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.

Functional capacity and muscular abnormalities in subclinical hypothyroidism.

BACKGROUND: Neuromuscular abnormalities and low exercise tolerance are frequently observed in overt hypothyroidism, but it remains controversial if they can also occur in subclinical hypothyroidism (sHT). The aim of this study is to evaluate neuromuscular symptoms, muscle strength, and exercise capacity in sHT, compared with healthy euthyroid individuals. METHODS: A cross-sectional study was performed with 44 sHT and 24 euthyroid outpatients from a university hospital. Neuromuscular symptoms were questioned. Muscle strength was tested for neck, shoulder, arm, and hip muscle groups, using manual muscle testing (MMT). Quadriceps muscle strength was tested with a chair dynamometer and inspiratory muscle strength (IS) by a manuvacuometer. Functional capacity was estimated based on the peak of oxygen uptake (mL/kg/min), using the Bruce treadmill protocol. RESULTS: Cramps (54.8% versus 25.0%; P < 0.05), weakness (45.2% versus 12.6; P < 0.05), myalgia (47.6% versus 25.0%; P = 0.07), and altered MMT (30.8% versus 8.3%; P = 0.040) were more frequent in sHT. Quadriceps strength and IS were not impaired in sHT and the same was observed for functional capacity. IS was significantly lower in patients complaining of fatigue and weakness (P < 0.05) and tended to be lower in those with altered MMT (P = 0.090). CONCLUSION: Neuromuscular complaints and altered MMT were significantly more frequent in sHT than in controls, and IS was lower in patients with these abnormalities. Results suggest that altered muscle strength by MMT and the coexistence of neuromuscular complaints in patients with sHT may indicate neuromuscular dysfunction.

Perceived health status of women with overt and subclinical hypothyroidism.

OBJECTIVE: The objective of this study was to investigate the health status of women with overt and subclinical hypothyroidism and relate it to the presence of clinical signs and symptoms of the disease. SUBJECTS AND METHODS: A cross-sectional study was conducted on 232 women divided into 3 groups: overt hypothyroidism (n = 14); subclinical hypothyroidism (n = 152), and controls (n = 66). Health status was evaluated by the questionnaire SF-36, and the clinical signs and symptoms of hypothyroidism were assessed with the Billewicz scale modified by Zulewski. The Kruskal-Wallis test followed by the Mann-Whitney U test with Bonferroni correction was applied to compare continuous variables between the groups. To assess the relationship between SF-36 domains and the clinical score, as well as SF-36 domains and serum thyroid-stimulating hormone levels, the Spearman correlation coefficient was calculated. RESULTS: Patients with overt hypothyroidism presented systematically lower scores in all SF-36 domains (p < 0.05), both in relation to subclinical hypothyroidism patients and controls. This indicates a great dissatisfaction with health status in this group. Patients with subclinical hypothyroidism presented statistically lower scores in relation to controls with the exception of the role-emotional and bodily pain domains, where although they were not statistically significant, scores were clinically different. Highly negative correlations between SF-36 domains and the clinical score were observed in overt hypothyroidism (physical function r = -0.80, p < 0.01; bodily pain r = -0.74, p < 0.01). CONCLUSION: Overt hypothyroidism seemed to be associated with worse perception of health status, negatively associated with clinical score.

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.

Are neuropsychological changes relevant in subclinical hypothyroidism?

INTRODUCTION: Neuropsychological changes are still controversial in patients with subclinical hypothyroidism (SH). The objective of this study is to assess these changes. METHOD: Cross-sectional study comparing the results of the neurocognitive evaluation of 65 SH patients and 31 individuals without thyroid disease. Subclinical hypothyroidism was defined as at least two elevated serum TSH levels (> 4 microUI/ml) with normal serum free T4 levels (0.9-1.8 ng/dl). The participants underwent the following neuropsychological assessment: Buschkes Selective Reminding Procedure, Rey-Osterrieth Complex Figure Test, Warrington's Recognition Memory Test for Words and Faces, and the Vocabulary subtest of the WAIS-R. RESULTS: The groups were similar in regard to mean age, sex and educational level. No neuropsychological change was found in patients with SH when compared with euthyroid individuals. CONCLUSION: No difference was observed in the performance of the neuropsychological tests between both groups in regard to the functions studied.

Subclinical hypothyroidism: psychiatric disorders and symptoms.

