1
|
Sert UY, Celik HK, Karakaya BK, Caglar AT, Erdogan G, Engin-Ustun Y. The Impact of First Trimester TSH Level on Fetal Growth and Post-Term Pregnancy. Fetal Pediatr Pathol 2022; 41:584-591. [PMID: 34106035 DOI: 10.1080/15513815.2021.1933280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Objective: First trimester thyroid-stimulating hormone (TSH) level is an important determiner of neonatal outcome. In this study we investigated the relationship between first-trimester TSH level and fetal birthweight. Materials-Methods: First-trimester serum TSH, age, gravidity, parity, body mass index (BMI), gestational age, and birth weight were analyzed. Patients were divided two ways. The first division- group 1 with TSH < 2.5 mU/l, group 2 with TSH > 2.5 mU/l). The second division- group 3 with TSH < 4 mU/l and group 4 with TSH > 4 mU/l). Results: The study included 302 patients. High TSH levels are associated with an increased risk of macrosomic and post-term babies. A significant association was found for both thresholds of 2.5 and 4.0 mU/l. However, this relation was not significant after binary logistic regression. Conclusion: High maternal first trimester TSH levels are not associated with birth weight after separating out macrosomia-related factors.
Collapse
Affiliation(s)
- Umit Yasemin Sert
- Department of Obstetrics and Gynecology, University of Health Sciences Ankara City Hospital, Ankara, Turkey
| | - Hatice Kansu Celik
- Department of Obstetrics and Gynecology, University of Health Sciences Ankara City Hospital, Ankara, Turkey
| | - Burcu Kısa Karakaya
- Ankara Medical Park Hospital, Department of Obstetrics and Gynecology, Ankara, Turkey
| | - Ali Turhan Caglar
- Department of Obstetrics and Gynecology, University of Health Sciences, Etlik Zübeyde Hanım, Education and Research Hospital, Ankara, Turkey
| | - Gokcen Erdogan
- Department of Obstetrics and Gynecology, Near East University, Cyprus
| | - Yaprak Engin-Ustun
- Department of Obstetrics and Gynecology, University of Health Sciences, Etlik Zübeyde Hanım, Education and Research Hospital, Ankara, Turkey
| |
Collapse
|
2
|
Yontem M, Arslan S, Erdogdu BS, Kocak FE. SERUM LEVELS OF OXIDATIVE STRESS MARKERS IN SUBCLINICAL AND OVERT HYPOTHYROIDISM VERSUS CONTROL GROUP IN POPULATION OF KUTAHYA CITY, TURKEY. GOMAL JOURNAL OF MEDICAL SCIENCES 2022. [DOI: 10.46903/gjms/19.04.935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Background: Overproduction of oxygen-related free radicals and inadequate antioxidant defense are critical in hypothyroidism, as they might lead to future life-threatening diseases. The objectives of this study were to compare serum levels of oxidative stress markers; total oxidant status (TOS), total antioxidant status (TAS), oxidative stress index (OSI), paraoxonase-1 (PON-1), and arylesterase (ARYL) in patients with subclinical hypothyroidism (SH) and overt hypothyroidism (OH) versus healthy controls in population of Kutahya city, Turkey.Materials Methods: This cross-sectional study was conducted at Department of Biochemistry, Faculty of Medicine, Kutahya University of Health Sciences, Kutahya, Turkey, from July to December, 2016. Three study groups of 45 each were formed as healthy controls, patients with SH and OH. Serum levels of TOS, TAS, OSI, PON-1, and ARYL were five research variables with ratio scale, but skewed, so described by median and IQR with 95% Cl. Kruskal-Wallis and multiple comparison tests were used for hypotheses testing.Results: Serum levels of TOS and OSI were higher in SH group (p-values 0.032; .0001; respectively) and OH group (p-values .0001; .0001, respectively) than healthy controls, while serum levels of TAS, PON-1 and ARYL were lower in SH group (p-values .0001; .0001; .0001, respectively) and OH group (p-values .0001; .0001; .0001, respectively) than control group.Conclusion: Our study showed that serum levels of TOS and OSI were higher in subclinical and overt hypothyroidism than in healthy controls; while serum levels of TAS, PON-1, and ARYL were lower in subclinical and overt hypothyroidism than in healthy controls.
Collapse
|
3
|
David UE, Asiwe JN, Fasanmade AA. Maternal hypothyroidism prolongs gestation period and impairs glucose tolerance in offspring of Wistar rats. Horm Mol Biol Clin Investig 2021; 43:323-328. [PMID: 34907695 DOI: 10.1515/hmbci-2021-0068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 12/03/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Pregnancy is a critical period keenly regulated by both maternal and foetal factors and a shift in these factors could result in severe complications manifesting in foetal and adult life. However, maternal hypothyroidism before and/or during pregnancy is a critical factor. This study investigated the effect of maternal hypothyroidism on glucose tolerance and thyroid function in male and female offspring. METHODS Fifteen adult female Wistar rats were divided into three groups: Group 1 (sham-control), Group 2 (thyrodectomized) and Group 3 (thyroidectomised + L-thyroxine treated). Blood thyroxine (T4) level was measured on the day 10 after thyroidectomy in Groups 1 and 2, and day 35 in Group 3. Males were introduced to the female rats after T4 measurement. At PND-112, T4 levels of their offspring were measured. Oral Glucose Tolerance Test (OGTT) was measured in offspring at PND-133. RESULTS Thyroxine reduced significantly in Group 2 and their offspring (male and female) compared to Group 3 while gestation period was prolonged significantly in Group 2 compared to Group 1. Hypothyroid male offspring showed depressed glucose tolerance, however, no effect was observed in female offspring. CONCLUSIONS This study suggests that maternal hypothyroidism prolonged gestation period, induced foetal hypothyroidism in both genders and depressed glucose tolerance in male offspring.
Collapse
Affiliation(s)
- Ubong Edem David
- Department of Physiology, University of Ibadan, Ibadan, Nigeria.,Department of Physiology, Ajayi Crowther University, Oyo, Nigeria
| | - Jerome Ndudi Asiwe
- Department of Physiology, University of Ibadan, Ibadan, Nigeria.,Department of Physiology, PAMO University of Medical Sciences, Port Harcourt, Rivers State, Nigeria
| | | |
Collapse
|
4
|
Papadopoulou AM, Bakogiannis N, Skrapari I, Moris D, Bakoyiannis C. Thyroid Dysfunction and Atherosclerosis: A Systematic Review. In Vivo 2020; 34:3127-3136. [PMID: 33144416 DOI: 10.21873/invivo.12147] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 09/23/2020] [Accepted: 09/25/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND/AIM Thyroid dysfunction, both hypo- and hyperthyroidism, has been associated with cardiovascular disease. The aim of this study was to evaluate the association between thyroid dysfunction and atherosclerosis measured mostly by carotid intima-media thickness, as well as discuss whether L-T4 replacement is able to reverse or slow down the progression of atherosclerosis. MATERIALS AND METHODS The review was conducted according the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. We performed on PubMed a literature search from May 2004 to January 2020, using the search terms 'subclinical hypothyroidism' or 'thyroid disorders' and 'carotid artery', 'carotid intima-media thickness (IMT)', 'levothyroxine', and 'atherosclerosis'. RESULTS Twenty-six studies were eligible and included in the analysis. Overall, the studies encompassed a total of 36.434 patients included in this review. Most studies indicated a proportional correlation between IMT and thyroid dysfunction. Levothyroxine (L-T4) replacement led to significant decrease of IMT after 1 year in most studies. CONCLUSION Most studies have concluded that thyroid dysfunction is associated with arterial wall remodeling and, thus, with increased cardiovascular risk. However, the exact mechanistic background of pathological structural changes in the arterial wall is still unsettled. Large randomized controlled studies are required to definitively address the extent to which T4 replacement therapy might benefit patients with subclinical thyroid disorders.
