Fatores de risco cardiovascular associados ao hipotireoidismo em crianças e adolescentes com Síndrome de Down
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Dec 29, 2024
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Resumo
Objetivo: Avaliar a associação entre fatores de risco cardiometabólicos e hipotireoidismo tratado em crianças e adolescentes com Síndrome de Down. Métodos: Dos 51 pacientes com Síndrome de Down, 20 preencheram os critérios de elegibilidade e participaram de um estudo transversal, foram submetidos a exame clínico, exames laboratoriais visando avaliar função tireoidiana, resistência insulínica e lipídios. Resultados: A idade variou de 4,0 a 19 anos (média: 11,6), 14 eram púberes, 8 (40%) tinham acantose nigricans, 7 (35%) estavam com sobrepeso/obesidade e 3 (15%) tinham circunferência abdominal aumentada, Z- O IMC foi maior no sexo masculino (p=0,034). Foram observadas elevações da insulina em 7(35%) pacientes, do índice HOMA-IR em 5(25%), dos triglicerídeos em 12(60%), da ferritina em 6(30%), redução do HDL-colesterol em 10 (50%). Os triglicerídeos e o colesterol não HDL foram significativamente maiores nos homens. As concentrações de T4 livre foram maiores no sexo feminino (p=0,043). As variáveis Z-IMC e circunferência da cintura apresentaram correlação inversa com T4 Livre e T3 Total e correlação direta com concentrações de insulina, ferritina e triglicerídeos. Conclusão: Os dados do presente estudo indicam a necessidade de otimização do tratamento do hipotireoidismo, prevenção e redução dos fatores de risco cardiometabólicos, principalmente no sexo masculino.
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Como Citar
AzzuzJ. P. R. G., SousaM. M. de, Silva JúniorC. R., TiossiL. B., PalharesH. M. da C., MarquiA. B. T. de, ToméJ. M., OliveiraM. M., & BorgesM. de F. (2024). Fatores de risco cardiovascular associados ao hipotireoidismo em crianças e adolescentes com Síndrome de Down. Revista Eletrônica Acervo Saúde, 24(12), e18712. https://doi.org/10.25248/reas.e18712.2024
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Referências
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2. ANTONARAKIS SE, et al. Down syndrome. Nature Reviews Disease Primers, 2020; 6(1): 9.
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9. CILHOROZ BT, et al. Cardiovascular physiology and pathophysiology in Down syndrome. Physiological Research, 2022; 71(1): 1-16.
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13. GARCÍA CUARTERO B, et al. Indice HOMA y QUICKI, insulina y péptido C en niños sanos. Puntos de corte de riesgo cardiovascular [The HOMA and QUICKI indexes, and insulin and C-peptide levels in healthy children. Cut off points to identify metabolic syndrome in healthy children]. Anales de Pediatría (Barcelona), 2007; 66(5): 481-490.
14. GIMÉNEZ-BARCONS M, et al. Autoimmune predisposition in Down syndrome may result from a partial central tolerance failure due to insufficient intrathymic expression of AIRE and peripheral antigens. Journal of Immunology, 2014; 193(8): 3872-3879.
15. GONZÁLEZ-AGÜERO A, et al. Dimorfismo sexual en grasa corporal en adolescentes con síndrome de Down. Revista Española de Obesidad, 2010; 8(1): 214-219.
16. HETMAN M, et al. Predisposition to atherosclerosis in children and adults with trisomy 21: biochemical and metabolomic studies. Pediatric Endocrinology Diabetes and Metabolism, 2023; 29(3): 143-155.
17. IUGHETTI L, et al. Ten-year longitudinal study of thyroid function in children with Down's syndrome. Hormone Research in Paediatrics, 2014; 82(2): 113-121.
