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Fukuda T, Tachibana S, Osako T, Mori Y, Shindo H, Takahashi H, Satoh S, Nagayama Y, Yamashita H. Alterations in Body Weight and Composition in Patients With Graves' Disease Treated with Total Thyroidectomy. Cureus 2024; 16:e63338. [PMID: 39070443 PMCID: PMC11283590 DOI: 10.7759/cureus.63338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2024] [Indexed: 07/30/2024] Open
Abstract
OBJECTIVE Thyrotoxicosis causes excess energy expenditure, resulting in weight loss, despite increased appetite, and changes in body composition, which are typically reversible with the normalization of thyroid hormone levels. However, patients with hyperthyroidism due to Graves' disease are sometimes hesitant to undergo treatment because of the perceived morbidity associated with weight gain. Therefore, obtaining data to explain the details of such weight gain to these patients is important. This study aimed to investigate changes in body weight and composition in patients with Graves' disease after total thyroidectomy. METHODS In total, 21 patients with Graves' disease who underwent total thyroidectomy were enrolled. Among them, nine patients were hyperthyroid (group A) and 12 were euthyroid (group B, control) immediately before surgery. Body weight, height, and body composition using bioelectrical impedance were measured preoperatively and five months postoperatively. RESULTS In all patients, body weight, body mass index, and skeletal muscle mass, but not fat mass, significantly increased postoperatively. In individual groups, a significant increase in skeletal muscle and fat masses was observed solely in groups A and B, respectively. Furthermore, a significant positive correlation between preoperative thyroid function and differences in skeletal muscle mass preoperatively and postoperatively was found. CONCLUSION Our study shows that the normalization of thyroid function using thyroidectomy in patients with Graves' disease is accompanied by weight gain, mainly due to an increase in skeletal muscle mass. These data are clinically significant because they enable physicians to explain to patients that weight gain after surgical treatment for Graves' disease is favorable and reassure them of their concern.
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Affiliation(s)
- Takashi Fukuda
- Department of Endocrinology, Yamashita Thyroid Hospital, Fukuoka City, JPN
| | - Seigo Tachibana
- Department of Endocrinology, Yamashita Thyroid Hospital, Fukuoka City, JPN
| | - Tomohiro Osako
- Department of Endocrinology, Tomo Thyroid Clinic, Kagoshima City, JPN
| | - Yusuke Mori
- Department of Endocrinology, Tomo Thyroid Clinic, Kagoshima City, JPN
| | - Hisakazu Shindo
- Department of Surgery, Yamashita Thyroid Hospital, Fukuoka City, JPN
| | - Hiroshi Takahashi
- Department of Surgery, Yamashita Thyroid Hospital, Fukuoka City, JPN
| | - Shinya Satoh
- Department of Surgery, Yamashita Thyroid Hospital, Fukuoka City, JPN
| | - Yuji Nagayama
- Department of Endocrinology, Yamashita Thyroid Hospital, Fukuoka City, JPN
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Pan Y, Hu M, Zhao F, Ren J. Associations between low muscle mass and clinical characteristics of health population in China. Osteoporos Sarcopenia 2024; 10:35-39. [PMID: 38690545 PMCID: PMC11056461 DOI: 10.1016/j.afos.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 11/27/2023] [Accepted: 02/24/2024] [Indexed: 05/02/2024] Open
Abstract
Objectives The primary aim of this study is to discern the association between specific clinical parameters and low muscle mass (LMM). We endeavor to elucidate the determinants of LMM and the predictive potency of individual factors. Methods In this retrospective cross-sectional study, we encompassed 450 older adult Chinese participants (252 males and 198 females). Muscle mass quantifications were performed using bioelectrical impedance analysis. Comprehensive data encompassing demographic details (age, sex, height, and weight) and laboratory results (complete blood count, thyroid function, liver function, and renal function) were systematically recorded. Logistic regression models, coupled with receiver operating characteristic curve analytics, were employed to ascertain the variables influencing LMM and to evaluate the predictive validity of each parameter on LMM. Results Upon confounding adjustment for age, gender, body mass index (BMI), and free thyroxine (FT4) persisted as a determinant of LMM. Specifically, individuals with an FT4 exceeding 1.105 ng/dL exhibited a 1.803-fold increased propensity for LMM relative to those with FT4 values below the specified threshold. Incorporating age, gender, BMI, and FT4 in the diagnostic algorithm enhanced the precision of LMM. The results differ between men and women. In the male population, we can still observe that FT4 has a certain value in the diagnosis of LMM, but this phenomenon is not found in the female population. Conclusions Elevated FT4 concentrations, albeit within clinically accepted limits, are inversely associated with muscle mass. As such, FT4 could be postulated as a potential biomarker for LMM in geriatric individuals, especially in the male group.