Collapse
Affiliation(s)
| | | | - Ioanna Skrapari
- 1st Department of Internal Medicine, Evangelismos General Hospital, Athens, Greece
| | - Dimitrios Moris
- Department of Surgery, Duke University Medical Center, Durham, NC, U.S.A.
| | - Chris Bakoyiannis
- First Department of Surgery, Laikon General Hospital, Athens, Greece
| |
Collapse
|
5
|
Al-Naimi MS, Hussien NR, Rasheed HA, Al-Kuraishy HM, Al-Gareeb AI. Levothyroxine improves Paraoxonase (PON-1) serum levels in patients with primary hypothyroidism: Case-control study. J Adv Pharm Technol Res 2018; 9:113-118. [PMID: 30338238 PMCID: PMC6174702 DOI: 10.4103/japtr.japtr_298_18] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Primary hypothyroidism is associated with oxidative stress and insufficient antioxidant capacity. This study was conducted to evaluate the effects of levothyroxine replacement therapy on paraoxonase 1 (PON-1) serum levels in a patients with primary hypothyroidism. Thirty-one patients with primary hypothyroidism compared to 20 healthy controls were recruited from. A venous blood sample were taken after an overnight fasting for biochemical parameters, before and after starting levothyroxine therapy (100 μ g/day) for 3 months duration. The biochemical variables were PON-1 serum levels, lipid profiles, triiodothyronine (T3), thyroxin (T4), and thyroid stimulating hormone (TSH) serum levels. Levothyroxine replacement therapy leads to a significant amelioration of thyroid functions, lipid profile, cardiometabolic measures P < 0.05 in patients with primary hypothyroidism. Levothyroxine leads to significant elevation in PON-1 serum levels from 188.42 ± 19.81 (U/mL) to 361.23 ± 33.62 (U/mL) P < 0.0001. This study concluded that levothyroxine replacement therapy significantly increases PON-1 serum levels in patients with primary hypothyroidism and attenuating hypothyroidism-induced oxidative stress.
Collapse
Affiliation(s)
- Marwa S Al-Naimi
- Department of Clinical Pharmacology, College of Medicine, Al-Mustansiriya University, Baghdad, Iraq
| | - Nawar R Hussien
- Department of Clinical Pharmacology, College of Medicine, Al-Mustansiriya University, Baghdad, Iraq
| | - Huda A Rasheed
- Department of Clinical Pharmacology, College of Medicine, Al-Mustansiriya University, Baghdad, Iraq
| | - Hayder M Al-Kuraishy
- Department of Clinical Pharmacology and Therapeutic, Medical Faculty, College of Medicine, Al-Mustansiriya University, Baghdad, Iraq
| | - Ali I Al-Gareeb
- Department of Clinical Pharmacology and Therapeutic, Medical Faculty, College of Medicine, Al-Mustansiriya University, Baghdad, Iraq
| |
Collapse
|
6
|
van Tienhoven-Wind LJN, Gruppen EG, James RW, Bakker SJL, Gans ROB, Dullaart RPF. Serum paraoxonase-1 activity is inversely related to free thyroxine in euthyroid subjects: The PREVEND Cohort Study. Eur J Clin Invest 2018; 48. [PMID: 29171874 DOI: 10.1111/eci.12860] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2017] [Accepted: 11/18/2017] [Indexed: 01/10/2023]
Abstract
BACKGROUND Low-normal thyroid function within the euthyroid range has been suggested to enhance atherosclerosis susceptibility. Paraoxonase-1 (PON-1) may protect against atherosclerotic cardiovascular disease development by attenuating oxidative stress. We evaluated relationships of PON-1 with thyroid stimulating hormone (TSH), free T4 , free T3 , lipids and apolipoprotein (apo)A-I in euthyroid subjects, and assessed whether such relationships are modified in the context of the metabolic syndrome (MetS). MATERIALS AND METHODS Serum PON-1 activity (arylesterase activity), TSH, free T4 , free T3 , lipids and apoA-I was measured in 2206 euthyroid subjects (aged 28-75 years; 1138 men (age 49 ± 13 years) and 1068 women (age 46 ± 12 years), recruited from the general population (PREVEND cohort). RESULTS In age- and sex-adjusted analysis, PON-1 activity (divided into tertiles) was positively related to TSH (β = -0.045, P = .036) and inversely to free T4 (β = -0.042, P = .050) but not to free T3 (β = -0.027, P = .20). PON-1 activity was positively related to total cholesterol, non-HDL cholesterol and triglycerides, as well as to HDL cholesterol and apoA-I (P < .01 to <.001). The inverse relationship of PON-1 activity with free T4 remained present after adjustment for lipids and other potential confounders (β = -0.066, P = .002), but the positive relationship with TSH lost significance (β = 0.034, P = .11). The inverse relationship of PON-1 activity with free T4 was not different in subjects with vs without MetS (P = .94), nor modified by the presence of its individual components (P ≥ .22 for each). CONCLUSIONS Serum PON-1 activity is inversely associated with free T4 in euthyroid subjects, suggesting that low-normal thyroid function may affect PON-1 regulation.
