Frequência das doenças subclínicas da tireóide e de fatores de risco para doença cardiovascular em mulheres em um local de trabalho
Palavras-chave:
Doenças da glândula tireóide, Hipotireoidismo, Hipertireoidismo, Fatores de risco, Doenças cardiovascularesResumo
Contexto E OBJETIVO: A doença tireoidiana subclínica é muito frequente na prática clínica e há evidências que sugerem associação com doença cardiovascular. O objetivo foi estabelecer a frequência das doenças subclínicas da tireóide e de fatores de risco para doença cardiovascular em mulheres no local de trabalho, bem como avaliar a associação da doença tireoidiana subclínica com fatores de risco para doença cardiovascular nessas mulheres. TIPO DE ESTUDO E LOCAL: Estudo transversal em 314 mulheres com 40 ou mais anos de idade que trabalham na Universidade de São Paulo. Métodos: Todas as mulheres responderam a questionário sobre características sócio-demográficas, fatores de risco para doença cardiovascular, questionário de angina de Rose, e foram realizadas medidas antropométricas e colhido sangue para dosagem de glicemia, colesterol total e frações, proteína C ultra-sensível, hormônio tireotrópico (TSH), tiroxina-livre (TS-livre) e anticorpos anti-tireoperoxidase. Resultados: As frequências de hipotireoidismo subclínico e de hipertireoidismo subclínico foram respectivamente de 7,3% e 5,1%. Os níveis de anticorpos antiperoxidase foram mais elevados nas mulheres com doença subclínica da tireoide comparadas às mulheres com função tireoidiana normal (P = 0,01). Não houve nenhuma diferença estatisticamente significativa entre os fatores sociodemográficos e de risco para doença cardiovascular entre os grupos exceto pela maior presença de sedentarismo entre as mulheres com hipotireoidismo subclínico. Restringir a comparação somente às mulheres com hipotireoidismo subclínico (TSH > 10 mIU/l) não mudou os resultados. Conclusão: Nesta amostra de mulheres, não houve nenhuma associação entre um perfil inadequado dos fatores de risco para doença cardiovascular e a presença de doença subclínica da tireóide que justificasse o rastreamento no local de trabalho.
Downloads
Referências
Helfand M; U.S. Preventive Services Task Force. Screening for subclinical thyroid dysfunction in nonpregnant adults: a summary of the evidence for the U.S. Preventive Services Task Force. Ann Intern Med. 2004;140(2):128-41.
Canaris GJ, Manowitz NR, Mayor G, Ridgway EC. The Colorado thyroid disease prevalence study. Arch Intern Med. 2000;160(4):526-34.
Hollowell JG, Staehling NW, Flanders WD, et al. Serum TSH, T(4), and thyroid antibodies in the United States population (1988-1994): National Health and Nutrition Examination Survey (NHANES III). J Clin Endocrinol Metab. 2002;87(2):489-99.
Díez JJ, Iglesias P. Spontaneous subclinical hypothyroidism in patients older than 55 years: an analysis of natural course and risk factors for the development of overt thyroid failure. J Clin Endocrinol Metab. 2004;89(10):4890-7.
Vanderpump MP, Tunbridge WM, French JM, et al. The incidence of thyroid disorders in the community: a twenty-year follow-up of the Whickham Survey. Clin Endocrinol (Oxf). 1995;43(1)55-68.
Vanderpump M. Subclinical hypothyroidism: the case against treatment. Trends Endocrinol Metab. 2003;14(6):262-6.
Chu JW, Crapo LM. The treatment of subclinical hypothyroidism is seldom necessary. J Clin Endocrinol Metab. 2001;86(10):4591-9.
Ladenson PW, Singer PA, Ain KB, et al. American Thyroid Association guidelines for detection of thyroid dysfunction. Arch Intern Med. 2000;160(11):1573-5.
