Effects of subclinical hypothyroidism treatment on psychiatric symptoms, muscular complaints, and quality of life.

OBJECTIVES: To evaluate the impact of subclinical hypothyroidism (sHT) treatment on health-related quality of life (QoL), psychiatric symptoms, clinical score, and muscle function. MATERIALS AND METHODS: In this randomized double-blind study, patients were assigned either to treatment (n = 35) or placebo (n = 36). Clinical and psychiatric symptoms were assessed by the Zulewski, Hamilton and Beck scales. QoL was assessed by the SF-36 questionnaire. Assessments of quadriceps (QS) and inspiratory muscle (IS) strength were performed by a chair dynamometer and a manuvacuometer. RESULTS: Treatment improved IS (+11.5 ± 17.2; p = 0.041), as did QoL domains "Pain" and "Role Physical" (+19.7 ± 15.2, 0.039 and +22.1 ± 47.5, p = 0.054; respectively). Clinical and psychiatric symptoms showed similar responses to both interventions. CONCLUSIONS: sHT treatment improved IS and physical aspects of QoL, despite no impact in other muscle parameters. Clinical score, psychiatric symptoms, and SF-36 domains, based on mental dimensions of QoL may be more susceptible to "placebo effect" in patients with sHT.

Effects of subclinical hypothyroidism treatment on psychiatric symptoms, muscular complaints, and quality of life / Efeitos do tratamento do hipotiroidismo subclínico sobre sintomas psiquiátricos, queixas musculares e qualidade de vida

OBJECTIVES: To evaluate the impact of subclinical hypothyroidism (sHT) treatment on health-related quality of life (QoL), psychiatric symptoms, clinical score, and muscle function. MATERIALS AND METHODS: In this randomized double-blind study, patients were assigned either to treatment (n = 35) or placebo (n = 36). Clinical and psychiatric symptoms were assessed by the Zulewski, Hamilton and Beck scales. QoL was assessed by the SF-36 questionnaire. Assessments of quadriceps (QS) and inspiratory muscle (IS) strength were performed by a chair dynamometer and a manuvacuometer. RESULTS: Treatment improved IS (+11.5 ± 17.2; p = 0.041), as did QoL domains "Pain" and "Role Physical" (+19.7 ± 15.2, 0.039 and +22.1 ± 47.5, p = 0.054; respectively). Clinical and psychiatric symptoms showed similar responses to both interventions. CONCLUSIONS: sHT treatment improved IS and physical aspects of QoL, despite no impact in other muscle parameters. Clinical score, psychiatric symptoms, and SF-36 domains, based on mental dimensions of QoL may be more susceptible to "placebo effect" in patients with sHT.

OBJETIVOS: Avaliar o impacto do tratamento do hipotireoidismo subclínico (sHT) na qualidade de vida relacionada à saúde (QoL), aos sintomas psiquiátricos, ao escore clínico e à função muscular. MATERIAIS E MÉTODOS: Em um ensaio randomizado duplo-cego, pacientes foram randomizados para tratamento (n = 35) ou uso de placebo (n = 36). Sintomas clínicos e psiquiátricos foram acessados por meio das escalas de Zulewski, Hamilton e Beck. A QoL foi avaliada pelo questionário SF-36. Medidas da força de quadríceps (QS) e inspiratória (IS) foram obtidas por um dinamômetro de cadeira e um manovacuômetro. RESULTADOS: O tratamento melhorou a IS (+11,5 ± 17,2; p = 0,041), assim como os domínios "Dor" e "Aspectos Físicos" da QoL (+19,7 ± 15,2, 0,039 e +22,1 ± 47,5, p = 0,054, respectivamente). Sintomas clínicos e psiquiátricos demonstraram respostas similares a ambas as formas de intervenção. CONCLUSÕES: Tratamento do sHT melhorou IS e aspectos físicos da QoL, apesar de não ter impacto em outros parâmetros musculares. Escore clínico, sintomas psiquiátricos e domínios do SF-36 que focam em dimensões mentais podem ser mais suscetíveis ao "efeito placebo" em pacientes com sHT.

