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Hou LY, Li X, Zhang GQ, Xi C, Shen CT, Song HJ, Bai WK, Qiu ZL, Luo QY. Transiently impaired endothelial function during thyroid hormone withdrawal in differentiated thyroid cancer patients. Front Endocrinol (Lausanne) 2023; 14:1164789. [PMID: 37424871 PMCID: PMC10327818 DOI: 10.3389/fendo.2023.1164789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 05/11/2023] [Indexed: 07/11/2023] Open
Abstract
Purpose Endothelial dysfunction, which was associated with chronic hypothyroidism, was an early event in atherosclerosis. Whether short-term hypothyroidism following thyroxine withdrawal during radioiodine (RAI) therapy was associated with endothelial dysfunction in patients with differentiated thyroid cancer (DTC) was unclear. Aim of the study was to assess whether short-term hypothyroidism could impair endothelial function and the accompanied metabolic changes in the whole process of RAI therapy. Methods We recruited fifty-one patients who underwent total thyroidectomy surgery and would accept RAI therapy for DTC. We analyzed thyroid function, endothelial function and serum lipids levels of the patients at three time points: the day before thyroxine withdrawal(P1), the day before 131I administration(P2) and 4-6 weeks after RAI therapy(P3). A high-resolution ultrasound named flow-mediated dilation (FMD) was used to measure endothelial function of the patients. Results We analyzed the changes of FMD, thyroid function and lipids at three time points. FMD(P2) decreased significantly compared to FMD(P1) (P1vsP2, 8.05 ± 1.55vs 7.26 ± 1.50, p<0.001). There was no significant difference between FMD(P3) and FMD(P1) after restoring TSH (thyroid stimulating hormone) suppression therapy (P1 vs P3, 8.05 ± 1.55 vs 7.79 ± 1.38, p=0.146). Among all parameters, the change of low-density lipoprotein (ΔLDL) was the only factor correlated negatively with the change of FMD (ΔFMD) throughout the RAI therapy process (P1-2, r=-0.326, p=0.020; P2-3, r=-0.306, p=0.029). Conclusion Endothelial function was transiently impaired in DTC patients at short-term hypothyroidism state during the RAI therapy, and immediately returned to the initial state after restoring TSH suppression therapy.
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Affiliation(s)
- Li-ying Hou
- Department of Nuclear Medicine, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiao Li
- Department of Ultrasound in Medicine, The Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Institute of Ultrasound in Medicine, Shanghai, China
| | - Guo-qiang Zhang
- Department of Nuclear Medicine, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chuang Xi
- Department of Nuclear Medicine, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chen-tian Shen
- Department of Nuclear Medicine, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hong-jun Song
- Department of Nuclear Medicine, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wen-kun Bai
- Department of Ultrasound in Medicine, The Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Institute of Ultrasound in Medicine, Shanghai, China
| | - Zhong-ling Qiu
- Department of Nuclear Medicine, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Quan-yong Luo
- Department of Nuclear Medicine, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Stojković M, Žarković M. Subclinical Thyroid Dysfunction and the Risk of Cardiovascular Disease. Curr Pharm Des 2020; 26:5617-5627. [PMID: 33213317 DOI: 10.2174/1381612826666201118094747] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 08/19/2020] [Indexed: 01/07/2023]
Abstract
The prevalence of subclinical hypothyroidism (SH) is 3-10%. The prevalence of subclinical hyperthyroidism (SHr) is 0.7-9.7%. Thyroid hormones affect cardiac electrophysiology, contractility, and vasculature. SH is associated with an increased risk of coronary heart disease (CHD), especially in subjects under 65. SHr seems to be associated with a slightly increased risk of CHD and an increase in CHD-related mortality. Both SH and SHr carry an increased risk of developing heart failure (HF), especially in those under 65. Both SH and SHr are associated with worse prognoses in patients with existing HF. SH is probably not associated with atrial fibrillation (AF). SHr, low normal thyroid-stimulating hormone (TSH) and high normal free thyroxine (FT4) are all associated with the increased risk of AF. An association between endothelial dysfunction and SH seems to exist. Data regarding the influence of SHr on the peripheral vascular system are conflicting. SH is a risk factor for stroke in subjects under 65. SHr does not increase the risk of stroke. Both SH and SHr have an unfavourable effect on cardiovascular disease (CVD) and all-cause mortality. There is a U-shaped curve of mortality in relation to TSH concentrations. A major factor that modifies the relation between subclinical thyroid disease (SCTD) and mortality is age. SH increases blood pressure (BP). SHr has no significant effect on BP. Lipids are increased in patients with SH. In SHr, high-density lipoprotein cholesterol and lipoprotein( a) are increased. SCTD should be treated when TSH is over 10 mU/l or under 0.1 mU/l. Treatment indications are less clear when TSH is between normal limits and 0.1 or 10 mU/L. The current state of knowledge supports the understanding of SCTD's role as a risk factor for CVD development. Age is a significant confounding factor, probably due to age-associated changes in the TSH reference levels.
