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Guia Lopes ML, Bello C, Cidade JP, Cunha C, Limbert C, Sequeira Duarte J. Exploring Post-treatment Weight Changes in Overweight and Obese Patients With Graves' Disease: A Retrospective Analysis. Cureus 2024; 16:e59408. [PMID: 38826612 PMCID: PMC11139545 DOI: 10.7759/cureus.59408] [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: 04/30/2024] [Indexed: 06/04/2024] Open
Abstract
INTRODUCTION Graves' disease (GD) is associated with primary hyperthyroidism, leading to weight loss before treatment. During the treatment, weight gain is frequently observed, often surpassing the initial weight loss. This study aimed to analyze weight fluctuations in GD patients, focusing on the subset of overweight and obese (OAO) individuals, considering the significant metabolic implications and heightened cardiovascular risk of these weight changes. METHODS A retrospective cohort study included 122 GD patients with biochemical primary hyperthyroidism and at least 12 months of clinical follow-up after treatment for analysis. The OAO cohort comprised individuals with a body mass index (BMI) ≥25 kg/m². Data on laboratory, demographic, and weight variables were collected longitudinally. RESULTS During the hyperthyroidism state, 34.4% (n=42) of patients presented with weight loss, a phenomenon linked to lower serum thyroid-stimulating hormone levels at diagnosis (p=0.010) and an extended need for anti-thyroid drug treatment (p<0.001). Following treatment, around 60% (n=73) of individuals encountered weight gain, exhibiting a higher prevalence among women (p<0.001) and those undergoing definitive treatment modalities (p=0.024). Notably, 26.2% (n=32) experienced excessive weight gain, which was correlated with higher premorbid BMI and diminished weight loss induced by hyperthyroidism (p<0.001). Within the OAO cohort, 66.7% (n=26) observed an increase in weight post-treatment, and in 28.2% (n=11), excessive weight gain was reported. Weight gain and excessive weight gain were noted in patients with higher initial BMIs. CONCLUSIONS This study highlights that post-treatment weight gain is common, emphasizing the need for careful weight management in GD. In OAO GD patients, the association between initial BMI and increased weight underscores potential cardiovascular risks, warranting vigilant monitoring and early intervention.
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Affiliation(s)
| | - Carlos Bello
- Endocrinology, Hospital da Luz Lisboa, Lisbon, PRT
| | - José Pedro Cidade
- Intensive Care Medicine, Centro Hospitalar Lisboa Ocidental - Hospital São Francisco Xavier, Lisbon, PRT
- Clinical Medicine, NOVA Medical School - Universidade NOVA de Lisboa, Lisbon, PRT
| | - Clara Cunha
- Endocrinology, Centro Hospitalar Lisboa Ocidental - Hospital Egas Moniz, Lisbon, PRT
| | - Clotilde Limbert
- Endocrinology, Centro Hospitalar Lisboa Ocidental - Hospital Egas Moniz, Lisbon, PRT
| | - Joao Sequeira Duarte
- Endocrinology, Centro Hospitalar Lisboa Ocidental - Hospital Egas Moniz, Lisbon, PRT
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Medici BR, Nygaard B, la Cour JL, Krakauer M, Brønden A, Sonne MP, Holst JJ, Rehfeld JF, Vilsbøll T, Faber J, Knop FK. Effects of levothyroxine substitution therapy on hunger and food intake in individuals with hypothyroidism. Endocr Connect 2023; 12:e230314. [PMID: 37582332 PMCID: PMC10563635 DOI: 10.1530/ec-23-0314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 08/15/2023] [Indexed: 08/17/2023]
Abstract
Context In individuals with hypothyroidism and overweight, levothyroxine substitution therapy is often expected to cause weight loss due to its effect on resting energy expenditure. However, despite levothyroxine-induced enhancement of resting energy expenditure, fat mass loss is rarely seen after levothyroxine substitution therapy. The mechanism behind this conundrum is unknown. Aim The aim of the study was to assess the effect of levothyroxine therapy on hunger sensations and ad libitum food intake in individuals with hypothyroidism. Design and setting Prospective cohort study of 18 newly diagnosed hypothyroid women (thyroid-stimulating hormone (TSH) >10 mU/L). Participants were investigated at diagnosis, after normalization of TSH (<4.0 mU/L), and after 6 months of successful treatment. Eighteen age and body mass index-matched healthy controls were also included. Intervention Hypothyroid individuals were treated with levothyroxine according to European Thyroid Association guidelines. Main outcomes Changes in hunger sensation were assessed using visual analog scales (cm) before and during a standardized mixed meal test, and food intake was measured during a subsequent ad libitum meal (g). Results After 6 months of levothyroxine therapy, mean resting energy expenditure was increased by 144 kcal/day (10%) (P < 0.001). Weight loss was comprised of 0.8 kg fat-free mass while fat mass remained unchanged. Fasting hunger sensation increased from a mean of 4.5 (s.d. 2.2) cm to 5.5 (s.d. 2.2) cm (P = 0.047). The numerical increase in ad libitum meal intake did not reach statistical significance. Conclusion Our data suggest that levothyroxine-induced hunger may be a culprit in the lack of fat mass loss from levothyroxine therapy.