Collapse
Affiliation(s)
- Lynnda J N van Tienhoven-Wind
- Department of Internal Medicine, University Medical Center Groningen and University of Groningen, Groningen, the Netherlands
| | - Eke G Gruppen
- Department of Internal Medicine, University Medical Center Groningen and University of Groningen, Groningen, the Netherlands
| | - Richard W James
- Department of Internal Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Stephan J L Bakker
- Department of Internal Medicine, University Medical Center Groningen and University of Groningen, Groningen, the Netherlands
| | - Rijk O B Gans
- Department of Internal Medicine, University Medical Center Groningen and University of Groningen, Groningen, the Netherlands
| | - Robin P F Dullaart
- Department of Internal Medicine, University Medical Center Groningen and University of Groningen, Groningen, the Netherlands
| |
Collapse
|
7
|
Unal E, Akın A, Yıldırım R, Demir V, Yildiz İ, Haspolat YK. Association of Subclinical Hypothyroidism with Dyslipidemia and Increased Carotid Intima-Media Thickness in Children. J Clin Res Pediatr Endocrinol 2017; 9:144-149. [PMID: 28008862 PMCID: PMC5463287 DOI: 10.4274/jcrpe.3719] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [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 Subclinical hypothyroidism (SH) is defined as an elevated serum thyroid-stimulating hormone (TSH) level with free thyroxine (fT4) level in the normal range. There are very few studies in the literature reporting on the effect of SH on lipid metabolism and carotid intima-media thickness (CIMT) in children. METHODS The study included 38 children diagnosed with SH and a control group comprising 38 healthy, euthyroid children. SH was diagnosed based on an elevated TSH level (4.2-20 mIU/L) and normal fT4 level measured in two morning fasting blood samples obtained at an interval of 2 to 6 weeks. Blood samples were collected by venipuncture in the morning after an overnight fast. RESULTS The patient group included 38 children (16 male, 22 female) with SH and the control group -38 healthy, euthyroid children (20 male, 18 female). Mean age was 8.1±3.6 (range, 3.5-15) years in the patient group and 8.9±2.4 (range, 4.5-15) years in the control group. In the patient group, total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), TC/high-density lipoprotein cholesterol (HDL-C), and LDL-C/HDL-C were higher compared to the control group (p=0.049, p=0.014, p=0.002, and 0.003, respectively). In the patient group, CIMT was also significantly higher compared to the control group (p=0.001). The patient group was further divided into two subgroups based on their serum TSH level: (I) patients with mildly elevated TSH (TSH=4.2±10 mIU/L) (n=33) and (II) patients with high TSH (TSH≥10 mIU/L) (n=5). However, no significant difference was found between the patients with mild and severe SH with regard to TC, LDL-C, HDL-C, triglyceride level and CIMT levels (p=0.635, p=0.424, p=0.310, p=0.342, and 0.610, respectively). CONCLUSION Subclinical hypothyroidism leads to increased dyslipidemia (increased TC and LDL) and increased CIMT, which leads to increased risk of cardiovascular disease. Further studies are needed to substantiate these findings in children with SH.
Collapse
Affiliation(s)
- Edip Unal
- Dicle University Faculty of Medicine, Department of Pediatric Endocrinology, Diyarbakır, Turkey, Phone: +90 412 248 80 01 E-mail:
| | - Alper Akın
- Dicle University Faculty of Medicine, Department of Pediatric Cardiology, Diyarbakır, Turkey
| | - Ruken Yıldırım
- Dicle University Faculty of Medicine, Department of Pediatric Endocrinology, Diyarbakır, Turkey
| | - Vasfiye Demir
- Dicle University Faculty of Medicine, Department of Family Medicine, Diyarbakır, Turkey
| | - İsmail Yildiz
- Dicle University Faculty of Medicine, Department of Biostatistics, Diyarbakır, Turkey
| | - Yusuf Kenan Haspolat
- Dicle University Faculty of Medicine, Department of Pediatric Endocrinology, Diyarbakır, Turkey
| |
Collapse
|
8
|
Li H, Cui Y, Zhu Y, Yan H, Xu W. Association of high normal HbA1c and TSH levels with the risk of CHD: a 10-year cohort study and SVM analysis. Sci Rep 2017; 7:45406. [PMID: 28345646 PMCID: PMC5366946 DOI: 10.1038/srep45406] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 02/23/2017] [Indexed: 12/19/2022] Open
Abstract
This study aimed to determine the association between the clinical reference range of serum glycated hemoglobin A1c (HbA1c) and thyrotropin (TSH) and the risk of coronary heart disease (CHD) in non-diabetic and euthyroid patients. We examined baseline HbA1c and TSH in 538 healthy participants, and then analyzed the associations and potential value of these indicators for predicting CHD using Cox proportional hazard and support vector machine analyses. During the median follow-up of 120 months, 39 participants later developed CHD. The baseline HbA1c and TSH within the reference range were positively associated with CHD risk. No correlation and interaction were found between the baseline HbA1c and TSH for the development of CHD. Disease event-free survival varied among participants with different baseline HbA1c quintiles, whereas disease event-free survival was similar for different TSH tertiles. The combination of these baselines showed sensitivity of 87.2%, specificity of 92.7%, and accuracy of 92.3% for identifying the participants who will later develop CHD. Relatively high but clinically normal HbA1c and TSH levels may increase the risk of CHD. Therefore, the combination of these indicators can serve as a biomarker for identifying healthy individuals from those who would later develop CHD.
Collapse
Affiliation(s)
- Hui Li
- Department of Health Administration, Affiliated Central Hospital of Xinxiang Medical University, Xinxiang Central Hospital, Xinxiang, Henan, China
| | - Ying Cui
- Department of Health Administration, Affiliated Central Hospital of Xinxiang Medical University, Xinxiang Central Hospital, Xinxiang, Henan, China
| | - Yanan Zhu
- Department of Health Administration, Affiliated Central Hospital of Xinxiang Medical University, Xinxiang Central Hospital, Xinxiang, Henan, China
| | - Haiying Yan
- Department of Health Administration, Affiliated Central Hospital of Xinxiang Medical University, Xinxiang Central Hospital, Xinxiang, Henan, China
| | - Wenge Xu
- Department of Health Administration, Affiliated Central Hospital of Xinxiang Medical University, Xinxiang Central Hospital, Xinxiang, Henan, China
| |
Collapse
|
9
|
Lee JE, Jeong SJ, Lee SJ, Lee YH, Lee Y, Lee SJ, Kim CH. Alteration of Lipid Profiles in Patients with Subclinical Hypothyroidism. J Lipid Atheroscler 2017. [DOI: 10.12997/jla.2017.6.2.84] [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
Affiliation(s)
- Jung Eun Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Sejong General Hospital, Bucheon, Korea
| | - Su Jin Jeong
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Sejong General Hospital, Bucheon, Korea
| | - Sol Jae Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Sejong General Hospital, Bucheon, Korea
| | - Young Hoon Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Sejong General Hospital, Bucheon, Korea
| | - Yuchang Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Sejong General Hospital, Bucheon, Korea
| | - Sook Jung Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Sejong General Hospital, Bucheon, Korea
| | - Chong Hwa Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Sejong General Hospital, Bucheon, Korea
| |
Collapse
|
10
|
Affiliation(s)
- Rafik Elmehdawi
- Department of medicine, faculty of medicine, University of Garyounis, Benghazi, Libya
| | - Ebtehal Lashika
- Department of Obstetric and Gynecology, Al Marej Hospital, Libya
| |
Collapse
|
11
|
Kovar FM, Fang IF, Perkmann T, Haslacher H, Slavka G, Födinger M, Endler G, Wagner OF. Subclinical hypothyroidism and mortality in a large Austrian cohort: a possible impact on treatment? Wien Klin Wochenschr 2015; 127:924-30. [PMID: 26373750 DOI: 10.1007/s00508-015-0846-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2015] [Accepted: 07/29/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND Clinical implications of subclinical hypothyroidism (SCH) are still matter of intense debate, resulting in the controversial discussion whether subclinical hypothyroidism should be treated. We performed a cohort study to evaluate the impact of subclinical hypothyroidism on vascular and overall mortality. METHODS Between 02/1993 and 03/2004, a total of 103,135 persons attending the General Hospital Vienna with baseline serum thyrotropin (TSH, thyroid-stimulating hormone) and free thyroxin (fT4) measurements could be enrolled in a retrospective cohort study. Subclinical hypothyroidism was defined by elevated TSH ranging from 4.5 to 20.0 mIU/L and normal fT4 concentration (0.7-1.7 ng/dL). Overall and vascular mortality as primary endpoints were assessed via record linkage with the Austrian Death Registry. RESULTS A total of 80,490 subjects fulfilled inclusion criteria of whom 3934 participants (3.7%) were classified as SCH (868 males and 3066 females, median age 48 years). The mean follow-up among the 80,490 subjects was 4.1 years yielding an observation period of 373,301 person-years at risk. In a multivariate Cox regression model adjusted for age and gender TSH levels showed a dose-dependent association with all-cause mortality. The association between SCH and overall or vascular mortality was stronger in men below 60 years compared to older males or females. CONCLUSION Our data support the hypothesis that SCH might represent an independent risk factor for overall and vascular mortality, especially in men below 60 years. Whether this group would benefit from replacement therapy should be evaluated in interventional studies.
