Consenso brasileiro para a abordagem clínica e tratamento do hipotireoidismo subclínico em adultos: recomendações do Departamento de Tireoide da Sociedade Brasileira de Endocrinologia e Metabologia

Sgarbi, José Augusto; Teixeira, Patrícia de Fátima dos Santos; Maciel, Léa Maria Zanini; Mazeto, Gláucia Maria Ferreira da Silva; Vaisman, Mário; Montenegro, Renan Magalhães; Ward, Laura Sterian

doi:10.1590/s0004-27302013000300003

Cited by 41 publications

(25 citation statements)

References 151 publications

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“…SCH may be graded as mild (serum TSH, 4.5-9 mU/l) or moderate/severe (serum replacement (7,8,9,10). Previous studies have also suggested an association between SCH and coronary artery disease (CAD) (11,12,13,14).…”

Section: Introductionmentioning

confidence: 99%

Subclinical hypothyroidism represents an additional risk factor for coronary artery calcification, especially in subjects with intermediate and high cardiovascular risk scores

Silva¹,

Santos²,

Morais³

et al. 2014

European Journal of Endocrinology

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Objective: Several studies have suggested an association between subclinical hypothyroidism (SCH) and increased cardiovascular risk. The aim of this study was to evaluate the presence of coronary artery disease (CAD) in asymptomatic patients with SCH by measuring the coronary artery calcium score (CACS). Design: A total of 222 asymptomatic subjects (103 SCH and 119 euthyroid (EU)), who were between the ages of 35 and 65 years and had no previous history of CAD, were enrolled for this cross-sectional analysis. Methods: The criteria for SCH included a confirmed normal serum free thyroxine and high TSH levels. Lipid profile, Framingham risk score (FRS) and CACS analyses were performed for all subjects. Results: The SCH and EU groups were comparable with respect to age, gender, BMI and frequency of diabetes, systemic arterial hypertension, hypercholesterolaemia and smoking. There was no difference in the median CACS between the SCH and EU groups. However, in the subgroup of subjects with intermediate/high FRS (AR 10y R10%), CACS was higher in the SCH subjects compared with EU subjects (EU vs SCH, 0.0 (57.0) vs 23.0 (161.5); PZ0.045). Multivariate analysis revealed that the risk for CACS O100 was independently associated with male gender, age O55 years, and the presence of simultaneous SCH and AR 10y R10% (ORZ87.5 (CIZ2.1-3500); PZ0.001). Serum TSH was positively correlated with CACS, especially in intermediate/high FRS subjects (r s Z0.301, PZ0.045). Conclusions: It was demonstrated that SCH represents an additional risk factor for CAD, notably in intermediate and high FRS subjects.

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Section: Introductionmentioning

confidence: 99%

Subclinical hypothyroidism represents an additional risk factor for coronary artery calcification, especially in subjects with intermediate and high cardiovascular risk scores

Silva¹,

Santos²,

Morais³

et al. 2014

European Journal of Endocrinology

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“…Recent researches have suggested that the upper reference value for serum TSH levels varies among age strata [16–19]. However, until now, there is no exact definition of these specific cutoffs, according to age, in our population [20–22]. …”

Section: Introductionmentioning

confidence: 99%

“…These findings have being considered in clinical practice to suggest that patients with minimal elevations of serum TSH should not be treated when their age are above a specific range [20–22, 33, 34]. A doubt is that regardless to possible improve quality of life of elderly subjects the restoration of euthyroidism might be associated with worse endpoints [20–22].…”

Section: Introductionmentioning

confidence: 99%

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Impact of thyroid status and age on comprehensive geriatric assessment

et al. 2013

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This study aimed to evaluate the prevalence of thyroid dysfunction in elderly subjects attending an outpatient clinic at a tertiary hospital and to assess whether subclinical hypothyroidism (SCH) or aging affected activities of daily living (ADLs), instrumental activities of daily living (IADLs), cognitive status, or depressive symptoms. This crosssectional study included 411 patients recruited in the outpatient geriatric setting. 48 subjects reported levothyroxine use and were evaluated separately. After excluding subjects with diseases or drugs which could influence thyroid status, the 284 subjects remaining were classified as having euthyroidism (n = 235, 82.8 %), subclinical hypothyroidism (n = 43, 15.1 %), subclinical hyperthyroidism (n = 4, 1.4 %), or overt hyperthyroidism (n = 2, 0.7 %). ADLs and IADLs were assessed using the Katz Index (ranging from 0 [independence] to 6 [dependence in all activities]) and Health Assessment Questionnaire (ranging from 0 to 3 [severely disabled]), respectively. Cognition was assessed using the mini mental state depressive symptoms that were assessed using the Geriatric depression scale or cornell scale for depression in dementia. SCH did not reduce performance in ADLs or IADLs in elderly subjects as a whole, but was an independent protective factor against dependence in ADLs (OR = 0.196 [0.045–0.853]; p = 0.003) and IADLs (OR = 0.060 [0.010–0.361]; p = 0.002) in subjects aged ≥85 years. Very old subjects with SCH showed better performance in ADLs than did those with euthyroidism (Katz Index: 0.9 ± 1.6 [median: 0.5] vs. 1.7 ± 1.7 [1.0], p = 0.024; HAQ: 1.2 ± 0.8 [0.9] vs. 1.8 ± 1.0 [1.9], p = 0.015). This putative protective effect of SCH was not found in subjects aged <85 years. The number of falls, number of medications used, depressive symptoms, and cognitive impairment did not differ among thyroid status groups, regardless of age. In conclusion, SCH does not have impact functional performance in the elderly population as a whole, but was associated with better functional status in subjects aged ≥85 years.

