Although muscle metabolism and exercise capacity seem to be affected in patients with subclinical hypothyroidism, there is little evidence indicating improvement of the exercise tolerance due to levothyroxine (L-T(4)) replacement. The aim of the present study was to verify possible cardiopulmonary changes during exercise in patients with subclinical hypothyroidism on L-T(4) replacement with a normal serum TSH for six months. Twenty-three patients with subclinical hypothyroidism were randomized into treated (no.=11) and untreated (no.=12) patients. A cardiopulmonary test was performed with a treadmill, using the modified Balke protocol. Heart rate, oxygen uptake, minute ventilation and other cardiopulmonary parameters were assessed at the 5th minute of exercise. FT4 levels increased while TSH normalized after hormone replacement. Oxygen uptake decreased significantly after hormone replacement (24.1+/-6.3 vs 17.1+/-4.2 ml x kg x min(-1); p=0.03).Minute ventilation also showed an enhanced performance in treated patients (28.0+/-8.1 vs 23.5+/-5.6 l x min(-1); p=0.03), as did the heart rate (128+/-17 vs 121+/-17 bpm; p=0.03). There were no changes in the untreated group. The results demonstrate that submaximal cardiopulmonary exercise performance improved after six months of TSH normalization and this improvement can help enhance the ability to carry out daily life activities in patients with subclinical hypothyroidism.

Objective: The objective of this study was to investigate the health status of women with overt and subclinical hypothyroidism and relate it to the presence of clinical signs and symptoms of the disease. Subjects and Methods: A cross-sectional study was conducted on 232 women divided into 3 groups: overt hypothyroidism (n = 14); subclinical hypothyroidism (n = 152), and controls (n = 66). Health status was evaluated by the questionnaire SF-36, and the clinical signs and symptoms of hypothyroidism were assessed with the Billewicz scale modified by Zulewski. The Kruskal-Wallis test followed by the Mann-Whitney U test with Bonferroni correction was applied to compare continuous variables between the groups. To assess the relationship between SF-36 domains and the clinical score, as well as SF-36 domains and serum thyroid-stimulating hormone levels, the Spearman correlation coefficient was calculated. Results: Patients with overt hypothyroidism presented systematically lower scores in all SF-36 domains (p < 0.05), both in relation to subclinical hypothyroidism patients and controls. This indicates a great dissatisfaction with health status in this group. Patients with subclinical hypothyroidism presented statistically lower scores in relation to controls with the exception of the role-emotional and bodily pain domains, where although they were not statistically significant, scores were clinically different. Highly negative correlations between SF-36 domains and the clinical score were observed in overt hypothyroidism (physical function r = –0.80, p < 0.01; bodily pain r = –0.74, p < 0.01). Conclusion: Overt hypothyroidism seemed to be associated with worse perception of health status, negatively associated with clinical score.

Novel cardiovascular risk markers, such as ambulatory blood pressure (BP) and aortic stiffness, have been proposed. The aim of this study was to investigate the relationship between physical fitness and some of these risk markers in 575 type 2 diabetic patients. In a cross-sectional design, clinical, laboratory, echocardiographic, aortic pulse wave velocity and 24-h ambulatory BP monitoring data were obtained. Fitness was self-reported using a standard questionnaire of daily activities, and then assessed as belonging to one of the three categories: low (o4 metabolic equivalents (METs)), moderate (X4 to o7 METs) and high fitness (X7 METs). In a random sub-sample of 265 patients, self-reported fitness was confirmed by a standard treadmill test. Statistical analysis was carried out, using tests including bivariate tests among the three categories and multivariate logistic regression. Agreement between self-reported and measured fitness was substantial (weighted j: 0.63). High fitness patients were younger, frequently male, had a decreased prevalence of degenerative complications, lower office and ambulatory BP levels, particularly during the night and had an increased prevalence of the normal nocturnal dipping pattern. High fitness patients also had lower hemoglobin A1c and C-reactive protein levels, a decreased prevalence of left ventricular hypertrophy and increased aortic stiffness. On multiple logistic regression, after adjustments for several confounders, high fitness was independently associated with a higher likelihood of having low C-reactive protein (odds ratio (OR): 2.3, 95% confidence interval (CI): 1.3-3.9), controlled nighttime BP (OR: 2.3, 95% CI: 1.4-3.8), normal dipping pattern (OR: 2.1, 95% CI: 1.2-3.5) and low aortic stiffness (OR: 2.5, 95% CI: 1.3-4.8). Patients with moderate fitness had intermediate OR. In conclusion, a moderate to high level of physical fitness was independently associated with several favorable intermediate cardiovascular risk markers, which may contribute to decreasing the burden of morbi-mortality in patients with type 2 diabetes. Hypertension Research (2011) 34, 856-861; doi:10.1038/hr.2011; published online 12 May 2011Keywords: ambulatory blood pressure; aortic stiffness; cardiorespiratory fitness; C-reactive protein; type 2 diabetes INTRODUCTION Studies in type 2 diabetic patients have found that high levels of aerobic fitness are associated with lower levels of overall mortality and mortality due to cardiovascular events, independent of traditional cardiovascular risk factors. 1,2 However, the relationship between cardiorespiratory fitness and some recently described non-traditional cardiovascular risk factors, such as ambulatory blood pressures (BPs), aortic stiffness and C-reactive protein, has not been as well characterized for type 2 diabetic patients. Whether these factors contribute independently to low fitness or merely reflect more advanced cardiovascular complications is unknown.Compared with office BPs, ambulatory BPs are stronger cardiovascular risk predictors...