OBJECTIVE: To evaluate the prevalence of psychiatric disorders and symptoms in patients with subclinical hypothyroidism. METHOD: Ninety-four outpatients with at least two elevated serum thyrotrophin levels (> 4 microU/ml) and normal FT4, and 43 euthyroid outpatients, both groups from HUCFF-UFRJ, were evaluated. Psychiatric diagnosis was based on the Structured Clinical Interview Diagnostic for the DSM-IV axis I (SCID-I/DSM-IV), the psychopathological symptoms on Hamilton anxiety and depression scales, and the Beck Inventory. RESULTS: Our data showed an increased prevalence of psychiatric disorders in the subclinical hypothyroidism patients when compared to the euthyroid group (45.7% vs 25.6%; p = 0.025), mood disorders being the most frequent. The prevalence of depressive symptoms based on Beck's Scale among subclinical hypothyroidism patients was about 2.3 times higher than among euthyroid ones (45.6% vs 20.9%, p = 0.006). Anxiety symptoms were also more frequent among subclinical hypothyroidism patients (87.0% vs 60.5%, p < 0.001), mainly clinical anxiety (44.6% vs 23.3%; p = 0.001). CONCLUSION: Our results showed a significant association of subclinical hypothyroidism with psychiatric disorders and an increased frequency of subsyndromic depression and anxiety symptoms in subclinical hypothyroidism in relation to the euthyroid group.

Are neuropsychological changes relevant in subclinical hypothyroidism?

INTRODUCTION: Neuropsychological changes are still controversial in patients with subclinical hypothyroidism (SH). The objective of this study is to assess these changes. METHOD: Cross-sectional study comparing the results of the neurocognitive evaluation of 65 SH patients and 31 individuals without thyroid disease. Subclinical hypothyroidism was defined as at least two elevated serum TSH levels (> 4 æUI/ml) with normal serum free T4 levels (0.9-1.8 ng/dl). The participants underwent the following neuropsychological assessment: BuschkeÆs Selective Reminding Procedure, Rey-Osterrieth Complex Figure Test, WarringtonÆs Recognition Memory Test for Words and Faces, and the Vocabulary subtest of the WAIS-R. RESULTS: The groups were similar in regard to mean age, sex and educational level. No neuropsychological change was found in patients with SH when compared with euthyroid individuals. CONCLUSION: No difference was observed in the performance of the neuropsychological tests between both groups in regard to the functions studied.

INTRODUÇÃO: Até o presente momento, não se tem confirmação da presença de alterações neuropsicológicas em pacientes com hipotireoidismo subclínico (HS). O objetivo desta pesquisa foi avaliar essas alterações. MÉTODO: Estudo seccional comparando os achados neuropsicológicos de 65 pacientes com HS e 31 indivíduos eutireoidianos. HS foi confirmado por duas dosagens plasmáticas elevadas de TSH (> 4 æUI/ml) associadas com dosagem sérica de T4L na faixa da normalidade (0,9-1,8 ng/dl). Para avaliação neuropsicológica, foram utilizados o procedimento de Buschke, a figura de Rey-Osterrieth, o reconhecimento de palavras e faces de Warrington e o subteste Vocabulário do WAIS-R. RESULTADOS: Os grupos foram similares quanto a idade, sexo e nível de escolaridade. Não encontramos alterações neuropsicológicas nos pacientes com HS em comparação ao grupo eutireoidiano. CONCLUSÃO: Não foi encontrada nenhuma diferença nos resultados dos testes neuropsicológicos entre os dois grupos em relação às funções estudadas.

Subclinical hypothyroidism: psychiatric disorders and symptoms

OBJECTIVE: To evaluate the prevalence of psychiatric disorders and symptoms in patients with subclinical hypothyroidism. METHOD: Ninety-four outpatients with at least two elevated serum thyrotrophin levels (> 4 æU/ml) and normal FT4, and 43 euthyroid outpatients, both groups from HUCFF-UFRJ, were evaluated. Psychiatric diagnosis was based on the Structured Clinical Interview Diagnostic for the DSM-IV axis I (SCID-I/DSM-IV), the psychopathological symptoms on Hamilton anxiety and depression scales, and the Beck Inventory. RESULTS: Our data showed an increased prevalence of psychiatric disorders in the subclinical hypothyroidism patients when compared to the euthyroid group (45.7 percent vs 25.6 percent; p = 0.025), mood disorders being the most frequent. The prevalence of depressive symptoms based on Beck's Scale among subclinical hypothyroidism patients was about 2.3 times higher than among euthyroid ones (45.6 percent vs 20.9 percent, p = 0.006). Anxiety symptoms were also more frequent among subclinical hypothyroidism patients (87.0 percent vs 60.5 percent, p < 0.001), mainly clinical anxiety (44.6 percent vs 23.3 percent; p = 0.001). CONCLUSION: Our results showed a significant association of subclinical hypothyroidism with psychiatric disorders and an increased frequency of subsyndromic depression and anxiety symptoms in subclinical hypothyroidism in relation to the euthyroid group.

