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Zheng Y, Wang J, Liu M, Zhou X, Lin X, Liang Q, Yang J, Zhang M, Chen Z, Li M, Wang Y, Sui J, Qiang W, Guo H, Shi B, He M. Time-restricted eating with or without a low-carbohydrate diet improved myocardial status and thyroid function in individuals with metabolic syndrome: secondary analysis of a randomized clinical trial. BMC Med 2024; 22:362. [PMID: 39227921 PMCID: PMC11373390 DOI: 10.1186/s12916-024-03595-6] [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: 01/02/2024] [Accepted: 08/28/2024] [Indexed: 09/05/2024] Open
Abstract
BACKGROUND Obesity and metabolic syndrome (MetS) have become urgent worldwide health problems, predisposing patients to unfavorable myocardial status and thyroid dysfunction. Low-carbohydrate diet (LCD) and time-restricted eating (TRE) have been confirmed to be effective methods for weight management and improving MetS, but their effects on the myocardium and thyroid are unclear. METHODS We conducted a secondary analysis in a randomized clinical diet-induced weight-loss trial. Participants (N = 169) diagnosed with MetS were randomized to the LCD group, the 8 h TRE group, or the combination of the LCD and TRE group for 3 months. Myocardial enzymes and thyroid function were tested before and after the intervention. Pearson's or Spearman's correlation was assessed between functions of the myocardium and thyroid and cardiometabolic parameters at baseline. RESULTS A total of 162 participants who began the trial were included in the intention-to-treat (ITT) analysis, and 57 participants who adhered to their assigned protocol were involved in the per-protocol (PP) analysis. Relative to baseline, lactate dehydrogenase, creatine kinase MB, hydroxybutyrate dehydrogenase, and free triiodothyronine (FT3) declined, and free thyroxine (FT4) increased after all 3 interventions (both analyses). Creatine kinase (CK) decreased only in the TRE (- 18 [44] U/L, P < 0.001) and combination (- 22 [64] U/L, P = 0.003) groups (PP analysis). Thyrotropin (- 0.24 [0.83] μIU/mL, P = 0.011) and T3 (- 0.10 ± 0.04 ng/mL, P = 0.011) decreased in the combination group (ITT analysis). T4 (0.82 ± 0.39 μg/dL, P = 0.046), thyroglobulin antibodies (TgAb, 2 [1] %, P = 0.021), and thyroid microsomal antibodies (TMAb, 2 [2] %, P < 0.001) increased, while the T3/T4 ratio (- 0.01 ± 0.01, P = 0.020) decreased only in the TRE group (PP analysis). However, no significant difference between groups was observed in either analysis. At baseline, CK was positively correlated with the visceral fat area. FT3 was positively associated with triglycerides and total cholesterol. FT4 was negatively related to insulin and C-peptide levels. TgAb and TMAb were negatively correlated with the waist-to-hip ratio. CONCLUSIONS TRE with or without LCD confers remarkable metabolic benefits on myocardial status and thyroid function in subjects with MetS. TRIAL REGISTRATION ClinicalTrials.gov, NCT04475822.
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Affiliation(s)
- Yixuan Zheng
- Department of Endocrinology, the First Affiliated Hospital of Xi'an JiaoTong University, 277 West Yanta Road, Xi'an, Shaanxi, 710061, People's Republic of China
| | - Jingya Wang
- Department of Gastroenterology, Xi'an Children's Hospital, Shaanxi Research Institute for Pediatric Diseases, The Affiliated Children's Hospital of Xi'an JiaoTong University and National Regional Medical Center for Children (Northwest), No 69, Xiju Yuan Lane, Xi'an, Shaanxi, 710003, People's Republic of China
| | - Mengmeng Liu
- Department of Endocrinology, the First Affiliated Hospital of Xi'an JiaoTong University, 277 West Yanta Road, Xi'an, Shaanxi, 710061, People's Republic of China
| | - Xingchen Zhou
- Department of Endocrinology, the First Affiliated Hospital of Xi'an JiaoTong University, 277 West Yanta Road, Xi'an, Shaanxi, 710061, People's Republic of China
| | - Xiaoying Lin
- Department of Endocrinology, the First Affiliated Hospital of Xi'an JiaoTong University, 277 West Yanta Road, Xi'an, Shaanxi, 710061, People's Republic of China
| | - Qian Liang
- Department of Endocrinology, the First Affiliated Hospital of Xi'an JiaoTong University, 277 West Yanta Road, Xi'an, Shaanxi, 710061, People's Republic of China
