Hipotiroidismo en tratamiento en el Área de Salud de Guadalajara (España): características y prevalencia estimadas a partir del consumo de hormona tiroidea / Hypothyroidism under treatment in the Guadalajara (Spain) health care area: characteristics and prevalence based on the intake of thyroid hormone

Objetivo. Nos proponemos estimar la prevalencia del hipotiroidismo tratado en nuestra Área de Salud a partir de la prescripción de hormona tiroidea. Describimos asimismo sus características y diferencias en base a diversos factores sociodemográficos. Diseño. Estudio descriptivo de corte transversal. Emplazamiento. Área Sanitaria de Guadalajara (España). Participantes. Sujetos en tratamiento con levotiroxina por hipotiroidismo incluidos en tarjeta sanitaria durante el año 2009. Mediciones Principales. Se evaluaron la distribución por sexo, edad y lugar de residencia, previo ajuste de tasas. Otras variables analizadas fueron el tipo de hipotiroidismo, última dosis prescrita y niveles de TSH, comparando en función de variables sociodemográficas. Resultados. Un 3,3% de la población (IC 95%: 3,3-3,4) recibió tratamiento con levotiroxina (5,8% mujeres y 1,0% varones), observando la tasa más elevada en mujeres mayores de 65 años (11,9%). La tasa ajustada fue 38,8/1000 (IC 95%: 37,7-40,0) para el medio urbano y 34,6/1000 (IC 95%: 33,4-35,8) para el rural. Edad media de 56,6 años (DE: 18,2). Se asume origen autoinmune en el 76% de los casos con causa reconocible, utilizando una dosis media de 76,84mcg/día. Un 76,2% de los pacientes presentaron un rango correcto de TSH. Conclusiones. El hipotiroidismo subclínico es un proceso frecuente entre los usuarios de un Centro de Salud y mayoritariamente tiene origen autoinmune. El diagnóstico es más frecuente en el sexo femenino y en población mayor. Existe habitualmente un buen control de las cifras de TSH. Las diferencias geográficas son poco relevantes(AU)

Objective. It is our aim to estimate the prevalence of hypothyroidism treated in our health care area from the prescription of thyroid hormone. Likewise, we describe its characteristics and differences on the basis of various socio-demographic factors. Design. Cross sectional descriptive-type study. Location. Guadalajara (Spain) health care area. Participants. Subjects under treatment with levothyroxine for hypothyroidism included on health card throughout the year 2009. Main Measures. Distribution by gender, age and place of residence, after rate adjustment. Other analyzed variables were the type of hypothyroidism, last prescribed dosage and TSH levels, compared according to socio-demographic variables. Results. 3,3% of the population (IC 95%: 3,3-3,4) were treated with levothyroxine (5,8% female y 1,0% male), with the highest rate being seen in women over 65 years old (11,9%). The adjusted rate was 38,8/1000 (IC 95%: 37,7-40,0) for urban areas and 34,6/1000 (IC 95%: 33,4-35,8) for rural areas. Average age 56,6 years (DE: 18,2). An autoimmune origin is assumed in 76% of cases with a recognizable cause, using an average dose of 76,84mcg/day. 76,2% of the patients showed a correct level TSH. Conclusions. Subclinical hypothyroidism is a frequent complaint among Health Centre users and has a chiefly autoimmune origin. Diagnosis is more frequent in females and in older members of the population. TSH figures are usually closely checked. Geographical differences of little significance(AU)

Serum albumin levels, an additional factor implicated in hyperparathyroidism outcome in peritoneal dialysis: a prospective study with paired bone biopsies.

Renal osteodystrophy encompasses several histologic subtypes, all of which can undergo change over time. In peritoneal dialysis (PD) patients, we studied bone histology and the factors influencing any changes over 1 year In 44 PD patients, we collected two paired bone biopsies (at baseline and after 12 months) and biochemical and treatment data (at baseline and every 3 months). Of the 44 original patients, 24 completed the study. Of these 24 patients, 19 were initially diagnosed with adynamic bone lesion (ABL). After 1 year, 12 still had ABL; the other 7 had changed to high turnover bone lesion (HTBL). Another 5 patients were initially diagnosed with HTBL. Among these, 4 still had HTBL at 1 year; 1 had changed to ABL. In patients who changed to HTBL from ABL, serum albumin had increased to 4.2 +/- 0.3 g/dL at month 12 from 3.7 +/- 0.4 g/dL at baseline (p < 0.05). In patients who still had ABL, serum albumin did not change. Additionally, the percentage increase in serum albumin over the study was higher in HTBL patients than in ABL patients (0.1408 +/- 0.139 g/dL vs. -0.0076 +/- 0.113 g/dL, p = 0.009). A lower likelihood of diabetes (p = 0.033) and a higher serum albumin [area under the curve: 0.822; 95% confidence interval (CI): 0.651 to 0.993] identified a HTBL diagnosis at 12 months. Older age increased the probability of changing to ABL (OR: 1.2935; 95% CI: 1.03 to 1.67; p= 0.02). Bone lesions can change over time, and this change is associated with age, diabetes, and serum albumin. A change to HTBL was associated with improvement in serum albumin. Protein status is possibly a factor influencing bone lesion outcome.