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Yao S, Zhang B, Fei X, Xiao M, Lu L, Liu D, Zhang S, Cui J. AI-Assisted Ultrasound for the Early Diagnosis of Antibody-Negative Autoimmune Thyroiditis. J Multidiscip Healthc 2023; 16:1801-1810. [PMID: 37404960 PMCID: PMC10315148 DOI: 10.2147/jmdh.s408117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 05/12/2023] [Indexed: 07/06/2023] Open
Abstract
The prevalence of antibody-negative chronic autoimmune thyroiditis (SN-CAT) is increasing. The early diagnosis of SN-CAT can effectively prevent its further development. Thyroid ultrasound can diagnose autoimmune thyroiditis and predict hypothyroidism. Primary hypothyroidism with a hypoechoic pattern suggested by thyroid ultrasound and negative thyroid serum antibodies is the main basis for the diagnosis of SN-CAT. However, for early SN-CAT, only hypoechoic thyroid changes and serological antibodies are currently available. This study explored how to achieve an accurate and early diagnosis of SN-CAT and prevent the development of SN-CAT combined with hypothyroidism. The diagnosis of a hypoechoic thyroid by artificial intelligence is expected to be a breakthrough in the accurate diagnosis of SN-CAT.
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Affiliation(s)
- Shengsheng Yao
- China Medical University - Department of Thyroid and Breast Surgery, Liaoning Provincial People’s Hospital, Shenyang, Liaoning Province, 110015, People’s Republic of China
| | - Bo Zhang
- Department of Science and Education, The 10th Division of Xinjiang Production and Construction Corps, Beitun General Hospital, Beitun City, Xinjiang Province, 831300, People’s Republic of China
| | - Xiang Fei
- Department of Thyroid and Breast Surgery, People’s Hospital of China Medical University (Liaoning Provincial People’s Hospital), Shenyang, Liaoning Province, 110015, People's Republic of China
| | - Mingming Xiao
- Department of Pathology, People’s Hospital of China Medical University (Liaoning Provincial People’s Hospital), Shenyang, Liaoning Province, 110015, People’s Republic of China
| | - Li Lu
- Department of Endocrinology, People’s Hospital of China Medical University (Liaoning Provincial People’s Hospital), Shenyang, Liaoning Province, 110015, People’s Republic of China
| | - Daming Liu
- Department of Ultrasound, People’s Hospital of China Medical University (Liaoning Provincial People’s Hospital), Shenyang, Liaoning Province, 110015, People’s Republic of China
| | - Siyuan Zhang
- Department of Thyroid and Breast Surgery, The 10th Division of Xinjiang Production and Construction Corps, Beitun General Hospital, Beitun City, Xinjiang Province, 831300, People’s Republic of China
| | - Jianchun Cui
- Department of Thyroid and Breast Surgery, People’s Hospital of China Medical University (Liaoning Provincial People’s Hospital), Shenyang, Liaoning Province, 110015, People's Republic of China
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Urgatz B, Razvi S. Subclinical hypothyroidism, outcomes and management guidelines: a narrative review and update of recent literature. Curr Med Res Opin 2023; 39:351-365. [PMID: 36632720 DOI: 10.1080/03007995.2023.2165811] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Subclinical hypothyroidism (SCH) is diagnosed when serum thyroid stimulation hormone (thyrotropin; TSH) levels are above the reference range, accompanied by levels of free thyroxine within its reference range. The management of SCH remains a diagnostic and therapeutic challenge despite many years of research relating to its epidemiology, aetiology, effectiveness of treatment and safety. European Thyroid Association (ETA) guidelines for the management of SCH were published almost a decade ago. This narrative review summarizes the clinical literature relating to SCH and outcomes since the publication of these guidelines. Clinical evidence emerging during the previous decade generally supports the view that SCH is associated with adverse outcomes to an extent that is intermediate between euthyroidism and overt hypothyroidism although evidence that treatment with thyroid hormone replacement is beneficial is lacking. Accordingly, the rationale for the recommendations for intervention in the ETA guidelines based on the age of the patient, level of serum TSH, symptoms and comorbidities remains valid today.
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Affiliation(s)
| | - Salman Razvi
- Translational and Clinical Research Institute, Newcastle University, Newcastle-upon-Tyne, UK
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Chen K, Chen L, Dai J, Ye H. MAFLD in Patients with Cushing's Disease Is Negatively Associated with Low Free Thyroxine Levels Rather than with Cortisol or TSH Levels. Int J Endocrinol 2023; 2023:6637396. [PMID: 37091746 PMCID: PMC10115525 DOI: 10.1155/2023/6637396] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 03/14/2023] [Accepted: 03/20/2023] [Indexed: 04/25/2023] Open
Abstract
Purpose This study aims to analyze the clinical characteristic of metabolic associated fatty liver disease (MAFLD) in patients with active Cushing's disease (CD) and determine associations of thyroid hormones with MAFLD. Methods Patients with active CD were included in this cross-sectional study. All subjects were assessed for hepatic steatosis by abdominal ultrasonography and thyroid functions. Demographic and clinical characteristic parameters were collected for correlation analysis and logistic analysis. Results 290 individuals with active CD were included in Huashan hospital from January 2014 to February 2022. We found that the prevalence of CD with MAFLD was 33.79%. The MAFLD group had a lower level of FT4 and a higher level of FT3/FT4 but no difference in levels of cortisol, 24 h UFC, TSH, TT4, TT3, and FT3. Correlation analysis showed positive associations of TSH, TT4, TT3, FT3, and FT3/FT4 with BMI. In age-, BMI-, sex-, cortisol-, and 24 h UFC-adjusted analysis, FT4 was independently associated with MAFLD in patients with CD. This association remained similar even after adjusting for the presence of metabolic syndrome components. Conclusion Lower FT4 levels were associated with higher risk of MAFLD in patients with CD. FT4 may be used as a helpful indicator to predict MAFLD and provide novel ideas for the treatment of MAFLD in patients with CD in the future.
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Affiliation(s)
- Kuangyang Chen
- Department of Endocrinology and Metabolism, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai 200040, China
| | - Lijiao Chen
- Department of Endocrinology and Metabolism, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai 200040, China
| | - Jiarong Dai
- Department of Endocrinology and Metabolism, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai 200040, China
| | - Hongying Ye
- Department of Endocrinology and Metabolism, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai 200040, China
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Lenti MV, Rossi CM, Melazzini F, Gastaldi M, Bugatti S, Rotondi M, Bianchi PI, Gentile A, Chiovato L, Montecucco C, Corazza GR, Di Sabatino A. Seronegative autoimmune diseases: A challenging diagnosis. Autoimmun Rev 2022; 21:103143. [PMID: 35840037 DOI: 10.1016/j.autrev.2022.103143] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 07/10/2022] [Indexed: 12/19/2022]
Abstract
Autoimmune diseases (AID) are increasingly prevalent conditions which comprise more than 100 distinct clinical entities that are responsible for a great disease burden worldwide. The early recognition of these diseases is key for preventing their complications and for tailoring proper management. In most cases, autoantibodies, regardless of their potential pathogenetic role, can be detected in the serum of patients with AID, helping clinicians in making a definitive diagnosis and allowing screening strategies for early -and sometimes pre-clinical- diagnosis. Despite their undoubted crucial role, in a minority of cases, patients with AID may not show any autoantibody, a condition that is referred to as seronegative AID. Suboptimal accuracy of the available laboratory tests, antibody absorption, immunosuppressive therapy, immunodeficiencies, antigen exhaustion, and immunosenescence are the main possible determinants of seronegative AID. Indeed, in seronegative AID, the diagnosis is more challenging and must rely on clinical features and on other available tests, often including histopathological evaluation and radiological diagnostic tests. In this review, we critically dissect, in a narrative fashion, the possible causes of seronegativity, as well as the diagnostic and management implications, in several AID including autoimmune gastritis, celiac disease, autoimmune liver disease, rheumatoid arthritis, autoimmune encephalitis, myasthenia gravis, Sjögren's syndrome, antiphospholipid syndrome, and autoimmune thyroid diseases.
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Affiliation(s)
- Marco Vincenzo Lenti
- Department of Internal Medicine and Medical Therapeutics, University of Pavia, Pavia, Italy; Department of Internal Medicine, IRCCS San Matteo Hospital Foundation, Pavia, Italy
| | - Carlo Maria Rossi
- Department of Internal Medicine and Medical Therapeutics, University of Pavia, Pavia, Italy; Department of Internal Medicine, IRCCS San Matteo Hospital Foundation, Pavia, Italy
| | - Federica Melazzini
- Department of Internal Medicine and Medical Therapeutics, University of Pavia, Pavia, Italy; Department of Internal Medicine, IRCCS San Matteo Hospital Foundation, Pavia, Italy
| | - Matteo Gastaldi
- Neuroimmunology Laboratory, IRCCS Mondino Foundation, Pavia, Italy
| | - Serena Bugatti
- Department of Internal Medicine and Medical Therapeutics, University of Pavia, Pavia, Italy; Unit of Rheumatology, IRCCS San Matteo Hospital Foundation, Pavia, Italy
| | - Mario Rotondi
- Department of Internal Medicine and Medical Therapeutics, University of Pavia, Pavia, Italy; Istituti Clinici Scientifici Maugeri IRCCS, Unit of Internal Medicine and Endocrinology, Laboratory for Endocrine Disruptors, Pavia, Italy
| | - Paola Ilaria Bianchi
- Department of Internal Medicine, IRCCS San Matteo Hospital Foundation, Pavia, Italy
| | - Antonella Gentile
- Department of Internal Medicine and Medical Therapeutics, University of Pavia, Pavia, Italy; Department of Internal Medicine, IRCCS San Matteo Hospital Foundation, Pavia, Italy
| | - Luca Chiovato
- Department of Internal Medicine and Medical Therapeutics, University of Pavia, Pavia, Italy; Istituti Clinici Scientifici Maugeri IRCCS, Unit of Internal Medicine and Endocrinology, Laboratory for Endocrine Disruptors, Pavia, Italy
| | - Carlomaurizio Montecucco
- Department of Internal Medicine and Medical Therapeutics, University of Pavia, Pavia, Italy; Unit of Rheumatology, IRCCS San Matteo Hospital Foundation, Pavia, Italy
| | - Gino Roberto Corazza
- Department of Internal Medicine and Medical Therapeutics, University of Pavia, Pavia, Italy; Department of Internal Medicine, IRCCS San Matteo Hospital Foundation, Pavia, Italy
| | - Antonio Di Sabatino
- Department of Internal Medicine and Medical Therapeutics, University of Pavia, Pavia, Italy; Department of Internal Medicine, IRCCS San Matteo Hospital Foundation, Pavia, Italy.
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Fitzgerald SP, Falhammar H. Redefinition of Successful Treatment of Patients With Hypothyroidism. Is TSH the Best Biomarker of Euthyroidism? Front Endocrinol (Lausanne) 2022; 13:920854. [PMID: 35784560 PMCID: PMC9243528 DOI: 10.3389/fendo.2022.920854] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 05/10/2022] [Indexed: 12/14/2022] Open
Abstract
In recent years evidence has accumulated supporting a revised view of the nature of euthyroidism and the biomarkers of thyroid function. Within the normal range, variations in thyroid hormone levels are associated with variations in clinical parameters and outcomes. There are therefore no readily identified individually specific optimum levels of thyroid hormones for any individual. Levels around the middle of the normal population range may best reflect euthyroidism. These levels may have evolutionary advantages on the basis that adverse outcomes often increase with divergence from such levels, and physiological processes tend to minimise such inter-individual and intra-individual divergence. In populations of predominantly untreated individuals, levels of thyroid hormones and in particular levels of free thyroxine (FT4) correlate more often with clinical parameters than do levels of thyrotropin (TSH). Levels of thyroid hormones may therefore be regarded as the best available biomarkers of euthyroidism and dysthyroidism. It follows that 'subclinical hypothyroidism' (normal FT4/raised TSH levels), rather than being an accurate marker of peripheral tissue hypothyroidism is more a marker of decreased thyroid reserve and prognosis. The recent evidence suggests that treatment of hypothyroxinemia, regardless of the TSH level, and monitoring therapy using FT4 and/or triiodothyronine levels, depending on the replacement regime, may result in more successful treatment of hypothyroidism than relying on thyrotropin levels for patient selection and subsequent treatment monitoring. The equivalents of mid-range levels of thyroid hormones (especially FT4), adjusted by individual comorbidity concerns, may be rational general replacement targets. These implications of the new evidence may create opportunities for novel trials of thyroid replacement therapy.
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Affiliation(s)
- Stephen P. Fitzgerald
- The Departments of General Medicine and Endocrinology, The Royal Adelaide Hospital, Adelaide, SA, Australia
- School of Medicine, The University of Adelaide, Adelaide, SA, Australia
| | - Henrik Falhammar
- Department of Endocrinology, Karolinska University Hospital, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Menzies School of Health Research and Royal Darwin Hospital, Tiwi, NT, Australia
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Fitzgerald SP, Bean NG, Fitzgerald SP, Falhammar H. The application of new concepts of the assessment of the thyroid state to pregnant women. Front Endocrinol (Lausanne) 2022; 13:987397. [PMID: 36051398 PMCID: PMC9424676 DOI: 10.3389/fendo.2022.987397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 07/25/2022] [Indexed: 11/25/2022] Open
Abstract
Recently proposed concepts regarding the nature and assessment of the thyroid state have provided a model more consistent with empiric evidence. It now appears likely that there are no such entities as thyroid set points and individual euthyroidism. Rather than there being discrete thyroid states, peripheral organ parameters are associated with thyroid function in a continuous manner. Thyroid hormone levels and, in particular, levels of free thyroxine now appear to be superior to thyrotropin levels as indicators of the thyroid state. Complicating the assessment of the correlations of the thyroid state with pregnancy outcomes are the contribution of the placenta to maternal thyroid function, fetal thyroid development, the multiple potential pathways to any particular outcome, the likely presence of small critical periods of time, the differing genetics of fetal and maternal tissues, and the unreliability of thyroid hormone assays. Nevertheless, there is no apparent reason for there to be a change in pregnancy to the basic principles of thyroid hormone action. The relationships between mild abnormalities of the thyroid state and pregnancy outcomes and the value of treating such mild abnormalities remain uncertain and controversial. The evidence suggests that further investigation of these clinical questions might better be based on thyroid hormone, particularly free thyroxine, levels. In the investigation of borderline low thyroid states, the categories of subclinical hypothyroidism and isolated hypothyroxinemia might both be abandoned with attention being directed to low free thyroxine levels regardless of the thyroid-stimulating hormone (TSH) levels. For these changes to occur, there would ideally be improvements in the assays for free thyroxine in pregnancy. The evidence suggests that, just as in the non-pregnant situation, pregnancy guidelines based on thyrotropin levels may need revision.
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Affiliation(s)
- Stephen P. Fitzgerald
- The Departments of General Medicine and Endocrinology, The Royal Adelaide Hospital, Adelaide, SA, Australia
- School of Medicine, The University of Adelaide, Adelaide, SA, Australia
- *Correspondence: Stephen P. Fitzgerald,
| | - Nigel G. Bean
- Adjunct Professor, School of Mathematical Science, University of Adelaide, Adelaide, SA, Australia
| | - Samuel P. Fitzgerald
- Department of Obstetrics and Gynaecology, The Townsville Hospital, Townsville, QLD, Australia
- School of Medicine, University of Queensland, St Lucia, QLD, Australia
| | - Henrik Falhammar
- Department of Endocrinology, Karolinska University Hospital, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
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Ataeinosrat A, Saeidi A, Abednatanzi H, Rahmani H, Daloii AA, Pashaei Z, Hojati V, Basati G, Mossayebi A, Laher I, Alesi MG, Hackney AC, VanDusseldorp TA, Zouhal H. Intensity Dependent Effects of Interval Resistance Training on Myokines and Cardiovascular Risk Factors in Males With Obesity. Front Endocrinol (Lausanne) 2022; 13:895512. [PMID: 35757424 PMCID: PMC9226680 DOI: 10.3389/fendo.2022.895512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 04/26/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To determine the effects of different intensities of interval resistance training (IRT) protocols on the levels of select myokines (decorin, follistatin, myostatin, activin A, transforming growth factor beta-1 [TGF-β1]), and cardiometabolic and anthropometric measures in males with obesity. METHODS Forty-four obese males (age: 27.5 ± 9.4 yr.; height: 165.4 ± 2.8 cm; weight: 97.9 ± 2.6 kg and BMI: 35.7 ± 4.3 kg/m2) were randomly assigned to one of four groups (n=11 per group): low-intensity interval resistance training (LIIRT), moderate-intensity interval resistance training (MIIRT), high-intensity interval resistance training (HIIRT) or control (C). The LIIRT group performed 10 exercises in 3 sets of 40% (20 repetitions), the MIIRT group performed 10 exercises in three sets of 60% (13 repetitions), and the HIIRT group performed 10 exercises in three sets of 80% (10 repetitions) of one maximum repetition (1RM), which were followed with active rest of 20% of 1RM and 15 repetitions. The resistance training groups exercised ~70 min per session, 3 days per week, for 12 weeks. Measurements were taken at baseline and after 12 weeks of exercise training. RESULTS Baseline levels of myokines, cardiovascular risk factors, anthropometry, body composition, and cardio-respiratory fitness were not different between the four groups (p>0.05). The group x time interactions for decorin, activin A, follistatin, myostatin, and TGF-β1, total cholesterol (TC), triglyceride (TG), high-density cholesterol (HDL), low-density cholesterol (LDL), anthropometry, body composition, and cardio-respiratory fitness were statistically significant (p<0.05). There were increases in post-test values for decorin, follistatin, HDL (p<0.05) and decreases in TC, TG, TGF-β1, LDL, and myostatin levels in the LIIRT, MIIRT, and HIIRT groups compared to pretest values (p<0.05). Changes in fat mass, VO2peak, HDL, TG, glucose, activin A, decorin were not significant in LIIRT compared to the control group, while changes in activin A, follistatin, and TFG-β1 levels were greater in HIIRT and MIIRT groups compared to the LIIRT group (p<0.05). CONCLUSION The LIIRT, MIIRT, and HIIRT protocols all produced beneficial changes in decorin, activin A, follistatin, myostatin, and TGF-β1 levels, and cardiometabolic risk factors, with greater effects from the MIIRT and HIIRT protocols compared to LIIRT.
