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Sun M, Yu L, Zhao X, Ren L, Liu X, Gang X, Wang G. Correlation between thyroid hormone sensitivity and diabetic peripheral neuropathy in euthyroid patients with type 2 diabetes mellitus. Sci Rep 2024; 14:19603. [PMID: 39179647 PMCID: PMC11343854 DOI: 10.1038/s41598-024-70673-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Accepted: 08/20/2024] [Indexed: 08/26/2024] Open
Abstract
Previous studies have revealed that thyroid hormone (TH) levels are associated with the risk of diabetic peripheral neuropathy (DPN) in euthyroid patients with type 2 diabetes mellitus (T2DM). However, the relationship between TH sensitivity, a complementary method for assessing thyroid function, and DPN remains unclear. This study aimed to investigate the correlation between DPN and TH sensitivity in euthyroid patients with T2DM. Exactly 708 euthyroid adults with T2DM were retrospectively enrolled. The FT3/FT4 ratio was used to estimate peripheral TH sensitivity. Central TH sensitivity was assessed using the Thyrotroph T4 Resistance Index (TT4RI), Thyroid-Stimulating Hormone Index (TSHI), Thyroid Feedback Quantile-based Index (TFQI), and Parametric TFQI (PTFQI). DPN was assessed using neurologic symptoms, signs, and nerve conduction velocity tests. The relationship between DPN and TH sensitivity was examined using logistic regression analysis. We observed that an elevated FT3/FT4 ratio was associated with DPN (OR = 1.36, 95%CI: 1.13-1.63, p = 0.0012). For each standard deviation (SD) increase in the TT4RI, TSHI, TFQI, and PTFQI, the OR of DPN was 0.80 (95%CI: 0.68-0.94, p = 0.0078), 0.72 (95%CI: 0.60-0.86, p = 0.0002), 0.69 (95%CI: 0.58-0.83, p < 0.0001), and 0.69 (95%CI: 0.58-0.82, p < 0.0001), respectively. These results suggested that reduced central and peripheral TH sensitivity is associated with a decreased risk of developing DPN.
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Affiliation(s)
- Meixin Sun
- Department of Endocrinology and Metabolism, The First Hospital of Jilin University, 71 Xinmin Street, Chaoyang District, Changchun, 130021, China
| | - Lu Yu
- Department of Endocrinology and Metabolism, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430000, China
| | - Xue Zhao
- Department of Endocrinology and Metabolism, The First Hospital of Jilin University, 71 Xinmin Street, Chaoyang District, Changchun, 130021, China
| | - Linan Ren
- Department of Endocrinology and Metabolism, The First Hospital of Jilin University, 71 Xinmin Street, Chaoyang District, Changchun, 130021, China
| | - Xinming Liu
- Department of Endocrinology and Metabolism, The First Hospital of Jilin University, 71 Xinmin Street, Chaoyang District, Changchun, 130021, China
| | - Xiaokun Gang
- Department of Endocrinology and Metabolism, The First Hospital of Jilin University, 71 Xinmin Street, Chaoyang District, Changchun, 130021, China.
| | - Guixia Wang
- Department of Endocrinology and Metabolism, The First Hospital of Jilin University, 71 Xinmin Street, Chaoyang District, Changchun, 130021, China.
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Janovsky CCPS, Meneghini V, Tebar W, Martins JRM, Sgarbi JA, Teixeira PDFDS, Jones SR, Blaha MJ, Toth PP, Lotufo PA, Bittencourt MS, Santos RD, Santos IS, Chaker L, Bensenor IM. Branched-Chain Amino Acids, Alanine, and Thyroid Function: A Cross-Sectional, Nuclear Magnetic Resonance (NMR)-Based Approach from ELSA-Brasil. Metabolites 2024; 14:437. [PMID: 39195533 DOI: 10.3390/metabo14080437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Revised: 07/26/2024] [Accepted: 08/01/2024] [Indexed: 08/29/2024] Open
Abstract
The association of thyroid function with essential and non-essential amino acids is understudied, despite their common metabolic roles. Thus, our aim was to evaluate the association of thyroid function with the levels of branched-chain amino acids (BCAAs-leucine, isoleucine, and valine) and of alanine in the general population. We utilized data from the São Paulo research center of ELSA-Brasil, a longitudinal population-based cohort study. Thyroid parameters included thyroid stimulating hormone (TSH), free T4 and free T3 levels, and the FT4:FT3 ratio. BCAAs and alanine were analyzed on a fully automated NMR platform. The current analysis included euthyroid participants and participants with subclinical hyperthyroidism and hypothyroidism. We used Pearson's coefficient to quantify the correlation between thyroid-related parameters and amino acids. Linear regression models were performed to analyze whether thyroid parameters were associated with BCAAs and alanine levels. We included 4098 participants (51.3 ± 9.0 years old, 51.5% women) in this study. In the most adjusted model, higher levels of TSH were associated with higher levels of alanine, FT4 levels were inversely associated with isoleucine levels, FT3 levels were statistically significant and positively associated with valine and leucine, and the T3:T4 ratio was positively associated with all amino acids. We observed that subclinical hypothyroidism was positively associated with isoleucine and alanine levels in all models, even after full adjustment. Our findings highlight the association of subclinical hypothyroidism and thyroid-related parameters (including TSH, free T4, free T3, and FT4:FT3 ratio) with BCAAs and alanine. Further studies are needed to explore the mechanisms underlying this association. These insights contribute to our understanding of the influence of thyroid-related parameters on BCAA and alanine metabolism.
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Grants
- grants of baseline: 01 06 0010.00 RS, 01 06 0212.00 BA, 01 06 0300.00 ES, 01 06 0278.00 MG, 01 06 0115.00 SP, 01 06 0071.00 RJ; and grants of 4-year follow-up 01 10 0643-03 RS, 01 10 0742-00 BA, 01 12 0284-00 ES, 01 10 0746-00 MG, 01 10 0773-00 SP, and 01 National Council for Scientific and Technological Development
- 2015/17213- 2 Fundação de Amparo à Pesquisa do Estado de São Paulo
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Affiliation(s)
- Carolina Castro Porto Silva Janovsky
- Center for Clinical and Epidemiological Research, University Hospital, University of São Paulo, São Paulo 05508-000, Brazil
- Division of Endocrinology, Federal University of São Paulo/Escola Paulista de Medicina, São Paulo 04039-032, Brazil
| | - Vandrize Meneghini
- Center for Clinical and Epidemiological Research, University Hospital, University of São Paulo, São Paulo 05508-000, Brazil
| | - William Tebar
- Center for Clinical and Epidemiological Research, University Hospital, University of São Paulo, São Paulo 05508-000, Brazil
| | - Joao Roberto Maciel Martins
- Division of Endocrinology, Federal University of São Paulo/Escola Paulista de Medicina, São Paulo 04039-032, Brazil
| | - José Augusto Sgarbi
- Division of Endocrinology, Faculty of Medicine of Marília (FAMEMA), Marília 17519-030, Brazil
| | | | - Steven R Jones
- Johns Hopkins, Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD 21287, USA
| | - Michael J Blaha
- Johns Hopkins, Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD 21287, USA
| | - Peter P Toth
- CGH Medical Center, Department of Preventive Cardiology, Sterling, IL 61081, USA
| | - Paulo A Lotufo
- Center for Clinical and Epidemiological Research, University Hospital, University of São Paulo, São Paulo 05508-000, Brazil
| | - Marcio S Bittencourt
- Department of Medicine and Department of Radiology, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Raul D Santos
- Heart Institute (InCor), University of São Paulo, São Paulo 05403-900, Brazil
- Hospital Israelita Albert Einstein, São Paulo 05652-900, Brazil
| | - Itamar S Santos
- Center for Clinical and Epidemiological Research, University Hospital, University of São Paulo, São Paulo 05508-000, Brazil
| | - Layal Chaker
- Department of Internal Medicine and Rotterdam Thyroid Center, Erasmus University Medical Center, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus University Medical Center, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Isabela M Bensenor
- Center for Clinical and Epidemiological Research, University Hospital, University of São Paulo, São Paulo 05508-000, Brazil
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Bloomer RJ, Pence J, Hellenbrand J, Davis A, Davis S, Stockton M, Martin KR. Randomized Trial to Assess the Safety and Tolerability of Daily Intake of an Allulose Amino Acid-Based Hydration Beverage in Men and Women. Nutrients 2024; 16:1766. [PMID: 38892699 PMCID: PMC11174401 DOI: 10.3390/nu16111766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 05/28/2024] [Accepted: 05/29/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND Maintaining adequate hydration is critical to optimal health, well-being, and performance. Those who are physically active in stressful environments, such as warm and/or humid scenarios, may be at particular risk for dehydration with ensuing loss of electrolytes, leading to sluggishness and impaired physical performance. METHODS We evaluated an electrolyte and amino acid product containing L-alanine and L-glutamine, as well as select vitamins [B3 (niacin), B5 (pantothenic acid), B6 (pyridoxine), B12 (cobalamin), and vitamin C (ascorbic acid)]. Subjects (n = 40; four groups, n = 10) were randomized to consume either a placebo packet or one, two, or three packets daily of the test product for 4 weeks with site visits at 0, 2, and 4 weeks. We tested safety and tolerability by analyzing hematological parameters (complete blood counts), metabolic parameters (hepatic, renal, acid-base balance), urinalysis end products, thyroid status [T3 (triiodothyronine), T4 (thyroxine), TSH (thyroid-stimulating hormone)], tolerability (via questionnaire), vital signs, and dietary intake. RESULTS Statistical analyses displayed ten significant main effects (p < 0.05) with white blood cells, lymphocytes, neutrophils, urinary pH, thyroxine, urination frequency, calcium, calories, fat, and cholesterol. Interactions for time and group (p < 0.05) were observed for MCV, eGFR, potassium, overall tolerability, bloating, and cramping-demonstrating mild GA disturbances. Little to no change of physiological relevance was noted for any outcome variable, regardless of dosing level. CONCLUSIONS Our results indicate the product was well-tolerated at all dosing levels and no significant adverse changes occurred in any of the test parameters compared to the placebo group, indicating relative safety of ingestion over a 4-week treatment period, at the volumes used, and outside the context of physical stress.
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Affiliation(s)
- Richard J. Bloomer
- Center for Nutraceutical and Dietary Supplement Research, College of Health Sciences, University of Memphis, Memphis, TN 38152, USA; (J.P.); (J.H.); (A.D.); (S.D.); (M.S.); (K.R.M.)
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Birck MG, Janovsky CCPS, Goulart AC, Meneghini V, Pititto BDA, Sgarbi JA, Teixeira PDFDS, Bensenor IM. Associations of TSH, free T3, free T4, and conversion ratio with incident hypertension: results from the prospective Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2024; 68:e230301. [PMID: 38739525 PMCID: PMC11156177 DOI: 10.20945/2359-4292-2023-0301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 02/08/2024] [Indexed: 05/16/2024]
Abstract
Objective To evaluate the association of TSH, free T3 (FT3), free T4 (FT4), and conversion (FT3:FT4) ratio values with incident hypertension. Materials and methods The study included data from participants of the ELSA-Brasil study without baseline hypertension. Serum TSH, FT4 and FT3 levels, and FT3:FT4 ratio values were assessed at baseline, and incident hypertension (defined by blood pressure levels ≥ 140/90 mmHg) was estimated over a median of 8.2 years of follow-up. The risk of incident hypertension was evaluated considering a 1-unit increase in TSH, FT4, FT3, and conversion ratio values and after dividing these variables into quintiles for further analysis using Poisson regression with robust variance. The results are presented as relative risks (RR) and 95% confidence intervals (CIs) before and after adjustment for multiple variables. Results The primary analysis incorporated data from 5,915 euthyroid individuals, and the secondary analysis combined data from all euthyroid individuals, 587 individuals with subclinical hypothyroidism, and 31 individuals with subclinical hyperthyroidism. The rate of incident hypertension was 28% (95% CI: 27%-29.3%). The FT4 levels in the first quintile (0.18-1.06 ng/dL) were significantly associated with incident hypertension (RR: 1.03, 95% CI: 1.01-1.06) at follow-up. The association between FT4 levels in the first quintile and incident hypertension was also observed in the analysis of combined data from euthyroid individuals and participants with subclinical thyroid dysfunction (RR: 1.04, 95% CI: 1.01-1.07). The associations were predominantly observed with systolic blood pressure levels in euthyroid individuals. However, in the combined analysis incorporating euthyroid participants and individuals with subclinical thyroid dysfunction, the associations were more pronounced with diastolic blood pressure levels. Conclusion Low FT4 levels may be a mild risk factor for incident hypertension in euthyroid individuals and persons with subclinical thyroid dysfunction.
