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Song L, Lei J, Jiang K, Lei Y, Tang Y, Zhu J, Li Z, Tang H. The Association Between Subclinical Hypothyroidism and Sleep Quality: A Population-Based Study. Risk Manag Healthc Policy 2019; 12:369-374. [PMID: 31908553 PMCID: PMC6927586 DOI: 10.2147/rmhp.s234552] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 12/05/2019] [Indexed: 02/05/2023] Open
Abstract
Background and Aim The relationship between subclinical hypothyroidism (SHYPO) and sleep quality is still unclear. Our objective was to compare the sleep quality between SHYPO patients and a control group with normal thyroid function. Methods A total of 2224 patients with SHYPO and 12,622 euthyroid (EUTH) control group patients were included in the present study. The Pittsburgh Sleep Quality Index (PSQI) was used to assess sleep quality. The sleep outcomes were compared to explore the association between SHYPO and sleep quality. Furthermore, we tried to identify the risk factors of poor sleep in SHYPO patients. Results Compared to the EUTH control patients, SHYPO patients had a higher PSQI score (6.83 ± 2.67 vs 6.64 ± 2.63, p =0.004) and a higher proportion of poor sleepers (67.09% vs 64.75%, p =0.033). Moreover, subjects with SHYPO were associated with poorer sleep (Odd Ratio (OR) 1.120, 95% Confidence Intervals (CI) 1.016 to 1.235, p =0.023), longer sleep latency (OR 1.162, 95% CI 1.053 to 1.282, p =0.003), and shorter sleep duration (OR 1.148, 95% CI 1.019 to 1.293, p =0.023) after adjusting for potential confounders. Furthermore, we found that lower age, lower body mass index, and women were risk factors for poor sleep quality in SHYPO patients. Conclusion Our findings suggest a relationship between SHYPO and poor sleep quality in a large Chinese population.
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Affiliation(s)
- Linlin Song
- Thyroid and Parathyroid Surgery Center, West China Hospital of Sichuan University, Chengdu 610041, People's Republic of China
| | - Jianyong Lei
- Thyroid and Parathyroid Surgery Center, West China Hospital of Sichuan University, Chengdu 610041, People's Republic of China
| | - Ke Jiang
- Thyroid and Parathyroid Surgery Center, West China Hospital of Sichuan University, Chengdu 610041, People's Republic of China
| | - Yali Lei
- Health and Management Center, West China Hospital of Sichuan University, Chengdu 610041, People's Republic of China
| | - Yuting Tang
- Health and Management Center, West China Hospital of Sichuan University, Chengdu 610041, People's Republic of China
| | - Jingqiang Zhu
- Thyroid and Parathyroid Surgery Center, West China Hospital of Sichuan University, Chengdu 610041, People's Republic of China
| | - Zhihui Li
- Thyroid and Parathyroid Surgery Center, West China Hospital of Sichuan University, Chengdu 610041, People's Republic of China
| | - Huairong Tang
- Health and Management Center, West China Hospital of Sichuan University, Chengdu 610041, People's Republic of China
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Diffuse Myocardial Injuries are Present in Subclinical Hypothyroidism: A Clinical Study Using Myocardial T1-mapping Quantification. Sci Rep 2018; 8:4999. [PMID: 29567964 PMCID: PMC5864753 DOI: 10.1038/s41598-018-22970-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 03/02/2018] [Indexed: 12/31/2022] Open
Abstract
Subclinical hypothyroidism (SHT) is a common disorder that may represent early thyroid dysfunction and is related to adverse cardiovascular events. However, myocardial injuries induced by SHT are difficult to detect. Our previous study demonstrated that the cardiac magnetic resonance (CMR) myocardial longitudinal relaxation time (T1) mapping technique is a useful tool for assessing diffuse myocardial injuries in overt hypothyroidism patients. This study was designed to detect whether diffuse myocardial injuries were present in SHT by using the T1 mapping technique. We found that SHT participants had significantly increased native T1 values within four segments of the left ventricle (all p < 0.01), especially patients with thyroid-stimulating hormone (TSH) levels ≥10 µIU/mL, compared with those in the controls. In addition, the native T1 values were negatively correlated with free thyroxine (FT4) (r = −0.476, p = 0.003) and were positively correlated with TSH (r = 0.489, p = 0.002). Furthermore, left ventricular diastolic function estimated by the peak filling rate (PFR) was significantly lower in patients with TSH levels ≥10 µIU/mL than that in the controls (p < 0.05). In conclusion, diffuse myocardial injuries were present in SHT, and T1 mapping may be a useful tool for evaluating mild myocardial injuries in SHT at an early stage. Our study is the first to confirm myocardial injuries in SHT patients using T1 mapping.