Collapse
Affiliation(s)
- Florian Maria Kovar
- Department for Trauma Surgery, Medical University of Vienna, Vienna, Austria
| | - I-Fei Fang
- Central Laboratory, Wilhelminenspital der Stadt Wien, Vienna, Austria
| | - Thomas Perkmann
- Department of Medical and Chemical Laboratory Diagnostics, Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Vienna, AKH-Wien Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Helmuth Haslacher
- Department of Medical and Chemical Laboratory Diagnostics, Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Vienna, AKH-Wien Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Georg Slavka
- Central Laboratory, Wilhelminenspital der Stadt Wien, Vienna, Austria
| | - Manuela Födinger
- Department of Medical and Chemical Laboratory Diagnostics, Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Vienna, AKH-Wien Waehringer Guertel 18-20, 1090, Vienna, Austria
- Central Laboratory, Kaiser Franz Josef-Spital der Stadt Wien, Vienna, Austria
| | - Georg Endler
- Department of Medical and Chemical Laboratory Diagnostics, Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Vienna, AKH-Wien Waehringer Guertel 18-20, 1090, Vienna, Austria
- Labors.at, Vienna, Austria
| | - Oswald F Wagner
- Department of Medical and Chemical Laboratory Diagnostics, Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Vienna, AKH-Wien Waehringer Guertel 18-20, 1090, Vienna, Austria.
| |
Collapse
|
12
|
Yetkin DO, Dogantekin B. The Lipid Parameters and Lipoprotein(a) Excess in Hashimoto Thyroiditis. Int J Endocrinol 2015; 2015:952729. [PMID: 26064115 PMCID: PMC4433708 DOI: 10.1155/2015/952729] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Revised: 04/16/2015] [Accepted: 04/19/2015] [Indexed: 02/07/2023] Open
Abstract
Objective. The risk of atherosclerotic heart disease is increased in autoimmune thyroiditis, although the reason is not clear. Lipoprotein(a) (Lp(a)) excess has been identified as a powerful predictor of premature atherosclerotic vascular diseases. The aim of this study is to investigate the relationship between Lp(a) levels and thyroid hormones in Hashimoto patients. Method. 154 premenopausal female Hashimoto patients (48 patients with overthypothyroid (OH), 50 patients with subclinical hypothyroid (SH), and 56 patients with euthyroid Hashimoto to (EH)) were enrolled in this study. The control group consists of 50 age matched volunteers. In every group, thyroid function tests and lipid parameters with Lp(a) were measured. Lp(a) excess was defined as Lp(a) > 30 mg/dL. Results. Total-C, LDL-C, TG, and Lp(a) levels were increased in Hashimoto group. Total-C, LDL-C, and TG levels were higher in SH group than in the control group. Total-C and LDL-C levels were also higher in EH group compared to controls. Lp(a) levels were similar in SH and EH groups with controls. However, excess Lp(a) was more common in subclinical hypothyroid and euthyroid Hashimoto group than in the control group. Conclusion. The Total-C and LDL-C levels and excess Lp(a) were higher even in euthyroid Hashimoto patients. Thyroid autoimmunity may have some effect on Lp(a) and lipid metabolism.
Collapse
Affiliation(s)
- D. O. Yetkin
- Department of Endocrinology, Kolan International Hospital, 36384 Istanbul, Turkey
- *D. O. Yetkin:
| | - B. Dogantekin
- Department of Internal Medicine, Goztepe Education and Research Hospital, 34722 Istanbul, Turkey
| |
Collapse
|
13
|
Shojaei Nik MH, Darabi M, Ziaee A, Hajmanoochehri F. Serum Phospholipase A2-IIA, hs-CRP, and Lipids in Women With Subclinical Hypothyroidism. Int J Endocrinol Metab 2014; 12:e16967. [PMID: 25237323 PMCID: PMC4166036 DOI: 10.5812/ijem.16967] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Revised: 05/09/2014] [Accepted: 05/10/2014] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Subclinical hypothyroidism (SCH) is a metabolic disorder characterized by elevated TSH level but normal T4 level. Some previous studies suggest that SCH is associated with inflammation. OBJECTIVES The present study aimed to compare lipid serum levels in SCH patients and normal participants, also explore possible association between SCH and the two inflammatory markers hs-CRP and PLA2-IIA. PATIENTS AND METHODS This study was performed on 77 women aged 20-45 (39 with SCH and 38 in the control group). TSH and T4 levels were measured by electrochemiluminescenceassay. Lipid profiles were analyzed using enzymatic-colorimetric methods. Hs-CRP and PLA2-IIA were determined using the ELISA method. IBM SPSS 19.0 was used for statistical analysis. RESULTS Serum levels of TG, cholesterol, and LDL were higher in the SCH group than the control group. However, there was no significant difference between the two groups for HDL level. Likewise, no difference was observed for the serum level of hs-CRP. PLA2-IIA mean value was higher in the SCH group. CONCLUSIONS SCH is associated with increased level of PLA2-IIA, which is independent of BMI. The stronger association of SCH with PLA2-IIA than with hs-CRP indicates that PLA2-IIA is an inducer of inflammation while hs-CRP is not.