Impact of subclinical hypothyroidism treatment in systolic and diastolic cardiac function.

OBJECTIVE: To evaluate the effects of levothyroxine (L-T4) replacement in echocardiographic parameters of middle-aged women with subclinical hypothyroidism (SH). SUBJECTS AND METHODS: This was a randomized, double-blind, placebo-controlled study. Echocardiographic evaluation was carried out at baseline and one year after restoration of euthyroidism. Thirty-three women with SH were assigned to one of two groups (L-T4 or placebo). RESULTS: The two groups had similar basal characteristics. There was a significant deterioration of left ventricular Tei index after one year of placebo use, which differed from the effect of L-T4 replacement (+0.086 ± 0.092 vs. -0.014 ± 0.012; p = 0.047). There was also a slight reduction in cardiac output and cardiac index with placebo use, which was not different from L-T4 effect. CONCLUSION: Results suggest a positive impact of L-T4 replacement in cardiac function of middle-aged women with SH.

Impact of subclinical hypothyroidism treatment in systolic and diastolic cardiac function / Impacto do tratamento do hipotireoidismo subclínico na função cardíaca sistólica e diastólica

OBJECTIVE: To evaluate the effects of levothyroxine (L-T4) replacement in echocardiographic parameters of middle-aged women with subclinical hypothyroidism (SH). SUBJECTS AND METHODS: This was a randomized, double-blind, placebo-controlled study. Echocardiographic evaluation was carried out at baseline and one year after restoration of euthyroidism. Thirty-three women with SH were assigned to one of two groups (L-T4 or placebo). RESULTS: The two groups had similar basal characteristics. There was a significant deterioration of left ventricular Tei index after one year of placebo use, which differed from the effect of L-T4 replacement (+0.086 ± 0.092 vs. -0.014 ± 0.012; p = 0.047). There was also a slight reduction in cardiac output and cardiac index with placebo use, which was not different from L-T4 effect. CONCLUSION: Results suggest a positive impact of L-T4 replacement in cardiac function of middle-aged women with SH.

OBJETIVO: Avaliar os efeitos da reposição de levotiroxina (L-T4) nos parâmetros ecocardiográficos em mulheres de meia-idade com hipotireoidismo subclínico (HS). SUJEITOS E MÉTODOS: Realizado estudo duplo-cego, controlado com placebo com avaliação dos parâmetros ecocardiográficos no início e um ano após o restabelecimento do eutireoidismo. Trinta e três mulheres foram incluídas em dois grupos (uso de L-T4 ou placebo). RESULTADOS: Os dois grupos tinham características basais similares. Houve uma significativa piora do índice TEI do ventrículo esquerdo no grupo que usou placebo por um ano. Já no grupo em reposição com L-T4 observou-se uma leve melhora desse índice (+0,086 ± 0,092 vs. -0,014 ± 0,012; p = 0,047). Ocorreu também uma leve redução no débito cardíaco e no índice cardíaco com placebo, os quais não diferiram do efeito da reposição de L-T4. CONCLUSÃO: Os resultados sugerem um impacto positivo com a reposição de L-T4, na função cardíaca de mulheres de meia-idade, com HS.

Monitorização ambulatorial da pressão arterial em pacientes normotensos com hipotireoidismo subclínico / Ambulatory blood pressure monitoring in normotensive patients with subclinical hypothyroidism

