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1.
Arch. endocrinol. metab. (Online) ; 64(1): 52-58, Jan.-Feb. 2020. tab, graf
Article in English | LILACS | ID: biblio-1088768

ABSTRACT

ABSTRACT Objective This study aimed to present the impact of age and gender on thyroid hormone levels in a large Chinese population with sufficient iodine intake. Subjects and methods A total of 83643 individuals were included and were stratified by age and gender. The median, 2.5th and 97.5th of thyrotropin (TSH), free triiodothyronine (FT3), free thyroxine (FT4) and FT3/FT4 ratio were calculated for both genders for every decade from 18 to over 80 years. TSH, FT3, FT4, FT3/FT4 distribution in each age group was evaluated for females and males using smoothing splines in the generalized additive models (GAM). TSH concentrations were compared in the different age groups in gender. Results In the over 80s age group, the TSH level (median: 2.57 mIU/L, 2.5th-97.5th: 0.86-7.56 mIU/L) was significantly higher than other age groups, irrespective to gender (P<0.001). Females had a higher TSH value than males in all age groups (P<0.001). Results of the smoothing curves showed that TSH increased with age, FT3 concentration was higher in males than in females and the tendency of the FT3/FT4 ratio was basically similar to that of FT3. TSH concentration in the 50s age group (median 2.48 mIU/L for females versus 2.00 mIU/L for males) was significantly higher than that in the 30s age group (median 2.18 mIU/L for females versus median 1.85 mIU/L for males). Conclusions In accord with increasing TSH values during aging, females and older adults have lower FT3 values and lower FT3/FT4 ratios, while the FT4 values remain stable.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Thyroxine/blood , Triiodothyronine/blood , Thyrotropin/blood , Sex Factors , Age Factors , Reference Values , Thyroid Function Tests , Retrospective Studies , Asian Continental Ancestry Group
2.
Arch. endocrinol. metab. (Online) ; 64(1): 66-70, Jan.-Feb. 2020. tab, graf
Article in English | LILACS | ID: biblio-1088765

ABSTRACT

ABSTRACT Objective Familial Mediterranean fever (FMF) is an autosomal recessive autoinflammatory disorder that is frequently seen in the eastern Mediterranean region. The thyroid gland can be affected in FMF patients through autoimmunity or amyloidosis. Here, we aimed to evaluate the structure and functions of the thyroid gland in addition to possible autoimmunity in FMF patients. Subjects and methods The study was conducted by the Endocrinology and Metabolism and Internal Medicine Departments. Thirty FMF patients and 30 age and gender-matched healthy controls were enrolled in the study. Free thyroxin (fT4), free triiodothyronine (fT3), thyroid-stimulating hormone (TSH), and anti-thyroid peroxidase (anti-TPO) autoantibodies were investigated. Detailed thyroid grayscale and Doppler Ultrasonography examinations and shear-wave elastosonography (SWE) were performed in the patient and control groups. Results Anti-TPO was detected in 24% (n = 7) of the patients. On the grayscale US, mean thyroid volumes were similar between the FMF and the control groups (p > 0.05). By Doppler US, thyroid vascularity observed was detected in 10.3% (n = 3) of the patients. SWE revealed that the mean velocity value of right vs. left lobe in the patient group was 1.77 ± 0.45 m/s and 1.95 ± 0.51 m/s, respectively. Compared to the control group, the mean velocity values were significantly higher in the right (p = 0.004) and left (p = 0.01) lobes of the patient group. The mean stiffness value in the patient group was also significantly higher in the right and left lobes [10.13 ± 5.65 kPa (p = 0.005) and 12.24 ± 6.17 kPa (p = 0.02), respectively]. Conclusion Recognizing the complications of FMF early in the course of the disease is as important as the early diagnosis of the disorder. Based on this, thyroid functions and changes in its structure should be evaluated carefully for early diagnosis of a possible coexisting thyroid disorder. Arch Endocrinol Metab. 2020;64(1):66-70


Subject(s)
Humans , Male , Female , Adult , Familial Mediterranean Fever/physiopathology , Familial Mediterranean Fever/immunology , Autoantibodies/immunology , Autoimmunity/immunology , Familial Mediterranean Fever/diagnostic imaging , Autoantibodies/blood , Thyroid Gland/immunology , Triiodothyronine/immunology , Triiodothyronine/blood , Thyrotropin/immunology , Thyrotropin/blood , Case-Control Studies , Ultrasonography, Doppler , Iodide Peroxidase/immunology , Iodide Peroxidase/blood
3.
Medicina (B.Aires) ; 79(5): 419-423, oct. 2019. graf, tab
Article in Spanish | LILACS | ID: biblio-1056744

ABSTRACT

Se presenta el caso de una paciente que, durante los estudios por búsqueda de fertilidad y posterior embarazo, mostraba un perfil tiroideo alterado con niveles elevados de T4 libre y TSH normal. Luego de descartar un adenoma tirotropo y ante la ausencia de sintomatología clínica de hipertiroidismo, se investigó la posibilidad de interferencias analíticas en los inmunoensayos utilizados para la medición de las hormonas. Se han descrito interferencias causadas por anticuerpos heterófilos, macro TSH, anticuerpos anti-tiroideos, biotina, y en menor medida anticuerpos anti-estreptavidina y anti-rutenio. Los análisis de la paciente se realizaron en autoanalizador cuya plataforma emplea el sistema estreptavidina-biotina que es muy susceptible a varios interferentes. Un algoritmo propuesto incluye una serie de pruebas simples de realizar e interpretar que permiten detectar o descartar la presencia de interferentes. De acuerdo al mismo, se efectuó la comparación con una plataforma analítica diferente (que no utiliza el sistema estreptavidina-biotina), diluciones seriadas, precipitación con polietilenglicol 6000 y tratamiento con micropartículas recubiertas con estreptavidina. Los resultados obtenidos confirmaron la presencia de anticuerpos anti-estreptavidina en el suero de la paciente. Ante discordancias entre las manifestaciones clínicas y los resultados de laboratorio, se debe investigar la posibilidad de interferencias metodológicas para evitar el riesgo iatrogénico potencial que implica una interpretación bioquímica errónea.


