RESUMO
La relación entre síndrome metabólico y disfunción tiroidea subclínica es un tema aun controvertido. Por tal motivo, el objetivo principal de nuestro trabajo fue tratar de establecer la existencia de una asociación entre la insulinorresistencia medida por el HOMA-IR (Homeostasis Model Assessment) con los niveles de TSH en pacientes eutiroideos o con disfunción tiroidea subclínica. A su vez, y en forma secundaria, se valoraron cambios en el perfil lipídico. Se analizaron los niveles de T4L, TSH, insulina, glucemia, colesterol total, HDL colesterol, triglicéridos e índice de masa corporal en 233 pacientes eutiroideos o con disfunción tiroidea subclínica y se dividieron en tres grupos según su nivel de TSH: Grupo A: TSH < de 0,4; Grupo B: TSH entre 0,4 y 2,5 y Grupo C: TSH > de 2,5 mUI/L. Encontramos que, los niveles de insulina y el HOMA-IR en el grupo B fueron significativamente menores que en el grupo C (7,91 ± 0,67 mUI/L vs. 10,23 ± 0,91 mUI/L - p = 0,0073 y 1,84 ± 0,17 vs. 2,49 ± 0,27 - p = 0,0113, respectivamente). Esta diferencia fue independiente de la edad y del IMC. Además, se encontró una leve pero significativa disminución de los niveles de HDL-colesterol en el grupo C respecto al B (48,3 ± 0,5 vs. 46,3± 0,7 mg/dl; p = 0,0455) y un incremento de los triglicéridos (146,9 ± 11,9 vs. 112,3 ± 5,6 mg/dl; p = 0,0162). La prevalencia de insulinorresistencia definida como un valor de HOMA-IR > de 2,5 fue superior en el grupo C comparado con el B (39,5 % vs. 23,9 %; OR de 2,06 - IC 95 %: 1,19-3,63 - p = 0,013). Por último, se observó una débil pero significativa correlación negativa entre HOMA-IR y T4L (r - 0,2336; p = 0,0047) y positiva entre HOMA-IR y TSH (r = 0,1909; p = 0,0066) en toda la cohorte analizada. Concluimos que en la población analizada, los pacientes con TSH > de 2,5 mUI/L presentaron: a) niveles de HDL colesterol más bajos, b) triglicéridos y HOMA-IR más elevados, independientemente de la edad y del IMC, y c) un aumento significativo del riesgo de tener insulinorresistencia medida por HOMA-IR. Los autores declaran no poseer conflictos de interés.
Introduction: The association between alterations of the thyroid function and an increased risk of developing cardiovascular diseases has been established for several years. Strong published evidence supports the notion that clinical hypothyroidism increases the levels of LDL cholesterol, induces arterial hypertension, and increases the levels of homocystein. However, the relationship between all these well-known risk factors for coronary disease and subclinical thyroid dysfunction remains a controversial topic. In addition, the presence of Metabolic Syndrome, known as an association of cardiovascular risk factors including: central obesity, insulin resistance, dyslipidemia and arterial hypertension, increases the possibility of developing cardiovascular diseases, to such an extent that the main cause of death in patients with type 2 diabetes, who generally present all the aforementioned factors plus hyperglycemia, is myocardial infarction. Objective: The main objective of our study was to investigate the existence of an association between insulin resistance measured by HOMA-IR and TSH levels in euthyroid patients or subclinical thyroid dysfunction. Secondarily, we evaluated changes in the lipid profile of the groups studied. Methods: This was a retrospective study. We analyzed the levels of free T4, TSH, insulin, basal plasma glucose, total and HDL cholesterol, triglycerides and body mass index in 233 patients with euthyroidism or diagnosed with subclinical thyroid dysfunction. Patients were divided into three groups according to TSH levels: Group A (n = 31) with values of TSH less than 0.4 mIU/L; Group B (n = 136) with TSH between 0.4 and 2.5 mIU/L, and Group C (n = 66) with TSH above 2.5 mIU/L. Free T4, TSH and insulin were measured with immunochemiluminescence assays (Immulite 2000). Basal plasma glucose, total cholesterol, HDL cholesterol and triglycerides were measured with automated methods (Technicon/Bayer RA 1000 Chemistry Analyzer). All measurements were performed from the same blood sample, obtained early in the morning after a minimum fasting period of 12 hours. Results: We found that the levels of insulin and HOMA-IR in group B were significantly lower that in group C (7.91 ± 0.67 mIU/L vs. 10.23 ± 0.91 mIU/L - p = 0.0073 and 1.84 ± 0.17 vs. 2.49 ± 0.27 - p = 0.0113, respectively). This difference was independent of age and BMI. In addition, we observed a slight but significant decrease in HDL-cholesterol levels in group C as compared to group B (48.3 ± 0.5 vs. 46.3 ± 0.7 mg/dl; p = 0.0455) and an increase in triglycerides (146.9 ± 11.9 vs. 112.3 ± 5.6 mg/dl; p = 0.0162). The prevalence of insulin resistance defined as a value of HOMA-IR higher than 2.5 was greater in group C compared to B (39.5 % vs. 23.9 %; OR 2.06 - IC 95 %: 1.19-3.63 - p = 0.013). Finally, a weak but significant negative correlation was observed between HOMA-IR and free T4 (r - 0.22276; p = 0.0059) and a positive correlation was observed between HOMA-IR and TSH (r = 0.1909; p = 0.0066) in the whole cohort. Conclusions: We conclude that in the studied population, patients with TSH above 2.5 mIU/L vs. those with TSH between 0.4 and 2.5 mIU/L presented: 1) lower levels of HDL cholesterol, 2) higher levels of triglycerides, insulin and HOMA-IR, independently of age and BMI and, 3) a significant increase in the risk of having insulin resistance measured by HOMA-IR.
RESUMO
Se presenta la experiencia del equipo quirúrgico en colecistectomía videolaparoscópica, en una serie prospectiva de 48 pacientes de ambos sexos, de 60 o mas años de edad, operados entre marzo y julio del año 2003, en el Departamento y Servicio de Cirugía del Hospital Barros Luco Trudeau; analizando la patología médica asociada, presente en el 70,83 por ciento de los pacientes; los hallazgos más relevantes del estudio ecotomográfico preoperatorio (97,91 por ciento de los pacientes); las cifras de conversión a cirugía laparotómica (14,57 por ciento) y los resultados en términos de morbilidad (8,33 por ciento) y mortalidad (0 por ciento).