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Affiliation(s)
- Ali Ataeinosrat
- Department of Physical Education and Sport Science, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Ayoub Saeidi
- Department of Physical Education and Sport Sciences, Faculty of Humanities and Social Sciences, University of Kurdistan, Sanandaj, Iran
| | - Hossein Abednatanzi
- Department of Physical Education and Sport Science, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Hiwa Rahmani
- Department of Sport Sciences and Health, Shahid Beheshti University, Tehran, Iran
| | - Asieh Abbassi Daloii
- Department of Exercise Physiology, Ayatollah Amoli Branch, Islamic Azad University, Amol, Iran
| | - Zhaleh Pashaei
- Department of Exercise Physiology, Faculty of Physical Education and Sport Sciences, University of Tabriz, Tabriz, Iran
| | - Vida Hojati
- Department of Biology, Damghan Branch, Islamic Azad University, Damghan, Iran
| | - Gholam Basati
- Department of Clinical Biochemistry, Faculty of Medicine, Ilam University of Medical Sciences, Ilam, Iran
| | - Ali Mossayebi
- Department of Kinesiology, College of Health Sciences, University of Texas at El Paso, El Paso, TX, United States
| | - Ismail Laher
- Department of Anesthesiology, Pharmacology, and Therapeutics, The University of British Columbia, Vancouver BC, Canada
| | - Michaela G. Alesi
- Department of Exercise Science and Sport Management, Kennesaw State University, Kennesaw, GA, United States
| | - Anthony C. Hackney
- Department of Exercise & Sport Science; Department of Nutrition, University of North Carolina, Chapel Hill, NC, United States
| | - Trisha A. VanDusseldorp
- Department of Exercise Science and Sport Management, Kennesaw State University, Kennesaw, GA, United States
- *Correspondence: Hassane Zouhal, ; Trisha A. VanDusseldorp,
| | - Hassane Zouhal
- Univ Rennes, M2S (Laboratoire Mouvement, Sport, Santé), Rennes, France
- Institut International des Sciences du Sport (2I2S), Irodouer, France
- *Correspondence: Hassane Zouhal, ; Trisha A. VanDusseldorp,
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Le Moli R, Vella V, Tumino D, Piticchio T, Naselli A, Belfiore A, Frasca F. Inflammasome activation as a link between obesity and thyroid disorders: Implications for an integrated clinical management. Front Endocrinol (Lausanne) 2022; 13:959276. [PMID: 36060941 PMCID: PMC9437482 DOI: 10.3389/fendo.2022.959276] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 08/03/2022] [Indexed: 11/25/2022] Open
Abstract
Obesity is strongly associated with chronic low-grade inflammation. Obese patients have an increased risk to develop thyroid autoimmunity and to became hypothyroid, suggesting a pathogenetic link between obesity, inflammation and autoimmunity. Moreover, type 2 diabetes and dyslipidemia, also characterized by low-grade inflammation, were recently associated with more aggressive forms of Graves' ophthalmopathy. The association between obesity and autoimmune thyroid disorders may also go in the opposite direction, as treating autoimmune hyper and hypothyroidism can lead to weight gain. In addition, restoration of euthyroidism by L-T4 replacement therapy is more challenging in obese athyreotic patients, as it is difficult to maintain thyrotropin stimulation hormone (TSH) values within the normal range. Intriguingly, pro-inflammatory cytokines decrease in obese patients after bariatric surgery along with TSH levels. Moreover, the risk of thyroid cancer is increased in patients with thyroid autoimmune disorders, and is also related to the degree of obesity and inflammation. Molecular studies have shown a relationship between the low-grade inflammation of obesity and the activity of intracellular multiprotein complexes typical of immune cells (inflammasomes). We will now highlight some clinical implications of inflammasome activation in the relationship between obesity and thyroid disease.
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Neves JS, Fontes-Carvalho R, Borges-Canha M, Leite AR, von Hafe M, Vale C, Martins S, Guimarães JT, Carvalho D, Leite-Moreira A, Azevedo A. Association of thyroid function, within the euthyroid range, with cardiovascular risk: The EPIPorto study. Front Endocrinol (Lausanne) 2022; 13:1067801. [PMID: 36518251 PMCID: PMC9742360 DOI: 10.3389/fendo.2022.1067801] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 11/09/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Thyroid hormones are important modulators of cardiovascular function. Both hypothyroidism and hyperthyroidism are known to contribute to an increased cardiovascular risk. It remains uncertain whether thyroid hormones level within the euthyroid range are associated with cardiometabolic risk. We aimed to evaluate the association between thyroid function levels within the euthyroid range and cardiovascular risk in a population-based cohort. METHODS Eight hundred thirty-five subjects aged ≥45 years from the EPIPorto population-based cohort were included. We excluded participants with TSH, free T4 (FT4), or free T3 (FT3) outside of the reference range, or with previous cardiovascular or thyroid disease. The associations between thyroid function, cardiovascular risk factors and the 10-year estimated risk of cardiovascular events (using SCORE2 and SCORE2-OP) were evaluated in linear and logistic regression models, crudely and adjusting for age, sex, BMI, diabetes, and smoking. RESULTS The mean age of the participants was 61.5 (SD 10.5) years and 38.9% were men. Eleven percent of the participants had diabetes, 47.8% had dyslipidemia, and 54.8% had hypertension. The mean body mass index (BMI) was 27.4 (SD 4.6) kg/m2, and the median (percentile25-75) 10-year risk of cardiovascular events was 5.46% (2.92, 10.11). Participants with higher BMI, larger waist circumference and higher hs-CRP had higher levels of FT3 and FT3/FT4 ratio. Lower FT3/FT4 ratio and higher FT4 levels were associated with higher prevalence of diabetes and more adverse lipid profile. Higher TSH, lower FT3 and lower FT3/FT4 ratio were associated with lower eGFR. Lower FT3, lower FT3/FT4 ratio and higher FT4 were associated with an increased 10-year risk of cardiovascular events. CONCLUSIONS In a population-based study, variations of thyroid function within the euthyroid range were associated with cardiovascular risk factors. On one hand, individuals with higher BMI, larger waist circumference and higher hs-CRP had higher levels of FT3 and FT3/FT4 ratio. On the other hand, a decreased conversion of T4 to T3 (lower FT3, lower FT3/FT4 ratio and/or higher FT4) was associated with a higher prevalence of diabetes, a more adverse lipid profile, a lower eGFR and an increased 10-year risk of cardiovascular events.
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Affiliation(s)
- João Sérgio Neves
- Departamento de Cirurgia e Fisiologia, Unidade de Investigação Cardiovascular, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de São João; Faculdade de Medicina da Universidade do Porto, Porto, Portugal
- *Correspondence: João Sérgio Neves,
| | - Ricardo Fontes-Carvalho
- Departamento de Cirurgia e Fisiologia, Unidade de Investigação Cardiovascular, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
- Department of Cardiology, Centro Hospitalar Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Marta Borges-Canha
- Departamento de Cirurgia e Fisiologia, Unidade de Investigação Cardiovascular, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de São João; Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Ana Rita Leite
- Departamento de Cirurgia e Fisiologia, Unidade de Investigação Cardiovascular, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Madalena von Hafe
- Departamento de Cirurgia e Fisiologia, Unidade de Investigação Cardiovascular, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Catarina Vale
- Departamento de Cirurgia e Fisiologia, Unidade de Investigação Cardiovascular, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Sandra Martins
- Department of Clinical Pathology, Centro Hospitalar Universitário de São João, Porto, Portugal
- EPIUnit – Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
| | - João Tiago Guimarães
- Department of Clinical Pathology, Centro Hospitalar Universitário de São João, Porto, Portugal
- EPIUnit – Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Department of Biomedicine, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
| | - Davide Carvalho
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de São João; Faculdade de Medicina da Universidade do Porto, Porto, Portugal
- Instituto de Investigação e Inovação em Saúde (i3S), Universidade do Porto, Porto, Portugal
| | - Adelino Leite-Moreira
- Departamento de Cirurgia e Fisiologia, Unidade de Investigação Cardiovascular, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Ana Azevedo
- EPIUnit – Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
- Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
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Arithmetical Analysis of Gender-Based Relative Behavior on Life Satisfaction and Self-esteemed Mental Health. HUMAN ARENAS 2021. [DOI: 10.1007/s42087-020-00116-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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11
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Croce L, Pallavicini C, Crotti S, Coperchini F, Minnelli L, Magri F, Chiovato L, Rotondi M. Basal and longitudinal changes in serum levels of TSH in morbid obese patients experiencing failure or success of dietary treatment. Eat Weight Disord 2021; 26:1949-1955. [PMID: 33068274 PMCID: PMC8292288 DOI: 10.1007/s40519-020-01043-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 09/30/2020] [Indexed: 11/28/2022] Open
Abstract
PURPOSE The relationship between thyroid function and obesity is a widely investigated one. The impact of thyroid hormones in determining the outcome of dietary/lifestyle interventions remains to be fully elucidated. The aim of this study was to compare basal and post dietary-intervention circulating thyroid-function parameters, lipid profile and fasting-glucose in euthyroid obese patients according to a success or failure of a dietary intervention program. METHODS In a retrospective longitudinal case-control study we enrolled 50 euthyroid obese patients who experienced a success in dietary intervention, as defined by a BMI reduction of at least 5% from baseline (Success Group) and 50 sex and age-matched euthyroid obese patients who experienced failure in dietary intervention as defined by either stable or increased body weight throughout the follow-up (Failure Group). Serum thyroid function parameters and metabolic profile at baseline and at the end of follow-up were collected. RESULTS At baseline, the two groups showed similar BMI, total-cholesterol, HDL-cholesterol and fasting-blood-glucose, but patients in Success Group had a significantly higher TSH as compared with Failure Group (2.20 ± 0.97 vs 1.66 ± 0.73, respectively, p < 0.001). Throughout a mean follow-up of 21.4 months TSH significantly decreased in Success Group (2.20 ± 0.97 vs 2.06 ± 0.98; p = 0.029) and increased in Failure Group (1.63 ± 0.72 vs 2.01 ± 0.99; p < 0.001). Multiple regression analysis showed that the outcome of the dietary intervention was significantly and independently related to baseline BMI (0.925; 0.861-0.993), age (0.957; 0.922-0.993), TSH (0.531; 0.290-0.973) and TSH-changes (1.011; 1.000-1.022) during follow-up. CONCLUSIONS Baseline serum TSH level is related to the final outcome of a dietary intervention program in obese patients. LEVEL OF EVIDENCE III Evidence obtained from a retrospective cohort or case-control analytic studies.
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Affiliation(s)
- Laura Croce
- Unit of Internal Medicine and Endocrinology, Laboratory for Endocrine Disruptors, Department of Internal Medicine and Therapeutics, Istituti Clinici Scientifici Maugeri IRCCS, University of Pavia, Via S. Maugeri 4, 27100, Pavia, Italy.,Department of Internal Medicine and Therapeutics, University of Pavia, 27100, Pavia, Italy.,PhD Course in Experimental Medicine, University of Pavia, 27100, Pavia, Italy
| | - Cristina Pallavicini
- Unit of Internal Medicine and Endocrinology, Laboratory for Endocrine Disruptors, Department of Internal Medicine and Therapeutics, Istituti Clinici Scientifici Maugeri IRCCS, University of Pavia, Via S. Maugeri 4, 27100, Pavia, Italy
| | - Silvia Crotti
- Unit of Internal Medicine and Endocrinology, Laboratory for Endocrine Disruptors, Department of Internal Medicine and Therapeutics, Istituti Clinici Scientifici Maugeri IRCCS, University of Pavia, Via S. Maugeri 4, 27100, Pavia, Italy
| | - Francesca Coperchini
- Unit of Internal Medicine and Endocrinology, Laboratory for Endocrine Disruptors, Department of Internal Medicine and Therapeutics, Istituti Clinici Scientifici Maugeri IRCCS, University of Pavia, Via S. Maugeri 4, 27100, Pavia, Italy
| | - Linda Minnelli
- Department of Internal Medicine and Therapeutics, University of Pavia, 27100, Pavia, Italy
| | - Flavia Magri
- Unit of Internal Medicine and Endocrinology, Laboratory for Endocrine Disruptors, Department of Internal Medicine and Therapeutics, Istituti Clinici Scientifici Maugeri IRCCS, University of Pavia, Via S. Maugeri 4, 27100, Pavia, Italy.,Department of Internal Medicine and Therapeutics, University of Pavia, 27100, Pavia, Italy
| | - Luca Chiovato
- Unit of Internal Medicine and Endocrinology, Laboratory for Endocrine Disruptors, Department of Internal Medicine and Therapeutics, Istituti Clinici Scientifici Maugeri IRCCS, University of Pavia, Via S. Maugeri 4, 27100, Pavia, Italy. .,Department of Internal Medicine and Therapeutics, University of Pavia, 27100, Pavia, Italy.
| | - Mario Rotondi
- Unit of Internal Medicine and Endocrinology, Laboratory for Endocrine Disruptors, Department of Internal Medicine and Therapeutics, Istituti Clinici Scientifici Maugeri IRCCS, University of Pavia, Via S. Maugeri 4, 27100, Pavia, Italy.,Department of Internal Medicine and Therapeutics, University of Pavia, 27100, Pavia, Italy
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12
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Alidrisi HA, Odhaib SA, Altemimi MT, Mansour AA. Patterns of Bodyweight Changes in Patients With Hypothyroidism, a Retrospective Study From Basrah, Southern Iraq. Cureus 2021; 13:e15408. [PMID: 34262799 PMCID: PMC8259075 DOI: 10.7759/cureus.15408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2021] [Indexed: 11/19/2022] Open
Abstract
Background Weight gain is one of the most important hypothyroidism-related concerns in patients with hypothyroidism. However, unexpectedly, levothyroxine replacement does not necessarily result in body weight (BWT) reduction among those patients. The study aimed to assess the patterns of BWT changes through time in patients with hypothyroidism. Method In a retrospective database study from Faiha Specialized Diabetes, Endocrine, and Metabolism Center, a total of 346 adult patients with hypothyroidism (192 newly diagnosed and 154 known hypothyroidism patients) who had one visit every three months, five visits in one year were included. Of these, 116 new and 69 known hypothyroidism patients had completed nine visits in two years. Each visit involved thyroid-stimulating hormone (TSH) and BWT measurements. Patients with chronic liver or renal disease, diabetes mellitus, thyroid cancer, or other malignancies, pregnancy, and steroid or hormonal therapies were excluded. The patients were further subdivided based on average TSH levels into controlled (TSH ≤ 4.2 μIU/ml) and uncontrolled (TSH > 4.2 μIU/ml). Repeated measures analysis of variance (ANOVA) with a Greenhouse-Geisser correction and post hoc tests using the Bonferroni correction were used to evaluate TSH and BWT changes through the study. Results Both in newly diagnosed and known hypothyroidism patients with an average TSH > 4.2 μIU/mL, BWT increased significantly through visits over one and two years. For newly diagnosed patients assessed over one year (F(2.41, 321.60) = 3.28, p = 0.03), the mean BWT increase was 1.4 ± 0.38 kg from 3rd to 12th month visits (p = 0.004). For newly diagnosed patients assessed over two years (F(3.10, 263.89) = 9.08, P < 0.0005), the mean BWT increase was 3.02 ± 0.77 kg from 3rd to 24th month visits (p = 0.007). For patients with known hypothyroidism assessed over one year (F(2.56, 187.47) = 7.11, p = 0.0003), the mean BWT increase was 1.97 ± 0.64 kg at 12th month visit, and over two years (F(2.35, 77.56) = 4.67, P = 0.009), the mean BWT increase was 3.78 ± 1.26 kg at 24th month visit. While in all other patients with an average TSH ≤ 4.2 μIU/mL, the BWT changed non-significantly through the visits for newly diagnosed patients over one year and two years (p = 0.10, 0.34, respectively), and known patients over one year and two years (p = 0.47, 0.34, respectively). Conclusion Contrary to what is believed, adequate treatment with levothyroxine does not associate with weight reduction. Instead, either the patient kept on the same weight or continued to gain more weight.