We present the case of a patient who, during studies for fertility and subsequent pregnancy, showed an altered thyroid profile with elevated levels of free T4 and normal TSH. After ruling out a thyrotropic adenoma and in the absence of clinical symptoms of hyperthyroidism, the possibility of analytical interference in the immunoassays used to measure hormones was investigated. Interferences caused by heterophile antibodies, macro TSH, anti-thyroid antibodies, biotin, and to a lesser extent anti-streptavidin and anti-ruthenium antibodies have been described. The analysis of the patient was carried out in a self-analyzer whose platform uses the streptavidin-biotin system that is very susceptible to several interferents. A proposed algorithm includes a series of simple tests to perform and interpret that allow detecting or ruling out the presence of interferents. Accordingly, a comparison was made with a different analytical platform (which does not use the streptavidin-biotin system), serial dilutions, precipitation with polyethylene glycol 6000 and treatment with microparticles coated with streptavidin. Results obtained confirmed the presence of anti-streptavidin antibodies in the patient's serum. In the case of disagreements between clinical manifestations and laboratory results, the possibility of methodological interferences should be investigated in order to avoid the potential iatrogenic risk involved in an erroneous biochemical interpretation.


Subject(s)
Humans , Female , Pregnancy , Adult , Pituitary Neoplasms/diagnosis , Adenoma/diagnosis , Antibodies, Anti-Idiotypic/immunology , Streptavidin/immunology , Hyperthyroidism/diagnosis , Pituitary Neoplasms/immunology , Thyroxine/blood , Triiodothyronine/blood , Thyrotropin/blood , Adenoma/immunology , Diagnostic Errors , Hyperthyroidism/immunology
4.
Rev. Assoc. Med. Bras. (1992) ; 65(7): 988-992, July 2019. tab, graf
Article in English | LILACS | ID: biblio-1013006

ABSTRACT

SUMMARY OBJECTIVE The objective of this study was to investigate the effects of low triiodothyronine syndrome (LT3S) on platelet function and clotting factors in patients with nephrotic syndrome(NS). METHODS Patients with primary nephrotic syndrome were divided into two groups, normal thyroid function (group A) and LT3S (group B), based on whether they had LT3S or not. Healthy subjects were selected as the control group (group C). Blood coagulation function was detected in each group. The platelet activation function (CD62P, CD63) was determined by flow cytometry. The platelet aggregation rate was detected by an optical method using adenosine diphosphate and arachidonic acid as inducers. RESULTS The proportion of primary nephrotic syndrome with LT3S was 23.2% (69/298). Compared with group C, group A had higher CD62P and PAgTADP, and group B had higher CD62P, CD63, PAgTAA, and PAgTADP; the difference was statistically significant (all P < 0.05). There was no significant difference in renal pathology between group A and group B (X2 = 4.957, P = 0.421). Compared with group A, the 24-hour urine protein, CD63, PAgTAA, and PAgTADP were higher in group B, and APTT and Alb were lower. The difference was statistically significant (P < 0.05). Logistic regression analysis showed that LT3S was associated with CD36 (OR: 3.516; 95% CI: 1.742~8.186; P = 0.004) and PAgTAA (OR: 0.442; 95% CI: 1.001~1.251; P = 0.037). CONCLUSION NS patients are prone to LT3S. Patients with LT3S may have abnormal platelet activation and increase of platelet aggregation.


RESUMO OBJETIVO O objetivo deste estudo foi investigar os efeitos da síndrome do baixo triiodotironina (LT3S) na função plaquetária e nos fatores de coagulação em pacientes com síndrome nefrótica (SN). MÉTODOS Pacientes com síndrome nefrótica primária foram divididos em dois grupos, função tireoidiana normal (grupo A) e LT3S (grupo B), com base na presença ou não de LT3S. Indivíduos saudáveis foram selecionados como grupo de controle (grupo C). A função de coagulação do sangue foi analisada em cada grupo. A função de ativação plaquetária (CD62P, CD63) foi determinada por citometria de fluxo. A taxa de agregação plaquetária foi detectada por um método óptico usando adenosina difosfato e ácido araquidônico como indutores. RESULTADOS A proporção de síndrome nefrótica primária com LT3S foi de 23,2% (69/298). Em comparação com o grupo C, o grupo A apresentou níveis mais altos de CD62P e PAgTADP, e o grupo B apresentou maiores CD62P, CD63, PAgTAA e PAgTADP; a diferença teve significância estatística (P < 0,05). Não houve diferença significativa na patologia renal entre o grupo A e o grupo B (X2 = 4,957, P = 0,421). Em comparação com o grupo A, a proteína em urina de 24 horas, CD63, PAgTAA e PAgTADP foram maiores no grupo B, já APTT e Alb foram mais baixos. A diferença apresentou significância estatística (P < 0,05). A análise de regressão logística mostrou uma associação entre LT3S e CD36 (OR: 3,516; 95% IC: 1,742~8,186; P = 0,004) e PAgTAA (OR: 0,442; 95% IC: 1,001~1,251; P = 0,037). CONCLUSÃO Pacientes com síndrome nefrótica estão propensos à síndrome do baixo triiodotironina (LT3S). Pacientes com LT3S podem ter ativação plaquetária anormal e aumento da agregação plaquetária.


Subject(s)
Humans , Male , Female , Adult , Triiodothyronine/blood , Blood Platelets/physiology , Euthyroid Sick Syndromes/physiopathology , Euthyroid Sick Syndromes/blood , Nephrotic Syndrome/physiopathology , Nephrotic Syndrome/blood , Platelet Count , Platelet Function Tests , Reference Values , Triiodothyronine/deficiency , Platelet Activation/drug effects , Platelet Activation/physiology , Platelet Aggregation/drug effects , Platelet Aggregation/physiology , Regression Analysis , Flow Cytometry , Middle Aged , Nephrotic Syndrome/complications
5.
Braz. j. med. biol. res ; 52(10): e8491, 2019. tab, graf
Article in English | LILACS | ID: biblio-1039254

