Screening for thyroid disorders in asymptomatic adults from Brazilian populations
Palavras-chave:
Hipotireoidismo, Sub-clínico, Sintomas, Doenças da tireóide, Doenças cardiovascularesResumo
O avanço no diagnóstico das doenças da tireóide criou uma nova categoria de doenças representada pelo hipertireoidismo e hipotireoidismo subclínicos. Na década de 80, surgiram os métodos imunométricos para dosagem da tireotropina (TSH) considerados os mais custo-efetivos para o rastreamento de doenças da tireóide. O segundo passo no rastreamento das doenças da tireóide é a determinação dos níveis séricos de tiroxina, e vários métodos custo-efetivos estão disponíveis no mercado. Usando-se o TSH e a tiroxina é possível diagnosticar quatro situações clínicas: hipotireoidismo e hipertireoidismo e hipotireoidismo subclínico e hipertireoidismo subclínico. O hipotireoidismo subclínico pode ser um fator de risco muito importante para doença cardiovascular em mulheres idosas. A mortalidade cardiovascular nas mulheres brasileiras é uma das mais elevadas do mundo ocidental. Os fatores de risco para doença cardiovascular mais conhecidos são tabagismo, hipercolesterolemia, hipertensão arterial e diabetes mellitus. Esses fatores, tidos como primários, podem ser conseqüência de fatores de risco primordiais como pode ser o caso do hipotireoidismo subclínico. A detecção precoce de doenças da tireóide em mulheres com mais de 50 anos pode ser uma opção custo-efetiva na prevenção das doenças cardiovasculares nas mulheres brasileiras.
Downloads
Referências
Lotufo PA. Premature mortality from heart diseases in Brazil. A comparison with other countries. Arq Bras Cardiol 1998;70:321-5.
Preventive Services Task Force. Guide to clinical preventive serv- ices. 2nd ed. Baltimore: Williams & Wilkins; 1996.p.209-18.
Vanderpump MP, Allquist JA, Franklyn JA, et al. Consensus statement for good practice and audit measures in the manage- ment of hypothyroidism and hyperthyroidism. BMJ 1996;313:539-44.
Ladenson PW, Singer PA, Ain KB, et al. American Thyroid Association guidelines for detection of thyroid dysfunction. Arch Intern Med 2000;160:1573-5.
Clinical practice guidelines for the evaluation and treatment of hyperthyroidism and hypothyroidism. Jacksonville: American Association of Clinical Endocrinologists; 1996.
Glenn GC. Practice parameter on laboratory panel testing for screening and case finding in asymptomatic adults. Laboratory Testing Task Force of the College of the American Pathologists. Arch Pathol Lab Med 1996 Oct;120(10):929-43.
Periodic Health Examination: summary of AAFP policy rec- ommendations and age charts, revision 4.0. Kansas City: Ameri- can Academy of Family Physicians; 2000.
American College of Physicians. Screening for thyroid diseases. Annals Intern Med; 1998.p.141-3. Part I.
American College of Physicians. Screening for thyroid diseases. Annals Intern Med 1998;129:143-58. Part II.
An update in obstetrics and gynecology: primary & preventive care. Washington: American College of Obstetrics and Gynecology; 1998.
Cooper DS. Subclinical hypothyroidism. N Engl J Med 2001;345:260-5
Toft AD. Subclinical hyperthyroidism. N Engl J Med 2001;345:512-6.
Tunbridge WMG, Evered DC, Hall R, et al. The spectrum of thyroid disease in a community: the Whickham Survey. Clin Endocrinol 1977;7:481-93.
Vanderpump MPJ, Tunbridge WMG, French JM, et al. The incidence of thyroid disorders in the community: a twenty-year follow-up of the Whickham Survey. Clin Endocrinol 1995;43:55-68.
Sawin CT, Castelli WP, Hershman JM, McNamara P, Bacharat P. The aging thyroid. Arch Intern Med 1985;145:1386-8.
Klee GG, Hay ID. Biochemical test of thyroid function. Endocrinol and Metab Clinics of North America 1997;26:763-75.
Eggertsen R, Petersen K, Lundberg PA, Nyström E, Lindstedt G. Screening for thyroid disease in a primary care unit with a thyroid stimulating hormone assay with a low detection limit. BMJ 1988;297:1586-92.
Petersen K, Lindstedt G, Lundberg PA, Bengtsson C, Lapidus L, Nyström E. Thyroid disease in middle-aged and elderly Swed- ish women: thyroid-related hormones, thyroid dysfunction and goiter in relation to age and smoking. J Intern Med 1991;229:407-13.
Parle JV, Franklyn JA, Cross KW, Jones SC, Sheppard MC. Prevalence and follow-up of abnormal thyrotropin levels (TSH) concentrations in the elderly in the United Kingdom. Clin Endocrinol (Oxf ) 1991;34:77-83.
Sawin CT, Geller A, Wolf PA, et al. Low serum thyrotropin concentrations as a risk factor for atrial fibrillation in older per- sons. N Eng J Med 1994;331:1249-52.
Parle JV, Maisonneuve P, Sheppard MC, Boyle P, Franklyn JA. Prediction of all-cause and cardiovascular mortality in elderly people from one low serum thyrotropin result: a 10-year co- hort study. Lancet 2001;358:861-5.
Füldes J, Tarján G, Szathmari M, et al. Bone mineral density in patients with endogenous subclinical hyperthyroidism: is the thyroid status a risk factor for osteoporosis? Clin Endocrinol (Oxf ) 1993;39:521-7.
Mudde AH, Reijnders FJ, Kruseman AC. Peripheral bone den- sity in women with untreated multinodular goiter. Clin Endocrinol (Oxf ) 1992;37:35-9.