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Affiliation(s)
- Bjarke R Medici
- Department of Medicine, Herlev Hospital, University of Copenhagen, Herlev, Denmark
- Center for Clinical Metabolic Research, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - Birte Nygaard
- Department of Medicine, Herlev Hospital, University of Copenhagen, Herlev, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jeppe L la Cour
- Department of Medicine, Herlev Hospital, University of Copenhagen, Herlev, Denmark
| | - Martin Krakauer
- Department of Clinical Physiology and Nuclear Medicine, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
- Department of Clinical Physiology and Nuclear Medicine, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Andreas Brønden
- Center for Clinical Metabolic Research, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
- Department of Clinical Pharmacology, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Mette P Sonne
- Department of Medicine, Herlev Hospital, University of Copenhagen, Herlev, Denmark
| | - Jens J Holst
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jens F Rehfeld
- Department of Clinical Biochemistry, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Tina Vilsbøll
- Center for Clinical Metabolic Research, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Steno Diabetes Center Copenhagen, Herlev, Denmark
| | - Jens Faber
- Department of Medicine, Herlev Hospital, University of Copenhagen, Herlev, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Filip K Knop
- Center for Clinical Metabolic Research, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Steno Diabetes Center Copenhagen, Herlev, Denmark
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Tosheva G, Siderova M. THYROTOXICOSIS AND ITS RELATION TO SARCOPENIA, MUSCLE STRENGTH, MUSCLE MASS AND PHYSICAL PERFORMANCE. ACTA ENDOCRINOLOGICA (BUCHAREST, ROMANIA : 2005) 2023; 19:269-273. [PMID: 37908874 PMCID: PMC10614585 DOI: 10.4183/aeb.2023.269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
Background Sarcopenia is a syndrome, considered one of the main risk factors for morbidity and mortality among adults. Thyrotoxicosis may contribute to its development. Aim To assess the physical well-being among women with thyrotoxicosis and to determine the risk of sarcopenia among them; 13 women over 40 years of age with thyrotoxicosis took part in this study. Materials and Methods Grip strength was used to assess muscle strength. Appendicular skeletal muscle mass, adjusted for body size was used to asses muscle quantity. Physical performance was measured by gait speed test. We divided women in groups: group A - patients with newly diagnosed thyrotoxicosis and group B - patients who had started treatment. Results The values of muscle strength, muscle mass and gait speed were lower in group A compared to group B. Three of the patients in group A were diagnosed with severe sarcopenia. Thus the frequency of sarcopenia was 50% in this group. None of the women in group B met the criteria for sarcopenia.Despite the small number of women in this study, we can conclude that untreated thyrotoxicosis is a risk factor for decreased muscle strength, quantity and physical performance and could cause secondary sarcopenia.