Baskin HJ, Cobin RH, Duick DS, et al. American Association of Clinical Endocrinologists medical guidelines for clinical practice for the evaluation and treatment of hyperthyroidism and hypothyroidism. Endocr Pract. 2002;8(6):457-69.
U.S. Department of Health & Human Services. Agengy for Healthcare Research and Quality.
U.S. Preventive Services Task Force. Screening for thyroid disease. Available from: http:// www.ahrq.gov/clinic/uspstf/uspsthyr.htm. Accessed in 2009 (Dec 22).
Cooper DS. Clinical practice. Subclinical hypothyroidism. N Engl J Med. 2001;345(4):260-5.
Toft AD. Clinical practice. Subclinical hyperthyroidism. N Engl J Med. 2001;345(7):512-6.
Surks MI, Ortiz E, Daniels GH, et al. Subclinical thyroid disease: scientific review and guide- lines for diagnosis and management. JAMA. 2004;291(2):228-38.
Cooper DS. Thyroid disease in the oldest old: the exception to the rule. JAMA. 2004;292(21):2651-4.
Klein I, Ojamaa K. Thyroid hormone and the cardiovascular system. N Engl J Med. 2001;344(7):501-9.
Bengel FM, Nekolla SG, Ibrahim T, Weniger C, Ziegler SI, Schwaiger M. Effect of thyroid hor- mones on cardiac function, geometry, and oxidative metabolism assessed noninvasively by positron emission tomography and magnetic resonance imaging. J Clin Endocrinol Metab. 2000;85(5):1822-7.
Biondi B, Palmieri EA, Lombardi G, Fazio S. Effects of subclinical thyroid dysfunction on the heart. Ann Intern Med. 2002;137(11):904-14.
Hak AE, Pols HA, Visser TJ, Drexhage HA, Hofman A, Witteman JC. Subclinical hypothyroidism is an independent risk factor for atherosclerosis and myocardial infarction in elderly women: the Rotterdam Study. Ann Intern Med. 2000;132(4):270-8.
Danese MD, Ladenson PW, Meinert CL, Powe NR. Clinical review 115: effect of thyroxine therapy on serum lipoproteins in patients with mild thyroid failure: a quantitative review of the literature. J Clin Endocrinol Metab. 2000;85(9):2993-3001.
Meier C, Staub JJ, Roth CB, et al. TSH-controlled L-thyroxine therapy reduces cholesterol levels and clinical symptoms in subclinical hypothyroidism: a double blind, placebo-con- trolled trial (Basel Thyroid Study). J Clin Endocrinol Metab. 2001;86(10):4860-6.
Imaizumi M, Akahoshi M, Ichimaru S, et al. Risk of ischemic heart disease and all-cause mortality in subclinical hypothyroidism. J Clin Endocrinol Metab. 2004;89(7):3365-70.
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 cohort study. Lancet. 2001;358(9285):861-5.
Vanderpump MP, Tunbridge WM, French JM, et al. The development of ischemic heart disease in relation to autoimmune thyroid disease in a 20-year follow-up study of an English com- munity. Thyroid. 1996;6(3):155-60.
Gussekloo J, van Exel E, de Craen AJ, Meinders AE, Frölich M, Westendorp RG. Thyroid status, disability and cognitive function, and survival in old age. JAMA. 2004;292(21): 2591-9.
Sawin CT, Geller A, Wolf PA, et al. Low serum thyrotropin concentrations as a risk factor for atrial fibrillation in older persons. N Engl J Med. 1994;331(19):1249-52.
Biondi B, Cooper DS. The clinical significance of subclinical thyroid dysfunction. Endocr Rev. 2008;29(1):76-131.
Lotufo PA. Mortalidade precoce por doenças do coração no Brasil. Comparação com outros países [Premature mortality from heart diseases in Brazil. A comparison with other coun- tries]. Arq Bras Cardiol. 1998;70(5):321-5.
Lotufo PA. Non-communicable diseases in Brazil: mortality patterns, morbidity studies and risk factors. Arch Latinoam Nutr. 1997;47(2 Suppl 1):25-9.