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Syamsunder AN, Pal P, Pal GK, Kamalanathan CS, Parija SC, Nanda N, Sirisha A. Decreased baroreflex sensitivity is linked to the atherogenic index, retrograde inflammation, and oxidative stress in subclinical hypothyroidism. Endocr Res 2017; 42:49-58. [PMID: 27260547 DOI: 10.1080/07435800.2016.1181648] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
UNLABELLED Purpose/aim of the study: The present study investigated the link of hyperlipidemia, inflammation and oxidative stress (OS) to cardiovascular (CV) risks in subclinical hypothyroidism (SCH). MATERIALS AND METHODS We enrolled 81 subclinical hypothyroid patients and 80 healthy subjects as control. Their CV and autonomic functions were assessed by spectral analysis of heart rate variability (HRV), continuous blood pressure variability (BPV) measurement and conventional autonomic function testing. Thyroid profile, lipid profile, immunological, inflammatory and OS markers were estimated and correlated with the baro-reflex sensitivity (BRS), the marker of sympathovagal imbalance (SVI) & CV risk. RESULTS Mean arterial pressure (MAP, P<0.0001), total peripheral resistance (TPR, P<0.0001), ratio of low-frequency to high-frequency power of HRV (LF-HF ratio) (P<0.0001) were significantly higher and BRS (P<0.0001) was significantly lower in SCH group than the control group. BRS significantly correlated with heart rate, MAP, LF-HF ratio, lipid risk factors, anti-thyroperoxidase antibody, thyroid-stimulating hormone, high-sensitive C-reactive protein (hsCRP), malondialdehyde (MDA) and SCH. CONCLUSIONS It was concluded that SVI is associated with SCH. Though dyslipidemia, inflammation and OS contributed to decreased BRS, SCH per se contributed maximally to it. Decreased BRS could be a physiological basis of increased CV risks in patients with SCH.
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Affiliation(s)
- Avupati Naga Syamsunder
- a Department of Physiology , Jawaharlal Institute of Post-graduate Medical Education and Research (JIPMER) , Puducherry , India
| | - Pravati Pal
- a Department of Physiology , Jawaharlal Institute of Post-graduate Medical Education and Research (JIPMER) , Puducherry , India
| | - Gopal Krushna Pal
- a Department of Physiology , Jawaharlal Institute of Post-graduate Medical Education and Research (JIPMER) , Puducherry , India
| | | | - Subhash Chandra Parija
- c Department of Microbiology , Jawaharlal Institute of Post-graduate Medical Education and Research (JIPMER) , Puducherry , India
| | - Nivedita Nanda
- d Department of Biochemistry , Jawaharlal Institute of Post-graduate Medical Education and Research (JIPMER) , Puducherry , India
| | - Allampalli Sirisha
- a Department of Physiology , Jawaharlal Institute of Post-graduate Medical Education and Research (JIPMER) , Puducherry , India