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Ordookhani A, Burman KD. Hemostasis in Overt and Subclinical Hyperthyroidism. Int J Endocrinol Metab 2017; 15:e44157. [PMID: 29201071 PMCID: PMC5702470 DOI: 10.5812/ijem.44157] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 02/24/2017] [Accepted: 03/14/2017] [Indexed: 11/29/2022] Open
Abstract
CONTEXT There are contradictory results on the effect of hyperthyroidism on hemostasis. Inadequate population-based studies limited their clinical implications, mainly on the risk of venous thromboembolism (VTE). The present review focuses on hemostatic changes in overt and subclinical hyperthyroidism. METHODS A systematic literature search was conducted employing MEDLINE database. The following words were used for the search: Hyperthyroidism; thyrotoxicosis; Graves disease; goiter, nodular; hemostasis; blood coagulation factors; blood coagulation disorders; venous thromboembolism; bleeding; fibrinolysis. The articles that were related to hyperthyroidism and hemostasis are used in this manuscript. RESULTS Hyperthyroidism, either overt or subclinical, renders a hypercoagulable state, although there are several studies with contradictory findings in the literature. Hypercoagulability may be caused by an increase in the level of various coagulation factors such as factor (F) VIII, FX, FIX, von Willebrand F (vWF), and fibrinogen, while hypofibrinolysis by changes in coagulation parameters such as a decrease in plasmin and plasmin activator or an increase in α2-antiplasmin, plasminogen activator inhibitor-1 and thrombin activatable fibrinolysis inhibitor. CONCLUSIONS Although many reports are in favor of a hypercoagulable state in overt hyperthyroidism but this finding at the biochemical level and its clinical implication, on the occurrence of VTE, has yet to be confirmed.