FUNDAMENTO: O hipotireoidismo manifesto está associado com elevação da pressão arterial diastólica; entretanto, a associação entre o hipotireoidismo subclínico (HS) e alteração da pressão arterial (PA) é desconhecida. OBJETIVO: O objetivo do presente estudo foi avaliar a monitorização ambulatorial da pressão arterial (MAPA) por 24 horas em pacientes normotensos com HS em comparação a indivíduos normotensos eutireóideos (EU). MÉTODOS: Foi realizado um estudo transversal com 50 participantes (HS = 30 e EU = 20) que não apresentavam diferenças em relação a fatores de risco para hipertensão. A monitorização ambulatorial de pressão arterial foi realizada com um monitor Dynamapa®, utilizando-se um método oscilométrico validado pela AAMI (Association for the Advancement of Medical Instrumentation) e pela BHS (British Hypertension Society). RESULTADOS: Os níveis séricos médios de TSH e T4 livre foram respectivamente 6,9 ± 2,2 µUI/ml e 1,1 ± 0,2 ng/dl em pacientes com HS. Apesar de não haver diferença em relação à média da pressão arterial sistólica e diastólica entre os dois grupos, houve uma correlação positiva entre os níveis de pressão arterial diastólica média (PADM) e os valores séricos de TSH em pacientes com HS (r:0,477; p = 0,004). Essa correlação foi detectada por medidas diurnas (r:0,498; p = 0,002) e noturnas (r:0,322; p = 0,032). CONCLUSÃO: A pressão arterial não diferiu entre pacientes com ou sem HS; contudo, os resultados sugerem que a progressão de hipotireoidismo subclínico para níveis mais elevados de TSH pode aumentar o risco cardiovascular através do aumento da pressão arterial diastólica.

BACKGROUND: Overt hypothyroidism is associated with elevation of diastolic blood pressure; however the association of subclinical hypothyroidism (SH) with arterial blood pressure (ABP) alteration is unknown. OBJECTIVE: The aim of the present study was to evaluate ambulatory blood pressure monitoring (ABPM), over 24 hours, in normotensive patients with SH in comparison to euthyroid (EU) normotensive individuals. METHODS: A cross-sectional study was performed with 50 participants (SH = 30 and EU = 20) that did not differ regarding risk factors for hypertension. The ABPM was carried out with a DINAMAPA TM monitor, using the oscillometric method validated by AAMI (Association for the Advancement of Medical Instrumentation) and by the BHS (British Hypertension Society). RESULTS: The mean serum TSH and FT4 were respectively 6.9 ± 2.2 µUI/ml and 1.1 ± 0.2 ng/dl in SH patients. Although there was no difference in the mean values of systolic and diastolic blood pressure between the two groups, there was a positive correlation between the mean values of diastolic blood pressure (DBP) and serum TSH levels in SH patients (r:0.477; p = 0.004). These correlations were detected at daytime (r:0.498; p = 0.002) and sleep-time (r:0.322; p = 0.032) measurements. CONCLUSION: The blood pressure was not different between patients with or without SH; however, the results suggest that the progression of subclinical hypothyroidism to higher levels of TSH may increase the cardiovascular risk by increasing diastolic blood pressure.

[Ambulatory blood pressure monitoring in normotensive patients with subclinical hypothyroidism].

BACKGROUND: Overt hypothyroidism is associated with elevation of diastolic blood pressure; however the association of subclinical hypothyroidism (SH) with arterial blood pressure (ABP) alteration is unknown. OBJECTIVE: The aim of the present study was to evaluate ambulatory blood pressure monitoring (ABPM), over 24 hours, in normotensive patients with SH in comparison to euthyroid (EU) normotensive individuals. METHODS: A cross-sectional study was performed with 50 participants (SH = 30 and EU = 20) that did not differ regarding risk factors for hypertension. The ABPM was carried out with a DINAMAPA TM monitor, using the oscillometric method validated by AAMI (Association for the Advancement of Medical Instrumentation) and by the BHS (British Hypertension Society). RESULTS: The mean serum TSH and FT4 were respectively 6.9 +/- 2.2 microUI/ml and 1.1 +/- 0.2 ng/dl in SH patients. Although there was no difference in the mean values of systolic and diastolic blood pressure between the two groups, there was a positive correlation between the mean values of diastolic blood pressure (DBP) and serum TSH levels in SH patients (r:0.477; p = 0.004). These correlations were detected at daytime (r:0.498; p = 0.002) and sleep-time (r:0.322; p = 0.032) measurements. CONCLUSION: The blood pressure was not different between patients with or without SH; however, the results suggest that the progression of subclinical hypothyroidism to higher levels of TSH may increase the cardiovascular risk by increasing diastolic blood pressure.

