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Wang Y, Tian X, Song Q, Wang W, Guo X, Cui T, Pan Z, Chen Y, Chen W, Tan L, Zhang W. Application and Comparison of Different Regression Models in Iodine Balance Experiment on Women of Childbearing Age and Pregnant Women. Biol Trace Elem Res 2024; 202:2474-2487. [PMID: 37807000 DOI: 10.1007/s12011-023-03867-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 09/12/2023] [Indexed: 10/10/2023]
Abstract
The iodine balance experiment is a traditional approach to evaluate the physiological requirement for iodine, while the simple linear regression model (SLM) and the mixed effects model (MEM) are two primary methods used to analyze iodine balance experiments. In the present study, we aimed to compare the effects of these two regression models on the evaluation of iodine balance experiments to investigate appropriate valuation methods. By constructing SLM and MEM, zero iodine balance values (IBV) were determined, and the evaluation effects were compared. No changes were made to the experimental data for women of childbearing age, and cutoff values of 600 µg/day and 1000 µg/day, respectively, were chosen for further processing of the experimental data for pregnant women. Equation combinations 1-3 (EC1-3) were obtained by fitting SLM, and zero IBV were calculated as 110.26 µg/day, 333.06 µg/day, and 434.84 µg/day, respectively. EC4-6 were obtained by fitting MEM, and zero IBV were calculated as 110.44 µg/day, 335.79 µg/day, and 418.06 µg/day, respectively. The inclusion of inter-measurement variation as a random factor in the MEM yielded EC7-8, which reduced the test power of the iodine balance experiment on women of childbearing age. Our study suggested that when experimental conditions were tightly controlled, with fewer uncertainties or significant influences, computationally straightforward and well-understood SLM was preferred. If some uncertain factors might cause large changes in the experimental results, it was advised to use a more "conservative" MEM to calculate the zero IBV. ClinicalTrials.gov Identifier: Registered at Clinicaltrials.gov, NCT03279315 (17th September 2017, retrospectively registered), NCT03710148 (18th October 2018, retrospectively registered).
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Affiliation(s)
- Yu Wang
- Department of Nutrition and Food Hygiene, School of Public Health, Tianjin Medical University, 22 Qixiangtai Road, Heping District, Tianjin, China
| | - Xiaoxiao Tian
- Department of Nutrition and Food Hygiene, School of Public Health, Tianjin Medical University, 22 Qixiangtai Road, Heping District, Tianjin, China
- Tianjin Third Central Hospital Nutrition Department, Tianjin, China
| | - Qiuyi Song
- Department of Nutrition and Food Hygiene, School of Public Health, Tianjin Medical University, 22 Qixiangtai Road, Heping District, Tianjin, China
| | - Wenqiang Wang
- Department of Nutrition and Food Hygiene, School of Public Health, Tianjin Medical University, 22 Qixiangtai Road, Heping District, Tianjin, China
| | - Xiaohui Guo
- Department of Nutrition and Food Hygiene, School of Public Health, Tianjin Medical University, 22 Qixiangtai Road, Heping District, Tianjin, China
- Tianjin Nankai District Center for Disease Control and Prevention, Tianjin, China
| | - Tingkai Cui
- Department of Nutrition and Food Hygiene, School of Public Health, Tianjin Medical University, 22 Qixiangtai Road, Heping District, Tianjin, China
| | - Ziyun Pan
- Department of Nutrition and Food Hygiene, School of Public Health, Tianjin Medical University, 22 Qixiangtai Road, Heping District, Tianjin, China
| | - Yongjie Chen
- Department of Epidemiology and Health Statistics, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Wen Chen
- Department of Nutrition and Food Hygiene, School of Public Health, Tianjin Medical University, 22 Qixiangtai Road, Heping District, Tianjin, China
| | - Long Tan
- Department of Nutrition and Food Hygiene, School of Public Health, Tianjin Medical University, 22 Qixiangtai Road, Heping District, Tianjin, China.
| | - Wanqi Zhang
- Department of Nutrition and Food Hygiene, School of Public Health, Tianjin Medical University, 22 Qixiangtai Road, Heping District, Tianjin, China
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Staníková D, Krajčovičová L, Lobotková D, Vitariušová E, Tichá Ľ, Pribilincová Z, Ukropcová B, Ukropec J, Staník J. Thyroid hormone levels and BMI-SDS changes in adolescents with obesity. Front Endocrinol (Lausanne) 2023; 14:1304970. [PMID: 38169759 PMCID: PMC10758615 DOI: 10.3389/fendo.2023.1304970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 11/27/2023] [Indexed: 01/05/2024] Open
Abstract
Background Thyroid hormones play an important role in energy metabolism and weight control, explained mostly by inducing thermogenesis and increasing basal metabolic rate. It has recently been shown that FT4 levels are associated with food preferences, which might also play a role in modulating body weight. The aim of this longitudinal follow-up study was to analyze the relationship of thyroid hormones levels (FT4, TSH) at baseline with weight/BMI-SDS changes in children and adolescents with obesity. Methods Three hundred seventy-seven children and adolescents have been enrolled to this study and followed up without a systematic intervention program for 5.59 ± 1.85months. Children and adolescents were divided into three subgroups: 1) 144 adolescents with obesity (15-19 years), 2) 213 children with obesity (10-14.9 years), and 3) 20 lean adolescents (15-19 years). Thyroid hormones were measured at the baseline, and anthropometry was performed at the baseline and during the follow-up. For further analyses, participants were divided according to the BMI-SDS change into two groups: 1. with BMI-SDS decrease, and 2. with BMI-SDS increase. Results Adolescents with obesity from the BMI-SDS decrease group had significantly lower baseline serum levels of TSH compared to the BMI-SDS increase group (2.4 ± 1.0 vs. 3.2 ± 2.0mIU/l; p=0.005). Similar difference was found for FT4 levels (14.7 ± 2.2 in the BMI-SDS decrease group vs. 15.5 ± 2.7pmol/l in the BMI-SDS increase group, p=0.048). Moreover, the BMI-SDS decrease was present in significantly higher percentage of adolescents with obesity with lower than median TSH level compared to those with higher than median TSH level at baseline (61.1% vs 38.6%, p=0.011). Likewise, the BMI-SDS decrease was present in significantly higher percentage of adolescent females with obesity and lower than median FT4 compared to those with higher than median FT4 level at baseline (70.6% vs. 23.5%, p<0.001). No associations of baseline thyroid hormones with the BMI-SDS change were observed in children with obesity or lean adolescents. Conclusion Adolescents with obesity and increased BMI-SDS during the follow-up had significantly higher baseline levels of both TSH and FT4 compared to BMI-SDS decrease group. These results support the previous findings that higher FT4 in individuals with obesity may influence weight gain.
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Affiliation(s)
- Daniela Staníková
- Department of Pediatrics, Medical Faculty of Comenius University and National Institute for Children´s Diseases, Bratislava, Slovakia
- Department of Metabolic Research, Institute of Experimental Endocrinology, Biomedical Research Center, Slovak Academy of Sciences, Bratislava, Slovakia
| | - Lea Krajčovičová
- Department of Pediatrics, Medical Faculty of Comenius University and National Institute for Children´s Diseases, Bratislava, Slovakia
| | - Denisa Lobotková
- Department of Pediatrics, Medical Faculty of Comenius University and National Institute for Children´s Diseases, Bratislava, Slovakia
| | - Eva Vitariušová
- Department of Pediatrics, Medical Faculty of Comenius University and National Institute for Children´s Diseases, Bratislava, Slovakia
| | - Ľubica Tichá
- Department of Pediatrics, Medical Faculty of Comenius University and National Institute for Children´s Diseases, Bratislava, Slovakia
| | - Zuzana Pribilincová
- Department of Pediatrics, Medical Faculty of Comenius University and National Institute for Children´s Diseases, Bratislava, Slovakia
| | - Barbara Ukropcová
- Department of Metabolic Research, Institute of Experimental Endocrinology, Biomedical Research Center, Slovak Academy of Sciences, Bratislava, Slovakia
- Institute of Pathophysiology, Medical Faculty of Comenius University, Bratislava, Slovakia
| | - Jozef Ukropec
- Department of Metabolic Research, Institute of Experimental Endocrinology, Biomedical Research Center, Slovak Academy of Sciences, Bratislava, Slovakia
| | - Juraj Staník
- Department of Pediatrics, Medical Faculty of Comenius University and National Institute for Children´s Diseases, Bratislava, Slovakia
- Department of Metabolic Research, Institute of Experimental Endocrinology, Biomedical Research Center, Slovak Academy of Sciences, Bratislava, Slovakia
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Rosenbaum M, Foster G. Differential mechanisms affecting weight loss and weight loss maintenance. Nat Metab 2023; 5:1266-1274. [PMID: 37612402 DOI: 10.1038/s42255-023-00864-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 07/13/2023] [Indexed: 08/25/2023]
Abstract
In most lifestyle, pharmacological and surgical interventions, weight loss occurs over an approximately 6- to 9-month period and is followed by a weight plateau and then weight regain. Overall, only about 15% of individuals can sustain a 10% or greater non-surgical, non-pharmacological, weight loss. A key question is the degree to which the genotypes, phenotypes and environmental correlates of success in weight loss and weight loss maintenance are continuous or dichotomous. This Perspective is a comparison of the interactions of weight loss and maintenance with genetic, behavioural, physiological and environmental homeostatic systems and a discussion of the implications of these findings for research in, and treatment of, obesity. Data suggest that weight loss and weight loss maintenance are physiologically and psychologically different in many ways. Consequently, individuals may require different interventions designed for temporarily sustaining a negative energy balance during weight loss versus permanently maintaining energy balance after weight loss.
