause. Not always it is so asymptomatic, and main affections occur on cardiovascular and osseous system. This medical condition may be spontaneously reversible. Due to controversial of this topic, present paper approaching the more significant clinical features and the strategy to go on(AU)

Hipertensão arterial pulmonar e doenças da tireoide: [revisão] / Pulmonary arterial hypertension and thyroid disease: [review]

Estudos recentes têm sugerido uma associação entre hipertensão arterial pulmonar (HAP) e tireoidopatias (hipotireoidismo e hipertireoidismo). Esta associação tem um bom prognóstico, porque o aumento na pressão da artéria pulmonar geralmente é leve e reversível com o tratamento da tireoidopatia. O mecanismo exato envolvido na patogênese desta associação não está estabelecido, e a influência direta dos hormônios da tireoide e a autoimunidade são consideradas como hipóteses. Devido à alta prevalência de doenças da tireoide em pacientes com HAP, testes de função tireoidiana devem ser considerados na investigação de todo paciente com HAP. Neste artigo de revisão, descrevemos a prevalência de HAP em pacientes com doenças da tireoide e a prevalência de tireoidopatias em pacientes com HAP, assim como destacamos os principais efeitos das doenças da tireoide no sistema respiratório. A seguir, relatamos os efeitos do tratamento destas patologias.

Recent studies have suggested an association between pulmonary arterial hypertension (PAH) and thyroid diseases (hypothyroidism and hyperthyroidism). This combination has a good prognosis, because the increase in the pulmonary artery pressure is usually slight and reverses after the treatment of the thyroid disease. Although the exact mechanism involved in the pathogenesis of this combination has not yet been established, it has been hypothesized that thyroid hormones and autoimmunity have a direct influence. Due to the high prevalence of thyroid disease in patients with PAH, thyroid function tests should be considered in the investigation of every patient with PAH. In this review, we describe the prevalence of PAH in patients with thyroid diseases and the prevalence of thyroid disease in patients with PAH, as well as addressing the principal effects that thyroid diseases have on the respiratory system. In addition, we report the treatment effects in patients with these diseases.

Hipertiroidismo en niños y adolescentes / Hyperthyroidism in children and adolescents

Background: Hyperthyroidism (HT) prevalence is 0.1/100,000 children and 1/100,000 adolescents and Graves Disease is the most frequent etiology. Objective: To evaluate the clinical presentation, etiology and treatment in hyperthyroid children. Method: Retrospective review of clinical charts of children under 15 years-old, between June 2004 and August 2005. Hyperthyroidism diagnosis was performed with suppressed TSH and increased thyroid hormones levels. Etiological study was done by TRAb, ATPO, ATG, thyroid echotomography and I131 capture. Results: 26 patients were evaluated; 84.6 percent females and age at diagnosis was 9.8 +/- 3,5 years-old (range: 3,8 - 14,5). Goiter was the most frequent clinical sign (96,2 percent), tachicardy and swelling. Etiology: Graves Disease (73 percent),Hashitoxicosis (15,3 percent) and unknown etiology (11,5 percent). Treatment: 88,4 percent began with anti-thyroid drugs (DAT): 78 percent PTU and 22 percent Tiamazol. 62.5 percent became euthyroid after 6 months and 79.1 percent after 12 months. 31.5 percent of GD presented hypothyroidism at 6.3 +/- 4 months of DAT, requiring LT4 substitution. I131 was applied to 4 children (16.6 percent); 3 due to hepatic compromise pre or post PTU use and 1 girl for missing treatment, developing a thyrotoxic torment. Thyroidectomy was done in 2 patients (8.3 percent), both with GD; 1 for giant goiter without DAT response at 19 months and 1 for persistant hyperthyroidism after 25 months of DAT. 92 percent received (3-blockers (Propanolol) for adrenergic symptoms for 5 +/- 4 months. Conclusions: Goiter was the most frequent pediatric HT symptom and Graves disease the main etiology. DAT treatment control HT in 76.9 percent patients and no adverse reactions with I131 were observed. These resUIts promote DAT treatment as first line in HT management, prefering Tiamazol for its better adherence and less adverse reactions. Radioiodide therapy and thyroidectomy are alternatives if treatment fails...

El hipertiroidismo (HT) tiene una prevalencia de 0,1/100 000 en niños y 1/100 000 en adolescentes, siendo la enfermedad de Graves (EG) la etiología más frecuente. Objetivo: Revisar presentación clínica, etiología y manejo de niños con HT. Método: Estudio retrospectivo de fichas clínicas de niños con HT menores de 15 años, evaluados entre Junio/04 y Agosto/05. El diagnóstico de HT se hizo con TSH suprimida y hormonas tiroideas elevadas. El estudio etiológico se realizó en base a anticuerpos TRAb, ATPO, ATG; Ecotomograña tiroidea, y captación de I131. Resultados: Se evaluaron 26 pacientes; 84,6 por ciento fueron mujeres. Edad promedio al diagnóstico fue 9,8 +/- 3,5 años (rango 3,8 a 14,5). La presentación clínica más frecuente fue bocio (96,2 por ciento), seguidos por taquicardia y sudoración. Etiología: Enfermedad de Graves 73 por ciento, Hashitoxicosis 15,3 por ciento y etiología no precisada 11,5 por ciento. Manejo: 88,4 por ciento inician con drogas antitiroideas (DAT); 78 por ciento PTU y 22 por ciento con Tiamazol. 62,5 por ciento se hizo eutiroideo a los 6 meses y 79,1 por ciento a los 12 meses. El 31,5 por ciento de EG presentó hipotiroidismo a los 6,3 +/- 4 meses de uso de DAT, requiriendo sustitución con LT4. El I131 fue indicado a 4 niños (16,6 por ciento): en 3 casos por compromiso hepático importante pre o post uso de PTU y 1 niña por abandono de tratamiento y reingreso con tormenta tiroidea. Tiroidectomía: se indicó a 2 pacientes (8,3 por ciento), ambos con EG; uno por bocio gigante, sin respuesta a DAT después de 19 meses de uso y el otro por persistir hipertiroideo después de 25 meses de uso de DAT. El 92 por ciento recibió (3 bloqueador (propanolol) para manejo de los síntomas adrenérgicos, (5 +/- 4 meses). Discusión y conclusiones: El bocio es el síntoma principal en pediatría. La etiología más frecuente es la Enf de Graves. Las DAT permitieron controlar el HT en 76,9 por ciento de los pacientes, no observamos complicaciones con el uso de I131...