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Aweimer A, Dietrich JW, Santoro F, Fàbregas MC, Mügge A, Núñez-Gil IJ, Vazirani R, Vedia O, Pätz T, Ragnatela I, Arcari L, Volpe M, Corbì-Pascual M, Martinez-Selles M, Almendro-Delia M, Sionis A, Uribarri A, Thiele H, Brunetti ND, Eitel I, Stiermaier T, Hamdani N, Abumayyaleh M, Akin I, El-Battrawy I. Takotsubo syndrome outcomes predicted by thyroid hormone signature: insights from cluster analysis of a multicentre registry. EBioMedicine 2024; 102:105063. [PMID: 38502972 PMCID: PMC10963195 DOI: 10.1016/j.ebiom.2024.105063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 02/28/2024] [Accepted: 03/03/2024] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND Recently, abnormal thyroid function was shown to be common in patients with Takotsubo syndrome (TTS), being classified into "endocrine-type" and "stress-type" responses. The aim of this study was to investigate the association between thyroid homeostasis and TTS in a larger international registry. METHODS In total 288 patients with TTS were enrolled through the GEIST multicentre registry from Germany, Italy and Spain. Thyrotropin (TSH), free T4 (FT4) and free T3 (FT3) concentrations were analysed at admission. Data were collected both retrospectively and prospectively from 2017 onwards. Primary endpoints included in-hospital and all-cause fatality, determined by cluster analysis using an unsupervised machine learning algorithm (k-medoids). FINDINGS Three clusters were identified, classifying TTS with low (TSLT), high (TSHT) and normal (TSNT) thyroid output, based on TSH and FT4 levels in relation to the median thyroid's secretory capacity (SPINA-GT). Although TSH and FT4 concentrations were similar among survivors and non-survivors, these clusters were significantly associated with patient outcomes. In the longitudinal Kaplan-Meier analysis including in- and out-of-hospital survival, the prognosis related to concentrations of TSH, FT4, and FT3 as well as SPINA-GT, deiodinase activity (SPINA-GD) and clusters. Patients in the TSHT cluster and with cardiogenic shock had a lower initial left ventricular ejection fraction (LVEF). INTERPRETATION This study suggests that thyroid hormones may impact the evolution and prognosis of TTS. The findings indicate that thyroid-derived biomarkers may help identify high-risk patients and pave the way for novel personalized and preventive therapeutic options. FUNDING This research was not funded by any public, commercial, or not-for-profit agencies.
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Affiliation(s)
- Assem Aweimer
- Cardiology and Angiology Department, Medical Hospital II, Bergmannsheil University Hospitals, Ruhr University of Bochum, Bochum, NRW, Germany.
| | - Johannes W Dietrich
- Diabetes, Endocrinology and Metabolism Section, Department of Medicine I, St. Josef University Hospital, Ruhr University of Bochum, Bochum, NRW, Germany; Diabetes Centre Bochum/Hattingen, St. Elisabeth Hospital Blankenstein, Im Vogelsang 5-11, Hattingen 45527, Germany; Centre for Rare Endocrine Diseases, Ruhr Centre for Rare Diseases (CeSER), Ruhr University Bochum and Witten/Herdecke University, Alexandrinenstr. 5, Bochum 44791, Germany; Centre for Diabetes Technology, Catholic Hospitals Bochum, Gudrunstr. 56, Bochum 44791, Germany; Centre for Thyroid Medicine, Catholic Hospitals Bochum, Gudrunstr. 56, Bochum 44791, Germany
| | - Francesco Santoro
- University of Foggia, Department of Medical and Surgical Sciences, Foggia, Italy
| | - Mireia Camins Fàbregas
- Diabetes, Endocrinology and Metabolism Section, Department of Medicine I, St. Josef University Hospital, Ruhr University of Bochum, Bochum, NRW, Germany; Diabetes Centre Bochum/Hattingen, St. Elisabeth Hospital Blankenstein, Im Vogelsang 5-11, Hattingen 45527, Germany; Centre for Rare Endocrine Diseases, Ruhr Centre for Rare Diseases (CeSER), Ruhr University Bochum and Witten/Herdecke University, Alexandrinenstr. 5, Bochum 44791, Germany; Centre for Diabetes Technology, Catholic Hospitals Bochum, Gudrunstr. 56, Bochum 44791, Germany; Centre for Thyroid Medicine, Catholic Hospitals Bochum, Gudrunstr. 56, Bochum 44791, Germany
| | - Andreas Mügge
- Cardiology and Angiology Department, Medical Hospital II, Bergmannsheil University Hospitals, Ruhr University of Bochum, Bochum, NRW, Germany
| | - Iván J Núñez-Gil
- Hospital Clínico Universitario San Carlos, Interventional Cardiology, Cardiovascular Institute, Madrid, Spain
| | - Ravi Vazirani
- Hospital Clínico Universitario San Carlos, Interventional Cardiology, Cardiovascular Institute, Madrid, Spain
| | - Oscar Vedia
- Hospital Clínico Universitario San Carlos, Interventional Cardiology, Cardiovascular Institute, Madrid, Spain
| | - Toni Pätz
- University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine) and German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Ilaria Ragnatela
- University of Foggia, Department of Medical and Surgical Sciences, Foggia, Italy
| | - Luca Arcari
- Institute of Cardiology, Madre Giuseppina Vannini Hospital, Rome, Italy
| | - Massimo Volpe
- Department of Clinical and Molecular Medicine, University of Rome Sapienza and IRCCS San Raffaele Rome, Italy
| | | | - Manuel Martinez-Selles
- Department of Cardiology, Hospital General Universitario Gregorio Marañon, CIBERCV, Madrid, Spain; Universidad Europea, Universidad Complutense, Madrid, Spain
| | | | - Alessandro Sionis
- Servicio de Cardiología, Hospital Virgen de la Macarena, Sevilla, Spain
| | - Aitor Uribarri
- Cardiology Service, Vall d'Hebron, University Hospital, Barcelona, Spain; CIBERCV, Madrid, Spain
| | - Holger Thiele
- Heart Center Leipzig at University of Leipzig and Leipzig Heart Science, Department of Internal Medicine/Cardiology, Leipzig, Germany
| | | | - Ingo Eitel
- University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine) and German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Thomas Stiermaier
- University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine) and German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Nazha Hamdani
- Institut für Forschung und Lehre (IFL), Department of Molecular and Experimental Cardiology, Ruhr-University Bochum, Bochum, Germany; Institute of Physiology, Ruhr-University Bochum, Bochum, Germany
| | - Mohammad Abumayyaleh
- First Department of Medicine, Faculty of Medicine University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany
| | - Ibrahim Akin
- First Department of Medicine, Faculty of Medicine University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany
| | - Ibrahim El-Battrawy
- Cardiology and Angiology Department, Medical Hospital II, Bergmannsheil University Hospitals, Ruhr University of Bochum, Bochum, NRW, Germany
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Xiao XQ, Fu FS, Xiang C, Yan HC. Sensitivity to thyroid hormones is associated with sleep duration in the euthyroid population with depression degree lower than moderate. Sci Rep 2024; 14:6583. [PMID: 38503873 PMCID: PMC10951236 DOI: 10.1038/s41598-024-57373-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 03/18/2024] [Indexed: 03/21/2024] Open
Abstract
We collected thyroid-related hormone index levels, sleep duration, and other basic characteristics of the population with depression from the NHANES 2009-2012 cycles and evaluated the association of Thyroid-Stimulating Hormone Index (TSHI) with sleep duration in the euthyroid population with depression via different analysis methods. We found that the association between TSHI and sleep duration was only found in patients with depression degree < Moderate (score: 1-14) rather than > Moderate group. Among the populations with degree < Moderate (N = 1918), only 4 indexes (parametric Thyroid Feedback Quantile Index, PTFQI, Thyrotroph Thyroxine Resistance Index, TT4RI, Thyroid-Stimulating Hormone TSH, and TSHI) reflecting the sensitivity to thyroid hormones were related to the sleep duration, with a significant non-linear relationship after adjusting for potential confounders (all P < 0.05). Trend analysis indicated that with the level increase of these 4 indexes, the sleep duration increased (all P for trend < 0.001). Further, we found that TSHI was relatively more important among the 4 indexes. Sum up, sensitivity to thyroid hormones is associated with sleep duration in the euthyroid population with depression degree lower than Moderate. Poor sensitivity referred to a longer sleep duration.