ABSTRACT

Considering the recognized role of thyroid hormones on the cardiovascular system during health and disease, we hypothesized that type 2 deiodinase (D2) activity, the main activation pathway of thyroxine (T4)-to-triiodothyronine (T3), could be an important site to modulate thyroid hormone status, which would then constitute a possible target for β-adrenergic blocking agents in a myocardial infarction (MI) model induced by left coronary occlusion in rats. Despite a sustained and dramatic fall in serum T4 concentrations (60-70%), the serum T3 concentration fell only transiently in the first week post-infarction (53%) and returned to control levels at 8 and 12 weeks after surgery compared to the Sham group (P<0.05). Brown adipose tissue (BAT) D2 activity (fmol T4·min-1·mg ptn-1) was significantly increased by approximately 77% in the 8th week and approximately 100% in the 12th week in the MI group compared to that of the Sham group (P<0.05). Beta-blocker treatment (0.5 g/L propranolol given in the drinking water) maintained a low T3 state in MI animals, dampening both BAT D2 activity (44% reduction) and serum T3 (66% reduction in serum T3) compared to that of the non-treated MI group 12 weeks after surgery (P<0.05). Propranolol improved cardiac function (assessed by echocardiogram) in the MI group compared to the non-treated MI group by 40 and 57%, 1 and 12 weeks after treatment, respectively (P<0.05). Our data suggested that the beta-adrenergic pathway may contribute to BAT D2 hyperactivity and T3 normalization after MI in rats. Propranolol treatment maintained low T3 state and improved cardiac function additionally.


Subject(s)
Animals , Male , Rats , Propranolol/administration & dosage , Thyroxine/blood , Adipose Tissue, Brown/metabolism , Adrenergic beta-Agonists/administration & dosage , Iodide Peroxidase/metabolism , Myocardial Infarction/metabolism , Thyroxine/drug effects , Triiodothyronine/drug effects , Triiodothyronine/blood , Adipose Tissue, Brown/drug effects , Rats, Wistar , Disease Models, Animal , Iodide Peroxidase/drug effects
6.
Arch. endocrinol. metab. (Online) ; 62(6): 609-614, Dec. 2018. tab, graf
Article in English | LILACS | ID: biblio-983815

ABSTRACT

ABSTRACT Objective: The conversion of Hashimoto's thyroiditis (HT) to hyperthyroidism due to thyrotropin receptor antibodies is intriguing and considered rare. The contribution of TSH receptor blocking antibodies (TRAb), which may be stimulators (TSAb) or blockers (TBAb), is suspected. We describe clinical and biological variables in a series of patients switching from Hashimoto's thyroiditis to Grave's disease. Subjects and methods: Retrospective case study of 24 patients with Hashimoto's thyroiditis followed during 48 ± 36 months that developed later Graves' disease (GD). These variables were analysed in the hypo and hyperthyroid phase: age, sex, initial TSH, free triiodothyronine (fT3), free thyroxine (fT4), anti-TPO, TBII antibodies, parietal cell autoantibodies, time between hypo and hyperthyroidism, thyroid volume and levothyroxine doses (LT). Results: In HT, mean TSH was 9.4 ± 26.1 UI/L and levothyroxine treatment was 66.2 ± 30.8 µg/day. The switch to GD was observed 38 ± 45 months after HT diagnosis. As expected, we found significant differences on TSH, FT3, FT4 and TBAb levels. Three out of 14 patients had parietal cell autoantibodies. In two of these three cases there was an Helicobacter pylori infection. There were no significant differences between HT and GD groups with respect to thyroid volume. Conclusions: To our knowledge, large series documenting the conversion of HT to GD are scarce. Although rare, this phenomenon should not be misdiagnosed. Suspicion should be raised whenever thyroxine posology must be tapered down during the follow-up of HT patients. Further immunological and genetic studies are needed to explain this unusual autoimmune change.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Young Adult , Receptors, Thyrotropin/immunology , Graves Disease/immunology , Hashimoto Disease/immunology , Autoantibodies/immunology , Thyroid Function Tests , Thyroxine/administration & dosage , Thyroxine/blood , Triiodothyronine/blood , Receptors, Thyrotropin/blood , Thyrotropin/blood , Graves Disease/blood , Retrospective Studies , Statistics, Nonparametric , Immunoglobulins, Thyroid-Stimulating/immunology , Hashimoto Disease/blood , Hypothyroidism/immunology , Luminescent Measurements
7.
Arch. endocrinol. metab. (Online) ; 62(4): 410-415, July-Aug. 2018. tab, graf
Article in English | LILACS | ID: biblio-950086

ABSTRACT

ABSTRACT Objective: The association between coronary artery disease (CAD) and thyroid function remains controversial. We evaluated the thyroid function and graduated well-defined CAD as confirmed by quantitative coronary angiography (CA). Subjects and methods: We evaluated the serum TSH, free thyroxine, free triiodothyronine and thyroid antibody levels in 300 consecutive patients (age 61.6 ± 9.9 years and 54% were male) undergoing CAD diagnosis as confirmed by CA. Plaques with ≥ 50% stenosis being indicative of obstructive CAD, and patients were divided into groups according to main epicardial coronary arteries with plaques (0, 1, 2, 3). Lipid profiles and a homeostasis model assessment (HOMA-IR) were determined. Results: Serum median (25% and 75% percentile) TSH levels in patients with group 2 and 3 (2.25; 1.66-3.12 mU/L and 4.99; 4.38-23.60 mU/L, respectively) had significantly higher TSH concentrations (p < 0.0001) than the group 0 (1.82; 1.35-2.51 mU/L). Furthermore, patients of group 3 had higher TSH concentration (p < 0.0001) than those of group 1 (1.60; 0.89-2.68 mU/L). Group 3 were older (64 ± 8.5 vs. 59 ± 9.5, p = 0.001), had more patients with dyslipidemia (84% versus 58%, p < 0.001), male (54% versus 44%, p = 0.01), hypertension (100% versus 86%, p < 0.001), and smoking (61% versus 33%, p < 0.001) than group 0. Multivariate stepwise logistic analysis showed TSH, age, HbA1c, and HOMA-IR were the CAD associated variables. Conclusions: In this cohort, elevated TSH levels in the high normal range or above are associated with the presence and severity of CAD besides may represent a weak CAD risk factor.