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Affiliation(s)
- Marina Gabriela Birck
- Centro de Pesquisas Clínicas e Epidemiológicas, Hospital Universitário, Universidade de São Paulo, São Paulo, SP, Brasil
- MGP and CCPSJ share first authorship
| | - Carolina C. P. S. Janovsky
- Centro de Pesquisas Clínicas e Epidemiológicas, Hospital Universitário, Universidade de São Paulo, São Paulo, SP, Brasil
- Serviço de Endocrinologia, Departamento de Medicina, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
- MGP and CCPSJ share first authorship
| | - Alessandra Carvalho Goulart
- Centro de Pesquisas Clínicas e Epidemiológicas, Hospital Universitário, Universidade de São Paulo, São Paulo, SP, Brasil
- Departamento de Epidemiologia, Faculdade de Saúde Pública, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Vandrize Meneghini
- Centro de Pesquisas Clínicas e Epidemiológicas, Hospital Universitário, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Bianca de Almeida Pititto
- Departamento de Medicina Preventiva, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - José Augusto Sgarbi
- Unidade de Endocrinologia, Faculdade de Medicina de Marília, Marília, SP, Brasil
| | | | - Isabela M Bensenor
- Centro de Pesquisas Clínicas e Epidemiológicas, Hospital Universitário, Universidade de São Paulo, São Paulo, SP, Brasil,
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Persky V, Abasilim C, Tsintsifas K, Day T, Sargis RM, Daviglus M, Cai J, Freels S, Kaplan R, Isasi CR, Pirzada A, Meyer ML, Talavera GA, Thyagarajan B, Agarwal S, Chavez N, Grieco A, Turyk ME. Thyroid Hormones and Diabetes in Euthyroid Hispanic/Latino Adults of Diverse Backgrounds: HCHS/SOL. J Endocr Soc 2024; 8:bvae039. [PMID: 38623380 PMCID: PMC11017329 DOI: 10.1210/jendso/bvae039] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Indexed: 04/17/2024] Open
Abstract
Context Previous studies have demonstrated associations of endogenous thyroid hormones with diabetes; less is known about stages of diabetes development at which they are operative, mechanisms of associations, and the role of the hypothalamic-pituitary-thyroid axis. Objective This study examined associations of thyroid hormones with incident prediabetes and diabetes and with changes in glycemic traits in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL), the largest cohort of Hispanic/Latino adults with diverse backgrounds in the United States. Methods The study includes 592 postmenopausal euthyroid women and 868 euthyroid men aged 45 to 74 years without diabetes at baseline participating in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). Baseline hormones included thyrotropin (TSH), free thyroxine (FT4), total triiodothyronine (T3), and indices calculated from thyroid hormones evaluating pituitary sensitivity to thyroid hormone. Transitions to diabetes and prediabetes, and changes in glycemic traits determined at the 6-year follow-up visit, were examined using multivariable Poisson and linear regressions. Results Among women, T3 (incident rate ratio [IRR] = 1.65; 95% CI, 1.22-2.24; P = .001) and TSH (IRR = 2.09; 95% CI, 1.01-4.33; P = .047) were positively, while FT4 (IRR = 0.59; 95% CI, 0.39-0.88; P = .011) was inversely, associated with transition from prediabetes to diabetes. Among men, the T3/FT4 ratio was positively associated with transition from normoglycemia to prediabetes but not from prediabetes to diabetes. Indices measuring sensitivity of the pituitary to thyroid hormone suggested increased sensitivity in men who transitioned from prediabetes to diabetes. Conclusion Positive associations in women of T3 and TSH and inverse associations of FT4, as well as inverse associations of thyroid indices in men with transition from prediabetes to diabetes, but not from normoglycemia to diabetes, suggest decreased pituitary sensitivity to thyroid hormones in women and increased sensitivity in men later in the development of diabetes.
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Affiliation(s)
- Victoria Persky
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois Chicago, Chicago, IL 60612, USA
| | - Chibuzor Abasilim
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois Chicago, Chicago, IL 60612, USA
| | - Konstantina Tsintsifas
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois Chicago, Chicago, IL 60612, USA
| | - Tessa Day
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois Chicago, Chicago, IL 60612, USA
| | - Robert M Sargis
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of Illinois Chicago and Medical Service, Jesse Brown VA Medical Center, Chicago, IL 60612, USA
| | - Martha Daviglus
- Institute for Minority Health Research, University of Illinois Chicago, Chicago, IL 60612, USA
| | - Jianwen Cai
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Sally Freels
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois Chicago, Chicago, IL 60612, USA
| | - Robert Kaplan
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY 10461, USA
- Public Health Sciences Division, Fred Hutchinson Cancer Center, Seattle, WA 98109, USA
| | - Carmen R Isasi
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Amber Pirzada
- Institute for Minority Health Research, University of Illinois Chicago, Chicago, IL 60612, USA
| | - Michelle L Meyer
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Gregory A Talavera
- Department of Psychology, San Diego State University, San Diego, CA 92182, USA
| | - Bharat Thyagarajan
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN 55415, USA
| | - Shivani Agarwal
- Fleischer Institute for Diabetes and Metabolism, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY 10461, USA
| | - Noel Chavez
- Division of Community Health Sciences, University of Illinois Chicago, Chicago, IL 60612, USA
| | - Arielle Grieco
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois Chicago, Chicago, IL 60612, USA
| | - Mary E Turyk
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois Chicago, Chicago, IL 60612, USA
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Shi C, Liu X, Du Z, Tian L. Impaired Sensitivity to Thyroid Hormones is Associated with the Risk of Diabetic Nephropathy in Euthyroid Patients with Type 1 Diabetes Mellitus. Diabetes Metab Syndr Obes 2024; 17:611-618. [PMID: 38347912 PMCID: PMC10860863 DOI: 10.2147/dmso.s449870] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 01/19/2024] [Indexed: 02/15/2024] Open
Abstract
Purpose This study aims to investigate the relationship between thyroid and type 1 diabetic nephropathy (T1DN) in euthyroid populations, focusing on thyroid hormone sensitivity. Methods A cross-sectional study was conducted between January 2016 and December 2021, including 357 euthyroid patients with type 1 diabetes mellitus (T1DM). Parameters representing thyroid hormone sensitivity were assessed, including the thyroid feedback quantile-based index (TFQI), parameter thyroid feedback quantile index (PTFQI), thyroid stimulating hormone index (TSHI), thyrotropin thyroxine resistance index (TT4RI), and free triiodothyronine/free thyroxine (FT3/FT4). Logistic regression and restricted cubic spline regression were performed to detect the association between thyroid hormone sensitivity and the risk of T1DN. Results The study found a negative correlation between the risk of T1DN and FT3/FT4 in euthyroid T1DM patients (OR 0.71, 95% CI 0.51-0.97, P <0.01). PTFQI (P<0.05), TSHI (P<0.05), and TT4RI (P<0.01) showed an M-shaped nonlinear relationship with the risk of T1DN. Elevated risk of T1DN was associated with PTFQI, TSHI, and TT4RI values outside the range of zero, 2.3-3.88, and 27.56-32.19, respectively. Conclusion This study confirms the relationship between impaired thyroid hormone sensitivity and the risk of T1DN in euthyroid patients. It emphasizes the importance of evaluating thyroid hormone sensitivity in T1DM patients, even when their thyroid function appears normal, to promptly prevent the occurrence of T1DN.
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Affiliation(s)
- Chunxia Shi
- School of Medicine, Jiangsu University, Zhenjiang, People’s Republic of China
- Department of Endocrinology, Gansu Provincial Hospital, Lanzhou, People’s Republic of China
- Clinical Research Center for Metabolic Diseases, Lanzhou, Gansu Province, People’s Republic of China
| | - Xiaoning Liu
- Institution of Health Statistics and Epidemiology, School of Public Health, Lanzhou University, Lanzhou, People’s Republic of China
| | - Zouxi Du
- Department of Endocrinology, Gansu Provincial Hospital, Lanzhou, People’s Republic of China
- Clinical Research Center for Metabolic Diseases, Lanzhou, Gansu Province, People’s Republic of China
- The First School of Clinical Medicine, Lanzhou University, Lanzhou, People’s Republic of China
| | - Limin Tian
- Department of Endocrinology, Gansu Provincial Hospital, Lanzhou, People’s Republic of China
- Clinical Research Center for Metabolic Diseases, Lanzhou, Gansu Province, People’s Republic of China
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Deng L, Zheng X, Shuai P, Yu X. Thyroid-Related Hormones Changes Predict Changes in Anthropometric Measures and Incidence of Obesity in Chinese Euthyroid Persons. Horm Metab Res 2023; 55:684-691. [PMID: 37557908 DOI: 10.1055/a-2151-1538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/11/2023]
Abstract
The purpose of this study was to investigate the correlation of thyroid-related hormones changes within the reference range with the changes in anthropometric measures and incidence of obesity. The study included 4850 subjects with normal thyroid-related hormones at baseline and at follow-up. We evaluated the relationship of changes in thyroid-related biomarkers with anthropometric measures changes and incidence of obesity. In euthyroid persons, changes in serum thyroid stimulating hormone (TSH), free triiodothyronine (FT3), and free thyroxine (FT4) concentrations and FT3/FT4 ratio were independent predictors of changes in body mass index (BMI) and waist circumference (WC) in men, changes in serum FT3 and FT4 concentrations and FT3/FT4 ratio were independent predictors of changes in BMI and WC in women. Every single unit increment in ΔFT3/FT4 was accompanied by a 7.144 and 7.572 times risk of having obesity in men and women, respectively. Every single unit decrement in ΔFT4 was accompanied by a 21.0% and 26.9% lower risk of having obesity in men and women, respectively. In conclusion, in euthyroid individuals, changes in thyroid-related hormones were associated with anthropometric measures changes and incidence of obesity.
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Affiliation(s)
- Ling Deng
- Laboratory of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, China
- Department of Health Management & Institute of Health Management, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Xiaoxia Zheng
- Department of Health Management & Institute of Health Management, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Ping Shuai
- Department of Health Management & Institute of Health Management, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Xijie Yu
- Laboratory of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, China
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Zhao X, Sun J, Xu X, Xin S, Zhang X. The effect of Central and peripheral thyroid resistance indices on diabetic retinopathy: a study of hospitalized euthyroid patients with T2DM in China. Ann Med 2023; 55:2249017. [PMID: 37634057 PMCID: PMC10494739 DOI: 10.1080/07853890.2023.2249017] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 08/13/2023] [Accepted: 08/14/2023] [Indexed: 08/28/2023] Open
Abstract
OBJECTIVE This study aims to explore the correlation between central and peripheral thyroid resistance indices and diabetic retinopathy(DR) in patients with type 2 diabetes mellitus (T2DM), so as to provide a clinical basis for the prevention and treatment of diabetic retinopathy. METHODS This study retrospectively analyzed 1249 euthyroid patients with T2DM hospitalized in the Department of Endocrinology, Peking University International Hospital from January 2017 to June 2022, including 852 males and 397 females, with an average age of 54.73 ± 13.40 years. According to the degree of DR, the patients were divided into three groups including the no diabetic retinopathy (NDR) group, non-proliferative diabetic retinopathy (NPDR) group and proliferative diabetic retinopathy (PDR) group. RESULTS Free thymidine (FT4), thyroid stimulating hormone (TSH), thyroid feedback quantile index (TFQI), thyrotropin-T4 resistance index (TT4RI), thyroid stimulating hormone index (TSHI) and free triiodothyronine/free thyroxine (FT3/FT4) levels among the three groups were significantly different, with the NDR group having lowest TSH, TFQI, TT4QI, TSHI and the highest in the PDR group (all p < 0.05). Logistic regression showed that after adjusting for age, body mass index (BMI), sex, diabetes duration, blood pressure, blood lipid, HbA1c, lower level of FT4 was an independent risk factor for DR, high level of TSH, TFQI, TSHI and TT4RI were independent risk factors for DR. Central and peripheral thyroid sensitivity indices have predictive value for DR, the overall predictive accuracy of FT3/FT4 was 0.61 (95%CI 0.57, 0.65), the overall predictive accuracy of TFQI was 0.66(95%CI 0.63, 0.70), the overall predictive accuracy of TSHI was 0.66(95%CI 0.62, 0.68), the overall predictive accuracy of TT4RI was 0.63 (95%CI 0.59, 0.66). CONCLUSION The reduction of central and peripheral thyroid hormone sensitivity is an independent risk factor for DR. These results can help predict the risk of the occurrence and development of DR, which may provide a clinical basis for the prevention and treatment of DR in T2DM patients.
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Affiliation(s)
- Xin Zhao
- Department of Endocrinology, Peking University International Hospital, Beijing, P.R. China
| | - Jianbin Sun
- Department of Endocrinology, Peking University International Hospital, Beijing, P.R. China
| | - Xiumei Xu
- Department of Endocrinology, Peking University International Hospital, Beijing, P.R. China
| | - Sixu Xin
- Department of Endocrinology, Peking University International Hospital, Beijing, P.R. China
| | - Xiaomei Zhang
- Department of Endocrinology, Peking University International Hospital, Beijing, P.R. China
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Iwakura H, Takagi T, Inaba H, Doi A, Ueda Y, Uraki S, Takeshima K, Furukawa Y, Ishibashi T, Morita S, Matsuno S, Nishi M, Furuta H, Matsuoka TA, Akamizu T. Thyroid function, glycemic control, and diabetic nephropathy in patients with type 2 diabetes over 24 months: prospective observational study. BMC Endocr Disord 2023; 23:146. [PMID: 37430240 PMCID: PMC10332001 DOI: 10.1186/s12902-023-01393-4] [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] [Received: 06/05/2022] [Accepted: 06/28/2023] [Indexed: 07/12/2023] Open
Abstract
BACKGROUND The higher prevalence of thyroid dysfunction in type 1 diabetes patients has been well established, whereas it is a matter of debate whether that is also observed in type 2 diabetes patients. This study was conducted to reveal whether higher prevalence of thyroid dysfunction is observed in patients with type 2 diabetes. METHODS We examined thyroid functions and thyroid autoantibodies in 200 patients with type 2 diabetes and 225 controls, with 24 months follow up for those with type 2 diabetes. RESULTS Serum free triiodothyronine (fT3) levels and fT3/free thyroxine (fT4) ratio were significantly lower, while fT4 levels were significantly higher in patients with type 2 diabetes. The number of patients with thyroid dysfunction or patients positive for thyroid autoantibodies were not different between the two groups. The fT3/fT4 ratio was positively and negatively correlated with serum c-peptide and HbA1c levels, respectively, suggesting that the difference can be attributable to insulin resistance and diabetic control. In the follow-up observation, we found no significant correlation between basal thyrotropin (TSH), fT3, fT4 or fT3/fT4 ratio with the amounts of changes of HbA1c levels at 12 or 24 months after the basal measurements. There was a negative relationship between TSH levels and eGFR at baseline measurements, but TSH levels did not seem to predict future decline of eGFR levels. No relationship was observed between urine albumin/ g‧cre levels and thyroid function. CONCLUSION Thyroid dysfunction and thyroid autoantibodies were not different in prevalence between patients with type 2 diabetes and controls, although in patients with type 2 diabetes, the fT3/fT4 ratio was decreased. Basal thyroid function did not predict future diabetes control or renal function within 24 months of follow-up.
