Introdução: As disfunções tireoidianas subclínicas são comuns na prática clínica, particularmente entre mulheres de meia idade. Existem algumas evidências de que as disfunções tireoidianas subclínicas podem afetar o risco cardiovascular de forma negativa, além de afetar a qualidade de vida e produzir sintomas somáticos e psicológicos. Entretanto ainda existe muita controvérsia sobre se o tratamento destas disfunções afeta positivamente algum desfecho clínico e se estaria indicado realizar um rastreamento populacional destas disfunções. Objetivo: Este estudo teve como objetivo determinar a freqüência das disfunções tireoidianas subclínicas e sua associação com fatores de risco cardiovasculares tradicionais e com alguns fatores psico-sociais em mulheres com 40 anos ou mais em seu local de trabalho. Métodos: Estudo transversal de rastreamento com funcionárias da Universidade de São Paulo com 40 anos ou mais. Todas as participantes foram entrevistadas e responderam a quatro questionários específicos validados [um questionário sobre características sócio-demográficas, o questionário de angina de Rose, o Short Form Health Survey - 36 (SF-36) e o Self-Report Questionnaire (SRQ-20)], foram submetidas a mensuração de medidas antropométricas e da pressão arterial e tiveram uma amostra de sangue colhida para avaliação de função tireoidiana (TSH e T4-livre) e anticorpos antitireoperoxidase (anti-TPO), glicemia de jejum e colesterol total, LDL-colesterol e HDL-colesterol. Em uma subamostra do estudo também foi dosada a proteína C ultra-sensível (hsCPR). As mulheres foram analisadas de acordo com seu estado funcional tireoidiano. Resultados: Das 736 funcionárias com 40 anos ou mais convidadas a participar, 314 (42,7%) aceitaram o convite. As freqüências de hipotireoidismo e hipertireoidismo subclínico foram, respectivamente, 7,3% e 5,1%. Anticorpos anti-tireoperoxidase positivos foram encontrados em 51 mulheres (16,2%). Níveis de TSH < 10 mIU/l estavam presentes em 78,3% das mulheres com hipotireoidismo subclínico. Não houve diferença nas características gerais, nos fatores de risco para doença cardiovascular, nos fatores psico-sociais nem, de uma forma geral, na qualidade de vida comparando-se as mulheres de acordo com sua função tireoidiana. Conclusão: Não se encontrou nenhuma associação entre disfunção tireoidiana subclínica e fatores de risco para doença cardiovascular. Não se encontrou nenhuma associação de disfunção tireoidiana subclínica e fatores psico-sociais (qualidade de vida, sintomas somáticos e psicológicos). Os resultados deste estudo transversal não suportam a prática de rastreamento rotineiro de disfunção tireoidiana subclínica. / Rational: Subclinical thyroid dysfunction is very common in clinical practice, particularly among middle-aged women. There is some evidence that subclinical thyroid dysfunction may affect cardiovascular risk in a negative fashion, and also affect quality of life and produce somatic and psychological symptoms. There remains much controversy as whether there should be a population based screening for these dysfunctions and whether treatment of these dysfunctions have any positive impact on clinical outcomes. Objective: The aim of this study was to determine the approximate frequency of subclinical thyroid dysfunction and its association with traditional cardiovascular risk factors as well as some psychosocial factors in women 40 years of age or older at the worksite. Methods: Cross-sectional screening study with women 40 years of age or older, working at the University of São Paulo. All the women answered four specific questionnaires [a questionnaire on socio-demographic characteristics, the Rose Angina Questionnaire, the Short Form Health Survey -36 (SF-36) and the Self- Report Questionnaire (SRQ-20)], had antropometric variables and blood pressure measured, and blood analyzed for total-cholesterol, LDL-cholesterol, HDL-cholesterol, tryglicerides, fasting glucose, thyroid-stimulating hormone (TSH), free-thyroxine (free-T4) and anti-thyreoperoxidase antibodies (anti-TPO). In a sub-sample of these women high-sensitive C reactive protein (hsCRP) was measured. Women were analyzed according to their thyroid function status. Results: Of the 736 women invited to participate, 314 (42.7%) accepted the invitation. The frequencies of subclinical hypothyroidism and subclinical hyperthyroidism were, respectively, 7.3% and 5.1%. Positive antibodies against thyreoperoxidase were present in 51 women (16.2%). TSH levels < 10 mIU/l were present in 78.3% of women with subclinical hypothyroidism. There was no difference in general characteristics, cardiovascular risk factors, psychosocial factors nor, in a general way, in quality of life among these women according to their thyroid function status. Conclusion: No association between cardiovascular risk factors and subclinical thyroid dysfunction was found. No association between subclinical thyroid dysfunction and psychosocial factors (quality of life, somatic and psychological symptoms) was found either. The results of this cross-section study do not support the routine screening of subclinical thyroid dysfunction.