Collapse
Affiliation(s)
- Mohammad Hossein Shojaei Nik
- Department of Biochemistry and Clinical Laboratories, International Branch (Aras), Tabriz University of Medical Sciences, Tabriz, IR Iran
| | - Masoud Darabi
- Liver and Gastrointestinal Disease Research Center, Faculty of Medicine, Tabriz University of Medical Science, Tabriz, IR Iran
| | - Amir Ziaee
- Metabolic Diseases Research Center, Qazvin University of Medical Sciences, Qazvin, IR Iran
| | - Fatemeh Hajmanoochehri
- Metabolic Diseases Research Center, Qazvin University of Medical Sciences, Qazvin, IR Iran
- Corresponding author: Fatemeh Hajmanoochehri, Department of Pathology, Qazvin University of Medical Sciences, Booali-Sina St. Booali-Sina Hospital, Qazvin Metabolic Diseases Research Center, Qazvin, IR Iran. Tel: +98-2813360084, Fax: +98-2813326033, E-mail:
| |
Collapse
|
14
|
The platelet activating factor acetyl hydrolase, oxidized low-density lipoprotein, paraoxonase 1 and arylesterase levels in treated and untreated patients with polycystic ovary syndrome. Arch Gynecol Obstet 2014; 290:929-35. [DOI: 10.1007/s00404-014-3275-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Accepted: 04/28/2014] [Indexed: 12/31/2022]
|
15
|
Myocardial perfusion and intima-media thickness in patients with subclinical hypothyroidism. Adv Med Sci 2014; 58:44-9. [PMID: 23640950 DOI: 10.2478/v10039-012-0068-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
PURPOSE The data concerning the relation between subclinical hypothyroidism (SH) and the risk of cardiovascular disease are divergent. We aimed to assess myocardial perfusion in contrast-enhanced echocardiography and intima-media thickness (IMT) in patients with SH. MATERIAL/METHODS Forty females with SH without symptoms of coronary artery disease and 15 healthy female volunteers were examined. Echocardiographic evaluation of the left ventricle function as well as carotid and femoral IMT complex measurements were performed at baseline. Thereafter, dobutamine stress echocardiography with myocardial perfusion assessment at rest and on the peak of stress test was performed. SonoVue® intravenous bolus as a contrast medium was used. The myocardial perfusion was assessed by quantitative method using Q-LAB Philips software (ROI modality). The perfusion index was calculated (a number of left ventricle segments with improved perfusion/a number of all segments). RESULTS A mean IMT value in the SH group was significantly higher than in the controls (0.7 mm vs. 0.38 mm, p=0.001). Myocardial perfusion at rest and at the peak of stress test was significantly lower in the SH patients as compared to the controls (at rest 120 Db in SH vs. 181 Db in controls, p=0.039 and at the peak of stress 115 Db and 188 Db, p=0.01, respectively). The perfusion index was not significantly worse in the SH group (p=0.6). IMT values negatively correlated with the myocardial perfusion index at the peak of stress (r=-0.54, p=0.014). CONCLUSIONS In patients with SH contrast-enhanced echocardiographic examination revealed myocardial hypoperfusion and increased IMT. Our results may suggest that the patients with SH are at risk of the development of cardiovascular disease.
Collapse
|
16
|
Rizos CV, Elisaf MS, Liberopoulos EN. Effects of thyroid dysfunction on lipid profile. Open Cardiovasc Med J 2011; 5:76-84. [PMID: 21660244 PMCID: PMC3109527 DOI: 10.2174/1874192401105010076] [Citation(s) in RCA: 165] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2010] [Revised: 01/05/2011] [Accepted: 01/06/2011] [Indexed: 12/31/2022] Open
Abstract
Thyroid dysfunction has a great impact on lipids as well as a number of other cardiovascular risk factors. Hypothyroidism is relatively common and is associated with an unfavorable effect on lipids. Substitution therapy is beneficial for patients with overt hypothyroidism, improving lipid profile. However, whether subclinical hypothyroidism should be treated or not is a matter of debate. On the other hand, hyperthyroidism can be associated with acquired hypocholesterolemia or unexplained improvement of lipid profile. Overall, thyroid dysfunction should be taken into account when evaluating and treating dyslipidemic patients.
Collapse
Affiliation(s)
- C V Rizos
- Department of Internal Medicine, School of Medicine, University of Ioannina, Ioannina, Greece
| | | | | |
Collapse
|
17
|
Lai Y, Wang J, Jiang F, Wang B, Chen Y, Li M, Liu H, Li C, Xue H, Li N, Yu J, Shi L, Bai X, Hou X, Zhu L, Lu L, Wang S, Xing Q, Teng X, Teng W, Shan Z. The relationship between serum thyrotropin and components of metabolic syndrome. Endocr J 2011; 58:23-30. [PMID: 21135510 DOI: 10.1507/endocrj.k10e-272] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
To explore the relationship between serum thyrotropin and components of metabolic syndrome in a Chinese cohort. A total of 1534 adult inhabitants in DaDong district of Shenyang were asked to fulfill the questionnaire, complete physical examination and OGTT. Blood samples were collected to test thyrotropin (TSH), fasting plasma glucose (FPG), OGTT 2h PG, fasting insulin (FINS), triglyceride (TG) and high density lipoprotein cholesterol (HDL-C). Serum TSH in metabolic syndrome group was higher than that in the non-metabolic syndrome group (2.54 mIU/L vs. 2.22 mIU/L, p<0.05). TG level increased significantly in subclinical hypothyroid group compared with euthyroid subjects (1.73±0.12 mmol/L vs. 1.47±0.03 mmol/L, p<0.05), and HDL-C decreased significantly in patients with subclinical hypothyroidism compared with euthyroid subjects (1.26±0.27 mmol/L vs. 1.33±0.27 mmol/L, p<0.05). The prevalence of hypertension was higher in the subclinical hypothyroid group than that in euthyroid group (42.86% vs. 33.2%, p<0.05). The serum TSH within the reference range was positively related with the prevalence of overweight/obesity. Slight increase in serum TSH maybe a risk factor for metabolic syndrome.
Collapse
Affiliation(s)
- Yaxin Lai
- Department of Endocrinology and Metabolism, The First Hospital of China Medical University, No. 155 Nanjing Bei Street, Heping, Shenyang, China
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
18
|
Torun AN, Kulaksizoglu S, Kulaksizoglu M, Pamuk BO, Isbilen E, Tutuncu NB. Serum total antioxidant status and lipid peroxidation marker malondialdehyde levels in overt and subclinical hypothyroidism. Clin Endocrinol (Oxf) 2009; 70:469-74. [PMID: 18727709 DOI: 10.1111/j.1365-2265.2008.03348.x] [Citation(s) in RCA: 136] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Mitochondria are the main production site of free oxygen radicals, which can cause organ dysfunction by oxidation of cellular macromolecules such as carbohydrates, lipids and proteins. Oxidative stress may result from either overproduction of these species or from failure of the antioxidant defence systems. Thyroid hormones have well-known effects on mitochondrial oxygen consumption, but data about how hypothyroidism affects oxidative stress are controversial, and little is known about oxidative stress in subclinical hypothyroidism. Total antioxidant status (TAS) gives information about all of the antioxidants in the organism, while malondialdehyde (MDA) is a lipid peroxidation marker used to assess lipid peroxidation due to increased oxidative stress. We aimed to determine how hypothyroidism and subclinical hypothyroidism affect serum MDA and TAS. SUBJECTS AND METHODS Serum TAS, MDA, C-reactive protein levels and lipid compositions were studied in 20 hypothyroid, 40 subclinical hypothyroid and 40 healthy subjects. RESULTS MDA was elevated in both hypothyroid and subclinical hypothyroid patients compared with controls, while TAS levels show no significant differences between groups. Low-density lipoprotein (LDL) cholesterol levels were significantly high in both hypothyroid and subclinical hypothyroid patients. Triglyceride levels were high only in hypothyroid patients when compared with the controls. MDA showed a correlation with LDL cholesterol, total cholesterol and triglyceride. CONCLUSIONS These results suggest an increased oxidative stress in both hypothyroid and subclinical hypothyroidism states, which can be explained by both the insufficient increase in the antioxidant status and the altered lipid metabolism in these cases.