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Affiliation(s)
- G. Tosheva
- “St.Marina” University Hospital - Clinic of Endocrinology and Metabolic Diseases, Varna, Bulgaria
| | - M. Siderova
- “St.Marina” University Hospital - Clinic of Endocrinology and Metabolic Diseases, Varna, Bulgaria
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Le Moli R, Malandrino P, Russo M, Tumino D, Piticchio T, Naselli A, Rapicavoli V, Belfiore A, Frasca F. Levothyroxine therapy, calculated deiodinases activity and basal metabolic rate in obese or nonobese patients after total thyroidectomy for differentiated thyroid cancer, results of a retrospective observational study. Endocrinol Diabetes Metab 2023; 6:e406. [PMID: 36722311 PMCID: PMC10000637 DOI: 10.1002/edm2.406] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 12/26/2022] [Accepted: 01/02/2023] [Indexed: 02/02/2023] Open
Abstract
INTRODUCTION Therapy for hypothyroid obese patients is still under definition since the thyrotropin-stimulating hormone (TSH) level is a less reliable marker of euthyroidism than nonobese patients. Indeed, TSH levels positively correlate with body mass index (BMI), and this increase may be a compensatory mechanism aimed at increasing energy expenditure in obese people. In contrast, the correlation of BMI with thyroid hormone levels is not completely clear, and conflicting results have been obtained by several studies. The L-T4 replacement dose is more variable in obese hypothyroid patients than in nonobese patients, and a recent study indicated that the L-T4 replacement dose is related to lean body mass in obese thyroidectomized patients. We aimed to study the correlations of L-T4-administered dose, thyroid hormone levels and TSH secretion with basal metabolic rate (BMR) and total calculated deiodinase activity (GD) in obese and nonobese athyreotic patients. We also looked for individualized L-T4 replacement dose set points to be used in clinical practice. METHODS We studied retrospectively 160 athyreotic patients, 120 nonobese and 40 obese. GD was calculated by SPINA Thyr 4.2, the responsiveness of the hypothalamic/pituitary thyrotrope by Jostel's thyrotropin (TSH) index and BMR by the Mifflin-St. Jeor formula, the interplay of GD and BMR with L-T4, thyroid hormones and TSH index (TSHI) was also evaluated. RESULTS In our study, the L-T4 dose was an independent predictor of GD, and approximately 30% of athyreotic patients under L-T4 therapy had a reduced GD; FT4 levels were higher and negatively modulated by BMR in obese athyreotic patients respect to nonobese, in these patients a T4 to T3 shunt, in terms of TSHI suppression is observed suggesting a defective hypothalamic pituitary T4 to T3 conversion and a resistance to L-T4 replacement therapy. CONCLUSIONS L-t4 dose is the most important predictor of GD, BMR modulates T4 levels in obese athyreotic patients that are resistant to L-T4 replacement therapy.
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Affiliation(s)
- Rosario Le Moli
- Endocrinology Unit, Department of Clinical and Experimental MedicineUniversity of Catania, Garibaldi Nesima HospitalCataniaItaly
| | - Pasqualino Malandrino
- Endocrinology Unit, Department of Clinical and Experimental MedicineUniversity of Catania, Garibaldi Nesima HospitalCataniaItaly
| | - Marco Russo
- Endocrinology Unit, Department of Clinical and Experimental MedicineUniversity of Catania, Garibaldi Nesima HospitalCataniaItaly
| | - Dario Tumino
- Endocrinology Unit, Department of Clinical and Experimental MedicineUniversity of Catania, Garibaldi Nesima HospitalCataniaItaly
| | - Tommaso Piticchio
- Endocrinology Unit, Department of Clinical and Experimental MedicineUniversity of Catania, Garibaldi Nesima HospitalCataniaItaly
| | - Adriano Naselli
- Endocrinology Unit, Department of Clinical and Experimental MedicineUniversity of Catania, Garibaldi Nesima HospitalCataniaItaly
| | - Valentina Rapicavoli
- Endocrinology Unit, Department of Clinical and Experimental MedicineUniversity of Catania, Garibaldi Nesima HospitalCataniaItaly
| | - Antonino Belfiore
- Endocrinology Unit, Department of Clinical and Experimental MedicineUniversity of Catania, Garibaldi Nesima HospitalCataniaItaly
| | - Francesco Frasca
- Endocrinology Unit, Department of Clinical and Experimental MedicineUniversity of Catania, Garibaldi Nesima HospitalCataniaItaly
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Sun L, Goh HJ, Verma S, Govindharajulu P, Sadananthan SA, Michael N, Henry CJ, Goh JPN, Velan SS, Leow MKS. Brown adipose tissues mediate the metabolism of branched chain amino acids during the transitioning from hyperthyroidism to euthyroidism (TRIBUTE). Sci Rep 2022; 12:3693. [PMID: 35256693 PMCID: PMC8901628 DOI: 10.1038/s41598-022-07701-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 02/22/2022] [Indexed: 11/09/2022] Open
Abstract