Introdução: As disfunções tireoidianas subclínicas são comuns na prática clínica, particularmente entre mulheres de meia idade. Existem algumas evidências de que as disfunções tireoidianas subclínicas podem afetar o risco cardiovascular de forma negativa, além de afetar a qualidade de vida e produzir sintomas somáticos e psicológicos. Entretanto ainda existe muita controvérsia sobre se o tratamento destas disfunções afeta positivamente algum desfecho clínico e se estaria indicado realizar um rastreamento populacional destas disfunções. Objetivo: Este estudo teve como objetivo determinar a freqüência das disfunções tireoidianas subclínicas e sua associação com fatores de risco cardiovasculares tradicionais e com alguns fatores psico-sociais em mulheres com 40 anos ou mais em seu local de trabalho. Métodos: Estudo transversal de rastreamento com funcionárias da Universidade de São Paulo com 40 anos ou mais. Todas as participantes foram entrevistadas e responderam a quatro questionários específicos validados [um questionário sobre características sócio-demográficas, o questionário de angina de Rose, o Short Form Health Survey - 36 (SF-36) e o Self-Report Questionnaire (SRQ-20)], foram submetidas a mensuração de medidas antropométricas e da pressão arterial e tiveram uma amostra de sangue colhida para avaliação de função tireoidiana (TSH e T4-livre) e anticorpos antitireoperoxidase (anti-TPO), glicemia de jejum e colesterol total, LDL-colesterol e HDL-colesterol. Em uma subamostra do estudo também foi dosada a proteína C ultra-sensível (hsCPR). As mulheres foram analisadas de acordo com seu estado funcional tireoidiano. Resultados: Das 736 funcionárias com 40 anos ou mais convidadas a participar, 314 (42,7%) aceitaram o convite. As freqüências de hipotireoidismo e hipertireoidismo subclínico foram, respectivamente, 7,3% e 5,1%. Anticorpos anti-tireoperoxidase positivos foram encontrados em 51 mulheres (16,2%). Níveis de TSH < 10 mIU/l estavam presentes em 78,3% das mulheres com hipotireoidismo subclínico. Não houve diferença nas características gerais, nos fatores de risco para doença cardiovascular, nos fatores psico-sociais nem, de uma forma geral, na qualidade de vida comparando-se as mulheres de acordo com sua função tireoidiana. Conclusão: Não se encontrou nenhuma associação entre disfunção tireoidiana subclínica e fatores de risco para doença cardiovascular. Não se encontrou nenhuma associação de disfunção tireoidiana subclínica e fatores psico-sociais (qualidade de vida, sintomas somáticos e psicológicos). Os resultados deste estudo transversal não suportam a prática de rastreamento rotineiro de disfunção tireoidiana subclínica. / Rational: Subclinical thyroid dysfunction is very common in clinical practice, particularly among middle-aged women. There is some evidence that subclinical thyroid dysfunction may affect cardiovascular risk in a negative fashion, and also affect quality of life and produce somatic and psychological symptoms. There remains much controversy as whether there should be a population based screening for these dysfunctions and whether treatment of these dysfunctions have any positive impact on clinical outcomes. Objective: The aim of this study was to determine the approximate frequency of subclinical thyroid dysfunction and its association with traditional cardiovascular risk factors as well as some psychosocial factors in women 40 years of age or older at the worksite. Methods: Cross-sectional screening study with women 40 years of age or older, working at the University of São Paulo. All the women answered four specific questionnaires [a questionnaire on socio-demographic characteristics, the Rose Angina Questionnaire, the Short Form Health Survey -36 (SF-36) and the Self- Report Questionnaire (SRQ-20)], had antropometric variables and blood pressure measured, and blood analyzed for total-cholesterol, LDL-cholesterol, HDL-cholesterol, tryglicerides, fasting glucose, thyroid-stimulating hormone (TSH), free-thyroxine (free-T4) and anti-thyreoperoxidase antibodies (anti-TPO). In a sub-sample of these women high-sensitive C reactive protein (hsCRP) was measured. Women were analyzed according to their thyroid function status. Results: Of the 736 women invited to participate, 314 (42.7%) accepted the invitation. The frequencies of subclinical hypothyroidism and subclinical hyperthyroidism were, respectively, 7.3% and 5.1%. Positive antibodies against thyreoperoxidase were present in 51 women (16.2%). TSH levels < 10 mIU/l were present in 78.3% of women with subclinical hypothyroidism. There was no difference in general characteristics, cardiovascular risk factors, psychosocial factors nor, in a general way, in quality of life among these women according to their thyroid function status. Conclusion: No association between cardiovascular risk factors and subclinical thyroid dysfunction was found. No association between subclinical thyroid dysfunction and psychosocial factors (quality of life, somatic and psychological symptoms) was found either. The results of this cross-section study do not support the routine screening of subclinical thyroid dysfunction.