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Affiliation(s)
- Hiroshi Iwakura
- The First Department of Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8509, Japan.
| | - Tomoyuki Takagi
- Wakayama City Medical Association Seijinbyo Center, 2-1-2 Tebira, Wakayama, Wakayama, 640-8319, Japan
| | - Hidefumi Inaba
- The First Department of Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8509, Japan
| | - Asako Doi
- The First Department of Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8509, Japan
| | - Yoko Ueda
- The First Department of Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8509, Japan
| | - Shinsuke Uraki
- The First Department of Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8509, Japan
| | - Ken Takeshima
- The First Department of Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8509, Japan
| | - Yasushi Furukawa
- The First Department of Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8509, Japan
| | - Tatsuya Ishibashi
- The First Department of Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8509, Japan
| | - Shuhei Morita
- The First Department of Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8509, Japan
| | - Shohei Matsuno
- The First Department of Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8509, Japan
| | - Masahiro Nishi
- The First Department of Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8509, Japan
| | - Hiroto Furuta
- The First Department of Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8509, Japan
| | - Taka-Aki Matsuoka
- The First Department of Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8509, Japan
| | - Takashi Akamizu
- The First Department of Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8509, Japan
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Wang Q, Li Y, Ren H, Huang Q, Wang X, Zhou Y, Wu Q, Liu Y, Li M, Wang Y, Liu T, Zhang X. Metabolic characteristics, prevalence of anxiety and its influencing factors in first-episode and drug-naïve major depressive disorder patients with impaired fasting glucose. J Affect Disord 2023; 324:341-348. [PMID: 36586596 DOI: 10.1016/j.jad.2022.12.096] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 11/19/2022] [Accepted: 12/23/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND Both major depressive disorder (MDD) and impaired fasting glucose (IFG) are associated with metabolic abnormalities and anxiety, but few studies have investigated the relationship between abnormal metabolism and anxiety in first-episode and drug-naïve (FEDN) MDD patients with IFG. This study investigated the psychological status, metabolic properties, the prevalence and influencing factors of anxiety symptoms in the FEDN MDD patients with IFG. METHODS A total of 1718 FEDN MDD outpatients were recruited. Sociodemographic and suicide data were collected for each participant. The Positive and Negative Syndrome Scale (PANSS), Hamilton Depression Rating Scale (HAMD), and Hamilton Anxiety Rating Scale (HAMA) were used to assess patients' clinical symptoms. Fasting blood glucose, lipids, body mass index (BMI), and thyroid function-related indicators were also measured. RESULTS FEDN MDD patients with IFG (IFG group) had higher psychotic symptoms, suicide attempts, HAMD score, and HAMA score than FEDN MDD patients without IFG (NIFG group). There were also significant differences in blood lipids, BMI, and thyroid function indicators between the two groups. The prevalence of anxiety symptoms in the IFG group was 20.9 %, which was significantly higher than that in the NIFG group (10.4 %). Furthermore, anxiety symptoms were significantly associated with female, marital status, psychotic symptoms, suicide attempts, and low high-density lipoprotein (HDL-C). CONCLUSION FEDN MDD patients with anxiety who have IFG are more likely to have problems with thyroid function, lipid metabolism, psychotic symptoms and suicide attempts, especially in female patients. Prevention of these problems should be enhanced when treating such patients.
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Affiliation(s)
- Qianjin Wang
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China.
| | - Yifan Li
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China.
| | - Honghong Ren
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China; Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China.
| | - Qiuping Huang
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China.
| | - Xuyi Wang
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China.
| | - Yanan Zhou
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China.
| | - Qiuxia Wu
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China.
| | - Yueheng Liu
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China.
| | - Manyun Li
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China.
| | - Yunfei Wang
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China.
| | - Tieqiao Liu
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China.
| | - Xiangyang Zhang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China.
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11
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Exploring associations of anthropometric parameters and serum triglycerides with serum thyroid hormones in young women. Sci Rep 2022; 12:17374. [PMID: 36253522 PMCID: PMC9576678 DOI: 10.1038/s41598-022-22371-1] [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] [Received: 11/22/2021] [Accepted: 10/13/2022] [Indexed: 01/10/2023] Open
Abstract
Establishing links between serum thyroid hormone panel and triglyceride (TG) concentrations with non-invasively obtained measurements of anthropometric parameters of young women may provide preliminary knowledge about the homeostasis of metabolic processes and body composition and about the strategic role of the tested parameters as early screening tests for assessing the health status of apparently healthy women in the period preceding pregnancy. The study was conducted in 381 healthy female students (aged 18-26 years, mean ± SD = 22.1 ± 1.3). Anthropometric indices (BMI, waist-to-hip ratio, FAT%) were calculated and serum concentrations of thyroid hormones (TSH, fT3, fT4) were determined using electrochemiluminescence immunoassays and serum triglycerides (TG) with a commercially available test. No association was established between serum TSH and anthropometric indices in healthy young women. Increased serum concentrations of fT4, fT3 and TG were found in overweight subjects, i.e. BMI > 24.9 kg/m2 (p < 0.05). A significant negative association between fT3 and TG was found in underweight subjects (r = - 0.258, p = 0.049) and a significantly positive association in normal-weight subjects (r = 0.139, p = 0.019). In healthy young women differences in BMI are not related to thyroid function. The opposite directions between the associations fT3 vs TG in underweight compared to normal-weight young prepregnant females may suggest dependencies of fT3 and TG in the regulation of specific BMI-dependent metabolic processes.
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12
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Galofré JC, Attanasio R, Hegedüs L, Nagy E, Negro R, Papini E, Perros P, Díez JJ. Use of thyroid hormone in hypothyroid patients and euthyroid subjects in Spain: A THESIS* questionnaire survey. ENDOCRINOL DIAB NUTR 2022; 69:520-529. [PMID: 36084989 DOI: 10.1016/j.endien.2022.07.001] [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: 05/18/2021] [Accepted: 07/08/2021] [Indexed: 06/15/2023]
Abstract
BACKGROUND Hypothyroidism is one of the leading conditions in endocrinology. Despite that fact, clinical indications for treatment still vary among Spanish specialists. AIMS To identify attitudes of Spanish specialists relating to the use of levothyroxine (LT4) and the management of hypothyroidism. METHODS The members of the Sociedad Española de Endocrinología y Nutrición (Spanish Society of Endocrinology and Nutrition) were invited to participate in a web-based survey. The survey, initially in English, was modified to reflect in accordance with the availability of thyroid hormone formulations in Spain. RESULTS A total of 505 of 1956 (25.8%) members (66% female) completed the survey; 97.4% declared that LT4 is the first-line therapy for hypothyroidism. The indications for LT4 therapy in euthyroidism were infertility in thyroid antibody-positive women (48.5%) and simple goitre (21.2%). However, 44.2% of specialists reported that there was no indication for LT4 therapy in such patients. Only a minority of respondents (2.6%) considered combining LT4 with liothyronine as the treatment of choice from inception, whereas 49% stated that it should never be used. CONCLUSIONS The standard of treatment of hypothyroidism in Spain is almost exclusively with LT4 tablets. Availability of other formulations of LT4 or combination therapy for hypothyroidism management remains to be explored, especially in patients with persistent symptoms. Notably, non-evidence-based use of LT4 is widely practiced in Spain for euthyroid women with autoimmune thyroiditis and fertility issues.
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Affiliation(s)
- Juan C Galofré
- Department of Endocrinology, Clínica Universidad de Navarra, Pamplona, Spain; Instituto de Investigación Sanitaria de Navarra (IdiSNA), Spain; Thyroid Task Force from the Sociedad Española de Endocrinología y Nutrición (SEEN), Madrid, Spain.
| | | | - Laszlo Hegedüs
- Department of Endocrinology and Metabolism, Odense University Hospital, Odense, Denmark
| | - Endre Nagy
- Division of Endocrinology, Department of Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Roberto Negro
- Division of Endocrinology, V. Fazzi Hospital, Lecce, Italy
| | - Enrico Papini
- Department of Endocrinology and Metabolism, Regina Apostolorum Hospital, Rome, Italy
| | - Petros Perros
- Department of Endocrinology, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
| | - Juan J Díez
- Thyroid Task Force from the Sociedad Española de Endocrinología y Nutrición (SEEN), Madrid, Spain; Department of Endocrinology, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain; Instituto de Investigación Sanitaria Puerta de Hierro Segovia de Arana, Majadahonda, Madrid, Spain; Department of Medicine, Universidad Autónoma de Madrid, Spain
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13
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Wang Y, Lu S, Xu X, Zhang L, Yang J, Hu W. The interactive effects of pre-pregnancy body mass index, thyroid function, and blood lipid levels on the risk of gestational diabetes mellitus: a crossover analysis. BMC Pregnancy Childbirth 2022; 22:580. [PMID: 35858832 PMCID: PMC9301852 DOI: 10.1186/s12884-022-04908-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 07/12/2022] [Indexed: 11/13/2022] Open
Abstract
Background Studies have demonstrated the associations between pre-pregnancy obesity, thyroid dysfunction, dyslipidemia, and increased risk of gestational diabetes mellitus (GDM) in pregnant women. This study was designed to investigate whether and to what extent, the interactions between these factors contribute to the risk of GDM. Methods A case–control study of 232 GDM cases and 696 controls was conducted among pregnant women from Hangzhou, China. Multiple logistic regression analysis was applied to identify independent risk factors of GDM. Crossover analysis was performed to assess the interactive effects of pre-pregnancy body mass index (pBMI), thyroid hormones, and blood lipid profiles on the risk of GDM. The indexes including attributable proportion (AP) to the interaction and the relative excess risk due to interaction (RERI) were calculated. Results Chinese pregnant women with pBMI > 23 kg/m2 (adjusted: OR = 4.162, p < 0.001), high triglyceride levels (> 2.30 mmol/L) (adjusted: OR = 1.735, p < 0.001), and the free triiodothyronine/free thyroxine (FT3/FT4) ratio ≥ 0.502 (OR = 4.162, p < 0.001) have significantly increased risk of GDM. Crossover analysis indicated that there were significant interactions between pre-pregnancy overweight/obesity and FT3/FT4 ≥ 0.502 (AP = 0.550, p < 0.001; RERI = 7.586, p = 0.009), high TG levels and FT3/FT4 ≥ 0.502 (AP = 0.348, 95%CI = 0.081–0.614, P = 0.010; RERI = 2.021, 95%CI = 0.064–3.978, p = 0.043) on the risk of GDM. Conclusion The interactions between pBMI and FT3/FT4 ratio, TG level and FT3/FT4 ratio may have significant impacts on the risk of GDM in pregnant women. Such findings may help improve our understanding of the pathogenesis of GDM as well as develop comprehensive strategies for the management of GDM.
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Affiliation(s)
- Ying Wang
- Department of Nutrition and Toxicology, Hangzhou Normal University School of Public Health, Hangzhou, China.,Department of Obstetrics, The Affiliated Hangzhou Women's Hospital, Hangzhou Normal University, Hangzhou, China
| | - Sha Lu
- Department of Obstetrics, The Affiliated Hangzhou Women's Hospital, Hangzhou Normal University, Hangzhou, China
| | - Xianrong Xu
- Department of Nutrition and Toxicology, Hangzhou Normal University School of Public Health, Hangzhou, China
| | - Lijun Zhang
- Department of Nutrition and Toxicology, Hangzhou Normal University School of Public Health, Hangzhou, China
| | - Jun Yang
- Department of Nutrition and Toxicology, Hangzhou Normal University School of Public Health, Hangzhou, China. .,Zhejiang Provincial Research Center for the Diagnosis and Treatment of Uterine Cancer, The Affiliated Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China.
| | - Wensheng Hu
- Department of Obstetrics, The Affiliated Hangzhou Women's Hospital, Hangzhou Normal University, Hangzhou, China.
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14
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Fang LN, Zhong S, Ma D, Hao YM, Gao Y, Zhang L, Shen LW, Sun HP, Lu K, Li C. Association between thyroid hormones and skeletal muscle and bone in euthyroid type 2 diabetes patients. Ther Adv Chronic Dis 2022; 13:20406223221107848. [PMID: 35813190 PMCID: PMC9260573 DOI: 10.1177/20406223221107848] [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] [Received: 02/11/2022] [Accepted: 06/01/2022] [Indexed: 11/25/2022] Open
Abstract
Background: The impact of thyroid hormones within their normal ranges on skeletal muscle
and bone in patients with type 2 diabetes mellitus (T2DM) remains unknown.
The purpose of this study was to investigate the relationships of thyroid
hormones with muscle and bone in euthyroid patients with T2DM. Methods: This cross-sectional study included 344 euthyroid T2DM patients. Muscle mass
and bone mineral density were measured by dual-energy X-ray absorptiometry.
The levels of thyroid-stimulating hormone (TSH), free triiodothyronine
(FT3), and free thyroxin (FT4) were measured by electrochemiluminescence
immunoassay. Results: The results revealed that FT3 was positively correlated with body mass index
(BMI) in male patients after age correction. In men, FT4 was negatively
correlated with body weight, BMI, total muscle mass, appendicular skeletal
muscle mass (ASM), and ASM index (ASMI), while FT3/FT4 was positively
correlated with body weight, BMI, total muscle mass, ASM, and ASMI after age
correction. In women, FT4 was negatively correlated with ASM and ASMI, while
FT3/FT4 was positively correlated with ASM and ASMI after age correction.
FT3/FT4 was significantly lower in men with low muscle mass than in those
with normal muscle mass. The age-adjusted odds for incident low muscle mass
comparing the lowest and highest FT3/FT4 increased in men. Conclusions: FT3/FT4 was positively correlated with ASM and ASMI in both men and women.
Therefore, FT3/FT4 may be a parameter indicative of low muscle mass in
euthyroid men with T2DM.
