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TSH Trajectories During Levothyroxine Treatment in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) Cohort.
Ettleson, Matthew D; Penna, Gustavo C E; Wan, Wen; Benseñor, Isabela M; Laiteerapong, Neda; Bianco, Antonio C.
Afiliação
  • Ettleson MD; Section of Endocrinology, Diabetes, and Metabolism, University of Chicago, Chicago, IL 60637, USA.
  • Penna GCE; Section of Endocrinology, Diabetes, and Metabolism, University of Chicago, Chicago, IL 60637, USA.
  • Wan W; Section of General Internal Medicine, University of Chicago, Chicago, IL 60637, USA.
  • Benseñor IM; Center for Clinical and Epidemiological Research, Clinical Hospital, Department of Medicine, University of Sao Paulo, Sao Paulo, 05508-000, Brazil.
  • Laiteerapong N; Section of General Internal Medicine, University of Chicago, Chicago, IL 60637, USA.
  • Bianco AC; Section of Endocrinology, Diabetes, and Metabolism, University of Chicago, Chicago, IL 60637, USA.
J Clin Endocrinol Metab ; 2024 May 23.
Article em En | MEDLINE | ID: mdl-38780968
ABSTRACT
CONTEXT Thyroid-stimulating hormone (TSH) trajectory classification represents a novel approach to defining the adequacy of levothyroxine (LT4) treatment for hypothyroidism over time.

OBJECTIVE:

This is a proof of principle study that uses longitudinal clinical data, including thyroid hormone levels from a large prospective study to define classes of TSH trajectories and examine changes in cardiovascular (CV) health markers over the study period.

METHODS:

Growth mixture modeling (GMM), including latent class growth analysis (LCGA), was used to classify LT4-treated individuals participating in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) based on serial TSH levels. Repeated measure analyses were then utilized to assess within-class changes in blood pressure, lipid levels, hemoglobin A1c, and CV-related medication utilization.

RESULTS:

From the 621 LT4-treated study participants, the best-fit GMM approach identified 4 TSH trajectory classes, as defined by their relationship to the normal TSH range (1) high-high normal TSH, (2) normal TSH, (3) normal to low TSH, and (4) low to normal TSH. Notably, the average baseline LT4 dose was lowest in the high-high normal TSH group (77.7 µg, P < .001). There were no significant differences in CV health markers between the classes at baseline. At least 1 significant difference in CV markers occurred in all classes, highlighted by the low to normal class, in which total and high-density lipoprotein cholesterol, triglycerides, and A1c all increased significantly (P = .049, P < .001, P < .001, and P = .001, respectively). Utilization of antihypertensive, antihyperlipidemic, and antidiabetes medications increased in all classes.

CONCLUSION:

GMM/LCGA represents a viable approach to define and examine LT4 treatment by TSH trajectory. More comprehensive datasets should allow for more complex trajectory modeling and analysis of clinical outcome differences between trajectory classes.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE País/Região como assunto: America do sul / Brasil Idioma: En Revista: J Clin Endocrinol Metab Ano de publicação: 2024 Tipo de documento: Article País de afiliação: Estados Unidos País de publicação: Estados Unidos
Texto completo
Adicionar na Minha BVS
Imprimir
XML
PubMed Links
Buscar no Google

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE País/Região como assunto: America do sul / Brasil Idioma: En Revista: J Clin Endocrinol Metab Ano de publicação: 2024 Tipo de documento: Article País de afiliação: Estados Unidos País de publicação: Estados Unidos