Lipid profile in different degrees of hypothyroidism and effects of levothyroxine replacement in mild thyroid failure.

The aim of this study was to evaluate the lipid profile of patients with different degrees of hypothyroidism and the effect of levothyroxine replacement in subclinical hypothyroidism (SH). Initially, a cross-sectional study was performed with 226 participants [SH = 133 participants, manifest hypothyroidism (MH) = 23 participants, and euthyroidism (EU) = 70 participants]. The mean levels of atherogenic lipid variables were greater in MH than in SH and were greater in SH than in EU, although the differences between SH and EU did not reach statistical significance. The SH subgroup with greater serum thyrotropin (TSH) levels and that with positive antithyroperoxidase antibodies (TPO-Ab) had greater levels of triglycerides and of the atherogenic index Apo B/Apo A. A positive correlation exists between serum TSH and total cholesterol (rs = 0.167; P = 0.006), triglycerides (rs = 0.219; P < 0.001), and ApoB levels (rs = 0.205; P < 0.001). Eleven patients who received levothyroxine (L-T4) treatment and 15 patients who received placebo were reevaluated 1 year after TSH adjusted intervention. A fall in atherogenic variables was observed in the L-T4-treated group, with significance for total cholesterol (-20.0 vs +16.1 mg/dL in the placebo group) and LDL-c (-21.7 vs +17.2 mg/dL). We concluded that SH leads to an intermediary lipid profile between euthyroid individuals and that found in manifest hypothyroidism and that a significant lipid profile improvement occurred 1 year after L-T4 replacement therapy.

[Evaluation of clinical and psychiatric symptoms in sub clinical hypothyroidism]. / Avaliação clínica e de sintomas psiquiátricos no hipotireoidismo subclínico.

BACKGROUND: This investigation evaluated and correlated clinical, laboratorial aspects and psychiatric symptoms in sub clinical hypothyroidism (SH). METHODS: Cross sectional study involving 103 patients with SH and 60 subjects without thyroid disease. Clinical and psychiatric evaluation was respectively based on the Zulewski score and Hamilton A, Hamilton D and Beck questionnaires. Serum thyreotropin (TSH), (thyroxine) FT4 and (antithyroperoxidase) ATPO were measured in all participants. Analysis of continuums data was assessed by the Student t- test, for normally distributed data, and by the Mann- Whitney and Kruskal Wallis tests for non-parametric data. The chi2, Fisher's and Kruskal Wallis tests were used to study qualitative variables. Multivariate analyses were used to study confounding variables. RESULTS: Mean serum TSH level was 7.76 +/- 2.9 micro UI/mL in SH and 1.66 +/- 0.6 micro UI/mL in the group without thyroid disease (p=0.001). Mean serum T4L was slightly lower among patients with HS, and showed a negative linear correlation with TSH. Higher frequencies of abnormal clinical score (48.3 vs. 67.0%; p=0.02), depression self reported symptoms (20.5 vs. 44.2%; p=0.011) and anxiety symptoms (86.0 vs. 63.4%; p=0.004) occurred more frequently in SH. Frequency of psychiatric symptoms had a positive correlation with the clinical score and serum TSH. There was no association between the clinical and psychiatric findings and the etiology of SH, presence of ATPO, age or menopause. CONCLUSIONS: The study showed that SH was associated with clinical findings and with psychiatric symptoms. Clinical trials are required to evaluate possible improvement with levotiroxine.

[Clinical and muscular evaluation in patients with subclinical hypothyroidism]. / Avaliação clínica e da função muscular em pacientes com hipotireoidismo subclínico.