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Affiliation(s)
- Xian-Qiu Xiao
- Thyroid and Breast Surgery, The 904th Hospital of Joint Logistic Support Force of PLA (Wuxi Taihu Hospital), Wuxi, 214044, Jiangsu, China
| | - Fu-Shan Fu
- Head and Neck Thyroid Surgery, The First Affiliated Hospital of Baotou Medical College of Inner Mongolia University of Science and Technology, Baotou, 014010, Neimenggu, China
| | - Cheng Xiang
- Department of Thyroid Surgery, The Second Affiliated Hospital of Zhejiang University School of Medicine, No. 88 Jiefang Road, Shangcheng District, Hangzhou, 310009, Zhejiang, China.
| | - Hai-Chao Yan
- Department of Thyroid Surgery, The Second Affiliated Hospital of Zhejiang University School of Medicine, No. 88 Jiefang Road, Shangcheng District, Hangzhou, 310009, Zhejiang, China.
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Chen S, Yang W, Guo Z, Lv X, Zou Y. Association between serum vitamin D levels and sensitivity to thyroid hormone indices: a cross-sectional observational study in NHANES 2007-2012. Front Endocrinol (Lausanne) 2023; 14:1243999. [PMID: 37745711 PMCID: PMC10513485 DOI: 10.3389/fendo.2023.1243999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 08/07/2023] [Indexed: 09/26/2023] Open
Abstract
Objective We designed this study to determine whether there is a link between vitamin D levels and sensitivity to thyroid hormone and to provide a new perspective for studying the relationship between vitamin D and thyroid disease. Methods Our study included 8,126 participators from the National Health and Nutrition Examination Survey (NHANES) database between 2007 and 2012. We used weighted multiple linear regression models to enquire the connection between serum vitamin D levels and thyroid hormone sensitivity indicators, including the following: Thyroid-stimulating hormone index (TSHI), Free Triiodothyronine/Free thyroxine (FT3/FT4), Thyroid Feedback Quantile-based Index (TFQI), and Thyrotroph Thyroxine Resistance Index (TT4RI). Finally, we used constrained cubic splines to explore possible nonlinear relationships. All data cleaning and statistical analyses were performed using R software. Results The final Results were reached after adjusting for various confounding factors. We found a U-shaped relationship between TFQI and serum vitamin D, and the lowest TFQI appeared when the serum vitamin D concentration was 25.77ng/ml. However, an inverse U-shaped relationship was found between FT3/FT4 and vitamin D levels. When the serum vitamin D concentration was 25.43ng/ml, the ratio of FT3/FT4 was the highest. Conclusion In the US population, our study concluded that FTQI and FT3/FT4 were U-shaped or inverse-U-shaped with serum vitamin D levels respectively after several adjustments. Therefore, FTQI and FT3/FT4 are considered indicators of the complex relationship between thyroid hormone resistance and vitamin D metabolism. In the future, more complex prospective investigations are needed to confirm these findings and find a causal link between them.
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Affiliation(s)
| | | | | | - Xiaofei Lv
- Department of Internal Medicine, Guangdong Women and Children Hospital, Guangzhou, Guangdong, China
| | - Yandun Zou
- Department of Internal Medicine, Guangdong Women and Children Hospital, Guangzhou, Guangdong, China
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Wu X, Zhai F, Chang A, Wei J, Guo Y, Zhang J. Association between sensitivity to thyroid hormone indices and osteoporosis in euthyroid patients with type 2 diabetes mellitus. Ther Adv Chronic Dis 2023; 14:20406223231189230. [PMID: 37538345 PMCID: PMC10395177 DOI: 10.1177/20406223231189230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 06/08/2023] [Indexed: 08/05/2023] Open
Abstract
Background Thyroid hormones are known to regulate bone metabolism and may influence bone mineral density (BMD), as well as the risk of osteoporosis (OP) and fractures in patients with type 2 diabetes mellitus (T2DM). Recently, sensitivity to thyroid hormone indices has been linked with T2DM and OP independently. However, the relationship between thyroid hormone sensitivity and OP in euthyroid T2DM patients has yet to be investigated. Objectives The aim of this study was to determine the association between sensitivity to thyroid hormone indices and the risk of OP in euthyroid patients with T2DM. Design This study employed a retrospective, cross-sectional design and utilized data acquired from the Cangzhou Central Hospital in China between 2019 and 2020. Methods We retrospectively analyzed the data of 433 patients with T2DM for anthropometric measurements, clinical laboratory test results, and BMD. The thyroid-stimulating hormone index, thyrotroph thyroxine resistance index, and thyroid feedback quantile-based index (TFQI) were calculated to determine thyroid hormone sensitivity. Finally, multivariable logistic regression, generalized additive models, and subgroup analysis were performed to detect the association between sensitivity to thyroid hormone indices and the risk of OP in these patients. Results We did not observe a statistically significant linear relationship between sensitivity to thyroid hormones indices and OP after covariate adjustment. However, a nonlinear relationship existed between TFQI and the prevalence of OP. The inflection point of the TFQI was at -0.29. The effect sizes (odds ratio) on the left and right of the inflection point were 0.07 [95% confidence interval (CI): 0.01-0.71; p = 0.024] and 2.78 (95% CI: 1.02-7.58; p = 0.046), respectively. This trend was consistent in older female patients with higher body mass index (BMI; 25-30 kg/m2). Conclusion An approximate U-shaped relationship was observed between sensitivity to thyroid hormone indices and OP risk in euthyroid patients with T2DM with variations in sex, age, and BMI. These findings provide a new perspective to elucidate the role of thyroid hormones in OP, specifically in patients with T2DM.
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Affiliation(s)
- Xuelun Wu
- Department of Endocrinology, Cangzhou Central Hospital, 16 Xinhua West Road, Cangzhou City 061000, Hebei Province, PR China
| | - Furui Zhai
- Gynecological clinic, Cangzhou Central Hospital, Cangzhou City, Hebei Province, PR China
| | - Ailing Chang
- Department of Endocrinology, Cangzhou Central Hospital, Cangzhou City, Hebei Province, PR China
| | - Jing Wei
- Department of Endocrinology, Cangzhou Central Hospital, Cangzhou City, Hebei Province, PR China
| | - Yanan Guo
- Department of Endocrinology, Cangzhou Central Hospital, Cangzhou City, Hebei Province, PR China
| | - Jincheng Zhang
- Department of Endocrinology, Cangzhou Central Hospital, Cangzhou City, Hebei Province, PR China
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Fitzgerald SP, Bean NG, Falhammar H, Hoermann R. Physiological linkage of thyroid and pituitary sensitivities. Endocrine 2023; 79:143-151. [PMID: 36115005 PMCID: PMC9813051 DOI: 10.1007/s12020-022-03184-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 08/28/2022] [Indexed: 01/09/2023]
Abstract
OBJECTIVES The sensitivities of the pituitary to thyroxine feedback, and the thyroid to thyrotropin stimulation determine the free thyroxine /thyrotropin feedback loop and can be described mathematically by two curves. It is not well understood how the two curves combine in a healthy population with normal thyroid function to express the individual balance points that are observed. This study was directed at this issue testing the possibilities of random combination and directed linkage between the two curves. METHODS We reverse-engineered two sets of population data, on the assumption of independent combinations of thyroid and pituitary sensitivities, to obtain estimates of the curve describing thyroid sensitivity. Sensitivity studies were performed. RESULTS No analysis resulted in a physiologically feasible estimate of the curve describing thyroid sensitivity. There was evidence of linkage of the two curves in terms of their combination throughout the normal range. Thyroid response curves reflecting a low free thyroxine response to thyrotropin tended to be combined in individuals with thyrotropin curves reflecting a high thyrotropin response to free thyroxine, and vice versa. CONCLUSIONS Thyroid and pituitary sensitivities are linked, being combined in individuals in a non-random directed pattern. Direct mutual interaction may contribute to this linkage. This linkage precludes the derivation of the curves describing these sensitivities from population data of the free thyroxine and thyrotropin relationship and complicates their derivation by physiological experimentation. This linkage and probable interaction may also bestow evolutionary advantage by minimising inter-individual variation in free thyroxine levels and by augmenting homeostasis.