AbstractBoth hyperthyroidism and elevated plasma branched chain amino acids (BCAA) are associated with insulin resistance. BCAA utilization and clearance relative to thyroid status changes remains unclear. We investigate amino acids changes, specifically BCAA, during the transition from hyperthyroidism to euthyroidism, and the impact of active brown adipose tissue (BAT) on the metabolic effects of BCAA. Newly diagnosed Graves’ disease participants were recruited. Hyperthyroidism was treated via a titration dosing regimen of thionamide anti-thyroid drug to establish euthyroidism over 12–24 weeks. All underwent energy expenditure (EE) measurement within a chamber calorimeter, 18F-fluorodeoxyglucose (18F-FDG) positron-emission tomography/magnetic resonance (PET/MR) imaging and plasma amino acids measurement during hyperthyroidism and euthyroidism. PET BAT maximum standardized uptake value (SUVmax), SUVmean and MR supraclavicular fat fraction (FF) quantified BAT activity. Twenty-two patients completed the study. Plasma BCAA level was significantly reduced in BAT-positive but not in BAT-negative patients during the transition from hyperthyroidism to euthyroidism. Plasma valine but not leucine and isoleucine correlated positively with insulin and HOMA-IR in hyperthyroidism. Plasma valine, leucine and isoleucine correlated with insulin and HOMA-IR in euthyroidism. Plasma valine correlated with insulin and HOMA-IR in BAT-negative but not in BAT-positive participants in both hyperthyroid and euthyroid state. However, the change (i.e. decrease) in plasma valine concentration from hyperthyroid to euthyroid state was affected by BAT-status. BAT utilizes and promotes BCAA plasma clearance from hyperthyroid to euthyroid state. Active BAT can potentially reduce circulating BCAA and may help to ameliorate insulin resistance and improve metabolic health.Clinical trial registration: The trial was registered at clinicaltrials.gov as NCT03064542.
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Cai Z, Chen Q, Ling Y. Weight Gain and Body Composition Changes during the Transition of Thyroid Function in Patients with Graves' Disease Undergoing Radioiodine Treatment. Int J Endocrinol 2022; 2022:5263973. [PMID: 35898314 PMCID: PMC9314154 DOI: 10.1155/2022/5263973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 06/07/2022] [Accepted: 06/30/2022] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE This study aimed at investigating the dynamic changes in the body weight and body composition in a group of patients with Graves' disease undergoing radioiodine therapy. METHODS Seventeen patients with Graves' disease undergoing 131I treatment and forty-three euthyroid controls were recruited. Body weight, BMI, and body composition via bioelectrical impedance were measured for the participants at baseline, hypothyroid stage, and euthyroid stage. RESULTS Body weight increased significantly during the transition from hyperthyroidism to euthyroidism. However, there were no significant changes in body fat %, lean mass %, and bone mineral %. The body weight of 9 patients at the euthyroid stage exceeded their premorbid weight, while the remaining 8 patients' weight did not exceed the premorbid weight. In the group with excessive weight gain, both body fat and lean mass increased significantly. However, in the group without excessive weight gain, only lean mass increased significantly. The patients with excessive weight gain had significantly higher body fat %, while lower lean mass % compared to patients without excessive weight gain at baseline and at the euthyroid stage. Moreover, body fat % of patients with excessive weight gain was significantly higher than that of controls, while lean mass % was significantly lower than that of controls. There was no difference of body fat % and lean mass % between patients without excessive weight gain and controls. CONCLUSION 131I treatment caused significant weight gain in patients with Graves' disease. An undesirable body composition at presentation may be a risk factor for excessive weight gain after hyperthyroidism treatment.
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Affiliation(s)
- Zhenqin Cai
- Department of Endocrinology and Metabolism, Zhongshan Hospital, Fudan University, No.180 Fenglin Road, Shanghai 200032, China
| | - Qiyu Chen
- Department of Endocrinology and Metabolism, Zhongshan Hospital, Fudan University, No.180 Fenglin Road, Shanghai 200032, China
| | - Yan Ling
- Department of Endocrinology and Metabolism, Zhongshan Hospital, Fudan University, No.180 Fenglin Road, Shanghai 200032, China
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Hsps70 and 90 protect the heart of hyperthyroid rats via nitric oxide production and VEGF inhibition of apoptosis. ENDOCRINE AND METABOLIC SCIENCE 2021. [DOI: 10.1016/j.endmts.2021.100097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Yoshida H, Nakajima K, Hayashi H, Kimura S, Irie Y. An unusual finding of giant fat-rich retroperitoneal masses in a patient with Graves' disease. Oxf Med Case Reports 2020; 2020:omaa044. [PMID: 32728447 PMCID: PMC7376979 DOI: 10.1093/omcr/omaa044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 04/27/2020] [Accepted: 05/22/2020] [Indexed: 11/13/2022] Open
Abstract
We report the case of a 48-year-old man who was unexpectedly found by abdominal ultrasonography to have large retroperitoneal masses accompanied by Graves' disease. Computed tomography and magnetic resonance imaging further demonstrated giant fat-rich soft masses arising within both renal sinuses. Histopathological examination of the mass was performed twice at 5-year intervals, with both examinations indicating fatty tissue cells with chronic fibrous panniculitis. Intravenous pulse therapy and successive oral glucocorticoid therapy were ineffective against Graves' ophthalmopathy or mass lesion. An antithyroid hormone regimen was followed by subtotal thyroid resection, leading to improvements in hyperthyroidism. Mass growth then attenuated slowly as the thyroid hormones returned to normal levels. The long-term follow-up of this patient should carefully monitor the appearance of warning signs such as mass effects.