Collapse
Affiliation(s)
- Ayse Nur Torun
- Department of Endocrinology, Baskent University Faculty of Medicine, Ankara, Turkey.
| | | | | | | | | | | |
Collapse
|
19
|
Serum platelet-activating factor acetylhydrolase activity: A novel potential inflammatory marker in type 1 diabetes. Prostaglandins Other Lipid Mediat 2008; 87:42-6. [DOI: 10.1016/j.prostaglandins.2008.07.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2008] [Revised: 07/04/2008] [Accepted: 07/21/2008] [Indexed: 11/20/2022]
|
20
|
Metabolic and cardiovascular risk in patients with a history of differentiated thyroid carcinoma: A case-controlled cohort study. Thyroid Res 2008; 1:2. [PMID: 19014658 PMCID: PMC2577042 DOI: 10.1186/1756-6614-1-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2008] [Accepted: 09/29/2008] [Indexed: 01/26/2023] Open
Abstract
Hyperthyroidism seems to increase metabolic and cardiovascular risk, while the effects of sub-clinical hyperthyroidism are controversial. We evaluated metabolic and cardiovascular parameters in differentiated thyroid carcinoma (DTC) patients with suppressed thyrotropin (TSH) due to levo-thyroxine (L-T4) therapy. We studied DTC patients and, as a control group, patients with a history of surgery for non-malignant thyroid pathology. Significantly higher insulin and lower HDL-cholesterol levels were recorded in DTC subjects. In both groups, insulin levels were significantly related with body mass index (BMI) but not with age or L-T4 dosage. In DTC patients, a significant negative correlation was seen between HDL-cholesterol and BMI or L-T4 dosage. In both groups, intima-media thickness (IMT) correlated positively with age, BMI, glucose levels and systolic blood pressure. In DTC patients, increased IMT was significantly correlated with glycated hemoglobin (HbA1c), cholesterol and triglycerides. In DTC patients, C-reactive protein correlated positively with insulin, insulin resistance, triglycerides and systolic blood pressure, and negatively with HDL-cholesterol. In both DTC and control subjects, fibrinogen correlated positively with age, BMI, increased IMT, HbA1c and systolic blood pressure. In DTC subjects, plasma fibrinogen concentrations correlated positively with insulin resistance, cholesterol and LDL-cholesterol, and negatively with TSH levels. Our data confirm that the favorable evolution of DTC can be impaired by a high incidence of abnormal metabolic and cardiovascular data that are, at least in part, related to L-T4 therapy. These findings underline the need for adequate L-T4 titration.
Collapse
|
21
|
Gardner AA, Reichert EC, Topham MK, Stafforini DM. Identification of a domain that mediates association of platelet-activating factor acetylhydrolase with high density lipoprotein. J Biol Chem 2008; 283:17099-106. [PMID: 18434304 DOI: 10.1074/jbc.m802394200] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
The plasma form of platelet-activating factor (PAF) acetylhydrolase (PAF-AH), also known as lipoprotein-associated phospholipase A(2) (Lp-PLA(2)) inactivates potent lipid messengers such as PAF and modified phospholipids generated in settings of oxidant stress. In humans, PAF-AH circulates in blood in fully active form and associates with high and low density lipoproteins (HDL and LDL). Several studies suggest that the location of PAF-AH affects both the catalytic efficiency and the function of the enzyme in vivo. The distribution of PAF-AH among lipoproteins varies widely among mammals. Here, we report that mouse and human PAF-AHs associate with human HDL particles of different density. We made use of this observation in the development of a binding assay to identify domains required for association of human PAF-AH with human HDL. Sequence comparisons among species combined with domain-swapping and site-directed mutagenesis studies led us to the identification of C-terminal residues necessary for the association of human PAF-AH with human HDL. Interestingly, the region identified is not conserved among PAF-AHs, suggesting that PAF-AH interacts with HDL particles in a manner that is unique to each species. These findings contribute to our understanding of the mechanisms responsible for association of human PAF-AH with HDL and may facilitate future studies aimed at precisely determining the function of PAF-AH in each lipoprotein particle.
Collapse
Affiliation(s)
- Alison A Gardner
- Huntsman Cancer Institute and Department of Internal Medicine, University of Utah, Salt Lake City, Utah 84112, USA
| | | | | | | |
Collapse
|
22
|
Teixeira PDFDS, Reuters VS, Ferreira MM, Almeida CP, Reis FAA, Buescu A, Costa AJL, Vaisman M. Lipid profile in different degrees of hypothyroidism and effects of levothyroxine replacement in mild thyroid failure. Transl Res 2008; 151:224-31. [PMID: 18355770 DOI: 10.1016/j.trsl.2007.12.006] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2007] [Revised: 11/16/2007] [Accepted: 12/15/2007] [Indexed: 12/18/2022]
Abstract
The aim of this study was to evaluate the lipid profile of patients with different degrees of hypothyroidism and the effect of levothyroxine replacement in subclinical hypothyroidism (SH). Initially, a cross-sectional study was performed with 226 participants [SH = 133 participants, manifest hypothyroidism (MH) = 23 participants, and euthyroidism (EU) = 70 participants]. The mean levels of atherogenic lipid variables were greater in MH than in SH and were greater in SH than in EU, although the differences between SH and EU did not reach statistical significance. The SH subgroup with greater serum thyrotropin (TSH) levels and that with positive antithyroperoxidase antibodies (TPO-Ab) had greater levels of triglycerides and of the atherogenic index Apo B/Apo A. A positive correlation exists between serum TSH and total cholesterol (rs = 0.167; P = 0.006), triglycerides (rs = 0.219; P < 0.001), and ApoB levels (rs = 0.205; P < 0.001). Eleven patients who received levothyroxine (L-T4) treatment and 15 patients who received placebo were reevaluated 1 year after TSH adjusted intervention. A fall in atherogenic variables was observed in the L-T4-treated group, with significance for total cholesterol (-20.0 vs +16.1 mg/dL in the placebo group) and LDL-c (-21.7 vs +17.2 mg/dL). We concluded that SH leads to an intermediary lipid profile between euthyroid individuals and that found in manifest hypothyroidism and that a significant lipid profile improvement occurred 1 year after L-T4 replacement therapy.