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Affiliation(s)
- Stephen Paul Fitzgerald
- The Departments of General Medicine and Endocrinology, The Royal Adelaide Hospital, Adelaide, SA, Australia.
- The University of Adelaide, School of Medicine, Adelaide, SA, Australia.
| | - Nigel G Bean
- School of Mathematical Sciences and ARC Centre of Excellence for Mathematical and Statistical Frontiers, University of Adelaide, Adelaide, SA, 5000, Australia
| | - Henrik Falhammar
- Department of Endocrinology, Karolinska University Hospital, 171 76, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, 171 76, Stockholm, Sweden
| | - Rudolf Hoermann
- Klinikum Lüdenscheid, Paulmannshöherstr. 14, 58515, Lüdenscheid, Germany
- 113 Andersons Road, Yandina, QLD, 4561, Australia
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Yang J, Ding W, Wang H, Shi Y. Association Between Sensitivity to Thyroid Hormone Indices and Diabetic Retinopathy in Euthyroid Patients with Type 2 Diabetes Mellitus. Diabetes Metab Syndr Obes 2023; 16:535-545. [PMID: 36874555 PMCID: PMC9984276 DOI: 10.2147/dmso.s399910] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 01/27/2023] [Indexed: 03/03/2023] Open
Abstract
OBJECTIVE Normal thyroid hormone (TH) levels and their relation to microvascular complications in patients with type 2 diabetes mellitus (T2DM) have been studied. However, the relationship between TH sensitivity and diabetic retinopathy (DR) remains unclear. Thus, this study aimed to investigate the relationship between TH sensitivity and the risk of DR in euthyroid T2DM patients. METHODS This retrospective study analyzed 422 T2DM patients and calculated their sensitivity to TH indices. Multivariable logistic regression, generalized additive model, and subgroup analysis were performed to examine the association between sensitivity to TH indices and DR risk. RESULTS After adjusting for covariates, the binary logistic regression model showed no statistically significant association between the sensitivity of TH indices and the risk of DR in euthyroid T2DM patients. However, a non-linear relationship was found between sensitivity to TH indices (thyroid-stimulating hormone index, thyroid feedback quantile index [TFQI]) and the risk of DR in the crude model; TFQI and DR in the adjusted model. The inflection point of the TFQI was 0.23. The effect size (odds ratio) on the left and right of the inflection point were 3.19 (95% confidence interval [CI]: 1.24 to 8.17 p=0.02) and 0.11 (95% CI: 0.01, 0.93 p=0.04), respectively. Moreover, this relationship was maintained by men stratified by sex. In euthyroid patients with T2DM, an approximate inverted U-shaped relationship and a threshold effect were demonstrated between TH index sensitivity and DR risk with sex differences. This study provided an in-depth understanding of the relationship between thyroid function and DR, which has important clinical implications for risk stratification and individual prediction.
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Affiliation(s)
- Jie Yang
- Department of Endocrinology, Cangzhou Central Hospital, Cangzhou, Hebei Province, 061000, People’s Republic of China
- Correspondence: Jie Yang, Department of Endocrinology, Cangzhou Central Hospital, Cangzhou, Hebei Province, 061000, People’s Republic of China, Email
| | - Wencui Ding
- Department of Endocrinology, Cangzhou Central Hospital, Cangzhou, Hebei Province, 061000, People’s Republic of China
| | - Haiying Wang
- Department of Endocrinology, Cangzhou Central Hospital, Cangzhou, Hebei Province, 061000, People’s Republic of China
| | - Yanan Shi
- Department of Endocrinology, Cangzhou Central Hospital, Cangzhou, Hebei Province, 061000, People’s Republic of China
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Hoermann R, Pekker MJ, Midgley JEM, Dietrich JW. The role of supporting and disruptive mechanisms of FT3 homeostasis in regulating the hypothalamic-pituitary-thyroid axis. Ther Adv Endocrinol Metab 2023; 14:20420188231158163. [PMID: 36936128 PMCID: PMC10017955 DOI: 10.1177/20420188231158163] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 12/18/2022] [Indexed: 03/18/2023] Open
Abstract
BACKGROUND Thyroid hormones are controlled by the hypothalamic-pituitary-thyroid (HPT) axis through a complex network of regulatory loops, involving the hormones TRH, TSH, FT4, and FT3. The relationship between TSH and FT4 is widely used for diagnosing thyroid diseases. However, mechanisms of FT3 homeostasis are not well understood. OBJECTIVE We used mathematical modelling to further examine mechanisms that exist in the HPT axis regulation for protecting circulating FT3 levels. METHODS A mathematical model consisting of a system of four coupled first-order parameterized non-linear ordinary differential equations (ODEs) was developed, accounting for the interdependencies between the hormones in the HPT axis regulation. While TRH and TSH feed forward to the pituitary and thyroid, respectively, FT4 and FT3 feed backward to both the pituitary and hypothalamus. Stable equilibrium solutions of the ODE system express homeostasis for a particular variable, such as FT3, if this variable stays in a narrow range while certain other parameter(s) and system variable(s) may vary substantially. RESULTS The model predicts that (1) TSH-feedforward protects FT3 levels if the FT4 production rate declines and (2) combined negative feedback by FT4 and FT3 on both TSH and TRH production rates keeps FT3 levels insensitive to moderate changes in FT4 production rates and FT4 levels. The optimum FT4 and FT3 feedback and TRH and TSH-feedforward ranges that preserve FT3 homeostasis were found by numerical continuation analysis. Model predictions were in close agreement with clinical studies and individual patient examples of hypothyroidism and hyperthyroidism. CONCLUSIONS These findings further extend the concept of HPT axis regulation beyond TSH and FT4 to integrate the more active sister hormone FT3 and mechanisms of FT3 homeostasis. Disruption of homeostatic mechanisms leads to disease. This provides a perspective for novel testable concepts in clinical studies to therapeutically target the disruptive mechanisms.
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Affiliation(s)
| | - Mark J. Pekker
- Mathematical Sciences Department, University of Alabama, Huntsville, AL, USA
| | | | - Johannes W. Dietrich
- Diabetes, Endocrinology and Metabolism Section, Department of Medicine I, St. Josef Hospital, Ruhr University Hospitals, Bochum, Germany
- Diabetes Centre Bochum/Hattingen, Blankenstein Hospital, Hattingen, Germany
- Centre for Diabetes Technology (ZDT), Catholic Hospitals Bochum, Bochum, Germany
- Centre for Rare Endocrine Diseases (ZSEK), Ruhr Center for Rare Diseases (CeSER), Ruhr University of Bochum and Witten/Herdecke University, Bochum, Germany
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Müller P, Leow MKS, Dietrich JW. Minor perturbations of thyroid homeostasis and major cardiovascular endpoints—Physiological mechanisms and clinical evidence. Front Cardiovasc Med 2022; 9:942971. [PMID: 36046184 PMCID: PMC9420854 DOI: 10.3389/fcvm.2022.942971] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 07/22/2022] [Indexed: 11/13/2022] Open
Abstract
It is well established that thyroid dysfunction is linked to an increased risk of cardiovascular morbidity and mortality. The pleiotropic action of thyroid hormones strongly impacts the cardiovascular system and affects both the generation of the normal heart rhythm and arrhythmia. A meta-analysis of published evidence suggests a positive association of FT4 concentration with major adverse cardiovascular end points (MACE), but this association only partially extends to TSH. The risk for cardiovascular death is increased in both subclinical hypothyroidism and subclinical thyrotoxicosis. Several published studies found associations of TSH and FT4 concentrations, respectively, with major cardiovascular endpoints. Both reduced and elevated TSH concentrations predict the cardiovascular risk, and this association extends to TSH gradients within the reference range. Likewise, increased FT4 concentrations, but high-normal FT4 within its reference range as well, herald a poor outcome. These observations translate to a monotonic and sensitive effect of FT4 and a U-shaped relationship between TSH and cardiovascular risk. Up to now, the pathophysiological mechanism of this complex pattern of association is poorly understood. Integrating the available evidence suggests a dual etiology of elevated FT4 concentration, comprising both ensuing primary hypothyroidism and a raised set point of thyroid function, e. g. in the context of psychiatric disease, chronic stress and type 2 allostatic load. Addressing the association between thyroid homeostasis and cardiovascular diseases from a systems perspective could pave the way to new directions of research and a more personalized approach to the treatment of patients with cardiovascular risk.