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Zeigler CC, Wondimu B, Marcus C, Modéer T. Pathological periodontal pockets are associated with raised diastolic blood pressure in obese adolescents. BMC Oral Health 2015; 15:41. [PMID: 25884594 PMCID: PMC4373518 DOI: 10.1186/s12903-015-0026-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 03/10/2015] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Obesity, a well-known risk factor for developing cardiovascular disease (CVD), is associated with chronic periodontitis in adults. This cross-sectional pilot study on obese adolescents was designed to investigate whether periodontal disease in terms of pathological periodontal pockets is associated with raised blood pressure and other risk markers for CVD. METHODS The study included 75 obese subjects between 12 to 18 years of age, mean 14.5. Subjects answered a questionnaire regarding health, oral hygiene habits and sociodemographic factors. A clinical examination included Visible Plaque Index (VPI %), Gingival inflammation (BOP %) and the occurrence of pathological pockets exceeding 4 mm (PD ≥ 4 mm). Blood serum were collected and analyzed. The systolic and diastolic blood pressures were registered. RESULTS Adolescents with pathological periodontal pockets (PD ≥ 4 mm; n = 14) had significantly higher BOP >25% (P = 0.002), higher diastolic blood pressure (P = 0.008), higher levels of Interleukin (IL)-6 (P < 0.001), Leptin (P = 0.018), Macrophage Chemoattractant Protein-1 (MCP-1) (P = 0.049) and thyroid stimulating hormone (TSH) (P = 0.004) in blood serum compared with subjects without pathological periodontal pockets (PD ≥ 4 mm; n = 61). The bivariate linear regression analysis demonstrated that PD ≥ 4 mm (P = 0.008) and systolic blood pressure (P < 0.001) were significantly associated with the dependent variable "diastolic blood pressure". The association between PD ≥ 4 mm and diastolic blood pressure remained significant (P = 0.006) even after adjusting for potential confounders BMI-sds, age, gender, mother's country of birth, BOP >25%, IL-6, IL-8, Leptin, MCP-1, TSH and total cholesterol in the multiple regression analysis. CONCLUSION In conclusion, this study indicates an association between pathological periodontal pockets and diastolic blood pressure in obese adolescents. The association was unaffected by other risk markers for cardiovascular events or periodontal disease. The results call for collaboration between pediatric dentists and medical physicians in preventing obesity development and its associated disorders.
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Affiliation(s)
- Cecilia C Zeigler
- Division of Pediatric Dentistry, Department of Dental Medicine, Karolinska Institutet, Box 4064, SE-141 04, Huddinge, Stockholm, Sweden.
| | - Biniyam Wondimu
- Division of Pediatric Dentistry, Department of Dental Medicine, Karolinska Institutet, Box 4064, SE-141 04, Huddinge, Stockholm, Sweden.
| | - Claude Marcus
- National Childhood Obesity Centre, Division of Pediatrics Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
| | - Thomas Modéer
- Division of Pediatric Dentistry, Department of Dental Medicine, Karolinska Institutet, Box 4064, SE-141 04, Huddinge, Stockholm, Sweden.