Subject(s)
Humans , Male , Middle Aged , Aged , Coronary Artery Disease/blood , Thyrotropin/blood , Thyroid Function Tests , Thyroxine/blood , Triiodothyronine/blood , Coronary Artery Disease/diagnostic imaging , Glycated Hemoglobin A/analysis , Insulin Resistance , Cholesterol/blood , Cross-Sectional Studies , Risk Factors , Age Factors , Coronary Angiography , Coronary Stenosis/diagnostic imaging
8.
Arch. endocrinol. metab. (Online) ; 62(4): 392-398, July-Aug. 2018. tab
Article in English | LILACS | ID: biblio-950084

ABSTRACT

ABSTRACT Objective: Treatment of subclinical hypothyroidism (ScH), especially the mild form of ScH, is controversial because thyroid hormones influence cardiac function. We investigate left ventricular systolic and diastolic function in ScH and evaluate the effect of 5-month levothyroxine treatment. Subjects and methods: Fifty-four patients with newly diagnosed mild ScH (4.2 <TSH < 10.0 mU/L) and 30 euthyroid subjects matched by age were analysed. Laboratory analyses and an echocardiography study were done at the first visit and after 5 months in euthyroid stage in patients with ScH. Results: Compared to healthy controls, patients with ScH had a lower E/A ratio (1.03 ± 0.29 vs. 1.26 ± 0.36, p < 0.01), higher E/e' sep. ratio (762 ± 2.29 vs. 6.04 ± 1.64, p < 0.01), higher myocardial performance index (MPI) (0.47 ± 0.08 vs. 0.43 ± 0.07, p < 0.05), lower global longitudinal strain (GLS) (-19.5 ± 2.3 vs. −20.9 ± 1.7%, p < 0.05), and lower S wave derived by tissue Doppler imaging (0.077 ± 0.013 vs. 0.092 ± 0.011 m/s, p < 0.01). Levothyroxine treatment in patients with ScH contributed to higher EF (62.9 ± 3.9 vs. 61.6 ± 4.4%, p < 0.05), lower E/e' sep. ratio (6.60 ± 2.06 vs. 762 ± 2.29, p < 0.01), lower MPI (0.43 ± 0.07 vs. 0.47 ± 0.08%, p < 0.01), and improved GLS (-20.07 ± 2.7 vs. −19.55 ± 2.3%, p < 0.05) compared to values in ScH patients at baseline. Furthermore, in all study populations (ScH patients before and after levothyroxine therapy and controls), TSH levels significantly negatively correlated with EF (r = −0.15, p < 0.05), E/A (r = −0.14, p < 0.05), GLS (r = −0.26, p < 0.001), and S/TDI (r = −0.22, p < 0.01) and positively correlated with E/e' sep. (r = 0.14, p < 0.05). Conclusion: Patients with subclinical hypothyroidism versus healthy individuals had subtle changes in certain parameters that indicate involvement of systolic and diastolic function of the left ventricle. Although the values of the parameters were in normal range, they were significantly different compared to ScH and the control group at baseline, as well as to the ScH groups before and after treatment.The results of our study suggest that patients with ScH must be followed up during treatment to assess improvement of the disease. Some of the echocardiography obtained parameters were reversible after levothyroxine therapy.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Systole/drug effects , Thyroxine/pharmacology , Ventricular Function, Left/drug effects , Diastole/drug effects , Hypothyroidism/drug therapy , Systole/physiology , Thyroxine/administration & dosage , Thyroxine/blood , Thyroxine/therapeutic use , Triiodothyronine/blood , Thyrotropin/blood , Case-Control Studies , Prospective Studies , Echocardiography, Doppler, Pulsed , Diastole/physiology , Heart Ventricles/physiopathology , Heart Ventricles/diagnostic imaging
9.
Arch. endocrinol. metab. (Online) ; 61(1): 54-61, Jan.-Feb. 2017. tab
Article in English | LILACS | ID: biblio-838410

ABSTRACT

ABSTRACT Objective The aim of this study was to evaluate the association between thyroid function abnormalities and breast cancer and, in particular, the prognostic markers of breast cancer.. Subjects and methods Baseline levels of thyrotropin, free triiodothyronine, free thyroxine and thyroid autoantibodies were measured in 97 women with primary breast cancer, 27 women with benign breast disease, and 4 women with atypical ductal hyperplasia. Their baseline levels were compared with those in 48 healthy women with a normal mammography in the last 2 years. Results There were no significant associations between history of thyroid disease and breast cancer (p = 0.33). The mean baseline levels of triiodothyronine and thyrotropin did not differ significantly between the compared groups. The mean baseline levels of free thyroxine were found to be significantly higher in the breast cancer group, even after adjusting for thyroid replacement therapy. The presence of thyroid antibodies did not differ significantly between the compared groups. In a subgroup analysis, breast cancer cases with thyroid disease and particularly hypothyroidism had a significantly lower incidence of lymph node metastases compared with breast cancer cases without thyroid disease. Conclusions Our data confirmed the proliferative effect of thyroid hormones on breast cells, which had previously been shown in vitro. Additionally, thyroid disease and particularly hypothyroid function appeared to be associated with a lower incidence of lymph node metastases. Further studies to determine the prognostic role of thyroid hormones in breast cancer are warranted.


Subject(s)
Humans , Female , Middle Aged , Thyroid Gland/physiopathology , Breast Neoplasms/complications , Biomarkers/blood , Prognosis , Autoantibodies/blood , Thyroid Gland/blood supply , Thyroxine/blood , Triiodothyronine/blood , Breast Neoplasms/physiopathology , Breast Neoplasms/blood , Thyrotropin/blood , Immunohistochemistry , Case-Control Studies
11.
Arch. endocrinol. metab. (Online) ; 60(6): 562-572, Nov.-Dec. 2016. tab, graf
Article in English | LILACS | ID: biblio-827785