OBJETIVO: Avaliar a prevalência de sintomas e alterações psiquiátricas em pacientes com hipotireoidismo subclínico. MÉTODO: Foram estudados 94 pacientes ambulatoriais com pelo menos duas dosagens plasmáticas elevadas de tireotropina (> 4 æU/ml) e com T4 livre normal e, 43 eutireoidianos, ambos os grupos do HUCFF-UFRJ. Para diagnóstico psiquiátrico foi utilizada a entrevista clínica estruturada do eixo I (SCID-I/DSM-IV) e, para sintomas psicopatológicos, as escalas de ansiedade e depressão de Hamilton (HAM-A e HAM-D) e inventário de Beck. RESULTADOS: Encontramos uma prevalência aumentada de transtornos psiquiátricos no hipotireoidismo subclínico em comparação ao grupo eutireoidiano (45,7 por cento vs 25,6 por cento; p = 0,025), sendo o transtorno do humor o de maior freqüência. Sintomas de depressão no grupo com hipotireoidismo subclínico foram cerca de 2,3 vezes mais freqüentes que entre os eutireoidianos (45,6 por cento vs 20,9 por cento; p = 0,006) quando o instrumento utilizado foi a escala de Beck. Da mesma forma, sintomas de ansiedade também foram mais freqüentes no hipotireoidismo subclínico (87,0 por cento vs 60,5 por cento; p < 0,001), principalmente ansiedade clínica (44,6 por cento vs 23,3 por cento; p = 0,001). CONCLUSÃO: Os resultados indicaram uma associação do hipotireoidismo subclínico com os transtornos psiquiátricos, além de uma freqüência aumentada de sintomas de depressão e ansiedade subsindrômicos em relação ao grupo eutireoidiano.

[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.

Hipotireoidismo subclínico e alterações neuropsiquiátricas: uma revisão / Subclinical hypothyroidism and neuropsychiatric features: a review

A relação entre a disfunção tireoidiana e as doenças psiquiátricas é conhecida há quatro séculos. O funcionamento insuficiente da tireóide pode apresentar-se dentro de um espectro que vai do hipotireoidismo subclínico (HS) ao mixedema. O HS é definido como a elevação da tireotrofina (TSH) associada a níveis séricos normais de tiroxina (T4) e triidotironina (T3). Vale lembrar que apesar de a definição ser laboratorial, há discussões acerca da presença de possíveis sinais e sintomas relacionados a esta alteração. Há anos tem-se procurado mostrar a ligação entre disfunção tireoidiana e alterações neuropsiquiátricas. Não há dúvidas quanto ao aparecimento de depressão no hipotireoidismo franco, mas o mesmo não pode ser dito quanto ao HS. Há um grande interesse no estudo deste assunto, com vários trabalhos que indicam uma provável relação entre o HS e alterações psiquiátricas, embora ainda exista controvérsia. Para se encontrar uma resposta definitiva sobre esta associação são necessários estudos maiores, prospectivos, que possam indicar quais pacientes deverão ser tratados com levotiroxina. O presente trabalho se propõe a apresentar uma revisão bibliográfica sobre a relação entre as alterações neuropsiquiátricas e a função tireodiana, incluindo o HS

Hipotireoidismo subclínico e risco cardiovascular / Hypothyroidism subclinics and cardiovascular risk

O hipotireoidismo subclínico é freqüente napopulação adulta, principalmente idosa, e pode ser oestágio inicial de uma insuficiência tireoidiana, apesarde os níveis circulantes de hormônios tireoidianosestarem normais. Os pacientes podem apresentarsintomas clínicos e evoluir para hipotireoidismomanifesto. Um fato que pode contribuir para a maiormorbidade é a sua relação com maior riscoaterogênico, não necessariamente relacionado comdislipidemia. Estuda-se sua influência nacontratilidade miocárdica, função endotelial e níveisde homocisteinemia, entre outros. Nesse artigopropõe-se a revisão de diferentes aspectosrelacionados ao hipotireoidismo subclínico quepodem correlacionar-se a esse risco, concluindo-seque os estudos são conflitantes em relação à presençade tais alterações e principalmente quanto ao benefícioda reposição com levotiroxina. São necessáriosgrandes estudos controlados, randomizados e complacebo para maiores conclusões