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Ghetti FDF, Lacerda RP, Wernek FZ, Coelho EF, Vaisman M, Lima JRPD, Martinez DG, Laterza MC. [Impairment of muscle vasodilation during mental stress in women with subclinical hypothyroidism]. ARQUIVOS BRASILEIROS DE ENDOCRINOLOGIA E METABOLOGIA 2014; 58:750-7. [PMID: 25372585 DOI: 10.1590/0004-2730000003252] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Accepted: 06/11/2014] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To test the hypothesis that women with subclinical hypothyroidism (SH) have forearm vascular conductance (FVC) impaired during mental stress. SUBJECTS AND METHODS We evaluated 20 women with SH and 21 euthyroid (Control group), matched for age (p = 0.699) and body mass index (p = 0.462). Muscle blood flow (MBF) was assessed by venous occlusion plethysmography and blood pressure by Dixtal2023. Both variables were recorded simultaneously for 3 minutes of baseline followed by 3 minutes of mental stress. The FVC was calculated by dividing MBF by mean arterial pressure. Significant differences were assumed at p < 0.05. RESULTS The SH group had higher concentrations of thyroid stimulating hormone (7.57 ± 3.17 vs. 2.10 ± 0,88 mU/L, p < 0.001). At baseline, the SH and control groups were similar for MBF (2.50 ± 0.79 vs. 2.55 ± 0,71 mL/ min/100 mL, p = 0.905, respectively) and FVC (2.80 ± 0.90 vs. 2.92 ± 0.88 units, p = 0.952, respectively). Throughout the mental stress test the SH and Control groups increased the MBF (time effect, p < 0.001) and FVC (time effect, p < 0.001) compared to baseline protocol. However, these variables were lower in SH group during the first (MBF: 3.66 ± 0.96 vs. 4.66 ± 1,61 mL/min/100 mL, p = 0.018, FVC: 3.95 ± 1.08 vs. 5.19 ± 1,96 units, p = 0.010) and second (MBF: 3.55 ± 1.01 vs. 4.62 ± 2,27 mL/min/100 ml, p = 0.018; FVC: 3.75 ± 1.07 vs. 4.92 ± 2,37 units, p = 0.020) minutes of mental stress test. CONCLUSION Women with SH have reduced muscle vasodilatatory response during mental stress.
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Affiliation(s)
| | | | | | | | | | | | - Daniel Godoy Martinez
- Unidade de Investigação Cardiovascular e Fisiologia do Exercício, Hospital Universitário
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Tadic M, Ilic S, Kostic N, Caparevic Z, Celic V. Subclinical hypothyroidism and left ventricular mechanics: a three-dimensional speckle tracking study. J Clin Endocrinol Metab 2014; 99:307-14. [PMID: 24187401 DOI: 10.1210/jc.2013-3107] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
CONTEXT Subclinical hypothyroidism (SHT) is associated with left ventricular (LV) remodeling. The LV mechanics has not been previously assessed by two- and three-dimensional (2DE and 3DE) speckle tracking imaging in the SHT patients. OBJECTIVES The objective of the study was to investigate LV mechanics by 2DE and 3DE speckle tracking in the SHT patients and evaluate the influence of levothyroxine therapy on LV remodeling. DESIGN We conducted a prospective study. All SHT patients received levothyroxine therapy and were followed up for 1 year after the euthyroid state had been achieved. SETTING The study was performed at a university hospital. PATIENTS We included 54 untreated women with SHT and 40 healthy control women who were of similar age. MAIN OUTCOME MEASURES The 2DE strain and strain rates, 3DE volumes, 3DE strain, and thyroid hormones levels were assessed. RESULTS The 2DE LV longitudinal and circumferential strain and systolic and early diastolic strain rates were significantly decreased in the SHT patients before therapy in comparison with the controls or the SHT patients after therapy. The 3DE LV cardiac output and ejection fraction were significantly reduced in the SHT patients at baseline compared with the controls or patients after 1 year of treatment. The 3DE LV longitudinal and radial strains were significantly lower in the SHT group before treatment in comparison with the controls or patients after therapy, whereas the 3DE LV circumferential and area strains gradually increased from untreated SHT patients, among the treated SHT patients, to the controls. CONCLUSION SHT significantly affects LV deformation assessed by 2DE and 3DE speckle tracking. The improvement of LV mechanics after 1 year of levothyroxine treatment is significant but incomplete.