18. LUTON D, et al. Thyroid function in fetuses with down syndrome. Hormone Research in Paediatrics, 2012; 78(2): 88-93.
19. MADEIRA IR, et al. Ponto de corte do índice Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) avaliado pela curva Receiver Operating Characteristic (ROC) na detecção de síndrome metabólica em crianças pré-púberes com excesso de peso [Cut-off point for Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) index established from Receiver Operating Characteristic (ROC) curve in the detection of metabolic syndrome in overweight pre-pubertal children]. Arquivos Brasileiros de Endocrinologia & Metabologia, 2008; 52(9): 1466-1473.
20. MAGGE SN, et al. Leptin levels among prepubertal children with Down syndrome compared with their siblings. Jornal de Pediatria, 2008; 152(3): 321-326.
21. MAGGE SN, et al. Cardiometabolic Risk and Body Composition in Youth With Down Syndrome. Pediatrics, 2019; 144(2): 20190137.
22. MOREAU M, et al. Metabolic Diseases and Down Syndrome: How Are They Linked Together? Biomedicines, 2021; 9(2): 221.
23. MULLUR R, et al. Thyroid hormone regulation of metabolism. Physiological Reviews, 2014; 94(2): 355-382.
24. NCD Risk Factor Collaboration (NCD-RisC). Worldwide trends in underweight and obesity from 1990 to 2022: a pooled analysis of 3663 population-representative studies with 222 million children,adolescents, and adults. Lancet, 2024; 403(10431): 1027-1050.
25. NOGUEIRA-DE-ALMEIDA CA, et al. Critério da Associação Brasileira de Nutrologia para diagnóstico e tratamento da síndrome metabólica em crianças e adolescentes. International Journal of Nutrology, 2020; 13(3): 54-68.
26. PALHARES HM, et al. Incidence of congenital hypothyroidism in the city of Uberaba/Minas Gerais and etiological evaluation of the affected subjects. Arquivos Brasileiros de Endocrinologia & Metabologia, 2012; 56(5): 305-312.
27. PALHARES HMDC, et al. Association between Acanthosis Nigricans and other Cardiometabolic Risk Factors in Children and Adolescents with Overweight and Obesity. Revista Paulista de Pediatria, 2018; 36(3): 301-308.
28. PALUMBO ML e McDougle CJ. Pharmacotherapy of Down syndrome. Expert Opinion on Pharmacotherapy, 2018; 19(17): 1875-1889.
29. PECORARO L, et al. Body composition and laboratory parameters in children with down syndrome: The DONUT study. Clinical Nutrition ESPEN, 2023; 57: 253-257.
30. SANTORO M, et al. Sex differences for major congenital heart defects in Down Syndrome: A population based study. European Journal of Medical Genetics, 2018; 61(9): 546-550.
31. SILVA APD, et al. Prevalence of overweight and obesity and associated factors in school children and adolescents in a medium-sized Brazilian city. Clinics (Sao Paulo), 2018; 73: 438.
32. SOBEY CG, et al. Risk of Major Cardiovascular Events in People with Down Syndrome. PLoS One, 2015; 10(9): 0137093.
33. VALENTINI D, et al. Nonalcoholic Fatty Liver Disease in Italian Children with Down Syndrome: Prevalence and Correlation with Obesity-Related Features. Jornal de Pediatria, 2017; 189: 92-971.
34. WANG F, et al. DUOX2 and DUOXA2 Variants Confer Susceptibility to Thyroid Dysgenesis and Gland-in-situ With Congenital Hypothyroidism. Frontiers in Endocrinology (Lausanne), 2020; 11: 237.
35. WHOOTEN R, et al. Endocrine manifestations of Down syndrome. Current Opinion in Endocrinology, Diabetes and Obesity, 2018; 25(1): 61-66.
36. WISNIEWSKI KE e Bobinski M. Hypothalamic abnormalities in Down syndrome. Progress in Clinical and Biological Research, 1991; 373: 153-167.
37. ZIMMERMANN MB, et al. New reference values for thyroid volume by ultrasound in iodine-sufficient schoolchildren: a World Health Organization/Nutrition for Health and Development Iodine Deficiency Study Group Report. The American Journal of Clinical Nutrition, 2004; 79(2): 231-237.
