ABSTRACT Objective: Selenium (Se) supplementation has been used to help prevent the progression of Graves’ ophthalmopathy (GO) and autoimmune thyroid diseases (AITD) patients. We investigated Se serum and selenoprotein P (SePP) levels in Graves’ disease (GD) with and without GO, Hashimoto's thyroiditis (HT) patients and in 27 control individuals (C). Subjects and methods: We studied 54 female and 19 male patients: 19 with GD without GO, 21 GD with GO, 14 with HT and 19 with HT+LT4. Se values were measured using graphite furnace atomic absorption spectrophotometry. Serum SePP levels were measured by ELISA. Results: Median Se levels were similar among all groups; GD patients: 54.2 (46.5-61.1 μg/L), GO: 53.6 (43.5-60.0 μg/L), HT: 51.9 (44.6-58.5 μg/L), HT+LT4 54.4 (44-63.4) and C group patients: 56.0 (52.4-61.5 μg/L); P = 0.48. However, serum SePP was lower in GO patients: 0.30 (0.15-1.05 μg/mL) and in HT patients: 0.35 (0.2-1.17 μg/mL) compared to C group patients: 1.00 (0.564.21 μg/mL) as well as to GD patients: 1.19 (0.62-2.5 μg/mL) and HT+LT4 patients: 0.7 (0,25-1.95); P = 0.002. Linear regression analysis showed a significant relationship between SePP and TPOAb values (r = 0.445, R2 = 0.293; P < 0.0001). Multiple regression analysis found no independent variables related to Se or SePP. Conclusion: A serum Se concentration was lower than in some other countries, but not significantly among AITD patients. The low serum SePP levels in GO and HT patients seems to express inflammatory reactions with a subsequent increase in Se-dependent protein consumption remains unclear.

CONTEXTO E OBJETIVO: A frequência de obesidade em idade precoce pode contribuir para a aterosclerose e doença cardiovascular (DCV) em adultos. Este estudo mediu a frequência de obesidade e fatores de risco cardiovascular em crianças e adolescentes com idades entre 6 e 17 anos.TIPO DE ESTUDO E LOCAL: Estudo transversal em escola localizada numa região de baixa renda e baixo nível socioeconômico em Santa Rita do Sapucaí, Minas Gerais, Brasil.MÉTODOS: Um total de 175 alunos foi classificado pelo índice de massa corporal (IMC) e foram aferidas circunferência da cintura, pressão arterial, horas de sedentarismo e alimentação escolar. Realizaram-se dosagens séricas de glicemia de jejum, colesterol total (CT), triglicerídeos (TG), lipoproteína de baixa densidade (LDL-C) e lipoproteína de alta densidade (HDL-C).RESULTADOS: 37,2% dos alunos tinham IMC acima do percentil 85 e apresentaram idade significativamente menor, prevalência mais alta de hipertensão, CT sérico, LDL-C e TG elevados e maior circunferência abdominal em comparação com aqueles com IMC abaixo do percentil 85. Observou-se hipertensão em 2,9% dos estudantes, 5,1% apresentavam tolerância à glicose diminuída, 40% tinham dois fatores de risco para aterosclerose, e 26,9% tinham três fatores de risco. O sedentarismo foi significativamente menor em indivíduos com IMC acima do percentil 85 e foi significativamente correlacionado com as concentrações séricas de CT e LDL-C. A merenda escolar estava hipoglicêmica, hiperproteica e hiperlipídica.CONCLUSÃO: Um terço das crianças e adolescentes avaliados tinham pesos iguais ou superiores ao peso ajustado à idade, e isso foi associado a maiores circunferência abdominal, hipertensão e prevalência de dislipidemia.

CONTEXT AND OBJECTIVE: The frequency of obesity at an early age may contribute to atherosclerosis and cardiovascular disease (CVD) in adults. This study measured the frequency of obesity and cardiovascular risk factors in children and adolescents aged 6 to 17 years.DESIGN AND SETTING: Cross-sectional study in a school located in a region of low income and socioeconomic status in Santa Rita do Sapucai, Minas Gerais, Brazil.METHODS: A total of 175 students were classified using body mass index (BMI) and their waist circumference, blood pressure, number of hours of sedentary behavior and school meals were evaluated. Serum concentrations of fasting blood glucose, total cholesterol (TC), triglycerides (TG), low-density lipoprotein (LDL-C) and high-density lipoprotein (HDL-C) were analyzed.RESULTS: 37.2% of the students had BMI above the 85th percentile and had significantly lower age, higher prevalence of hypertension, higher serum TC, LDL-C and TG, and greater waist circumference than those with BMI below the 85th percentile. Hypertension was observed in 2.9% of the students; 5.1% presented impaired glucose tolerance, 40% had two risk factors for atherosclerosis and 26.9% had three risk factors. A sedentary lifestyle was significantly less prevalent among subjects with BMI above the 85thpercentile and was significantly correlated with serum TC and LDL-C. The school meals were hypoglycemic, hyperproteic and hyperlipidemic.CONCLUSION: One third of the children and adolescents had weights greater than or equal to the age-adjusted weight, and this was associated with greater waist circumference, hypertension and prevalence of dyslipidemia.