| | - Jing Yang
- Department of Endocrinology, the First Affiliated Hospital of Xi'an JiaoTong University, 277 West Yanta Road, Xi'an, Shaanxi, 710061, People's Republic of China
- Med-X Institute, Center for Immunological and Metabolic Diseases, The First Affiliated Hospital of Xi'an JiaoTong University, 277 West Yanta Road, Xi'an, Shaanxi, 710061, People's Republic of China
| | - Meng Zhang
- Department of Endocrinology, the First Affiliated Hospital of Xi'an JiaoTong University, 277 West Yanta Road, Xi'an, Shaanxi, 710061, People's Republic of China
| | - Ziyi Chen
- Department of Endocrinology, the First Affiliated Hospital of Xi'an JiaoTong University, 277 West Yanta Road, Xi'an, Shaanxi, 710061, People's Republic of China
| | - Meng Li
- Department of Endocrinology, the First Affiliated Hospital of Xi'an JiaoTong University, 277 West Yanta Road, Xi'an, Shaanxi, 710061, People's Republic of China
| | - Yue Wang
- Department of Endocrinology, the First Affiliated Hospital of Xi'an JiaoTong University, 277 West Yanta Road, Xi'an, Shaanxi, 710061, People's Republic of China
| | - Jing Sui
- Department of Endocrinology and International Medical Center, the First Affiliated Hospital of Xi'an JiaoTong University, 277 West Yanta Road, Xi'an, Shaanxi, 710061, People's Republic of China
| | - Wei Qiang
- Department of Endocrinology, the First Affiliated Hospital of Xi'an JiaoTong University, 277 West Yanta Road, Xi'an, Shaanxi, 710061, People's Republic of China
| | - Hui Guo
- Department of Endocrinology, the First Affiliated Hospital of Xi'an JiaoTong University, 277 West Yanta Road, Xi'an, Shaanxi, 710061, People's Republic of China
| | - Bingyin Shi
- Department of Endocrinology, the First Affiliated Hospital of Xi'an JiaoTong University, 277 West Yanta Road, Xi'an, Shaanxi, 710061, People's Republic of China.
| | - Mingqian He
- Department of Endocrinology, the First Affiliated Hospital of Xi'an JiaoTong University, 277 West Yanta Road, Xi'an, Shaanxi, 710061, People's Republic of China.
- Med-X Institute, Center for Immunological and Metabolic Diseases, The First Affiliated Hospital of Xi'an JiaoTong University, 277 West Yanta Road, Xi'an, Shaanxi, 710061, People's Republic of China.
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Calcaterra V, Magenes VC, Siccardo F, Hruby C, Basso M, Conte V, Maggioni G, Fabiano V, Russo S, Veggiotti P, Zuccotti G. Thyroid dysfunction in children and adolescents affected by undernourished and overnourished eating disorders. Front Nutr 2023; 10:1205331. [PMID: 37841407 PMCID: PMC10576529 DOI: 10.3389/fnut.2023.1205331] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 09/06/2023] [Indexed: 10/17/2023] Open
Abstract
Eating disorders (ED) are one of the most prevalent chronic disorders in adolescents and young adults, with a significantly increasing prevalence in younger children, particularly in girls. Even if obesity in essence is not framed as an eating disorder and has always been considered a separate pathology, ED and obesity could be considered part of a continuum. It has become evident that one condition can lead to another, such as binge eating disorder (BED) and bulimia nervosa, and that they share the same repercussions in terms of psychosocial, metabolic, and nutritional health. This narrative review aims to investigate the hypothalamic-pituitary-thyroid axis in undernourished and overnourished patients with ED, including obesity, in order to highlight the relationship between weight control and thyroid function and its effects and to consider therapeutic and preventive strategies in children and adolescents. Literature data report that thyroid alterations occur in patients with ED, both underweight and overweight, and represent a continuum of changes depending on the severity and time course of the disease involving the endocrine system. Considering the relevant role thyroid hormones (TH) play not only in energy expenditure (EE) but also in metabolic control and cardiovascular risks related to dysmetabolism and mood regulation, continuous monitoring of thyroid homeostasis in patients with ED is mandatory to prevent severe complications and to start early treatment when necessary.