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Affiliation(s)
- Hiromichi Yoshida
- Division of Internal Medicine, San-ai Memorial Hospital, Chiba, Japan
| | | | | | - Shinjiro Kimura
- Division of Radiology, Inoue Memorial Hospital, Chiba, Japan
| | - Yasufumi Irie
- Division of Internal Medicine, San-ai Memorial Hospital, Chiba, Japan
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Kyriacou A, Kyriacou A, Makris KC, Syed AA, Perros P. Weight gain following treatment of hyperthyroidism-A forgotten tale. Clin Obes 2019; 9:e12328. [PMID: 31267667 DOI: 10.1111/cob.12328] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 04/12/2019] [Accepted: 05/28/2019] [Indexed: 12/14/2022]
Abstract
Hyperthyroidism causes weight loss in the majority, but its effect is variable and 10% of patients gain weight. Its treatment usually leads to weight gain and some studies have reported an excess weight regain. However, there is considerable inter-individual variability and a differential effect on body weight by different treatments, with some studies reporting more weight increase with radioiodine, and perhaps surgery, compared with anti-thyroid drugs. The excess weight regain may relate to treatment-induced hypothyroidism. Furthermore, the transition from hyperthyroidism to euthyroidism may unmask, or exacerbate, the predisposition that some patients have towards obesity. Other risk factors commonly implicated for such weight increase include the severity of thyrotoxicosis at presentation and underlying Graves' disease. Conflicting data exist whether lean body mass or fat mass or both are increased post-therapy and whether such increments occur concurrently or in a sequential manner; this merits clarification. In any case, clinicians need to counsel their patients regarding this issue at presentation. Limited data on the effect of dietary interventions on weight changes with treatment of hyperthyroidism are encouraging in that they cause significantly lesser weight gain compared to standard care. More research is indicated on the impact of the treatment of hyperthyroidism on various anthropometric indices and the predisposing factors for any excessive weight gain. Regarding the impact of dietary management or other weight loss interventions, there is a need for well-designed and, ideally, controlled intervention studies.
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Affiliation(s)
- Angelos Kyriacou
- Cyprus International Institute for Environmental and Public Health, Cyprus University of Technology, Limassol, Cyprus
- Department of Endocrinology & Dietetics, CEDM Centre of Endocrinology, Diabetes & Metabolism, Limassol, Cyprus
- Diabetes, Endocrinology & Obesity Medicine, Salford Royal NHS Foundation Trust, Salford, UK
| | - Alexis Kyriacou
- Department of Endocrinology & Dietetics, CEDM Centre of Endocrinology, Diabetes & Metabolism, Limassol, Cyprus
- School of Health Sciences, University of Stirling, Stirling, UK
| | - Konstantinos C Makris
- Cyprus International Institute for Environmental and Public Health, Cyprus University of Technology, Limassol, Cyprus
| | - Akheel A Syed
- Diabetes, Endocrinology & Obesity Medicine, Salford Royal NHS Foundation Trust, Salford, UK
- Division of Diabetes, Endocrinology & Gastroenterology, Faculty of Biology, Medicine & Health, The University of Manchester, Manchester, UK
| | - Petros Perros
- Department of Endocrinology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
- Institute of Human Genetics, University of Newcastle, Newcastle upon Tyne, UK
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Bande AR, Kalra P, Dharmalingam M, Selvan C, Suryanarayana KM. Serum Fibroblast Growth Factor 21 Levels in Patients with Hyperthyroidism and its Association with Body Fat Percentage. Indian J Endocrinol Metab 2019; 23:557-562. [PMID: 31803597 PMCID: PMC6873261 DOI: 10.4103/ijem.ijem_273_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Most of the actions of thyroid hormone (TH) on body metabolisms like maintenance of basal metabolic rate (BMR) and body fat are similar to that of fibroblast growth factor 21 (FGF21). We hypothesized that in patients with hyperthyroidism, the pathological changes in the BMR, body fat are mediated by TH through FGF21. OBJECTIVES To study the association of serum FGF21 levels with hyperthyroidism and correlate body fat percentage with serum FGF21 levels in hyperthyroid patients. STUDY DESIGN Case-control prospective follow-up study. METHODOLOGY A total of 68 hyperthyroid patients and age, sex-matched