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Affiliation(s)
- Ling-Na Fang
- Department of Endocrinology and Metabolism, Kunshan Hospital Affiliated with Jiangsu University, Kunshan, China
| | - Shao Zhong
- Department of Endocrinology and Metabolism, Kunshan Hospital Affiliated with Jiangsu University, Kunshan, China
| | - Dan Ma
- Department of Endocrinology and Metabolism, Kunshan Hospital Affiliated with Jiangsu University, Kunshan, China
| | - Yan-Min Hao
- Department of Orthopaedics, Kunshan Hospital Affiliated with Jiangsu University, Kunshan, China
| | - Yan Gao
- Department of Orthopaedics, Kunshan Hospital Affiliated with Jiangsu University, Kunshan, China
| | - Li Zhang
- Department of Endocrinology and Metabolism, Kunshan Hospital Affiliated with Jiangsu University, Kunshan, China
| | - Li-Wen Shen
- Department of Endocrinology and Metabolism, Kunshan Hospital Affiliated with Jiangsu University, Kunshan, China
| | - He-Ping Sun
- Department of Endocrinology and Metabolism, Kunshan Hospital Affiliated with Jiangsu University, Kunshan, China
| | - Ke Lu
- Department of Orthopaedics, Kunshan Hospital Affiliated with Jiangsu University, Kunshan, China
| | - Chong Li
- Department of Orthopaedics, Kunshan Hospital Affiliated with Jiangsu University, Qianjin road 91#, Kunshan, Jiangsu, 215300, China(mainland)
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15
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Jiskra J, Paleček J, Attanasio R, Hegedüs L, Nagy EV, Papini E, Perros P, Negro R, Kršek M. Use of thyroid hormones in hypothyroid and euthyroid patients: a 2020 THESIS questionnaire survey of members of the Czech Society of Endocrinology. BMC Endocr Disord 2022; 22:117. [PMID: 35501788 PMCID: PMC9063132 DOI: 10.1186/s12902-022-01027-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 04/12/2022] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Inconsistencies in the management of hypothyroidism have been reported among endocrinologists in different European countries. Aim of this study was to explore Czech endocrinologists' use of thyroid hormones in hypothyroid and euthyroid patients. METHODS We used a web-based survey containing 32 questions regarding the use of thyroid hormones. Four-hundred thirty-two members of the Czech Society of Endocrinology received an e-mail invitation to participate in the survey. RESULTS We received and analysed 157 responses (112 females and 45 males) from the 432 members (36.3%). According to 99.4% of the respondents, levothyroxine (LT4) is the primary drug of choice for the treatment of hypothyroidism. Liothyronine (LT3) was used in clinical practice by 29.9% of responders. According to 90.5% of respondents, thyroid hormones may be indicated in biochemically euthyroid patients. Female physicians prescribe thyroid hormones in euthyroid infertile women with high antibody levels more frequently than male physicians (P = 0.003). Most Czech endocrinologists (76.4%) consider combined therapy with LT4 and LT3 in various clinical scenarios, but only 1 of 29 hypothyroid physicians (3.5%) would recommend it to their patients, and only 4 out of 128 respondents (3.1%) would consider LT3 or desiccated thyroid for themselves, if diagnosed with hypothyroidism. CONCLUSION LT4 is the primary thyroid hormone used in the Czech Republic for treatment of hypothyroidism. At variance with thyroid guideline recommendations, Czech endocrinologists are quite liberal when prescribing thyroid hormones to euthyroid patients and in the use of LT4/LT3 combination treatment for hypothyroid patients with persisting symptoms.
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Affiliation(s)
- Jan Jiskra
- 3rd Department of Medicine, 1st Faculty of Medicine, Charles University, General University Hospital, Prague, Czech Republic.
| | - Jan Paleček
- 3rd Department of Medicine, 1st Faculty of Medicine, Charles University, General University Hospital, Prague, Czech Republic
| | - Roberto Attanasio
- Scientific Committee of Associazione Medici Endocrinologi, Milan, Italy
| | - Laszlo Hegedüs
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
| | - Endre V Nagy
- Division of Endocrinology, Department of Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Enrico Papini
- Department of Endocrinology and Metabolism, Regina Apostolorum Hospital, Rome, Italy
| | - Petros Perros
- Department of Endocrinology, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Roberto Negro
- Division of Endocrinology, "V. Fazzi" Hospital, Lecce, Italy
| | - Michal Kršek
- 3rd Department of Medicine, 1st Faculty of Medicine, Charles University, General University Hospital, Prague, Czech Republic
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16
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Wang C, Han S, Li Y, Tong F, Li Z, Sun Z. Value of FT3/FT4 Ratio in Prognosis of Patients With Heart Failure: A Propensity-Matched Study. Front Cardiovasc Med 2022; 9:859608. [PMID: 35498022 PMCID: PMC9039517 DOI: 10.3389/fcvm.2022.859608] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 03/21/2022] [Indexed: 12/13/2022] Open
Abstract
Aims Abnormal thyroid hormone secretions can alter the manifestation and prognosis of cardiovascular disease. To assess the effect of the free triiodothyronine (FT3)/free thyroxine (FT4) ratio on the prognosis of patients with heart failure (HF), we performed a propensity-matched study on patients with well-balanced baseline characteristics. Methods Overall, 8,887 patients with HF were divided into two groups according to the FT3/FT4 ratio. Propensity scores were calculated from each patient. A cohort comprising 2,164 pairs with high or low ratios and with 34 well-balanced baseline characteristics was then assembled. The endpoints were Cardiovascular (CV) mortality and all-cause mortality. The correlation between FT3/FT4 ratio and prognosis was assessed using matched Cox regression analyses. The mean follow-up was 3.3 years. Results In the full pre-match cohort, 3,710 (41.7%) patients died, with 2,581 (29.0%) cases of CV mortality. In the matched-pair cohort, all-cause mortality occurred in 923 (1,238/10,000 person-years of follow-up) patients with a high ratio and 1,036 (1,484/10,000 person-years) patients with a low ratio, resulting in a matched HR of 0.841 (95% CI: 0.769-0.919; P < 0.001). For CV mortality, the result was 638 (856/10,000 person-years) and 714 (1,023/10,000 person-years) patients, respectively, resulting in a matched HR of 0.844 (95% CI: 0.759-0.940; P < 0.001). Subgroup analysis revealed that a low FT3/FT4 ratio had a greater predictive value for all-cause and CV mortality in elderly or male patients and in patients with coronary artery disease (CAD), hypertension, diabetes mellitus, HFmrEF, or HFpEF. Conclusions A low FT3/FT4 ratio is valuable for predicting CV mortality and all-cause mortality in patients with HF.
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Affiliation(s)
- Chuanhe Wang
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Su Han
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Ying Li
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Fei Tong
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Zhichao Li
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Zhijun Sun
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang, China
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17
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Mirjanić-Azarić B, Milinković N, Bogavac-Stanojević N, Avram S, Stojaković-Jelisavac T, Stojanović D. Indirect estimation of reference intervals for thyroid parameters using advia centaur XP analyzer. J Med Biochem 2022; 41:238-245. [PMID: 35510197 PMCID: PMC9010039 DOI: 10.5937/jomb0-33543] [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] [Received: 08/19/2021] [Accepted: 08/27/2021] [Indexed: 11/21/2022] Open
Abstract
Background The aim of this study was to determine the reference intervals (RIs) for thyroid stimulating hormone (TSH), free thyroxine (FT4), free triiodothyronine (FT3) and FT3/FT4 ratio using indirect methods. Methods We analyzed 1256 results TSH, FT4 and FT3 collected from a laboratory information system between 2017 and 2021. All measurements were performed on a Siemens ADVIA Centaur XP analyzer using the chemiluminescent immunoassay. We calculated the values of the 2.5th and 97.5th percentiles as recommended by the IFCC (CLSI C28-A3). Results The RIs derived for TSH, FT4, FT3 and FT3/FT4 ratio were 0.34-4.10 mIU/L, 11.3-20.6 pmol/L, 3.5-6.32 pmol/L and 0.21-0.47, respectively. We found a significant difference between calculated RIs for the TSH and FT4 and those recommended by the manufacturer. Also, FT3 values were significantly higher in the group younger than 30 years relative to the fourth decade (5.26 vs. 5.02, p=0.005), the fifth decade (5.26 vs. 4.94, p=0.001), the sixth decade (5.26 vs. 4.87, p<0.001), the seventh decade (5.26 vs. 4.79, p<0.001) and the group older than 70 years old (5.26 vs. 4.55, p<0.001). Likewise, we found for TSH values and FT3/FT4 ratio a significant difference (p <0.001) between different age groups. Conclusions The establishing RIs for the population of the Republic of Srpska were significantly differed from the recommended RIs by the manufacturer for TSH and FT4. Our results encourage other laboratories to develop their own RIs for thyroid parameters by applying CLSI recommendations.
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Affiliation(s)
- Bosa Mirjanić-Azarić
- University of Banja Luka, Faculty of Medicine, Banja Luka, Bosnia and Herzegovina
| | - Neda Milinković
- University of Belgrade, Faculty of Pharmacy, Department of Medical Biochemistry, Belgrade
| | | | - Sanja Avram
- University Clinical Centre of the Republic of Srpska, Institute of Laboratory Diagnostic, Banja Luka, Bosnia and Herzegovina
| | - Tanja Stojaković-Jelisavac
- University Clinical Centre of the Republic of Srpska, Institute of Laboratory Diagnostic, Banja Luka, Bosnia and Herzegovina
| | - Darja Stojanović
- University Clinical Centre of the Republic of Srpska, Institute of Laboratory Diagnostic, Banja Luka, Bosnia and Herzegovina
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Lee KW, Shin Y, Lee S, Lee S. Inherited Disorders of Thyroid Hormone Metabolism Defect Caused by the Dysregulation of Selenoprotein Expression. Front Endocrinol (Lausanne) 2022; 12:803024. [PMID: 35126314 PMCID: PMC8807339 DOI: 10.3389/fendo.2021.803024] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 12/20/2021] [Indexed: 11/25/2022] Open
Abstract
Consistent activation and functioning of thyroid hormones are essential to the human body as a whole, especially in controlling the metabolic rate of all organs and systems. Impaired sensitivity to thyroid hormones describes any process that interferes with the effectiveness of thyroid hormones. The genetic origin of inherited thyroid hormone defects and the investigation of genetic defects upon the processing of thyroid hormones are of utmost importance. Impaired sensitivity to thyroid hormone can be categorized into three conditions: thyroid hormone cell membrane transport defect (THCMTD), thyroid hormone metabolism defect (THMD), and thyroid hormone action defect (THAD). THMD is caused by defects in the synthesis and processing of deiodinases that convert the prohormone thyroxine (T4) to the active hormone triiodothyronine (T3). Deiodinase, a selenoprotein, requires unique translation machinery that is collectively composed of the selenocysteine (Sec) insertion sequence (SECIS) elements, Sec-insertion sequence-binding protein 2 (SECISBP2), Sec-specific eukaryotic elongation factor (EEFSEC), and Sec-specific tRNA (TRU-TCA1-1), which leads to the recognition of the UGA codon as a Sec codon for translation into the growing polypeptide. In addition, THMD could be expanded to the defects of enzymes that are involved in thyroid hormone conjugation, such as glucuronidation and sulphation. Paucity of inherited disorders in this category leaves them beyond the scope of this review. This review attempts to specifically explore the genomic causes and effects that result in a significant deficiency of T3 hormones due to inadequate function of deiodinases. Moreover, along with SECISBP2, TRU-TCA1-1, and deiodinase type-1 (DIO1) mutations, this review describes the variants in DIO2 single nucleotide polymorphism (SNP) and thyroid stimulating hormone receptor (TSHR) that result in the reduced activity of DIO2 and subsequent abnormal conversion of T3 from T4. Finally, this review provides additional insight into the general functionality of selenium supplementation and T3/T4 combination treatment in patients with hypothyroidism, suggesting the steps that need to be taken in the future.
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Affiliation(s)
- Kyu Won Lee
- Department of Food Science and Engineering, Ewha Womans University, Seoul, South Korea
| | - Yoochan Shin
- Laboratory of Genomics and Translational Medicine, Department of Internal Medicine, Gachon University College of Medicine, Incheon, South Korea
| | - Sungahn Lee
- Laboratory of Genomics and Translational Medicine, Department of Internal Medicine, Gachon University College of Medicine, Incheon, South Korea
| | - Sihoon Lee
- Laboratory of Genomics and Translational Medicine, Department of Internal Medicine, Gachon University College of Medicine, Incheon, South Korea
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Yu L, Li Z, Yang R, Pan G, Cheng Q, He Y, Liu Y, Liu F, Ma M, Yang T, Wang Y, Su J, Zheng Y, Gao S, Xu Q, Li L, Yu C. Impaired Sensitivity to Thyroid Hormones Is Associated With Elevated Blood Glucose in Coronary Heart Disease. Front Endocrinol (Lausanne) 2022; 13:895843. [PMID: 35784545 PMCID: PMC9240192 DOI: 10.3389/fendo.2022.895843] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 04/28/2022] [Indexed: 11/16/2022] Open
Abstract
CONTEXT Thyroid hormones influence glucose homeostasis through central and peripheral regulation. To date, the association between thyroid hormone sensitivity and elevated blood glucose (EBG) in patients with coronary heart disease (CHD) remains unknown. The purpose of this study was to investigate the association between thyroid hormone sensitivity and risk of EBG in patients with CHD, and to further explore their association in different sexes and ages. METHODS This large multicenter retrospective study included 30,244 patients with CHD (aged 30-80 years) between 1 January 2014 and 30 September 2020. Parameters representing central and peripheral sensitivity to thyroid hormones were calculated. Central sensitivity to thyroid hormones was assessed by calculating the Thyroid Feedback Quantile-based Index (TFQI), Thyroid-stimulating Hormone Index (TSHI), and Thyrotropin Thyroxine Resistance Index (TT4RI), and Parametric Thyroid Feedback Quantile-based Index (PTFQI); peripheral sensitivity to thyroid hormones was evaluated using the ratio of free triiodothyronine (FT3) /free thyroxine (FT4). Taking normal glucose tolerance (NGT) as a reference, logistic regression was used to analyse the relationship between central and peripheral thyroid hormone sensitivity and EBG in patients with CHD. RESULTS Among the 30,244 participants, 15,493 (51.23%) had EBG. The risk of EBG was negatively correlated with TSHI (OR: 0.91; 95%CI: 0.91 to 0.92; P < 0.001), TT4RI (OR: 0.99; 95% CI: 0.99 to 0.99; P<0.001), TFQI (OR: 0.82; 95%CI: 0.80 to 0.84; P <0.001) and PTFQI (OR: 0.76; 95%CI: 0.74 to 0.78; P<0.001). Compared to males and patients aged 60 and below, the OR value for EBG was lower in females and in patients aged over 60 years old. Conversely, EBG risk was positively associated with FT3/FT4 (OR: 1.08; 95% CI: 1.07 to 1.09; P <0.001) and in the sex-categorized subgroups, males had higher OR values than females. CONCLUSIONS This study showed that thyroid hormone sensitivity is significantly associated with EBG in patients with CHD. This association is higher in females than in males, and the association in those aged over 60 years old is higher than that in patients aged 60 years and below.