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Affiliation(s)
- Michael Rosenbaum
- Columbia University Irving Medical Center, Departments of Pediatrics and Medicine, Division of Molecular Genetics and the Irving Center for Clinical and Translational Research (MR), New York, NY, USA.
| | - Gary Foster
- WW International, Perelman School of Medicine at the University of Pennsylvania, Department of Psychiatry, Weight and Eating Disorders Program (GF), New York, NY, USA
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Byeon H, Moon Y, Lee S, Son GI, Lee E. Effect of the Marine Exercise Retreat Program on Thyroid-Related Hormones in Middle-Aged Euthyroid Women. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1542. [PMID: 36674297 PMCID: PMC9863542 DOI: 10.3390/ijerph20021542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 01/11/2023] [Accepted: 01/12/2023] [Indexed: 06/17/2023]
Abstract
This study aimed to investigate the effects of a marine exercise retreat program on thyroid-related hormone levels. A total of 62 middle-aged euthyroid women participated in a 6-day marine exercise retreat program. Using thyroid-stimulating hormone (TSH) and free thyroxine (fT4) hormone levels, the participants were divided into high and low-hormone-level groups. Despite decreased TSH and fT4 levels after the program, the factors influencing changes in each group were different. TSH levels were influenced by changes in the normalized low frequency (nLF) of heart rate variability and carbon monoxide (CO) from all the participants, and changes in body fat percentage, nLF, and nitrogen dioxide (NO2) exposure level in the high TSH group. fT4 levels were influenced by changes in body mass index (BMI), NO2 exposure, and particulate matter diameter of 10 µm or less (PM10) exposure in all participants. Changes in BMI and CO exposure influenced the low fT4 group. Lastly, changes in the exercise stress test affected the high fT4 group. Thus, the marine exercise retreat program affected euthyroid thyroid-related hormone levels, and influencing factors differ depending on the initial value of the hormone.
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Affiliation(s)
- Hangjin Byeon
- Department of Public Health, College of Medicine, Korea University, Seoul 02841, Republic of Korea
| | - Yesol Moon
- Department of Biomedical Science, Graduate School, Korea University, Seoul 02841, Republic of Korea
- Department of Preventive Medicine, College of Medicine, Korea University, Seoul 02841, Republic of Korea
| | - Seoeun Lee
- Department of Biomedical Science, Graduate School, Korea University, Seoul 02841, Republic of Korea
- Department of Preventive Medicine, College of Medicine, Korea University, Seoul 02841, Republic of Korea
| | - Gwang-Ic Son
- Department of Biomedical Science, Graduate School, Korea University, Seoul 02841, Republic of Korea
- Department of Preventive Medicine, College of Medicine, Korea University, Seoul 02841, Republic of Korea
| | - Eunil Lee
- Department of Public Health, College of Medicine, Korea University, Seoul 02841, Republic of Korea
- Department of Biomedical Science, Graduate School, Korea University, Seoul 02841, Republic of Korea
- Department of Preventive Medicine, College of Medicine, Korea University, Seoul 02841, Republic of Korea
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Urrea CR, Pedroso AP, Thomazini F, do Carmo ACF, Telles MM, Sawaya AL, Franco MDCP, Ribeiro EB. Thyroid axis hormones and anthropometric recovery of children/adolescents with overweight/obesity: A scoping review. Front Nutr 2023; 9:1040167. [PMID: 36712547 PMCID: PMC9880327 DOI: 10.3389/fnut.2022.1040167] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 12/19/2022] [Indexed: 01/15/2023] Open
Abstract
Introduction Thyroid hormones exert multiple physiological effects essential to the maintenance of basal metabolic rate (BMR), adaptive thermogenesis, fat metabolism, growth, and appetite. The links between obesity and the hormones of the thyroid axis, i.e., triiodothyronine (T3), thyroxine (T4), and thyrotropin (TSH), are still controversial, especially when considering children and adolescents. This population has high rates of overweight and obesity and several treatment approaches, including nutritional, psychological, and physical exercise interventions have been used. Understanding the importance of the hormones of the thyroid axis in the recovery from overweight and obesity may help directing measures to the maintenance of a healthy body composition. The present scoping review was carried out to analyze studies evaluating these hormonal levels throughout interventions directed at treating overweight and obesity in children and adolescents. The main purpose was to ascertain whether the hormones levels vary during weight loss. Methods We selected for analysis 19 studies published between 1999 and 2022. Results Most of the studies showed that changes in different anthropometric indicators, in response to the multidisciplinary interventions, correlated positively with free T3 (fT3), total T3 (TT3), and TSH. With respect to free T4 (fT4) and total T4 (TT4). Discussion The most common finding was of unchanged levels and, hence, no significant association with weight loss. Moreover, thyroxine supplementation has failed to affect the response to the interventions. Further studies are necessary to elucidate the relevance of the variations in hormone levels to the establishment of overweight/obesity and to the recovery from these conditions in children/adolescents. Systematic review registration https://www.crd.york.ac.uk/prospero/, identifier CRD42020203359.
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Affiliation(s)
- Carlos Ramos Urrea
- Department of Physiology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil,*Correspondence: Carlos Ramos Urrea,
| | - Amanda Paula Pedroso
- Department of Physiology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Fernanda Thomazini
- Department of Physiology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | - Mônica Marques Telles
- Department of Physiology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Ana Lydia Sawaya
- Department of Physiology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | - Eliane Beraldi Ribeiro
- Department of Physiology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
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Ruiz S, Vázquez F, Pellitero S, Puig-Domingo M. ENDOCRINE OBESITY: Pituitary dysfunction in obesity. Eur J Endocrinol 2022; 186:R79-R92. [PMID: 35333754 DOI: 10.1530/eje-21-0899] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 03/24/2022] [Indexed: 11/08/2022]
Abstract
Obesity, the growing pandemic of the 21st century, is associated with multiple organ dysfunction, either by a direct increase in fatty organ content or by indirect modifications related to general metabolic changes driven by a specific increase in biologic products. The pituitary gland is not protected against such a situation. Different hypothalamic-pituitary axes experience functional modifications initially oriented to an adaptive situation that, with years of obesity, turn to maladaptive dynamics that contribute to perpetuating obesity and specific symptoms of their hormonal nature. This paper reviews the recent knowledge on obesity-related pituitary dysfunction and its pathogenic mechanisms and discusses potential therapeutic actions aimed at contributing to ameliorating the complex treatment of severe cases of obesity.
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Affiliation(s)
- Sabina Ruiz
- Department of Endocrinology and Nutrition, Germans Trias i Pujol University Hospital and Research Institute, Badalona, Catalonia, Spain
| | - Federico Vázquez
- Department of Endocrinology and Nutrition, Germans Trias i Pujol University Hospital and Research Institute, Badalona, Catalonia, Spain
| | - Silvia Pellitero
- Department of Endocrinology and Nutrition, Germans Trias i Pujol University Hospital and Research Institute, Badalona, Catalonia, Spain
| | - Manel Puig-Domingo
- Department of Endocrinology and Nutrition, Germans Trias i Pujol University Hospital and Research Institute, Badalona, Catalonia, Spain
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Weiland A, Nannette LK, Zipfel S, Ehehalt S, Ziser K, Junne F, Mack I. Predictors of Weight Loss and Weight Loss Maintenance in Children and Adolescents With Obesity After Behavioral Weight Loss Intervention. Front Public Health 2022; 10:813822. [PMID: 35400038 PMCID: PMC8989956 DOI: 10.3389/fpubh.2022.813822] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 03/02/2022] [Indexed: 12/12/2022] Open
Abstract
Objective Predictors of body weight loss (BWL) and body weight loss maintenance (BWLM) after behavioral weight loss intervention are well-investigated in adults. Less is known for children and adolescents and a systematic overview on the topic for this age group was aim of the review. Methods A systematic research according to PRISMA guidelines using several databases was performed. The outcome was the BMI z-Score of longitudinal studies. The extracted predictors were classified in clusters (Physiology, Behavior, Psychology, Environment) and compared with a theory-driven model based on international guidelines and known predictors for adults. Results Out of 2,623 articles 24 met the eligibility criteria, 23 investigating BWL and 8 BWLM. The expected key predictor in research for adults “Behavior” was hardly investigated in children. The most examined cluster was “Physiology” with the most significant predictors, in particular genetics (BWL) and blood parameters (BWLM). Factors in the cluster “Psychology” also predicted BWL and BWLM. The cluster “Environment,” which was highlighted in most intervention guidelines, was neglected in studies regarding BWLM and hardly investigated in studies with BWL. Conclusion The comparison with the theory-driven children model outlined research gaps and differences between predictors for adults and children providing further direction of research. Systematic Review Registration http://www.crd.york.ac.uk/PROSPERO/, identifier: CRD42020200505.