Objetivo: Valorar si existe asociación entre el hipotiroidismo subclínico y la resistencia a la insulina en pacientes no diabéticos de una clínica privada de Lima. Materiales y métodos: Se realizó un estudio observacional analítico de corte transversal. Se incluyeron como participantes a adultos que acudieron a consulta ambulatoria de endocrinología de una clínica privada de Lima en los años 2012 a 2018. Se excluyeron a los pacientes que previamente habían sido diagnosticados de diabetes o patologías tiroideas, que recibían alguna terapia con corticoides sistémicos o hipolipemiantes, o que estaban gestando. Las variables de estudio principales fueron hipotiroidismo subclínico y resistencia a la insulina, las cuales se trabajaron como variables categóricas. Para definir la variable hipotiroidismo subclínico se utilizaron los valores de TSH mayor o igual a 4.5 mU/L, y T4L en valores normales, mientras que la variable resistencia a la insulina se definió utilizando el valor de HOMA-IR mayor a 2.79. Asimismo, también se estudiaron otras variables como IMC, porcentaje de grasa corporal y sexo. Para valorar la asociación entre el hipotiroidismo subclínico y la resistencia a la insulina, se llevó a cabo un modelo lineal generalizado de la familia Poisson con varianza robusta crudo y ajustado. Se presentó como media de asociación a la razón de prevalencia (RP) con su intervalo de confianza al 95% Resultados: Se analizó 1389 pacientes, el promedio de edad fue 39.56 (13.54) años (SD) y el porcentaje de varones fue 25.87%. La prevalencia de HSC fue 13.17% (n=183) y la prevalencia de RI fue 40.4% en el grupo con HSC, y 46.2% en el grupo de eutiroideos. En el modelo de regresión crudo se encontró que los pacientes con HSC tenían un 12% menos probabilidades de tener RI en el análisis crudo (PR 0.876 IC 95%: 0.727-1.055) y 7% menos en el ajustado (PR 0.927, IC 95%: 0.792-1.084); no obstante, ninguno obtuvo una significancia estadística. Secundariamente, se encontró asociaciones entre RI con el IMC, porcentaje de grasa corporal y el sexo masculino. Conclusiones: En nuestra población de estudio no se encontró asociación entre hipotiroidismo subclínico y resistencia a la insulina. / Objective: To assess whether there is an association between subclinical hypothyroidism and insulin resistance in non-diabetic patients at a private clinic in Lima. Materials and methods: An analytical observational cross-sectional study was carried out. Participants were adults who attended the endocrinology outpatient clinic of a private clinic in Lima in the years 2012 to 2018. Patients who were previously diagnosed with diabetes or thyroid diseases, who received systemic corticosteroids, who took lipid-lowering drugs, were excluded. or that they were brewing. The main variables were subclinical hypothyroidism and insulin resistance, which were worked as categorical variables. To define the subclinical hypothyroidism variable, TSH values ​​greater than or equal to 4.5 mU / L and T4L were used in normal values, while the variable insulin resistance was defined using the HOMA-IR value greater than 2.79. Likewise, other variables such as BMI, percentage of body fat and sex were also studied. To assess the association between subclinical hypothyroidism and insulin resistance, a generalized linear model of the Poisson family with crude and adjusted robust variance was carried out. It was presented as an association measure to the prevalence ratio (PR) with its 95% confidence interval. Results: We analyzed 1389 patients, the average age was 39.56 (13.54) years (SD) and the % of men was 27.87%. The prevalence of HSC was 13.17% (n = 183) and the prevalence of IR was 40.4% in the HSC group and 46.2% in the non-HSC group. In the crude regression model, it was found that patients with HSC had a 12% lower probability of having IR in the crude analysis (PR 0.876 IC 95%: 0.727-1.055) and 7% less in the adjusted one (PR 0.927, IC 95%: 0.792-1.084); however, none obtained statistical significance. Secondarily, associations were found in IR with the IMC, percentage of body fat and male sex. Conclusions: In our study population there was no association between subclinical hypothyroidism and insulin resistance. / Tesis