ABSTRACT

ABSTRACT Objective To compare the effects of a unique fixed combination levothyroxine/liothyronine (LT4/LT3) therapy in patients with primary hypothyroidism. Subjects and methods This is a randomized, double-blind, crossover study. Adults with primary hypothyroidism (n = 32, age 42.6 ± 13.3, 30 females) on stable doses of LT4 for ≥ 6 months (125 or 150 μg/day) were randomized to continue LT4 treatment (G1) or to start LT4/LT3 therapy (75/15 μg/day; G2). After 8 weeks, participants switched treatments for 8 more weeks. Thyroid function, lipid profile, plasma glucose, body weight, electrocardiogram, vital signs, and quality of life (QoL) were evaluated at weeks 0, 8 and 16. Results Free T4 levels were significantly lower while on LT4/LT3 (G1: 1.07 ± 0.29 vs. 1.65 ± 0.46; G2: 0.97 ± 0.26 vs. 1.63 ± 0.43 ng/dL; P < 0.001). TSH and T3 levels were not affected by type of therapy. More patients on LT4/LT3 had T3 levels above the upper limit (15% vs. 3%). The combination therapy led to an increase in heart rate, with no significant changes in electrocardiogram or arterial blood pressure. Lipid profile, body weight and QoL remained unchanged. Conclusions The combination therapy yielded significantly lower free T4 levels, with no changes in TSH or T3 levels. More patients on LT4/T3 had elevated T3 levels, with no significant alterations in the evaluated outcomes. No clear clinical benefit of the studied formulation could be observed. Future trials need to evaluate different formulations and the impact of the combined therapy in select populations with genetic polymorphisms.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Thyroxine/therapeutic use , Triiodothyronine/therapeutic use , Hypothyroidism/drug therapy , Quality of Life , Thyroid Function Tests , Thyroxine/blood , Thyroxine/pharmacology , Triiodothyronine/blood , Triiodothyronine/pharmacology , Blood Glucose/analysis , Body Weight/drug effects , Thyrotropin/drug effects , Cholesterol/blood , Double-Blind Method , Cross-Over Studies , Drug Combinations , Hypothyroidism/blood
12.
Arq. bras. cardiol ; 107(2): 147-153, Aug. 2016. tab, graf
Article in English | LILACS | ID: lil-794560

ABSTRACT

Abstract Background: Thyroid hormone deficiency during fetal life could affect the cardiac function in later life. The mechanism underlying this action in fetal hypothyroidism (FH) in rats has not been elucidated thus far. Objective: The aim of this study is to evaluation the effect of FH on cardiac function in male rats and to determine the contribution of α-myosin heavy chain (MHC) and β-MHC isoforms. Methods: Six pregnant female rats were randomly divided into two groups: The hypothyroid group received water containing 6-propyl-2-thiouracil during gestation and the controls consumed tap water. The offspring of the rats were tested in adulthood. Hearts from the FH and control rats were isolated and perfused with langendroff setup for measuring hemodynamic parameters; also, the heart mRNA expressions of α- MHC and β-MHC were measured by qPCR. Results: Baseline LVDP (74.0 ± 3.1 vs. 92.5 ± 3.2 mmHg, p < 0.05) and heart rate (217 ± 11 vs. 273 ± 6 beat/min, p < 0.05) were lower in the FH rats than controls. Also, these results showed the same significance in ±dp/dt. In the FH rats, β-MHC expression was higher (201%) and α- MHC expression was lower (47%) than control. Conclusion: Thyroid hormone deficiency during fetal life could attenuate normal cardiac functions in adult rats, an effect at least in part due to the increased expression of β-MHC to α- MHC ratio in the heart.


Resumo Fundamento: Deficiência de hormônio da tireoide durante vida fetal pode afetar a função cardíaca no futuro. O mecanismo subjacente dessa ação em hipotireoidismo fetal (HF) em ratos ainda não tem explicação. Objetivo: O objetivo desse estudo é avaliar o efeito de HF na função cardíaca em ratos macho e determinar a contribuição da α-miosina de cadeia pesada (α-MCP) e de isoformas β-MCP. Métodos: Seis ratos fêmea gestantes foram aleatoriamente divididas em dois grupos. O grupo do hipotireoidismo recebeu água contendo 6-propil-2-tiouracil durante a gestação, e os ratos no grupo de controle receberam água de torneira. Os filhotes dos ratos foram testados quando atingiram idade adulta. O coração dos ratos HF e controle foram isolados e submetidos a perfusão pelo método de Langendorff para medição de parâmetros hemodinâmicos. Também foram medidas as expressões de mRNA do coração de α-MCP e β-MCP por qPCR. Resultados: PVED de base (74,0 ± 3,1 vs. 92,5 ± 3,2 mmHg, p < 0,05) e pressão arterial (217 ± 11 vs. 273 ± 6 batidas/min, p < 0,05) mostraram-se mais baixas em ratos HF do que em ratos controle. Além disso, esses resultados mostraram a mesma significância em ±dp/dt. Em ratos HF, a expressão de β-MCP foi mais alta (201%) e a de α-MCP foi mais baixa (47%) do que em ratos controle. Conclusão: Deficiência de hormônio da tireoide durante a vida fetal pode enfraquecer funções cardíacas normais em ratos adultos, efeito devido em parte à expressão aumentada de β-MCP em relação a α-MCP no coração.


Subject(s)
Animals , Male , Female , Pregnancy , Body Weight/drug effects , Myosin Heavy Chains/metabolism , Congenital Hypothyroidism/metabolism , Myocardium/metabolism , Propylthiouracil , Antithyroid Agents , Thyroxine/blood , Triiodothyronine/blood , RNA, Messenger/metabolism , Random Allocation , Rats, Wistar , Ventricular Pressure , DNA, Complementary/metabolism , Congenital Hypothyroidism/chemically induced , Congenital Hypothyroidism/blood , Disease Models, Animal , Heart Rate
13.
Clinics ; 71(4): 221-225, Apr. 2016. tab
Article in English | LILACS | ID: lil-781424