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Affiliation(s)
- Alisa Weiland
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Hospital, Tübingen, Germany
| | - Lena Kasemann Nannette
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Hospital, Tübingen, Germany
| | - Stephan Zipfel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Hospital, Tübingen, Germany
| | - Stefan Ehehalt
- Public Health Department of Stuttgart, Stuttgart, Germany
| | - Katrin Ziser
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Hospital, Tübingen, Germany
| | - Florian Junne
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Hospital, Tübingen, Germany
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Magdeburg, Otto von Guericke University Magdeburg, Magdeburg, Germany
| | - Isabelle Mack
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Hospital, Tübingen, Germany
- *Correspondence: Isabelle Mack
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Arianas GΚ, Kostopoulou E, Ioannidis A, Dimopoulos I, Chiotis C, Prezerakos P, Spiliotis BE, Rojas Gil AP. Emotional intelligence scores in children and adolescents with subclinical hypothyroidism-correlation with serum serotonin and thyroid-stimulating hormone (TSH) concentrations. Hormones (Athens) 2022; 21:53-60. [PMID: 34780029 DOI: 10.1007/s42000-021-00320-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 09/03/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Thyroxine is essential for nervous system development. Subclinical hypothyroidism (SCH), also known as mild thyroid failure, is associated with impaired cognitive function in children and mood disorders in adults. Serotonin is also involved in brain development as well as in mood and behavior modulation. The possible interaction between thyroid function tests, serum serotonin concentrations, and emotional intelligence (EI) was studied. METHODS A total of 224 schoolchildren from the Peloponnese, Greece, aged 11-19, were included in the study, of whom 26.3% had SCH. Emotional quotients (EQ), such as well-being, self-control, emotionality, and sociability, were assessed using the TEIQue-ASF questionnaire, and TSH, fT4, and serum serotonin concentrations were also evaluated. RESULTS Children and adolescents with SCH had a lower EQ total score (p < 0.001), EQ well-being score (p = 0.025), EQ self-control score (p = 0.029), EQ emotionality score (p = 0.029), and EQ sociability score (p = 0.010) and lower serum serotonin concentrations (p < 0.001). CONCLUSIONS Children and adolescents with SCH exhibited lower EI scores and lower serum serotonin concentrations when compared with age-matched healthy controls.
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Affiliation(s)
- George Κ Arianas
- Faculty of Health Sciences, Department of Nursing, Laboratory of Biology and Biochemistry, University of Peloponnese, Dept. of Economics Building 2nd floor, Sehi area, Tripoli, 22100, Greece
| | - Eirini Kostopoulou
- Division of Pediatric Endocrinology, Department of Pediatrics, University of Patras School of Medicine, 26504, Patras, Greece
| | - Anastasios Ioannidis
- Faculty of Health Sciences, Department of Nursing, Laboratory of Biology and Biochemistry, University of Peloponnese, Dept. of Economics Building 2nd floor, Sehi area, Tripoli, 22100, Greece
| | | | | | - Panagiotis Prezerakos
- Faculty of Health Sciences, Department of Nursing, Laboratory of Biology and Biochemistry, University of Peloponnese, Dept. of Economics Building 2nd floor, Sehi area, Tripoli, 22100, Greece
| | - Bessie E Spiliotis
- Division of Pediatric Endocrinology, Department of Pediatrics, University of Patras School of Medicine, 26504, Patras, Greece
| | - Andrea Paola Rojas Gil
- Faculty of Health Sciences, Department of Nursing, Laboratory of Biology and Biochemistry, University of Peloponnese, Dept. of Economics Building 2nd floor, Sehi area, Tripoli, 22100, Greece.
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Adamczewska K, Adamczewski Z, Lewiński A, Stawerska R. Leptin Does Not Influence TSH Levels in Obese Short Children. Front Endocrinol (Lausanne) 2022; 13:838881. [PMID: 35399935 PMCID: PMC8989378 DOI: 10.3389/fendo.2022.838881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 02/21/2022] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Growth hormone (GH) and thyroid hormones are important for children growing. In some obese children a slightly elevated TSH concentration is observed. This may be an adaptive mechanism: stimulation of pro-TRH biosynthesis in the hypothalamus in response to elevated leptin. The increased TSH may also reflect the necessity of maintaining the resting energy expenditure or may be a result of inappropriate, low FT4 concentration. Thus, we evaluated serum TSH and FT4 concentrations in idiopathic short stature (ISS) children (non GH-deficient) and examined the effect of children's nutritional status and levels of selected adipocytokines on thyroid function, searching for the presence of various forms of subclinical hypothyroidism, which may be the cause of the slow growth rate. METHODS The study group included 115 children (50 girls and 65 boys) with ISS, aged (mean ± SD) 10.4 ± 3.34 years. In each child, lipids, TSH, FT4, IGF-1, maxGH during the stimulation tests, leptin, adiponectin and resistin concentrations were determined. Based on BMI SDS, 3 subgroups: slim (n=26), obese (n=21) and normal weight (n=68) were distinguished. RESULTS There was no correlation between leptin level and TSH, FT4 levels. The levels of leptin, total cholesterol and LDL-cholesterol in obese short children were significantly higher than in children from other subgroups. In turn, the levels of adiponectin, resistin, TSH and FT4 did not differ between subgroups. In 7% of children, an elevated TSH level was found (but less than 10 mIU/L), with a similar frequency across subgroups. The higher the leptin, the lower maxGH in clonidine stimulation test was recorded. CONCLUSIONS It seems that in obese children with idiopathic short stature leptin does not increase TSH secretion. This may be related to a disruption of the effect of leptin on TSH production and could indicate wide ranging disturbances of hypothalamic signals, and consequently be the cause of inappropriate GH secretion.
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Affiliation(s)
| | | | - Andrzej Lewiński
- Department of Endocrinology and Metabolic Diseases, Polish Mother’s Memorial Hospital-Research Institute, Lodz, Poland
- Department of Endocrinology and Metabolic Diseases, Medical University of Lodz, Lodz, Poland
| | - Renata Stawerska
- Department of Endocrinology and Metabolic Diseases, Polish Mother’s Memorial Hospital-Research Institute, Lodz, Poland
- Department of Pediatric Endocrinology, Medical University of Lodz, Lodz, Poland
- *Correspondence: Renata Stawerska,
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Wang X, Gao X, Han Y, Zhang F, Lin Z, Wang H, Teng W, Shan Z. Causal Association Between Serum Thyrotropin and Obesity: A Bidirectional, Mendelian Randomization Study. J Clin Endocrinol Metab 2021; 106:e4251-e4259. [PMID: 33754627 PMCID: PMC8475201 DOI: 10.1210/clinem/dgab183] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Indexed: 12/29/2022]
Abstract
CONTEXT The association between serum thyrotropin (TSH) and obesity traits has been investigated previously in several epidemiological studies. However, the underlying causal association has not been established. OBJECTIVE This work aimed to determine and analyze the causal association between serum TSH level and obesity-related traits (body mass index [BMI] and obesity). METHODS The latest genome-wide association studies (GWASs) on TSH, BMI, and obesity were searched to obtain full statistics. Bidirectional 2-sample mendelian randomization (MR) was performed to explore the causal relationship between serum TSH and BMI and obesity. The inverse variance-weighted (IVW) and MR-Egger methods were used to combine the estimation for each single-nucleotide variation (formerly single-nucleotide polymorphism). Based on the preliminary MR results, free thyroxine (fT4) and free 3,5,3'-triiodothyronine (fT3) levels were also set as outcomes to further analyze the impact of BMI on them. BMI and obesity were treated as the outcomes to evaluate the effect of serum TSH on them, and TSH was set as the outcome to estimate the effect of BMI and obesity on it. RESULTS IVW and MR-Egger results both indicated that genetically driven serum TSH did not causally lead to changes in BMI or obesity. Moreover, the IVW method showed that the TSH level could be significantly elevated by genetically predicted high BMI (β = .038, SE = 0.013, P = .004). In further MR analysis, the IVW method indicated that BMI could causally increase the fT3 (β = 10.123, SE = 2.523, P < .001) while not significantly affecting the fT4 level. CONCLUSION Together with fT3, TSH can be significantly elevated by an increase in genetically driven BMI.
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Affiliation(s)
- Xichang Wang
- Department of Endocrinology and Metabolism and the institute of Endocrinology, The First Hospital of China Medical University, Shenyang, Liaoning, 110001, P.R. China
| | - Xiaotong Gao
- Department of Endocrinology and Metabolism and the institute of Endocrinology, The First Hospital of China Medical University, Shenyang, Liaoning, 110001, P.R. China
| | - Yutong Han
- Department of Endocrinology and Metabolism and the institute of Endocrinology, The First Hospital of China Medical University, Shenyang, Liaoning, 110001, P.R. China
| | - Fan Zhang
- Department of Endocrinology and Metabolism and the institute of Endocrinology, The First Hospital of China Medical University, Shenyang, Liaoning, 110001, P.R. China
| | - Zheyu Lin
- Department of Endocrinology and Metabolism and the institute of Endocrinology, The First Hospital of China Medical University, Shenyang, Liaoning, 110001, P.R. China
| | - Hong Wang
- Department of Endocrinology and Metabolism and the institute of Endocrinology, The First Hospital of China Medical University, Shenyang, Liaoning, 110001, P.R. China
| | - Weiping Teng
- Department of Endocrinology and Metabolism and the institute of Endocrinology, The First Hospital of China Medical University, Shenyang, Liaoning, 110001, P.R. China
| | - Zhongyan Shan
- Department of Endocrinology and Metabolism and the institute of Endocrinology, The First Hospital of China Medical University, Shenyang, Liaoning, 110001, P.R. China
- Correspondence: Zhongyan Shan, MD, Department of Endocrinology and Metabolism and the institute of Endocrinology, The First Hospital of China Medical University, No. 155, Nanjing Bei St, Shenyang, 110001 P.R. China.
