Glucose and insulin reverse the effects of fasting on 3,5,3'-triiodothyronine neogenesis in primary cultures of rat hepatocytes

Type of sweet flavour carrier affects thyroid axis activity in male rats

PURPOSE

Non-nutritive sweeteners are the most widely used food additives worldwide. However, their metabolic outcomes are still a matter of controversy and their effect on the thyroid activity, a key regulator of metabolism, has not been previously studied. Therefore, we aim to determine the influence of the sweet type flavour carrier on selected parameters of thyroid axis activity.

METHODS

Male Sprague-Dawley rats (n = 105) were divided into 3 groups fed ad libitum for three weeks isocaloric diets (3.76 ± 0.5 kcal/g): two with the same sweet flavour intensity responded to 10% of sucrose (with sucrose-SC-and sucralose-SU) and one non-sweet diet (NS). To evaluate the post-ingested effects, animals were euthanised at fast and 30, 60, 120, 180 min after meal.

RESULTS

The results obtained indicate that both the presence and the type of sweet taste flavour carrier affect thyroid axis activity both at fasting and postprandial state. Compared to diet with sucrose which stimulates thyroid axis activity, sucralose addition diminishes thyroid hormone synthesis as thyroid peroxidase (TPO) activity, plasma thyroxine (T4), and triiodothyronine (T3) concentration was lower than in SC and NS while in non-sweet diet the lowest level of hepatic deiodinase type 1 (DIO1) and the highest reverse T3 (rT3) level indicate on altered thyroid hormone peripheral metabolism.

CONCLUSION

Both the presence and the type of sweet flavour carrier have a significant impact on thyroid axis activity. Our findings suggest that this organochlorine sweetener is metabolically active and might exacerbate metabolic disorders via an adverse effect on thyroid hormone metabolism.

Relationship of thyroid function with body mass index and insulin-resistance in euthyroid obese subjects

BACKGROUND AND AIMS

It is recognized that overt thyroid dysfunction is associated with weight changes, but the influence of a minor alteration of thyroid function remains unclear. This study aimed to further investigate the relationship between obesity and thyroid function and to examine the possible role of insulin resistance on the hypothalamic-pituitary- thyroid axis.

METHODS AND RESULTS

Serum TSH and free T4 (FT4) levels, anthropometric and metabolic parameters were evaluated in 581 obese patients. In all patients TSH values progressively increased according to the severity of obesity and were positively correlated with body mass index (p=0.001, r=0.13) and waist circumference (p=0.02, r=0.11). Patients with insulin resistance showed higher TSH (1.8±1.0 vs 1.6±0.9 μUI/l; p=0.03) and lower FT4 levels (13.8±2.3 vs 15.0±2.2 pmol/l; p<0.001), as compared with patients with normal insulin sensitivity. Moreover, TSH was positively correlated with fasting insulin (p<0.001, r=0.152) and homeostasis model assessment of insulin resistance (HOMA-IR; p<0.001, r=0.148), and negatively correlated with Quantitative Insulin Sensitivity Check Index (QUICKI; p<0.001, r=-0.148); FT4 was negatively associated with fasting insulin (p<0.001, r=-0.287) and HOMA-IR (p<0.001, r=-0.295), and positively associated with QUICKI (p<0.001, r=0.295).

CONCLUSIONS

A relationship between thyroid function and overweight/ obesity condition seems to exist, mainly influenced by insulin resistance. Whether variations in TSH and/or thyroid hormones, within a normal range, can influence body weight or whether obesity per se can alter thyroid function cannot be stated so far. Further studies are needed to assess the link between thyroid function and body weight, by considering not only changes in thyroid hormones, but also body fat distribution, obesity duration and low-grade inflammation.

Factors related to clinical hypothyroid severity in thyroid cancer patients after thyroid hormone withdrawal

BACKGROUND

Thyroid hormone withdrawal (THW) to stimulate thyrotropin (TSH) secretion produces acute thyroid hormone deficiency in patients who have undergone thyroidectomy for differentiated thyroid cancer (DTC), but not all patients developed clinically overt features of hypothyroidism. This prospective study was performed to test the hypothesis that selected factors, including serum thyroid hormone levels and insulin resistance, are associated with the development of overt features of hypothyroidism.