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Affiliation(s)
- Arash Ordookhani
- Endocrine Section, Department of Internal Medicine, Providence Hospital, Washington, DC, 20017
| | - Kenneth D. Burman
- Endocrine Section, MedStar Washington Hospital Center, Washington, DC, 20010
- Corresponding author: Kenneth D. Burman, Endocrine Section, MedStar Washington Hospital Center, Washington, DC, 20010, E-mail:
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Ordookhani A, Burman KD. Hemostasis in Hypothyroidism and Autoimmune Thyroid Disorders. Int J Endocrinol Metab 2017; 15:e42649. [PMID: 29026409 PMCID: PMC5626118 DOI: 10.5812/ijem.42649] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2016] [Revised: 02/11/2017] [Accepted: 02/15/2017] [Indexed: 02/06/2023] Open
Abstract
CONTEXT There are contradictory results on the effect of hypothyroidism on the changes in hemostasis. Inadequate population-based studies limited their clinical implications, mainly on the risk of venous thromboembolism (VTE). This paper reviews the studies on laboratory and population-based findings regarding hemostatic changes and risk of VTE in hypothyroidism and autoimmune thyroid disorders. EVIDENCE ACQUISITION A comprehensive literature search was conducted employing MEDLINE database. The following words were used for the search: Hypothyroidism; thyroiditis, autoimmune; blood coagulation factors; blood coagulation tests; hemostasis, blood coagulation disorders; thyroid hormones; myxedema; venous thromboembolism; fibrinolysis, receptors thyroid hormone. The papers that were related to hypothyroidism and autoimmune thyroid disorder and hemostasis are used in this review. RESULTS Overt hypothyroidism is more associated with a hypocoagulable state. Decreased platelet count, aggregation and agglutination, von Willebrand factor antigen and activity, several coagulation factors such as factor VIII, IX, XI, VII, and plasminogen activator-1 are detected in overt hypothyrodism. Increased fibrinogen has been detected in subclinical hypothyroidism and autoimmune thyroid disease rendering a tendency towards a hypercoagulability state. Increased factor VII and its activity, and plasminogen activator inhibitor-1 are among several findings contributing to a prothrombotic state in subclinical hypothyroidism. CONCLUSIONS Overt hypothyroidism is associated with a hypocoagulable state and subclinical hypothyroidism and autoimmune thyroid disorders may induce a prothrombotic state. However, there are contradictory findings for the abovementioned thyroid disorders. Prospective studies on the risk of VTE in various levels of hypofunctioning of the thyroid and autoimmune thyroid disorders are warranted.
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Affiliation(s)
- Arash Ordookhani
- Endocrine Section, Department of Internal Medicine, Providence Hospital, Washington, DC, 20017
| | - Kenneth D. Burman
- Endocrine Section, MedStar Washington Hospital Center, Washington, DC, 20010
- Corresponding author: Kenneth D. Burman, MD, The Endocrine Section, Rm. 2A72, MedStar Washington Hospital Center, 110 Irving St., NW, Washington, DC 20010. E-mail:
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Hosseini SM, Bakhtyari EK, Heshmat-Ghahdarijani K, Khalili N. Evaluation of endothelial function in exogenous subclinical hyperthyroidism and the effect of treatment. Adv Biomed Res 2016; 5:173. [PMID: 28028513 PMCID: PMC5157004 DOI: 10.4103/2277-9175.194800] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Accepted: 02/20/2016] [Indexed: 11/15/2022] Open
Abstract
Background: Subclinical hyperthyroidism (SHy) is a widespread condition in which cardiovascular manifestations are frequently occur, but there is still a debate about the vascular responsiveness in it. Measuring flow-mediated dilation (FMD) and intimae-media thickness (IMT) are used to evaluate endothelial function in these patients. Materials and Methods: Twenty-five patients with a diagnosis of exogenous SHy and 25 full matched healthy subjects were enrolled. At first FMD of brachial artery and IMT of common carotid artery were obtained from all the participants. In the second phase, in the second phase of study, the dosage of levothyroxine was reduced at least 25% of prior dosage, and this was continued until thyroid stimulating hormone became normal range. Measuring FMD and IMT was repeated after this intervention in the case group. Results: The mean age of case and control groups were 38.48 ± 12.05 and 36.72 ± 11.15 years, respectively. The mean of FMD in healthy people was dramatically higher than the subclinical hyperthyroid patients (P < 0.001) but no statistically significant difference was found for IMT (P = 0.459). After intervention in the case group, FMD was meaningfully increased (P < 0.001) but IMT of common carotid artery was not considerably changed (P = 0.491). Conclusions: This study demonstrated that FMD decreased in exogenous subclinical hyperthyroid patients which could be partially restored by treatment. These findings suggest that treatment of subclinical hyperthyroid state could improve endothelial dysfunction and at the end decreased the cardiovascular complications.