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Affiliation(s)
- Lu Yu
- Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Zhu Li
- Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Rongrong Yang
- Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Guangwei Pan
- Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Qi Cheng
- Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Yuanyuan He
- Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Yijia Liu
- Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Fanfan Liu
- Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Mei Ma
- Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Tong Yang
- Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Yang Wang
- Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Jinyu Su
- Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Yanchao Zheng
- Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Shan Gao
- Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Qiang Xu
- Second Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- *Correspondence: Chunquan Yu, ; Lin Li, ; Qiang Xu,
| | - Lin Li
- Tianjin University of Traditional Chinese Medicine, Tianjin, China
- *Correspondence: Chunquan Yu, ; Lin Li, ; Qiang Xu,
| | - Chunquan Yu
- Tianjin University of Traditional Chinese Medicine, Tianjin, China
- *Correspondence: Chunquan Yu, ; Lin Li, ; Qiang Xu,
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20
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Hong J, Liu WY, Hu X, Chen WW, Jiang FF, Xu ZR, Shen FX, Zhu H. Free Triiodothyronine and Free Triiodothyronine to Free Thyroxine Ratio Predict All-Cause Mortality in Patients with Diabetic Foot Ulcers. Diabetes Metab Syndr Obes 2022; 15:467-476. [PMID: 35210796 PMCID: PMC8863187 DOI: 10.2147/dmso.s354754] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 01/29/2022] [Indexed: 12/14/2022] Open
Abstract
PURPOSE Free triiodothyronine (FT3) and FT3/free thyroxine (FT4) ratio have been associated with mortality in various diseases. However, no study to date has identified a link between FT3, FT3/FT4 ratio and all-cause mortality in patients with diabetic foot ulcers (DFUs). This study aimed to investigate this relationship. METHODS This retrospective cohort study included 726 patients diagnosed with DFUs in a public hospital from January 2015 to October 2019. Patients were classified by the optimal cut-off values of the FT3 and FT3/FT4 ratio, respectively. The association of FT3 and FT3/FT4 ratio with all-cause mortality was evaluated in a multivariable cox regression model. Directed acyclic graphs were used to assess the minimally sufficient sets of confounding variables. RESULTS Log rank tests indicated that patients with low FT3 and FT3/FT4 ratio had lower overall survival rates (all p < 0.001). The adjusted HRs for all-cause mortality were 0.48 (95% CI: 0.32-0.73, P = 0.001) when comparing high versus low FT3 and 0.47 (95% CI: 0.32-0.70, P < 0.001) when comparing high versus low FT3/FT4 ratio. Subgroup analyses showed that these associations existed only in elderly patients (≥65 years) and women, after adjustment. In men, only high FT3/FT4 ratio was associated with low all-cause mortality, after adjustment. CONCLUSION Routine assessment of FT3 and FT3/FT4 ratio may be a simple and effective way to identify high-risk patients with DFUs, especially in elderly patients and women.
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Affiliation(s)
- Jing Hong
- Department of Endocrinology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, People’s Republic of China
| | - Wen-Yue Liu
- Department of Endocrinology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, People’s Republic of China
| | - Xiang Hu
- Department of Endocrinology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, People’s Republic of China
| | - Wen-Wen Chen
- Department of Geriatrics, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, People’s Republic of China
| | - Fei-Fei Jiang
- Department of Endocrinology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, People’s Republic of China
| | - Ze-Ru Xu
- Department of Endocrinology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, People’s Republic of China
| | - Fei-Xia Shen
- Department of Endocrinology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, People’s Republic of China
| | - Hong Zhu
- Department of Endocrinology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, People’s Republic of China
- Correspondence: Hong Zhu, Department of Endocrinology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, People’s Republic of China, Tel +86 577-55579622, Fax +86 577-55578522, Email
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21
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Inaba M, Mori K, Tsujimoto Y, Yamada S, Yamazaki Y, Emoto M, Shoji T. Association of Reduced Free T3 to Free T4 Ratio with Lower Serum Creatinine in Japanese Hemodialysis Patients. Nutrients 2021; 13:nu13124537. [PMID: 34960089 PMCID: PMC8703624 DOI: 10.3390/nu13124537] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 12/15/2021] [Accepted: 12/16/2021] [Indexed: 01/24/2023] Open
Abstract
PURPOSE Low T3 syndrome is defined by a fall in free triiodothyronine (FT3) in spite of normal serum thyroid-stimulating hormone (TSH) and often normal free thyroxin (FT4). A low FT3/FT4 ratio, a relevant marker for low T3 syndrome, is known as a risk of mortality in hemodialysis (HD) patients, as well as low muscle mass in the general population. Because of the local activation of T4 to FT3 in muscle tissue, we examined the association of FT3/FT4 ratio with serum creatinine, a marker of muscle mass and strength in HD patients to investigate the significance of muscle tissue in the development of low T3 syndrome in HD patients. METHODS This was a cross-sectional study derived from our prospective cohort study, named DREAM, of Japanese HD patients. After the exclusion of patients with treated and untreated thyroid dysfunction, 332 patients were analyzed in the study. RESULTS The serum FT4 and TSH of HD patients (n = 332) were 0.9 ± 0.1 ng/dL. and 2.0 ± 0.9 μIU/mL, which were within the respective normal range, while serum FT3 was 2.2 ± 0.3 pg/mL. As many as 101 out of 332 (30.4%) HD patients exhibited a serum FT3 less than the normal lower limit of 2.2 pg/mL. The serum FT3/FT4 ratio correlated significantly positively with serum creatinine, and inversely with serum log CRP and total cholesterol, while it exhibited a tendency towards positive correlation with serum albumin. Multiple regression analysis, which included serum creatinine, albumin, and log CRP, simultaneously, in addition to sex, age, diabetic kidney disease or not, log HD duration, body mass index, systolic blood pressure, and Kt/V, as independent variables, revealed an independent and significant positive association of serum creatinine, but not serum albumin or CRP, with the serum FT3/FT4 ratio. CONCLUSIONS The present study demonstrated an independent and positive correlation of serum creatinine with the serum FT3/FT4 ratio in HD patients. The lack of association of the serum FT3/FT4 ratio with serum albumin and CRP suggested the presence of a creatinine-specific mechanism to associate with serum FT3/FT4 ratio. Because of the local activation of T4 to T3 at muscle tissue, a lower muscle mass may be causatively associated with low T3 syndrome.
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Affiliation(s)
- Masaaki Inaba
- Renal Center, Ohno Memorial Hospital, 1-26-10, Minami-Horie Nishi-ku, Osaka 550-0015, Japan
- Correspondence: ; Tel.: +81-6-6531-1805; Fax: +81-6-6531-1807
| | - Katsuhito Mori
- Department of Nephrology, Osaka City University School of Medicine, 1-4-3, Asahi-machi, Abeno-ku, Osaka 545-8585, Japan;
| | - Yoshihiro Tsujimoto
- Division of Internal Medicine, Inoue Hospital, 16-17 enoki-machi, Osaka 564-0053, Japan;
| | - Shinsuke Yamada
- Department of Metabolism, Endocrinology, and Molecular Medicine, Osaka City University School of Medicine, 1-4-3, Asahi-machi, Abeno-ku, Osaka 545-8585, Japan; (S.Y.); (Y.Y.); (M.E.)
| | - Yuko Yamazaki
- Department of Metabolism, Endocrinology, and Molecular Medicine, Osaka City University School of Medicine, 1-4-3, Asahi-machi, Abeno-ku, Osaka 545-8585, Japan; (S.Y.); (Y.Y.); (M.E.)
| | - Masanori Emoto
- Department of Metabolism, Endocrinology, and Molecular Medicine, Osaka City University School of Medicine, 1-4-3, Asahi-machi, Abeno-ku, Osaka 545-8585, Japan; (S.Y.); (Y.Y.); (M.E.)
- Vascular Science Center for Translational Research, Osaka City University Graduate School of Medicine 1-4-3, Asahi-machi, Abeno-ku, Osaka 545-8585, Japan;
| | - Tetsuo Shoji
- Vascular Science Center for Translational Research, Osaka City University Graduate School of Medicine 1-4-3, Asahi-machi, Abeno-ku, Osaka 545-8585, Japan;
- Department of Vascular Medicine, Osaka City University Graduate School of Medicine, 1-4-3, Asahi-machi, Abeno-ku, Osaka 550-0015, Japan
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Taprogge J, Carnegie-Peake L, Murray I, Gear JI, Flux GD. Adjustment of the iodine ICRP population pharmacokinetic model for the use in thyroid cancer patients after thyroidectomy. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2021; 41:1034-1044. [PMID: 34261047 DOI: 10.1088/1361-6498/ac149a] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 07/14/2021] [Indexed: 06/13/2023]
Abstract
Biokinetic models developed for healthy humans are not appropriate to describe biokinetics in thyroid cancer patients following thyroidectomy. The aim of this study was to adjust the population model for iodine proposed by the International Commission on Radiological Protection (ICRP) for the use in these patients. Rate constants of the ICRP publication 128 model for iodine were adjusted using the population modelling software package Monolix to describe activity retention in whole-body, thyroid, blood and protein-bound iodine observed in 23 patients. The new set of rate constants was compared to the four uptake scenarios proposed in ICRP publication 128. Flow from the inorganic iodide in blood compartment into the first thyroid compartment decreases to 0.15 d-1compared to a value of 7.27 d-1for the ICRP publication 128 model with a medium uptake. The transfer from first to second thyroid compartments and the outflow from the second thyroid compartment increases. An increased turnover rate of extrathyroidal organic iodine is observed. The rate constant from inorganic iodide in blood to kidney was also adjusted. Overall a good agreement was found between the adjusted model and the activity retention in thyroid cancer patients. The adjustment of population pharmacokinetic models to describe the biokinetic properties of specific patient populations for therapeutic radiopharmaceuticals is essential to capture the changes in biokinetics. The proposed set of rate constants for the established ICRP publication 128 model can be used to more accurately assess radiation protection requirements for the treatment of thyroid cancer patients using radioiodine.
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Affiliation(s)
- Jan Taprogge
- Joint Department of Physics, Royal Marsden NHSFT, Downs Road, Sutton SM2 5PT, United Kingdom
- The Institute of Cancer Research, 123 Old Brompton Road, London SW7 3RP, United Kingdom
| | - Lily Carnegie-Peake
- Joint Department of Physics, Royal Marsden NHSFT, Downs Road, Sutton SM2 5PT, United Kingdom
- The Institute of Cancer Research, 123 Old Brompton Road, London SW7 3RP, United Kingdom
| | - Iain Murray
- Joint Department of Physics, Royal Marsden NHSFT, Downs Road, Sutton SM2 5PT, United Kingdom
- The Institute of Cancer Research, 123 Old Brompton Road, London SW7 3RP, United Kingdom
| | - Jonathan I Gear
- Joint Department of Physics, Royal Marsden NHSFT, Downs Road, Sutton SM2 5PT, United Kingdom
- The Institute of Cancer Research, 123 Old Brompton Road, London SW7 3RP, United Kingdom
| | - Glenn D Flux
- Joint Department of Physics, Royal Marsden NHSFT, Downs Road, Sutton SM2 5PT, United Kingdom
- The Institute of Cancer Research, 123 Old Brompton Road, London SW7 3RP, United Kingdom
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23
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Galofré JC, Attanasio R, Hegedüs L, Nagy E, Negro R, Papini E, Perros P, Díez JJ. Use of thyroid hormone in hypothyroid patients and euthyroid subjects in Spain: A THESIS* questionnaire survey. ENDOCRINOL DIAB NUTR 2021; 69:S2530-0164(21)00190-7. [PMID: 34509420 DOI: 10.1016/j.endinu.2021.07.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 07/04/2021] [Accepted: 07/08/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND Hypothyroidism is one of the leading conditions in endocrinology. Despite that fact, clinical indications for treatment still vary among Spanish specialists. AIMS To identify attitudes of Spanish specialists relating to the use of levothyroxine (LT4) and the management of hypothyroidism. METHODS The members of the Sociedad Española de Endocrinología y Nutrición (Spanish Society of Endocrinology and Nutrition) were invited to participate in a web-based survey. The survey, initially in English, was modified to reflect in accordance with the availability of thyroid hormone formulations in Spain. RESULTS A total of 505 of 1956 (25.8%) members (66% female) completed the survey; 97.4% declared that LT4 is the first-line therapy for hypothyroidism. The indications for LT4 therapy in euthyroidism were infertility in thyroid antibody-positive women (48.5%) and simple goitre (21.2%). However, 44.2% of specialists reported that there was no indication for LT4 therapy in such patients. Only a minority of respondents (2.6%) considered combining LT4 with liothyronine as the treatment of choice from inception, whereas 49% stated that it should never be used. CONCLUSIONS The standard of treatment of hypothyroidism in Spain is almost exclusively with LT4 tablets. Availability of other formulations of LT4 or combination therapy for hypothyroidism management remains to be explored, especially in patients with persistent symptoms. Notably, non-evidence-based use of LT4 is widely practiced in Spain for euthyroid women with autoimmune thyroiditis and fertility issues.
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Affiliation(s)
- Juan C Galofré
- Department of Endocrinology, Clínica Universidad de Navarra, Pamplona, Spain; Instituto de Investigación Sanitaria de Navarra (IdiSNA), Spain; Thyroid Task Force from the Sociedad Española de Endocrinología y Nutrición (SEEN), Madrid, Spain.
| | | | - Laszlo Hegedüs
- Department of Endocrinology and Metabolism, Odense University Hospital, Odense, Denmark
| | - Endre Nagy
- Division of Endocrinology, Department of Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Roberto Negro
- Division of Endocrinology, V. Fazzi Hospital, Lecce, Italy
| | - Enrico Papini
- Department of Endocrinology and Metabolism, Regina Apostolorum Hospital, Rome, Italy
| | - Petros Perros
- Department of Endocrinology, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
| | - Juan J Díez
- Thyroid Task Force from the Sociedad Española de Endocrinología y Nutrición (SEEN), Madrid, Spain; Department of Endocrinology, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain; Instituto de Investigación Sanitaria Puerta de Hierro Segovia de Arana, Majadahonda, Madrid, Spain; Department of Medicine, Universidad Autónoma de Madrid, Spain
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Relationship between thyroid hormones and metabolic syndrome in a normal thyroid function population in Western China: a cross-sectional study based on both epidemiological and genetic analysis. Chin Med J (Engl) 2021; 135:350-352. [PMID: 35108229 PMCID: PMC8812676 DOI: 10.1097/cm9.0000000000001553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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The prevalence and related factors of metabolic syndrome in outpatients with first-episode drug-naive major depression comorbid with anxiety. Sci Rep 2021; 11:3324. [PMID: 33558554 PMCID: PMC7870819 DOI: 10.1038/s41598-021-81653-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 01/06/2021] [Indexed: 01/13/2023] Open
Abstract
Metabolic syndrome (MetS) is associated with depression, but its role in major depressive disorder comorbid with anxiety (AMD) is unclear. This study aimed to investigate the prevalence and clinical correlates of MetS in first-episode drug-naive (FEDN) patients with AMD in a Chinese Han population. In total, 1380 FEDN outpatients with AMD were recruited in this cross-sectional study. The sociodemographic features, clinical characteristics, history of suicide attempts, thyroid-stimulating hormone (TSH) levels, and MetS parameters of each subject were evaluated. All subjects were rated on the Hamilton Depression Rating Scale (HAM-D), Hamilton Anxiety Rating Scale (HAM-A), and the Positive and Negative Syndrome Scale positive symptom subscale. The prevalence of MetS among AMD patients was 8.04%. Compared to the non-MetS group, age, age of onset, TSH level, HAM-A and HAM-D scores, history of attempted suicide, and comorbid psychiatric symptoms were higher in the MetS group. Those in this group were also more likely to be married, and they had a lower educational level. Furthermore, age, psychiatric symptoms, suicide attempts, and higher TSH levels were independently associated with MetS in AMD patients. This study suggests a lower prevalence of MetS in FEDN patients with AMD in a Chinese Han population. Older age, comorbid psychiatric symptoms, history of attempted suicide, and higher TSH levels are related factors for MetS in AMD patients.