ABSTRACT

OBJECTIVE: This study was performed to evaluate the effects of metabolic parameters and thyroid dysfunction on the development of non-alcoholic fatty liver disease (NAFLD). METHODS: The current study evaluated a total of 115 patients, 75 female and 40 male. Physical examination and anthropometric measurements were applied to all participants. Hypothyroidism was considered at a thyroid stimulating hormone level ≥ 4.1 mIU/L. Patients with euthyroidism and patients with hypothyroidism were compared. Abdominal ultrasonography was used to diagnose non-alcoholic fatty liver disease. The participants were further compared with regard to the presence of non-alcoholic fatty liver disease. Logistic regression modeling was performed to identify the relationship between non-alcoholic fatty liver disease and independent variables, such as metabolic parameters and insulin resistance. RESULTS: Non-alcoholic fatty liver disease was identified in 69 patients. The mean waist circumference, body mass index, fasting plasma insulin, HOMA-IR (p<0.001) and FT3/FT4 ratio (p=0.01) values were significantly higher in the patients with NAFLD compared to those without it. Multivariate regression analysis revealed that FT3/FT4 ratio, waist circumference and insulin resistance were independent risk factors for non-alcoholic fatty liver disease. CONCLUSION: Insulin resistance, enlarged waist circumference, elevated body mass index, higher FT3/FT4 ratio and hypertriglyceridemia are independent risk factors for NADLF, whereas hypothyroidism is not directly related to the condition.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Hypothyroidism/complications , Non-alcoholic Fatty Liver Disease/etiology , Thyroid Gland/physiopathology , Thyroxine/blood , Triiodothyronine/blood , Biomarkers/blood , Cholesterol/blood , Insulin Resistance , Metabolic Syndrome/complications , Non-alcoholic Fatty Liver Disease/blood , Non-alcoholic Fatty Liver Disease/diagnostic imaging , Non-alcoholic Fatty Liver Disease/physiopathology , Obesity/complications , Regression Analysis , Risk Factors , Triglycerides/blood , Waist Circumference
14.
Arch. endocrinol. metab. (Online) ; 59(6): 528-534, Dec. 2015. tab
Article in English | LILACS | ID: lil-767921

ABSTRACT

ABSTRACT Objective To assess hormonal changes in nonthyroidal illness syndrome (NTIS) in full-term newborns (NT) with sepsis. Materials and methods We included 28 NT with sepsis divided into 2 groups according to the time of normalization of serum and clinical indicators of infection: group A(A), 16 NT with improvement in up to 8 days; and group B(B), 12 NT improvement after 8 days. Among the 28 NT, 15 NT progressed to septic shock, with 5 NT group A and 10 NT in group B. NT were excluded when they showed severe sepsis and asphyxia, and congenital malformations, as well as those whose mothers had thyroid disease and IUGR. Results 17 NT (60.7%) presented NTIS. Low T3 was observed in NTIS in 10 NT (58.8%), and low T4 and T3 in 5 NT (29.5%), all of them with septic shock. Two NT showed mixed changes (11.7%). After sepsis was cured, there was no hormonal change, except in 3 NT. Administration of dopamine, furosemide, and corticosteroids did not affect the results. Conclusions This study indicates that nonthyroidal illness syndrome may be transiently present during sepsis in full-term newborns, especially in cases of prolonged sepsis. Low T3 can occur without changes in reverse T3 (different from adults), and low T4 and T3 occur mainly in patients with septic shock. Arch Endocrinol Metab. 2015;59(6):528-34.


Subject(s)
Humans , Infant , Infant, Newborn , Euthyroid Sick Syndromes/complications , Shock, Septic/complications , Disease Progression , Euthyroid Sick Syndromes/blood , Sepsis/complications , Shock, Septic/blood , Term Birth , Time Factors , Thyroxine/blood , Triiodothyronine/blood
15.
Arq. gastroenterol ; 52(2): 124-128, Apr-Jun/2015. tab, graf
Article in English | LILACS | ID: lil-748170

ABSTRACT

Background Thyroid dysfunction has been reported in most chronic illnesses including severe liver disease. These defects in thyroid hormone metabolism result in the sick euthyroid syndrome, also known as low T3 syndrome. Objectives Our objective was to evaluate the thyroid function in patients with end stage liver disease prior and after deceased donor liver transplantation and to correlate thyroid hormonal changes with the MELD score (Model for End stage Liver Disease). Methods In a prospective study, serum levels of thyrotropin (thyroid stimulating hormone TSH), total thyroxine (tT4), free thyroxine (fT4) and triiodothyronine (T3) from 30 male adult patients with end stage liver disease were measured two to four hours before and 6 months after liver transplantation (LT). MELD was determined on the day of transplant. For this analysis, extra points were not added for patients with hepatocellular carcinoma. Results The patients had normal TSH and fT4 levels before LT and there was no change after the procedure. Total thyroxine and triiodothyronine were within the normal range before LT, except for four patients (13.3%) whose values were lower. Both hormones increased to normal values in all four patients after LT (P=0.02 and P<0.001, respectively). When the patients were divided into two groups (MELD <18 and MELD >18), it was observed that there was no change in the TSH, freeT4, and total T4 levels in both groups after LT. Although there was no significant variation in the level of T3 in MELD <18 group (P=0.055), there was an increase in the MELD >18 group after LT (P=0.003). Conclusion Patients with end stage liver disease subjected to liver transplantation had normal TSH and fT4 levels before and after LT. In a few patients with lower tT4 and T3 levels before LT, the level of these hormones increased to normal after LT. .


Contexto A disfunção tireoidiana tem sido relatada em associação com a maioria das doenças crônicas, incluindo a doença hepática terminal. Estes defeitos no metabolismo dos hormônios tireoidianos resultam na síndrome do doente eutireoideo ou, também conhecida como síndrome do T3 baixo. Objetivos Avaliar a função tireoidiana em pacientes com doença hepática avançada, antes e depois de serem submetidos ao transplante hepático cadavérico (THC) e, correlacionar as alterações hormonais da tireóide com o MELD. Métodos Em um estudo prospectivo, os níveis séricos de tireotropina (hormônio estimulante da tireóide TSH), tiroxina total (T4 total), tiroxina livre (T4 livre) e triiodotironina (T3) de 30 pacientes adultos do sexo masculino com doença hepática terminal foram dosados 2 e 4 horas antes e 6 meses após o THC. O valor do MELD foi determinado no dia do procedimento. Para esta análise, os pontos extras não foram adicionados para os pacientes com carcinoma hepatocelular. Resultados Os pacientes apresentaram níveis de TSH e T4 livre normais antes do THC e não houve nenhuma alteração após o procedimento. As dosagens de T4 total e T3 no início do estudo estavam dentro da faixa normal, exceto por quatro pacientes (13,3%), os quais apresentavam valores abaixo da referência. Ambos os hormônios apresentaram um aumento 6 meses após o THC (P=0,02 e P<0,001, respectivamente). Quando os pacientes foram divididos em dois grupos (MELD <18 e MELD >18) não observamos diferença nos níveis de TSH, T4 total e T4 livre entre os grupos após THC. Apesar de não haver variação nos níveis de T3 no grupo com MELD <18 (P=0,055), houve um aumento no grupo MELD >18 após THC (P=0,003). Conclusão Os pacientes com cirrose hepática submetidos a transplante hepático tinham valores normais de TSH e T4 livre antes e após o THC. Nos poucos pacientes que apresentavam valores baixos de T4 total e T3 antes do THC, houve normalização destes hormônios após o THC. .


