3 research outputs found
Nível De Atividade Física De Mulheres Menopausadas Com Baixa Densidade Mineral óssea
Introduction Proper physical activity is related to the prevention and the treatment of osteoporosis. Purpose To assess the level of physical activity (PA) in post-menopausal women with low bone mineral density (BMD). Methods This cross-sectional clinicai study included 123 post-menopausal women. The inclusión criteria were: age of ≥ 45 years with last menses at least 12 months prior to the Initiation of the study, and bone density sean (BDS) valúes measured over the preceding 12 months. Women with severe Osteoarthritis were excluded. Women were allocated into three groups, according to BMD measured by BDS [osteoporosis (OP; 54 women), osteopenia (35 women), and normal bone density (NBD; 35 women)], and compared for general, clinicai, and anthropometric data, and for PA level. The latter was assessed using the International Physical Activity Questionnaire (IPAQ), in metabolic equivalent of task (MET) units. Participants were classified as sedenta ry, active or very active. Quantitative variables were compared using ANOVA followed by Tukey's test. Associations between qualitative variables were tested by chi-square (χ2) or Fisher's exact test. In order to check for differences among groups and IPAQ domains, a generalized linear model with Gamma distribution was adjusted for valúes in METs. Results The OP group differed from the NBD group regarding age (61.8 ± 10.1 and 52.9 ± 5.4 years), percentage of participants with self-declared white ethnicity (43.9 and 28.0%), body mass index (BMI - 25.7 ± 5.4 and 30.9 ± 5.1 kg/m2), and time since menopause (15.5 ± 7.5 and 5.8 ± 4.5 years). Smoking rates were higher in the OP (55.6%) and NBD groups (33.3%) than in the osteopenia group (11.1%). Within the OP group, the rate of subjects with sedentary lifestyles was higher (42.6%), and time spent sitting was greater (344.3 ± 204.8 METs) than in the groups with osteopenia (20.0% and 300.9 ± 230.6 METs) and NBD (17.7% and 303.2 ± 187.9 METs). Conclusions The rate of sedentary lifestyles was higher in post-menopausal women with OP than in those with either osteopenia or NBD. In order to change this physical inactivity profile, strategies should be created to address this group of patients. © 2016 by Thieme Publicações Ltda, Rio de Janeiro, Brazil.38522523
The Brazilian Consensus For The Clinical Approach And Treatment Of Subclinical Hypothyroidism In Adults: Recommendations Of The Thyroid Department Of The Brazilian Society Of Endocrinology And Metabolism [consenso Brasileiro Para A Abordagem Clínica E Tratamento Do Hipotireoidismo Subclínico Em Adultos: Recomendações Do Departamento De Tireoide Da Sociedade Brasileira De Endocrinologia E Metabologia]
Introduction: Subclinical hypothyroidism (SCH), defined as elevated concentrations of thyroid stimulating hormone (TSH) despite normal levels of thyroid hormones, is highly prevalent in Brazil, especially among women and the elderly. Although an increasing number of studies have related SCH to an increased risk of coronary artery disease and mortality, there have been no randomized clinical trials verifying the benefit of levothyroxine treatment in reducing these risks, and the treatment remains controversial. Objective: This consensus, sponsored by the Thyroid Department of the Brazilian Society of Endocrinology and Metabolism and developed by Brazilian experts with extensive clinical experience with thyroid diseases, presents these recommendations based on evidence for the clinical management of SCH patients in Brazil. Materials and methods: After structuring the clinical questions, the search for evidence in the literature was initially performed in the MedLine-PubMed database and later in the Embase and SciELO - Lilacs databases. The strength of evidence was evaluated according to the Oxford classification system and established based on the experimental design used, considering the best available evidence for each question and the Brazilian experience. Results: The topics covered included SCH definition and diagnosis, natural history, clinical significance, treatment and pregnancy, and the consensus issued 29 recommendations for the clinical management of adult patients with SCH. Conclusion: Treatment with levothyroxine was recommended for all patients with persistent SCH with serum TSH values ≥ 10 mU/L and for certain patient subgroups.573166183Surks, M.I., Ortiz, E., Daniels, G.H., Sawin, C.T., Col, N.F., Cobin, R.H., Subclinical