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Incidence of thyroid subclinical and overt thyroid disorders in the Brazilian Longitudinal Study of Adult Health


Cardiovascular disease is the main cause of mortality worldwide whiel the crescent importance of depression and cognitive impairment as cause of years lived without quality of life is increasing worldwide and in Brazil. The majority of cohort studies are in US/Europe focused on risk factor for cardiovascular disease. Emerging factors as subclinical and overt thyroid functions are less studied. Since the Wickham study with 2800 participants followed for more than 20 years until the more recent results of the "Framingham Heart Study" about thyroid function, there was an important increase in knowledge about the relationship between thyroid function and cardiovascular disease. However, little is known about the mechanisms of this association and if the results would be similar in other populations out of US/Europe.Few studies in Brazil evaluated prevalence of thyroid dysfunction and none evaluated incidence. ELSA-Brasil is a cohort study of 15,105 civil servants 35-74 years from 6 public institutions in Brazil. The baseline data collection (wave 1) occurred from August 2008/December 2010 and the 2nd data collection (wave 2) occurred from August 2012/December 2014. The data collection included interviews/exams. Telephone surveillance for outcomes is annual as well as linkage with official statistics databanks. In the baseline examination (wave 1) all participants had TSH values determined but free-thyroxine (FT4) was only tested in participants with an altered TSH: < 0.4mcUI/mL or >4.0 mcUI/mL. Serum samples were stored. In wave 2 no test to evaluate thyroid function was performed, but new samples of fasting serum were stored. TSH/FT4 were measured by a 3rd generation immunoenzymatic assay. Cut-off levels for FT4 were <0.8 ng/dL for hypo/>1.9 ng/dL for hyperthyroidism. Based on information about TSH, FT4 and use of medication/hormones, participants were classified as overt hyper/hypothyroidism, and subclinical hyper/hypothyroidism. To perform anti-TPO antibodies we will use a chemiluminescent assay with monoclonal antibodies (Siemens). Mental diagnoses were assessed by by Portuguese version of the Clinical Interview Schedule - Revised (CIS-R) to evaluate psychiatric disorders. We used 3 cognitive tests of the CERAD: memory learning and retention, a Semantic/Phonemic Verbal Fluency Test and Trial Making Test B (executive function). Statistical analysis: Incidence of thyroid function and anti-TPO after a 4-year follow-up will be calculated/10,000 participants. We will use Cox proportional hazards to calculate the relative risk (RR; 95% CI) as crude, adjusted for age/sex and after multivariate adjustment for confounders. The main objective of this proposal is to focuse all resources of the ELSA-Brasil to reach an internationally competitive study to evaluate the relationship between thyroid function and cardiovascular disease, risk factors associated to lipid metabolism, cognitive impairment and psychiatric disturbs. We can highlight the extension of the partnership with researches of US/Europe: University of Miami, Brown University, com o Baptist Hospital of Miami, Brigham and Women´s Hospital/Harvard Medical School e com a Johns Hopkins as well as with biotechnologies companies such as Atherotech (Birmingham, Alabama, US and Liposcience, now LabCorp (Raleigh, North Carolina, US) that did with no costs to the project the lipid profile using vertical ultracentrifugation and magnetic resonance imaging, respectively. (AU)

Articles published in Pesquisa FAPESP Magazine about the research grant:
El peso de las emociones sobre el corazón 
Emotions weigh heavy on the heart 

Scientific publications
(References retrieved automatically from Web of Science and SciELO through information on FAPESP grants and their corresponding numbers as mentioned in the publications by the authors)
HOSHI, ROSANGELA A.; ANDREAO, V, RODRIGO; SANTOS, ITAMAR S.; DANTAS, EDUARDO M.; MILL, JOSE GERALDO; LOTUFO, PAULO A.; BENSENOR, ISABELA M. Linear and nonlinear analyses of heart rate variability following orthostatism in subclinical hypothyroidism. MEDICINE, v. 98, n. 4 JAN 2019. Web of Science Citations: 0.
PEIXOTO DE MIRANDA, E. J. F.; BITTENCOURT, M. S.; STANIAK, H. L.; SHAROVSKY, R.; PEREIRA, A. C.; FOPPA, M.; SANTOS, I. S.; LOTUFO, P. A.; BENSENOR, I. M. Thyrotropin and free thyroxine levels and coronary artery disease: cross-sectional analysis of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Brazilian Journal of Medical and Biological Research, v. 51, n. 5, p. -, 2018. Web of Science Citations: 2.

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