Subject(s)
Adult , Female , Humans , Male , Middle Aged , End Stage Liver Disease/blood , Liver Transplantation , Thyroid Hormones/blood , Biomarkers/blood , End Stage Liver Disease/physiopathology , End Stage Liver Disease/surgery , Prospective Studies , Severity of Illness Index , Thyroid Gland/physiopathology , Thyrotropin/blood , Thyroxine/blood , Triiodothyronine/blood
16.
Arch. endocrinol. metab. (Online) ; 59(2): 141-147, 04/2015. tab, graf
Article in English | LILACS | ID: lil-746464

ABSTRACT

Objective Investigate the effect of GC-1 on tolerance to exercise in rats with experimental hypothyroidism. Materials and methods Hypothyroidism was induced with methimazole sodium and perchlorate treatment. Six groups with eight animals were studied: control group (C), hypothyroid group without treatment (HYPO); hypothyroidism treated with physiological doses of tetraiodothyronine (T4) or 10 times higher (10×T4); hypothyroidism treated with equal molar doses of GC-1 (GC-1) or 10 times higher (10×GC-1). After eight weeks, each animal underwent an exercise tolerance test by measuring the time (seconds), in which the rats were swimming with a load attached to their tails without being submerging for more than 10 sec. After the test, the animals were killed, and blood samples were collected for biochemical analysis, and the heart and soleus muscle were removed for weighing and morphometric analysis of the cardiomyocyte. Results Hypothyroidism significantly reduced tolerance to exercise and, treatment with GC-1 1× or T4 in physiological doses recover tolerance test to normal parameters. However, high doses of T4 also decreased tolerance to physical exercise. Conversely, ten times higher doses of GC-1 did not impair tolerance to exercise. Interestingly, hypothyroidism, treated or not with T4 in a physiological range, GC-1 or even high doses of GC-1 (10X) did not change cardiomyocyte diameters and relative weight of the soleus muscle. In contrast, higher doses of T4 significantly increased cardiomyocyte diameter and induced atrophy of the soleus muscle. Conclusion Unlike T4, GC-1 in high doses did not modify tolerance to physical exercise in the rats with hypothyroidism. .


Subject(s)
Animals , Acetates/pharmacology , Exercise Tolerance/drug effects , Hypothyroidism/drug therapy , Phenols/pharmacology , Thyroid Hormone Receptors beta/agonists , Exercise Tolerance/physiology , Hypothyroidism/blood , Hypothyroidism/chemically induced , Hypothyroidism/physiopathology , Methimazole , Muscle, Skeletal/drug effects , Myocytes, Cardiac/drug effects , Perchlorates , Rats, Wistar , Sodium Compounds , Swimming , Thyrotropin/blood , Thyroxine/administration & dosage , Thyroxine/blood , Triiodothyronine/blood
17.
Arch. endocrinol. metab. (Online) ; 59(1): 42-46, 02/2015. tab, graf
Article in English | LILACS | ID: lil-746443

ABSTRACT

Objective Patients with incidental nonfunctioning adrenal adenoma are associated with increased risk of obesity, impaired glucose tolerance and dyslipidemia. We aimed to investigate the relationship between thyroid function, serum lipids and insulin resistance in patients with nonfunctioning adrenal incidentaloma. Subjects and methods Forty patients who had diagnosed as adrenal incidentaloma (AI) in our department were included in the study. Serum free triiodothyronine (fT3), free thyroxine (fT4), thyroid stimulating hormone (TSH), anti-thyroperoxidase antibody (anti-TPO Ab) and anti-thyroglobulin antibody (anti-Tg Ab), lipid profile, hs-CRP, fasting insulin levels were measured and insulin resistance calculated by HOMA-IR. Thyroid volume (TV) was assessed. Results None of the patients showed specific signs and symptoms of hormone excess. TV, TSH and fT3 levels in the patient and control groups did not differ significantly (p > 0.05). The serum fT4, anti-TG Ab, anti-TPO Ab levels in the patient group were significantly higher than in the control group (p = 0.013, p < 0.0001, p = 0.016 respectively). The HOMA-IR, hs-CRP and HDL cholesterol levels in the AI patients were significantly higher than the control group (p = 0.034, p = 0.041, p = 0.002, respectively). Statistically significant relationship was found between HOMA-IR and thyroid volume (r = 0.373, p = 0.018), fT4 (r = 0.382, p = 0.015), hs-CRP (r = 0.512, p = 0.001), HDL cholesterol (r = 0,351 p = 0.026) in AI patients. There were significant correlation between anti-TG Ab, anti-TPO Ab and TSH levels in AI patients (r = 0.431 p = 0.006, r = 0.402 p = 0.012). Conclusions Patients with nonfunctioning adrenal incidentaloma have several metabolic disturbances. At the same time autoimmune thyroid disorders are more frequent in nonfunctioning adrenal incidentaloma patient so that thyroid functions must be evaluated in those patients. Arch Endocrinol Metab. 2015;59(1):42-6 .