thyroid disease: Scientific review and guidelines for diagnosis and management (2004) JAMA., 291, pp. 228-238Cooper, D.S., Biondi, B., Subclinical thyroid disease (2012) Lancet., 379, pp. 1142-1154Romaldini, J.H., Sgarbi, J.A., Farah, C.S., Subclinical thyroid disease: Subclinical hypothyroidism and hyperthyroidism (2004) Arq Bras Endocrinol Metab., 48, pp. 147-158Hollowell, J.G., Staehling, N.W., Flanders, W.D., Hannon, W.H., Gunter, E.W., Spencer, C.A., Serum TSH, T(4), and thyroid antibodies in the United States population (1988 to 1994): National Health and Nutrition Examination Survey (NHANES III) (2002) J Clin Endocrinol Metab., 87, pp. 489-499Canaris, G.J., Manowitz, N.R., Mayor, G., Ridgway, E.C., The Colorado Thyroid Disease Prevalence Study (2000) Arch Int Med., 160, pp. 526-534Parle, J.V., Franklyn, J.A., Cross, K.W., Jones, S.C., Sheppard, M.C.L., Prevalence and follow up of abnormal thyrotrophin (TSH) concentrations in the elderly in the United Kingdom (1991) Clin Endocrinol (Oxf)., 34, pp. 77-83Vanderpump, M.P., Tunbridge, W.M., French, J.M., Appleton, D., Bates, D., Clark, F., The incidence of thyroid disorders in the community: A twenty-year follow-up of the Whickman Survey (1995) Clin Endocrinol (Oxf)., 43, pp. 55-68Sichieri, R., Baima, J., Marante, T., de Vasconcellos, M.T., Moura, A.S., Vaisman, M., Low prevalence of hypothyroidism among black and Mulatto people in a population-based study of Brazilian women (2007) Clin Endocrinol (Oxf)., 66, pp. 803-807Camargo, R.Y., Tomimori, E.K., Neves, S.C., Rubio, I.G., Galrão, A.L., Knobel, M., Thyroid and the environment: Exposure to excessive nutritional iodine increases the prevalence of thyroid disorders in Sao Paulo, Brazil (2008) Eur J Endocrinol., 159, pp. 293-299Sgarbi, J.A., Matsumura, L.K., Kasamatsu, T.S., Ferreira, S.R., McIel, R.M., Subclinical thyroid dysfunctions are independent risk factors for mortality in a 7.5-year follow-up: The Japanese-Brazilian thyroid study (2010) Eur J Endocrinol., 162, pp. 569-577Benseñor, I.M., Goulart, A.C., Lotufo, P.A., Menezes, P.R., Scazufca, M., Prevalence of thyroid disorders among older people: Results from the São Paulo Ageing & Health Study (2011) Cad Saude Publica., 27, pp. 155-161Walsh, J.P., Bremner, A.P., Bulsara, M.K., O'Leary, P., Leedman, P.J., Feddema, P., Subclinical thyroid dysfunction as a risk factor for cardiovascular disease (2005) Arch Intern Med., 165, p. 2467Cappola, A.R., Fried, L.P., Arnold, A.M., Danese, M.D., Kuller, L.H., Burke, G.L., Thyroid status, cardiovascular risk, and mortality in older adults (2006) JAMA., 295, pp. 1033-1041Iervasi, G., Molinaro, S., Landi, P., Taddei, M.C., Galli, E., Mariani, F., Association between increased mortality and mild thyroid dysfunction in cardiac patients (2007) Arch Intern Med., 167, pp. 1526-1532Asvold, B.O., Bjoro, T., Nilsen, T.I., Gunnell, D., Vatten, L.J., Thyrotropin levels and risk of fatal coronary heart disease: The HUNT study (2008) Arch Intern Med., 168, pp. 855-860Boekholdt, S.M., Titan, S.M., Wiersinga, W.M., Chatterjee, K., Basart, D.C., Luben, R., Initial thyroid status and cardiovascular risk factors: The EPIC-Norfolk prospective population study (2010) Clin Endocrinol (Oxf)., 72, pp. 404-410McQuade, C., Skugor, M., Brennan, D.M., Hoar, B., Stevenson, C., Hoogwerf, B.J., Hypothyroidism and moderate subclinical hypothyroidism are associated with increased all-cause mortality independent of coronary heart disease risk factors: A PreCIS database study (2011) Thyroid., 21, pp. 837-843Asvold, B.O., Bjøro, T., Platou, C., Vatten, L.J., Thyroid function and the risk of coronary heart disease: 12-year follow-up of the HUNT Study in Norway (2012) Clin Endocrinol (Oxf)., 77, pp. 911-917Biondi, B., Cooper, D.S., The clinical significance of subclinical thyroid dysfunction (2008) Endocr Rev., 29, pp. 76-131Rodondi, N., Aujesky, D., Vittinghoff, E., Cornuz, J., Bauer, D.C., Subclinical hypothyroidism and the risk of coronary heart disease: A meta-analysis (2006) Am J Med., 119, pp. 541-551Volzke, H., Schwahn, C., Wallaschofski, H., Dorr, M., Review: The association of thyroid dysfunction with all-cause and circulatory mortality: Is there a causal relationship? 