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Affiliation(s)
- Sayed Mohammad Hosseini
- Department of Internal Medicine, Isfahan Endocrine and Metabolism Research Center, Isfahan, Iran
| | | | | | - Noushin Khalili
- Department of Internal Medicine, Isfahan Endocrine and Metabolism Research Center, Isfahan, Iran
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Gazdag A, Nagy EV, Erdei A, Bodor M, Berta E, Szabó Z, Jenei Z. Aortic stiffness and left ventricular function in patients with differentiated thyroid cancer. J Endocrinol Invest 2015; 38:133-42. [PMID: 25194423 DOI: 10.1007/s40618-014-0143-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Accepted: 07/25/2014] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The aim of this study was to investigate aortic stiffness and left ventricular (LV) systolic and diastolic function in patients with differentiated thyroid cancer (DTC) on thyroxine (L-T4) therapy and after L-T4 withdrawal to assess the cardiovascular impact of long-term subclinical hyperthyroidism and short-term overt hypothyroidism. METHODS Twenty-four patients who had had total thyroidectomy and radioiodine ablation for differentiated thyroid cancer were studied on two occasions: on TSH suppressive L-T4 therapy (sTSH 0.24 ± 0.11 mU/L), and 4 weeks after L-T4 withdrawal (sTSH 89.82 ± 29.36 mU/L). Echocardiography was performed and thyroid function, serum thyroglobulin, lipid parameters, homocystine, C-reactive protein, fibrinogen and von Willebrand factor activity (vWF) were measured. Twenty-two healthy volunteers matched for age and sex served as euthyroid controls. RESULTS Aortic stiffness was increased both in hypothyroidism (6.04 ± 2.88 cm(2)/dyn/10(3), p < 0.05) and subclinical hyperthyroidism (9.27 ± 4.81 cm(2)/dyn/10(3), p < 0.05) vs. controls (3.92 ± 1.84 cm(2)/dyn/10(3)). Subclinical hyperthyroidism had a more marked effect (p < 0.05). LV dimensions and ejection fractions were similar before and after L-T4 withdrawal. The E'/A' was higher in euthyroid controls (1.34 ± 1.02) as compared to both subclinical hyperthyroidism (1.0 ± 0.14, p < 0.05) and overt hypothyroidism (1.13 ± 0.98, p < 0.05). Change of aortic stiffness correlated with change of free-thyroxine (fT4), vWF and fibrinogen levels in a positive manner. CONCLUSION Long-term thyrotropin-suppression therapy has continuous adverse effects on the arterial wall. The degree of TSH suppression in patients with DTC should be kept at the possible minimum, based on individually determined potential benefits and risks of treatment, especially in patients with cardiovascular co-morbidities.
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Affiliation(s)
- A Gazdag
- Division of Endocrinology, Department of Medicine, Faculty of Medicine, University of Debrecen, P.O.B. 19, Debrecen, 4012, Hungary.
| | - E V Nagy
- Division of Endocrinology, Department of Medicine, Faculty of Medicine, University of Debrecen, P.O.B. 19, Debrecen, 4012, Hungary
| | - A Erdei
- Division of Endocrinology, Department of Medicine, Faculty of Medicine, University of Debrecen, P.O.B. 19, Debrecen, 4012, Hungary
| | - M Bodor
- Division of Endocrinology, Department of Medicine, Faculty of Medicine, University of Debrecen, P.O.B. 19, Debrecen, 4012, Hungary
| | - E Berta
- Division of Endocrinology, Department of Medicine, Faculty of Medicine, University of Debrecen, P.O.B. 19, Debrecen, 4012, Hungary
| | - Z Szabó
- Division of Endocrinology, Department of Medicine, Faculty of Medicine, University of Debrecen, P.O.B. 19, Debrecen, 4012, Hungary
| | - Z Jenei
- Division of Endocrinology, Department of Medicine, Faculty of Medicine, University of Debrecen, P.O.B. 19, Debrecen, 4012, Hungary
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Ozkan C, Akturk M, Altinova AE, Cerit ET, Gulbahar O, Yalcin MM, Cakir N, Balos Toruner F. Proprotein convertase subtilisin/kexin type 9 (PCSK9), soluble lectin-like oxidized LDL receptor 1 (sLOX-1) and ankle brachial index in patients with differentiated thyroid cancer. Endocr J 2015; 62:1091-9. [PMID: 26490048 DOI: 10.1507/endocrj.ej15-0308] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The cardiovascular effects of short-term overt hypothyroidism are not well known. We investigated proprotein convertase subtilisin/kexin type 9 (PCSK9), soluble lectin-like oxidized LDL receptor 1 (sLOX-1) and the ankle brachial index (ABI) in thyroid cancer patients with short-term overt hypothyroidism due to thyroid hormone withdrawal (THW). Twenty-one patients requiring radioactive