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Affiliation(s)
- Haider A Alidrisi
- Diabetes and Endocrinology, Faiha Specialized Diabetes, Endocrine and Metabolism Center, Basrah, IRQ.,Endocrinology, College of Medicine, University of Basrah, Basrah, IRQ
| | - Samih A Odhaib
- Diabetes and Endocrinology, Faiha Specialized Diabetes, Endocrine and Metabolism Center, Basrah, IRQ
| | - Mahmood Thamer Altemimi
- Diabetes and Endocrinology, Thi Qar Specialized Diabetes, Endocrine and Metabolism Center, Thi Qar Health Directorate, Basrah, IRQ
| | - Abbas A Mansour
- Diabetes and Endocrinology, Faiha Specialized Diabetes, Endocrine and Metabolism Center, Basrah, IRQ.,Medicine, College of Medicine, University of Basrah, Basrah, IRQ
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13
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Effect of the Cut-Off Level for Thyroid-Stimulating Hormone on the Prevalence of Subclinical Hypothyroidism among Infertile Mexican Women. Diagnostics (Basel) 2021; 11:diagnostics11030417. [PMID: 33804476 PMCID: PMC8001256 DOI: 10.3390/diagnostics11030417] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 02/24/2021] [Accepted: 02/25/2021] [Indexed: 01/21/2023] Open
Abstract
The primary aim of this study was to compare the prevalence of subclinical hypothyroidism (SCH) using two different cut-off levels for TSH values (≥2.5 mIU/L versus ≥4.1 mIU/L). The secondary objective was to analyze the clinical-biochemical characteristics in women with and without SCH. This was a retrospective cross-sectional study. In total, 1496 Mexican women with infertility were included: Group 1, women with TSH levels ranging between 0.3 and 2.49 mIU/L, n = 886; Group 2, women with TSH between 2.5 and 4.09 mIU/L, n = 390; and Group 3, women with TSH ≥4.1 mIU/L n = 220. SCH prevalence was 40.7% (CI 95%: 38.3-43.3%) with TSH cut-off ≥ 2.5 mIU/L, and 14.7% (CI 95%: 12.7-16.5%) with TSH cut-off ≥ 4.1 mIU/L, (p = 0.0001). The prevalence of overweight was higher in Group 2 than in Groups 1 and 3. Thyroid autoimmunity, obesity and insulin resistance were higher in Group 3 than in Group 1 (p < 0.05). No other differences were observed between groups. Conclusions: The prevalence of SCH in our selected patients increased almost three times using a TSH cut-off ≥ 2.5 mIU/L compared with a TSH cut-off ≥ 4.1 mIU/L. Women with TSH ≥4.1 mIU/L compared with TSH cut-off ≤ 2.5 mIU/L more often presented with obesity, thyroid autoimmunity and insulin resistance.
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14
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Saari A, Pokka J, Mäkitie O, Saha MT, Dunkel L, Sankilampi U. Early Detection of Abnormal Growth Associated with Juvenile Acquired Hypothyroidism. J Clin Endocrinol Metab 2021; 106:e739-e748. [PMID: 33245341 DOI: 10.1210/clinem/dgaa869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Indexed: 11/19/2022]
Abstract
CONTEXT Development of the typical growth phenotype in juvenile acquired hypothyroidism (JHT), the faltering linear growth with increasing weight, has not been thoroughly characterized. OBJECTIVE To describe longitudinal growth pattern in children developing JHT and investigate how their growth differs from the general population in systematic growth monitoring. DESIGN Retrospective case-control study. SETTING JHT cases from 3 Finnish University Hospitals and healthy matched controls from primary health care. PATIENTS A total of 109 JHT patients aged 1.2 to 15.6 years (born 1983-2010) with 554 height and weight measurements obtained for 5 years preceding JHT diagnosis. Each patient was paired with 100 healthy controls (born 1983-2008) by sex and age. Longitudinal growth pattern was evaluated in mixed linear models. Growth monitoring parameters were evaluated using receiver operating characteristics analysis. RESULTS At diagnosis, JHT patients were heavier (mean adjusted body mass index-for-age [BMISDS] difference, 0.65 [95% CI, 0.46-0.84]) and shorter (mean adjusted height-for-age deviation from the target height [THDEVSDS] difference, -0.34 [95% CI, -0.57 to -0.10]) than healthy controls. However, 5 years before diagnosis, patients were heavier (mean BMISDS difference, 0.33 [95% CI, 0.12-0.54]) and taller (mean THDEVSDS difference, 0.29 [95% CI, 0.06-0.52]) than controls. JHT could be detected with good accuracy when several growth parameters were used simultaneously in screening (area under the curve, 0.83 [95% CI, 0.78-0.89]). CONCLUSIONS Abnormal growth pattern of patients with JHT evolves years before diagnosis. Systematic growth monitoring would detect abnormal growth at an early phase of JHT and facilitate timely diagnosis of JHT.
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Affiliation(s)
- Antti Saari
- Department of Paediatrics, Kuopio University Hospital, Kuopio, Finland
- Department of Paediatrics, School of Medicine, University of Eastern Finland, Kuopio, Finland
| | - Jari Pokka
- Department of Paediatrics, School of Medicine, University of Eastern Finland, Kuopio, Finland
| | - Outi Mäkitie
- Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Folkhälsan Research Centre, Helsinki, Finland
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Marja-Terttu Saha
- Department of Paediatrics, Tampere University Hospital, Tampere, Finland
| | - Leo Dunkel
- Centre for Endocrinology, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Ulla Sankilampi
- Department of Paediatrics, Kuopio University Hospital, Kuopio, Finland
- Department of Paediatrics, School of Medicine, University of Eastern Finland, Kuopio, Finland
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15
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Fitzgerald SP, Bean NG, Falhammar H, Tuke J. Clinical Parameters Are More Likely to Be Associated with Thyroid Hormone Levels than with Thyrotropin Levels: A Systematic Review and Meta-Analysis. Thyroid 2020; 30:1695-1709. [PMID: 32349628 PMCID: PMC7757573 DOI: 10.1089/thy.2019.0535] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background: Though the functional states of other endocrine systems are not defined on the basis of levels of controlling hormones, the assessment of thyroid function is based on levels of the controlling hormone thyrotropin (TSH). We, therefore, addressed the question as to whether levels of thyroid hormones [free thyroxine (fT4), total triiodothyronine (TT3)/free triiodothyronine (fT3)], or TSH levels, within and beyond the reference ranges, provide the better guide to the range of clinical parameters associated with thyroid status. Methods: A PubMed/MEDLINE search of studies up to October 2019, examining associations of levels of thyroid hormones and TSH, taken simultaneously in the same individuals, with clinical parameters was performed. We analyzed atrial fibrillation, other cardiac parameters, osteoporosis and fracture, cancer, dementia, frailty, mortality, features of the metabolic syndrome, and pregnancy outcomes. Studies were assessed for quality by using a modified Newcastle-Ottawa score. Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines were followed. A meta-analysis of the associations was performed to determine the relative likelihood of fT4, TT3/fT3, and TSH levels that are associated with the clinical parameters. Results: We identified 58 suitable articles and a total of 1880 associations. In general, clinical parameters were associated with thyroid hormone levels significantly more often than with TSH levels-the converse was not true for any of the clinical parameters. In the 1880 considered associations, fT4 levels were significantly associated with clinical parameters in 50% of analyses. The respective frequencies for TT3/fT3 and TSH levels were 53% and 23% (p < 0.0001 for both fT4 and TT3/fT3 vs. TSH). The fT4 and TT3/fT3 levels were comparably associated with clinical parameters (p = 0.71). More sophisticated statistical analyses, however, indicated that the associations with TT3/fT3 were not as robust as the associations with fT4. Conclusions: Thyroid hormones levels, and in particular fT4 levels, seem to have stronger associations with clinical parameters than do TSH levels. Associations of clinical parameters with TSH levels can be explained by the strong negative population correlation between thyroid hormones and TSH. Clinical and research components of thyroidology currently based on the measurement of the thyroid state by reference to TSH levels warrant reconsideration.
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Affiliation(s)
- Stephen P. Fitzgerald
- Department of General Medicine and Royal Adelaide Hospital, Adelaide, South Australia
- Department of Endocrinology, Royal Adelaide Hospital, Adelaide, South Australia
- School of Medicine, University of Adelaide, Adelaide, South Australia
| | - Nigel G. Bean
- School of Mathematical Sciences, University of Adelaide, Adelaide, South Australia
- ARC Centre of Excellence for Mathematical and Statistical Frontiers, University of Adelaide, Adelaide, South Australia
| | - Henrik Falhammar
- Department of Endocrinology, Metabolism and Diabetes, Karolinska University Hospital, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Wellbeing and Chronic Preventable Diseases Division, Menzies School of Health Research and Royal Darwin Hospital, Tiwi, Australia
| | - Jono Tuke
- School of Mathematical Sciences, University of Adelaide, Adelaide, South Australia
- ARC Centre of Excellence for Mathematical and Statistical Frontiers, University of Adelaide, Adelaide, South Australia
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16
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Croce L, De Martinis L, Pinto S, Coperchini F, Dito G, Bendotti G, Pasquali D, Cappelli C, Latrofa F, Magri F, Chiovato L, Rotondi M. Compared with classic Hashimoto's thyroiditis, chronic autoimmune serum-negative thyroiditis requires a lower substitution dose of L-thyroxine to correct hypothyroidism. J Endocrinol Invest 2020; 43:1631-1636. [PMID: 32319047 DOI: 10.1007/s40618-020-01249-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 04/06/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE Serum-negative-chronic-autoimmune-thyroiditis (SN-CAT) is considered a milder variant of classic Hashimoto's thyroiditis (CHT). However, its prevalence remains unknown and it is still unclear whether SN-CAT behaves differently in terms of L-thyroxine (LT4) substitution treatment of hypothyroidism. Aims of this study were to estimate the prevalence of SN-CAT in a large series of hypothyroid patients and to compare LT4 requirements in hypothyroid patients with SN-CAT and CHT. METHODS Five-hundred-eighty-one consecutive patients with primary-autoimmune-hypothyroidism were enrolled in a cross-sectional study. LT4 requirements and thyroid-volume changes were longitudinally evaluated in 49 hypothyroid patients with SN-CAT and in 98 sex and age-matched hypothyroid patients with CHT. RESULTS In our series the prevalence of SN-CAT was 20.8%. At diagnosis, patients in the CHT and SN-CAT groups had similar male/female ratio, age and BMI, while serum TSH and thyroid-volume were significantly greater in the CHT group. In the longitudinal study, during a follow-up of 8.9 ± 4.6 years, 8 out of 49 (16.3%) SN-CAT patients developed positive tests for of circulating TPO-Ab and/or Tg-Ab. Thyroid-volume significantly decreased in CHT patients, but not in those with SN-CAT. The maximum daily substitution dose of LT4 was smaller in SN-CAT patients as compared with the CHT ones. Multivariate analysis showed that age, BMI, basal TSH and thyroid antibody status independently and significantly predicted the maximum daily substitution dose of LT4. CONCLUSIONS SN-CAT accounts for a significant proportion of patients with autoimmune hypothyroidism. Compared with hypothyroid patients diagnosed with CHT, the SN-CAT ones require smaller doses of LT4 to correct their hypothyroidism.
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Affiliation(s)
- L Croce
- Unit of Internal Medicine and Endocrinology, Laboratory for Endocrine Disruptors, Istituti Clinici Scientifici Maugeri IRCCS, 27100, Pavia, Italy
- Department of Internal Medicine and Therapeutics, University of Pavia, 27100, Pavia, Italy
- PhD Course in Experimental Medicine, University of Pavia, 27100, Pavia, Italy
| | - L De Martinis
- Unit of Internal Medicine and Endocrinology, Laboratory for Endocrine Disruptors, Istituti Clinici Scientifici Maugeri IRCCS, 27100, Pavia, Italy
| | - S Pinto
- Unit of Internal Medicine and Endocrinology, Laboratory for Endocrine Disruptors, Istituti Clinici Scientifici Maugeri IRCCS, 27100, Pavia, Italy
| | - F Coperchini
- Unit of Internal Medicine and Endocrinology, Laboratory for Endocrine Disruptors, Istituti Clinici Scientifici Maugeri IRCCS, 27100, Pavia, Italy
| | - G Dito
- Unit of Internal Medicine and Endocrinology, Laboratory for Endocrine Disruptors, Istituti Clinici Scientifici Maugeri IRCCS, 27100, Pavia, Italy
| | - G Bendotti
- Unit of Internal Medicine and Endocrinology, Laboratory for Endocrine Disruptors, Istituti Clinici Scientifici Maugeri IRCCS, 27100, Pavia, Italy
| | - D Pasquali
- Department of Advanced Medical and Surgical Science, A.O.U. Vanvitelli, University of Campania "Luigi Vanvitelli", 80138, Naples, Italy
| | - C Cappelli
- Department of Clinical and Experimental Sciences, University of Brescia, 25123, Brescia, Italy
| | - F Latrofa
- Department of Clinical and Experimental Medicine, University of Pisa, 56124, Pisa, Italy
| | - F Magri
- Unit of Internal Medicine and Endocrinology, Laboratory for Endocrine Disruptors, Istituti Clinici Scientifici Maugeri IRCCS, 27100, Pavia, Italy
- Department of Internal Medicine and Therapeutics, University of Pavia, 27100, Pavia, Italy
| | - L Chiovato
- Unit of Internal Medicine and Endocrinology, Laboratory for Endocrine Disruptors, Istituti Clinici Scientifici Maugeri IRCCS, 27100, Pavia, Italy.
- Department of Internal Medicine and Therapeutics, University of Pavia, 27100, Pavia, Italy.
| | - M Rotondi
- Unit of Internal Medicine and Endocrinology, Laboratory for Endocrine Disruptors, Istituti Clinici Scientifici Maugeri IRCCS, 27100, Pavia, Italy
- Department of Internal Medicine and Therapeutics, University of Pavia, 27100, Pavia, Italy
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Habib A, Molayemat M, Habib A. Elevated serum TSH concentrations are associated with higher BMI Z-scores in southern Iranian children and adolescents. Thyroid Res 2020; 13:9. [PMID: 32547643 PMCID: PMC7293126 DOI: 10.1186/s13044-020-00084-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 06/03/2020] [Indexed: 01/16/2023] Open
Abstract
Background Subclinical hypothyroidism is defined as elevated TSH levels while T4 or FT4 levels are normal. Elevated TSH levels are linked with obesity in adults. In a recent meta-analysis in Iran, 6.1% of children below 18 had obesity. Due to the low number of studies on the subject in children we, designed the study to assess the relation between BMI Z-score and TSH levels in children and adolescence. Method This cross-sectional study was performed in a pediatric endocrinology clinic in Shiraz. Children aged between 2 to 18 years that came to the clinic for routine growth assessment follow up from January till April 2018 were considered. 850 children including 365 boys and 485 girls were included. Results Prevalence of subclinical hypothyroidism is increased in higher BMI groups. 9.9, 13.8, 17.2 and 20.5% of underweight, healthy weight, overweight and obese had subclinical hypothyroidism respectively. Obese and overweight participants had higher odds of subclinical hypothyroidism than those who were not (OR:1.649, P = 0.010, CI95% 1.126–2.413). On the other hand, Subclinical hypothyroid participants had higher odds of overweight or obesity than those who were euthyroid (OR:1.650, P = 0.010, CI95% 1.128–2.413). When TSH is set as a dependent value, TSH level is increased (β = 0.126, r = 0.125, P = 0.001) with an increase in BMI Z-score. When BMI Z-score is set as a dependent value, BMI Z-score is increased (β = 0.113, r = 0.243, P = 0.001) with an increase in TSH level. Conclusion BMI Z-score and elevated TSH levels are positively correlated however studies should be performed on establishing the causality.