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Nie X, Ma X, Xu Y, Shen Y, Wang Y, Bao Y. Increased Serum Adipocyte Fatty Acid-Binding Protein Levels Are Associated with Decreased Sensitivity to Thyroid Hormones in the Euthyroid Population. Thyroid 2020; 30:1718-1723. [PMID: 32394790 DOI: 10.1089/thy.2020.0011] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background: Serum adipocyte fatty acid-binding protein (A-FABP) and thyroid hormones are closely associated with metabolic disorders; however, their relationship remains unknown. We aimed at investigating the associations of serum A-FABP levels with single and composite indices of the thyroid system. Methods: The study included 1057 community-based euthyroid participants (age range: 27-81 years) in Shanghai, among whom 601 were women. Serum free triiodothyronine (fT3), free thyroxine (fT4), and thyrotropin (TSH) were measured by electrochemical luminescence immunoassay. The thyroid feedback quantile-based index (TFQI), thyrotropin index (TSHI), and thyrotroph thyroxine resistance index (TT4RI) were calculated to evaluate central sensitivity to thyroid hormones. Peripheral sensitivity to thyroid hormones was evaluated by the fT3 to fT4 ratio (fT3/fT4). Enzyme-linked immunosorbent assay was used to measure serum A-FABP levels. Results: Serum A-FABP levels were 6.41 [95% confidence interval: 6.10-6.74] ng/mL among all subjects. Multiple cardiovascular metabolic risk factors were adjusted in the multivariate linear regression analysis and the multinomial logistic regression analysis (nonordinal). In both sexes, serum A-FABP levels were positively associated with fT4 (men: standardized β = 0.150, p = 0.001; women: standardized β = 0.218, p < 0.001), TFQI (men: standardized β = 0.119, p = 0.009; women: standardized β = 0.165, p < 0.001), and TSHI (men: standardized β = 0.108, p = 0.017; women: standardized β = 0.114, p = 0.005); while they were negatively associated with fT3/fT4 (men: standardized β = -0.122, p = 0.008; women: standardized β = -0.129, p = 0.001). Serum A-FABP levels were not associated with fT3, TSH, or TT4RI. Compared with the first quartile group of TFQI, for every 10 ng/mL increase in A-FABP, the odds ratio (OR) for the third quartile group of TFQI was 2.213 in women (p = 0.035); the ORs for the fourth quartile group of TFQI were 2.614 in men (p = 0.022) and 3.425 in women (p = 0.002). Conclusions: In a euthyroid population, increased serum A-FABP levels were associated with decreased sensitivity to thyroid hormones, suggesting that A-FABP may mediate the "cross-talk" between adipose tissue and the thyroid system.
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Affiliation(s)
- Xiaomin Nie
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
- Shanghai Clinical Center for Diabetes, Shanghai, China
- Shanghai Key Clinical Center for Metabolic Disease, Shanghai, China
- Shanghai Diabetes Institute, Shanghai, China
- Shanghai Key Laboratory of Diabetes Mellitus, Shanghai, China
| | - Xiaojing Ma
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
- Shanghai Clinical Center for Diabetes, Shanghai, China
- Shanghai Key Clinical Center for Metabolic Disease, Shanghai, China
- Shanghai Diabetes Institute, Shanghai, China
- Shanghai Key Laboratory of Diabetes Mellitus, Shanghai, China
| | - Yiting Xu
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
- Shanghai Clinical Center for Diabetes, Shanghai, China
- Shanghai Key Clinical Center for Metabolic Disease, Shanghai, China
- Shanghai Diabetes Institute, Shanghai, China
- Shanghai Key Laboratory of Diabetes Mellitus, Shanghai, China
| | - Yun Shen
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
- Shanghai Clinical Center for Diabetes, Shanghai, China
- Shanghai Key Clinical Center for Metabolic Disease, Shanghai, China
- Shanghai Diabetes Institute, Shanghai, China
- Shanghai Key Laboratory of Diabetes Mellitus, Shanghai, China
| | - Yufei Wang
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
- Shanghai Clinical Center for Diabetes, Shanghai, China
- Shanghai Key Clinical Center for Metabolic Disease, Shanghai, China
- Shanghai Diabetes Institute, Shanghai, China
- Shanghai Key Laboratory of Diabetes Mellitus, Shanghai, China
| | - Yuqian Bao
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
- Shanghai Clinical Center for Diabetes, Shanghai, China
- Shanghai Key Clinical Center for Metabolic Disease, Shanghai, China
- Shanghai Diabetes Institute, Shanghai, China
- Shanghai Key Laboratory of Diabetes Mellitus, Shanghai, China
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Negro R, Attanasio R, Nagy EV, Papini E, Perros P, Hegedüs L. Use of Thyroid Hormones in Hypothyroid and Euthyroid Patients; the 2019 Italian Survey. Eur Thyroid J 2020; 9:25-31. [PMID: 32071899 PMCID: PMC7024857 DOI: 10.1159/000502057] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 07/09/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The incidence and prevalence of hypothyroidism are increasing and the threshold for the treatment of hypothyroid as well as individuals without evident thyroid disease with thyroid hormone is declining. OBJECTIVE To investigate endocrinologists' use of thyroid hormones in hypothyroid and euthyroid patients in Italy, a country where different formulations of levothyroxine (LT4; tablet, liquid solution and soft-gel capsule) are available on the market. METHODS Members of the Associazione Medici Endocrinologi (Italian Association of Clinical Endocrinologists) were invited to participate in a web-based survey investigating the topic. RESULTS A total of 797 of 2,028 (39.3%) members completed all the sections of the survey; 98.7% declared that the treatment of choice for hypothyroidism is LT4. A significant minority (37.3%) indicated that LT4 may be considered in infertile euthyroid women seeking pregnancy and harbouring positive thyroperoxidase antibodies (TPOAb) and in goitre increasing in size (18.1%). LT4 + LT3 was considered by 43.2% for LT4-replaced patients and normal TSH, if they reported persistent symptoms. High percentages of respondents chose LT4 in a liquid solution or soft-gel capsules when taken together with other drugs interfering with LT4 absorption (81.8%), in patients with a history of celiac disease, malabsorption, lactose intolerance, intolerance to common excipients (96.6%), or unexplained poor biochemical control of hypothyroidism (74.4%), or in patients not able to adhere to ingesting LT4 fasted and/or separated from food/drink (98.9%). In total, 43.6% of responders would use LT4 in a liquid solution or soft-gel capsules for hypothyroid patients with biochemical euthyroidism on LT4, who had persistent symptoms. CONCLUSIONS The preferred treatment for hypothyroidism is LT4; LT3 + LT4 combination treatment is mainly considered in patients with persistent symptoms. A significant minority would offer LT4 to euthyroid women with positive TPOAb and infertility and to euthyroid patients with progressive simple goitre. Alternative LT4 formulations like liquid solution or soft-gel capsules are largely reserved for specific conditions (interfering drugs, actual or suspected malabsorption, inability to take LT4 in the fasting state, unexplained poor biochemical control of hypothyroidism).
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Affiliation(s)
- Roberto Negro
- Division of Endocrinology, V. Fazzi Hospital, Lecce, Italy
- *Roberto Negro, Division of Endocrinology, V. Fazzi Hospital, Piazza Muratore, IT–73100 Lecce (Italy), E-Mail
| | | | - Endre V. Nagy
- Division of Endocrinology, Department of Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Enrico Papini
- Department of Endocrinology and Metabolism, Ospedale Regina Apostolorum, Rome, Italy
| | - Petros Perros
- Department of Endocrinology, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
| | - Laszlo Hegedüs
- Department of Endocrinology and Metabolism, Odense University Hospital, Odense, Denmark
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Qin K, Zhang F, Wu Q, Liu Z, Huang Y, Tan J, Zhou Y, An Z, Li S, Li S. Thyroid Hormone Changes in Euthyroid Patients with Diabetes. Diabetes Metab Syndr Obes 2020; 13:2533-2540. [PMID: 32765032 PMCID: PMC7371990 DOI: 10.2147/dmso.s260039] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 06/23/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Thyroid dysfunction is associated with diabetes, but it is unclear if the thyroid hormone levels change in euthyroid adults with diabetes. OBJECTIVE To investigate the association between thyroid hormone levels and diabetes in euthyroid adults. METHODS Among the euthyroid adults who underwent health examination in West China Hospital of Sichuan University in 2016, patients with diabetes were identified according to the medical history, fasting blood glucose and HbA1c. Age and sex matched controls were identified from the population. The patients with diabetes group was further divided into two subgroups: patients with newly diagnosed diabetes (NDD) and with previously diagnosed diabetes (PDD). Independent t-test and multivariate logistic regression models were used to investigate the difference in the levels of thyroid stimulating hormone (TSH), free thyroxine (FT4), free triiodothyronine (FT3) and the ratio of FT4/FT3 between groups. RESULTS We included 32,557 participants, 2,271 with diabetes. Compared to the adults without diabetes, the odds ratios (ORs) per one unit elevation of TSH, FT4, FT4/FT3 ratio and FT3 in patients with diabetes were 0.88 [95% confidence interval (CI): 0.82-0.95], 1.11 (95% CI: 1.08-1.14), 2.05 (95% CI: 1.81-2.32) and 0.85 (95% CI: 0.78-0.93), respectively. Compared to the NDD group, the ORs per one unit elevation of TSH, FT4, FT4/FT3 ratio and FT3 of the PDD group were 0.81 (95% CI: 0.71-0.92), 1.08 (95% CI: 1.04-1.12), 1.76 (95% CI: 1.49-2.08) and 1.01 (95% CI: 0.92-1.12), respectively. CONCLUSION In euthyroid adults, diabetes was associated with increased FT4/FT3 ratio, which is linked to the peripheral turnover of the thyroid hormones.
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Affiliation(s)
- Ken Qin
- Physical Examination Center, West China Hospital, Sichuan University, Chengdu610041, People’s Republic of China
| | - Fan Zhang
- Physical Examination Center, West China Hospital, Sichuan University, Chengdu610041, People’s Republic of China
| | - Qinqin Wu
- Physical Examination Center, West China Hospital, Sichuan University, Chengdu610041, People’s Republic of China
| | - Zhenrong Liu
- Physical Examination Center, West China Hospital, Sichuan University, Chengdu610041, People’s Republic of China
| | - Yan Huang
- Physical Examination Center, West China Hospital, Sichuan University, Chengdu610041, People’s Republic of China
| | - Jing Tan
- Chinese Evidence-Based Medicine Center CREAT Group, West China Hospital, Sichuan University, Chengdu610041, People’s Republic of China
| | - Yiling Zhou
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu610041, People’s Republic of China
| | - Zhenmei An
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu610041, People’s Republic of China
| | - Shuangqing Li
- General Medical Center, West China Hospital, Sichuan University, Chengdu610041, People’s Republic of China
- Shuangqing Li General Medical Center, West China Hospital, Sichuan University, Chengdu610041, People’s Republic of ChinaTel +86 18980601354 Email
| | - Sheyu Li
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu610041, People’s Republic of China
- Chinese Evidence-Based Medicine Center, Cochrane China Center and MAGIC China Center, West China Hospital, Sichuan University, Chengdu610041, People’s Republic of China
- Engineering Research Center for Medical Information Technology, Ministry of Education, West China Hospital of Sichuan University, Chengdu610041, People’s Republic of China
- Correspondence: Sheyu Li Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu610041, People’s Republic of ChinaTel +86 13194874843 Email
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Zupo R, Castellana F, Sardone R, Lampignano L, Paradiso S, Giagulli VA, Triggiani V, Di Lorenzo L, Giannelli G, De Pergola G. Higher Muscle Mass Implies Increased Free-Thyroxine to Free-Triiodothyronine Ratio in Subjects With Overweight and Obesity. Front Endocrinol (Lausanne) 2020; 11:565065. [PMID: 33117281 PMCID: PMC7553046 DOI: 10.3389/fendo.2020.565065] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 09/10/2020] [Indexed: 12/12/2022] Open
Abstract
UNLABELLED Thyroid hormones control both metabolic pathways and body composition, whereas little knowledge is available about the possible influence of skeletal muscle mass (MM) on thyroid hormone metabolism and circulating levels. This was a cross-sectional study conducted at the Population Health Unit of the National Institute of Gastroenterology IRCCS "S. de Bellis" (Italy) and investigating the extent to which skeletal MM affects thyroid function in obesity. Two hundred twenty-seven consecutive healthy volunteers (155 women and 72 men) with overweight and obesity (BMI ≥ 25 kg/m2) and taking no medication or supplement were assessed for hormone, metabolic and routine laboratory parameters. Body composition parameters were collected by using bioelectrical impedance analysis (BIA). MM was directly related to the body mass index (BMI), waist circumference (WC), insulin, triglycerides, uric acid and free-triiodothyronine (FT3) serum levels, FT3 to the free-thyroxine (FT4) ratio, and insulin-resistance (HOMA-IR), and inversely related to age, total, and HDL-cholesterol serum levels. Multiple regression models confirmed the relationship between MM and the FT3 to FT4 ratio, independently of age, BMI, TSH, triglycerides, and insulin serum levels. The same analyses run by gender showed that this relationship maintained significance only in men. Increased skeletal MM in obesity results in improved thyroid activity mediated by increased T4 conversion to T3, and higher FT3 circulating levels, particularly in men. In conclusion, preserving a greater skeletal MM in obesity helps to enhance thyroid activity. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov, identifier NCT04327375.