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Guidelines of the American Thyroid Association for the diagnosis and management of thyroid disease during pregnancy and postpartum (2011) Thyroid., 21, pp. 1081-1125Stricker, R., Echenard, M., Eberhart, R., Chevailler, M.C., Perez, V., Quinn, F.A., Evaluation of maternal thyroid function during pregnancy: The importance of using gestational age-specific reference intervals (2007) Eur J Endocrinol., 157, pp. 509-514Lee, R.H., Spencer, C.A., Mestman, J.H., Miller, E.A., Petrovic, I., Braverman, L.E., Free T4 immunoassays are flawed during pregnancy (2009) Am J Obstet Gynecol., 200, pp. 260.e1-260.e6Vieira, J.G.H., Kanashiro, I., Tachibana, T.T., Ghiringhello, M.T., Hauache, O.M., McIel, R.M.B., Definição de valores normais de tiroxina livre durante a gravidez (2004) Arq Bras Endocrinol Metab., 48, pp. 305-309Benhadi, N., Wiersinga, W.M., Reitsma, J.B., Vrijkotte, T.G., Bonsel, G.J., Higher maternal TSH levels in pregnancy are associated with increased risk for miscarriage, fetal or neonatal death (2009) Eur J Endocrinol., 160, pp. 985-991Levels of Evidence and Grades of Recommendations-Oxford Centre for Evidence-Based Medicine, , http://www.cebm.net/index.aspx?o=1025, Disponível em URLNegro, R., Schwartz, A., Gismondi, R., Tinelli, A., Mangieri, T., Stagnaro-Green, A., Thyroid antibody positivity in the first trimester of pregnancy is associated with negative pregnancy outcomes (2011) J Clin Endocrinol Metab., 96, pp. E920-E924Allan, W.C., Haddow, J.E., Palomaki, G.E., Williams, J.R., Mitchell, M.L., Hermos, R.J., Maternal thyroid deficiency and pregnancy complications: Implications for population screening (2000) J Med Screen., 7, pp. 127-130Casey, B.M., Dashe, J.S., Wells, C.E., McIntire, D.D., Leveno, K.J., Cunningham, F.G., Subclinical hyperthyroidism and pregnancy outcomes (2006) Obstet Gynecol., 107, pp. 337-341Cleary-Goldman, J., Malone, F.D., Lambert-Messerlian, G., Sullivan, L., Canick, J., Porter, T.F., Maternal thyroid hypofunction and pregnancy outcome (2008) Obstet Gynecol., 112, pp. 85-92Lavado-Autric, R., Ausó, E., García-Velasco, J.V., Arufe Mdel, C., del Escobar Rey, F., Berbel, P., Early maternal hypothyroxinemia alters histogenesis and cerebral cortex cytoarchitecture of the progeny (2003) J Clin Invest., 111, pp. 1073-1082Pop, V.J., Kuijpens, J.L., van Baar, A.L., Verkerk, G., van Son, M.M., de Vijlder, J.J., Low maternal free thyroxine concentrations during early pregnancy are associated with impaired psychomotor development in infancy (1999) Clin Endocrinol (OxfPrograma Diretrizes, , http://www.projetodiretrizes.amb.org.br, Associação Médica Brasileira. 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The Brazilian Consensus For The Diagnosis And Treatment Of Hyperthyroidism: Recommendations By The Thyroid Department Of The Brazilian Society Of Endocrinology And Metabolism [consenso Brasileiro Para O Diagnóstico E Tratamento Do Hipertireoidismo: Recomendações Do Departamento De Tireoide Da Sociedade Brasileira De Endocrinologia E Metabologia]
Introduction: Hyperthyroidism is characterized by increased synthesis and release of thyroid hormones by the thyroid gland. Thyrotoxicosis refers to the clinical syndrome resulting from excessive circulating thyroid hormones, secondary to hyperthyroidism or due to other causes. This article describes evidence-based guidelines for the clinical management of thyrotoxicosis. Objective: This consensus, developed by Brazilian experts and sponsored by the Department of Thyroid Brazilian Society of Endocrinology and Metabolism, aims to address the management, diagnosis and treatment of patients with thyrotoxicosis, according to the most recent evidence from the literature and appropriate for the clinical reality of Brazil. Materials and methods: After structuring clinical questions, search for evidence was made available in the literature, initially in the database Medline, PubMed and Embase databases and subsequently in SciELO - Lilacs. The strength of evidence was evaluated by Oxford classification system was established from the study design used, considering the best available evidence for each question. Results: We have defined 13 questions about the initial clinical approach for the diagnosis and treatment that resulted in 53 recommendations, including the etiology, treatment with antithyroid drugs, radioactive iodine and surgery. We also addressed hyperthyroidism in children, teenagers or pregnant patients, and management of hyperthyroidism in patients with Graves' ophthalmopathy and various other causes of thyrotoxicosis. Conclusions: The clinical diagnosis of hyperthyroidism usually offers no difficulty and should be made with measurements of serum TSH and thyroid hormones. 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