Collapse
|
23
|
Abstract
Subclinical thyroid disease (SCTD) is defined as serum free T(4) and free T(3) levels within their respective reference ranges in the presence of abnormal serum TSH levels. SCTD is being diagnosed more frequently in clinical practice in young and middle-aged people as well as in the elderly. However, the clinical significance of subclinical thyroid dysfunction is much debated. Subclinical hyper- and hypothyroidism can have repercussions on the cardiovascular system and bone, as well as on other organs and systems. However, the treatment and management of SCTD and population screening are controversial despite the potential risk of progression to overt disease, and there is no consensus on the thyroid hormone and thyrotropin cutoff values at which treatment should be contemplated. Opinions differ regarding tissue effects, symptoms, signs, and cardiovascular risk. Here, we critically review the data on the prevalence and progression of SCTD, its tissue effects, and its prognostic implications. We also examine the mechanisms underlying tissue alterations in SCTD and the effects of replacement therapy on progression and tissue parameters. Lastly, we address the issue of the need to treat slight thyroid hormone deficiency or excess in relation to the patient's age.
Collapse
Affiliation(s)
- Bernadette Biondi
- Department of Clinical and Molecular Endocrinology and Oncology, University of Naples Federico II, Via S. Pansini 5, 80131 Naples, Italy.
| | | |
Collapse
|
24
|
Duggal J, Singh S, Barsano CP, Arora R. Cardiovascular risk with subclinical hyperthyroidism and hypothyroidism: pathophysiology and management. ACTA ACUST UNITED AC 2007; 2:198-206. [PMID: 17786084 DOI: 10.1111/j.1559-4564.2007.06583.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Previous studies have suggested that subclinical thyroid dysfunction, as manifested by abnormalities in thyroid-stimulating hormone (TSH) levels, are associated with detrimental effects on the cardiovascular system. Subclinical hypothyroidism is characterized by abnormal lipid metabolism, cardiac dysfunction, diastolic hypertension conferring an elevated risk of atherosclerosis, and ischemic heart disease. Similarly, patients with subclinical hyperthyroidism have nearly 3 times the likelihood of atrial fibrillation over a 10-year follow-up interval, raising the question of whether patients with subclinical hyperthyroidism should be treated to prevent atrial fibrillation. A single measurement of low serum TSH in individuals aged 60 years or older has been reported to be associated with increased mortality from all causes and in particular from circulatory and cardiovascular disease in a 10-year follow-up study. Subclinical thyroid dysfunction is currently the subject of numerous studies and remains controversial, particularly as it relates to cardiovascular morbidity and mortality and clinical applications.
Collapse
Affiliation(s)
- Jasleen Duggal
- Department of Medicine, Chicago Medical School, Rosalind Franklin University of Medicine and Science; North Chicago, IL 60064, USA
| | | | | | | |
Collapse
|
25
|
Abstract
Hypothyroidism is one of the most common disorders encountered in an endocrine office practice. This article reviews the epidemiology, etiology, clinical presentation, diagnosis, and treatment of hypothyroidism. We emphasize some of the more recent issues, such as combination thyroid hormone therapy, management of hypothyroidism during pregnancy, and the management of subclinical hypothyroidism.
Collapse
Affiliation(s)
- Madhuri Devdhar
- Washington Hospital Center, 110 Irving Street, NW, Room 2A-72, Washington, DC 20010-2975, USA
| | | | | |
Collapse
|
26
|
Elmehdawi RR, Lashika EI. Prolonged pregnancy: A possible complication of hypothyroidism due to myometriopathy. Med Hypotheses 2007; 70:209-10. [PMID: 17597305 DOI: 10.1016/j.mehy.2007.04.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2007] [Accepted: 04/16/2007] [Indexed: 10/23/2022]
|
27
|
Papi G, Uberti ED, Betterle C, Carani C, Pearce EN, Braverman LE, Roti E. Subclinical hypothyroidism. Curr Opin Endocrinol Diabetes Obes 2007; 14:197-208. [PMID: 17940439 DOI: 10.1097/med.0b013e32803577e7] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Mild or subclinical hypothyroidism is characterized by normal serum free thyroxine concentrations with elevated serum thyroid-stimulating hormone concentrations. Subclinical hypothyroidism is relatively prevalent in the general population, especially among women and the elderly. The main cause of subclinical hypothyroidism is autoimmune chronic thyroiditis. The present report reviews the most important and recent studies on subclinical hypothyroidism, and discusses the most controversial aspects of this topic. RECENT FINDINGS Several studies have demonstrated that subclinical hypothyroidism may affect both diastolic and systolic cardiac function. It may also worsen many risk factors for cardiovascular disease, including hypertension, abnormal endothelial function, and elevated low-density lipoprotein cholesterol concentrations. Furthermore, a growing body of evidence suggests that subclinical hypothyroidism may cause symptoms or progress to symptomatic overt hypothyroidism. SUMMARY Prompt treatment of subclinical hypothyroidism in pregnant women is mandatory to decrease risks for pregnancy complications and impaired cognitive development in offspring. Children with subclinical hypothyroidism should be treated to prevent growth retardation. Whether nonpregnant adult patients with subclinical hypothyroidism should be treated, and at what thyroid-stimulating hormone values, is debatable.
Collapse
|
28
|
Singh S, Duggal J, Molnar J, Maldonado F, Barsano CP, Arora R. Impact of subclinical thyroid disorders on coronary heart disease, cardiovascular and all-cause mortality: a meta-analysis. Int J Cardiol 2007; 125:41-8. [PMID: 17434631 DOI: 10.1016/j.ijcard.2007.02.027] [Citation(s) in RCA: 150] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2006] [Revised: 01/08/2007] [Accepted: 02/17/2007] [Indexed: 11/20/2022]
Abstract
BACKGROUND Previous studies have suggested that sub-clinical thyroid states may have detrimental effects on the coronary heart disease (CHD). Whether subclinical thyroid dysfunction is a risk factor for the above is controversial. METHODS A systemic search of the literature using Pubmed, Medline and Ovid online tool was performed to identify relevant studies. Amongst the clinical studies, crossectional study and studies with follow-up period ranging between 4 and 20 yr were identified (Walsh JP, Bremner AP, Bulsara MK, et al. Subclinical thyroid dysfunction as a risk factor for cardiovascular disease. Arch Intern Med 2005 Nov 28;165 (21):2467-72.; Rodondi N, Newman AB, Vittinghoff E, et al. Subclinical hypothyroidism and the risk of heart failure, other cardiovascular events, and death. Arch Intern Med 2005 Nov 28; 165 (21):2460-6.; Rotterdam study, Imaizumi M, Akahoshi M, Ichimaru S, et al. Risk for coronary heart disease and all-cause mortality in subclinical hypothyroidism. J Clin Endocrinol Metab 2004 Jul; 89 (7):3365-70.; Capolla et al.; Parle JV, Maisonneuve P, Sheppard MC, Boyle P, Franklyn JA. Prediction of all-cause and cardiovascular mortality in elderly people from one low serum thyrotropin result: a 10-year cohort study. Lancet 2001 Sep 15; 358 (9285):861-5). RESULTS Sub-clinical hypothyroidism: The pooled estimate of the relative risk of CHD revealed significant difference both at baseline [RR with 95% CI: 1.533 (1.312-1.791), P<0.05] and at follow-up [RR with 95% CI: 1.188 (1.024-1.379), P<0.05]. The relative risk of all-cause mortality at follow-up revealed no significant difference. However, the relative risk of death from cardiovascular causes at follow-up was significantly higher [RR with 95% CI: 1.278 (1.023-1.597), P<0.05]. Sub-clinical hyperthyroidism: The pooled estimate of the relative risk of CHD revealed no significant difference both at baseline [RR with 95% CI: 1.156 (0.709-1.883)] and at follow-up [RR with 95% CI: 1.207 (0.780-1.870)].The relative risk of death from cardiovascular causes at follow-up was also not significantly higher. CONCLUSION The present meta-analysis indicates that sub-clinical hypothyroidism is associated with both, a significant risk of CHD at baseline and at follow-up. In addition, mortality from cardiovascular causes is significantly higher at follow-up. Sub-clinical hyperthyroidism is not associated with CHD or mortality from cardiovascular causes.