healthy controls who fulfilled the inclusion and exclusion criteria were studied. Among them, 45 cases were followed up at 3 to 6 months after the achievement of euthyroidism. Body fat percentage was calculated from Jackson and Pollock 3 site equation and Siri equation. BMR percentage was calculated by the Gale formula. RESULTS The mean age in years in the cases was similar to that of controls (36.14 ± 10.01 vs. 36.57 ± 10.53, P = 0.81). The serum FGF21 levels at baseline were significantly elevated in patients with hyperthyroidism compared to controls [median 406.6 pg/ml (interquartile range, 262.9-655.6) vs. 252.3 (125.1-341) P < 0.001] and declined dramatically following treatment with anti-thyroid drugs [405 (275.5-680.4) vs. 203.6 (154.6-230.6) P < 0.001]. Serum FGF21 levels negatively correlated with body fat percentage (r = -0.268, P = 0.002). After adjusting to various confounding factors, serum FGF21 was independently associated with hyperthyroidism and was significant. (OR [95%CI] 3.78 (1.046-13.666) P = 0.043). CONCLUSION Serum FGF21 levels were elevated in hyperthyroid patients and decreased following treatment with anti-thyroid drugs. It was independently associated with hyperthyroidism. There may be a future therapeutic role of FGF21 inhibition in the reversal of these changes in addition to anti-thyroid drugs in patients with hyperthyroidism.
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Affiliation(s)
- Aashish Reddy Bande
- Department of Endocrinology, Ramaiah Medical College and Hospitals, Bengaluru, Karnataka, India
| | - Pramila Kalra
- Department of Endocrinology, Ramaiah Medical College and Hospitals, Bengaluru, Karnataka, India
| | - Mala Dharmalingam
- Department of Endocrinology, Ramaiah Medical College and Hospitals, Bengaluru, Karnataka, India
| | - Chitra Selvan
- Department of Endocrinology, Ramaiah Medical College and Hospitals, Bengaluru, Karnataka, India
| | - K M Suryanarayana
- Department of Endocrinology, Ramaiah Medical College and Hospitals, Bengaluru, Karnataka, India
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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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Yavuz S, Salgado Nunez Del Prado S, Celi FS. Thyroid Hormone Action and Energy Expenditure. J Endocr Soc 2019; 3:1345-1356. [PMID: 31286098 PMCID: PMC6608565 DOI: 10.1210/js.2018-00423] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Accepted: 05/10/2019] [Indexed: 12/20/2022] Open
Abstract
Energy metabolism is one of the most recognized targets of thyroid hormone action, which indeed plays a critical role in modulating energy expenditure in all of its components. This is because thyroid hormone receptors are ubiquitous, and thyroid hormones interact and influence most metabolic pathways in virtually all systems throughout the entire life of the organism. The pleiotropic actions of thyroid hormone are the results of interaction between the local availability of T3 and the signal transduction machinery, which confer in physiologic conditions time and tissue specificity of the hormonal signal despite negligible variations in circulating levels. Historically, the measurement of energy expenditure has been used as the gold standard for the clinical assessment of the hormonal action until the advent of the immunoassays for TSH and thyroid hormone, which have since been used as proxy for measurement of thyroid hormone action. Although the clinical correlates between thyroid hormone action and energy expenditure in cases of extreme dysfunction (florid hyperthyroidism or hypothyroidism) are well recognized, there is still controversy on the effects of moderate, subclinical thyroid dysfunction on energy expenditure and, ultimately, on body weight trajectory. Moreover, little information is available on the effects of thyroid hormone replacement therapy on energy expenditure. This mini review is aimed to define the clinical relevance of thyroid hormone action in normal physiology and functional disorders, as well the effects of thyroid hormone therapy on energy expenditure and the effects of changes in energy status on the thyroid hormone axis.
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Affiliation(s)
- Sahzene Yavuz
- Division of Endocrinology, Diabetes and Metabolism, Virginia Commonwealth University, Richmond, Virginia
| | | | - Francesco S Celi
- Division of Endocrinology, Diabetes and Metabolism, Virginia Commonwealth University, Richmond, Virginia
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