iodine (RAI) ablation or scanning and 36 healthy control subjects were enrolled. Patients were evaluated in the subclinical thyrotoxic phase when they were on suppressive levothyroxine therapy and in the overt hypothyroid phase due to THW for four weeks. PCSK9, sLOX-1, lipids and ABI were measured in the patient and control groups. Total cholesterol, LDL cholesterol, triglycerides and Apo B levels were increased in short overt hypothyroidism compared with the control group (p<0.001). PCSK9 levels increased before THW and after THW in the patients compared to control group (p<0.001, p=0.004, respectively). sLOX-1 levels were not different between patients with short term overt hypothyroidism and control group (p=0.27). ABI was found to be significantly decreased in patients with thyroid cancer before and after THW compared to control group (p=0.04, p=0.002 respectively). PCSK9 levels were correlated negatively with ABI (r=-0.38, p=0.004). In conclusion; our study demonstrated that patients with differentiated thyroid cancer both before and after THW which is a short term overt hypothyroid phase, had increased PCSK9 levels and decreased ABI. Short term overt hypothyroidism also leads to increased HDL, LDL, total cholesterol, Apo A and Apo B levels.
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Affiliation(s)
- Cigdem Ozkan
- Gazi University Faculty of Medicine, Department of Endocrinology and Metabolism, Ankara, Turkey
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Fatourechi MM, Fatourechi V. An update on subclinical hypothyroidism and subclinical hyperthyroidism. Expert Rev Endocrinol Metab 2014; 9:137-151. [PMID: 30743756 DOI: 10.1586/17446651.2014.887433] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Subclinical thyroid dysfunction is characterized by normal levels of peripheral thyroid hormone, paired with a TSH level that is either lower than (subclinical hyperthyroidism) or higher than (subclinical hypothyroidism) the normal laboratory reference range. Slight shifts in peripheral hormone levels result in significant serum TSH changes. The exact upper limit of normal TSH and the management of subclinical hypothyroidism are still controversial. For those with TSH between high upper limit of normal and 10 mIU/L, the authors suggest selective use of thyroxine therapy. The authors agree with the general consensus in favor of therapy for those with serum TSH levels above 10 mIU/L. This recommendation is compatible with guidelines of American Thyroid Association and American Association of Clinical Endocrinologists. For subclinical hyperthyroidism persistent serum TSH <0.1 mIU/L should be treated particularly if the etiology is nodular toxic goiter. For serum TSH between 0.1 mIU/L and lower limit of normal, serum TSH co-morbidities such as cardiac risk factors and osteoporosis may favor therapy.
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Affiliation(s)
| | - Vahab Fatourechi
- b Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, MN, USA
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Shin DY, Kim KJ, Cho Y, Park KH, Hwang S, Chung WY, Lee EJ. Body Mass Index Is Associated with Hypercholesterolemia following Thyroid Hormone Withdrawal in Thyroidectomized Patients. Int J Endocrinol 2014; 2014:649016. [PMID: 25114682 PMCID: PMC4120900 DOI: 10.1155/2014/649016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Revised: 05/19/2014] [Accepted: 05/19/2014] [Indexed: 12/28/2022] Open
Abstract
Thyroid hormone withdrawal (THW) for postoperative radioiodine adjuvant therapy or diagnostic radioiodine whole body scan in patients with differentiated thyroid cancers results in acute thyroid hormone deficiency and abnormal lipid profiles. To better clarify the clinical pattern of dyslipidemia occurring after THW, we retrospectively analyzed the association between serum total cholesterol level after THW and various clinical factors in a total of 61 patients who underwent total thyroidectomy due to papillary thyroid cancers from January 2010 to March 2012, in Severance Hospital, Seoul, Korea. Preoperative baseline total cholesterol was significantly correlated with post-THW total cholesterol level; however, age, gender, or elevated TSH level after THW itself was not correlated with post-THW total cholesterol level. A significant correlation between preoperative measured BMI and post-THW total cholesterol level was found (r = 0.263, P = 0.041). In multiple logistic analysis, BMI was an independent determining factor of post-THW total cholesterol level (P = 0.012).