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Affiliation(s)
- Ashkan Habib
- School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Asadollah Habib
- Department of Endocrinology, School of Medicine, Kazerun Branch, Islamic Azad University., First Floor, Zafar Building, Zand St, PO Box: 71384-37984, Shiraz, Iran
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18
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Xia MF, Chang XX, Zhu XP, Yan HM, Shi CY, Wu W, Zhong M, Zeng HL, Bian H, Wu HF, Gao X. Preoperative Thyroid Autoimmune Status and Changes in Thyroid Function and Body Weight After Bariatric Surgery. Obes Surg 2020; 29:2904-2911. [PMID: 31256358 DOI: 10.1007/s11695-019-03910-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Bariatric surgery has emerged as the most effective therapy for morbid obesity. There is increasing evidence that bariatric surgery could alleviate systemic inflammation and influence thyroid function. The current study aimed to investigate the associations of preoperative thyroid autoimmune status with the changes in body weight and thyroid function after bariatric surgery. METHODS We recruited 101 patients with morbid obesity (44 men and 57 women) who received bariatric surgery at Zhongshan Hospital, Fudan University. Those who had used thyroid hormone replacement or antithyroid drugs were excluded. General linear models were used to compare the changes in body weight and thyroid function in participants with different thyroid autoimmune statuses. RESULTS After bariatric surgery, serum-free triiodothyronine (FT3) (4.94 ± 0.73 vs 4.33 ± 0.59 pmol/L, P < 0.001) and thyroid-stimulating hormone (TSH) (3.13 ± 1.59 vs 2.26 ± 1.26 μIU/mL, P < 0.001) were significantly reduced, accompanied by reductions in BMI (42.1 ± 7.6 vs 31.4 ± 6.5 kg/m2, P < 0.001), and estimated basal metabolic rate (2002 ± 398 vs 1700 ± 336 kcal/day, P = 0.001) and an improvement in lipid profiles. Serum thyroperoxidase antibody (TPOAb) and thyroglobulin antibody (TgAb) levels also decreased significantly from 79.3 and 177.1 IU/mL to 57.8 and 66.0 IU/mL in participants with positive thyroid antibodies (P < 0.05). Further analysis showed that the positive preoperative thyroid autoimmune status was associated with less reduction in serum TSH (0.05 ± 1.59 vs - 1.00 ± 1.43 μIU/mL, P = 0.021) and BMI (- 8.3 ± 3.6 vs - 11.0 ± 4.5 kg, P = 0.049) after bariatric surgery. CONCLUSION Our study highlights a group of patients with morbid obesity, who have positive preoperative thyroid autoimmunity and less reduction in serum TSH levels and body weight after bariatric surgery.
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Affiliation(s)
- Ming-Feng Xia
- Department of Endocrinology and Metabolism, Zhongshan Hospital, Fudan University, Shanghai, China.,Fudan Institute for Metabolic Diseases, Shanghai, 200032, China
| | - Xin-Xia Chang
- Department of Endocrinology and Metabolism, Zhongshan Hospital, Fudan University, Shanghai, China.,Fudan Institute for Metabolic Diseases, Shanghai, 200032, China
| | - Xiao-Peng Zhu
- Department of Endocrinology and Metabolism, Zhongshan Hospital, Fudan University, Shanghai, China.,Fudan Institute for Metabolic Diseases, Shanghai, 200032, China
| | - Hong-Mei Yan
- Department of Endocrinology and Metabolism, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Chen-Ye Shi
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Wei Wu
- Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Ming Zhong
- Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Hai-Luan Zeng
- Department of Endocrinology and Metabolism, Zhongshan Hospital, Fudan University, Shanghai, China.,Fudan Institute for Metabolic Diseases, Shanghai, 200032, China
| | - Hua Bian
- Department of Endocrinology and Metabolism, Zhongshan Hospital, Fudan University, Shanghai, China.,Fudan Institute for Metabolic Diseases, Shanghai, 200032, China
| | - Hai-Fu Wu
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China.
| | - Xin Gao
- Department of Endocrinology and Metabolism, Zhongshan Hospital, Fudan University, Shanghai, China. .,Fudan Institute for Metabolic Diseases, Shanghai, 200032, China.
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Baranowska-Bik A, Bik W. The Association of Obesity with Autoimmune Thyroiditis and Thyroid Function-Possible Mechanisms of Bilateral Interaction. Int J Endocrinol 2020; 2020:8894792. [PMID: 33381173 PMCID: PMC7755496 DOI: 10.1155/2020/8894792] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Revised: 11/28/2020] [Accepted: 12/04/2020] [Indexed: 12/17/2022] Open
Abstract
A growing number of patients suffer from autoimmune diseases, including autoimmune thyroid disease. There has simultaneously been a significant increase in the prevalence of obesity worldwide. It is still an open question whether adiposity can directly influence activation of inflammatory processes affecting the thyroid in genetically predisposed individuals. Adipokines, biologically active substances derived from the adipocytes, belong to a heterogenic group of compounds involved in numerous physiological functions, including the maintenance of metabolism, hormonal balance, and immune response. Notably, the presence of obesity worsens the course of selected autoimmune diseases and impairs response to treatment. Moreover, the excess of body fat may result in the progression of autoimmune diseases. Nutritional status, body weight, and energy expenditure may influence thyroid hormone secretion. Interestingly, thyroid hormones might influence the activity of adipose tissue as metabolic alterations related to fat tissue are observed under pathological conditions in which there are deficits or overproduction of thyroid hormones. Functioning TSH receptors are expressed on adipocytes. Thermogenesis may presumably be stimulated by TSH binding to its receptor on brown adipocytes. There could be a bilateral interaction between the thyroid and adipose. Obesity may influence the onset and course of autoimmune disease.
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Affiliation(s)
- Agnieszka Baranowska-Bik
- Department of Endocrinology, Centre of Postgraduate Medical Education, Ceglowska 80, Warsaw 01-809, Poland
| | - Wojciech Bik
- Department of Neuroendocrinology, Centre of Postgraduate Medical Education, Marymoncka 99/103, Warsaw 01-813, Poland
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Zynat J, Li S, Ma Y, Han L, Ma F, Zhang Y, Xing B, Wang X, Guo Y. Impact of Abdominal Obesity on Thyroid Auto-Antibody Positivity: Abdominal Obesity Can Enhance the Risk of Thyroid Autoimmunity in Men. Int J Endocrinol 2020; 2020:6816198. [PMID: 32256575 PMCID: PMC7093900 DOI: 10.1155/2020/6816198] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 10/29/2019] [Accepted: 12/06/2019] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND The interrelation between obesity and autoimmune thyroid diseases is complex and has not been confirmed. The aim of the present study was to observe the relationship between thyroid autoimmunity and obesity, especially abdominal obesity, in a large population. METHODS A total of 2253 residents who had lived in Xinjiang for more than 3 years were enrolled. Serum thyroid hormone concentration, thyroid autoantibodies, lipid parameters, Weight, height, and waist and hip circumference were measured. RESULTS The prevalence of thyroid peroxidase antibody (TPOAb) and/or thyroglobulin antibody (TgAb) positive was 32.1% (21.2% in men and 37% in women, P < 0.01). Compared with women, men had significantly higher TG levels, waist circumference, and hip circumference levels (P < 0.01), while women showed higher TSH, TPOAb, and TgAb levels (P < 0.01). The prevalence of overweight and obesity was 71.1% in men and 63.5% in women. Men had a higher prevalence of abdominal obesity than women (56.6% in men and 47.6% in women, P < 0.01). TPOAb correlates positively with waist circumference (r = 0.100, P < 0.05) in men. Binary logistic analysis showed that TPOAb positivity had increased risks of abdominal obesity in men, and the OR was 1.1044 (95% CI 1.035, 1.151, P < 0.05). CONCLUSION Our results indicate that men had higher lipid levels, thicker waist circumference, and higher prevalence of overweight, obesity, and abdominal obesity. Abdominal obesity is a risk factor for TPOAb positivity in men, suggesting that abdominal obesity can enhance the risk of thyroid autoimmunity in men.
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Affiliation(s)
- Jazyra Zynat
- Department of Endocrinology, People's Hospital of Xinjiang Uygur Autonomous Region, Ürümqi, Xinjiang, China
| | - Suli Li
- Department of Endocrinology, People's Hospital of Xinjiang Uygur Autonomous Region, Ürümqi, Xinjiang, China
| | - Yanrong Ma
- Department of Endocrinology, People's Hospital of Xinjiang Uygur Autonomous Region, Ürümqi, Xinjiang, China
| | - Li Han
- Department of Endocrinology, People's Hospital of Xinjiang Uygur Autonomous Region, Ürümqi, Xinjiang, China
| | - Fuhui Ma
- Department of Endocrinology, People's Hospital of Xinjiang Uygur Autonomous Region, Ürümqi, Xinjiang, China
| | - Yuyuan Zhang
- Department of Endocrinology, People's Hospital of Xinjiang Uygur Autonomous Region, Ürümqi, Xinjiang, China
| | - Bei Xing
- Department of Endocrinology, People's Hospital of Xinjiang Uygur Autonomous Region, Ürümqi, Xinjiang, China
| | - Xinling Wang
- Department of Endocrinology, People's Hospital of Xinjiang Uygur Autonomous Region, Ürümqi, Xinjiang, China
| | - Yanying Guo
- Department of Endocrinology, People's Hospital of Xinjiang Uygur Autonomous Region, Ürümqi, Xinjiang, China
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Mohammadi Sefat S, Shabani R, Nazari M. The effect of concurrent aerobic-resistance training on thyroid hormones, blood glucose hemostasis, and blood lipid indices in overweight girls with hypothyroidism. Horm Mol Biol Clin Investig 2019; 40:/j/hmbci.ahead-of-print/hmbci-2019-0031/hmbci-2019-0031.xml. [DOI: 10.1515/hmbci-2019-0031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Accepted: 09/02/2019] [Indexed: 01/28/2023]
Abstract
Abstract
Background
The present study aimed to explore the effect of 8 weeks of concurrent aerobic-resistance training on thyroid stimulating hormone (TSH), thyroxine (T4), blood lipid profile, and blood glucose hemostasis in adolescent girls with hypothyroidism.
Materials and methods
In this clinical trial, 20 adolescent girls with hypothyroidism [age: 12.10 ± 1.94 years; body mass index (BMI): 25.25 ± 2.91 kg/m2] were selected and randomly assigned to experimental and control groups. The experimental group was treated with 8 weeks of concurrent aerobic [60–80% heart rate reserve (HHR)] and resistance (40–65% of 1RM) training. Blood was sampled before and after training. Data were analyzed using a pairwise t-test and an independent t-test (α < 0.05).
Results
Within-group comparison revealed significant decline of body index, BMI, fat percentage, fasting blood sugar, and homeostatic model assessment (HOMA) in the experimental group (p = 0.002, p = 0.001, p = 0.001, p = 0.03, and p = 0.02, respectively). Also, inter-group comparisons indicated significant differences in weight, BMI, fat percentage and HOMA (p = 0.001). But, no significant difference was observed in the blood sugar index (p > 0.05).
Conclusion
A short-term period of concurrent aerobic-resistance training may improve blood glucose hemostasis and body composition of adolescent girls with hypothyroidism. However, further research is necessary.
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Granzotto PCD, Mesa Junior CO, Strobel R, Radominski R, Graf H, de Carvalho GA. Thyroid function before and after Roux-en-Y gastric bypass: an observational study. Surg Obes Relat Dis 2019; 16:261-269. [PMID: 31924503 DOI: 10.1016/j.soard.2019.11.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 10/25/2019] [Accepted: 10/25/2019] [Indexed: 01/07/2023]
Abstract
BACKGROUND Population studies have shown a positive association between thyroid-stimulating hormone (TSH) and body mass index. Recent studies have shown a significant increase in the prevalence of subclinical hypothyroidism (SCH) in obesity. Weight reduction after Roux-en-Y gastric bypass (RYGB) seems to significantly decrease TSH levels. OBJECTIVES The purpose of this study was to evaluate the prevalence of SCH in obese patients (class II and III) and to observe the behavior of thyroid hormones (TSH, hormone triiodothyronine, thyroxine, free thyroxine) with significant weight loss after RYGB. SETTING Hospital Nossa Senhora das Graças, Curitiba, Paraná, Brazil. METHODS We retrospectively reviewed the medical records of 215 obese patients who underwent RYGB between 2005 and 2012 with a follow-up of at least 2 years. The study was observational and descriptive. The selected times for clinical and laboratory evaluations were preoperative, 3, 6, 12, and 24 months after the procedure. Association, correlation, and variance analyses were performed. RESULTS The prevalence of SCH preoperatively was 9.3%. SCH was corrected in 89.5% of patients 12 months after RYGB. We did not find an association between TSH and BMI (r = .002, P = .971). There was a positive impact of bariatric surgery on all metabolic variables. We showed that serum TSH level had no positive correlation with the presence or absence of metabolic syndrome. CONCLUSIONS Weight loss after bariatric surgery leads to normalization of TSH levels in most patients and none developed overt hypothyroidism. Obese patients with SCH should not be treated with thyroid hormone replacement. Serial monitoring of thyroid function after obesity therapy seems to be a reasonable approach.
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Affiliation(s)
| | - Cleo Otaviano Mesa Junior
- Endocrinology and Metabolism Department, Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, Brazil
| | - Rodrigo Strobel
- Bariatric and Metabolic Surgery Center, Hospital Nossa Senhora das Graças, Curitiba, Paraná, Brazil
| | - Rosana Radominski
- Endocrinology and Metabolism Department, Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, Brazil
| | - Hans Graf
- Endocrinology and Metabolism Department, Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, Brazil
| | - Gisah Amaral de Carvalho
- Endocrinology and Metabolism Department, Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, Brazil
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Unal E, Taş FF, Kaya MM, Yıldırım R, Aktar F, Haspolat YK. Obez Çocuk ve Adölesanlarda Tiroid Fonksiyonlarının Değerlendirilmesi. DICLE MEDICAL JOURNAL 2019. [DOI: 10.5798/dicletip.574971] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Sitoris G, Veltri F, Kleynen P, Belhomme J, Rozenberg S, Poppe K. Screening for Thyroid Dysfunction in Pregnancy With Targeted High-Risk Case Finding: Can It Be Improved? J Clin Endocrinol Metab 2019; 104:2346-2354. [PMID: 30608533 DOI: 10.1210/jc.2018-02303] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 12/26/2018] [Indexed: 01/28/2023]
Abstract
CONTEXT AND OBJECTIVE Targeted screening is proposed for the detection of thyroid dysfunction in pregnant women rather than universal screening (US). We aimed to determine the detection rate of subclinical hypothyroidism (SCH) and overt hypothyroidism (OH) based on American Thyroid Association guidelines (ATA-GL) and whether it could be improved. DESIGN, SETTING, AND PARTICIPANTS Cross-sectional study of 1832 pregnant women in a single center. Thyroid function (TSH and free T4) and iron status were determined. The high-risk group (HRG) included women with one or more ATA-GL risk factors and the low-risk group (LRG) included women without. Participants with other risk factors [body mass index (BMI) 30 to 39.9 kg/m2, Caucasian background] were classified as HRG+ and those with iron deficiency as HRG++. RESULTS The HRG included 64% of women and the LRG included 36% (P < 0.001). Of all participants, 4.5% had SCH and 0.5% OH. The detection rate of SCH and OH was comparable between the LRG and HRG (46% vs 54% and 25% vs 75%; P = 0.560 and 0.157, respectively). In the HRG, the detection rate of SCH was lower than that of US (54% vs 100%; P < 0.001), but that of OH was comparable (75%; P = 0.596). The detection rate of SCH in the HRG+ and HRG++ was comparable to that in the US group (81% and 88% vs 100%; P = 0.220 and 0.439, respectively). CONCLUSIONS Targeted high-risk case finding screening was not effective for the detection of SCH but performed better for OH. When obesity in the range BMI 30 to 39.9 kg/m2 and a Caucasian background were included as risk factors, the detection rate of SCH became comparable with that of US.
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Affiliation(s)
- Georgiana Sitoris
- Endocrine Unit, Centre Hospitalier Universitaire Saint Pierre, Université Libre de Bruxelles, Brussels, Belgium
| | - Flora Veltri
- Endocrine Unit, Centre Hospitalier Universitaire Saint Pierre, Université Libre de Bruxelles, Brussels, Belgium
| | - Pierre Kleynen
- Endocrine Unit, Centre Hospitalier Universitaire Saint Pierre, Université Libre de Bruxelles, Brussels, Belgium
| | - Julie Belhomme
- Department of Gynecology and Obstetrics, Centre Hospitalier Universitaire Saint Pierre, Université Libre de Bruxelles, Brussels, Belgium
| | - Serge Rozenberg
- Department of Gynecology and Obstetrics, Centre Hospitalier Universitaire Saint Pierre, Université Libre de Bruxelles, Brussels, Belgium
| | - Kris Poppe
- Endocrine Unit, Centre Hospitalier Universitaire Saint Pierre, Université Libre de Bruxelles, Brussels, Belgium
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Bruyneel M, Veltri F, Poppe K. Prevalence of newly established thyroid disorders in patients with moderate-to-severe obstructive sleep apnea syndrome. Sleep Breath 2018; 23:567-573. [PMID: 30368659 DOI: 10.1007/s11325-018-1746-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 10/08/2018] [Accepted: 10/19/2018] [Indexed: 01/08/2023]
Abstract
BACKGROUND Hypothyroidism can directly cause obstructive sleep apnea (OSA) but may also contribute to it through its impact on the metabolic syndrome. The purpose of this study was to establish the prevalence of known and newly diagnosed overt and subclinical hypothyroidism (SCH) among patients with OSA. METHODS We prospectively included all consecutive moderate or severe OSA patients referred for CPAP therapy. A fasting blood sample was collected to determine thyroid-stimulating hormone (TSH) and free T4 (FT4) levels. RESULTS A total of 280 patients were included (70% male). Mean ± SD body mass index (BMI) and apnea-hypopnea index (AHI) were 33 ± 7 kg/m2 and 49 ± 25, respectively. Median (range) serum TSH levels and mean ± SD FT4 levels were comparable between severe and moderate OSA (1.7 (1.3-2.6) vs 2.1 (1.2-2.8); p = 0.378 and 15.3 ± 2.3 vs 15.3 ± 2.3; p = 0.981). TSH and FT4 levels were not correlated with AHI (p = 0.297 and p = 0.370, respectively), but TSH was correlated with BMI (p = 0.049).Of all patients, 8.9% had increased serum TSH levels (severe and moderate OSA patients had similar levels (p = 0.711)) and 8.2% were newly diagnosed patients (no differences were observed between severe and moderate OSA (p = 0.450)). A total of 16.4% of patients had some type of thyroid disorder. Thyroid function parameters were associated with BMI but not with the severity of OSA. CONCLUSION In our population of moderate or severe OSA, 16% of patients had a thyroid problem and 8% of these were newly diagnosed with SCH.