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Affiliation(s)
- Valeria Calcaterra
- Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
- Department of Pediatric, Buzzi Children's Hospital, Milan, Italy
| | | | | | - Chiara Hruby
- Department of Pediatric, Buzzi Children's Hospital, Milan, Italy
| | - Martina Basso
- Child and Adolescent Neuropsychiatry Unit (UONPIA), ASST-Fatebenefratelli-Sacco, Milan, Italy
| | - Veronica Conte
- Child and Adolescent Neuropsychiatry Unit (UONPIA), ASST-Fatebenefratelli-Sacco, Milan, Italy
| | - Giulia Maggioni
- Child and Adolescent Neuropsychiatry Unit (UONPIA), ASST-Fatebenefratelli-Sacco, Milan, Italy
| | - Valentina Fabiano
- Department of Pediatric, Buzzi Children's Hospital, Milan, Italy
- Department of Biomedical and Clinical Science, University of Milano, Milan, Italy
| | - Susanna Russo
- Child and Adolescent Neuropsychiatry Unit (UONPIA), ASST-Fatebenefratelli-Sacco, Milan, Italy
| | - Pierangelo Veggiotti
- Department of Biomedical and Clinical Science, University of Milano, Milan, Italy
- Pediatric Neurology Unit, Buzzi Children's Hospital, Milan, Italy
| | - Gianvincenzo Zuccotti
- Department of Pediatric, Buzzi Children's Hospital, Milan, Italy
- Department of Biomedical and Clinical Science, University of Milano, Milan, Italy
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Abstract
In this review, we discuss the characteristics, pathophysiology, and therapeutic implications of the euthyroid sick syndrome. Multiple mechanisms have been identified to contribute to the development of euthyroid sick syndrome, including alterations in the iodothyronine deiodinases, thyroid-stimulating hormone secretion, thyroid hormone binding to plasma protein, transport of thyroid hormone in peripheral tissues, and thyroid hormone receptor activity. The euthyroid sick syndrome appears to be a complex mix of physiologic adaptation and pathologic response to acute illness. The underlying cause for these alterations has not yet been elucidated. Treatment of the euthyroid sick syndrome with thyroid hormone to restore normal serum thyroid hormone levels in an effort to improve disease prognosis and outcomes continues to be a focus of many clinical studies, although currently available data do not provide evidence of a clear benefit of treatment.
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Affiliation(s)
- Sun Lee
- Section of Endocrinology, Diabetes and Nutrition, Department of Medicine, Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts, USA
| | - Alan P Farwell
- Section of Endocrinology, Diabetes and Nutrition, Department of Medicine, Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts, USA
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Abstract
PURPOSE OF REVIEW The current state of the pathophysiology, diagnosis, and therapeutic implications of the nonthyroidal illness syndrome is reviewed. RECENT FINDINGS Previous studies attributed the development of the nonthyroidal illness syndrome to alterations in three main areas of thyroid hormone metabolism: deiodinase activity, thyroid-stimulating hormone secretion, and hormone binding to serum proteins. New studies suggest that alterations in thyroid hormone transport into tissues and alterations of the nuclear thyroid hormone receptors may also play a role. Therapy of the nonthyroidal illness syndrome remains a controversial topic. SUMMARY Multiple factors lead to the development of the nonthyroidal illness syndrome, including alterations in type 1 and 3 deiodinase activity, thyrotropin-releasing hormone and thyroid-stimulating hormone secretion, hormone binding to plasma proteins, thyroid hormone transporter expression and activity, and the thyroid hormone nuclear receptor complex. These data show that acute and chronic illness affect all aspects of thyroid hormone metabolism and action. Some of these changes are physiologic and some are pharmacologic. The mediators of these alterations are still largely unclear. There continues to be no indication for thyroid hormone therapy in the vast majority of patients with the nonthyroidal illness syndrome, although interesting data suggest a possible role for treating a small subset of patients.
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Affiliation(s)
- Alan P Farwell
- Section of Endocrinology, Diabetes and Nutrition, Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts 01583, USA.
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Dilli D, Dilmen U. The role of interleukin-6 and C-reactive protein in non-thyroidal illness in premature infants followed in neonatal intensive care unit. J Clin Res Pediatr Endocrinol 2012; 4:66-71. [PMID: 22672862 PMCID: PMC3386775 DOI: 10.4274/jcrpe.625] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE To investigate the role of interleukin-6 (IL-6) and C-reactive protein (CRP) in non-thyroidal illness (NTI) in premature infants. METHODS Serum levels of IL-6 and CRP, thyroid-stimulating hormone (TSH), total thyroxine (T4), free T4 (fT4), total triiodothyronine (T3), and free T3 (fT3) were determined at the 1st, 2nd and 4th weeks of postnatal life in 148 premature infants born before 33 weeks of gestation. RESULTS At the 1st week, serum T3 was negatively correlated with IL-6 (r= -0.33, p= 0.001) and CRP (r= -0.17, p= 0.03). Serum T3 was negatively and more strongly correlated with IL-6 (r= -0.49, p= 0.001) and CRP (r=- 0.33, p= 0.03) at the 2nd week, at which time sepsis frequency and low T3 rates were the highest. At the 4th week, mortality rate was higher among infants with lower T3 levels. CONCLUSIONS High IL-6 and CRP values related to neonatal sepsis might have a significant role in the pathogenesis of NTI in premature infants.