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11
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Croce L, Pallavicini C, Crotti S, Coperchini F, Minnelli L, Magri F, Chiovato L, Rotondi M. Basal and longitudinal changes in serum levels of TSH in morbid obese patients experiencing failure or success of dietary treatment. Eat Weight Disord 2021; 26:1949-1955. [PMID: 33068274 PMCID: PMC8292288 DOI: 10.1007/s40519-020-01043-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 09/30/2020] [Indexed: 11/28/2022] Open
Abstract
PURPOSE The relationship between thyroid function and obesity is a widely investigated one. The impact of thyroid hormones in determining the outcome of dietary/lifestyle interventions remains to be fully elucidated. The aim of this study was to compare basal and post dietary-intervention circulating thyroid-function parameters, lipid profile and fasting-glucose in euthyroid obese patients according to a success or failure of a dietary intervention program. METHODS In a retrospective longitudinal case-control study we enrolled 50 euthyroid obese patients who experienced a success in dietary intervention, as defined by a BMI reduction of at least 5% from baseline (Success Group) and 50 sex and age-matched euthyroid obese patients who experienced failure in dietary intervention as defined by either stable or increased body weight throughout the follow-up (Failure Group). Serum thyroid function parameters and metabolic profile at baseline and at the end of follow-up were collected. RESULTS At baseline, the two groups showed similar BMI, total-cholesterol, HDL-cholesterol and fasting-blood-glucose, but patients in Success Group had a significantly higher TSH as compared with Failure Group (2.20 ± 0.97 vs 1.66 ± 0.73, respectively, p < 0.001). Throughout a mean follow-up of 21.4 months TSH significantly decreased in Success Group (2.20 ± 0.97 vs 2.06 ± 0.98; p = 0.029) and increased in Failure Group (1.63 ± 0.72 vs 2.01 ± 0.99; p < 0.001). Multiple regression analysis showed that the outcome of the dietary intervention was significantly and independently related to baseline BMI (0.925; 0.861-0.993), age (0.957; 0.922-0.993), TSH (0.531; 0.290-0.973) and TSH-changes (1.011; 1.000-1.022) during follow-up. CONCLUSIONS Baseline serum TSH level is related to the final outcome of a dietary intervention program in obese patients. LEVEL OF EVIDENCE III Evidence obtained from a retrospective cohort or case-control analytic studies.
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Affiliation(s)
- Laura Croce
- Unit of Internal Medicine and Endocrinology, Laboratory for Endocrine Disruptors, Department of Internal Medicine and Therapeutics, Istituti Clinici Scientifici Maugeri IRCCS, University of Pavia, Via S. Maugeri 4, 27100, Pavia, Italy.,Department of Internal Medicine and Therapeutics, University of Pavia, 27100, Pavia, Italy.,PhD Course in Experimental Medicine, University of Pavia, 27100, Pavia, Italy
| | - Cristina Pallavicini
- Unit of Internal Medicine and Endocrinology, Laboratory for Endocrine Disruptors, Department of Internal Medicine and Therapeutics, Istituti Clinici Scientifici Maugeri IRCCS, University of Pavia, Via S. Maugeri 4, 27100, Pavia, Italy
| | - Silvia Crotti
- Unit of Internal Medicine and Endocrinology, Laboratory for Endocrine Disruptors, Department of Internal Medicine and Therapeutics, Istituti Clinici Scientifici Maugeri IRCCS, University of Pavia, Via S. Maugeri 4, 27100, Pavia, Italy
| | - Francesca Coperchini
- Unit of Internal Medicine and Endocrinology, Laboratory for Endocrine Disruptors, Department of Internal Medicine and Therapeutics, Istituti Clinici Scientifici Maugeri IRCCS, University of Pavia, Via S. Maugeri 4, 27100, Pavia, Italy
| | - Linda Minnelli
- Department of Internal Medicine and Therapeutics, University of Pavia, 27100, Pavia, Italy
| | - Flavia Magri
- Unit of Internal Medicine and Endocrinology, Laboratory for Endocrine Disruptors, Department of Internal Medicine and Therapeutics, Istituti Clinici Scientifici Maugeri IRCCS, University of Pavia, Via S. Maugeri 4, 27100, Pavia, Italy.,Department of Internal Medicine and Therapeutics, University of Pavia, 27100, Pavia, Italy
| | - Luca Chiovato
- Unit of Internal Medicine and Endocrinology, Laboratory for Endocrine Disruptors, Department of Internal Medicine and Therapeutics, Istituti Clinici Scientifici Maugeri IRCCS, University of Pavia, Via S. Maugeri 4, 27100, Pavia, Italy. .,Department of Internal Medicine and Therapeutics, University of Pavia, 27100, Pavia, Italy.
| | - Mario Rotondi
- Unit of Internal Medicine and Endocrinology, Laboratory for Endocrine Disruptors, Department of Internal Medicine and Therapeutics, Istituti Clinici Scientifici Maugeri IRCCS, University of Pavia, Via S. Maugeri 4, 27100, Pavia, Italy.,Department of Internal Medicine and Therapeutics, University of Pavia, 27100, Pavia, Italy
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12
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Mehran L, Amouzegar A, Gharibzadeh S, Abdi H, Mansournia MA, Tohidi M, Azizi F. Cumulative Effects of Thyroid Hormones Over 10 Years and Risk of General and Abdominal Obesity. Horm Metab Res 2021; 53:335-340. [PMID: 33757130 DOI: 10.1055/a-1393-5864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
We aimed to assess if changes in thyrotropin (TSH) and free thyroxine (FT4) over 10 years of follow-up would be associated with changes in body mass index (BMI) and waist circumference (WC) or risk of obesity. We enrolled 2317 out of 4179 participants in Tehran Thyroid Study with serum TSH between 0.1-10 mU/l and without history of thyroid medication or surgery. Serum concentrations of FT4 and TSH were measured at baseline and three follow-ups (1999-2011). To account for within-subject correlation, the generalized estimating equation was used to assess the association between one standard deviation(SD) change in the main exposures [cumulative excess (CE)TSH and CEFT4] and changes in BMI and WC; calculated scores of CETSH and CEFT4 were included in models as time-varying exposures. Cumulative excess of TSH or FT4 was not associated with increased incidence of general or abdominal obesity. However, CEFT4 was negatively associated with BMI only in overweight and obese subjects. In GEE analysis, one unit increase in TSH was associated with 0.02 kg/m2 increase in BMI (95% CI: 0.01, 0.03), which remained significant only in women; although the association was not significant after adding FT4 to model. One unit increase in FT4 was associated with 1.5 kg/m2 decrease in BMI (95% CI:-1.8,-1.2) and 4.1 cm decrease in WC (95% CI:-5.1,-3.1) in both sexes independent of TSH and other confounders. Cumulative excess of TSH or FT4 indicated no risk for general or abdominal obesity. However, FT4 was negatively associated with BMI and WC independent of TSH.
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Affiliation(s)
- Ladan Mehran
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Atieh Amouzegar
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Safoora Gharibzadeh
- Department of Epidemiology and Biostatistics, Research Centre for Emerging and Reemerging infectious Disease Pasteur Institute of Iran, Tehran, Iran
| | - Hengameh Abdi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Mansournia
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Tohidi
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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13
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Aronne LJ, Hall KD, Jakicic JM, Leibel RL, Lowe MR, Rosenbaum M, Klein S. Describing the Weight-Reduced State: Physiology, Behavior, and Interventions. Obesity (Silver Spring) 2021; 29 Suppl 1:S9-S24. [PMID: 33759395 PMCID: PMC9022199 DOI: 10.1002/oby.23086] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 10/26/2020] [Accepted: 11/09/2020] [Indexed: 12/13/2022]
Abstract
Although many persons with obesity can lose weight by lifestyle (diet and physical activity) therapy, successful long-term weight loss is difficult to achieve, and most people who lose weight regain their lost weight over time. The neurohormonal, physiological, and behavioral factors that promote weight recidivism are unclear and complex. The National Institute of Diabetes and Digestive and Kidney Diseases convened a workshop in June 2019, titled "The Physiology of the Weight-Reduced State," to explore the mechanisms and integrative physiology of adaptations in appetite, energy expenditure, and thermogenesis that occur in the weight-reduced state and that may oppose weight-loss maintenance. The proceedings from the first session of this workshop are presented here. Drs. Michael Rosenbaum, Kevin Hall, and Rudolph Leibel discussed the physiological factors that contribute to weight regain; Dr. Michael Lowe discussed the biobehavioral issues involved in weight-loss maintenance; Dr. John Jakicic discussed the influence of physical activity on long-term weight-loss maintenance; and Dr. Louis Aronne discussed the ability of drug therapy to maintain weight loss.
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Affiliation(s)
- Louis J. Aronne
- Weill Cornell Medicine Comprehensive Weight Control Center, New York, New York, USA
| | - Kevin D. Hall
- Laboratory of Biological Modeling, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - John M. Jakicic
- Healthy Lifestyle Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Rudolph L. Leibel
- Departments of Pediatrics and Medicine, Division of Molecular Genetics, Columbia University, New York, New York, USA
| | - Michael R. Lowe
- Department of Psychology, Drexel University, Philadelphia, Pennsylvania, USA
| | - Michael Rosenbaum
- Departments of Pediatrics and Medicine, Division of Molecular Genetics, Columbia University, New York, New York, USA
| | - Samuel Klein
- Center for Human Nutrition, Washington University School of Medicine, St. Louis, Missouri, USA
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Murillo-Vallés M, Martinez S, Aguilar-Riera C, Garcia-Martin MA, Bel-Comós J, Ybern MLG. Subclinical hypothyroidism in childhood, treatment or only follow-up? BMC Pediatr 2020; 20:282. [PMID: 32505175 PMCID: PMC7275568 DOI: 10.1186/s12887-020-02177-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 05/27/2020] [Indexed: 12/18/2022] Open
Abstract
Abstract
Background
Subclinical hypothyroidism (SH) is defined as serum levels of thyroid-stimulating hormone (TSH) above the upper limit with normal concentrations of free T4 (fT4). Its management remains challenging. The aim of the study was to evaluate clinical and laboratory findings as well as the clinical course of children with SH followed in a third level hospital. Sixty-five patients aged between 2 and 18 years old were retrospectively studied.