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Affiliation(s)
- Yunfei Pan
- Department of General Medicine, Huzhou Hospital of Zhejiang University School of Medicine, Huzhou, Zhejing, 313000, China
| | - Mengjie Hu
- Department of General Medicine, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejing, 310003, China
| | - Feimin Zhao
- Department of Geriatric Medicine, Huzhou Central Hospital, Affiliated Central Hospital of Huzhou University, Huzhou, Zhejing, 313000, China
| | - Jingjing Ren
- Department of General Medicine, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejing, 310003, China
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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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Wang K, Zhang D, Cao G, Wang C, Wang L, Zhao R, He Q, Hou X, Gong L, Chen L. A Low Free T3 to Free T4 Ratio Is Associated with Sarcopenia in Euthyroid Patients with Type 2 Diabetes Mellitus. J Diabetes Res 2022; 2022:2305156. [PMID: 36034587 PMCID: PMC9402295 DOI: 10.1155/2022/2305156] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 06/16/2022] [Accepted: 08/03/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND This research evaluated the link between normal thyroid hormone levels and sarcopenia in patients with type 2 diabetes mellitus (T2DM). METHODS This cross-sectional study enrolled 312 euthyroid patients with T2DM from Qilu Hospital of the Shandong University, China. Body composition, grip strength, and physical performance were assessed as per the 2019 consensus guidelines of the Asian Working Group for Sarcopenia. Binary logistic regression was used to examine the correlation between thyroid hormone levels and sarcopenia and its components. RESULTS The prevalence of sarcopenia was 26.9%. Following adjustments for potential confounders, a high-normal serum free triiodothyronine (FT3) level (odds ratio (OR) = 0.522, 95% confidence interval (CI): 0.304-0.895, P = 0.018), a low-normal serum free thyroxine (FT4) level (OR = 1.126, 95% CI: 1.009-1.258, P = 0.034), and a heightened FT3/FT4 ratio (OR = 0.923, 95% CI: 0.879-0.969, P = 0.001) were linked to a low prevalence of sarcopenia. Considering the components of sarcopenia, FT3 concentration was positively associated with muscle strength (OR = 0.525, 95% CI: 0.305-0.902, P = 0.020) and physical performance (OR = 0.443, 95% CI: 0.259-0.758, P = 0.003), while FT4 concentration was negatively linked to muscle mass (OR = 1.114, 95% CI: 1.009-1.232, P = 0.036). The FT3/FT4 ratio was positively linked to muscle mass (OR = 0.943, 95% CI: 0.905-0.981, P = 0.006), muscle strength (OR = 0.945, 95% CI: 0.901-0.992, P = 0.021), and physical performance (OR = 0.934, 95% CI: 0.894-0.975, P = 0.002). Nevertheless, thyroid-stimulating hormone concentration was not associated with sarcopenia. CONCLUSION A high FT3/FT4 ratio was significantly linked to a lowered risk of sarcopenia in euthyroid patients with T2DM.
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Affiliation(s)
- Kewei Wang
- Department of Endocrinology, Qilu Hospital of Shandong University, Jinan 250012, China
- Institute of Endocrine and Metabolic Diseases of Shandong University, Jinan 250012, China
- Key Laboratory of Endocrine and Metabolic Diseases, Shandong Province Medicine & Health, Jinan 250012, China
- Jinan Clinical Research Center for Endocrine and Metabolic Diseases, Jinan 250012, China
| | - Di Zhang
- Department of Endocrinology, Qilu Hospital of Shandong University, Jinan 250012, China
- Institute of Endocrine and Metabolic Diseases of Shandong University, Jinan 250012, China
- Key Laboratory of Endocrine and Metabolic Diseases, Shandong Province Medicine & Health, Jinan 250012, China
- Jinan Clinical Research Center for Endocrine and Metabolic Diseases, Jinan 250012, China
| | - Guanglei Cao
- Department of Endocrinology, Qilu Hospital of Shandong University, Jinan 250012, China
- Institute of Endocrine and Metabolic Diseases of Shandong University, Jinan 250012, China
- Key Laboratory of Endocrine and Metabolic Diseases, Shandong Province Medicine & Health, Jinan 250012, China
- Jinan Clinical Research Center for Endocrine and Metabolic Diseases, Jinan 250012, China
| | - Chuan Wang
- Department of Endocrinology, Qilu Hospital of Shandong University, Jinan 250012, China
- Institute of Endocrine and Metabolic Diseases of Shandong University, Jinan 250012, China
- Key Laboratory of Endocrine and Metabolic Diseases, Shandong Province Medicine & Health, Jinan 250012, China
- Jinan Clinical Research Center for Endocrine and Metabolic Diseases, Jinan 250012, China
| | - Lingshu Wang
- Department of Endocrinology, Qilu Hospital of Shandong University, Jinan 250012, China
- Institute of Endocrine and Metabolic Diseases of Shandong University, Jinan 250012, China
- Key Laboratory of Endocrine and Metabolic Diseases, Shandong Province Medicine & Health, Jinan 250012, China
- Jinan Clinical Research Center for Endocrine and Metabolic Diseases, Jinan 250012, China
| | - Ruxing Zhao
- Department of Endocrinology, Qilu Hospital of Shandong University, Jinan 250012, China
- Institute of Endocrine and Metabolic Diseases of Shandong University, Jinan 250012, China
