Oral triiodothyronine for the prevention of thyroid hormone reduction in adult valvular cardiac surgery

Treatment of non-thyroidal illness by intravenous triiodothyronine (T3) after cardiac surgery causes a disproportional elevation of hormone levels. The administration of oral T3, which has never been studied in this context, could cause physiological hormone levels. The aim of this study was to test oral T3 for the prevention of T3 reduction during the postoperative period of valvular cardiac surgery in adults. Eighteen patients who underwent cardiac surgery for valvular disease with invasive hemodynamic monitoring were randomly assigned to 2 groups: the T group received oral T3 (N = 8), 25 æg three times/day, initiated 24 h before surgery and maintained for 48 h and the NT group (N = 10) received placebo. Serum T3, thyroxine and thyrotropin were determined at baseline, 1 h before surgery, within 30 min of cardiopulmonary bypass and 6, 12, 24, and 48 h after removal of the aortic cross-clamp. Baseline T3 was similar in both groups (T: 119 ± 13; NT: 131 ± 9 ng/dL). Serum T3 increased during the first 24 h in the T group compared to the NT group (232 ± 18 vs 151 ± 13 ng/dL; P < 0.001). In the NT group, T3 was reduced by 24 percent (P = 0.007) 6 h after removal of the aortic cross-clamp, confirming the non-thyroidal illness syndrome. There were no differences in clinical or hemodynamic parameters between groups. Administration of oral T3 prevented its serum reduction after valvular cardiac surgery in adults, with normal serum levels for 48 h without disproportional elevations.

Associaçäo entre diferentes indicadores de obesidade e prevalência de hipertensäo arterial / The association between different measurements of obesity and the prevalence of hypertension

OBJETIVO - Determinar a associaçäo entre índice de massa corporal (IMC), índice cintura-quadril e cintura com a prevalência de hipertensäo arterial (HAS) em amostra representativa de 1088 adultos de Porto Alegre, Brasil. MÉTODOS - Foram considerados hipertensos indivíduos com pressäo sistólica (PAS) 'maior ou igual' 160mmHg ou diastólica (PAD) 'maior ou igual' 95mmHg e definidos como obesos aqueles com IMC 'maior ou igual' 27kg/m², ou com razäo cintura/quadril 'maior ou igual'0,95 (homens) e 'maior ou igual'0,80 (mulheres) ou com cintura 'maior ou igual 96cm (homens) e 92 'maior ou igual'(mulheres). RESULTAODS - A obesidade aferida pelo IMC associou-se com prevalência de HAS em ambos sexos (RR 1,9, IC 1,0 - 3,2 masculino; RR 2,2, IC 1,3 - 3,8 feminino). Os outros índices associaram-se, significativamente, apenas nas mulheres. CONCLUSÄO - IMC 'maior ou igual' 27,0kg/m² associou-se mais, consistentemente com o risco de HAS. A magnitude similar das associaçöes dos demais indicadores demostram sua utilidade na avaliaçäo do risco para a hipertensäo.