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Affiliation(s)
- Patrick Müller
- Department for Electrophysiology, Medical Hospital I, Klinikum Vest, Recklinghausen, NRW, Germany
| | - Melvin Khee-Shing Leow
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (ASTAR), Singapore, Singapore
- Department of Endocrinology, Tan Tock Seng Hospital, Singapore, Singapore
- Metabolic Disorders Research Programme, Lee Kong Chian School of Medicine, Singapore, Singapore
- Cardiovascular and Metabolic Disorders Program, Duke-NUS Medical School, Singapore, Singapore
| | - Johannes W. Dietrich
- Diabetes, Endocrinology and Metabolism Section, Department of Internal Medicine I, St. Josef Hospital, Ruhr University Bochum, Bochum, NRW, Germany
- Diabetes Centre Bochum/Hattingen, St. Elisabeth-Hospital Blankenstein, Hattingen, NRW, Germany
- Centre for Rare Endocrine Diseases, Ruhr Centre for Rare Diseases (CeSER), Ruhr University Bochum and Witten/Herdecke University, Bochum, NRW, Germany
- Centre for Diabetes Technology, Catholic Hospitals Bochum, Ruhr University Bochum, Bochum, NRW, Germany
- *Correspondence: Johannes W. Dietrich
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Chen S, Sun X, Zhou G, Jin J, Li Z. Association between sensitivity to thyroid hormone indices and the risk of osteoarthritis: an NHANES study. Eur J Med Res 2022; 27:114. [PMID: 35820977 PMCID: PMC9275280 DOI: 10.1186/s40001-022-00749-1] [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: 05/26/2022] [Accepted: 06/17/2022] [Indexed: 11/10/2022] Open
Abstract
Objectives Thyroid hormones play an instrumental role in chondrogenic differentiation and matrix maturation. However, studies investigating the relationship between thyroid function and the risk of osteoarthritis (OA) remain scarce. This study was designed to investigate the correlation between thyroid status and OA from a novel perspective of sensitivity to thyroid hormones. Methods The study included 8478 people from the National Health and Nutrition Examination Survey (NHANES) 2007–2010. The sensitivity to thyroid hormone indices included Thyrotroph Thyroxine Resistance Index (TT4RI), Thyroid-stimulating hormone (TSHI), Thyroid Feedback Quantile-based Index (TFQI), and Free Triiodothyronine /Free thyroxine (FT3/FT4), which were calculated based on serum free triiodothyronine (FT3), free thyroxine (FT4), and thyroid stimulating hormone (TSH). Considering the complex survey design and sample weights, we employed multivariate linear regression models and stratified analysis to evaluate the correlation between sensitivity to thyroid hormone indices and OA. Results Study results indicated that participants with OA had elevated TT4RI, TSHI, and TFQI levels, and lower FT3/FT4 levels compared to those with non-arthritis. After adjusting for other covariates, FT3/FT4 was negatively associated with the risk of OA (OR = 1.162, 95%CI 1.048–1.478, P = 0.021); (OR = 1.261, 95%CI 1.078–1.623, P = 0.042). In subgroup analyses stratified by gender and BMI, participants with OA had higher TFQI levels compared to those without OA in both genders. (OR = 1.491, 95%CI 1.070–2.077, P = 0.018); (OR = 2.548, 95%CI 1.929–3.365, P < 0.001). The higher TFQI levels were consistently associated with the increased prevalence of OA in the BMI (< 18.5 kg/m2) group after adjusting for different covariates, but not in other BMI groups. In, addition, TFQI performed better than FT3/FT4, TSHI, and TT4RI on ROC analyses for OA prediction. Conclusions The levels of FT3/FT4, TSHI, TT4RI, and TFQI are strongly associated with the prevalence of OA, which illustrates the complex correlation between the thyroid system and chondrogenic differentiation. TFQI may be used as a helpful indicator to predict OA and provide novel ideas for the evaluation and treatment of OA.
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Affiliation(s)
- Shuai Chen
- Department of Orthopaedics, The Second Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Xiaohe Sun
- Department of Oncology, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Guowei Zhou
- Department of General Surgery, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Jie Jin
- Department of Orthopaedics, The Second Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Zhiwei Li
- Department of Orthopaedics, The Second Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China.
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10
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Han M, Wu H, Yang W, Chen J. Analysis of risk factors for the development of type 2 diabetes mellitus complicated with Hashimoto's thyroiditis. BMC Endocr Disord 2022; 22:173. [PMID: 35804367 PMCID: PMC9264533 DOI: 10.1186/s12902-022-01092-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 07/04/2022] [Indexed: 11/16/2022] Open
Abstract
AIMS The purpose of this study is to elucidate the correlation between thyroid hormone, glycosylated hemoglobin (HbA1c), vitamin D and type 2 diabetes mellitus (T2DM) with Hashimoto's thyroiditis (HT), and to seek the independent predictors affecting disease development. METHODS The study included 44 T2DM with HT, 94 T2DM, and 112 healthy subjects. We investigated some laboratory factors like thyroid hormone and compared the levels. Independent predictors determination by logistic univariate regression analysis were analyzed. The diagnostic value of thyroid-stimulating hormone (TSH) and threshold concentration were determined by ROC curve. RESULTS In T2DM with HT group, levels of PTH, HbA1c were lower and levels of TSH were significantly higher, when compared with T2DM group. But there was no significant difference in vitamin D between these two groups. In both logistic univariate regression analysis and multiple logistic regression analysis, TSH, HbA1c were independent predictors for T2DM with HT. Based on the ROC curve, the best cut-off value of the TSH was 4 mIU/L (sensitivity 72.7%, specificity 94.6%, AUC = 0.832) for predicting T2DM with HT in T2DM patients. CONCLUSIONS TSH has increased risk for T2DM evolving into T2DM complicated with HT, so it is important to monitor the concentrations of TSH in patients with T2DM. Although vitamin D was not the independent predictor in T2DM with HT development, effect of vitamin D deficiency on the progress of diabetes and its complications should be taken into consideration.
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Affiliation(s)
- Meng Han
- Jiangxi Province Key Laboratory of Laboratory Medicine, Department of Clinical Laboratory, the Second Affiliated Hospital of Nanchang University, Nanchang, 330006, Jiangxi, P.R. China
- Queen Mary School, Nanchang University, Nanchang, 330006, Jiangxi, P.R. China
| | - Haoneng Wu
- School of Public Health, Nanchang University, Nanchang, 330006, Jiangxi, P.R. China
| | - Weiming Yang
- Jiangxi Province Key Laboratory of Laboratory Medicine, Department of Clinical Laboratory, the Second Affiliated Hospital of Nanchang University, Nanchang, 330006, Jiangxi, P.R. China
| | - Juanjuan Chen
- Jiangxi Province Key Laboratory of Laboratory Medicine, Department of Clinical Laboratory, the Second Affiliated Hospital of Nanchang University, Nanchang, 330006, Jiangxi, P.R. China.