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Affiliation(s)
- Dilek Dilli
- Zekai Tahir Burak Maternity Teaching Hospital, Department of Neonatology, Ankara, Turkey.
| | - Uğur Dilmen
- Zekai Tahir Burak Maternity Teaching Hospital, Department of Neonatology, Ankara, Turkey
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Silvestri E, Lombardi A, de Lange P, Schiavo L, Lanni A, Goglia F, Visser TJ, Moreno M. Age-related changes in renal and hepatic cellular mechanisms associated with variations in rat serum thyroid hormone levels. Am J Physiol Endocrinol Metab 2008; 294:E1160-8. [PMID: 18430970 DOI: 10.1152/ajpendo.00044.2008] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Aging is associated with changes in thyroid gland physiology. Age-related changes in the contribution of peripheral tissues to thyroid hormone serum levels have yet to be systematically assessed. Here, we investigated age-related alterations in the contributions of the liver and kidney to thyroid hormone homeostasis using 6-, 12-, and 24-mo-old male Wistar rats. A significant and progressive decline in plasma thyroxine occurred with age, but triiodothyronine (T(3)) was decreased only at 24 mo. This was associated with an unchanged protein level of the thyroid hormone transporter monocarboxylate transporter 8 (MCT8) in the kidney and with a decreased MCT8 level in the liver at 24 mo. Hepatic type I deiodinase (D1) protein level and activity declined progressively with age. Renal D1 levels were decreased at both 12 and 24 mo but D1 activity was decreased only at 24 mo. In the liver, no changes occurred in thyroid hormone receptor (TR) TRalpha(1), whereas a progressive increase in TRbeta(1) occurred at both mRNA and total protein levels. In the kidney, both TRalpha(1) and TRbeta(1) mRNA and total protein levels were unchanged between 6 and 12 mo but increased at 24 mo. Interestingly, nuclear TRbeta1 levels were decreased in both liver and kidney at 12 and 24 mo, whereas nuclear TRalpha(1) levels were unchanged. Collectively, our data show differential age-related changes among hepatic and renal MCT8 and D1 and TR expressions, and they suggest that renal D1 activity is maintained with age to compensate for the decrease in hepatic T(3) production.
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Affiliation(s)
- Elena Silvestri
- Dipartimento di Scienze Biologiche ed Ambientali, Università degli Studi del Sannio, Benevento, Italy
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Yochem PK, Gulland FMD, Stewart BS, Haulena M, Mazet JAK, Boyce WM. Thyroid function testing in elephant seals in health and disease. Gen Comp Endocrinol 2008; 155:635-40. [PMID: 18190914 DOI: 10.1016/j.ygcen.2007.11.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2007] [Revised: 11/10/2007] [Accepted: 11/14/2007] [Indexed: 10/22/2022]
Abstract
Northern Elephant Seal Skin Disease (NESSD) is a severe, ulcerative, skin condition of unknown cause affecting primarily yearling northern elephant seals (Mirounga angustirostris); it has been associated with decreased levels of circulating thyroxine (T4) and triiodothyronine (T3). Abnormalities of the thyroid gland that result in decreased hormone levels (hypothyroidism) can result in hair loss, scaling and secondary skin infections. However, concurrent illness (including skin ailments) can suppress basal levels of thyroid hormones and mimic hypothyroidism; when this occurs in animals with normal thyroid glands it is called "sick euthyroid syndrome". The two conditions (true hypothyroidism vs. "sick euthyroid") can be distinguished in dogs by testing the response of the thyroid gland to exogenous thyrotropin (Thyroid Stimulating Hormone, TSH). To determine whether hypothyroidism is involved in the etiology of NESSD, we tested thyroid function of stranded yearling elephant seals in the following categories: healthy seals (rehabilitated and ready for release; N=9), seals suffering from NESSD (N=16) and seals with other illnesses (e.g., lungworm pneumonia; N=10). Levels of T4 increased significantly for all three categories of elephant seals following TSH stimulation, suggesting that seals with NESSD are "sick euthyroid" and that the disease is not associated with abnormal thyroid gland function.
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Affiliation(s)
- Pamela K Yochem
- Hubbs-SeaWorld Research Institute, 2595 Ingraham Street, San Diego, CA 92109, USA.
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