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Affiliation(s)
- Roberta Zupo
- Population Health Unit – “Salus in Apulia Study”, National Institute of Gastroenterology “Saverio de Bellis”, Research Hospital, Bari, Italy
- *Correspondence: Roberta Zupo,
| | - Fabio Castellana
- Population Health Unit – “Salus in Apulia Study”, National Institute of Gastroenterology “Saverio de Bellis”, Research Hospital, Bari, Italy
| | - Rodolfo Sardone
- Population Health Unit – “Salus in Apulia Study”, National Institute of Gastroenterology “Saverio de Bellis”, Research Hospital, Bari, Italy
| | - Luisa Lampignano
- Population Health Unit – “Salus in Apulia Study”, National Institute of Gastroenterology “Saverio de Bellis”, Research Hospital, Bari, Italy
| | - Silvia Paradiso
- Clinical Nutrition Unit, Department of Biomedical Science and Human Oncology, University of Bari, School of Medicine, Policlinico, Bari, Italy
| | - Vito Angelo Giagulli
- Section of Internal Medicine, Geriatrics, Endocrinology and Rare Disease, Interdisciplinary Department of Medicine, School of Medicine, University of Bari, Bari, Italy
| | - Vincenzo Triggiani
- Section of Internal Medicine, Geriatrics, Endocrinology and Rare Disease, Interdisciplinary Department of Medicine, School of Medicine, University of Bari, Bari, Italy
| | - Luigi Di Lorenzo
- Dipartimento di Medicina Interna e Medicina Pubblica, Sezione di Medicina del Lavoro “E.C. Vigliani”, University of Bari, Policlinico, Bari, Italy
| | - Gianluigi Giannelli
- Scientific Direction, National Institute of Gastroenterology “Saverio de Bellis”, Research Hospital, Bari, Italy
| | - Giovanni De Pergola
- Population Health Unit – “Salus in Apulia Study”, National Institute of Gastroenterology “Saverio de Bellis”, Research Hospital, Bari, Italy
- Clinical Nutrition Unit, Department of Biomedical Science and Human Oncology, University of Bari, School of Medicine, Policlinico, Bari, Italy
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Nie X, Ma X, Xu Y, Shen Y, Wang Y, Bao Y. Characteristics of Serum Thyroid Hormones in Different Metabolic Phenotypes of Obesity. Front Endocrinol (Lausanne) 2020; 11:68. [PMID: 32184757 PMCID: PMC7058591 DOI: 10.3389/fendo.2020.00068] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Accepted: 02/03/2020] [Indexed: 12/14/2022] Open
Abstract
Aim: Metabolically healthy obese (MHO) individuals have attracted broad attention. We aimed to investigate the characteristics of serum thyroid hormones in different metabolic phenotypes of obesity. Methods: The study included 1,023 community-based euthyroid subjects (age range: 27-81 years), of whom 586 were women. Fat% was detected by a bioelectrical impedance analyzer. Two definitions of obesity were applied as follows: (1) fat% ≥ 25% for men and ≥ 30% for women; (2) body mass index (BMI) ≥ 25 kg/m2. According to the diagnostic criteria for metabolic syndrome by the Chinese Diabetes Society, metabolically unhealthy was defined as two or more components of metabolic syndrome, excluding waist circumference. Serum-free triiodothyronine (FT3), free thyroxine (FT4), and thyroid-stimulating hormone (TSH) levels were measured by electrochemiluminescence immunoassay. Results: The proportions of obesity defined by fat% and BMI were 41.3 and 27.1%, respectively. The proportion of metabolically unhealthy was 41.6%. After adjusting for age and gender, regardless of the definitions based on fat% or BMI, FT3 was positively related to both the MHO and the metabolically unhealthy obese (MUO) phenotypes [MHO: odds ratio (OR)s = 1.676 based on fat% and 2.055 based on BMI; MUO: ORs = 1.818 based on fat% and 1.526 based on BMI; all P < 0.05]; FT4 was negatively related to the MUO phenotype (ORs = 0.870 based on fat% and 0.849 based on BMI, all P < 0.05); FT3/FT4 was also positively related to both the MHO and the MUO phenotypes (MHO: ORs = 1.678 based on fat% and 2.825 based on BMI; MUO: ORs = 2.866 based on fat% and 2.883 based on BMI; all P < 0.05); and TSH was positively related to the metabolically unhealthy non-obese phenotype (ORs = 1.329 based on fat% and 1.321 based on BMI, all P < 0.01). Conclusions: In euthyroid population, both the MHO and the MUO phenotypes were characterized by increased FT3 and FT3/FT4 levels.
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Affiliation(s)
- Xiaomin Nie
- Department of Endocrinology and Metabolism, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Clinical Center for Diabetes, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Xiaojing Ma
- Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Clinical Center for Diabetes, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
- *Correspondence: Xiaojing Ma
| | - Yiting Xu
- Department of Endocrinology and Metabolism, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Clinical Center for Diabetes, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Yun Shen
- Department of Endocrinology and Metabolism, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Clinical Center for Diabetes, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Yufei Wang
- Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Clinical Center for Diabetes, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Yuqian Bao
- Department of Endocrinology and Metabolism, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Clinical Center for Diabetes, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
- Yuqian Bao
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Abstract
PURPOSE OF REVIEW To summarize recent developments in the association of thyroid function with metabolic syndrome (MetS). RECENT FINDINGS Although thyroid hormones even within low normal range are associated with various metabolic abnormalities, the risk of MetS remains a controversial issue. Hyperthyroid state might be associated only with insulin resistance and dysglycemia. Autoimmune thyroid diseases may be a potential risk factor for metabolic abnormalities even in those with low normal thyroid function. SUMMARY The interrelation between thyroid stimulating hormone, free T3, freeT4 and metabolic parameters is complex and might be affected by age, sex, BMI, insulin resistance, smoking, iodine intake and inflammatory markers.
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Affiliation(s)
- Ladan Mehran
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Balercia G, Bonomi M, Giagulli VA, Lanfranco F, Rochira V, Giambersio A, Accardo G, Esposito D, Allasia S, Cangiano B, De Vincentis S, Condorelli RA, Calogero A, Pasquali D. Thyroid function in Klinefelter syndrome: a multicentre study from KING group. J Endocrinol Invest 2019; 42:1199-1204. [PMID: 30912057 DOI: 10.1007/s40618-019-01037-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 03/20/2019] [Indexed: 12/18/2022]
Abstract
PURPOSE The prevalence and the etiopathogenesis of thyroid dysfunctions in Klinefelter syndrome (KS) are still unclear. The primary aim of this study was to evaluate the pathogenetic role of hypogonadism in the thyroid disorders described in KS, with the scope to distinguish between patients with KS and hypogonadism due to other causes (Kallmann syndrome, idiopathic hypogonadotropic hypogonadism, iatrogenic hypogonadism and acquired hypogonadotropic hypogonadism after surgical removal of pituitary adenomas) called non-KS. Therefore, we evaluated thyroid function in KS and in non-KS hypogonadal patients. METHODS This is a case-control multicentre study from KING group: Endocrinology clinics in university-affiliated medical centres. One hundred and seventy four KS, and sixty-two non-KS hypogonadal men were enrolled. The primary outcome was the prevalence of thyroid diseases in KS and in non-KS. Changes in hormonal parameters were evaluated. Exclusion criterion was secondary hypothyroidism. Analyses were performed using Student's t test. Mann-Whitney test and Chi-square test. RESULTS FT4 was significantly lower in KS vs non-KS. KS and non-KS presented similar TSH and testosterone levels. Hashimoto's thyroiditis (HT) was diagnosed in 7% of KS. Five KS developed hypothyroidism. The ratio FT3/FT4 was similar in both groups. TSH index was 1.9 in KS and 2.3 in non-KS. Adjustment for differences in age, sample size and concomitant disease in multivariate models did not alter the results. CONCLUSIONS We demonstrated in KS no etiopathogenic link to hypogonadism or change in the set point of thyrotrophic control in the altered FT4 production. The prevalence of HT in KS was similar to normal male population, showing absence of increased risk of HT associated with the XXY karyotype.
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Affiliation(s)
- G Balercia
- Division of Endocrinology, Department of Clinical and Molecular Sciences, Umberto I Hospital, Polytechnic University of Marche, Ancona, Italy
| | - M Bonomi
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Division of Endocrine and Metabolic Diseases, Lab of Endocrine and Metabolic Research, IRCCS Istituto Auxologico Italiano, Milano, Italy
| | - V A Giagulli
- Outpatient Clinic for Endocrinology and Metabolic Diseases, Conversano Hospital, Conversano, Bari, Italy
| | - F Lanfranco
- Division of Endocrinology, Diabetology, and Metabolism, Department of Medical Sciences, University of Turin, Turin, Italy
| | - V Rochira
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria Di Modena, Ospedale Civile Di Baggiovara, Modena, Italy
| | - A Giambersio
- Healt Center "Maria Teresa Di Calcutta, Potenza, Italy
| | - G Accardo
- Department of Advanced Medical And Surgical Sciences, University of Campania "Luigi Vanvitelli", 80138, Naples, Italy
| | - D Esposito
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - S Allasia
- Division of Endocrinology, Diabetology, and Metabolism, Department of Medical Sciences, University of Turin, Turin, Italy
| | - B Cangiano
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Division of Endocrine and Metabolic Diseases, Lab of Endocrine and Metabolic Research, IRCCS Istituto Auxologico Italiano, Milano, Italy
| | - S De Vincentis
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria Di Modena, Ospedale Civile Di Baggiovara, Modena, Italy
| | - R A Condorelli
- Department of Clinical and Experimental Medicine, University of Catania, Policlinico "G. Rodolico", Catania, Italy
| | - A Calogero
- Department of Clinical and Experimental Medicine, University of Catania, Policlinico "G. Rodolico", Catania, Italy
| | - D Pasquali
- Department of Advanced Medical And Surgical Sciences, University of Campania "Luigi Vanvitelli", 80138, Naples, Italy.
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Azizi F, Amouzegar A, Tohidi M, Hedayati M, Cheraghi L, Mehrabi Y. Systemic Thyroid Hormone Status in Treated Graves' Disease. Int J Endocrinol Metab 2019; 17:e95385. [PMID: 31998382 PMCID: PMC6942169 DOI: 10.5812/ijem.95385] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 09/07/2019] [Accepted: 09/29/2019] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES We aimed to compare the markers of thyroid hormone status in treated euthyroid Graves' patients and levothyroxine (LT4)-treated hypothyroid Graves' patients. METHODS We collected the data of 277 patients, including 140 radioiodine-treated hypothyroid Graves' patients on LT4 treatment (group 1), 83 euthyroid Graves' patients on methimazole (MMI) therapy (group 2), and 54 euthyroid Graves' patients off MMI or radioiodine therapy for > 2 years (group 3). After the exclusion of diabetic patients, 130, 73, and 52 patients remained for analysis in groups 1, 2, and 3, respectively. Pearson and Spearman correlation coefficients were employed to assess the relationships between T3:T4 ratio and variables in each group along with univariate and multivariate linear regression models. RESULTS The mean age and female/male ratio were similar in the three groups. Serum fT4 was significantly higher and T3, TSH, TPOAb, and TRAb were significantly lower in group 1 than in group 2 and combined groups 2 and 3, which translated to 27% lower serum T3:T4 ratio in group 1. Higher BMI, serum cholesterol, and LDL cholesterol and lower HDL cholesterol were observed in group 1 than in combined groups 2 and 3. In multivariate regression analysis, the T3:T4 ratio was significantly higher in combined groups 2 and 3 than in group 1 in the presence of BMI and serum fasting blood glucose, triglycerides, and TSH. CONCLUSIONS Hypothyroid Graves' patients using LT4 exhibited lower T3:T4 ratio despite lower TSH levels and their BMI and lipid parameters differed from those of euthyroid Graves' patients.
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Affiliation(s)
- Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Corresponding Author: Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Atieh Amouzegar
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maryam Tohidi
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehdi Hedayati
- Cellular and Molecular Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Leila Cheraghi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Epidemiology and Biostatistics, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Yadollah Mehrabi
- Department of Epidemiology and Biostatistics, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Curtis SW, Terrell ML, Jacobson MH, Cobb DO, Jiang VS, Neblett MF, Gerkowicz SA, Spencer JB, Marder ME, Barr DB, Conneely KN, Smith AK, Marcus M. Thyroid hormone levels associate with exposure to polychlorinated biphenyls and polybrominated biphenyls in adults exposed as children. Environ Health 2019; 18:75. [PMID: 31443693 PMCID: PMC6708149 DOI: 10.1186/s12940-019-0509-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 07/30/2019] [Indexed: 05/03/2023]
Abstract
BACKGROUND Michigan residents were directly exposed to endocrine-disrupting compounds, polybrominated biphenyl (PBB) and polychlorinated biphenyl (PCB). A growing body of evidence suggests that exposure to certain endocrine-disrupting compounds may affect thyroid function, especially in people exposed as children, but there are conflicting observations. In this study, we extend previous work by examining age of exposure's effect on the relationship between PBB exposure and thyroid function in a large group of individuals exposed to PBB. METHODS Linear regression models were used to test the association between serum measures of thyroid function (total thyroxine (T4), total triiodothyronine (T3), free T4, free T3, thyroid stimulating hormone (TSH), and free T3: free T4 ratio) and serum PBB and PCB levels in a cross-sectional analysis of 715 participants in the Michigan PBB Registry. RESULTS Higher PBB levels were associated with many thyroid hormones measures, including higher free T3 (p = 0.002), lower free T4 (p = 0.01), and higher free T3: free T4 ratio (p = 0.0001). Higher PCB levels were associated with higher free T4 (p = 0.0002), and higher free T3: free T4 ratio (p = 0.002). Importantly, the association between PBB and thyroid hormones was dependent on age at exposure. Among people exposed before age 16 (N = 446), higher PBB exposure was associated with higher total T3 (p = 0.01) and free T3 (p = 0.0003), lower free T4 (p = 0.04), and higher free T3: free T4 ratio (p = 0.0001). No significant associations were found among participants who were exposed after age 16. No significant associations were found between TSH and PBB or PCB in any of the analyses conducted. CONCLUSIONS This suggests that both PBB and PCB are associated with thyroid function, particularly among those who were exposed as children or prenatally.
