Antonio José Leal Costa

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.

Metodologias e indicadores para avaliação da capacidade funcional: análise preliminar do Suplemento Saúde da Pesquisa Nacional por Amostra de - Domicílios PNAD, Brasil, 2003

A avaliacao das consequencias dos problemas de saude e um tema marcado pela diversidade conceitual e metodologica. Diferentes modelos conceituais sao utilizados para o desenvolvimento de metodos para avaliacao dos niveis de saude de populacoes humanas. A avaliacao das limitacoes e restricoes da atividade fisica, devido a sua importância no âmbito das consequencias das doencas cronicas, tem sido contemplada em inqueritos populacionais. Tais analises baseiam-se nas escalas de avaliacao das atividades diarias da vida ou das atividades instrumentais diarias da vida. A PNAD, por meio do seu Suplemento Saude realizado em 1998 e 2003, tem possibilitado a analise dos padroes de limitacao das atividades habituais na populacao brasileira com idade superior a 13 anos. Neste estudo foram apresentados indicadores de diferentes graus de limitacao, desenvolvidos com os dados da PNAD 2003. Os resultados preliminares mostram perfis diferenciados de limitacao das atividades, segundo categorias das variaveis sexo e faixa etaria. As mulheres e os individuos com mais idade apresentaram limitacoes com maior frequencia e em maior grau. A preocupacao com o vies do informante se justifica pelo fato de metade das respostas ter sido fornecida por terceiros.

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 Becks 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.

Food intake and prevalence of obesity in Brazil: an ecological analysis.

OBJECTIVE To investigate the correlation between the consumption of refined carbohydrates and fats and the prevalence of obesity in the state capitals of Brazil. DESIGN An ecological evaluation of obesity and dietary risk factors was carried out in twenty-six state capitals of Brazil. SETTING Analysis was based on the age-standardized prevalence of obesity (BMI >or= 30.0 kg/m2) among adults aged 20-59 years. Both intake and obesity prevalence were obtained from the last National Family Household Budget Survey (HBS). The survey was conducted from July 2002 to June 2003, based on a probabilistic national sample of 48 470 households. In each household, during seven consecutive days, all monetary and non-monetary expenses for food and beverages for family consumption were transformed into energy. The relative contribution of foods and food groups was expressed as the proportion (%) of total energy. Fruits and vegetables were also measured by the quantity bought in grams. RESULTS Prevalence of obesity varied from 5.1 % to 13.6 % among women and from 5.2 % to 17.6 % among men. For women, there were statistically significant correlations between obesity and intake of sugar and soft drinks (rS = 0.60; P = 0.001), ready-to-eat meals (rS = 0.39; P = 0.05) and potatoes (rS = 0.40; P = 0.04). For men there were no such associations. CONCLUSIONS Increasing intake of refined carbohydrates, mainly soft drinks, may play a role in the prevalence of obesity among women in Brazil. Effecting changes in family purchase patterns may be a strategy to reduce obesity.

Segmentação da demanda dos planos e seguros privados de saúde: uma análise das informações da PNAD/98

Este artigo apresenta uma investigacao preliminar da presenca da selecao adversa e do risco moral (moral hazard) na demanda ativa por planos de saude no Brasil, a partir dos dados da PNAD/98. O presente estudo compara individuos cujas coberturas decorrem do vinculo de trabalho, com aqueles cujos planos resultam de uma demanda individual as empresas que os comercializam e os que nao tem acesso a esquemas assistenciais alternativos ao SUS. A elaboracao de uma tipologia de planos de saude, combinada com variaveis relacionadas com as condicoes de saude, utilizacao de servicos e gastos com saude, sugere a existencia de falhas de mercado. A percepcao de uma condicao de saude mais desfavoravel parece estar associada a busca de cobertura e o tipo de cobertura com o maior uso de servicos de saude. Quando analisadas atraves de dois modelos de regressao logistica com multiplos controles, onde a variavel de desfecho e indicadora de selecao adversa ou moral hazard, essas diferencas se atenuam, com excecao dos gastos com saude. Os resultados nao evidenciam uma inquestionavel assimetria de informacoes, mas sinalizam a necessidade de aprofundar o conhecimento sobre as relacoes entre morbidade, utilizacao de servicos de saude, gastos com saude e tipo de cobertura.

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 c2, Fishers 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 µUI/mL in SH and 1.66 ± 0.6 µUI/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.

