Hypovitaminosis D in patients with cystic fibrosis: a cross-section study in South Brazil.

INTRODUCTION: Cystic fibrosis (CF) patients have a susceptibility to vitamin D deficiency because of nutrient malabsorption. OBJECTIVES: To evaluate the prevalence of hypovitaminosis D in CF patients and the factors associated with serum 25-hydroxyvitamin D levels. METHODS: We evaluated the prevalence of vitamin D deficiency defined as 25-hydroxyvitamin D <30 ng/mL, as suggested recently by the Cystic Fibrosis Foundation, and factors associated with its serum levels. Patients with confirmed CF were included. Nutritional status and hospital admissions were evaluated. Serum C-reactive protein, calcium, phosphate, magnesium, albumin, 25-hydroxyvitamin D and parathyroid hormone levels were measured. Lung function was evaluated by spirometry, and clinical and chest radiographic scores were assessed. Statistical significance level was set at P < 0.05. RESULTS: Fifty-nine patients were included. Prevalence of hypovitaminosis D was 61%. Patients with pancreatic insufficiency had a trend to have higher vitamin D levels. Sixteen patients had severe lung disease with percentage of forced expiratory volume in 1 s predicted below 40%. After multivariate analysis, body mass index and hospitalization in the last month remained significantly associated with serum vitamin D levels. CONCLUSIONS: Vitamin D insufficiency is still a problem in CF patients, even in those receiving supplementation.

Prevalence of thyroid-related abnormalities in adults with celiac disease: a cross-sectional study / Prevalência de alterações da tireoide em adultos com doença celíaca

An increased prevalence of autoimmune disorders, including thyroid diseases, has been reported in patients with celiac disease (CD). This study aimed to identify the prevalence of thyroid-related abnormalities in adults with CD.METHODS: Thirty-nine subjects with biopsy-proven CD, three men (7.7%) and 36 women (92.3%), answered a questionnaire. All patients were followed at the outpatient clinic of Hospital de Clínicas de Porto Alegre. Thyroid-related abnormalities were evaluated by serum thyroid stimulating hormone (TSH), free thyroxine (FT4)and anti-thyroperoxidase antibodies (anti-TPO) levels.RESULTS: Three subjects had grade 1 lesions; one had grade 2; 13 had grade 3a; eight had grade 3b; and 14 had grade 3c, according to the modified Marsh classification. Mean age was 50.8 ± 12.9 years. Twenty-nine (74.4%) subjects were euthyroid. Ten subjects (25.6%) had hypothyroidism: eight of them (20.5%) werealready taking levothyroxine, and subclinical hypothyroidism was identified during the study in the other two patients (5.1%). No patients were hyperthyroid. Mean serum FT4 levels were 1.15 ± 0.25 ng/dl. Median serum TSH levels were 2.39 (0.06-6.64)IU/ml. Serum anti-TPO levels were positive in six patients (15.4%): one with hypothyroidism, one with subclinical hypothyroidism, and four with normal thyroid function. No factors associated with thyroid-related abnormalities were identified. CONCLUSION: This study showed a high prevalence of thyroid-related abnormalities, as did other studies. Since anti-thyroid antibodies were positive in some patientswith normal thyroid function, periodic evaluation of thyroid function in CD patients is recommended.

INTRODUÇÃO: Tem-se observado um aumento na prevalência de doenças autoimunes, incluindo doenças da tireoide, em pacientes com doença celíaca (DC).O objetivo deste estudo foi identificar a prevalência de alterações da tireoide em adultos com DC.MÉTODOS: Trinta e nove indivíduos com diagnóstico comprovado de DC, três homens (7,7%) e 36 mulheres (92,3%), responderam a um questionário. Todos os pacientes foram acompanhados no ambulatório do Hospital de Clínicas de Porto Alegre, alterações relacionadas à tireoide foram detectadas por meio da medição dos níveis de hormônio estimulador da tireoide (TSH), tiroxina livre (T4 livre) e intraanticorpos antitireoperoxidase (anti-TPO), no soro.RESULTADOS: Três pacientes apresentavam lesões tipo 1; um paciente apresentava tipo 2; 13 pacientes, tipo 3a; oito pacientes, tipo 3b; e 14 tipo 3c, de acordo com a classificação modificada de Marsh. A média de idade foi de 50,8 ± 12,9 anos. Vinte e nove (74,4%) pacientes apresentaram tireoide nomal. Dez indivíduos (25,6%) apresentaram hipotireoidismo: oito pacientes (20,5%) já usavam levotiroxina e dois pacientes (5,1%) com hipotireoidismo subclínico foram identificados durante a avaliação. Nenhum paciente apresentou hipertireoidismo. Os níveis médios séricos de T4L foram 1,15 ± 0,25 ng/dl. A mediana do TSH sérico foi 2,39 (0,06-6,64) UI/ml. Níveis séricos de anti-TPO foram positivos em seis pacientes (15,4%), um com hipotireoidismo, um com hipotireoidismo subclínico e quatro com função tireoidiana normal. Não se identificou fator associado a anormalidades relacionadas à tireoide. CONCLUSÃO: Este estudo demonstrou uma alta prevalência de anormalidades tireoidianas, como observado em outros estudos. Uma vez que os anticorpos antitireoide estavam presentes em alguns pacientes com função tireoidiana normal, recomenda-se a avaliação periódica da função tireoidiana em pacientes com DC.