METHODS

Thirty-two patients (27 women, aged 51.1 +/- 12.3 years) with DTC who had undergone total or subtotal thyroidectomy were studied while on thyroid hormone suppressive therapy (THST) and 5 weeks after THW. Thyroid function and other tests as well as anthropometric parameters and the Zulewski score for clinical hypothyroidism were assessed. Overt clinical hypothyroidism was defined as having a Zulewski score of > or = 3 after THW. Clinical euthyroidism was defined as having a Zulewski score of <3.

RESULTS

Fifteen patients (46.9%) developed overt clinical hypothyroidism after THW. Patients with overt clinical hypothyroidism were older (p = 0.005), had lower baseline serum free thyroxine (p = 0.040) and free triiodothyronine (fT3) (p = 0.006), and higher body mass index (p = 0.038), fasting plasma glucose (p = 0.005), and homeostasis model assessment for insulin resistance (p = 0.043) than those with clinical euthyroidism. The independent factors related to overt clinical hypothyroidism after THW were higher HOMA-IR (odds ratio [OR], 1.098; confidence interval [CI], 1.007-1.198; p = 0.034), lower fT3 (OR, 0.069; CI, 0.006-0.733; p = 0.027), and higher Zulewski score (OR, 3.633; CI, 1.144-11.536; p = 0.029) before THW.

CONCLUSIONS

Nearly half of DTC patients suffer from overt clinical hypothyroidism after 5 weeks of THW, as assessed by Zulewski score. Patients with higher HOMA-IR, lower fT3 level, and higher initial Zulewski score are at greatest risk of overt clinical hypothyroidism after THW. Insulin resistance is closely related to post-THW hypothyroidism in patients of DTC.

Thyroid function in humans with morbid obesity

Morbidly obese subjects may present with abnormal thyroid function tests but the reported data are scarce. Therefore, we studied the thyroid parameters in 144 morbidly obese patients, 110 females and 34 males, to assess the prevalence of hypothyroidism. Eleven percent (11.8%) carried the diagnosis of hypothyroidism and were undergoing levothyroxine (LT4) replacement therapy, 7.7% had newly diagnosed subclinical hypothyroidism, 0.7% had subclinical hyperthyroidism and 7.7% were euthyroid with positive antibodies (anti-thyroid peroxidase antibodies [TPOAb]). From the 144 subjects, we selected a cohort of 78 euthyroid subjects with negative TPOAb, who did not receive LT4 replacement or suppression therapy (the experimental group) and compared them to 77 normal-weight euthyroid subjects, TPOA-negative, matched for age and gender who served as controls. The experimental group had higher serum levels of triiodothyronine (T3), thyroxine (T4), free triiodothyronine (FT3), and thyrotropin (TSH) compared to the control group. Serum TSH concentration was associated with fasting serum insulin levels and insulin resistance but not with serum leptin levels, body mass index (BMI), fat mass, and lean body mass. In conclusion, in morbidly obese individuals, the prevalence of overt and subclinical hypothyroidism was high (19.5%). The morbidly obese subjects have higher levels of T3, FT3, T4, and TSH, probably the result of the reset of their central thyrostat at higher level.

Influence of low protein diet on nonthyroidal illness syndrome in chronic renal failure

Renal failure causes alterations in thyroid hormone metabolism known as nonthyroidal illness syndrome. In the present study we have examined the effect of a low protein diet (LPD) on circulating levels of hormones of the pituitary-thyroid axis, and tumor necrosis factor alpha (TNF-alpha) in patients with chronic renal failure. Seventeen subjects with conservatively treated chronic renal failure (estimated creatinine clearance 39.5+/-11.1 mL/min) were studied before and after 8 wk of dietary intervention (0.6 g/kg of ideal body mass protein, 30% of calories derived from fat, 62% of calories derived from carbohydrates, and 10 mg/kg of phosphorus). Body fat and fat-free mass remained unchanged. Urea and TNF-alpha serum concentrations significantly decreased, whereas T3 and total and free T4 serum concentrations increased significantly. Triiodothyronine level after treatment correlated negatively with baseline urea level. Changes in T3, T4, and fT4 serum concentrations as well as calculated peripheral deiodinase activity correlated negatively with their baseline values. Alterations in TNF-alpha correlated positively with protein intake, whereas changes in T4 and T4/TSH were inversely related to vegetal protein intake. In conclusion, low protein, low phosphorus diet, which is often prescribed to patients with moderate impairment of renal function, exerts a beneficial effect on low T3 syndrome coexisting with renal failure. The effect of low protein diet on the pituitary-thyroid axis is dependent on the degree of renal functional impairment and LPD-induced decrease in TNF-alpha may also contribute to the observed effects of dietary treatment.