- Key Laboratory of Endocrine and Metabolic Diseases, Shandong Province Medicine & Health, Jinan 250012, China
- Jinan Clinical Research Center for Endocrine and Metabolic Diseases, Jinan 250012, China
| | - Qin He
- Department of Endocrinology, Qilu Hospital of Shandong University, Jinan 250012, China
- Institute of Endocrine and Metabolic Diseases of Shandong University, Jinan 250012, China
- Key Laboratory of Endocrine and Metabolic Diseases, Shandong Province Medicine & Health, Jinan 250012, China
- Jinan Clinical Research Center for Endocrine and Metabolic Diseases, Jinan 250012, China
| | - Xinguo Hou
- Department of Endocrinology, Qilu Hospital of Shandong University, Jinan 250012, China
- Institute of Endocrine and Metabolic Diseases of Shandong University, Jinan 250012, China
- Key Laboratory of Endocrine and Metabolic Diseases, Shandong Province Medicine & Health, Jinan 250012, China
- Jinan Clinical Research Center for Endocrine and Metabolic Diseases, Jinan 250012, China
| | - Lei Gong
- Department of Endocrinology, Qilu Hospital of Shandong University, Jinan 250012, China
- Institute of Endocrine and Metabolic Diseases of Shandong University, Jinan 250012, China
- Key Laboratory of Endocrine and Metabolic Diseases, Shandong Province Medicine & Health, Jinan 250012, China
- Jinan Clinical Research Center for Endocrine and Metabolic Diseases, Jinan 250012, China
| | - Li Chen
- Department of Endocrinology, Qilu Hospital of Shandong University, Jinan 250012, China
- Institute of Endocrine and Metabolic Diseases of Shandong University, Jinan 250012, China
- Key Laboratory of Endocrine and Metabolic Diseases, Shandong Province Medicine & Health, Jinan 250012, China
- Jinan Clinical Research Center for Endocrine and Metabolic Diseases, Jinan 250012, China
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Effraimidis G, Watt T, Feldt-Rasmussen U. Levothyroxine Therapy in Elderly Patients With Hypothyroidism. Front Endocrinol (Lausanne) 2021; 12:641560. [PMID: 33790867 PMCID: PMC8006441 DOI: 10.3389/fendo.2021.641560] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 02/03/2021] [Indexed: 01/06/2023] Open
Abstract
Levothyroxine (L-T4) treatment of overt hypothyroidism can be more challenging in elderly compared to young patients. The elderly population is growing, and increasing incidence and prevalence of hypothyroidism with age are observed globally. Elderly people have more comorbidities compared to young patients, complicating correct diagnosis and management of hypothyroidism. Most importantly, cardiovascular complications compromise the usual start dosage and upward titration of L-T4 due to higher risk of decompensating cardiac ischemia and -function. It therefore takes more effort and care from the clinician, and the maintenance dose may have to be lower in order to avoid a cardiac incidence. On the other hand, L-T4 has a beneficial effect on cardiac function by increasing performance. The clinical challenge should not prevent treating with L-T4 should the patient develop e.g., cardiac ischemia. The endocrinologist is obliged to collaborate with the cardiologist on prophylactic cardiac measures by invasive cardiac surgery or medical therapy against cardiac ischemic angina. This usually allows subsequent successful treatment. Management of mild (subclinical) hypothyroidism is even more complex. Prevalent comorbidities in the elderly complicate correct diagnosis, since many concomitant morbidities can result in non-thyroidal illness, resembling mild hypothyroidism both clinically and biochemically. The diagnosis is further complicated as methods for measuring thyroid function (thyrotropin and thyroxine) vary immensely according to methodology and background population. It is thus imperative to ensure a correct diagnosis by etiology (e.g., autoimmunity) before deciding to treat. Even then, there is controversy regarding whether or not treatment of such mild forms of hypothyroidism in elderly will improve mortality, morbidity, and quality of life. This should be studied in large cohorts of patients in long-term placebo-controlled trials with clinically relevant outcomes. Other cases of hypothyroidism, e.g., medications, iodine overload or hypothalamus-pituitary-hypothyroidism, each pose specific challenges to management of hypothyroidism; these cases are also more frequent in the elderly. Finally, adherence to treatment is generally challenging. This is also the case in elderly patients, which may necessitate measuring thyroid hormones at individually tailored intervals, which is important to avoid over-treatment with increased risk of cardiac morbidity and mortality, osteoporosis, cognitive dysfunction, and muscle deficiency.
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Affiliation(s)
- Grigoris Effraimidis
- Department of Medical Endocrinology and Metabolism, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Torquil Watt
- Department of Medical Endocrinology and Metabolism, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Internal Medicine, Endocrine Section, Copenhagen University Hospital Herlev Gentofte, Copenhagen, Denmark
| | - Ulla Feldt-Rasmussen
- Department of Medical Endocrinology and Metabolism, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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