Methods
The patients were followed for a median period of 9 months (range 6 months to 24 months). Those who normalized TSH levels were discharged (Group 1). If TSH persisted mildly elevated (5-10μUI/mL) with normal fT4 and negative TPOAb/TgAb, they were classified as Group 2 and followed semi-annually without treatment. Those patients whose TSH raised ≥10μUI/mL or who maintained TSH 5-10μUI/mL and positive TPOAb/TgAb were considered suitable for thyroxin therapy (Group 3, G3).
Results
In 89% of our patients, TSH concentrations spontaneously reverted to normality or remained stable without treatment (Groups 1 and 2), whereas less than 11% progressed to clinical hypothyroidism (Group 3). Baseline TSH was significantly lower in group 1 than in group 3. In group 3 the prevalence of female sex (71%) was higher and TPO antibodies were present in 85% of patients. The risk of developing overt hypothyroidism in patients with positive anti-thyroid antibodies respect to those who normalized TSH was 45 (95%CI 6.5–312.5).
Conclusion
Baseline TSH, female sex and the presence of thyroid autoimmunity were the best predictors of the evolution to SH over time.
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15
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Guo X, He Z, Shao S, Fu Y, Zheng D, Liu L, Gao L, Guan L, Zhao M, Zhao J. Interaction effect of obesity and thyroid autoimmunity on the prevalence of hyperthyrotropinaemia. Endocrine 2020; 68:573-583. [PMID: 32215813 DOI: 10.1007/s12020-020-02236-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 02/18/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE The role of thyroid autoimmunity in the association between obesity and hyperthyrotropinaemia remains unclear. We aimed to assess the relationship between obesity, autoimmunity, and hyperthyrotropinaemia. METHODS In this population-based cross-sectional study, 12531 Chinese individuals (18-80 years) with thyroid function test were categorized into three groups by body mass index (BMI) and were categorized into three layers by thyroid autoantibodies. Multivariate logistic regression was employed to assess the correlation and interaction effect. RESULTS There was no significant difference in prevalence of hyperthyrotropinaemia (P = 0.637) among three BMI groups. After stratification, the difference of serum thyrotropin (P < 0.01) and prevalence of hyperthyrotropinaemia (P < 0.01) between the three groups have significant linear trends at the positive levels of thyroid peroxidase antibody (TPOAb) or/and thyroglobulin antibody (TgAb). When TPOAb and TgAb were positive, the risk of hyperthyrotropinaemia increased 1.857-fold in overweight group and 2.201-fold in obese group compared with normal group. Compared with negative TPOAb and TgAb, the risk of hyperthyrotropinaemia for individuals with two positive antibodies increased 3.310-fold, 4.969-fold, and 5.122-fold in the three BMI groups. The adjusted OR (95% CI) for interaction were 1.033 (0.752-1.419) for overweight and one positive antibodies, 1.935 (1.252-2.990) for overweight and two positive antibodies, 1.435 (0.978-2.105) for obesity and one positive antibodies and 2.191 (1.252-3.832) for obesity and two positive antibodies. CONCLUSION Overweight and obesity were associated with hyperthyrotropinaemia only in presence of thyroid autoimmunity, and obesity might aggravate the pathogenic effect of autoimmunity on hyperthyrotropinaemia. There was an interaction effect between obesity and autoimmunity on the prevalence of hyperthyrotropinaemia.
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Affiliation(s)
- Xiaoyong Guo
- Department of Endocrinology, Shandong Provincial Hospital affiliated to Shandong University, Jinan, Shandong, China
- Department of Endocrinology, The Second affiliated Hospital of Baotou Medical College, Baotou, Inner Mongolia, China
- Institute of Endocrinology and metabolism, Shandong Academy of Clinical Medicine, Jinan, Shandong, China
- Shandong Clinical Medical Center of Endocrinology and Metabolism, Jinan, Shandong, China
| | - Zhao He
- Shandong Provincial Key Laboratory of Endocrinology and Lipid Metabolism, Jinan, Shandong, China
- School of Medicine, Shandong University, Jinan, Shandong, China
| | - Shanshan Shao
- Department of Endocrinology, Shandong Provincial Hospital affiliated to Shandong University, Jinan, Shandong, China
- Institute of Endocrinology and metabolism, Shandong Academy of Clinical Medicine, Jinan, Shandong, China
- Shandong Clinical Medical Center of Endocrinology and Metabolism, Jinan, Shandong, China
| | - Yilin Fu
- Department of Endocrinology, Shandong Provincial Hospital affiliated to Shandong University, Jinan, Shandong, China
- Institute of Endocrinology and metabolism, Shandong Academy of Clinical Medicine, Jinan, Shandong, China
- Shandong Clinical Medical Center of Endocrinology and Metabolism, Jinan, Shandong, China
| | - Dongmei Zheng
- Department of Endocrinology, Shandong Provincial Hospital affiliated to Shandong University, Jinan, Shandong, China
- Institute of Endocrinology and metabolism, Shandong Academy of Clinical Medicine, Jinan, Shandong, China
- Shandong Clinical Medical Center of Endocrinology and Metabolism, Jinan, Shandong, China
| | - Lu Liu
- Department of Endocrinology, Shandong Provincial Hospital affiliated to Shandong University, Jinan, Shandong, China
| | - Ling Gao
- Institute of Endocrinology and metabolism, Shandong Academy of Clinical Medicine, Jinan, Shandong, China
- Shandong Clinical Medical Center of Endocrinology and Metabolism, Jinan, Shandong, China
- Scientific Center, Shandong Provincial Hospital affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Liying Guan
- Health Management Center, Shandong Provincial Hospital affiliated to Shandong University, Jinan, Shandong, China.
| | - Meng Zhao
- Department of Endocrinology, Shandong Provincial Hospital affiliated to Shandong University, Jinan, Shandong, China.
- Institute of Endocrinology and metabolism, Shandong Academy of Clinical Medicine, Jinan, Shandong, China.
- Shandong Clinical Medical Center of Endocrinology and Metabolism, Jinan, Shandong, China.
| | - Jiajun Zhao
- Department of Endocrinology, Shandong Provincial Hospital affiliated to Shandong University, Jinan, Shandong, China.
- Institute of Endocrinology and metabolism, Shandong Academy of Clinical Medicine, Jinan, Shandong, China.
- Shandong Clinical Medical Center of Endocrinology and Metabolism, Jinan, Shandong, China.
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16
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Revisión de la evolución de los pacientes con hipertirotropinemia y estudio de costes. ENDOCRINOL DIAB NUTR 2019; 66:550-554. [DOI: 10.1016/j.endinu.2019.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Revised: 02/15/2019] [Accepted: 03/06/2019] [Indexed: 11/19/2022]
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Lee MK, Kim YM, Sohn SY, Lee JH, Won YJ, Kim SH. Evaluation of the relationship of subclinical hypothyroidism with metabolic syndrome and its components in adolescents: a population-based study. Endocrine 2019; 65:608-615. [PMID: 31044391 DOI: 10.1007/s12020-019-01942-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 04/22/2019] [Indexed: 12/20/2022]
Abstract
PURPOSE This study investigated the association of subclinical hypothyroidism (SCH) with metabolic syndrome (MetS) and its components in adolescents. METHODS The study population included 1006 adolescents (aged 10-18 years) from the Korea National Health and Nutrition Examination Surveys; SCH subjects were compared with euthyroid subjects. MetS was defined using the International Diabetes Federation criteria. The risks of MetS and its components in SCH and euthyroid subjects were calculated using binary logistic regression analyses. RESULTS Study subjects had a mean age of 14.2 ± 2.5 years, and 53% were male. The prevalence of MetS was 2.5% in the overall study population (3.2% of males and 1.7% of females). Among the 1006 subjects, 143 (14.2%) had SCH. The risk of MetS was not higher in SCH subjects than in euthyroid subjects (odds ratio [OR], 1.50; 95% confidence interval [CI], 0.54-4.11); however, among the components of MetS, the risk of abdominal obesity was higher in SCH subjects than in euthyroid subjects (OR, 2.08; 95% CI, 1.04-4.15) after adjusting for age, sex, and body mass index (BMI). Although not statistically significant, a trend toward increased risk of elevated blood pressure (BP) was observed in SCH subjects relative to euthyroid subjects after further adjusting for age, sex, and BMI (OR, 2.01; 95% CI, 0.89-4.52). Furthermore, non-obese SCH subjects had higher systolic BP compared with non-obese euthyroid subjects after adjusting for age, sex, and BMI (P = 0.014). CONCLUSIONS SCH was not associated with the presence of MetS. However, SCH may be associated with abdominal obesity and possibly elevated BP in adolescents.
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Affiliation(s)
- Min-Kyung Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Myongji Hospital, Hanyang University College of Medicine, Gyeonggi-do, Republic of Korea
| | - Yoo Mee Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Catholic Kwandong University College of Medicine, International St. Mary's Hospital, Incheon, Republic of Korea
| | - Seo-Young Sohn
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Myongji Hospital, Hanyang University College of Medicine, Gyeonggi-do, Republic of Korea
| | - Jae-Hyuk Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Myongji Hospital, Hanyang University College of Medicine, Gyeonggi-do, Republic of Korea
| | - Young Jun Won
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Catholic Kwandong University College of Medicine, International St. Mary's Hospital, Incheon, Republic of Korea
| | - Se Hwa Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Catholic Kwandong University College of Medicine, International St. Mary's Hospital, Incheon, Republic of Korea.