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Affiliation(s)
- Dong Yeob Shin
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Republic of Korea
- Department of Medicine, The Graduate School, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Republic of Korea
| | - Kwang Joon Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Republic of Korea
- Severance Executive Healthcare Clinic, Yonsei University Health System, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Republic of Korea
- Severance Check-up, Yonsei University Health System, 10 Tongil-ro, Jung-gu, Seoul 100-753, Republic of Korea
| | - Yongin Cho
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Republic of Korea
- Department of Medicine, The Graduate School, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Republic of Korea
| | - Kyeong Hye Park
- Department of Endocrinology and Metabolism, National Health Insurance Service, Ilsan Hospital, Goyang, Gyeonggi 410-719, Republic of Korea
| | - Sena Hwang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Republic of Korea
- Department of Medicine, The Graduate School, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Republic of Korea
| | - Woong Youn Chung
- Department of Surgery, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Republic of Korea
| | - Eun Jig Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Republic of Korea
- *Eun Jig Lee:
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Increased asymmetric dimethylarginine and enhanced inflammation are associated with impaired vascular reactivity in women with endometriosis. Atherosclerosis 2011; 219:784-8. [PMID: 21880316 DOI: 10.1016/j.atherosclerosis.2011.08.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2011] [Revised: 08/02/2011] [Accepted: 08/02/2011] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Enhanced inflammatory responses which may inhibit vascular reactivity, are associated with endometriosis development. Asymmetric dimethylarginine (ADMA), an inhibitor of endogenous nitric oxide synthase, is also implicated in endothelial dysfunction. We aimed to determine whether plasma ADMA and systemic inflammation are associated with endothelial function in women with endometriosis. METHODS We evaluated 41 women with and 28 women without endometriosis. Plasma levels of lipids and inflammatory markers such as high sensitive-C reactive protein (hs-CRP), serum amyloid protein A (SAA), and interleukin-6 (IL-6) were measured in the two groups. We also measured levels of ADMA and symmetric dimethylarginine (SDMA). High-resolution ultrasonography measured flow-mediated vasodilation (FMD) to assess vasodilatory responses. RESULTS FMD was significantly lower in women with endometriosis compared to those without endometriosis (8.39 ± 0.43% vs 10.79 ± 0.54%, P = 0.001). While plasma lipid levels did not differ significantly between groups, levels of AMDA, but not SDMA, were significantly higher in women with endometriosis (409.7 ± 10.1 pmol/L vs 383.0 ± 48.3 pmol/L, P = 0.04). Inflammatory markers were also significantly higher in these women (hs-CRP: 1053.3 ± 252.0 ng/mL vs 272.0 ± 83.3 ng/mL, P = 0.02; SAA: 8.00 ± 1.53 μg/mL vs 3.82 ± 0.42 μg/mL, P = 0.04; IL-6: 2.73 ± 0.75 pg/mL vs 1.05 ± 0.60 pg/mL, P = 0.04). FMD was negatively correlated with plasma levels of ADMA (r = -0.37, P=0.01) and log hs-CRP (r = -0.34, P = 0.01). CONCLUSION Increased plasma ADMA levels and enhanced inflammation are associated with inhibited endothelial function in women with endometriosis.
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