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“…3 O hipotireoidismo subclínico (HSC) tem sido definido por níveis normais dos hormônios tireoidianos e elevados do TSH. 4 Seu diagnóstico é estritamente laboratorial, pois os pacientes são assintomáticos, oligoassintomáticos ou com manifestações inespecíficas. Deve-se suspeitar e investigar os idosos que apresentem sintomas clínicos e/ou fatores de risco para hipotireoidismo como: mulheres acima de 60 anos; história pessoal ou familiar de doença tireoidiana, tireoidectomia, terapia com iodo radioativo ou radiação externa de pescoço; doença autoimune, em uso de medicamentos (lítio, amiodarona, interferon-alfa); doenças neuropsiquiátricas (depressão e demência), hiperprolactinemia, dislipidemia, anemia e insuficiência cardíaca (IC) (nível de recomendação D).…”

Section: Subclinical Hypothyroidism In Elderly In Primary Care: Emphaunclassified

Hipotireoidismo subclínico em idosos na atenção primária: ênfase na prevenção quaternária

2016

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227Resumo O diagnóstico do hipotireoidismo subclínico (HSC) no idoso tem elevado grau de dificuldade devido às mudanças decorrentes do envelhecimento. Nosso objetivo foi rastrear e avaliar o valor do TSH para intervenção do HSC em idosos assintomá-ticos acompanhados na Atenção Primária. Foram realizadas dosagens de T4l e TSH, utilizando as referências de TSH para adultos e faixa etária (grupos A: 60-69 anos; B: 70-79 anos e C: maior que 80 anos). O HSC foi definido como T4l normal e TSH acima limite normal até 10 mlU/L. Foram avaliados 123 idosos, 35 homens e 88 mulheres. O HSC foi diagnosticado em 8,1% (n = 10) dos idosos, sem diferença por gênero. A média do TSH foi maior no grupo com mais de 80 anos (p = 0,004). Foi observado aumento da proporção de HSC considerando o limite para adulto (A: 3,5%; B: 5% e C:15,4%; p < 0,05) e faixa etária (A: 7%; B: 5% e C: 11,5%; NS). Houve uma relação diretamente proporcional do TSH (r^2 = 0,93, p < 0,01) e T4l (r^2 = 0,54, p < 0,01) com a idade. Concluímos que o HSC é comum em idosos. Os níveis de TSH se correlacionam e aumentam com a idade, podendo significar um aumento fisiológico com possível papel cardioprotetor, melhor funcionalidade e maior longevidade. O TSH deve ser avaliado pela faixa etária e confirmado, evitando diagnósticos equivocados e tratamentos desnecessários, seguindo o preceito da prevenção quaterná-ria. É importante que os médicos de família e comunidade, responsáveis pela coordenação do cuidado, estejam atentos à abordagem do HSC no idoso.Descritores: Hipotireoidismo subclínico; Rastreamento; Idoso; Prevenção quaternária. Abstract Subclinical hypothyroidism in elderly in primary care: emphasis on quaternary attentionThe diagnosis of subclinical hypothyroidism (SCH) in the elderly is highly difficult due to the changes of aging. Our goal was to track and assess the value of TSH for HSC intervention in asymptomatic elderly seen in primary care. We perform FT4 and TSH, TSH using the references for adults and age group (group A: 60-69 years; B: 70-79 years and C: greater than 80 years). The HSC was defined as normal FT4 and TSH above normal limit to 10 mIU/L. We evaluated 123 elderly people, 35 men and 88 women. The HSC was diagnosed in 8.1% (n = 10) of the elderly, with no difference by gender. The mean TSH was higher in the group with more than 80 years (p = 0.004). We observed an increase of HSC ratio considering the limit for adult (A: 3.5%; B: 5% e C: 15.4%; p < 0. 7%; B: 5% e C: 11.5%; NS). There was a directly proportional relationship of TSH (r^2 = 0.93, p < 0.01) and FT4 (r^2 = 0.54, p<0.01) with age. We conclude that the HSC is common in the elderly. TSH levels correlate and increases with age, and can represent a physiological increase with a possible cardioprotective role, greater functionality and longevity. The TSH should be assessed by age and confirmed track, avoiding misdiagnosis and unnecessary treatments, following the precept of quaternary prevention. It is important that family and community doctors, responsible for the coordination of ...

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Consenso brasileiro para a abordagem clínica e tratamento do hipotireoidismo subclínico em adultos: recomendações do Departamento de Tireoide da Sociedade Brasileira de Endocrinologia e Metabologia

Cited by 41 publications

References 151 publications

Subclinical hypothyroidism represents an additional risk factor for coronary artery calcification, especially in subjects with intermediate and high cardiovascular risk scores

Subclinical hypothyroidism represents an additional risk factor for coronary artery calcification, especially in subjects with intermediate and high cardiovascular risk scores

Impact of thyroid status and age on comprehensive geriatric assessment

Hipotireoidismo subclínico em idosos na atenção primária: ênfase na prevenção quaternária

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