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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.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.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.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.

Paciente masculino, 31 anos, internado com quadro de dor abdominal, náuseas, vômitos, icterícia e febre, iniciado há duas semanas. História de hipertireoidismo e tratamento irregular com propiltiuracil há dois anos, interrompeu a medicação quando iniciou o quadro atual. Apresentava bócio difuso, cerca de 120 g, T4L 22,7 ng/dL (VN 0,8-1,9 ng/dL); TSH < 0,002 µUI/mL (VN 0,4-5 µUI/mL). Transaminases, bilirrubinas total e direta séricas elevadas. Foi mantido sem antitireoidiano e iniciado propranolol até a dose de 480 mg/dia. Ultra-sonografia de abdome foi normal e sorologias para hepatites A, B e C indicaram infecção aguda por vírus B. Ocorreu piora da função hepática e manutenção de níveis elevados de hormônios tireoidianos. Visando evitar necessidade futura de antitireoidiano, obter rápida normalização dos níveis de hormônios tireoidianos e em virtude do tamanho do bócio foi indicado tireoidectomia. O paciente foi submetido a uma sessão de plasmaférese terapêutica, imediatamente antes da cirurgia, e tireoidectomia subtotal sem intercorrências. No quinto dia após a cirurgia, o paciente apresentava melhora da função hepática e baixos níveis séricos de T4 livre. Concluímos que o hipertireoidismo prévio pode exacerbar e perpetuar a disfunção hepática causada por hepatite viral aguda e que a plasmaférese é um meio rápido, seguro e eficaz de reduzir os níveis de hormônio tireoidiano, permitindo uma tireoidectomia bem-sucedida em pacientes com tireotoxicose grave.

OBJECTIVE: To determine the consumption of slimming pills (SP) and its association with TSH levels. RESEARCH METHODS AND PROCEDURES: A survey was carried out in Rio de Janeiro (about 5 million inhabitants), Brazil, from June 2004 to April 2005. Households (1,500) were selected using three-stage probability sampling. Women were asked about use of SP, and blood sample was collected. Women were classified as users of SP any time in life, but not in previous two months (n = 293), current users (n = 150), and never users (n = 853). Weighted multivariate regression analyses compared TSH levels among these groups of users. RESULTS: The frequency of use of SP any time in life was 34% and the use in the previous two months was 11%. Both frequencies were greater among younger and obese women, and among those of high socioeconomic level (p-value < 0.001). TSH level was statistically lower among current users of SP (1.96 mUI/ml; 95%CI = 1.93-1.98) compared to previous users 2.83 mUI/ml (95%CI = 2.13-3.02) and never users 2.59 mUI/ml (95%CI = 2.20-3.21). These differences were still statistically significant after adjusting for age and body mass index. CONCLUSIONS: Use of SP decreased TSH levels among Brazilian women.

O hipotireoidismo subclínico (HS) já foi associado a aumento do risco cardiovascular. Na avaliação desse risco, a medida da espessura íntima-média (EIM) carotídea por ultra-sonografia é capaz de detectar alterações iniciais da aterosclerose. O objetivo deste estudo foi avaliar a EIM carotídea em pacientes com HS e sua associação com um provável aumento do risco cardiovascular. Não foi encontrada diferença significativa nas medidas da EIM das pacientes com HS e das controles. Os resultados encontrados nos dois grupos estudados foram, respectivamente: 0,573 ± 0,070 mm vs. 0,576 ± 0,068 mm para as carótidas comuns (p= 0,904) e 0,602 ± 0,079 mm vs. 0,617 ± 0,102 mm para as bifurcações (p= 0,714). Mesmo após estratificação das pacientes de acordo com o TSH e com a presença ou não de auto-imunidade, a diferença entre os sub-grupos permaneceu sem significância estatística. As medidas da EIM nesses grupos nos sítios avaliados foram: TSH 4-8 mUI/L: 0,579 ± 0,070 mm e 0,586 ± 0,063 mm; TSH > 8 mUI/L: 0,569 ± 0,073 mm e 0,616 ± 0,091 mm; anti-TPO+: 0,585 ± 0,070 mm e 0,621 ± 0,085 mm; anti-TPO-: 0,554 ± 0,072 mm e 0,571 ± 0,066 mm. Também não houve diferença no lipidograma e nas dosagens de apoproteína B e de lipoproteína (a). Este fato sugere que o HS, quando leve, sem alterações metabólicas associadas, não promove aumento do risco cardiovascular.

Thyrotoxicosis is confirmed by high serum total or free triiodothyronine (T3/FT3) and thyroxine (T4/FT4) and low serum thyrotropin (TSH) concentrations. In endemic areas, a predominant increase of T3 with normal or low T4 and FT4 can be found, referred to as "T3-thyrotoxicosis". One variant, known as "free T3-toxicosis" has recently been described presenting subnormal serum TSH, normal FT4 and total T3 concentrations, but high serum FT3. Thyrotoxicosis increases bone turnover, especially resorption, with bone loss and increases fracture rates; involves the cardiovascular system both in systemic hemodynamics and T3-mediated effects on cardiac myocite-specific gene expression. Detecting T3- thyrotoxicosis is important because of the high morbidity, increased risk of osteoporosis and arrythmias. Thus, the early diagnosis and treatment of the hyperthyroidism can prevent complications. We studied three patients with criteria for T3-toxicosis - one of them with FT3 toxicosis. They live in areas with adequate iodine intake and all three present with diffuse goiter. Because the screening for thyroid diseases only measures FT4 and TSH, we suggest that patients with subnormal TSH levels and normal FT4 should be worked up with measurement of total T3. If normal, a FT3 can be obtained to identify FT3 toxicosis. The study of such cases must continue to provide valuable insights into the thyrotoxicosis.