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Affiliation(s)
- Marie Bruyneel
- Department of Pulmonary Medicine, CHU Saint-Pierre, Rue Haute, 322, 1000, Brussels, Belgium. .,Université Libre de Bruxelles (ULB), Brussels, Belgium.
| | - Flora Veltri
- Université Libre de Bruxelles (ULB), Brussels, Belgium.,Department of Endocrinology, CHU Saint-Pierre, Brussels, Belgium
| | - Kris Poppe
- Université Libre de Bruxelles (ULB), Brussels, Belgium.,Department of Endocrinology, CHU Saint-Pierre, Brussels, Belgium
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Sami A, Iftekhar MF, Rauf MA, Sher A. Subclinical Hypothyroidism among local adult obese population. Pak J Med Sci 2018; 34:980-983. [PMID: 30190765 PMCID: PMC6115588 DOI: 10.12669/pjms.344.14127] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Revised: 03/12/2018] [Accepted: 07/02/2018] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE To determine the frequency of subclinical hypothyroidism in local adult obese population. METHODS The study was conducted at Hayatabad Medical Complex, Peshawar, from March, 2017 to August, 2017. All patients aged between 18 and 60 years with BMI of more than 29kg/m2 were included in the study. Patients on lipid lowering drugs, with renal failure, hepatic failure and already diagnosed cases of thyroid dysfunction were excluded from the study. Thyroid functions were measured for all patients. RESULTS A total of 127 adults were included in the study in a consecutive manner. Mean age was 34.5 + 7.9 years of which 46.5% were male and 53.5% were female. Mean BMI was 32.05±2.06 kg/m2. The mean serum TSH was 3.13±1.10 mIU/L and mean serum thyroxine level was 1.08±0.25ng/dl. Subclinical hypothyroidism was recorded in 15% of the study population. CONCLUSION Subclinical hypothyroidism is highly prevalent in our population with BMI of more than 29kg/m2. Further studies are recommended on relationship between thyroid functions and BMI and its effect on cardiovascular functions.
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Affiliation(s)
- Abdul Sami
- Dr. Abdul Sami, FCPS. Department of Cardiology, Hayatabad Medical Complex, Peshawar, Pakistan
| | - Malik Faisal Iftekhar
- Dr. Malik Faisal Iftekhar, FCPS. Department of Cardiology, Hayatabad Medical Complex, Peshawar, Pakistan
| | - Muhammad Abdur Rauf
- Dr. Muhammad Abdur Rauf, FCPS. Department of Cardiology, Hayatabad Medical Complex, Peshawar, Pakistan
| | - Akhter Sher
- Dr. Akhter Sher, FCPS, Department of Cardiology, District Headquarter Hospital, Swabi, Pakistan
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Nurcheshmeh Z, Aliasgarzadeh A, Bahrami A, Mobasseri M. The Effects of Metformin on Thyroid Function among Patients with Subclinical Hypothyroidism and Coexisting Metabolic Syndrome. PHARMACEUTICAL SCIENCES 2018. [DOI: 10.15171/ps.2018.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Toniazzo AP, M. Arcego D, Lazzaretti C, Lampert C, N. Weis S, Proto-Siqueira R, Krolow R, Dalmaz C. Sex-specific effects of prepubertal stress and high-fat diet on leptin signaling in rats. Nutrition 2018. [DOI: 10.1016/j.nut.2017.10.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Veltri F, Poppe K. Variables Contributing to Thyroid (Dys)Function in Pregnant Women: More than Thyroid Antibodies? Eur Thyroid J 2018; 7:120-128. [PMID: 30023343 PMCID: PMC6047490 DOI: 10.1159/000488279] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 03/06/2018] [Indexed: 01/03/2023] Open
Abstract
Variability in thyroid function in pregnant women is the result of 2 main determinants, each accounting for approximately half of it. The first is the genetically determined part of which the knowledge increases fast, but most remains to be discovered. The second determinant is caused by an ensemble of variables of which thyroid autoimmunity is the best known, but also by others such as parity, smoking, age, and BMI. More recently, new candidate variables have been proposed, such as iron, endocrine disruptors, and the ethnicity of the pregnant women. In the future, the diagnosis and treatment of thyroid (dys)function may be optimized by the use of each individual's pituitary-thyroid set point, corrected with a factor taking into account the impact of nongenetically determined variables.
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Affiliation(s)
| | - Kris Poppe
- *K. Poppe, MD, PhD, CHU Saint-Pierre, Université Libre de Bruxelles (ULB), Rue Haute 322, BE-1000 Brussels (Belgium), E-Mail
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Lundbäck V, Ekbom K, Hagman E, Dahlman I, Marcus C. Thyroid-Stimulating Hormone, Degree of Obesity, and Metabolic Risk Markers in a Cohort of Swedish Children with Obesity. Horm Res Paediatr 2018; 88:140-146. [PMID: 28614818 DOI: 10.1159/000475993] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 04/18/2017] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND/AIMS Thyroid-stimulating hormone (TSH) is affected in obesity and might influence metabolic risk. It is unclear what mechanisms cause elevated TSH in obesity. We aimed to investigate TSH status within the normal range and the association of TSH with degree of obesity and metabolic parameters in children with obesity. METHODS A total of 3,459 children, aged 3.0-17.9 years, were identified in the Swedish Childhood Obesity Treatment Registry, BORIS. Age, gender, TSH, free triiodothyronine (fT3), free thyroxine (fT4), body mass index standard deviation scores (BMI SDS), as well as variables of lipid and glucose metabolism were examined. RESULTS Children with high-normal TSH (>3.0 mU/L) (28.8%) had higher BMI SDS compared to children with low-normal TSH (<3.0 mU/L) (p < 0.001). Multivariable regression analysis adjusted for age and gender showed that TSH levels were associated with BMI SDS (β: 0.21, 95% CI: 0.14-0.28, p < 0.001). Associations of thyroid hormones with markers of lipid and glucose metabolism were observed, where TSH was associated with fasting insulin, HOMA (homeostatic model assessment of insulin resistance), total cholesterol, and triglycerides. CONCLUSIONS A positive association between TSH levels and BMI SDS was seen in children with obesity. Associations of TSH and free thyroid hormones with glucose metabolism indicated that TSH might be one of several factors acting to determine body weight and obesity co-morbidities, although the underlying mechanism remains unclear.
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Affiliation(s)
- Veroniqa Lundbäck
- Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Kerstin Ekbom
- Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Emilia Hagman
- Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Ingrid Dahlman
- Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Claude Marcus
- Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
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Sengupta S, Jaseem T, Ambalavanan J, Hegde A. Homeostatic Model Assessment-Insulin Resistance (HOMA-IR 2) in Mild Subclinical Hypothyroid Subjects. Indian J Clin Biochem 2018; 33:214-217. [PMID: 29651214 DOI: 10.1007/s12291-017-0647-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Accepted: 03/08/2017] [Indexed: 12/23/2022]
Abstract
Despite various studies with conflicting results, the effect of thyroid hormones on lipids and insulin levels in dysthyroidism is of great interest. This case control study was aimed to perceive the existence of IR and dyslipidemia in mild subclinical hypothyroid subjects (TSH ≤ 9.9 µIU/ml) as compared to their age and gender matched euthyroid controls. Basic demographic information like height, weight was recorded. Serum samples of all the subjects were assayed for thyroid profile, lipid profile, blood glucose, HbA1C and insulin. BMI and insulin resistance was calculated. Compared to controls patients with mild subclinical hypothyroidism demonstrated hyperinsulinemia and dyslipidemia observed by the higher LDL cholesterol. A significantly positive correlation was observed for HOMA-IR with TSH and LDL cholesterol. Hence, even in the mild subclinical hypothyroid state assessment of thyroid function should be combined with estimation of plasma glucose, insulin and serum lipids to monitor and prevent its associated effects.
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Affiliation(s)
- Shreejita Sengupta
- 1Kasturba Medical College, Manipal University, Mangaluru, Karnataka India
| | - T Jaseem
- 2Department of Biochemistry, Center for Basic Sciences, Kasturba Medical College, Manipal University, Mangaluru, Karnataka 575004 India
| | | | - Anupama Hegde
- 2Department of Biochemistry, Center for Basic Sciences, Kasturba Medical College, Manipal University, Mangaluru, Karnataka 575004 India
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Veltri F, Kleynen P, Grabczan L, Salajan A, Rozenberg S, Pepersack T, Poppe K. Pregnancy outcomes are not altered by variation in thyroid function within the normal range in women free of thyroid disease. Eur J Endocrinol 2018; 178:189-197. [PMID: 29187511 DOI: 10.1530/eje-17-0628] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 10/27/2017] [Accepted: 11/28/2017] [Indexed: 12/12/2022]
Abstract
OBJECTIVE In the recently revised guidelines on the management of thyroid dysfunction during pregnancy, treatment with thyroid hormone (LT4) is not recommended in women without thyroid autoimmunity (TAI) and TSH levels in the range 2.5-4.0 mIU/L, and in a recent study in that particular group of pregnant women, more complications were observed when a treatment with LT4 was given. The objective of the study was therefore to investigate whether variation in thyroid function within the normal (non-pregnant) range in women free of thyroid disease was associated with altered pregnancy outcomes? DESIGN Cross-sectional data analysis of 1321 pregnant women nested within an ongoing prospective collection of pregnant women's data in a single centre in Brussels, Belgium. METHODS Thyroid peroxidase antibodies (TPO-abs), thyroid-stimulating hormone (TSH), free T4 (FT4) and ferritin levels were measured and baseline characteristics were recorded. Women taking LT4, with TAI and thyroid function outside the normal non-pregnant range were excluded. Pregnancy outcomes and baseline characteristics were correlated with all TSH and FT4 levels within the normal range and compared between two groups (TSH cut-off < and ≥2.5 mIU/L). RESULTS Tobacco use was associated with higher serum TSH levels (OR: 1.38; CI 95%: 1.08-1.74); P = 0.009. FT4 levels were inversely correlated with age and BMI (rho = -0.096 and -0.089; P < 0.001 and 0.001 respectively) and positively correlated with ferritin levels (rho = 0.097; P < 0.001). Postpartum haemorrhage (>500 mL) was inversely associated with serum FT4 levels (OR: 0.35; CI 95%: 0.13-0.96); P = 0.040. Also 10% of women free of thyroid disease had serum TSH levels ≥2.5 mIU/L. CONCLUSIONS Variation in thyroid function during the first trimester within the normal (non-pregnant) range in women free of thyroid disease was not associated with altered pregnancy outcomes. These results add evidence to the recommendation against LT4 treatment in pregnant women with high normal TSH levels and without TPO antibodies.
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Affiliation(s)
- Flora Veltri
- Endocrine Unit, Centre Hospitalier Universitaire Saint Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Pierre Kleynen
- Endocrine Unit, Centre Hospitalier Universitaire Saint Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Lidia Grabczan
- Endocrine Unit, Centre Hospitalier Universitaire Saint Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Alexandra Salajan
- Departement of Gynecology and Obstetrics, Centre Hospitalier Universitaire Saint Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Serge Rozenberg
- Departement of Gynecology and Obstetrics, Centre Hospitalier Universitaire Saint Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Thierry Pepersack
- Geriatric Unit, Centre Hospitalier Universitaire Saint Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Kris Poppe
- Endocrine Unit, Centre Hospitalier Universitaire Saint Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium
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Emokpae MA, Obazelu PA. The Association of Triiodothyronine-to-Thyroxine Ratio with Body Mass Index in Obese Nigerian Children and Adolescents. Med Sci (Basel) 2017; 5:medsci5040036. [PMID: 29244733 PMCID: PMC5753665 DOI: 10.3390/medsci5040036] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 12/05/2017] [Accepted: 12/14/2017] [Indexed: 11/22/2022] Open
Abstract
The interest in the relationship between thyroid dysfunction and obesity is on the increase. This study compares the triiodothyronine-to-thyroxine (T3/T4) ratio in obese and lean children and adolescents, and correlates thyroid hormones with body mass index (BMI) in obese Nigerian children. It is a retrospective study of records of 76 obese children and adolescents with a BMI of 31.7 ± 0.1 kg/m2 (26 males aged 10.9 ± 0.35 years, and 50 females aged 10.8 ± 0.4 years) that were referred to the laboratory for thyroid hormone evaluation because of their obese status. The controls were 20 age-matched non-obese apparently healthy subjects, with a mean age of 11.0 ± 0.47 years and a BMI of 20.2 ± 0.2 kg/m2. Serum T3, T4, and thyroid stimulating hormone (TSH) were determined using ELECSYS 1010 auto-analyzer (Roche Diagnostics, Penzberg, Germany). The BMI (p < 0.001), T3 (p < 0.01), TSH (p < 0.001) and T3/T4 ratio (p < 0.001) were significantly higher in obese than non-obese children and adolescents. Triiodothyronine (r = 0.230; p < 0.05), TSH (r = 0.272; p < 0.02), and T3/T4 ratio (r = 0.232; p < 0.05) correlated positively with BMI in obese children and adolescents. The T3/T4 ratio (p < 0.005) was significantly higher in obese boys than obese girls. Serum T3, TSH, and T3/T4 ratio correlated positive with BMI in obese Nigerian children and adolescents. Since thyroid dysfunction represents a continuum from asymptomatic to clinical symptomatic disease, it is suggested that obese children be counseled on the need to maintain ideal BMI in order to avoid the risks associated with obesity.
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Affiliation(s)
- Mathias Abiodun Emokpae
- Department of Medical Laboratory Science, School of Basic Medical Sciences, College of Medical Sciences, University of Benin, Benin City 300001, Nigeria.
| | - Progress Arhenrhen Obazelu
- Department of Medical Laboratory Science, School of Basic Medical Sciences, College of Medical Sciences, University of Benin, Benin City 300001, Nigeria.
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Schübel J, Feldkamp J, Bergmann A, Drossard W, Voigt K. Latent Hypothyroidism in Adults. DEUTSCHES ARZTEBLATT INTERNATIONAL 2017; 114:430-438. [PMID: 28683860 PMCID: PMC5508068 DOI: 10.3238/arztebl.2017.430] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 07/28/2016] [Accepted: 01/18/2017] [Indexed: 01/07/2023]
Abstract
BACKGROUND The prevalence of latent/subclinical hypothyroidism is between 3% and 10%, according to epidemiologic studies that have been carried out in the USA, the United Kingdom, and Denmark. As persons with latent hypo - thyroidism are often asymptomatic, the diagnosis is often made incidentally in routine laboratory testing. METHODS This review is based on a selective search in PubMed for publications on the diagnosis and treatment of latent hypothyroidism. All pertinent articles and guidelines published from 1 January 2000 to 31 July 2016 were included. RESULTS The diagnosis of latent hypothyroidism is generally assigned after repeated measurement of a TSH concentration above 4.0 mU/L in a person whose fT4 concentration is in the normal range. The most common cause is autoimmune thyroiditis, which can be detected by a test for autoantibodies. L-thyroxin supplementation is a controversial matter: its purpose is to prevent the development of overt hypothyroidism, but there is a danger of overtreatment, which increases the risk of fracture. To date, no benefit of L-thyroxin supplementation has been demonstrated with respect to morbidity and mortality, health-related quality of life, mental health, cognitive function, or reduction of overweight. There is, however, evidence of a beneficial effect on cardiac function in women, and on the vascular system. At present, treatment is generally considered indicated only if the TSH level exceeds 10.0 mU/L. CONCLUSION Limited data are available on the relevant clinical endpoints and undesired side effects of supplementation therapy. Physicians should advise patients about the indications for such treatment on an individual basis after due consideration of the risks and benefits.