OBJETIVO: Avaliar a alteração de peso durante o tratamento do hipertiroidismo e correlacioná-la com IL-6 e TNF-alfa. SUJEITOS E MÉTODOS: Quarenta e dois pacientes foram incluídos. Peso corporal (PC), índice de massa corpórea (IMC), características clínicas e laboratoriais foram registrados. IL-6 e TNF-alfa foram determinados antes do tratamento com metimazol (MMI) e no estado de eutiroidismo. RESULTADOS: O PC foi de 59,62 ± 11,5 kg no estado de hipertiroidismo e de 69,91 ± 14,4 kg no estado de eutiroidismo (p < 0,001). O IMC aumentou de 23,1 ± 3,8 kg/m² para 27 ± 4,7 kg/m² durante o tratamento (p < 0,0001). Antes da terapia, 66,6% tinham IMC < 25 kg/m² e 33,3%, IMC > 25 kg/m². No estado de eutiroidismo, 38% dos pacientes apresentavam IMC < 25 kg/m² e 62%, IMC > 25 kg/m² (p = 0,01). No estado de eutiroidismo, encontrou-se significativa diminuição nos valores de IL-6 e TNF-alfa, mas nenhuma correlação entre IL-6 e TNF-alfa com PC ou IMC. CONCLUSÃO: Um importante aumento no PC e IMC foi observado durante o tratamento do hipertiroidismo e alterações de IL-6 e TNF-alfa relacionam-se somente com o retorno ao eutiroidismo.

OBJECTIVE: To evaluate weight change during hyperthyroidism treatment, and to correlate it with IL-6 and TNF-alpha concentrations. SUBJECTS AND METHODS: Forty two patients were included. Body weight (BW), body mass index (BMI), clinical and laboratory characteristics were recorded. IL-6 and TNF-alpha were determined before treatment with methimazole (MMI) and in euthyroidism. RESULTS: BW was 59.62 ± 11.5 kg in hyperthyroidism, and 69.91 ± 14.4 kg in euthyroidism (p < 0.001). BMI increased from 23.1 ± 3.8 kg/m² to 27 kg/m² ± 4.7 during treatment (p < 0.0001). Before treatment, 66.6% subjects had BMI < 25 kg/m² and 33.3%, BMI > 25 kg/m². In euthyroidism, 38% of patients had BMI < 25 kg/m² and 62%, BMI > 25 kg/m² (p = 0.01). In euthyroidism, we found a significant reduction in IL-6 and TNF-alpha concentrations, but no correlation between IL-6 and TNF-alpha, and BW or BMI. CONCLUSION: An important increase in BW and BMI was observed during hyperthyroidism treatment, and IL-6 and TNF-alpha alterations were only related with return to euthyroidism.

Hipotiroidismo subclínico (SHT) e hipertiroidismo subclínico (SCH) são definidos pelas concentrações normais de T4 e T3 livres séricos associadas com valores de TSH elevado (SHT) ou suprimido (SCH). As prevalências são baixas e sintomas e sinais de disfunção tiroideana escassos. No SHT, colesterol total e LDL-C estão ligeiramente elevados, e tratamento com levotiroxina pode influir nos valores dos lipídeos. Ocorre diminuição da contratilidade do miocárdio e aumento da resistência vascular periférica, que melhoram com o tratamento. Fibrilação atrial é mais freqüente no SCH, e há aumento do índice de massa do ventrículo esquerdo, da contratilidade cardíaca, disfunção diastólica e indução de batimentos atriais ectópicos que regridem com uso de beta-bloqueadores. No SCH, ocorre diminuição da densidade óssea. Depressão, doença do pânico e alterações de testes cognitivos são freqüentes no SHT. O tratamento do SHT é indicado com TSH sérico maior do que 8mU/L e presença de anticorpos antitiroideanos, e do SCH endógeno, quando existem sintomas, em idosos ou concentração de TSH menor do que 0,1mU/L.

Subclinical hypothyroidism (SHT) and subclinical hyperthyroidism (SCH) are defined as normal serum free T4 and T3 levels associated with elevated (SHT) or subnormal (SCH) serum TSH levels, respectively. Symptoms and signs of thyroid dysfunction are scarce. The prevalence is low. In SHT, total cholesterol and LDL-C are modestly elevated and levothyroxine may influence the lipids levels. There is decreased cardiac contractility and increased peripheral vascular resistance that improve with treatment. SCH is associated with atrial fibrillation, increased cardiac contractility and left ventricular mass, diastolic and systolic dysfunction that can be reversed with beta-adrenergic antagonists. Bone density is reduced in SCH. Depression, panic disorders and alterations in cognitive testing are frequent in SHT. Treatment of SHT is recommended for serum TSH levels greater than 8mU/L and presence of thyroid antibodies. Endogenous SCH should be treated for serum TSH levels less than 0.1mU/L, in the presence of symptoms and in elderly patents.