Metabolic, endocrine, and immune effects of stress hyperglycemia in a rabbit model of prolonged critical illness

Stress hyperglycemia is frequent in critically ill patients. The aim of this study was to investigate the effect of blood glucose control with insulin on endocrine, metabolic, and immune function in an animal model of severe injury. Seventy-two hours after alloxan injection and exogenous insulin infusion combined with continuous iv parenteral nutrition, male New Zealand White rabbits received a burn injury and were allocated to a normoglycemic (n = 17) or hyperglycemic (n = 13) group. In the normoglycemic group, blood glucose levels were kept between 3.3 and 6.1 mmol/liter by insulin infusion, whereas in the hyperglycemic group blood glucose levels were maintained at 13.8-16.6 mmol/liter. Blood was drawn for biochemical analysis at regular time points. At 24 and 72 h after burn injury, immune function of monocytes was assessed in vitro. Maintenance of normoglycemia with exogenous insulin after severe trauma to a large extent prevented weight loss, lactic acidosis, and hyponatremia. Furthermore, within 3 d after injury, the intervention improved phagocytosis of monocytes investigated in fresh cells by more than a mean 150% (P = 0.006) and after 24-h incubation with or without lipopolysaccharide by more than a mean 4-fold (P = 0.001) and 2-fold (P = 0.05), respectively. Oxidative killing after 24-h incubation was also improved by 2-fold (P = 0.05), but no effect on chemotaxis was detected. Concomitantly, inflammation and stress-induced growth hormone hypersecretion were suppressed. Prevention of catabolism, acidosis, excessive inflammation, and impaired innate immune function may explain previously documented beneficial effects of intensive insulin therapy on outcome of critical illness.

Hepatic monitoring of essential amino acid availability may regulate IGF-I activity, thermogenesis, and fatty acid oxidation/synthesis

Diets that are low in certain essential amino acids (EAAs), whether owing to low protein content or poor protein quality, tend to down-regulate systemic IGF-I activity, boost thermogenesis, and suppress hepatic capacity for lipogenesis, while promoting hepatic fatty acid oxidation. It is proposed that for each EAA there is a regulatory protein in hepatocytes whose activity is repressed by adequate levels of its EAA; if one (or more) of these regulatory proteins is active, it serves as a signal of EAA deficiency which then mediates the aforementioned effects on IGF-I activity, thermogenesis, and hepatic fatty acid metabolism. Mechanisms which monitor EAA availability likewise play a role in appetite regulation, thus accounting for the fact that spontaneous calorie consumption tends to be lower on high-protein diets. Diets low in protein quantity or quality may decrease insulin secretion, an effect which should contribute to their impact on IGF-I activity and lipid metabolism. The fact that vegans ingest diets that tend to be relatively low in certain EAAs may play a key role in their characteristic leanness and their decreased risk for diabetes, coronary disease, and cancer.

Isocaloric carbohydrate deprivation induces protein catabolism despite a low T3-syndrome in healthy men

Dietary carbohydrate content is a major factor determining endocrine and metabolic regulation. The aim of this study was to evaluate the relation between thyroid hormone levels and metabolic parameters during eucaloric carbohydrate deprivation. We measured thyroid hormone levels, resting energy expenditure (by indirect calorimetry) and urinary nitrogen excretion in six healthy males after 11 days of three isocaloric diets containing 15% of energy equivalents as protein and 85%, 44% and 2% as carbohydrates. In contrast to the high and intermediate carbohydrate diets, carbohydrate deprivation decreased plasma T3 values (1.78 +/- 0.09 and 1.71 +/- 0.07 vs. 1.33 +/- 0.05 nmol/l, respectively, P < 0.01), whereas reverse T3, T3 uptake and free T4 levels increased simultaneously compared to the other two diets. TSH values were not different among the three diets. Although dietary carbohydrate content did not influence resting energy expenditure, carbohydrate deprivation increased urinary nitrogen excretion (10.91 +/- 0.67 and 12.79 +/- 1.14 vs. 15.89 +/- 1.10 g/24 h, respectively, P = 0.03). Eucaloric carbohydrate deprivation increases protein catabolism despite decreased plasma T3 levels. Because it has previously been shown that starvation decreases plasma T3 levels, resting energy expenditure and nitrogen excretion, these discordant endocrine and metabolic changes following carbohydrate deprivation indicate that the effects of starvation on endocrine and metabolic regulation are not merely the result of carbohydrate deprivation.