Collapse
Affiliation(s)
- Sarabjeet Singh
- Department of Medicine, Chicago Medical School, Chicago, IL-60064, USA
| | | | | | | | | | | |
Collapse
|
29
|
Kebapcilar L, Akinci B, Bayraktar F, Comlekci A, Solak A, Demir T, Yener S, Küme T, Yesil S. Plasma thiobarbituric acid-reactive substance levels in subclinical hypothyroidism. Med Princ Pract 2007; 16:432-6. [PMID: 17917442 DOI: 10.1159/000107747] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2006] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The purpose of this study was to determine thiobarbituric acid-reactive substance (TBARS) levels in subclinical hypothyroidism and to examine the effect of levothyroxine replacement on TBARS levels. SUBJECTS AND METHODS A cohort of 28 female patients with subclinical hypothyroidism and 24 healthy controls were enrolled in this study. The levels of plasma TBARS, serum lipids, and high-sensitive C-reactive protein (CRP) in patients with subclinical hypothyroidism at baseline and after achieving euthyroid state by levothyroxine were assessed. RESULTS TBARS levels of the patients were similar to those of the control group in the subclinical hypothyroid state and after restoration of euthyroidism by levothyroxine replacement. TBARS levels decreased after levothyroxine treatment, but did not reach statistical significance. There was no significant correlation between TBARS, lipid and CRP levels. Serum CRP levels were higher in subclinical hypothyroidism (4.28 +/- 0.9 mg/l) than in the control group (1.95 +/- 0.34 mg/l) and the difference was statistically significant (p = 0.03). After achieving euthyroid state, CRP levels decreased significantly in patients with subclinical hypothyroidism from 4.28 +/- 0.9 to 2.32 +/- 0.6 mg/l (p = 0.006). CONCLUSION Our findings suggest that there is no significant alteration of plasma TBARS levels neither in subclinical hypothyroid state nor after achieving euthyroid state. Serum CRP level is higher in patients with subclinical hypothyroidism than in the control group. Normalization of thyroid state seems to effectively reduce serum CRP levels in subclinical hypothyroidism without any correlation with TBARS activity.
Collapse
Affiliation(s)
- Levent Kebapcilar
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Dokuz Eylul University Medical School, Izmir, Turkey
| | | | | | | | | | | | | | | | | |
Collapse
|
30
|
Karasawa K. Clinical aspects of plasma platelet-activating factor-acetylhydrolase. Biochim Biophys Acta Mol Cell Biol Lipids 2006; 1761:1359-72. [PMID: 17049457 DOI: 10.1016/j.bbalip.2006.06.017] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2006] [Accepted: 06/15/2006] [Indexed: 11/25/2022]
Abstract
Plasma platelet-activating factor (PAF)-acetylhydrolase (PAF-AH), which is characterized by tight association with plasma lipoproteins, degrades not only PAF but also phospholipids with oxidatively modified short fatty acyl chain esterified at the sn-2 position. Production and accumulation of these phospholipids are associated with the onset of inflammatory diseases and preventive role of this enzyme has been evidenced by many recent studies including prevalence of the genetic deficiency of the enzyme in the patients and therapeutic effects of treatment with recombinant protein or gene transfer. With respect to the atherosclerosis, however, it is not fully cleared whether this enzyme plays an anti-atherogenic role or pro-atherogenic role because plasma PAF-AH also might produce lysophosphatidylcholine (LysoPC) and oxidatively modified nonesterified fatty acids with potent pro-inflammatory and pro-atherogenic bioactivities. These dual roles of plasma PAF-AH might be regulated by the altered distribution of the enzyme between low density lipoprotein (LDL) and high density lipoprotein (HDL) particles because HDL-associated enzymes are considered to contribute to the protection of LDL from oxidative modification. This review focuses on the recent findings which address the role of this enzyme in the human diseases especially including asthma, septic shock and atherosclerosis.
Collapse
Affiliation(s)
- Ken Karasawa
- Laboratory of Molecular Pharmaceutics, Faculty of Pharmaceutical Sciences, Teikyo University, Sagamihara, Kanagawa 199-0195, Japan.
| |
Collapse
|
31
|
Abstract
UNLABELLED Thyroid disease in general, and hypothyroidism in particular, are very common in women. In the USA, the most common cause of primary thyroid deficiency is on an autoimmune basis due to lymphocytic (Hashimoto) thyroiditis. Because there are thyroid hormone receptors in virtually every tissue of the body, the manifestations of hypothyroidism are varied, but problems with abnormal menses, conception, fertility, and pregnancy can be especially troubling in young women. The single most important diagnostic test is measurement of serum thyrotropin (TSH). The overwhelming majority of patients with hypothyroidism are treated with a single daily dose of synthetic levothyroxine with the goal of therapy being restoration of a normal metabolic state with return of the TSH level down to the range of 0.5 to 1.5 mlU/L. "Subclinical" hypothyroidism refers to those patients with early or mild thyroid hypofunction manifested as slight elevations of thyrotropin (approximately 4-10 mlU/L) although serum thyroxine (T4) and triiodothyronine (T3) levels are within their reference ranges. The entity is somewhat controversial in regard to its consequences if left untreated, and whether or not we should be screening patients, at least susceptible populations, for the condition. Reports indicate an association between subclinical hypothyroidism and poor outcomes of pregnancy, as well as dyslipidemias, atherogenesis, and increased mortality in the long term. We believe these consequences are sufficiently compelling to warrant screening and treatment with levothyroxine when found to halt progression to overt hypothyroidism, and improve symptoms, pregnancy outcomes, lipid abnormalities, and cardiovascular function. TARGET AUDIENCE Obstetricians & Gynecologists, Family Physicians. LEARNING OBJECTIVES After completion of this article, the reader should be able to recall that hypothyroidism is a common disease in women, has many protean manifestations, and can be successfully diagnosed and treated; explain that the condition of subclinical hypothyroidism can be diagnosed and if treated can prevent many untoward complications; and state that there should be heightened awareness of the disease so that proper screening tests can be performed.
Collapse
|