[Evaluation of body weight in patients with Graves' disease during the treatment with methimazole]. / Avaliação do peso corporal em pacientes com doença de Graves durante o tratamento com metimazol.

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/m(2) to 27 kg/m(2) ± 4.7 during treatment (p < 0.0001). Before treatment, 66.6% subjects had BMI < 25 kg/m(2) and 33.3%, BMI > 25 kg/m(2). In euthyroidism, 38% of patients had BMI < 25 kg/m(2) and 62%, BMI > 25 kg/m(2) (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.

Avaliação do peso corporal em pacientes com doença de Graves durante o tratamento com metimazol / Evaluation of body weight in patients with Graves' disease during the treatment with methimazole

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.

Spontaneous hypothyroidism in the follow up of Graves hyperthyroid patients treated with antithyroid drugs.

AIM: Spontaneous hypothyroidism may follow the natural course of Graves disease (GD) after treatment with antithyroid drugs (ATD). METHODS: We studied retrospectively 139 remitted Graves hyperthyroid patients treated with ATD, with a follow-up period of 17.5 years (range 6 to 25 years). Elevated serum concentration of thyroid-stimulating hormone and low serum thyroxine concentrations confirmed the diagnosis. RESULTS: Thirteen patients (median age, 41 years; 26 to 48 years) developed spontaneous hypothyroidism, 4 to 144 months (median, 48 months ) following withdrawal of ATD. The prevalence of hypothyroidism was 9.3% and the incidence was 2.3% per year (13/ 563.6 patients/year of observation). There was no association with types of drugs used or the regimens. Spontaneous hypothyroid patients showed elevated titers (P = 0.02) of serum antithyroid peroxidase antibody (TPOAb) at the end of treatment with ATD, compared with the titers found at the beginning. These patients also had higher titers of TPOAb (P = 0.01) in relation to euthyroid patients. In contrast, the changes in serum antithyroglobulin antibody titers were not significant. CONCLUSIONS: Because of the shift from euthyroidism to spontaneous hypothyroidism, GD patients demanded a strict follow up after ATD therapy. It seems that there is an effect of TPOAb on thyroid destruction.

O receptor solúvel sérico da interleucina-2 na doença de Graves pode ser um marcador biológico da funçäo tiroideana / Seric soluble interleukin-2 receptor in Graves' disease can be a biological marker of the thyroid function

Nao está bem estabelecido se a diminuiçao do receptor solúvel sérico da IL-2 (sIL-2R), que se observa durante o tratamento do hipertiroidismo com metimazol (MMI), reflete a diminuiçao de T3 e T4 ou um efeito direto do MMI no sistema imune. O sIL-2R foi avaliado em 28 pacientes com doença de Graves, divididos nos seguintes grupos: A1) 13 pacientes com recidiva do hipertiroidismo após tratamento com MMI; 2) após 131-Iodo (seis meses); B1) 15 pacientes sem tratamento; B2) seis a 12 meses com MMI (10 a 30 mg/dia). O grupo controle (C) foi de 16 indivíduos normais. Concentraçoes séricas de SIL-2R foram determinadas por ELISA. Valores de sIL-2R dos pacientes com tirotoxicose (grupos A1 e B1) foram significativamente maiores (mediana: 2.881,5 pg/mL e amplitude de variaçao: 210 a 11.151 pg/mL) que aqueles do grupo C (913 pg/ml; 462 a 1.533 pg/mL; p < 0,05). Observou-se diminuiçao nao significante de sIL-2R do grupo A1 após radio-iodo (1.785; 210 a 4.536 pg/ml vs. 1.281; 25 a 4.162 pg/mL). O sIL-2R no grupo B2 foi significativamente menor do que em B1 (1.050; 210 a 3.150 pg/ml vs. 3.276; 1.260 a 11.151 pg/mL; p < 0,05). Houve correlaçao positiva e significante entre sIL-2R e T4 (r = 0,371; p < 0,01; n = 48) e entre sIL-2R e T3 (r = 0,593; p < 0,001; n = 72). Concentraçoes de sIL- 2R maiores nos pacientes em hipertiroidismo antes da administraçao de MMI, quando comparadas com aquelas dos pacientes em hipertiroidismo antes da dose terapêutica de (131)Iodo, sugerem que o MMI poderia exercer efeito imunomodulador na doença de Graves. Nossos dados sugerem que a concentraçao sérica de sIL-2R pode ser um marcador da funçao tiroidiana, podendo refletir um efeito do MMI sobre o sistema imune.