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Fitzgerald SP, Falhammar H. Redefinition of Successful Treatment of Patients With Hypothyroidism. Is TSH the Best Biomarker of Euthyroidism? Front Endocrinol (Lausanne) 2022; 13:920854. [PMID: 35784560 PMCID: PMC9243528 DOI: 10.3389/fendo.2022.920854] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 05/10/2022] [Indexed: 12/14/2022] Open
Abstract
In recent years evidence has accumulated supporting a revised view of the nature of euthyroidism and the biomarkers of thyroid function. Within the normal range, variations in thyroid hormone levels are associated with variations in clinical parameters and outcomes. There are therefore no readily identified individually specific optimum levels of thyroid hormones for any individual. Levels around the middle of the normal population range may best reflect euthyroidism. These levels may have evolutionary advantages on the basis that adverse outcomes often increase with divergence from such levels, and physiological processes tend to minimise such inter-individual and intra-individual divergence. In populations of predominantly untreated individuals, levels of thyroid hormones and in particular levels of free thyroxine (FT4) correlate more often with clinical parameters than do levels of thyrotropin (TSH). Levels of thyroid hormones may therefore be regarded as the best available biomarkers of euthyroidism and dysthyroidism. It follows that 'subclinical hypothyroidism' (normal FT4/raised TSH levels), rather than being an accurate marker of peripheral tissue hypothyroidism is more a marker of decreased thyroid reserve and prognosis. The recent evidence suggests that treatment of hypothyroxinemia, regardless of the TSH level, and monitoring therapy using FT4 and/or triiodothyronine levels, depending on the replacement regime, may result in more successful treatment of hypothyroidism than relying on thyrotropin levels for patient selection and subsequent treatment monitoring. The equivalents of mid-range levels of thyroid hormones (especially FT4), adjusted by individual comorbidity concerns, may be rational general replacement targets. These implications of the new evidence may create opportunities for novel trials of thyroid replacement therapy.
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Affiliation(s)
- Stephen P. Fitzgerald
- The Departments of General Medicine and Endocrinology, The Royal Adelaide Hospital, Adelaide, SA, Australia
- School of Medicine, The University of Adelaide, Adelaide, SA, Australia
| | - Henrik Falhammar
- Department of Endocrinology, Karolinska University Hospital, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Menzies School of Health Research and Royal Darwin Hospital, Tiwi, NT, Australia
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12
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Hoermann R, Pekker MJ, Midgley JEM, Larisch R, Dietrich JW. Principles of Endocrine Regulation: Reconciling Tensions Between Robustness in Performance and Adaptation to Change. Front Endocrinol (Lausanne) 2022; 13:825107. [PMID: 35757421 PMCID: PMC9219553 DOI: 10.3389/fendo.2022.825107] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 05/02/2022] [Indexed: 02/06/2023] Open
Abstract
Endocrine regulation in the hypothalamic-pituitary-thyroid (HPT) axis is orchestrated by physiological circuits which integrate multiple internal and external influences. Essentially, it provides either of the two responses to overt biological challenges: to defend the homeostatic range of a target hormone or adapt it to changing environmental conditions. Under certain conditions, such flexibility may exceed the capability of a simple feedback control loop, rather requiring more intricate networks of communication between the system's components. A new minimal mathematical model, in the form of a parametrized nonlinear dynamical system, is here formulated as a proof-of-concept to elucidate the principles of the HPT axis regulation. In particular, it allows uncovering mechanisms for the homeostasis of the key biologically active hormone free triiodothyronine (FT3). One mechanism supports the preservation of FT3 homeostasis, whilst the other is responsible for the adaptation of the homeostatic state to a new level. Together these allow optimum resilience in stressful situations. Preservation of FT3 homeostasis, despite changes in FT4 and TSH levels, is found to be an achievable system goal by joining elements of top-down and bottom-up regulation in a cascade of targeted feedforward and feedback loops. Simultaneously, the model accounts for the combination of properties regarded as essential to endocrine regulation, namely sensitivity, the anticipation of an adverse event, robustness, and adaptation. The model therefore offers fundamental theoretical insights into the effective system control of the HPT axis.
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Affiliation(s)
- Rudolf Hoermann
- Department for Nuclear Medicine, Klinikum Lüdenscheid, Lüdenscheid, Germany
| | - Mark J. Pekker
- Mathematical Sciences Department, University of Alabama, Huntsville, AL, United States
| | | | - Rolf Larisch
- Department for Nuclear Medicine, Klinikum Lüdenscheid, Lüdenscheid, Germany
| | - Johannes W. Dietrich
- Diabetes, Endocrinology and Metabolism Section, Department of Medicine I, St. Josef Hospital, Ruhr-University of Bochum, Bochum, Germany
- Diabetes Centre Bochum/Hattingen, Ruhr University of Bochum, Bochum, Germany
- Ruhr Center for Rare Diseases (CeSER), Ruhr University of Bochum and Witten/Herdecke University, Bochum, Germany
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13
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Fitzgerald SP, Bean NG, Fitzgerald SP, Falhammar H. The application of new concepts of the assessment of the thyroid state to pregnant women. Front Endocrinol (Lausanne) 2022; 13:987397. [PMID: 36051398 PMCID: PMC9424676 DOI: 10.3389/fendo.2022.987397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 07/25/2022] [Indexed: 11/25/2022] Open
Abstract
Recently proposed concepts regarding the nature and assessment of the thyroid state have provided a model more consistent with empiric evidence. It now appears likely that there are no such entities as thyroid set points and individual euthyroidism. Rather than there being discrete thyroid states, peripheral organ parameters are associated with thyroid function in a continuous manner. Thyroid hormone levels and, in particular, levels of free thyroxine now appear to be superior to thyrotropin levels as indicators of the thyroid state. Complicating the assessment of the correlations of the thyroid state with pregnancy outcomes are the contribution of the placenta to maternal thyroid function, fetal thyroid development, the multiple potential pathways to any particular outcome, the likely presence of small critical periods of time, the differing genetics of fetal and maternal tissues, and the unreliability of thyroid hormone assays. Nevertheless, there is no apparent reason for there to be a change in pregnancy to the basic principles of thyroid hormone action. The relationships between mild abnormalities of the thyroid state and pregnancy outcomes and the value of treating such mild abnormalities remain uncertain and controversial. The evidence suggests that further investigation of these clinical questions might better be based on thyroid hormone, particularly free thyroxine, levels. In the investigation of borderline low thyroid states, the categories of subclinical hypothyroidism and isolated hypothyroxinemia might both be abandoned with attention being directed to low free thyroxine levels regardless of the thyroid-stimulating hormone (TSH) levels. For these changes to occur, there would ideally be improvements in the assays for free thyroxine in pregnancy. The evidence suggests that, just as in the non-pregnant situation, pregnancy guidelines based on thyrotropin levels may need revision.