Bauer DC, Ettinger B, Newitt MC, Stone KL, Cummings SR. Women with low serum TSH have an increased risk of hip and vertebral fractures: a prospective study. The Study of Osteoporotic Fractures Research Group. J Bone Miner Res; 1995.p.10.
Tofi AD. Thyroxine Therapy. N Engl J Med 1994;331:1035.
Franklyn JA, Berteridge J, Dykin J, et al. Long-term thyroxine treatment and bone mineral density. Lancet 1992;1340:9-13.
Cooper DS, Halpern R, Wood LC, et al. L-thyroxine therapy in subclinical hypothyroidism. A double-blind, placebo-controlled trial. Ann Inter Med 1984;101:18-24.
Nyström E, Caidahl K, Fager G, et al. A double-blind crossover 12-month study of a L-thyroxine treatment of women with “sub- clinical” hypothyroidism. Clin Endocrinol (Oxf) 1988;29:63-75.
Jaeschke R, Guyatt G, Gerstein H, et al. Does treatment with L-thy- roxine influence health status in middle-aged and older adults with subclinical hypothyroidism? J Gen Intern Med 1996;11:744-9.
Kong WM, Scheikh M, Lumb P, et al. A randomized control- led trial of thyroxine treatment in mild subclinical hypothy- roidism. In: Program & Abstracts: the Endocrine Society’s 82nd Annual Meeting, Toronto, June 21-24, 2000. Bethesda, Md.: Endocrine Society Press; 2000. p.597. Abstract.
Meier C, Roth CB, Huber G, et al. Clinical and metabolic ef- fects of thyroxine replacement in patients with mild thyroid failure: results from a double-blind placebo-controlled study. In: Program & Abstracts: the Endocrine Society’s 82nd Annual Meeting, Toronto, June 21-24, 2000. Bethesda, Md.: Endo- crine Society Press; 2000. p.573. Abstract.
Danese MD, Powe NR, Sawin CT, et al. Screening for mild thyroid failure at the periodic health examination: a decision and cost-effectiveness analysis. JAMA 1996;276:285-92.
Tanis BC, Westendorp GJ, Smelt HM. Effect of thyroid substi- tution on hypercholesterolemia in patients with subclinical hy- pothyroidism: a reanalysis of intervention studies. Clin Endocrinol (Oxf ); 1996;44: 643-9.
Hak AE, Pols HAP, Visser TJ, et al. Subclinical hypothyroidism is an independent risk factor for atherosclerosis and myocardial infarction in elderly women: the Rotterdam Study. Ann Intern Med 2000;132:270-8.
Muller B, Zulewski H, Huber P, et al. Impaired action of thy- roid hormone associated with smoking in women with hypo- thyroidism. New Engl J Med 1995;15:964-9.
Stamler J, Fortmann SP, Levy RI, Prineas RJ, Tell G. Primordial prevention of cardiovascular disease risk factors: panel summary. Prev Med 1999;29(6 Pt 2):S130-5.
Bosma H, Peter R, Siegrist J, Marmot M. Two alternative job stress models and the risk of coronary heart disease. Am J Pub- lic Health 1998;88:68-74.
Kaplan GA, Keil JE. Socioeconomic factors and cardiovascular disease: a review of the literature. Circulation 1993;88(4 Pt 1):1973-98.
Murata M, Kawano K, Matsubara Y, Ishikawa K, Watanabe K, Ikeda Y. Genetic polymorphisms and risk of coronary artery disease. Semin Thromb Hemost 1998;24:245-50.
Bisi H, Fernandes VSO, Camargo RAC, Kock L, Abdo AH, Brito T. The prevalence of unsuspected thyroid pathology in 300 sequential autopsies, with special reference to the inciden- tal carcinoma. Cancer 1989;64:1888-93.
Bisi H, Fernandes VSO, Camargo RYA, Longatto Filho A, Ruggeri GB, Abdo AH. Neoplastic and non-neoplastic thyroid lesions in surgical material: historical review of five decades in São Paulo, Brazil. Tumori 1995;81:61-6.
Knobel M, Barca MF, Pedrinola F, Medeiros-Neto G. Preva- lence of anti-thyroid peroxidase antibodies in autoimmune and non-autoimmune thyroid disorder in a relatively low-iodine environment. J Endocrinol Invest 1994;17:837-42.
Tomimori E, Pedrinola F, Cavalieri H, Knobel M, Medeiros- Neto G. Prevalence of incidental thyroid disease in a relatively low iodine intake area. Thyroid 1995;5:273-6.
Grodstein F, Stampfer MJ, Colditz GA, et al. Postmenopausal hor- mone therapy and mortality. N Engl J Med 1997;336:1769-75.
Hulley S, Grady D, Bush T, et al. Randomized trial of estrogen plus progestin for secondary prevention of coronary heart dis- ease in postmenopausal women. Heart and Estrogen Progestin Replacement Study (HERS) Research Group JAMA 1998;280:605-13.
Women’s Health Initiative. WHI HRT Update, April, 2000 (mimeo). Unpublished data.
Hay JW, Yu WM, Ashraf T. Pharmacoeconomics of lipid-low- ering agents for primary and secondary prevention of coronary artery disease. Pharmacoeconomics 1999;15:47-74.
Hagerty JJ, Stern RA, Mason GA, et al. Subclinical hypothy- roidism: a modifiable risk factor for depression? Am J Psychiatr 2000;132:270-8.
Lotufo PA. Non-communicable diseases in Brazil: mortality patterns, morbidity studies and risk factors. Arch Latinoam Nutr 1997;47(2 Suppl 1):25-9.
Downloads
Publicado
Como Citar
Edição
Seção
Licença
Este trabalho está licenciado sob uma licença Creative Commons Attribution 4.0 International License.