Subject(s)
Aged , Female , Humans , Male , Middle Aged , Adrenal Gland Neoplasms/complications , Insulin Resistance/immunology , Thyroid Gland/physiopathology , Thyroiditis, Autoimmune/complications , Adrenal Gland Neoplasms/immunology , Autoantibodies/blood , Blood Glucose/analysis , Case-Control Studies , Cholesterol, HDL/blood , Insulin/blood , Peroxidase/immunology , Risk Factors , Statistics, Nonparametric , Thyroid Gland/immunology , Thyrotropin/blood , Thyroxine/blood , Triiodothyronine/blood
18.
Medical Forum Monthly. 2015; 26 (1): 13-17
in English | IMEMR | ID: emr-168187

ABSTRACT

This study was aimed to evaluate the effects of subclinical hypothyroidism on lipid profile with special reference to total cholesterol and triglyceride levels. Analytic study. This study was carried out at the Punjab Institute of Nuclear Medicine [PINUM], Faisalabad and IMBB, university of Lahore from January 2011 to September 2011. [Eight months] 100 female patients of age ranges from 20-50 years having subclinical hypothyroidism [SCH] and 20 euthyroidsubject of same age and sex [control] were included in this study. Serum FT[4], FT[3], TSH, total cholesterol and triglyceride of subclinical hypothyroid patients and control group were determined. In subclinical hypothyroid patients total cholesterol were significantly increased as compared to euthyroid group. Serum TSH and total cholesterol showed positive correlation. Serum triglyceride did not significantly increased in SCH. The total cholesterol level elevated in SCH. This increases the risk of atherosclerotic coronary artery disease [CAD] in subclinical hypothyroid patients


Subject(s)
Humans , Female , Triglycerides/blood , Cholesterol/blood , Thyroxine/blood , Triiodothyronine/blood , Thyrotropin/blood
19.
Arq. bras. endocrinol. metab ; 58(3): 288-291, abr. 2014. tab, graf
Article in English | LILACS | ID: lil-709354

ABSTRACT

Objective : The present study investigated the effects of different dosages of a GHS-R antagonist [D-Lys3] on some serum hormonal (cortisol, T3 and T4) and biochemical parameters in a rat.Materials and methods : Thirty-six 60-day-old male rats were assigned to four treatments. [D-Lys3]-GHRP-6 solutions were infused via intraperitoneal injections. Blood was collected and analyzed.Results : The large dosages of a GHS-R antagonist (200 ng/kg BW) caused increases in cortisol, whereas no significant changes occurred when low dosages were injected. There were no significant changes in T3 and T4 following the administration of the GHS-R antagonist, but a considerable increase was observed in blood glucose levels of the groups (G50, G100, and G200 ng/kg BW). There was a significant increase in total protein when the greatest dose was administrated (G200 ng/kg BW). However, total cholesterol, triglycerides, and albumin showed no significant changes.Conclusions : Exogenous GHS-R antagonist can cause an increase in glucose and moderate increases in cortisol and total protein, yet it has no significant effect on T3 and T4 levels or on the concentrations of serum lipids. The effect of GHS-R antagonist is not completely adverse to the effects of ghrelin. Further molecular studies are necessary to identify the physiological effects of the peptidic GHS-R antagonist. Arq Bras Endocrinol Metab. 2014;58(3):288-91.


Objetivo : O presente estudo investigou os efeitos de diferentes doses do antagonista do GHS-R [D-Lys3] sobre alguns parâmetros hormonais (cortisol, T3 e T4) e bioquímicos em ratos.Materiais e métodos : Trinta e seis ratos machos com 60 dias de idade foram alocados para quatro tratamentos. Soluções de [D-Lys3]-GHRP-6 foram administradas por meio de injeções intraperitoneais e foram coletadas e analisadas amostras.Resultados : Doses altas de antagonista de GHS-R (200 ng/kg PC) levaram a aumento do cortisol, enquanto não houve diferença significativa quando foram injetadas doses baixas. Não houve alterações significativas em T3 e T4 depois da administração do antagonista do GHS-R, mas foi observado aumento considerável nos níveis de glicose sanguínea dos grupos (G50, G100 e G200 ng/kg PC). Houve aumento significativo na proteína total quando foi administrada a maior dose (G200 ng/kg PC), entretanto, não foram observadas alterações no colesterol total, nos triglicérides e na albumina.Conclusões : O antagonista do GHS-R exógeno pode causar aumento da glicose e aumento moderado do cortisol e proteína total, embora não haja efeitos significativos nos níveis de T3 e T4 ou na concentração de lipídios séricos. O efeito do antagonista de GHS-R não é completamente adverso aos efeitos da grelina. Devem ser feitos outros estudos moleculares para se identificar os efeitos fisiológicos do peptídeo antagonista do GHS-R. Arq Bras Endocrinol Metab. 2014;58(3):288-91.


Subject(s)
Animals , Male , Hydrocortisone/blood , Oligopeptides/administration & dosage , Receptors, Ghrelin/antagonists & inhibitors , Thyroxine/blood , Triiodothyronine/blood , Blood Glucose/analysis , Cholesterol, HDL/blood , Injections, Intraperitoneal , Random Allocation , Rats, Wistar , Serum Albumin/analysis , Triglycerides/blood
20.
Article in English | WPRIM | ID: wpr-116732

ABSTRACT

BACKGROUND/AIMS: The aim of the present study was to evaluate the relationship between thyroid hormone levels and infarct severity in patients with ST-elevation myocardial infarction (STEMI). METHODS: We retrospectively reviewed thyroid hormone levels, infarct severity, and the extent of transmurality in 40 STEMI patients evaluated via contrast-enhanced cardiac magnetic resonance imaging. RESULTS: The high triiodothyronine (T3) group (> or = 68.3 ng/dL) exhibited a significantly higher extent of transmural involvement (late transmural enhancement > 75% after administration of gadolinium contrast agent) than did the low T3 group (60% vs. 15%; p = 0.003). However, no significant difference was evident between the high- and low-thyroid-stimulating hormone/free thyroxine (FT4) groups. When the T3 cutoff level was set to 68.3 ng/dL using a receiver operating characteristic curve, the sensitivity was 80% and the specificity 68% in terms of differentiating between those with and without transmural involvement. Upon logistic regression analysis, high T3 level was an independent predictor of transmural involvement after adjustment for the presence of diabetes mellitus (DM) and the use of glycoprotein IIb/IIIa inhibitors (odds ratio, 40.62; 95% confidence interval, 3.29 to 502; p = 0.004). CONCLUSIONS: The T3 level predicted transmural involvement that was independent of glycoprotein IIb/IIIa inhibitor use and DM positivity.


Subject(s)
Aged , Area Under Curve , Biomarkers/blood , Chi-Square Distribution , Contrast Media , Coronary Angiography , Female , Humans , Logistic Models , Magnetic Resonance Imaging, Cine , Male , Middle Aged , Multivariate Analysis , Myocardial Infarction/blood , Myocardium/pathology , Odds Ratio , Predictive Value of Tests , ROC Curve , Retrospective Studies , Severity of Illness Index , Thyroxine/blood , Triiodothyronine/blood
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