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Affiliation(s)
- Stephen P. Fitzgerald
- The Departments of General Medicine and Endocrinology, The Royal Adelaide Hospital, Adelaide, SA, Australia
- School of Medicine, The University of Adelaide, Adelaide, SA, Australia
- *Correspondence: Stephen P. Fitzgerald,
| | - Nigel G. Bean
- Adjunct Professor, School of Mathematical Science, University of Adelaide, Adelaide, SA, Australia
| | - Samuel P. Fitzgerald
- Department of Obstetrics and Gynaecology, The Townsville Hospital, Townsville, QLD, Australia
- School of Medicine, University of Queensland, St Lucia, QLD, Australia
| | - Henrik Falhammar
- Department of Endocrinology, Karolinska University Hospital, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
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14
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Chen S, Huang W, Zhou G, Sun X, Jin J, Li Z. Association between Sensitivity to Thyroid Hormone Indices and Bone Mineral Density in US Males. Int J Endocrinol 2022; 2022:2205616. [PMID: 36340930 PMCID: PMC9629943 DOI: 10.1155/2022/2205616] [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] [Received: 03/22/2022] [Revised: 07/28/2022] [Accepted: 09/14/2022] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES Thyroid hormone is acknowledged as a pivotal factor in skeletal development and adult bone maintenance. However, available data about the relationship between sensitivity to thyroid hormone and bone mineral density (BMD) remain limited and conflicting. The purpose of the study was to explore the complex relationship between sensitivity to thyroid hormone indices and BMD using cross-sectional analysis. METHODS An overall sample of 3,107 males from the National Health and Nutrition Examination Survey (NHANES) was studied in the study. The thyroid hormone sensitivity indices included free triiodothyronine/tree thyroxine (FT3/FT4), thyroid-stimulating hormone index (TSHI), thyrotroph thyroxine resistance index (TT4RI), and thyroid feedback quantile-based index (TFQI). Given the complex study design and sample weights, the correlation between sensitivity to thyroid hormone indices and BMD was evaluated through multivariate linear regression models, and extra subgroup analyses were performed to examine the robustness of the results. RESULTS Among the 3,107 participants, we demonstrated that FT3/FT4 was negatively correlated with lumbar BMD (β = -0.0.35, 95% CI: -0.084-0.013, P < 0.05). In the terms of central sensitivity to thyroid hormone, TFQI showed a significant negative relationship with the BMD of the lumbar (β = -0.018, 95% CI: -0.033 to -0.003, P < 0.05), total femur (β = -0.020, 95% CI: -0.035 to -0.006, P < 0.01), and femur neck (β = -0.018, 95% CI: -0.031 to -0.005, P < 0.01). In the subgroup analyses stratified by body mass index (BMI), the significant negative correlation between TFQI and lumbar BMD remained in the male participants with BMI between 18.5 and 24.9 kg/m2. CONCLUSIONS Decreased indices of sensitivity to thyroid hormones are strongly associated with increased lumbar BMD, suggesting that the dysfunction of peripheral and central response to thyroid hormone might contribute to bone loss. In addition, FT3/FT4 and TFQI were considered to be the preferable indicators to guide the prevention and clinical treatment of osteoporosis.
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Affiliation(s)
- Shuai Chen
- Department of Orthopaedics, The Second Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Wucui Huang
- Department of Respiratory and Critical Care Medicine, Zhongda Hospital Affiliated to Southeast University, Nanjing, China
| | - Guowei Zhou
- Department of General Surgery, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Xiaohe Sun
- Department of Oncology, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Jie Jin
- Department of Orthopaedics, The Second Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Zhiwei Li
- Department of Orthopaedics, The Second Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
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15
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Wu K, Zhou Y, Ke S, Huang J, Gao X, Li B, Lin X, Liu X, Liu X, Ma L, Wang L, Wu L, Wu L, Xie C, Xu J, Wang Y, Liu L. Lifestyle is associated with thyroid function in subclinical hypothyroidism: a cross-sectional study. BMC Endocr Disord 2021; 21:112. [PMID: 34049544 PMCID: PMC8161919 DOI: 10.1186/s12902-021-00772-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 05/17/2021] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Few studies have focused on the association between lifestyle and subclinical hypothyroidism (SCH). The purpose of this study was to investigate the association between lifestyle and thyroid function in SCH. METHODS This study was a part of a community-based and cross-sectional study, the Epidemiological Survey of Thyroid Diseases in Fujian Province, China. A total of 159 participants with SCH (81 males and 78 females) and 159 euthyroid (87 males and 72 females) participants without any missing data were included in the analysis. General information and lifestyle information including sleep, exercise, diet and smoking habits of the participants was collected by questionnaire and Pittsburgh sleep quality index scale (PSQI) was collected. Thyroid stimulating hormone (TSH), free thyroxine (FT4), thyroid peroxidase antibody (TPOAb), thyroid globulin antibody (TgAb) and urine iodine concentration (UIC) were tested. Thyroid homeostasis parameter thyroid' s secretory capacity (SPINA-GT), Jostel's TSH index (TSHI), thyrotroph T4 sensitivity index (TTSI) were calculated. Logistic regression and multiple linear regression were performed to assess associations. RESULTS Compared with euthyroid subjects, patients with SCH were more likely to have poor overall sleep quality (15.1 vs.25.8 %, P = 0.018) and l less likely to stay up late on weekdays (54.7 vs. 23.9 % P < 0.001). In SCH group, exercise was the influencing factor of TSH (β= -0.224, P = 0.004), thyroid secretory capacity (β = 0.244, P = 0.006) and thyrotropin resistance (β = 0.206, P = 0.009). Iodine excess was the influencing factor of thyroid secretory capacity (β = 0.209, P = 0.001) and pituitary thyroid stimulating function (β = 0.167, P = 0.034). Smoking was the influencing factor of pituitary thyroid stimulating function (β = 0.161, P = 0.040). Staying up late on weekends was the influencing factor of thyroid secretory capacity (β = 0.151, P = 0.047). After adjusting for possible confounders, logistic regression showed that those with poor overall sleep quality assessed by PSQI and iodine excess had an increased risk of SCH (OR 2.159, 95 %CI 1.186-3.928, P = 0.012 and OR 2.119, 95 %CI 1.008-4.456, P = 0.048, respectively). CONCLUSIONS Lifestyle including sleep, smoking, diet and exercise was closely related to thyroid function especially thyroid homeostasis in SCH.
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Affiliation(s)
- Kejun Wu
- Department of Endocrinology and Metabolism, Fujian Medical University Union Hospital, 29 Xinquan Road, Fujian, 350001, Fuzhou, China
| | - Yu Zhou
- Department of Endocrinology and Metabolism, Fujian Medical University Union Hospital, 29 Xinquan Road, Fujian, 350001, Fuzhou, China
- Department of Clinical Pharmacy and Pharmacy Administration, School of Pharmacy, Fujian Medical University, 350122, Fuzhou, Fujian, China
| | - Sujie Ke
- Department of Endocrinology and Metabolism, Fujian Medical University Union Hospital, 29 Xinquan Road, Fujian, 350001, Fuzhou, China
| | - Jingze Huang
- Department of Endocrinology and Metabolism, Fujian Medical University Union Hospital, 29 Xinquan Road, Fujian, 350001, Fuzhou, China
| | - Xuelin Gao
- Department of Endocrinology and Metabolism, Fujian Medical University Union Hospital, 29 Xinquan Road, Fujian, 350001, Fuzhou, China
| | - Beibei Li
- Department of Endocrinology and Metabolism, Fujian Medical University Union Hospital, 29 Xinquan Road, Fujian, 350001, Fuzhou, China
| | - Xiaoying Lin
- Department of Endocrinology and Metabolism, Fujian Medical University Union Hospital, 29 Xinquan Road, Fujian, 350001, Fuzhou, China
| | - Xiaohong Liu
- Department of Endocrinology and Metabolism, Fujian Medical University Union Hospital, 29 Xinquan Road, Fujian, 350001, Fuzhou, China
| | - Xiaoying Liu
- Department of Endocrinology and Metabolism, Fujian Medical University Union Hospital, 29 Xinquan Road, Fujian, 350001, Fuzhou, China
| | - Li Ma
- Department of Endocrinology and Metabolism, Fujian Medical University Union Hospital, 29 Xinquan Road, Fujian, 350001, Fuzhou, China
| | - Linxi Wang
- Department of Endocrinology and Metabolism, Fujian Medical University Union Hospital, 29 Xinquan Road, Fujian, 350001, Fuzhou, China
| | - Li Wu
- Department of Endocrinology and Metabolism, Fujian Medical University Union Hospital, 29 Xinquan Road, Fujian, 350001, Fuzhou, China
| | - Lijuan Wu
- Department of Endocrinology and Metabolism, Fujian Medical University Union Hospital, 29 Xinquan Road, Fujian, 350001, Fuzhou, China
| | - Chengwen Xie
- Department of Endocrinology and Metabolism, Fujian Medical University Union Hospital, 29 Xinquan Road, Fujian, 350001, Fuzhou, China
| | - Junjun Xu
- Department of Endocrinology and Metabolism, Fujian Medical University Union Hospital, 29 Xinquan Road, Fujian, 350001, Fuzhou, China
| | - Yanping Wang
- Department of Endocrinology and Metabolism, Fujian Medical University Union Hospital, 29 Xinquan Road, Fujian, 350001, Fuzhou, China.
| | - Libin Liu
- Department of Endocrinology and Metabolism, Fujian Medical University Union Hospital, 29 Xinquan Road, Fujian, 350001, Fuzhou, China.