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Rumińska M, Witkowska-Sędek E, Majcher A, Brzewski M, Krawczyk M, Pyrżak B. Serum TSH level in obese children and its correlations with atherogenic lipid indicators and carotid intima media thickness. J Ultrason 2019; 18:296-301. [PMID: 30763013 PMCID: PMC6444316 DOI: 10.15557/jou.2018.0043] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2018] [Indexed: 01/06/2023] Open
Abstract
Objective: Moderately elevated level of thyroid-stimulating hormone accompanied by normal serum concentrations of free thyroxine, suggesting subclinical hypothyroidism, is the most common hormonal abnormality in obese children. Controversy remains, whether a thyroid dysfunction related to obesity has an influence on the cardiovascular risk factors. The aim of the study was to assess correlation between thyroid-stimulating hormone and free thyroxine and chosen atherogenic lipid indicators, and carotid intima media thickness in obese children and adolescents. Methods: A study group consisted of 110 obese children (11.5 ± 2.9 years) and 38 healthy children (13.4 ± 2.6 years). Obesity was defined using International Obesity Task Force criteria. In each patient anthropometric measurements, thyroid-stimulating hormone, free thyroxine, a lipid profile were evaluated. Carotid intima-media thickness was measured in 74 obese children and 28 lean children. The resulting data were used to calculate indicators of atherogenesis: total cholesterol to HDL cholesterol ratio; triglycerides to HDL cholesterol ratio and LDL cholesterol to HDL cholesterol ratio. Results: Obese children had higher mean serum thyroid-stimulating hormone levels compared to their lean peers and an adverse atherogenic lipid profile. Serum free thyroxine concentrations were comparable between the groups. Serum thyroid-stimulating hormone values correlated with total cholesterol to HDL cholesterol ratio; triglycerides to HDL cholesterol ratio, LDL cholesterol to HDL cholesterol ratio, and intima-media thickness. In a multivariate regression analysis, thyroid-stimulating hormone weakly correlated only with intima-media thickness after adjustment for age, gender and Body Mass Index (β = 0.249, p = 0.04). This relationship weakened after considering a lipid profile (β = 0.242, p = 0.058). No relationship was found for free thyroxine. Conclusion: Serum level of thyroid-stimulating hormone in obese children did not seem to impact atherogenic lipid indicators and carotid intima-media thickness. Therefore, an adverse lipid profile should still be considered the main risk factor for development of cardiovascular diseases in obese children.
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Affiliation(s)
- Małgorzata Rumińska
- Department of Pediatrics and Endocrinology, Medical University of Warsaw , Poland
| | | | - Anna Majcher
- Department of Pediatrics and Endocrinology, Medical University of Warsaw , Poland
| | - Michał Brzewski
- Department of Pediatric Radiology, Medical University of Warsaw , Poland
| | - Monika Krawczyk
- Department of Pediatrics and Endocrinology, Medical University of Warsaw , Poland
| | - Beata Pyrżak
- Department of Pediatrics and Endocrinology, Medical University of Warsaw , Poland
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Marzullo P, Minocci A, Mele C, Fessehatsion R, Tagliaferri M, Pagano L, Scacchi M, Aimaretti G, Sartorio A. The relationship between resting energy expenditure and thyroid hormones in response to short-term weight loss in severe obesity. PLoS One 2018; 13:e0205293. [PMID: 30339686 PMCID: PMC6195261 DOI: 10.1371/journal.pone.0205293] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 09/21/2018] [Indexed: 02/06/2023] Open
Abstract
Background Regulating thermogenesis is a major task of thyroid hormones (THs), and involves TH-responsive energetic processes at the central and peripheral level. In severe obesity, little is known on the relationship between THs and resting energy expenditure (REE) before and after weight loss. Methods We enrolled 100 euthyroid subjects with severe obesity who were equally distributed between genders. Each was examined before and after completion of a 4-wk inpatient multidisciplinary dieting program and subjected to measurement of thyroid function, REE, fat-free mass (FFM, kg) and percent fat mass (FM). Results Baseline REE was lower than predicted in 70 obese patients, and overall associated with BMI, FFM and FM but not thyroid-related parameters. By the study end, both BMI and REE decreased (5.5% and 4.1%, p<0.001 vs. baseline) and their percent changes were significantly associated (p<0.05), while no association related percent changes of REE and FFM or FM. Individually, REE decreased in 66 and increased in 34 patients irrespective of gender, BMI and body composition. Weight loss significantly impacted TSH (-6.3%), FT3 (-3.3%) and FT4 levels (3.9%; p<0.001 for all). By the study end, a significant correlation became evident between REE and FT4 (r = 0.42, p<0.001) as well as FT3 (r = 0.24, p<0.05). In stepwise multivariable regression analysis, however, neither THs nor body composition entered the regression equation for REE response to weight loss. Conclusions In severe obesity, short-term weight loss discloses a positive relationship between REE and THs.
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Affiliation(s)
- Paolo Marzullo
- IRCCS Istituto Auxologico Italiano, Division of General Medicine, Piancavallo, Verbania, Italy
- Università del Piemonte Orientale, Department of Translational Medicine, Novara, Italy
- * E-mail:
| | - Alessandro Minocci
- IRCCS Istituto Auxologico Italiano, Division of Metabolic Diseases, Piancavallo, Verbania, Italy
| | - Chiara Mele
- IRCCS Istituto Auxologico Italiano, Division of General Medicine, Piancavallo, Verbania, Italy
- Università del Piemonte Orientale, Department of Translational Medicine, Novara, Italy
| | - Rezene Fessehatsion
- IRCCS Istituto Auxologico Italiano, Division of Metabolic Diseases, Piancavallo, Verbania, Italy
| | | | - Loredana Pagano
- University of Turin, Department of Medical Sciences, Turin, Italy
| | - Massimo Scacchi
- IRCCS Istituto Auxologico Italiano, Division of General Medicine, Piancavallo, Verbania, Italy
- University of Milan, Department of Clinical Sciences and Community Health, Milan, Italy
| | - Gianluca Aimaretti
- Università del Piemonte Orientale, Department of Translational Medicine, Novara, Italy
| | - Alessandro Sartorio
- IRCCS Istituto Auxologico Italiano, Division of Metabolic Diseases, Piancavallo, Verbania, Italy
- IRCCS Istituto Auxologico Italiano, Experimental Laboratory for Auxo-Endocrinological Research, Piancavallo, Verbania, Italy
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20
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An YM, Moon SJ, Kim SK, Suh YJ, Lee JE. Thyroid function in obese Korean children and adolescents: Korea National Health and Nutrition Examination Survey 2013-2015. Ann Pediatr Endocrinol Metab 2018; 23:141-147. [PMID: 30286570 PMCID: PMC6177661 DOI: 10.6065/apem.2018.23.3.141] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 11/17/2017] [Indexed: 01/17/2023] Open
Abstract
PURPOSE In recent years, there has been an increasing focus on thyroid function in pediatric obese patients, but no nationwide study evaluating the relationship between thyroid function and obesity has yet been conducted in Korea. We aimed to evaluate thyroid dysfunction in obese Korean children. METHODS We analyzed the associations between obesity and thyroid hormone levels among 975 Korean boys and girls aged 10-18 years and who participated in the Korean National Health and Nutrition Examination Survey VI (2013-2015). RESULTS Average serum thyrotropin (TSH) and serum free thyroxine (fT4) levels in the nonobese group were 2.7±0.1 μIU/mL and 1.3±0.0 ng/dL, respectively, and those in the overweight group were 3.1±0.2 μIU/mL and 1.2±0.0 ng/dL. Serum TSH level was significantly higher in the abdominal obesity group than in the normal group (P=0.023). fT4 level was significantly lower in both the overweight and abdominal obesity groups than in the normal group (P<0.001, P=0.014). Serum TSH level was associated positively with abdominal obesity and levels of high-density lipoprotein cholesterol and triglyceride. Serum fT4 level was negatively correlated with abdominal obesity (P=0.014). CONCLUSION Korean children with abdominal obesity showed increased TSH and decreased fT4 levels compared to normal children.
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Affiliation(s)
- Young Min An
- Department of Pediatrics, Inha University School of Medicine, Incheon, Korea
| | - Soon Jeong Moon
- Department of Pediatrics, Inha University School of Medicine, Incheon, Korea
| | - Soon Ki Kim
- Department of Pediatrics, Inha University School of Medicine, Incheon, Korea
| | - Young Ju Suh
- Department of Biomedical Sciences, Inha University School of Medicine, Incheon, Korea
| | - Ji Eun Lee
- Department of Pediatrics, Inha University School of Medicine, Incheon, Korea,Address for correspondence: Ji Eun Lee, MD, PhD Department of Pediatrics, Inha University Hospital, Inha University School of Medicine, 27 Inhang-ro, Jung-gu, Incheon 22332, Korea Tel: +82-32-890-3617 Fax: +82-32-890-3099 E-mail:
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21
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Vigone MC, Capalbo D, Weber G, Salerno M. Mild Hypothyroidism in Childhood: Who, When, and How Should Be Treated? J Endocr Soc 2018; 2:1024-1039. [PMID: 30187015 PMCID: PMC6117400 DOI: 10.1210/js.2017-00471] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 07/20/2018] [Indexed: 12/12/2022] Open
Abstract
Mild hypothyroidism, also known as subclinical hypothyroidism (SH), is biochemically defined as serum TSH levels above the upper limit of the reference range, in the presence of normal serum concentrations of total T4 and free T4 (FT4). In the neonatal period, mild hypothyroidism can be defined by the presence of a TSH value between 6 and 20 mIU/L and normal FT4 levels. After the neonatal period, SH can be defined mild if TSH ranges between 4.5 and 10 mIU/L. The management of mild hypothyroidism in childhood is challenging. The major concern is to establish whether this condition should always be considered an expression of mild thyroid dysfunction. Indeed, the effects of untreated mild hypothyroidism are still not completely defined. In the neonatal period, concern exists about neurocognitive outcome; in children, although there is no clear evidence of alterations in growth or neurocognitive development, subtle cardiovascular abnormalities have been documented. Therefore, there is still uncertainty about the need of treatment across all ages, and the management should be based on the age of the child, the etiology, and the degree of TSH elevation, as well as on other patient factors. This review updates current evidences on diagnosis and management of mild hypothyroidism in childhood.