Realizamos ultra-sonografia pélvica em tempo real e de alta resolução em 140 meninas com idade entre dois e 18 anos, para descrever a prevalência de ovários policísticos durante o desenvolvimento puberal normal. O volume dos ovários foi calculado e sua estrutura classificada como homogênea, microcística, multicística, policística e folicular. O volume aumentou e a freqüência das classes ovarianas variou de acordo com o status puberal. Os ovários eram de aspecto policístico em 8% (duas meninas pré-puberais e nove pós-puberais), com volume normal em 8/11 pacientes. Consideramos que a utilização do volume como critério diagnóstico de ovários policísticos pode ser de difícil interpretação durante este período e enfatizamos a importância da avaliação da ecogenicidade do estroma pelo ultra-som. Uma hipótese atrativa, mas que necessita de confirmação através de estudos longitudinais, é se essas meninas com ovários policísticos na ultra-sonografia serão destinadas, em alguns casos, a tornar-se adultas com a síndrome dos ovários policísticos.Real-time high-resolution ultrasonography of the pelvic organs was performed in 140 healthy females aged 2-18 years. The aim of this study was to establish the prevalence of polycystic ovaries during normal pubertal development. The volume of the ovaries was calculated and ovarian structure was classified as homogeneous, microcystic, multycystic, polycystic and follicular. The volume of the ovaries increased and the ovarian structure varied according to sexual development. The ovaries exhibited a polycystic appearance in 8% of the cases (two prepubertal and nine postpubertal girls). The volume of the ovaries was normal in 8/11 patients with polycystic ovaries. We consider that the using of the volume of the ovaries as a diagnostic criterion for polycystic ovaries is difficult to interpret and we emphasize the importance of the evaluation of the ovarian stroma with ultrasound. An attractive hypothesis that needs confirmation by longitudinal studies is wether girls with ultrasound diagnosed polycystic ovaries are at risk of developing polycystic ovarian syndrome in adulthood.

Realizamos ultra-sonografia pélvica em tempo real e de alta resolução em 140 meninas com idade entre dois e 18 anos, para descrever a prevalência de ovários policísticos durante o desenvolvimento puberal normal. O volume dos ovários foi calculado e sua estrutura classificada como homogênea, microcística, multicística, policística e folicular. O volume aumentou e a freqüência das classes ovarianas variou de acordo com o status puberal. Os ovários eram de aspecto policístico em 8% (duas meninas pré-puberais e nove pós-puberais), com volume normal em 8/11 pacientes. Consideramos que a utilização do volume como critério diagnóstico de ovários policísticos pode ser de difícil interpretação durante este período e enfatizamos a importância da avaliação da ecogenicidade do estroma pelo ultra-som. Uma hipótese atrativa, mas que necessita de confirmação através de estudos longitudinais, é se essas meninas com ovários policísticos na ultra-sonografia serão destinadas, em alguns casos, a tornar-se adultas com a síndrome dos ovários policísticos. Real-time high-resolution ultrasonography of the pelvic organs was performed in 140 healthy females aged 2-18 years. The aim of this study was to establish the prevalence of polycystic ovaries during normal pubertal development. The volume of the ovaries was calculated and ovarian structure was classified as homogeneous, microcystic, multycystic, polycystic and follicular. The volume of the ovaries increased and the ovarian structure varied according to sexual development. The ovaries exhibited a polycystic appearance in 8% of the cases (two prepubertal and nine postpubertal girls). The volume of the ovaries was normal in 8/11 patients with polycystic ovaries. We consider that the using of the volume of the ovaries as a diagnostic criterion for polycystic ovaries is difficult to interpret and we emphasize the importance of the evaluation of the ovarian stroma with ultrasound. An attractive hypothesis that needs confirmation by longitudinal studies is wether girls with ultrasound diagnosed polycystic ovaries are at risk of developing polycystic ovarian syndrome in adulthood.

Subclinical hypothyroidism (SHT) is a disease for which exact therapeutic approaches have not yet been established. Previous studies have suggested an association between SHT and coronary heart disease. Whether this association is related to SHT-induced changes in serum lipid levels or to endothelial dysfunction is unclear. The aim of this study was to determine endothelial function measured by the flow-mediated vasodilatation of the brachial artery and the carotid artery intima-media thickness (IMT) in a group of women with SHT compared with euthyroid subjects. Triglycerides, total cholesterol, HDL-C, LDL-C, apoprotein A (apo A), apo B, and lipoprotein(a) were also determined. Twenty-one patients with SHT (mean age: 42.4 +/- 10.8 years and mean thyroid-stimulating hormone (TSH) levels: 8.2 +/- 2.7 microIU/mL) and 21 euthyroid controls matched for body mass index, age and atherosclerotic risk factors (mean age: 44.2 +/- 8.5 years and mean TSH levels: 1.4 +/- 0.6 microIU/mL) participated in the study. Lipid parameters (except HDL-C and apo A, which were lower) and IMT values were higher in the common carotid and carotid bifurcation of SHT patients with positive serum thyroid peroxidase antibodies (TPO-Ab) (0.62 +/- 0.2 and 0.62 +/- 0.16 mm for the common carotid and carotid bifurcation, respectively) when compared with the negative TPO-Ab group (0.55 +/- 0.24 and 0.58 +/- 0.13 mm, for common carotid and carotid bifurcation, respectively). The difference was not statistically significant. We conclude that minimal thyroid dysfunction had no adverse effects on endothelial function in the population studied. Further investigation is warranted to assess whether subclinical hypothyroidism, with and without TPO-Ab-positive serology, has any effect on endothelial function.