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16
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Aweimer A, El-Battrawy I, Akin I, Borggrefe M, Mügge A, Patsalis PC, Urban A, Kummer M, Vasileva S, Stachon A, Hering S, Dietrich JW. Abnormal thyroid function is common in takotsubo syndrome and depends on two distinct mechanisms: results of a multicentre observational study. J Intern Med 2021; 289:675-687. [PMID: 33179374 DOI: 10.1111/joim.13189] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 08/25/2020] [Accepted: 09/15/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Several reports have described Takotsubo syndrome (TTS) secondary to thyrotoxicosis. A complex interaction of central and peripheral catecholamines with thyroid homeostasis has been suggested. In this study, we analysed sequential thyroid hormone profiles during the acute phase of TTS. METHODS Thyrotropin (TSH), free T4 (FT4) and free T3 (FT3) concentrations were analysed at predefined time points in 32 patients presenting with TTS or acute coronary syndrome (ACS, n = 16 in each group) in a 2-year period in two German university hospitals. Data were compared to age- and sex-matched controls (10 samples, each of 16 subjects), and an unsupervised machine learning (ML) algorithm identified patterns in the hormone signature. Subjects with thyroid disease and patients receiving amiodarone were excluded from follow-up. RESULTS Among patients with TTS, FT4 concentrations were significantly higher when compared to controls or ACS. Four subjects (25%) suffered from subclinical or overt thyrotoxicosis. Two additional patients developed subclinical or overt thyrotoxicosis during stay in hospital. In four subjects (25%), FT4 concentrations were increased, despite nonsuppressed TSH concentration, representing an elevated set point of thyroid homeostasis. The thyroid hormone profile was normal in only six patients (38%) presenting with TTS. CONCLUSION Abnormal thyroid function is frequent in patients with TTS. Primary hyperthyroidism and an elevated set point of thyroid homeostasis are common in TTS, suggesting a stress-dependent endocrine response or type 2 thyroid allostasis. Thyroid function may be a worthwhile target in treating or preventing TTS.
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Affiliation(s)
- A Aweimer
- From the, Department of Cardiology and Angiology, Bergmannsheil University Hospitals, Ruhr University of Bochum, Bochum, Germany
| | - I El-Battrawy
- First Department of Medicine, Faculty of Medicine University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany
| | - I Akin
- First Department of Medicine, Faculty of Medicine University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany
| | - M Borggrefe
- First Department of Medicine, Faculty of Medicine University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany
| | - A Mügge
- From the, Department of Cardiology and Angiology, Bergmannsheil University Hospitals, Ruhr University of Bochum, Bochum, Germany
| | - P C Patsalis
- From the, Department of Cardiology and Angiology, Bergmannsheil University Hospitals, Ruhr University of Bochum, Bochum, Germany
| | - A Urban
- Klinik für Anästhesiologie, Intensiv- und Palliativmedizin, Klinikum Kaufbeuren, Kaufbeuren, Germany
| | - M Kummer
- First Department of Medicine, Faculty of Medicine University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany
| | - S Vasileva
- Department of Endocrinology and Diabetes, Bergmannsheil University Hospitals, Ruhr University of Bochum, Bochum, Germany
| | - A Stachon
- Institut für Laboratoriumsmedizin, Westpfalz-Klinikum Kaiserslautern, Kaiserslautern, Germany
| | - S Hering
- Medizinische Klinik III, Diabetes Zentrum Rheine, Mathias Spital, Rheine, Germany
| | - J W Dietrich
- Department of Endocrinology and Diabetes, Bergmannsheil University Hospitals, Ruhr University of Bochum, Bochum, Germany.,Ruhr Center for Rare Diseases (CeSER), Ruhr University of Bochum and Witten/Herdecke University, Bochum, Germany
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17
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Zhou Y, Ke S, Wu K, Huang J, Gao X, Li B, Lin X, Liu X, Liu X, Ma L, Wang L, Wu L, Wu L, Xie C, Xu J, Wang Y, Liu L. Correlation between Thyroid Homeostasis and Obesity in Subclinical Hypothyroidism: Community-Based Cross-Sectional Research. Int J Endocrinol 2021; 2021:6663553. [PMID: 34135958 PMCID: PMC8179776 DOI: 10.1155/2021/6663553] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 04/26/2021] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE It remains unknown whether obesity has an effect on the pituitary-thyroid feedback control axis in subclinical hypothyroidism (SCH). We aimed to investigate the association of thyroid homeostasis with obesity in a SCH population. METHODS Our study consisted of a community-based and cross-sectional study from the Epidemiological Survey of Thyroid Diseases in Fujian Province, China. A total of 193 subjects with SCH (90 males and 103 females) without a history of treatment of thyroid disease, such as surgery, radiation, and thyroid hormone or antithyroid medication, were included in the present study. Indices of obesity, including body mass index (BMI), waist circumference (WC), and waist-height ratio (WHtR) were measured. RESULTS Our results showed that the secretory capacity of the thyroid gland (SPINA-GT) and Jostel's thyrotropin index (TSHI) were negatively correlated with BMI, WC, and WHtR, whereas the reciprocal of the thyrotroph thyroid hormone resistance index (TTSI-1) was positively correlated with BMI (all p < 0.05). After adjustment for age, sex, smoking, iodine status, and glucolipid metabolism, the associations between TSHI, TTSI (reciprocal transformation), and BMI still persisted (all p < 0.05). CONCLUSIONS These results suggest that low levels of thyroid homeostasis indexes may be associated with overall obesity in SCH, rather than central adiposity.