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Affiliation(s)
| | - Donatella Capalbo
- Department of Pediatrics, University Hospital Federico II, Naples, Italy
| | - Giovanna Weber
- Department of Pediatrics, Vita-Salute San Raffaele University, Milano, Italy
| | - Mariacarolina Salerno
- Department of Translational Medical Sciences-Pediatric Section, University of Naples Federico II, Naples, Italy
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22
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Lundbäck V, Ekbom K, Hagman E, Dahlman I, Marcus C. Thyroid-Stimulating Hormone, Degree of Obesity, and Metabolic Risk Markers in a Cohort of Swedish Children with Obesity. Horm Res Paediatr 2018; 88:140-146. [PMID: 28614818 DOI: 10.1159/000475993] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 04/18/2017] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND/AIMS Thyroid-stimulating hormone (TSH) is affected in obesity and might influence metabolic risk. It is unclear what mechanisms cause elevated TSH in obesity. We aimed to investigate TSH status within the normal range and the association of TSH with degree of obesity and metabolic parameters in children with obesity. METHODS A total of 3,459 children, aged 3.0-17.9 years, were identified in the Swedish Childhood Obesity Treatment Registry, BORIS. Age, gender, TSH, free triiodothyronine (fT3), free thyroxine (fT4), body mass index standard deviation scores (BMI SDS), as well as variables of lipid and glucose metabolism were examined. RESULTS Children with high-normal TSH (>3.0 mU/L) (28.8%) had higher BMI SDS compared to children with low-normal TSH (<3.0 mU/L) (p < 0.001). Multivariable regression analysis adjusted for age and gender showed that TSH levels were associated with BMI SDS (β: 0.21, 95% CI: 0.14-0.28, p < 0.001). Associations of thyroid hormones with markers of lipid and glucose metabolism were observed, where TSH was associated with fasting insulin, HOMA (homeostatic model assessment of insulin resistance), total cholesterol, and triglycerides. CONCLUSIONS A positive association between TSH levels and BMI SDS was seen in children with obesity. Associations of TSH and free thyroid hormones with glucose metabolism indicated that TSH might be one of several factors acting to determine body weight and obesity co-morbidities, although the underlying mechanism remains unclear.
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Affiliation(s)
- Veroniqa Lundbäck
- Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Kerstin Ekbom
- Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Emilia Hagman
- Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Ingrid Dahlman
- Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Claude Marcus
- Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
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23
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Neves JS, Souteiro P, Oliveira SC, Pedro J, Magalhães D, Guerreiro V, Costa MM, Bettencourt-Silva R, Santos AC, Queirós J, Varela A, Freitas P, Carvalho D. Preoperative thyroid function and weight loss after bariatric surgery. Int J Obes (Lond) 2018; 43:432-436. [PMID: 29769703 DOI: 10.1038/s41366-018-0071-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 02/24/2018] [Indexed: 01/02/2023]
Abstract
Thyroid function has an important role on body weight regulation. However, the impact of thyroid function on weight loss after bariatric surgery is still largely unknown. We evaluated the association between preoperative thyroid function and the excess weight loss 1 year after surgery, in 641 patients with morbid obesity who underwent bariatric surgery. Patients with a history of thyroid disease, treatment with thyroid hormone or antithyroid drugs and those with preoperative evaluation consistent with overt hypothyroidism or hyperthyroidism were excluded. The preoperative levels of TSH and FT4 were not associated with weight loss after bariatric surgery. The variation of FT3 within the reference range was also not associated with weight loss. In contrast, the subgroup with FT3 above the reference range (12.3% of patients) had a significantly higher excess weight loss than patients with normal FT3. This difference remained significant after adjustment for age, sex, BMI, type of surgery, TSH and FT4. In conclusion, we observed an association between high FT3 and a greater weight loss after bariatric surgery, highlighting a group of patients with an increased benefit from this intervention. Our results also suggest a novel hypothesis: the pharmacological modulation of thyroid function may be a potential therapeutic target in patients undergoing bariatric surgery.
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Affiliation(s)
- João Sérgio Neves
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar São João, Porto, Portugal. .,Department of Surgery and Physiology, Cardiovascular Research Center, Faculty of Medicine of the University of Porto, Porto, Portugal.
| | - Pedro Souteiro
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar São João, Porto, Portugal.,Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Sofia Castro Oliveira
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar São João, Porto, Portugal.,Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Jorge Pedro
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar São João, Porto, Portugal
| | - Daniela Magalhães
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar São João, Porto, Portugal.,Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Vanessa Guerreiro
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar São João, Porto, Portugal
| | - Maria Manuel Costa
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar São João, Porto, Portugal.,Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Rita Bettencourt-Silva
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar São João, Porto, Portugal.,Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Ana Cristina Santos
- Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal.,EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
| | - Joana Queirós
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar São João, Porto, Portugal.,Multidisciplinary Group for Surgical Management of Obesity, Centro Hospitalar São João, Porto, Portugal
| | - Ana Varela
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar São João, Porto, Portugal.,Faculty of Medicine of the University of Porto, Porto, Portugal.,Multidisciplinary Group for Surgical Management of Obesity, Centro Hospitalar São João, Porto, Portugal
| | - Paula Freitas
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar São João, Porto, Portugal.,Faculty of Medicine of the University of Porto, Porto, Portugal.,Multidisciplinary Group for Surgical Management of Obesity, Centro Hospitalar São João, Porto, Portugal.,Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal
| | - Davide Carvalho
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar São João, Porto, Portugal.,Faculty of Medicine of the University of Porto, Porto, Portugal.,Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal
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24
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Schwartz MW, Seeley RJ, Zeltser LM, Drewnowski A, Ravussin E, Redman LM, Leibel RL. Obesity Pathogenesis: An Endocrine Society Scientific Statement. Endocr Rev 2017; 38:267-296. [PMID: 28898979 PMCID: PMC5546881 DOI: 10.1210/er.2017-00111] [Citation(s) in RCA: 376] [Impact Index Per Article: 53.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 05/12/2017] [Indexed: 02/07/2023]
Abstract
Obesity is among the most common and costly chronic disorders worldwide. Estimates suggest that in the United States obesity affects one-third of adults, accounts for up to one-third of total mortality, is concentrated among lower income groups, and increasingly affects children as well as adults. A lack of effective options for long-term weight reduction magnifies the enormity of this problem; individuals who successfully complete behavioral and dietary weight-loss programs eventually regain most of the lost weight. We included evidence from basic science, clinical, and epidemiological literature to assess current knowledge regarding mechanisms underlying excess body-fat accumulation, the biological defense of excess fat mass, and the tendency for lost weight to be regained. A major area of emphasis is the science of energy homeostasis, the biological process that maintains weight stability by actively matching energy intake to energy expenditure over time. Growing evidence suggests that obesity is a disorder of the energy homeostasis system, rather than simply arising from the passive accumulation of excess weight. We need to elucidate the mechanisms underlying this "upward setting" or "resetting" of the defended level of body-fat mass, whether inherited or acquired. The ongoing study of how genetic, developmental, and environmental forces affect the energy homeostasis system will help us better understand these mechanisms and are therefore a major focus of this statement. The scientific goal is to elucidate obesity pathogenesis so as to better inform treatment, public policy, advocacy, and awareness of obesity in ways that ultimately diminish its public health and economic consequences.