Some symptoms and signs of hypothyroidism, as well as some laboratory abnormalities, may be present in subclinical hypothyroidism (SH). This study evaluates the prevalence of signs and symptoms of hypothyroidism and skeletal muscle dysfunction in 57 patients with SH compared to 37 euthyroid controls. The participants received a clinical score based on signs and symptoms of hypothyroidism. The muscle strength was estimated by manual testing and chair dynamometer and inspiratory force by manuvacuometer. Thyroid hormones and muscle enzymes were measured. The SH group presented with higher score (p< 0.01), complained about myalgia and weakness more frequently (p< 0.05), and showed strength disability in scapular and pelvic girdles (p< 0.05). The median free T4 serum levels were lower in SH (p< 0.001). These findings suggest that signs and symptoms of thyroid dysfunction may be related to lower levels of FT4 in SH and should be taken into account in the decision of beginning LT4 therapy.

Avaliação clínica e de sintomas psiquiátricos no hipotireoidismo subclínico / Evaluation of clinical and psychiatric symptoms in sub clinical hypothyroidism

OBJETIVO: Analisar e correlacionar características clínicas, sintomas psiquiátricos e dados laboratoriais no hipotireoidismo subclínico (HS). MÉTODOS: Estudo transversal comparando achados de 103 pacientes com HS aos de 60 indivíduos eutireoidianos. A avaliação clínica e a psiquiátrica foram baseadas, respectivamente, na escala de Zulewski e nos questionários de Hamilton A, Hamilton D e Beck. Todos foram submetidos a dosagens de tireotropina (TSH), T4 livre e antitireoperoxidase (ATPO). Variáveis contínuas foram analisadas por meio do teste t de Student, quando de distribuição normal, e dos testes de Mann-Whitney e Kruskal Wallis, quando "não normais". Variáveis categóricas por meio dos testes Qui-quadrado, exato de Fisher e Kruskal Wallis. Análise multivariada foi utilizada para estudo de variáveis de confundimento. RESULTADOS: O nível médio de TSH, no HS, foi 7,76 ± 2,9 æUI/mL e 1,66 ± 0,6 æUI/mL nos eutireoideanos (p=0,001). O nível de T4L foi menor no HS, apresentando correlação linear negativa com TSH. Ocorreu maior freqüência de escore clínico anormal (48,3 vs 67 por cento; p=0,020), de sintomas de depressão, pela escala de Beck no HS (20,5 vs 44,2 por cento; p=0,011) e de sintomas de ansiedade (86 vs 63,4 por cento; p=0,004) no HS. A presença de sintomas de depressão e ansiedade associou-se de forma positiva com pontuação no escore clínico e níveis de TSH. Não houve associação entre achados clínicos ou psiquiátricos e etiologia do HS, presença de ATPO, idade ou menopausa. CONCLUSÃO: O estudo aponta para associação entre HS, achados clínicos e sintomas psiquiátricos. Ensaios clínicos são necessários para avaliar uma possível melhora com levotiroxina.

Avaliação clínica e da função muscular em pacientes com hipotireoidismo subclínico / Clinical and muscular evaluation in patients with subclinical hypothyroidism

Alguns sintomas e sinais de hipotireoidismo, bem como alterações laboratoriais, podem estar presentes no hipotireoidismo subclínico (HS). Este trabalho avalia a prevalência de sintomas e sinais de hipotireoidismo e alterações músculo-esqueléticas em pacientes com HS (n= 57) comparado a um grupo controle sem disfunção tireoideana (n= 37). Baseado na presença de sintomas e sinais de hipotireoidismo, os participantes receberam pontuação específica (escore clínico). A força muscular foi aferida pelo teste muscular manual e por dinamômetro de cadeira e a força inspiratória por manovacuômetro. Os níveis de hormônios tireoideanos e enzimas musculares foram dosados. O grupo HS apresentou escore mais elevado (p< 0,01), maior freqüência das queixas de mialgia e fraqueza (p< 0,05) e redução de força das cinturas escapular e pélvica (p< 0,05). Os níveis médios de T4 livre foram menores no HS (p< 0,001). Os resultados sugerem que a presença de sintomas e sinais de disfunção tireoideana e níveis de T4 livre na faixa inferior da normalidade no HS possam estar relacionados e devem ser valorizados na decisão de iniciar LT4.