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Affiliation(s)
- Yu Zhou
- Department of Endocrinology and Metabolism, Fujian Medical University Union Hospital, Fuzhou 350001, Fujian, China
- Department of Clinical Pharmacy and Pharmacy Administration, School of Pharmacy, Fujian Medical University, Fuzhou 350122, Fujian, China
| | - Sujie Ke
- Department of Endocrinology and Metabolism, Fujian Medical University Union Hospital, Fuzhou 350001, Fujian, China
| | - Kejun Wu
- Department of Endocrinology and Metabolism, Fujian Medical University Union Hospital, Fuzhou 350001, Fujian, China
| | - Jingze Huang
- Department of Endocrinology and Metabolism, Fujian Medical University Union Hospital, Fuzhou 350001, Fujian, China
| | - Xuelin Gao
- Department of Endocrinology and Metabolism, Fujian Medical University Union Hospital, Fuzhou 350001, Fujian, China
| | - Beibei Li
- Department of Endocrinology and Metabolism, Fujian Medical University Union Hospital, Fuzhou 350001, Fujian, China
| | - Xiaoying Lin
- Department of Endocrinology and Metabolism, Fujian Medical University Union Hospital, Fuzhou 350001, Fujian, China
| | - Xiaohong Liu
- Department of Endocrinology and Metabolism, Fujian Medical University Union Hospital, Fuzhou 350001, Fujian, China
| | - Xiaoying Liu
- Department of Endocrinology and Metabolism, Fujian Medical University Union Hospital, Fuzhou 350001, Fujian, China
| | - Li Ma
- Department of Endocrinology and Metabolism, Fujian Medical University Union Hospital, Fuzhou 350001, Fujian, China
| | - Linxi Wang
- Department of Endocrinology and Metabolism, Fujian Medical University Union Hospital, Fuzhou 350001, Fujian, China
| | - Li Wu
- Department of Endocrinology and Metabolism, Fujian Medical University Union Hospital, Fuzhou 350001, Fujian, China
| | - Lijuan Wu
- Department of Endocrinology and Metabolism, Fujian Medical University Union Hospital, Fuzhou 350001, Fujian, China
| | - Chengwen Xie
- Department of Endocrinology and Metabolism, Fujian Medical University Union Hospital, Fuzhou 350001, Fujian, China
| | - Junjun Xu
- Department of Endocrinology and Metabolism, Fujian Medical University Union Hospital, Fuzhou 350001, Fujian, China
| | - Yanping Wang
- Department of Endocrinology and Metabolism, Fujian Medical University Union Hospital, Fuzhou 350001, Fujian, China
| | - Libin Liu
- Department of Endocrinology and Metabolism, Fujian Medical University Union Hospital, Fuzhou 350001, Fujian, China
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Dietrich JW, Hoermann R, Midgley JEM, Bergen F, Müller P. The Two Faces of Janus: Why Thyrotropin as a Cardiovascular Risk Factor May Be an Ambiguous Target. Front Endocrinol (Lausanne) 2020; 11:542710. [PMID: 33193077 PMCID: PMC7649136 DOI: 10.3389/fendo.2020.542710] [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: 03/13/2020] [Accepted: 10/02/2020] [Indexed: 12/12/2022] Open
Abstract
Elevated concentrations of free thyroid hormones are established cardiovascular risk factors, but the association of thyrotropin (TSH) levels to hard endpoints is less clear. This may, at least in part, ensue from the fact that TSH secretion depends not only on the supply with thyroid hormones but on multiple confounders including genetic traits, medication and allostatic load. Especially psychosocial stress is a still underappreciated factor that is able to adjust the set point of thyroid function. In order to improve our understanding of thyroid allostasis, we undertook a systematic meta-analysis of published studies on thyroid function in post-traumatic stress disorder (PTSD). Studies were identified via MEDLINE/PubMed search and available references, and eligible were reports that included TSH or free thyroid hormone measurements in subjects with and without PTSD. Additionally, we re-analyzed data from the NHANES 2007/2008 cohort for a potential correlation of allostatic load and thyroid homeostasis. The available evidence from 13 included studies and 3386 euthyroid subjects supports a strong association of both PTSD and allostatic load to markers of thyroid function. Therefore, psychosocial stress may contribute to cardiovascular risk via an increased set point of thyroid homeostasis, so that TSH concentrations may be increased for reasons other than subclinical hypothyroidism. This provides a strong perspective for a previously understudied psychoendocrine axis, and future studies should address this connection by incorporating indices of allostatic load, peripheral thyroid hormones and calculated parameters of thyroid homeostasis.
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Affiliation(s)
- Johannes Wolfgang Dietrich
- Endocrinology and Diabetes Department, Medical Hospital I, Bergmannsheil University Hospitals, Ruhr University of Bochum, Bochum, Germany
- Ruhr Center for Rare Diseases (CeSER), Ruhr University of Bochum and Witten/Herdecke University, Bochum, Germany
| | - Rudolf Hoermann
- Private Consultancy, Research and Development, Yandina, QLD, Australia
| | | | - Friederike Bergen
- Department of Psychiatry and Psychotherapy, LVR-Klinikum Düsseldorf, Düsseldorf, Germany
| | - Patrick Müller
- Department of Cardiology II, Münster University Hospitals, University of Münster, Münster, Germany
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Hoermann R, Midgley JEM, Larisch R, Dietrich JW. Individualised requirements for optimum treatment of hypothyroidism: complex needs, limited options. Drugs Context 2019; 8:212597. [PMID: 31516533 PMCID: PMC6726361 DOI: 10.7573/dic.212597] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Revised: 07/09/2019] [Accepted: 07/15/2019] [Indexed: 12/21/2022] Open
Abstract
Levothyroxine (LT4) therapy has a long history, a well-defined pharmacological profile and a favourable safety record in the alleviation of hypothyroidism. However, questions remain in defining the threshold for the requirement of treatment in patients with subclinical hypothyroidism, assessing the dose adequacy of the drug, and selecting the best treatment mode (LT4 monotherapy versus liothyronine [LT3]/LT4 combinations) for subpopulations with persisting complaints. Supplied as a prodrug, LT4 is enzymatically converted into the biologically more active thyroid hormone, triiodothyronine (T3). Importantly, tetraiodothyronine (T4) to T3 conversion efficiency may be impaired in patients receiving LT4, resulting in a loss of thyroid-stimulating hormone (TSH)-mediated feed-forward control of T3, alteration of the interlocking equilibria between serum concentrations of TSH, free thyroxine (FT4), and free triiodothyonine (FT3), and a decrease in FT3 to FT4 ratios. This downgrades the value of the TSH reference system derived in thyroid health for guiding the replacement dose in the treatment situation. Individualised conditionally defined setpoints may therefore provide appropriate biochemical targets to be clinically tested, together with a stronger focus on clinical presentation and future endpoint markers of tissue thyroid state. This cautionary note encompasses the use of aggregated statistical data from clinical trials which are not safely applicable to the individual level of patient care under these circumstances.
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Affiliation(s)
- Rudolf Hoermann
- Department for Nuclear Medicine, Klinikum Lüdenscheid, Paulmannshöherstr. 14, 58515 Lüdenscheid, Germany
| | | | - Rolf Larisch
- Department for Nuclear Medicine, Klinikum Lüdenscheid, Paulmannshöherstr. 14, 58515 Lüdenscheid, Germany
| | - Johannes W Dietrich
- Medical Department I, Endocrinology and Diabetology, Bergmannsheil University Hospitals, Ruhr University of Bochum, Buerkle-de-la-Camp-Platz 1, 44789 Bochum, Germany.,Ruhr Center for Rare Diseases (CeSER), Ruhr University of Bochum and Witten/Herdecke University, Alexandrinenstr. 5, 44791 Bochum, Germany
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Abstract
Objective Thyroid hormones affect airway contraction, but the specific effects of
thyroid hormones on airways are controversial. Methods We divided 78 advanced-age men with asthma into 3 groups: type I respiratory
failure (RF1), type II respiratory failure (RF2), and no respiratory failure
(NRF). Pulmonary function was measured after asthma stabilization. Results The free triiodothyronine (FT3) level was significantly higher in the RF1
than RF2 group, but the free thyroxine (FT4), total thyroxine (TT4), and
thyroid-stimulating hormone (TSH) levels were not significantly different.
In the RF1, RF2, and NRF groups, the correlation coefficients between FT3
and the forced expiratory volume in1 s (FEV1) were 0.317, 0.627,
and 0.213; those between FT3 and the FEV1/forced vital capacity
(FVC) ratio were 0.287, 0.412, and 0.156; those between FT4 and
FEV1 were 0.214, 0.231, and 0.167; and those between FT4 and
the FEV1/FVC ratio were 0.211, 0.215, and 0.218, respectively. In
the RF1 and RF2 groups, the correlation coefficients between the sum
activity of peripheral deiodinases (SPINA-GD) and the FEV1/FVC
ratio were 0.164 and 0.421, and those between SPINA-GD and FEV1
were 0.284 and 0.491, respectively. Conclusion The correlation between FT3 and pulmonary function is likely caused by
changes in thyroid enzymology.
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Affiliation(s)
- Zhan Bingyan
- Respiratory Medicine Department, The West District of Qingdao Municipal Hospital Group (Qingdao Ninth People's Hospital), Qingdao, Shandong, China
| | - Wei Dong
- Respiratory Medicine Department, Qingdao Municipal Hospital Group, Qingdao, Shandong, China
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