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Affiliation(s)
- Sarah W. Curtis
- Emory University School of Medicine, 101 Woodruff Circle NE, Ste 2205A, Atlanta, GA 30322 USA
| | - Metrecia L. Terrell
- Emory University Rollins School of Public Health, 1518 Clifton Rd, Atlanta, GA 30322 USA
| | - Melanie H. Jacobson
- Emory University Rollins School of Public Health, 1518 Clifton Rd, Atlanta, GA 30322 USA
| | - Dawayland O. Cobb
- Emory University School of Medicine, 101 Woodruff Circle NE, Ste 2205A, Atlanta, GA 30322 USA
| | - Victoria S. Jiang
- Emory University School of Medicine, 101 Woodruff Circle NE, Ste 2205A, Atlanta, GA 30322 USA
| | - Michael F. Neblett
- Emory University School of Medicine, 101 Woodruff Circle NE, Ste 2205A, Atlanta, GA 30322 USA
| | - Sabrina A. Gerkowicz
- Emory University School of Medicine, 101 Woodruff Circle NE, Ste 2205A, Atlanta, GA 30322 USA
| | - Jessica B. Spencer
- Emory University School of Medicine, 101 Woodruff Circle NE, Ste 2205A, Atlanta, GA 30322 USA
| | - M. Elizabeth Marder
- Emory University Rollins School of Public Health, 1518 Clifton Rd, Atlanta, GA 30322 USA
| | - Dana Boyd Barr
- Emory University Rollins School of Public Health, 1518 Clifton Rd, Atlanta, GA 30322 USA
| | - Karen N. Conneely
- Emory University School of Medicine, 615 Michael St, Atlanta, GA 30322 USA
| | - Alicia K. Smith
- Emory University School of Medicine, 101 Woodruff Circle NE, Ste 2205A, Atlanta, GA 30322 USA
| | - Michele Marcus
- Emory University Rollins School of Public Health, 1518 Clifton Rd, Atlanta, GA 30322 USA
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Brenta G, Caballero AS, Nunes MT. CASE FINDING FOR HYPOTHYROIDISM SHOULD INCLUDE TYPE 2 DIABETES AND METABOLIC SYNDROME PATIENTS: A LATIN AMERICAN THYROID SOCIETY (LATS) POSITION STATEMENT. Endocr Pract 2019; 25:101-105. [PMID: 30742573 DOI: 10.4158/ep-2018-0317] [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] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Latin American Thyroid Society (LATS) Hypothyroidism Clinical Practice Guidelines recommend case finding of hypothyroid patients in multiple and different situations that agree with other Society guidelines. However, the detection of hypothyroidism in type 2 diabetes mellitus (T2DM) or metabolic syndrome (MetS) patients is not mentioned in particular. In the recent years, several basic and epidemiologic studies have appeared showing that a lower thyroid function and MetS/T2DM are associated. Hence, the aim of this review is to manifest the LATS position on the diagnosis of hypothyroidism in both MetS and T2DM patients. METHODS A search was made in PubMed using the following terms: "hypothyroidism" AND "diabetes" OR "metabolic syndrome." The most relevant studies describing the prevalence and complications due to hypothyroidism in both MetS and T2DM patients were selected. RESULTS The current document reviews new information from studies that have shown that the prevalence of hypothyroidism is higher in T2DM patients (odds ratio [OR], 3.45; 95% confidence interval [CI], 2.5 to 4.7) and that diabetic complications are more prevalent in subclinical hypothyroidism (ScH). The incidence of T2DM is 1.09-fold higher with each doubling of thyroid-stimulating hormone (TSH) mIU/L (95% CI, 1.06 to 1.12), and the incidence of prediabetes increases 15% (hazard ratio, 1.15; 95% CI, 1.04 to 1.26) in patients with TSH >5 mIU/L. Similarly, MetS is more prevalent in ScH compared to euthyroid individuals (OR, 1.31; 95% CI, 1.08 to 1.60). CONCLUSION Thyroid function is affected in MetS and T2DM, and hypothyroidism is more common in these patients. Diabetic complications are more frequent in ScH patients. Therefore, LATS now recommends aggressive case finding of hypothyroidism in both MetS and T2DM patients. ABBREVIATIONS CI = confidence interval; GLUT4 = glucose transporter 4; HOMA-IR = homeostatic model assessment for insulin resistance; HR = hazard ratio; LATS = Latin American Thyroid Society; MetS = metabolic syndrome; OR = odds ratio; ScH = subclinical hypothyroidism; T2DM = type 2 diabetes mellitus; T3 = triiodothyronine; T4 = thyroxine; TSH = thyroid-stimulating hormone.
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Comparison of performance and metabolism from late pregnancy to early lactation in dairy cows with elevated v. normal body condition at dry-off. Animal 2019; 13:1478-1488. [DOI: 10.1017/s1751731118003385] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Dose–response relationship between thyroid stimulating hormone and hypertension risk in euthyroid individuals. J Hypertens 2019; 37:144-153. [DOI: 10.1097/hjh.0000000000001826] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Kwon H, Cho JH, Lee DY, Park SE, Park CY, Lee WY, Oh KW, Park SW, Rhee EJ. Association between thyroid hormone levels, body composition and insulin resistance in euthyroid subjects with normal thyroid ultrasound: The Kangbuk Samsung Health Study. Clin Endocrinol (Oxf) 2018; 89:649-655. [PMID: 30052274 DOI: 10.1111/cen.13823] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 07/07/2018] [Accepted: 07/24/2018] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Thyroid hormones play crucial roles in the control of energy homoeostasis and can influence body composition. In contrast, the changes in body composition might influence thyroid hormone levels. We evaluated associations between thyroid hormone levels, body composition and insulin resistance in euthyroid subjects with normal thyroid ultrasound (US) findings. DESIGN AND PATIENTS This retrospective cross-sectional study included 36 655 euthyroid subjects who joined the medical health check-up programme at our institution. Serum thyroid hormone levels were analysed in association with body fat percentage (BFP), skeletal muscle mass index (SMI) and homoeostatic model assessment of insulin resistance (HOMA-IR). Linear regression analyses were performed to evaluate relationships between thyroid hormone levels and anthropometric parameters. RESULTS Mean age was 36.4 years, and 49% of subjects were female. In multiple linear regression analysis, serum-free triiodothyronine (FT3) levels exhibited positive associations with waist circumference (WC) and HOMA-IR and a negative association with body weight, body mass index (BMI) and SMI among both men and women. The association between serum-free thyroxine (FT4) levels and anthropometric markers showed inconsistent results in men and women. Serum thyroid-stimulating hormone (TSH) levels showed a positive association with HOMA-IR in both men and women. CONCLUSIONS Lower SMI was significantly associated with higher serum FT3 levels, the active form of thyroid hormone, in both men and women. Higher insulin resistance was positively associated with serum FT3 levels and inversely associated with serum TSH levels in euthyroid subjects with normal thyroid US findings.
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Affiliation(s)
- Hyemi Kwon
- Department of Endocrinology and Metabolism, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jung-Hwan Cho
- Department of Endocrinology and Metabolism, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Da Young Lee
- Department of Endocrinology and Metabolism, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Se Eun Park
- Department of Endocrinology and Metabolism, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Cheol-Young Park
- Department of Endocrinology and Metabolism, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Won-Young Lee
- Department of Endocrinology and Metabolism, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ki-Won Oh
- Department of Endocrinology and Metabolism, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sung-Woo Park
- Department of Endocrinology and Metabolism, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Eun-Jung Rhee
- Department of Endocrinology and Metabolism, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
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Park E, Jung J, Araki O, Tsunekawa K, Park SY, Kim J, Murakami M, Jeong SY, Lee S. Concurrent TSHR mutations and DIO2 T92A polymorphism result in abnormal thyroid hormone metabolism. Sci Rep 2018; 8:10090. [PMID: 29973617 PMCID: PMC6031622 DOI: 10.1038/s41598-018-28480-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 06/21/2018] [Indexed: 12/11/2022] Open
Abstract
Deiodinase 2 (DIO2) plays an important role in thyroid hormone metabolism and its regulation. However, molecular mechanism that regulates DIO2 activity remains unclear; only mutaions in selenocysteine insertion sequence binding protein 2 and selenocysteine tranfer RNA (tRNA[Ser]Sec) are reported to result in decreased DIO2 activity. Two patients with clinical evidence of abnormal thyroid hormone metabolism were identified and found to have TSHR mutations as well as DIO2 T92A single nucleotide polymorphism (SNP). Primary-cultured fibroblasts from one patient present a high level of basal DIO2 enzymatic activity, possibly due to compensation by augmented DIO2 expression. However, this high enzymatic active state yet fails to respond to accelerating TSH. Consequently, TSHR mutations along with DIO2 T92A SNP ("double hit") may lead to a significant reduction in DIO2 activity stimulated by TSH, and thereby may have clinical relevance in a select population of hypothyroidism patients who might benefit from a T3/T4 combination therapy.
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Affiliation(s)
- Eunkuk Park
- Department of Medical Genetics, Ajou University School of Medicine, Suwon, Republic of Korea
- Department of Biomedical Sciences, Ajou University Graduate School of Medicine, Suwon, Republic of Korea
| | - Jaehoon Jung
- Department of Internal medicine, Gyeongsang Institute of Health Science, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Osamu Araki
- Department of Clinical Laboratory Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Katsuhiko Tsunekawa
- Department of Clinical Laboratory Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - So Young Park
- Department of Internal Medicine, Cheil General Hospital and Women's Healthcare Center, Dankook University College of Medicine, Seoul, Republic of Korea
| | - Jeonghyun Kim
- Department of Medical Genetics, Ajou University School of Medicine, Suwon, Republic of Korea
- Department of Biomedical Sciences, Ajou University Graduate School of Medicine, Suwon, Republic of Korea
| | - Masami Murakami
- Department of Clinical Laboratory Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Seon-Yong Jeong
- Department of Medical Genetics, Ajou University School of Medicine, Suwon, Republic of Korea.
- Department of Biomedical Sciences, Ajou University Graduate School of Medicine, Suwon, Republic of Korea.
| | - Sihoon Lee
- Department of Internal Medicine and Laboratory of Genomics and Translational Medicine, Gachon University School of Medicine, Incheon, Republic of Korea.
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Wolffenbuttel BHR, Wouters HJCM, Slagter SN, van Waateringe RP, Muller Kobold AC, van Vliet-Ostaptchouk JV, Links TP, van der Klauw MM. Thyroid function and metabolic syndrome in the population-based LifeLines cohort study. BMC Endocr Disord 2017; 17:65. [PMID: 29037214 PMCID: PMC5644133 DOI: 10.1186/s12902-017-0215-1] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 10/09/2017] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The metabolic syndrome (MetS) is a combination of unfavourable health factors which includes abdominal obesity, dyslipidaemia, elevated blood pressure and impaired fasting glucose. Earlier studies have reported a relationship between thyroid function and some MetS components or suggested that serum free thyroxine (FT4) or free triiodothyronine (FT3) levels within the normal range were independently associated with insulin resistance. We assessed how thyroid function relates to MetS prevalence in a large population-based study. METHODS Data of 26,719 people of western European descent, aged 18-80 years from the Dutch LifeLines Cohort study, all with normal thyroid stimulating hormone (TSH), FT4 and FT3 levels (electrochemiluminescent immunoassay, Roche Modular E170 Analyzer), were available. MetS was defined with the revised National Cholesterol Education Programs Adults Treatment Panel III (NCEP ATP III) criteria. We calculated prevalence of all MetS components according to TSH, FT4 and FT3 quartiles. RESULTS At similar TSH levels and age (mean 45 yrs), men had significantly higher levels of FT4, FT3, blood pressure (BP), heart rate, total and LDL-cholesterol, triglycerides (TG), and creatinine, but lower HDL-cholesterol compared to women (all p < 0.001). In total, 11.8% of women and 20.7% of men had MetS. In men, lower FT4 levels were associated with higher prevalence of MetS and all MetS components. In women, lower FT4 quartile was only associated with a higher prevalence of elevated TG, waist circumference, and MetS. However, when corrected for confounding factors like age, BMI, current smoking and alcohol consumption, a significant relationship was found between FT3 and three MetS components in men, and all five components in women. Moreover, the highest quartiles of FT3 and the FT3FT4 ratio predicted a 49% and 67% higher prevalence of MetS in men, and a 62 and 80% higher prevalence in women. CONCLUSIONS When corrected for possible confounding factors, higher plasma levels of FT3 are associated with several components of the MetS. Only in men, lower FT4 is related to MetS. In the highest FT3 and FT3FT4 quartiles, there is a 50-80% increased risk of having MetS compared to the lowest quartile. Further studies are needed to assess the possible causality of this relationship.
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Affiliation(s)
- Bruce H. R. Wolffenbuttel
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, HPC AA31, P.O. Box 30001, 9700 RB Groningen, The Netherlands
| | - Hanneke J. C. M. Wouters
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, HPC AA31, P.O. Box 30001, 9700 RB Groningen, The Netherlands
| | - Sandra N. Slagter
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, HPC AA31, P.O. Box 30001, 9700 RB Groningen, The Netherlands
| | - Robert P. van Waateringe
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, HPC AA31, P.O. Box 30001, 9700 RB Groningen, The Netherlands
| | - Anneke C. Muller Kobold
- Department of Clinical Chemistry, University of Groningen, University Medical Center Groningen, HPC AA31, P.O. Box 30001, 9700 RB Groningen, The Netherlands
| | - Jana V. van Vliet-Ostaptchouk
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, HPC AA31, P.O. Box 30001, 9700 RB Groningen, The Netherlands
| | - Thera P. Links
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, HPC AA31, P.O. Box 30001, 9700 RB Groningen, The Netherlands
| | - Melanie M. van der Klauw
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, HPC AA31, P.O. Box 30001, 9700 RB Groningen, The Netherlands
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