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Affiliation(s)
- Jeannine Schübel
- Technische Universität Dresden, Faculty of Medicine Carl Gustav Carus, Department of General Practice/MK3, Dresden, Germany
| | - Joachim Feldkamp
- Municipal Hospital Bielefeld, Department for Endocrinology and Diabetes, Bielefeld, Germany
| | - Antje Bergmann
- Technische Universität Dresden, Faculty of Medicine Carl Gustav Carus, Department of General Practice/MK3, Dresden, Germany
| | | | - Karen Voigt
- Technische Universität Dresden, Faculty of Medicine Carl Gustav Carus, Department of General Practice/MK3, Dresden, Germany
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Veltri F, Belhomme J, Kleynen P, Grabczan L, Rozenberg S, Pepersack T, Poppe K. Maternal thyroid parameters in pregnant women with different ethnic backgrounds: Do ethnicity-specific reference ranges improve the diagnosis of subclinical hypothyroidism? Clin Endocrinol (Oxf) 2017; 86:830-836. [PMID: 28346766 DOI: 10.1111/cen.13340] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 03/07/2017] [Accepted: 03/12/2017] [Indexed: 01/25/2023]
Abstract
OBJECTIVE Guidelines on the management of thyroid dysfunction during pregnancy have recently been updated and, for the diagnosis of subclinical hypothyroidism (SCH), a thyroid-stimulating hormone (TSH) upper reference limit (cut-off) of 4.0 mIU/L has been proposed when no institutional values are available. It is also suggested that serum TSH and thyroid autoimmunity (TAI) may be different according to the ethnic background of the women. We therefore determined the prevalence of TAI and SCH in pregnant women with different ethnic backgrounds and, to define SCH, we used different first trimester TSH upper reference cut-offs (institutional, ethnicity-specific, 2.5 mIU/L [Endocrine Society] and 4.0 mIU/L [American Thyroid Association]). DESIGN Cross-sectional data analysis of 1683 pregnant women nested within an ongoing prospective database of pregnant women. METHOD The study was performed in a single centre in Brussels, Belgium. During the first antenatal visit, thyroid peroxidase antibodies (TPO-abs), TSH and free T4 (FT4) were measured and baseline characteristics recorded. Data from 481 women with sub-Saharan (SaBg; 28.6%), 754 North African (NaBg; 44.8%) and 448 Caucasian (CaBg; 26.6%) backgrounds were analysed. For the calculation of TSH reference ranges, women with TAI, outliers, twin and assisted pregnancies were excluded. RESULTS The prevalence of TAI was significantly lower in the SaBg group than in NaBg and CaBg groups (3.3% vs 8.6% and 11.1%; P<.001, respectively). Median TSH was significantly lower in SaBg and NaBg groups as compared with the CaBg group (1.3 and 1.4 vs 1.5 mIU/L; P=.006 and .014, respectively). The prevalence of women with SCH was comparable between all groups when 2.5 mIU/L was used as cut-off, but when 4.0 mIU/L or the institutional cut-off (3.74 mIU/L) was used, it was significantly higher in the CaBg group vs the NaBg group (5.4% vs 2.1% and 7.1% vs 3.3%, P=.008 and .013, respectively). The use of ethnicity-specific cut-offs did not change the prevalence of SCH as compared to the use of institutional cut-offs. However, when these cut-offs were used, the prevalence of SCH reduced by >70% (4.5% instead of 16.7%; P<.001) relative to the 2.5 mIU/L cut-off. CONCLUSIONS Pregnant women with a sub-Saharan African background had a lower prevalence of TAI and TSH levels as compared with women from other backgrounds. The use of ethnicity-specific TSH cut-offs in early pregnancy was not more specific for the diagnosis of SCH as compared to the use of the institutional cut-off.
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Affiliation(s)
- Flora Veltri
- Endocrine Unit, Centre Hospitalier Universitaire Saint Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Julie Belhomme
- Departement of Gynecology and Obstetrics, Centre Hospitalier Universitaire Saint Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Pierre Kleynen
- Endocrine Unit, Centre Hospitalier Universitaire Saint Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Lidia Grabczan
- Endocrine Unit, Centre Hospitalier Universitaire Saint Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Serge Rozenberg
- Departement of Gynecology and Obstetrics, Centre Hospitalier Universitaire Saint Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Thierry Pepersack
- Geriatric Unit, Centre Hospitalier Universitaire Saint Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Kris Poppe
- Endocrine Unit, Centre Hospitalier Universitaire Saint Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium
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Al-Musa HM. Impact of Obesity on Serum Levels of Thyroid Hormones among Euthyroid Saudi Adults. J Thyroid Res 2017; 2017:5739806. [PMID: 28630779 PMCID: PMC5463130 DOI: 10.1155/2017/5739806] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Accepted: 05/02/2017] [Indexed: 12/29/2022] Open
Abstract
AIM OF STUDY To assess serum thyroid hormones levels among Saudi adults and to correlate participants' serum levels with their grades of body mass index (BMI). METHODOLOGY A total of 278 adult subjects were recruited. Participants were categorized according to their BMI grades into normal weight (BMI < 25 kg/m2), overweight (BMI 25-29.9 kg/m2), or obese (BMI ≥ 30 kg/m2). Serum thyroid hormones levels were assessed at the central laboratory of Aseer Central Hospital, Abha City, by chemiluminescence immunoassay. RESULTS More than three-fourths of participants were either overweight (31.3%) or obese (44.6%). Mean TSH serum levels showed a significantly increasing trend with increasing BMI (p < 0.001). A negative trend was observed regarding participants' mean serum levels of fT4 with their BMI, but there were no significant differences in mean serum fT4 levels according to BMI. Moreover, no significant differences were observed in serum fT3 levels according to BMI. CONCLUSIONS Mean TSH serum levels increase with BMI increase. Further largescale multicentric and longitudinal studies are necessary to prove the association between serum levels of thyroid hormones and BMI of euthyroid adults.
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Affiliation(s)
- Hassan M. Al-Musa
- Family and Community Medicine Department, College of Medicine, King Khalid University, Abha, Saudi Arabia
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Ezzeddine D, Ezzeddine D, Hamadi C, Abbas HA, Nassar A, Abiad M, Ghazeeri G. Prevalence and Correlation of Hypothyroidism With Pregnancy Outcomes Among Lebanese Women. J Endocr Soc 2017; 1:415-422. [PMID: 29264496 PMCID: PMC5686637 DOI: 10.1210/js.2017-00014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 03/17/2017] [Indexed: 11/19/2022] Open
Abstract
Purpose: Assessment of hypothyroidism prevalence and clinical significance among pregnant women in Lebanon. Methods: We performed a single-center retrospective cohort study at the American University of Beirut Medical Center. Clinical, demographic, and laboratory data were collected and analyzed using trimester-specific ranges for hypothyroidism. Results: Of 920 pregnant women, 17% had hypothyroidism during gestation. A history of previous miscarriage and morbid obesity were associated with hypothyroidism during pregnancy. Pregnant women with hypothyroidism were more likely to experience a miscarriage during the first trimester [odds ratio, 2.9; 95% confidence interval, (1.13 to 7.5); P = 0.02] and delivery at post-term (odds ratio, 3.9; 95% confidence interval, 1.05 to 14.9; P = 0.05). We found no substantial correlation with preterm or premature delivery, cesarean section delivery, or gestational hypertension despite increased odds among the hypothyroidism group. No substantial differences were found with respect to the fetal outcomes between the control and hypothyroidism groups. Conclusions: Hypothyroidism is prevalent in 17% of pregnant women in Lebanon and was associated with a history of miscarriage and morbid obesity. The presence of hypothyroidism correlated with miscarriage during the first trimester and with post-term delivery. Despite the lack of sufficient data supporting the efficacy of treatment of hypothyroidism during gestation, more studies should be conducted to assess the effect of hypothyroidism on gestational and fetal outcomes.
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Affiliation(s)
- Dima Ezzeddine
- Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut 1107 2020, Lebanon
| | - Diala Ezzeddine
- Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut 1107 2020, Lebanon
| | - Caroline Hamadi
- Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut 1107 2020, Lebanon
| | - Hussein A Abbas
- School of Medicine, American University of Beirut Medical Center, Beirut 1107 2020, Lebanon
| | - Anwar Nassar
- Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut 1107 2020, Lebanon
| | - May Abiad
- Department of Biology, American University of Beirut Medical Center, Beirut 1107 2020, Lebanon
| | - Ghina Ghazeeri
- Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut 1107 2020, Lebanon
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Chon SJ, Heo JY, Yun BH, Jung YS, Seo SK. Serum Thyroid Stimulating Hormone Levels Are Associated with the Presence of Coronary Atherosclerosis in Healthy Postmenopausal Women. J Menopausal Med 2016; 22:146-153. [PMID: 28119894 PMCID: PMC5256366 DOI: 10.6118/jmm.2016.22.3.146] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 08/08/2016] [Accepted: 08/16/2016] [Indexed: 12/25/2022] Open
Abstract
Objectives Menopause is a natural aging process causing estrogen deficiency, accelerating atherogenic processes including dyslipidemia. Prevalence of thyroid dysfunction is also high in postmenopausal women, and it is known to elevate the risk of cardiovascular disease (CVD). Therefore, we are to study on the associations in between serum thyroid stimulating hormone (TSH) and prevalence of CVD in postmenopausal women who have normal thyroid function. Methods We performed a retrospective review of 247 Korean postmenopausal women who visited the health promotion center from January, 2007 to December, 2009. Postmenopausal women with normal serum TSH were included in the study. Coronary atherosclerosis was assessed by 64-row multidetector computed tomography. Results In multiple linear regression analysis, serum TSH was associated with serum triglyceride (TG) (β = 0.146, P = 0.023). In multiple logistic regression analysis, increasing age and serum TSH were associated with an increased risk of coronary atherosclerosis in euthyroid postmenopausal women (odds ratio [OR] = 1.107 [1.024-1.197], P = 0.011 and OR = 1.303 [1.024-1.658], P = 0.031, respectively). Conclusions It revealed that significant predictor of serum TSH was serum TG, and increasing age and TSH were found to have associations with an increased risk of coronary atherosclerosis in euthyroid postmenopausal women. Screening and assessing risks for CVD in healthy postmenopausal women would be helpful before atherosclerosis develops.
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Affiliation(s)
- Seung Joo Chon
- Department of Obstetrics and Gynecology, Gil Hospital, Gachon University College of Medicine, Incheon, Korea
| | - Jin Young Heo
- Department of Obstetrics and Gynecology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.; Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Bo Hyon Yun
- Department of Obstetrics and Gynecology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.; Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Yeon Soo Jung
- Department of Obstetrics and Gynecology, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Seok Kyo Seo
- Department of Obstetrics and Gynecology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.; Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, Korea
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Zhang X, Yao B, Li C, Mao J, Wang W, Xie X, Teng X, Han C, Zhou W, Li C, Xu B, Bi L, Meng T, Du J, Zhang S, Gao Z, Yang L, Fan C, Teng W, Shan Z. Reference Intervals of Thyroid Function During Pregnancy: Self-Sequential Longitudinal Study Versus Cross-Sectional Study. Thyroid 2016; 26:1786-1793. [PMID: 27733101 DOI: 10.1089/thy.2016.0002] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND A self-sequential longitudinal reference interval may be expected to minimize the inter-individual variation of thyroid function. Comparison between the self-sequential longitudinal reference interval (SLRI) and cross-sectional reference interval (CSRI) in pregnancy has not been well investigated. The objectives of this study were to establish a stringent SLRI of thyroid function in pregnant women and to compare it with the conventional CSRI. METHODS Three cohorts were enrolled: group 1, pregnant women for an SLRI (n = 99); group 2, pregnant women for a CSRI (n = 1318); group 3, non-pregnant control women (NC) as a control group (n = 301) according to the criteria of the National Academy of Clinical Biochemistry. Thyrotropin (TSH), total thyroxine (TT4), free thyroxine (fT4), total triiodothyronine (TT3), free triiodothyronine (fT3), serum ferritin (SF), and urine iodine concentration (UIC) were measured in the three groups. RESULTS Compared with CSRI, the reference interval of the SLRI group had narrower reference intervals of fT4 in the first and second trimesters (p < 0.05). The median of TSH was at a low level during the first trimester, and then gradually elevated in the second and third trimesters. The median of fT4 persistently decreased from 12 weeks, and did not return to the level of the NC group until 12 months postpartum. The TT4 increased to 131.4 nmol/L at gestational week 8, and reached a peak (170.0 nmol/L) at gestational week 12. In the first trimester, the prevalence of hypothyroxinemia was 9.1%, 4.0%, and 2.0% with a fT4 value below the 10th, 5th, and 2.5th percentile, respectively. In contrast, 29.3% of TT4 values were below the lower non-pregnancy reference limit multiplied by 1.5. CONCLUSIONS No significant difference was found between a SLRI and a CSRI, even in a stringent self-sequential longitudinal reference interval of thyroid function in pregnant women. In addition, the limit of TT4 below the non-pregnant level multiplied by a factor 1.5 is not appropriate for diagnosing hypothyroxinemia in the first trimester.
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Affiliation(s)
- Xiaomei Zhang
- 1 Department of Endocrinology and Metabolism, Peking University International Hospital , Beijing, China
| | - Baoting Yao
- 2 Department of Endocrinology and Metabolism, The First Hospital of Dandong City , Dandong, China
| | - Chenyan Li
- 3 The Endocrine Institute and The Liaoning Provincial Key Laboratory of Endocrine Diseases, Department of Endocrinology and Metabolism, The First Hospital of China Medical University , Shenyang, China
| | - Jinyuan Mao
- 3 The Endocrine Institute and The Liaoning Provincial Key Laboratory of Endocrine Diseases, Department of Endocrinology and Metabolism, The First Hospital of China Medical University , Shenyang, China
| | - Weiwei Wang
- 3 The Endocrine Institute and The Liaoning Provincial Key Laboratory of Endocrine Diseases, Department of Endocrinology and Metabolism, The First Hospital of China Medical University , Shenyang, China
| | - Xiaochen Xie
- 3 The Endocrine Institute and The Liaoning Provincial Key Laboratory of Endocrine Diseases, Department of Endocrinology and Metabolism, The First Hospital of China Medical University , Shenyang, China
| | - Xiaochun Teng
- 3 The Endocrine Institute and The Liaoning Provincial Key Laboratory of Endocrine Diseases, Department of Endocrinology and Metabolism, The First Hospital of China Medical University , Shenyang, China
| | - Cheng Han
- 3 The Endocrine Institute and The Liaoning Provincial Key Laboratory of Endocrine Diseases, Department of Endocrinology and Metabolism, The First Hospital of China Medical University , Shenyang, China
| | - Weiwei Zhou
- 4 Department of Obstetrics and Gynecology, Shenyang Women's and Children's Hospital , Shenyang, China
| | - Chenyang Li
- 4 Department of Obstetrics and Gynecology, Shenyang Women's and Children's Hospital , Shenyang, China
| | - Bin Xu
- 5 Department of Obstetrics and Gynecology, No. 202 Hospital of People's Liberation Army , Shenyang, China
| | - Lihua Bi
- 6 Department of Obstetrics and Gynecology, Dalian Obstetrics and Gynecology Hospital , Dalian, China
| | - Tao Meng
- 7 Department of Obstetrics and Gynecology, The First Hospital of China Medical University , Shenyang, China
| | - Jianling Du
- 8 Department of Endocrinology, The First Affiliated Hospital of Dalian Medical University , Dalian, China
| | - Shaowei Zhang
- 9 Department of Endocrinology, No. 202 Hospital of People's Liberation Army , Shenyang, China
| | - Zhengnan Gao
- 10 Department of Endocrinology, Dalian Municipal Central Hospital Affiliated of Dalian Medical University , Dalian, China
| | - Liu Yang
- 11 Department of Obstetrics and Gynecology, Shenyang Women and Children Health Care Center , Shenyang, China
| | - Chenling Fan
- 3 The Endocrine Institute and The Liaoning Provincial Key Laboratory of Endocrine Diseases, Department of Endocrinology and Metabolism, The First Hospital of China Medical University , Shenyang, China
| | - Weiping Teng
- 3 The Endocrine Institute and The Liaoning Provincial Key Laboratory of Endocrine Diseases, Department of Endocrinology and Metabolism, The First Hospital of China Medical University , Shenyang, China
| | - Zhongyan Shan
- 3 The Endocrine Institute and The Liaoning Provincial Key Laboratory of Endocrine Diseases, Department of Endocrinology and Metabolism, The First Hospital of China Medical University , Shenyang, China
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Rotondi M, Castagna MG, Cappelli C, Ciuoli C, Coperchini F, Chiofalo F, Maino F, Palmitesta P, Chiovato L, Pacini F. Obesity Does Not Modify the Risk of Differentiated Thyroid Cancer in a Cytological Series of Thyroid Nodules. Eur Thyroid J 2016; 5:125-31. [PMID: 27493887 PMCID: PMC4949374 DOI: 10.1159/000445054] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Revised: 02/05/2016] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND A possible impact of obesity on the risk of thyroid cancer has been postulated in some studies, but it remains controversial. OBJECTIVE To investigate the association between obesity and differentiated thyroid carcinoma in a population of unselected patients subjected to fine-needle aspiration cytology (FNAC) for thyroid nodules. METHODS We retrospectively evaluated the results of FNAC of thyroid nodules in 4,849 patients (3,809 females and 1,040 males; mean age 55.9 ± 14.1 years). Patients were stratified according to their body mass index (BMI). There were 1,876 (38.7%) normal-weight patients (BMI 18-24.9), 1,758 (36.2%) overweight (BMI 25-29.9), 662 (13.7%) grade 1 obese (BMI 30-34.9), 310 (6.4%) grade 2 obese (BMI 35-39.9) and 243 (5.0%) grade 3 obese (BMI >40). RESULTS The prevalence of suspicious or malignant nodules (Thy4/Thy5) did not differ across the 5 BMI groups, i.e. it was 6.8% in normal-weight patients, 6.3% in overweight patients, 6.3% in grade 1 obese patients, 4.0% in grade 2 obese patients and 4.2% in grade 3 obese patients (p = 0.29). The prevalence of Thy4/Thy5 nodules did not differ when males and females were evaluated separately (p = 0.22 and p = 0.12, respectively). A significant, lower rate of Thy4/5 cytology was observed in female patients with grade 2-3 obesity (odds ratio 0.51; 95% confidence interval 0.284-0.920; p = 0.009). CONCLUSIONS The results of this study, in a retrospective series of patients with thyroid nodules, do not confirm previous findings reporting an association between obesity and differentiated thyroid carcinoma. Thus, obese patients with nodular thyroid disease should be managed the same as normal-weight patients.