Central insulin may up-regulate thyroid activity by suppressing neuropeptide Y release in the paraventricular nucleus

Down-regulation of thyroid activity during underfeeding or diabetes - and upregulation during overfeeding - have not been adequately explained. Experimental findings suggest that hypothalamic secretion of thyrotropin releasing hormone (TRH) is modulated by feeding status; neuropeptide Y may be a key mediator of this modulation. I propose that insulin, acting centrally as a signal of carbohydrate availability, promotes TRH secretion by inhibiting release of neuropeptide Y in the paraventricular nucleus. This mechanism may contribute to the weight loss reported during administration of certain insulin-sensitizing agents, and observed during low-fat diets.

In vitro hepatic thyroid hormone deiodination in iron-deficient rats: effect of dietary fat

The effects of different dietary fats on thyroid indices were studied in weanling iron-deficient rats. Rats were fed one of five different diets (safflower oil with a casein protein source, safflower oil with defatted beef as the protein source, prime rib, beef tallow with casein and stearate with casein). Both dietary fat and iron status (adequate, CN; deficient, ID; or iron-deficient replete, ID-replete) had significant effects on body weight and hemoglobin concentrations. The tallow-fed animals weighed the least relative to animals fed the other fats; ID rats were smaller than CN rats. The tallow- and stearate-fed animals had the highest hemoglobin concentrations. Type of dietary fat affected plasma thyroxine (T4), but not plasma triiodothyronine (T3) or rate of deiodination of reverse T3 (rT3). Iron deficiency decreased plasma concentrations of T3 and T4 and increased in vitro hepatic rT3 deiodination, suggesting that the ID animals tend to metabolize thyroid hormones via deactivating pathways. The alterations in thyroid hormone metabolism associated with iron deficiency are reversible with iron repletion.

Glucagon-induced changes in plasma thyroid hormone concentrations in healthy dogs resemble "euthyroid sick syndrome"

We recently demonstrated that glucagon infusion induced a decline in T3 and a rise in rT3 in anesthetized dogs. These changes in T3 and rT3 may be attributed, at least in part, to anesthesia itself, since general anesthesia is known to cause lowering of T3 and an elevation in rT3 during the perioperative period. Therefore, to eliminate the contribution, if any, of anesthesia to these changes in T3 and rT3, we assessed plasma glucose, T3 resin uptake (T3RU), T4, free T4, T3 and rT3 concentrations following intravenous glucagon (0.5 mg) or normal saline (0.5 ml) administration at frequent intervals for 3 h in 6 conscious dogs fasted for 16 h. No significant alterations were noted in T4, free T4, and T3RU levels during either study. However, glucagon infusion alone induced a significant fall in T3 (0.33 +/- 0.06 in nmol/l vs -0.03 +/- 0.03 nmol/l with normal saline; p less than 0.01) and marked elevations in glucose (3.66 +/- 0.22 mmol/l vs 0.61 +/- 0.11 nmol/l with normal saline, p less than 0.001) and rT3 concentrations (0.11 +/- 0.02 nmol/l vs 0.005 nmol/l; p less than 0.001). Furthermore, the integrated responses of T3 and rT3 as assessed by cumulative changes and areas under the curves were markedly greater during glucagon infusion when compared with saline administration (p less than 0.01 for all comparisons). Since the elevations in levels of stress hormones known to ensue during anesthesia do not occur during a conscious resting state, we believe that hyperglucagonemia may be a major contributor of thyroid hormone alterations observed in several euthyroid sick states, not associated with stress, and may enhance these changes during euthyroid sick syndrome associated with stressful crises. Finally, these changes may be attributed to altered metabolism of iodothyronines in peripheral tissues as reflected by lowered T3/T4 and increased rT3/T4 ratios.