Skeletal Muscle Dysfunction in Patients with Subclinical Hypothyroidism

The main objective of this study is to evaluate skeletal muscle dysfunction in sHT. 31 outpatients from HUCFF-UFRJ (29 women and 2 men aging between 18 and 75 years old) with 2 elevated TSH determinations were included. All of them were classified according to Billewicz’s score modified by Zulewski. Manual muscle testing was performed for a variety of muscle groups and quadriceps isometric strength was measured by an electromechanic chair dynamometer. The inspiratory force was estimated by the maximum inspiratory pressure register in a manovacuometer. Clinical score < 3 (normal) was found in 11 patients 35,52%, between 3 and 5 (subclinical dysfunction) in 14 (45,1%) and more than 5 (hypothyroidism) in 6 participants (19,4%). Fatigue was a complaint in 45% and showed positive association with score greater than 2. Shoulder abductors muscles strength was impaired in 14%. Severe reduction in inspiratory force (<60%) was present in 51,6%. No more significant correlation between the variables studied was found.  The reduction in inspiratory and peripheral muscular force in these patients may play a main role in fatigue. The lack of statistical significance found will probably be better understood with the increase in the number of patients, with the inclusion of a healthy sex-and-age matched control group and performing a prospective placebo-controlled thyroxine treatment trial.O presente trabalho objetiva verificar a presença de alterações músculo-esqueléticas em pacientes com HS.  Avaliados 31 pacientes acompanhados no ambulatório de endocrinologia do HUCFFUFRJ (27 mulheres e 2 homens com idade entre 18 e 75 anos) com pelo menos duas dosagens elevadas de TSH. Todos receberam uma pontuação (score) baseada na escala de Billewicz modificada por Zulewski. Foram aplicados testes musculares manuais (TMM) para as cinturas escapular e pelvica; medida a força muscular de quadríceps em dinamômetro de cadeira eletromecânico; e estimada a força dos músculos inspiratórios através do registro da pressão inspiratória máxima com manovacuômetro. Score < 3 (normal) foi observado em 11 pacientes (35,5%); entre 3 e 5 (disfunção subclínica) em 14 (45,1%) e superior a 5 (hipotireoidismo) em 6 (19,4%). Fadiga foi uma queixa freqüente (45%) e apresentou associação positiva com score maior que 2. O comprometimento da força muscular periférica (alteração no TMM) foi encontrado em 14% dos pacientes. Diminuição grave da força inspiratória (< 60% do previsto) estava presente em 28 participantes (51,6%). Nenhuma das demais alterações encontradas mostraram associação com o escore ou níveis de TSH. A redução da força muscular inspiratória e proximal pode contribuir para a referida fadiga. A ausência de associação estatística entre essas variáveis deverá ser melhor esclarecida com o aumento da amostra e com a inclusão de um grupo controle pareado além do desenvolvimento de um estudo prospectivo com utilização de levotiroxina e placebo

Treadmill training as an augmentation treatment for Alzheimer?s disease: a pilot randomized controlled study

Objective To assess the effect of aerobic exercise on the cognition and functional capacity in Alzheimer’s disease (AD) patients. Method Elderly (n=20) with mild dementia (NINCDS-ADRDA/CDR1) were randomly assigned to an exercise group (EG) on a treadmill (30 minutes, twice a week and moderate intensity of 60% VO2max) and control group (GC) 10 patients. The primary outcome measure was the cognitive function using Cambridge Cognitive Examination (CAMCOG). Specifics instruments were also applied to evaluate executive function, memory, attention and concentration, cognitive flexibility, inhibitory control and functional capacity. Results After 16 weeks, the EG showed improvement in cognition CAMCOG whereas the CG declined. Compared to the CG, the EG presented significant improvement on the functional capacity. The analysis of the effect size has shown a favorable response to the physical exercise in all dependent variables. Conclusion Walking on treadmill may be recommended as an augmentation treatment for patients with AD

Subclinical hypothyroidism: psychiatric disorders and symptoms Hipotireoidismo subclínico: transtornos e sintomas psiquiátricos

OBJECTIVE: To evaluate the prevalence of psychiatric disorders and symptoms in patients with subclinical hypothyroidism. METHOD: Ninety-four outpatients with at least two elevated serum thyrotrophin levels (> 4 µU/ml) and normal FT4, and 43 euthyroid outpatients, both groups from HUCFF-UFRJ, were evaluated. Psychiatric diagnosis was based on the Structured Clinical Interview Diagnostic for the DSM-IV axis I (SCID-I/DSM-IV), the psychopathological symptoms on Hamilton anxiety and depression scales, and the Beck Inventory. RESULTS: Our data showed an increased prevalence of psychiatric disorders in the subclinical hypothyroidism patients when compared to the euthyroid group (45.7% vs 25.6%; p = 0.025), mood disorders being the most frequent. The prevalence of depressive symptoms based on Beck's Scale among subclinical hypothyroidism patients was about 2.3 times higher than among euthyroid ones (45.6% vs 20.9%, p = 0.006). Anxiety symptoms were also more frequent among subclinical hypothyroidism patients (87.0% vs 60.5%, p < 0.001), mainly clinical anxiety (44.6% vs 23.3%; p = 0.001). CONCLUSION: Our results showed a significant association of subclinical hypothyroidism with psychiatric disorders and an increased frequency of subsyndromic depression and anxiety symptoms in subclinical hypothyroidism in relation to the euthyroid group.<br>OBJETIVO: Avaliar a prevalência de sintomas e alterações psiquiátricas em pacientes com hipotireoidismo subclínico. MÉTODO: Foram estudados 94 pacientes ambulatoriais com pelo menos duas dosagens plasmáticas elevadas de tireotropina (> 4 µU/ml) e com T4 livre normal e, 43 eutireoidianos, ambos os grupos do HUCFF-UFRJ. Para diagnóstico psiquiátrico foi utilizada a entrevista clínica estruturada do eixo I (SCID-I/DSM-IV) e, para sintomas psicopatológicos, as escalas de ansiedade e depressão de Hamilton (HAM-A e HAM-D) e inventário de Beck. RESULTADOS: Encontramos uma prevalência aumentada de transtornos psiquiátricos no hipotireoidismo subclínico em comparação ao grupo eutireoidiano (45,7% vs 25,6%; p = 0,025), sendo o transtorno do humor o de maior freqüência. Sintomas de depressão no grupo com hipotireoidismo subclínico foram cerca de 2,3 vezes mais freqüentes que entre os eutireoidianos (45,6% vs 20,9%; p = 0,006) quando o instrumento utilizado foi a escala de Beck. Da mesma forma, sintomas de ansiedade também foram mais freqüentes no hipotireoidismo subclínico (87,0% vs 60,5%; p < 0,001), principalmente ansiedade clínica (44,6% vs 23,3%; p = 0,001). CONCLUSÃO: Os resultados indicaram uma associação do hipotireoidismo subclínico com os transtornos psiquiátricos, além de uma freqüência aumentada de sintomas de depressão e ansiedade subsindrômicos em relação ao grupo eutireoidiano