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Affiliation(s)
- Mario Rotondi
- Unit of Internal Medicine and Endocrinology, Fondazione Salvatore Maugeri I.R.C.C.S., ISPESL Laboratory for Endocrine Disruptors and Chair of Endocrinology, University of Pavia, Pavia, Italy
| | - Maria Grazia Castagna
- Departments of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy
| | - Carlo Cappelli
- Department of Medical and Surgical Sciences, University of Brescia, Brescia, Italy
| | - Cristina Ciuoli
- Departments of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy
| | - Francesca Coperchini
- Unit of Internal Medicine and Endocrinology, Fondazione Salvatore Maugeri I.R.C.C.S., ISPESL Laboratory for Endocrine Disruptors and Chair of Endocrinology, University of Pavia, Pavia, Italy
| | - Francesco Chiofalo
- Departments of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy
| | - Fabio Maino
- Departments of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy
| | - Paola Palmitesta
- Departments of Social, Political and Cognitive Sciences, University of Siena, Siena, Italy
| | - Luca Chiovato
- Unit of Internal Medicine and Endocrinology, Fondazione Salvatore Maugeri I.R.C.C.S., ISPESL Laboratory for Endocrine Disruptors and Chair of Endocrinology, University of Pavia, Pavia, Italy
| | - Furio Pacini
- Departments of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy
- *Furio Pacini, MD, Department of Medical, Surgical and Neurological Sciences, University of Siena, Policlinico Santa Maria alle Scotte, Viale Bracci 1, IT–53100 Siena (Italy), E-Mail
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García-García E, Vázquez-López MA, García-Fuentes E, Galera-Martínez R, Gutiérrez-Repiso C, García-Escobar I, Bonillo-Perales A. Thyroid Function and Thyroid Autoimmunity in Relation to Weight Status and Cardiovascular Risk Factors in Children and Adolescents: A Population-Based Study. J Clin Res Pediatr Endocrinol 2016; 8:157-62. [PMID: 26761948 PMCID: PMC5096470 DOI: 10.4274/jcrpe.2687] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE In obese subjects, slight increases have been observed in thyrotropin [thyroid-stimulating hormone (TSH)] levels, but data in children are scarce. The aim of this study was to evaluate whether thyroid function and autoimmunity vary with weight status in a healthy population of children and adolescents and to determine whether hyperthyrotropinemia is associated with any cardiovascular risk factor. METHODS This cross-sectional epidemiological study was conducted in Almería (Spain) on a representative sample of 1317 healthy subjects aged 2-16 years. Thyroid function, thyroid autoimmunity and cardiovascular risk factors were measured. Chi-square test, analysis of variance and multiple linear regression were used in the statistical analyses. RESULTS The obese children and adolescents had thyrotropin levels (mean ± standard deviation) of 3.12±2.44 mU/L. These levels were higher than those of overweight subjects (2.79±1.51 mU/L) and of normal weight subjects (2.73±1.30 mU/L) (p=0.02). Levels of free thyroxine and urinary iodine did not differ significantly between the groups. The prevalence (95% confidence interval) of thyroid autoimmunity was lower in the individuals with normal weight (2.9%; 2.0-4.2) than in the overweight (6.3%; 3.9-9.9) and obese subjects (5.6%, 2.5-11.3) (p=0.02). TSH levels were associated with obesity (β=0.36; p<0.001) and thyroid autoimmunity (β=1.10; p<0.001). They were not associated with any cardiovascular risk factor. CONCLUSION Obese children and adolescents had higher levels of thyrotropin than those who were overweight and of normal weight. The differences among the groups were of very little clinical significance and could possibly be linked to the higher prevalence of thyroid autoimmunity in obese subjects. The hyperthyrotropinemia in these subjects was not associated with any cardiovascular risk factor.
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Affiliation(s)
- Emilio García-García
- Hospital Torrecárdenas, Clinic of Pediatrics, Almeria, Spain Phone: +34 605076059 E-mail:
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Chagas NB, Antoneli L, Furino VDO, Melo DG, Germano CMR. Triagem de hipotireoidismo em crianças - Visão dos médicos da atenção primária à saúde de um município de médio porte. REVISTA BRASILEIRA DE MEDICINA DE FAMÍLIA E COMUNIDADE 2016. [DOI: 10.5712/rbmfc11(38)1088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Objetivo: Avaliar quais parâmetros os médicos da atenção primária à saúde do município de São Carlos, SP, Brasil, adotam para realizar triagem de função tireoidiana em crianças e adolescentes, quais exames complementares são solicitados e qual a conduta diante de resultados laboratoriais alterados. Métodos: Estudo transversal descritivo, no qual participaram 26 profissionais, correspondendo a 96,3% de todos os médicos da atenção primária da cidade que atuam no cuidado de crianças e adolescentes. Os participantes responderam por escrito quais as três situações mais frequentes na prática clínica em que indicavam triagem de hipotireoidismo na população pediátrica, quais os exames laboratoriais solicitados nesta avaliação e a qual conduta frente a exames com resultados alterados. Resultados: As situações clínicas mais frequentes apontadas pelos participantes como indicações de avaliação tireoidiana foram: obesidade, com 23 respostas (88,5%); baixa estatura, com 16 (61,5%); e síndrome de Down, com 8 (30,8%). Nove médicos (34,6%) responderam realizar o rastreio pela dosagem de TSH e T4l e outros 9 (34,6%), pela dosagem de TSH isolado. A conduta mais frequente diante de um resultado alterado foi o encaminhamento ao endocrinologista pediátrico, com 14 respostas (53,8%). Conclusão: O cenário encontrado neste estudo mostra que exames de função tireoidiana são solicitados rotineiramente por médicos da atenção primária no acompanhamento de crianças obesas. Como a obesidade infantil tem uma alta prevalência, isso pode determinar aumento importante dos custos do serviço de saúde e sobrecarga nos serviços de atenção especializada.
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Stroeve JHM, Saccenti E, Bouwman J, Dane A, Strassburg K, Vervoort J, Hankemeier T, Astrup A, Smilde AK, van Ommen B, Saris WHM. Weight loss predictability by plasma metabolic signatures in adults with obesity and morbid obesity of the DiOGenes study. Obesity (Silver Spring) 2016; 24:379-88. [PMID: 26813527 DOI: 10.1002/oby.21361] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Revised: 07/30/2015] [Accepted: 09/01/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Aim is to predict successful weight loss by metabolic signatures at baseline and to identify which differences in metabolic status may underlie variations in weight loss success. METHODS In DiOGenes, a randomized, controlled trial, weight loss was induced using a low-calorie diet (800 kcal) for 8 weeks. Men (N = 236) and women (N = 431) as well as groups with overweight/obesity and morbid obesity were studied separately. The relation between the metabolic status before weight loss and weight loss was assessed by stepwise regression on multiple data sets, including anthropometric parameters, NMR-based plasma metabolites, and LC-MS-based plasma lipid species. RESULTS Maximally, 57% of the variation in weight loss success can be predicted by baseline parameters. The most powerful predictive models were obtained in subjects with morbid obesity. In these models, the metabolites most predictive for weight loss were acetoacetate, triacylglycerols, phosphatidylcholines, specific amino acids, and creatine and creatinine. This metabolic profile suggests that high energy metabolism activity results in higher amounts of weight loss. CONCLUSIONS Possible predictive (pre-diet) markers were found for amount of weight loss for specific subgroups.
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Affiliation(s)
- Johanna H M Stroeve
- Department of Microbiology and Systems Biology, TNO, Zeist, The Netherlands
- Netherlands Metabolomics Centre, Leiden, The Netherlands
| | - Edoardo Saccenti
- Netherlands Metabolomics Centre, Leiden, The Netherlands
- Biosystems Data Analysis, Swammerdam Institute for Life Sciences, University of Amsterdam, Amsterdam, The Netherlands
- Laboratory of Systems and Synthetic Biology, Wageningen University, Wageningen, The Netherlands
| | - Jildau Bouwman
- Department of Microbiology and Systems Biology, TNO, Zeist, The Netherlands
- Netherlands Metabolomics Centre, Leiden, The Netherlands
| | - Adrie Dane
- Netherlands Metabolomics Centre, Leiden, The Netherlands
- Leiden/Amsterdam Center for Drug Research, Leiden University, Leiden, The Netherlands
| | - Katrin Strassburg
- Netherlands Metabolomics Centre, Leiden, The Netherlands
- Leiden/Amsterdam Center for Drug Research, Leiden University, Leiden, The Netherlands
| | - Jacques Vervoort
- Netherlands Metabolomics Centre, Leiden, The Netherlands
- Laboratory of Biochemistry, Wageningen University, Wageningen, The Netherlands
| | - Thomas Hankemeier
- Netherlands Metabolomics Centre, Leiden, The Netherlands
- Leiden/Amsterdam Center for Drug Research, Leiden University, Leiden, The Netherlands
| | - Arne Astrup
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Frederiksberg, Denmark
| | - Age K Smilde
- Netherlands Metabolomics Centre, Leiden, The Netherlands
- Biosystems Data Analysis, Swammerdam Institute for Life Sciences, University of Amsterdam, Amsterdam, The Netherlands
| | - Ben van Ommen
- Department of Microbiology and Systems Biology, TNO, Zeist, The Netherlands
- Netherlands Metabolomics Centre, Leiden, The Netherlands
| | - Wim H M Saris
- Netherlands Metabolomics Centre, Leiden, The Netherlands
- DSM Food Specialties Delft, Delft, The Netherlands
- Department of Human Biology, Maastricht University, Maastricht, the Netherlands
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Lambrinoudaki I, Armeni E, Rizos D, Georgiopoulos G, Athanasouli F, Triantafyllou N, Panoulis K, Augoulea A, Creatsa M, Alexandrou A, Alevizaki M, Stamatelopoulos K. Indices of adiposity and thyroid hormones in euthyroid postmenopausal women. Eur J Endocrinol 2015; 173:237-45. [PMID: 26142102 DOI: 10.1530/eje-15-0141] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE We aimed to evaluate the association between thyroid hormones and indices of obesity in a sample of euthyroid postmenopausal women. DESIGN Cross-sectional study. METHODS Serum levels of TSH, free triiodothyronine (FT3), and free thyroxine (FT4) as well as BMI and waist:hip ratio (WHR) were evaluated in 194 healthy euthyroid postmenopausal women. Ultrasonography was used to assess abdominal fat layers (subcutaneous fat (SF), preperitoneal fat (PF), and SF:PF ratio). Indices of adiposity were defined as high vs low depending on the median value of the assessed parameters. RESULTS After multivariate adjustment for traditional risk factors, lower FT4 levels and a higher FT3:FT4 ratio predicted higher SF mass (FT4, Exp(β)=0.035, P=0.020 and FT3:FT4, Exp(β)=2.374, P=0.018), whereas higher FT3 predicted higher PF mass (Exp(β)=2.815, P=0.032). Women with FT3:FT4 above the highest quartile had a significantly higher SF mass as compared to women in the lowest quartile (1.81 ± 0.62 cm vs 1.54 ± 0.46 cm, P=0.027). BMI had a positive independent association with TSH (Exp(β)=1.829, P=0.018). Finally, FT3 was significantly associated with SF mass among women with higher BMI (FT3, β=0.259, P=0.040) and women with higher WHR (β=0.309, P=0.020) but not among women with lower BMI or WHR values. CONCLUSION Thyroid hormone levels, and in particular FT3, were independently associated with SF and PF in euthyroid postmenopausal women, and this association was mainly evident in women with higher BMIs. On the other hand, among traditional indices of adiposity, only TSH was positively associated with BMI. Larger prospective studies are needed to evaluate the significance of the present findings.
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Affiliation(s)
- Irene Lambrinoudaki
- Second Department of Obstetrics and GynecologyHormonal LaboratoryAretaieio Hospital, University of Athens, 76 Vas. Sofias Avenue, GR-11528 Athens, GreeceDepartment of TherapeuticsAlexandra Hospital, University of Athens, 80 Vas. Sofias Avenue, GR-11528 Athens, GreeceDepartment of NeurologyAiginiteion Hospital, University of Athens, 72-74 Vas. Sofias Avenue, GR-11528 Athens, Greece
| | - Eleni Armeni
- Second Department of Obstetrics and GynecologyHormonal LaboratoryAretaieio Hospital, University of Athens, 76 Vas. Sofias Avenue, GR-11528 Athens, GreeceDepartment of TherapeuticsAlexandra Hospital, University of Athens, 80 Vas. Sofias Avenue, GR-11528 Athens, GreeceDepartment of NeurologyAiginiteion Hospital, University of Athens, 72-74 Vas. Sofias Avenue, GR-11528 Athens, Greece
| | - Demetrios Rizos
- Second Department of Obstetrics and GynecologyHormonal LaboratoryAretaieio Hospital, University of Athens, 76 Vas. Sofias Avenue, GR-11528 Athens, GreeceDepartment of TherapeuticsAlexandra Hospital, University of Athens, 80 Vas. Sofias Avenue, GR-11528 Athens, GreeceDepartment of NeurologyAiginiteion Hospital, University of Athens, 72-74 Vas. Sofias Avenue, GR-11528 Athens, Greece
| | - Georgios Georgiopoulos
- Second Department of Obstetrics and GynecologyHormonal LaboratoryAretaieio Hospital, University of Athens, 76 Vas. Sofias Avenue, GR-11528 Athens, GreeceDepartment of TherapeuticsAlexandra Hospital, University of Athens, 80 Vas. Sofias Avenue, GR-11528 Athens, GreeceDepartment of NeurologyAiginiteion Hospital, University of Athens, 72-74 Vas. Sofias Avenue, GR-11528 Athens, Greece
| | - Foteini Athanasouli
- Second Department of Obstetrics and GynecologyHormonal LaboratoryAretaieio Hospital, University of Athens, 76 Vas. Sofias Avenue, GR-11528 Athens, GreeceDepartment of TherapeuticsAlexandra Hospital, University of Athens, 80 Vas. Sofias Avenue, GR-11528 Athens, GreeceDepartment of NeurologyAiginiteion Hospital, University of Athens, 72-74 Vas. Sofias Avenue, GR-11528 Athens, Greece
| | - Nikolaos Triantafyllou
- Second Department of Obstetrics and GynecologyHormonal LaboratoryAretaieio Hospital, University of Athens, 76 Vas. Sofias Avenue, GR-11528 Athens, GreeceDepartment of TherapeuticsAlexandra Hospital, University of Athens, 80 Vas. Sofias Avenue, GR-11528 Athens, GreeceDepartment of NeurologyAiginiteion Hospital, University of Athens, 72-74 Vas. Sofias Avenue, GR-11528 Athens, Greece
| | - Konstantinos Panoulis
- Second Department of Obstetrics and GynecologyHormonal LaboratoryAretaieio Hospital, University of Athens, 76 Vas. Sofias Avenue, GR-11528 Athens, GreeceDepartment of TherapeuticsAlexandra Hospital, University of Athens, 80 Vas. Sofias Avenue, GR-11528 Athens, GreeceDepartment of NeurologyAiginiteion Hospital, University of Athens, 72-74 Vas. Sofias Avenue, GR-11528 Athens, Greece
| | - Areti Augoulea
- Second Department of Obstetrics and GynecologyHormonal LaboratoryAretaieio Hospital, University of Athens, 76 Vas. Sofias Avenue, GR-11528 Athens, GreeceDepartment of TherapeuticsAlexandra Hospital, University of Athens, 80 Vas. Sofias Avenue, GR-11528 Athens, GreeceDepartment of NeurologyAiginiteion Hospital, University of Athens, 72-74 Vas. Sofias Avenue, GR-11528 Athens, Greece
| | - Maria Creatsa
- Second Department of Obstetrics and GynecologyHormonal LaboratoryAretaieio Hospital, University of Athens, 76 Vas. Sofias Avenue, GR-11528 Athens, GreeceDepartment of TherapeuticsAlexandra Hospital, University of Athens, 80 Vas. Sofias Avenue, GR-11528 Athens, GreeceDepartment of NeurologyAiginiteion Hospital, University of Athens, 72-74 Vas. Sofias Avenue, GR-11528 Athens, Greece
| | - Andreas Alexandrou
- Second Department of Obstetrics and GynecologyHormonal LaboratoryAretaieio Hospital, University of Athens, 76 Vas. Sofias Avenue, GR-11528 Athens, GreeceDepartment of TherapeuticsAlexandra Hospital, University of Athens, 80 Vas. Sofias Avenue, GR-11528 Athens, GreeceDepartment of NeurologyAiginiteion Hospital, University of Athens, 72-74 Vas. Sofias Avenue, GR-11528 Athens, Greece
| | - Maria Alevizaki
- Second Department of Obstetrics and GynecologyHormonal LaboratoryAretaieio Hospital, University of Athens, 76 Vas. Sofias Avenue, GR-11528 Athens, GreeceDepartment of TherapeuticsAlexandra Hospital, University of Athens, 80 Vas. Sofias Avenue, GR-11528 Athens, GreeceDepartment of NeurologyAiginiteion Hospital, University of Athens, 72-74 Vas. Sofias Avenue, GR-11528 Athens, Greece
| | - Kimon Stamatelopoulos
- Second Department of Obstetrics and GynecologyHormonal LaboratoryAretaieio Hospital, University of Athens, 76 Vas. Sofias Avenue, GR-11528 Athens, GreeceDepartment of TherapeuticsAlexandra Hospital, University of Athens, 80 Vas. Sofias Avenue, GR-11528 Athens, GreeceDepartment of NeurologyAiginiteion Hospital, University of Athens, 72-74 Vas. Sofias Avenue, GR-11528 Athens, Greece
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High Body Mass Index Is an Indicator of Maternal Hypothyroidism, Hypothyroxinemia, and Thyroid-Peroxidase Antibody Positivity during Early Pregnancy. BIOMED RESEARCH INTERNATIONAL 2015; 2015:351831. [PMID: 26273610 PMCID: PMC4530209 DOI: 10.1155/2015/351831] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Revised: 06/02/2015] [Accepted: 07/09/2015] [Indexed: 01/03/2023]
Abstract
Background. Maternal thyroid dysfunction in early pregnancy may increase the risk of adverse pregnancy complications and neurocognitive deficiencies in the developing fetus. Currently, some researchers demonstrated that body mass index (BMI) is associated with thyroid function in nonpregnant population. Hence, the American Thyroid Association recommended screening thyroid function in obese pregnant women; however, the evidence for this is weak. For this purpose, our study investigated the relationship between high BMI and thyroid functions during early pregnancy in Liaoning province, an iodine-sufficient region of China. Methods. Serum thyroid stimulating hormone (TSH), free thyroxine (FT4), thyroid-peroxidase antibody (TPOAb), thyroglobulin antibody (TgAb) concentration, urinary iodine concentration (UIC), and BMI were determined in 6303 pregnant women. Results. BMI ≥ 25 kg/m2 may act as an indicator of hypothyroxinemia and TPOAb positivity and BMI ≥ 30 kg/m2 was associated with increases in the odds of hypothyroidism, hypothyroxinemia, and TPOAb positivity. The prevalence of isolated hypothyroxinemia increased among pregnant women with BMI > 24 kg/m2. Conclusions. High BMI during early pregnancy may be an indicator of maternal thyroid dysfunction; for Asian women whose BMI > 24 kg/m2 and who are within 8 weeks of pregnancy, thyroid functions should be assessed especially.