2. ANTONARAKIS SE, et al. Down syndrome. Nature Reviews Disease Primers, 2020; 6(1): 9.
3. AVERSA T, et al. Peculiarities of presentation and evolution over time of Hashimoto's thyroiditis in children and adolescents with Down's syndrome. Hormones (Athens), 2015; 14(3): 410-416.
4. BERTAPELLI F, et al. Body mass index reference charts for individuals with Down syndrome aged 2-18 years. Jornal de Pediatria (Rio de Janeiro), 2017; 93(1): 94-99.
5. BERTAPELLI F, et al. Overweight and obesity in children and adolescents with Down syndrome-prevalence, determinants, consequences, and interventions: A literature review. Research in Developmental Disabilities, 2016; 57: 181-192.
6. BLOCH KV, et al. Prevalences of hypertension and obesity in Brazilian adolescents. Revista de Saúde Pública, 2016; 50(1): 9.
7. BRASIL. Sociedade Brasileira de Pediatria. Manual de Orientação: Hipertensão arterial na infância e adolescência. 2019. Disponível em: https ://www.sbp.com.br/fileadmin/user_upload/21635c-MO_-_Hipertensao_Arterial_Infanc_e_Adolesc.pdf. Acessado em: 10 de julho de 2024.
8. BROERS CJ, et al. Increased pro-inflammatory cytokine production in Down Syndrome children upon stimulation with live influenza A virus. Journal of Clinical Immunology, 2012; 32(2): 323-329.
9. CILHOROZ BT, et al. Cardiovascular physiology and pathophysiology in Down syndrome. Physiological Research, 2022; 71(1): 1-16.
10. DIMOPOULOS K, et al. Cardiovascular Complications of Down Syndrome: Scoping Review and Expert Consensus. Circulation, 2023; 147(5): 425-441.
11. EL GEBALI HH, et al. Leptin, insulin like growth factor-1 and thyroid profile in a studied sample of Egyptian children with Down syndrome. Egyptian Journal of Medical Human Genetics, 2014; 15(2): 131-138.
12. FARIA CD, et al. TSH neurosecretory dysfunction (TSH-nd) in Down syndrome (DS): low risk of progression to Hashimoto's thyroiditis. Arquivos Brasileiros de Endocrinologia & Metabologia, 2011; 55(8): 628-631.
13. GARCÍA CUARTERO B, et al. Indice HOMA y QUICKI, insulina y péptido C en niños sanos. Puntos de corte de riesgo cardiovascular [The HOMA and QUICKI indexes, and insulin and C-peptide levels in healthy children. Cut off points to identify metabolic syndrome in healthy children]. Anales de Pediatría (Barcelona), 2007; 66(5): 481-490.
14. GIMÉNEZ-BARCONS M, et al. Autoimmune predisposition in Down syndrome may result from a partial central tolerance failure due to insufficient intrathymic expression of AIRE and peripheral antigens. Journal of Immunology, 2014; 193(8): 3872-3879.
15. GONZÁLEZ-AGÜERO A, et al. Dimorfismo sexual en grasa corporal en adolescentes con síndrome de Down. Revista Española de Obesidad, 2010; 8(1): 214-219.
16. HETMAN M, et al. Predisposition to atherosclerosis in children and adults with trisomy 21: biochemical and metabolomic studies. Pediatric Endocrinology Diabetes and Metabolism, 2023; 29(3): 143-155.
17. IUGHETTI L, et al. Ten-year longitudinal study of thyroid function in children with Down's syndrome. Hormone Research in Paediatrics, 2014; 82(2): 113-121.