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Affiliation(s)
- Marijana Tadic
- Departments of Cardiology (M.T., V.C.) and Endocrinology (S.I., N.K., Z.C.), University Clinical Hospital Center "Dr Dragisa Misovic," Heroja Milana Tepica 1, and Faculty of Medicine (N.K., Z.C., V.C.), Doktora Subotica 6, 11000 Belgrade, Serbia
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Moon MK, Hong ES, Lim JA, Cho SW, Soo L, Choi SH, Yi KH, Park DJ, Park YJ, Jang HC. Associations between thyroid hormone levels and regional fat accumulation in euthyroid men. Eur J Endocrinol 2013; 168:805-10. [PMID: 23513229 DOI: 10.1530/eje-12-0991] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Body adiposity, especially ectopic fat accumulation, has a range of metabolic and cardiovascular effects. This study aimed to investigate whether thyroid function is associated with various regional fat quantities in euthyroid subjects. METHODS A total of 100 euthyroid men (free triiodothyronine (fT3), 4.77±1.21 pg/ml; free thyroxine (fT4), 1.38±0.21 ng/dl; and TSH, 2.09±0.91 μIU/ml) were enrolled in this cross-sectional study. We measured accumulated regional fat using 64-slice multi-detector computed tomography. Multiple linear regression analysis was used to determine whether accumulated fat in each region was associated with clinical parameters after adjusting for age. RESULTS FT3 was inversely correlated with BMI (R=0.232, P=0.029) and LDL cholesterol level (R=0.277, P=0.019). FT4 was inversely correlated with waist circumference (R=0.350, P=0.008) and BMI (R=0.355, P0.001). In multiple linear regression analysis, fT3 and fT4 levels were significantly associated with pericardial fat volume (fT3: B=-0.079, 95% CI -0.142 to -0.017, P=0.013; fT4: B=-0.411, 95% CI -0.780 to -0.042, P=0.030) in euthyroid men, independent of age. FT3 level was inversely associated with intramuscular fat area (B=-0.059, 95% CI -0.106 to -0.011, P=0.016) and hepatic fat quantity (B=-0.237, 95% CI -0.441 to -0.033, P=0.024) in euthyroid men, independent of age. CONCLUSIONS In euthyroid men, low levels of fT3 and fT4 were significantly associated with increased pericardial fat volume and BMI.
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Affiliation(s)
- Min Kyong Moon
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, Korea
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Hoermann R, Midgley JEM, Larisch R, Dietrich JW. Is pituitary TSH an adequate measure of thyroid hormone-controlled homoeostasis during thyroxine treatment? Eur J Endocrinol 2013. [PMID: 23184912 DOI: 10.1530/eje-12-0819] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE In recognition of its primary role in pituitary-thyroid feedback, TSH determination has become a key parameter for clinical decision-making. This study examines the value of TSH as a measure of thyroid hormone homoeostasis under thyroxine (T(4)) therapy. DESIGN AND METHODS We have examined the interrelationships between free triiodothyronine (FT(3)), free T(4) (FT(4)) and pituitary TSH by means of i) a retrospective analysis of a large clinical sample comprising 1994 patients either untreated or on varying doses of l-T(4) and ii) independent mathematical simulation applying a model of thyroid homoeostasis, together with a sensitivity analysis. RESULTS Over a euthyroid to mildly hyperthyroid functional range, we found markedly different correlation slopes of log TSH vs FT(3) and FT(4) between untreated patients and l-T(4) groups. Total deiodinase activity (G(D)) was positively correlated with TSH in untreated subjects. However, G(D) was significantly altered and the correlation was lost under increasing l-T(4) doses. Ninety-five per cent confidence intervals for FT(3) and FT(4), when assessed in defined TSH concentration bands, differed significantly for l-T(4)-treated compared with untreated patients. Higher doses were often needed to restore FT(3) levels within its reference range. Sensitivity analysis revealed the influence of various structural parameters on pituitary TSH secretion including an important role of pituitary deiodinase type 2. CONCLUSION The data reveal disjoints between FT(4)-TSH feedback and T(3) production that persist even when sufficient T(4) apparently restores euthyroidism. T(4) treatment displays a compensatory adaptation but does not completely re-enact normal euthyroid physiology. This invites a study of the clinical consequences of this disparity.
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Affiliation(s)
- Rudolf Hoermann
- Department of Nuclear Medicine, Klinikum Luedenscheid, Paulmannshoeher Street 14, D-58515 Luedenscheid, Germany.
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