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Association Between Thyroid Hormones, Lipids and Oxidative Stress Markers in Subclinical Hypothyroidism. J Med Biochem 2015; 34:323-331. [PMID: 28356843 PMCID: PMC4922350 DOI: 10.2478/jomb-2014-0044] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Accepted: 03/20/2014] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Oxidative stress plays a role in the pathogenesis of many chronic diseases. It is recognized in overt hypothyroidism while its existence in subclinical hypothyroidism (SCH) is not well established. The aim of this study was to determine whether there was increased oxidation of lipids and proteins in SCH, and examine their association with lipids and thyroid hormones. METHODS Male adults (35-59 years) with SCH (n=467) and euthyroid controls (n=190) were studied. Anthropometric measurements, plasma lipids, thyroid stimulating hormone (TSH), free thyroxine (FT4), free triiodothyronine (FT3), total antioxidant capacity (T-AOC), lipid peroxidation products, malondialdehyde (MDA), advanced oxidation protein products (AOPP) and dityrosine concentrations were measured. RESULTS Plasma concentrations of MDA were significantly higher (p<0.05) in SCH (8.11±1.39 nmol/mL) compared with euthyroid controls (7.34±1.31 nmol/mL) while AOPP, dityrosine and T-AOC levels were not different. MDA was not associated with TSH (β=-0.019, P=0.759), FT4 (β=-0.062, P=0.323) and FT3 (β=-0.018, P=0.780) in SCH while levels increased with elevated total cholesterol (β=0.229, P=0.001), LDL (β=0.203, P=0.009) and triglycerides (β=0.159, P=0.036) after adjustment for age and body mass index. T-AOC reduced (β=-0.327, P=0.030) with increased MDA in euthyroid controls and not in SCH (β=-0.068, P=0.349), while levels increased with elevated triglycerides in both groups. CONCLUSIONS Oxidative stress was increased in subclinical hypothyroidism as evidenced by the elevated lipid peroxidation product, malondialdehyde, while protein oxidation was absent. Thus, reduction of oxidative stress may be beneficial in patients with subclinical hypothyroidism.
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Matusik P, Gawlik A, Januszek-Trzciakowska A, Malecka-Tendera E. Isolated Subclinical Hyperthyrotropinemia in Obese Children: Does Levothyroxine (LT4) Improve Weight Reduction during Combined Behavioral Therapy? Int J Endocrinol 2015; 2015:792509. [PMID: 26229533 PMCID: PMC4503571 DOI: 10.1155/2015/792509] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 06/20/2015] [Accepted: 06/23/2015] [Indexed: 11/21/2022] Open
Abstract
Objective. The study aim was to analyze whether anthropometrical parameters and TSH values in obese children with isolated subclinical hypothyroidism (IsHT) treated with levothyroxine (LT4) and weight reduction program differ from those managed by dietary and behavior counselling only. Material and Methods. 51 obese children with IsHT, who were treated according to the same weight reduction program, were retrospectively analyzed. They were divided into two groups: Group 1, n = 26, and Group 2, n = 25, without or with LT4 therapy, respectively. Changes in anthropometrical (delta BMI z-score) and hormonal (delta TSH) status were analyzed at the first follow-up visit. Results. In both groups significant decrease of TSH and BMI z-score values were noted. TSH normalized in 80.9% of children from Group 1 versus 90.5% from Group 2, p = NS. Delta BMI z-score was insignificantly higher in Group 1 compared to Group 2. Delta TSH was significantly related to initial TSH level in children treated by lifestyle intervention program only. Conclusions. In obese children with sHT dietary-behavioral management intervention contributed to reduction of body mass index, irrespective of levothyroxine use. This finding suggests that moderately elevated levels of TSH are a consequence rather than cause of overweight and pharmacological treatment should be avoided.
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Affiliation(s)
- Pawel Matusik
- School of Medicine in Katowice, Department of Pediatrics, Pediatric Endocrinology and Diabetes, Medical University of Silesia, Medykow 16, 40-752 Katowice, Poland
- *Pawel Matusik:
| | - Aneta Gawlik
- School of Medicine in Katowice, Department of Pediatrics, Pediatric Endocrinology and Diabetes, Medical University of Silesia, Medykow 16, 40-752 Katowice, Poland
| | - Aleksandra Januszek-Trzciakowska
- School of Medicine in Katowice, Department of Pediatrics, Pediatric Endocrinology and Diabetes, Medical University of Silesia, Medykow 16, 40-752 Katowice, Poland
| | - Ewa Malecka-Tendera
- School of Medicine in Katowice, Department of Pediatrics, Pediatric Endocrinology and Diabetes, Medical University of Silesia, Medykow 16, 40-752 Katowice, Poland
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Lee SY, Braverman LE, Pearce EN. Changes in body weight after treatment of primary hypothyroidism with levothyroxine. Endocr Pract 2014; 20:1122-8. [PMID: 24936556 DOI: 10.4158/ep14072.or] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVE Surprisingly few studies have examined weight change in hypothyroid patients after initiation of levothyroxine (LT4) therapy. Our study aimed to investigate weight change after initiation of LT4 treatment for primary hypothyroidism. METHODS Using electronic medical records from Boston Medical Center, Boston, Massachusetts, we performed a retrospective cohort study between January 1, 2003, and February 1, 2011. Adults ≥18 years of age with newly diagnosed primary hypothyroidism with an initial thyroid-stimulating hormone (TSH) level ≥10 mIU/L were identified. Patients with postsurgical hypothyroidism, thyroid cancer, and a history of radioactive iodine or head/neck irradiation, congestive heart failure, anorexia nervosa, end-stage renal disease, cirrhosis, pregnancy, or use of prescription weight-loss medications were excluded. TSH and weight at diagnosis and up to 24 months after LT4 initiation were collected. Weight change was assessed at the first posttreatment serum TSH level <5 mIU/L. RESULTS A total of 101 patients (mean age, 48 ± 15 years; 71% women) were included. Initial median TSH was 18.3 mIU/L (range, 10.1 to 710.5 mIU/L) and initial median weight was 79.6 kg (range 41.5 to 167.5 kg). Posttreatment median TSH level was 2.3 mIU/L (range, 0.04 to 5 mIU/L), and weight change at a median of 5 months (range, 1.1 to 25.6 months) was -0.1 kg (range, -20.6 to 7.7 kg). Initial median body mass index (BMI) of 95 of the patients was 29.3 kg/m2 (range, 19.5 to 56.1 kg/m2), and the median change in BMI was -0.1 kg/m2 (range, -7.1 to 3.3 kg/m2). Only 52% of patients lost weight, with a mean weight loss of 3.8 ± 4.4 kg. Gender, race, education, insurance type, age, initial TSH level, time to normalization of TSH, and initial weight were not associated with changes in weight or BMI. CONCLUSION Contrary to popular belief, our study of 101 patients with primary hypothyroidism showed that no significant weight change occurs after initiation of LT4 treatment.
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Affiliation(s)
- Sun Y Lee
- Section of Endocrinology, Diabetes, and Nutrition, Boston University School of Medicine, Boston, Massachusetts
| | - Lewis E Braverman
- Section of Endocrinology, Diabetes, and Nutrition, Boston University School of Medicine, Boston, Massachusetts
| | - Elizabeth N Pearce
- Section of Endocrinology, Diabetes, and Nutrition, Boston University School of Medicine, Boston, Massachusetts
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Santini F, Marzullo P, Rotondi M, Ceccarini G, Pagano L, Ippolito S, Chiovato L, Biondi B. Mechanisms in endocrinology: the crosstalk between thyroid gland and adipose tissue: signal integration in health and disease. Eur J Endocrinol 2014; 171:R137-52. [PMID: 25214234 DOI: 10.1530/eje-14-0067] [Citation(s) in RCA: 133] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Obesity and thyroid diseases are common disorders in the general population and they frequently occur in single individuals. Alongside a chance association, a direct relationship between 'thyroid and obesity' has been hypothesized. Thyroid hormone is an important determinant of energy expenditure and contributes to appetite regulation, while hormones and cytokines from the adipose tissue act on the CNS to inform on the quantity of energy stores. A continuous interaction between the thyroid hormone and regulatory mechanisms localized in adipose tissue and brain is important for human body weight control and maintenance of optimal energy balance. Whether obesity has a pathogenic role in thyroid disease remains largely a matter of investigation. This review highlights the complexity in the identification of thyroid hormone deficiency in obese patients. Regardless of the importance of treating subclinical and overt hypothyroidism, at present there is no evidence to recommend pharmacological correction of the isolated hyperthyrotropinemia often encountered in obese patients. While thyroid hormones are not indicated as anti-obesity drugs, preclinical studies suggest that thyromimetic drugs, by targeting selected receptors, might be useful in the treatment of obesity and dyslipidemia.
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Affiliation(s)
- Ferruccio Santini
- Endocrinology UnitObesity Center, University Hospital of Pisa, Pisa, ItalyDepartment of Translational MedicineUniversity of Piemonte Orientale, Novara, ItalyDivision of General MedicineI.R.C.C.S. Istituto Auxologico Italiano, Verbania, ItalyUnit of Internal Medicine and EndocrinologyFondazione Salvatore Maugeri I.R.C.C.S., University of Pavia, Pavia, ItalyDepartment of Clinical Medicine and SurgeryUniversity of Naples Federico II, Via S. Pansini 5, 80131 Naples, Italy
| | - Paolo Marzullo
- Endocrinology UnitObesity Center, University Hospital of Pisa, Pisa, ItalyDepartment of Translational MedicineUniversity of Piemonte Orientale, Novara, ItalyDivision of General MedicineI.R.C.C.S. Istituto Auxologico Italiano, Verbania, ItalyUnit of Internal Medicine and EndocrinologyFondazione Salvatore Maugeri I.R.C.C.S., University of Pavia, Pavia, ItalyDepartment of Clinical Medicine and SurgeryUniversity of Naples Federico II, Via S. Pansini 5, 80131 Naples, Italy Endocrinology UnitObesity Center, University Hospital of Pisa, Pisa, ItalyDepartment of Translational MedicineUniversity of Piemonte Orientale, Novara, ItalyDivision of General MedicineI.R.C.C.S. Istituto Auxologico Italiano, Verbania, ItalyUnit of Internal Medicine and EndocrinologyFondazione Salvatore Maugeri I.R.C.C.S., University of Pavia, Pavia, ItalyDepartment of Clinical Medicine and SurgeryUniversity of Naples Federico II, Via S. Pansini 5, 80131 Naples, Italy
| | - Mario Rotondi
- Endocrinology UnitObesity Center, University Hospital of Pisa, Pisa, ItalyDepartment of Translational MedicineUniversity of Piemonte Orientale, Novara, ItalyDivision of General MedicineI.R.C.C.S. Istituto Auxologico Italiano, Verbania, ItalyUnit of Internal Medicine and EndocrinologyFondazione Salvatore Maugeri I.R.C.C.S., University of Pavia, Pavia, ItalyDepartment of Clinical Medicine and SurgeryUniversity of Naples Federico II, Via S. Pansini 5, 80131 Naples, Italy
| | - Giovanni Ceccarini
- Endocrinology UnitObesity Center, University Hospital of Pisa, Pisa, ItalyDepartment of Translational MedicineUniversity of Piemonte Orientale, Novara, ItalyDivision of General MedicineI.R.C.C.S. Istituto Auxologico Italiano, Verbania, ItalyUnit of Internal Medicine and EndocrinologyFondazione Salvatore Maugeri I.R.C.C.S., University of Pavia, Pavia, ItalyDepartment of Clinical Medicine and SurgeryUniversity of Naples Federico II, Via S. Pansini 5, 80131 Naples, Italy
| | - Loredana Pagano
- Endocrinology UnitObesity Center, University Hospital of Pisa, Pisa, ItalyDepartment of Translational MedicineUniversity of Piemonte Orientale, Novara, ItalyDivision of General MedicineI.R.C.C.S. Istituto Auxologico Italiano, Verbania, ItalyUnit of Internal Medicine and EndocrinologyFondazione Salvatore Maugeri I.R.C.C.S., University of Pavia, Pavia, ItalyDepartment of Clinical Medicine and SurgeryUniversity of Naples Federico II, Via S. Pansini 5, 80131 Naples, Italy
| | - Serena Ippolito
- Endocrinology UnitObesity Center, University Hospital of Pisa, Pisa, ItalyDepartment of Translational MedicineUniversity of Piemonte Orientale, Novara, ItalyDivision of General MedicineI.R.C.C.S. Istituto Auxologico Italiano, Verbania, ItalyUnit of Internal Medicine and EndocrinologyFondazione Salvatore Maugeri I.R.C.C.S., University of Pavia, Pavia, ItalyDepartment of Clinical Medicine and SurgeryUniversity of Naples Federico II, Via S. Pansini 5, 80131 Naples, Italy
| | - Luca Chiovato
- Endocrinology UnitObesity Center, University Hospital of Pisa, Pisa, ItalyDepartment of Translational MedicineUniversity of Piemonte Orientale, Novara, ItalyDivision of General MedicineI.R.C.C.S. Istituto Auxologico Italiano, Verbania, ItalyUnit of Internal Medicine and EndocrinologyFondazione Salvatore Maugeri I.R.C.C.S., University of Pavia, Pavia, ItalyDepartment of Clinical Medicine and SurgeryUniversity of Naples Federico II, Via S. Pansini 5, 80131 Naples, Italy
| | - Bernadette Biondi
- Endocrinology UnitObesity Center, University Hospital of Pisa, Pisa, ItalyDepartment of Translational MedicineUniversity of Piemonte Orientale, Novara, ItalyDivision of General MedicineI.R.C.C.S. Istituto Auxologico Italiano, Verbania, ItalyUnit of Internal Medicine and EndocrinologyFondazione Salvatore Maugeri I.R.C.C.S., University of Pavia, Pavia, ItalyDepartment of Clinical Medicine and SurgeryUniversity of Naples Federico II, Via S. Pansini 5, 80131 Naples, Italy
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Obesity in autoimmune diseases: Not a passive bystander. Autoimmun Rev 2014; 13:981-1000. [DOI: 10.1016/j.autrev.2014.07.001] [Citation(s) in RCA: 406] [Impact Index Per Article: 40.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Accepted: 07/20/2014] [Indexed: 02/06/2023]
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