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 Public Health. 1998;88(1):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(3):245-50.
Browner WS, Newman TB, Cummings SR, Hulley SB. Estimating sample size and power: the nitty-gritty. In: Hulley SB, Cummings SR, Browner WS, Grady D, Hearst N, Newman TB, editors. Designing clinical research. 2nd edition. Philadelphia: Lippincott Williams & Wilkins; 2001. p. 65-94.
Luepker RV, Evans A, McKeigue P, Reddy KS. Cardiovascular survey methods. 3rd edition. Geneva: World Health Organization; 2004.
Pearson TA, Mensah GA, Alexander RW, et al. Markers of inflammation and cardiovascular disease: application to clinical and public health practice: A statement for healthcare pro- fessionals from the Centers for Disease Control and Prevention and the American Heart Association. Circulation. 2003;107(3):499-511.
Surks MI, Goswami G, Daniels GH. The thyrotropin reference range should remain unchan- ged. J Clin Endocrinol Metab. 2005;90(9):5489-96.
Tunbridge WM, Evered DC, Hall R, et al. The spectrum of thyroid disease in a community: the Whickham survey. Clin Endocrinol (Oxf). 1977;7(6):481-93.
Helfand M, Redfern CC. Clinical guideline, part 2. Screening for thyroid disease: an update. American College of Physicians. Ann Intern Med. 1998;129(2):144-58.
Efstathiadou Z, Bitsis S, Milionis HJ, et al. Lipid profile in subclinical hypothyroidism: is L- thyroxine substitution beneficial? Eur J Endocrinol. 2001;145(6):705-10.
Staub JJ, Althaus BU, Engler H, et al. Spectrum of subclinical and overt hypothyroidism: effect on thyrotropin, prolactin, and thyroid reserve, and metabolic impact on peripheral target tissues. Am J Med. 1992;92(6):631-42.
Lindeman RD, Schade DS, LaRue A, et al. Subclinical hypothyroidism in a biethnic, urban community. J Am Geriatr Soc. 1999;47(6):703-9.
Kong WM, Sheikh MH, Lumb PJ, et al. A 6-month randomized trial of thyroxine treatment in women with mild subclinical hypothyroidism. Am J Med. 2002;112(5):348-54.
Christ-Crain M, Meier C, Guglielmetti M, et al. Elevated C-reactive protein and homocysteine values: cardiovascular risk factors in hypothyroidism? A cross-sectional and a double-blind, placebo-controlled trial. Atherosclerosis. 2003;166(2):379-86.
Jublanc C, Bruckert E, Giral P, et al. Relationship of circulating C-reactive protein levels to thyroid status and cardiovascular risk in hyperlipidemic euthyroid subjects: low free thyroxi- ne is associated with elevated hsCRP. Atherosclerosis. 2004;172(1):7-11.
Kvetny J, Heldgaard PE, Bladbjerg EM, Gram J. Subclinical hypothyroidism is associated with a low-grade inflammation, increased triglyceride levels and predicts cardiovascular disease in males below 50 years. Clin Endocrinol (Oxf). 2004;61(2):232-8.
Pearce EN, Bogazzi F, Martino E, et al. The prevalence of elevated serum C-reactive pro- tein levels in inflammatory and noninflammatory thyroid disease. Thyroid. 2003;13(7): 643-8.
Jung CH, Sung KC, Shin HS, et al. Thyroid dysfunction and their relation to cardiovascular risk factors such as lipid profile, hsCRP, and waist hip ratio in Korea. Korean J Intern Med. 2003;18(3):146-53.
Hueston WJ, King DE, Geesey ME. Serum biomarkers for cardiovascular inflammation in subclinical hypothyroidism. Clin Endocrinol (Oxf). 2005;63(5):582-7.
Downloads
Publicado
Como Citar
Edição
Seção
Licença
Este trabalho está licenciado sob uma licença Creative Commons Attribution 4.0 International License.