O mercado de planos e seguros de saúde no Brasil: uma abordagem exploratória sobre a estratificação das demandas segundo a PNAD 2003

A partir dos dados do Suplemento Saude da PNAD 1998, diversos estudos evidenciaram a presenca de diferencas significativas nos padroes socioeconomicos, acesso, utilizacao de servicos de saude e condicoes de saude entre os segmentos populacionais cobertos e nao cobertos por planos de saude. Buscando contribuir para aprimorar o acervo dos conhecimentos sobre a estrutura e a dinâmica do mercado de planos e seguros de saude no Brasil, admite-se e procura-se evidenciar a heterogeneidade dessas demandas. Para tanto, foi definida uma tipologia de planos de saude, fundamentada nas origens institucionais das demandas e, subsequentemente, pelas relacoes de dependencia com titulares de planos e seguros de saude, integrada por tres categorias principais: os planos empresariais privados, os planos empresariais publicos e os planos individuais. As caracteristicas etarias, socioeconomicas e de condicoes de saude variam segundo os diferentes tipos de plano, sugerindo a presenca de padroes distintos de demandas, especialmente entre os planos empresariais privados e os planos individuais.

Serum Leptin in Overt and Subclinical Hypothyroidism: Effect of Levothyroxine Treatment and Relationship to Menopausal Status and Body Composition

BACKGROUND The relationship between thyroid status, including subclinical hypothyroidism (SH) and serum leptin is controversial or uncertain. Therefore we evaluated serum leptin in SH and overt hypothyroidism (OH) and determined the effects of levothyroxine (LT(4)) replacement on serum leptin in these disorders. METHODS Serum leptin, thyrotropin (TSH), free thyroxine, insulin, glucose, and body composition parameters were compared in 55 SH, 20 OH, and 28 euthyroid (EU) pre- and postmenopausal women. In addition, the effect of LT(4) treatment on serum leptin in SH and OH was assessed. RESULTS The mean +/- SD (median) serum leptin concentrations in the OH and SH groups were higher than in the EU group (35.1 +/- 27.2 [33.0] and 36.6 +/- 21.9 [30.6] ng/mL, respectively, vs. 23.2 +/- 19.3 [17.9] ng/mL, p = 0.011), but the difference was only significant in postmenopausal women. The body mass index (BMI), fat mass index (FMI), and the homeostasis model assessment-insulin resistance (HOMA-IR) index values were not different among these groups. In premenopausal women there was no correlation between leptin, BMI, or FMI and serum TSH levels (r(s) = 0.009, p = 0.474; r(s) = 0.043, p = 0.367; r(s) = 0.092, p = 0.232). In the postmenopausal women, the partial correlation coefficient between TSH and leptin was present, even when controlling for BMI (r(s) = 0.297, p = 0.042) and FMI (r(s) = 0.275, p = 0.050). LT(4) treatment was associated with a reduction of serum leptin concentrations in the OH group (p = 0.008). In SH group there were no differences between LT(4) replacement or no treatment, since a fall in serum leptin levels was detected in both SH subgroups, despite a more pronounced fall with LT(4) use. Treatment of the SH and OH groups with LT(4) did not influence HOMA-IR index or body composition. CONCLUSIONS Serum leptin concentrations are elevated in postmenopausal women with SH or OH. A relationship between thyroid status and serum leptin is further supported by the fact that LT(4) treatment, to restore the EU status, reduced serum leptin levels in OH in the absence of significant effects on BMI. In women, hypothyroidism influences either leptin secretion or degradation and this effect is more pronounced in postmenopausal than in premenopausal women.

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, Warringtons 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.

Perception of disability in a public health perspective: a model based on fuzzy logic

Measures of functional levels, commonly used to assess the safety and quality of life of individuals and populations, have not yet been derived from a fuzzy framework. The aim of this study is to estimate the degree of disability associated with varying functional levels, through a model based on fuzzy sets theory. A fuzzy linguistic model was developed to measure varying levels of functional disability, in accordance with the definitions of an individuals social and physical activities and mobility. One year of an adults life whose mobility, social and physical activities were somewhat limited, was judged to be equivalent to 0.575 years free of functional disability. Results obtained from the fuzzy model approach those obtained with the quality of well-being scale (QWB), used as a conceptual framework. Such findings are encouraging, since the QWB is considered a consistent and valid approach for disability assessment and quality-of-life evaluation.