18. LUTON D, et al. Thyroid function in fetuses with down syndrome. Hormone Research in Paediatrics, 2012; 78(2): 88-93.
19. MADEIRA IR, et al. Ponto de corte do índice Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) avaliado pela curva Receiver Operating Characteristic (ROC) na detecção de síndrome metabólica em crianças pré-púberes com excesso de peso [Cut-off point for Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) index established from Receiver Operating Characteristic (ROC) curve in the detection of metabolic syndrome in overweight pre-pubertal children]. Arquivos Brasileiros de Endocrinologia & Metabologia, 2008; 52(9): 1466-1473.
20. MAGGE SN, et al. Leptin levels among prepubertal children with Down syndrome compared with their siblings. Jornal de Pediatria, 2008; 152(3): 321-326.
21. MAGGE SN, et al. Cardiometabolic Risk and Body Composition in Youth With Down Syndrome. Pediatrics, 2019; 144(2): 20190137.
22. MOREAU M, et al. Metabolic Diseases and Down Syndrome: How Are They Linked Together? Biomedicines, 2021; 9(2): 221.
23. MULLUR R, et al. Thyroid hormone regulation of metabolism. Physiological Reviews, 2014; 94(2): 355-382.
24. NCD Risk Factor Collaboration (NCD-RisC). Worldwide trends in underweight and obesity from 1990 to 2022: a pooled analysis of 3663 population-representative studies with 222 million children,adolescents, and adults. Lancet, 2024; 403(10431): 1027-1050.
25. NOGUEIRA-DE-ALMEIDA CA, et al. Critério da Associação Brasileira de Nutrologia para diagnóstico e tratamento da síndrome metabólica em crianças e adolescentes. International Journal of Nutrology, 2020; 13(3): 54-68.
26. PALHARES HM, et al. Incidence of congenital hypothyroidism in the city of Uberaba/Minas Gerais and etiological evaluation of the affected subjects. Arquivos Brasileiros de Endocrinologia & Metabologia, 2012; 56(5): 305-312.
27. PALHARES HMDC, et al. Association between Acanthosis Nigricans and other Cardiometabolic Risk Factors in Children and Adolescents with Overweight and Obesity. Revista Paulista de Pediatria, 2018; 36(3): 301-308.
28. PALUMBO ML e McDougle CJ. Pharmacotherapy of Down syndrome. Expert Opinion on Pharmacotherapy, 2018; 19(17): 1875-1889.
29. PECORARO L, et al. Body composition and laboratory parameters in children with down syndrome: The DONUT study. Clinical Nutrition ESPEN, 2023; 57: 253-257.
30. SANTORO M, et al. Sex differences for major congenital heart defects in Down Syndrome: A population based study. European Journal of Medical Genetics, 2018; 61(9): 546-550.
31. SILVA APD, et al. Prevalence of overweight and obesity and associated factors in school children and adolescents in a medium-sized Brazilian city. Clinics (Sao Paulo), 2018; 73: 438.
32. SOBEY CG, et al. Risk of Major Cardiovascular Events in People with Down Syndrome. PLoS One, 2015; 10(9): 0137093.
33. VALENTINI D, et al. Nonalcoholic Fatty Liver Disease in Italian Children with Down Syndrome: Prevalence and Correlation with Obesity-Related Features. Jornal de Pediatria, 2017; 189: 92-971.
34. WANG F, et al. DUOX2 and DUOXA2 Variants Confer Susceptibility to Thyroid Dysgenesis and Gland-in-situ With Congenital Hypothyroidism. Frontiers in Endocrinology (Lausanne), 2020; 11: 237.
35. WHOOTEN R, et al. Endocrine manifestations of Down syndrome. Current Opinion in Endocrinology, Diabetes and Obesity, 2018; 25(1): 61-66.
36. WISNIEWSKI KE e Bobinski M. Hypothalamic abnormalities in Down syndrome. Progress in Clinical and Biological Research, 1991; 373: 153-167.
37. ZIMMERMANN MB, et al. New reference values for thyroid volume by ultrasound in iodine-sufficient schoolchildren: a World Health Organization/Nutrition for Health and Development Iodine Deficiency Study Group Report. The American Journal of Clinical Nutrition, 2004; 79(2): 231-237.