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Affiliation(s)
| | - Randy J Seeley
- Department of Surgery, University of Michigan, Ann Arbor, Michigan 48109
| | - Lori M Zeltser
- Naomi Berrie Diabetes Center and Department of Pathology and Cell Biology, Columbia University, New York, New York 10032
| | - Adam Drewnowski
- Center for Public Health Nutrition, University of Washington, Seattle, Washington 98195
| | - Eric Ravussin
- John S. McIlhenny Skeletal Muscle Physiology Laboratory, Pennington Biomedical Research Center, Baton Rouge, Louisiana 70808
| | - Leanne M Redman
- John S. McIlhenny Skeletal Muscle Physiology Laboratory, Pennington Biomedical Research Center, Baton Rouge, Louisiana 70808
| | - Rudolph L Leibel
- Naomi Berrie Diabetes Center and Department of Pathology and Cell Biology, Columbia University, New York, New York 10032.,Division of Molecular Genetics, Department of Pediatrics, Columbia University, New York, New York 10032
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25
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Liu G, Liang L, Bray GA, Qi L, Hu FB, Rood J, Sacks FM, Sun Q. Thyroid hormones and changes in body weight and metabolic parameters in response to weight loss diets: the POUNDS LOST trial. Int J Obes (Lond) 2017; 41:878-886. [PMID: 28138133 DOI: 10.1038/ijo.2017.28] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Revised: 01/05/2017] [Accepted: 01/11/2017] [Indexed: 12/21/2022]
Abstract
BACKGROUND The role of thyroid hormones in diet-induced weight loss and subsequent weight regain is largely unknown. OBJECTIVES To examine the associations between thyroid hormones and changes in body weight and resting metabolic rate (RMR) in a diet-induced weight loss setting. SUBJECTS/METHODS Data analysis was conducted among 569 overweight and obese participants aged 30-70 years with normal thyroid function participating in the 2-year Prevention of Obesity Using Novel Dietary Strategies (POUNDS) LOST randomized clinical trial. Changes in body weight and RMR were assessed during the 2-year intervention. Thyroid hormones (free triiodothyronine (T3), free thyroxine (T4), total T3, total T4 and thyroid-stimulating hormone (TSH)), anthropometric measurements and biochemical parameters were assessed at baseline, 6 months and 24 months. RESULTS Participants lost an average of 6.6 kg of body weight during the first 6 months and subsequently regained an average of 2.7 kg of body weight over the remaining period from 6 to 24 months. Baseline free T3 and total T3 were positively associated, whereas free T4 was inversely associated, with baseline body weight, body mass index and RMR. Total T4 and TSH were not associated with these parameters. Higher baseline free T3 and free T4 levels were significantly associated with a greater weight loss during the first 6 months (P<0.05) after multivariate adjustments including dietary intervention groups and baseline body weight. Comparing extreme tertiles, the multivariate-adjusted weight loss±s.e. was -3.87±0.9 vs -5.39±0.9 kg for free T3 (Ptrend=0.02) and -4.09±0.9 vs -5.88±0.9 kg for free T4 (Ptrend=0.004). The thyroid hormones did not predict weight regain in 6-24 months. A similar pattern of associations was also observed between baseline thyroid hormones and changes in RMR. In addition, changes in free T3 and total T3 levels were positively associated with changes in body weight, RMR, body fat mass, blood pressure, glucose, insulin, triglycerides and leptin at 6 months and 24 months (all P<0.05). CONCLUSIONS In this diet-induced weight loss setting, higher baseline free T3 and free T4 predicted more weight loss, but not weight regain among overweight and obese adults with normal thyroid function. These findings reveal a novel role of thyroid hormones in body weight regulation and may help identify individuals more responsive to weight loss diets.
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Affiliation(s)
- G Liu
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA.,Key Laboratory of Nutrition and Metabolism, Institute for Nutritional Sciences, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, Shanghai, China
| | - L Liang
- Department of Epidemiology and Department of Biostatistics, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - G A Bray
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA, USA
| | - L Qi
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA.,Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA.,Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - F B Hu
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA.,Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - J Rood
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA, USA
| | - F M Sacks
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA.,Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Q Sun
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA.,Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
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26
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Salerno M, Capalbo D, Cerbone M, De Luca F. Subclinical hypothyroidism in childhood - current knowledge and open issues. Nat Rev Endocrinol 2016; 12:734-746. [PMID: 27364598 DOI: 10.1038/nrendo.2016.100] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Subclinical hypothyroidism is defined as serum levels of TSH above the upper limit of the reference range, in the presence of normal concentrations of total T4 or free T4. This biochemical profile might be an indication of mild hypothyroidism, with a potential increased risk of metabolic abnormalities and cardiovascular disease recorded among adults. Whether subclinical hypothyroidism results in adverse health outcomes among children is a matter of debate and so management of this condition remains challenging. Mild forms of untreated subclinical hypothyroidism do not seem to be associated with impairments in growth, bone health or neurocognitive outcome. However, ongoing scientific investigations have highlighted the presence of subtle proatherogenic abnormalities among children with modest elevations in their TSH levels. Although current findings are insufficient to recommend levothyroxine treatment for all children with mild asymptomatic forms of subclinical hypothyroidism, they highlight the potential need for assessment of cardiovascular risk among children with this condition. Increased understanding of the early metabolic risk factors associated with subclinical hypothyroidism in childhood will help to improve the management of affected individuals.
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Affiliation(s)
- Mariacarolina Salerno
- Department of Translational Medical Sciences - Pediatric Section, University of Naples Federico II, Naples, 80131, Italy
| | - Donatella Capalbo
- Department of Pediatrics, University Hospital Federico II, Naples, 80131, Italy
| | - Manuela Cerbone
- Department of Translational Medical Sciences - Pediatric Section, University of Naples Federico II, Naples, 80131, Italy
| | - Filippo De Luca
- Department of Pediatric, Gynecology, Microbiological and Biochemical Sciences, University of Messina, Messina, 98125, Italy
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27
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Le TN, Celi FS, Wickham EP. Thyrotropin Levels Are Associated with Cardiometabolic Risk Factors in Euthyroid Adolescents. Thyroid 2016; 26:1441-1449. [PMID: 27599541 PMCID: PMC5067795 DOI: 10.1089/thy.2016.0055] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Increased thyrotropin (TSH) levels and free triiodothyronine to free thyroxine (fT3:fT4) ratios, even within the euthyroid range, have been associated with cardiometabolic risk factors in adults but are less characterized in youth. This study sought to determine relations between TSH, thyroid hormones, and cardiometabolic risk factors in euthyroid adolescents. METHODS Data were extracted from the United States National Health and Nutrition Examination Survey, 2007-2010, for univariate and multivariate analyses of TSH, thyroid hormones, body mass index (BMI), blood pressure, lipids, and glucose metabolism. Subjects aged 12-18 years, with normal TSH and antithyroid peroxidase antibody levels, and without a history of thyroid disease, diabetes, or treatment of hypertension/dyslipidemia (n = 1167) were included. TSH and thyroid hormones were assessed for impact on BMI Z-score, systolic blood pressure (SBP) diastolic blood pressure, total cholesterol (TC), high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, apolipoprotein B, triglycerides, and glucose metabolism. RESULTS Univariate analyses revealed positive linear relations between TSH and SBP, TC, fasting and two-hour glucose, and homeostasis model assessment of insulin resistance (HOMA-IR). The fT3:fT4 ratio negatively correlated with high-density lipoprotein cholesterol but positively with BMI Z-score, SBP, triglycerides, fasting and two-hour glucose, fasting insulin, and HOMA-IR. In multivariate analyses controlling for age, sex, race/ethnicity, and BMI Z-score, relations between TSH and both TC and fasting glucose remained significant, and the fT3:fT4 ratio was positively associated with fasting glucose and HOMA-IR. CONCLUSIONS In an unselected population of euthyroid U.S. adolescents, TSH and thyroid hormones correlate with multiple cardiometabolic risk factors, with age- and sex-independent effects on cholesterol and glucose metabolism.
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Affiliation(s)
- Trang N. Le
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia
- Division of Pediatric Endocrinology and Metabolism, Children's Hospital of Richmond, Virginia Commonwealth University, Richmond, Virginia
| | - Francesco S. Celi
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia
| | - Edmond P. Wickham
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia
- Division of Pediatric Endocrinology and Metabolism, Children's Hospital of Richmond, Virginia Commonwealth University, Richmond, Virginia
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28
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Méndez-Villa L, García-Solís P, Solís-S JC, García-Gutiérrez DG, Pérez-Mora VA, Robles-Osorio L, Sampson-Zaldívar E. High Iodine and Salt Intakes and Obesity do not Modify the Thyroid Function in Mexican Schoolchildren. Biol Trace Elem Res 2016; 172:290-298. [PMID: 26689929 DOI: 10.1007/s12011-015-0591-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Accepted: 12/14/2015] [Indexed: 10/22/2022]
Abstract
Mexico is considered as a nutritional transition country with a high prevalence of overweight and obesity, and recent studies have reported a high iodine intake in children. Both high iodine intake and obesity have been associated with thyroid dysfunction. Our aim was to assess iodine and salt intake and thyroid function in Mexican schoolchildren with normal weight and obesity. A cross-sectional study was performed during 2012-2013 in schoolchildren from Queretaro, Mexico. Six hundred seventy-eight schoolchildren were evaluated to obtain nutrition status, urinary iodine concentration (UIC) and thyroid volume (TVol). The prevalence of overweight and obesity was 47.3 %, the median UIC was 428 μg/L and TVol was normal in all schoolchildren; however, obese girls had a higher TVol than normal weight at the age of 8, 10 and 12 years. A subsample of schoolchildren was divided in 6-8 and 9-12-year-old groups, in order to compare thyroid function (thyrotropin, free T4, and anti-thyroid antibodies); iodine and salt intake were estimated with 24-h urinary samples. No differences in thyroid function were observed in both age groups. In the 6-8-year-old group, obese schoolchildren had higher iodine intake than normal-weight children (415.5 vs. 269.1 μg/day, p < 0.05), but no differences in salt intake. In contrast, in the 9-12-year-old group, obese schoolchildren had higher salt intake than normal-weight children (6.2 vs. 3.8 g/day, p < 0.05), but no differences in iodine intake. Dietary patterns could explain the differences between both age groups. Further studies are needed to identify the main sources of iodine intake in Mexican populations.
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Affiliation(s)
- Lorena Méndez-Villa
- Laboratorio de Endocrinología y Nutrición, Departamento de Investigación Biomédica, Facultad de Medicina, Universidad Autónoma de Querétaro, Clavel 200. Fracc. Prados de la Capilla, Querétaro, Querétaro, CP. 76176, Mexico
| | - Pablo García-Solís
- Laboratorio de Endocrinología y Nutrición, Departamento de Investigación Biomédica, Facultad de Medicina, Universidad Autónoma de Querétaro, Clavel 200. Fracc. Prados de la Capilla, Querétaro, Querétaro, CP. 76176, Mexico.
| | - Juan Carlos Solís-S
- Laboratorio de Endocrinología y Nutrición, Departamento de Investigación Biomédica, Facultad de Medicina, Universidad Autónoma de Querétaro, Clavel 200. Fracc. Prados de la Capilla, Querétaro, Querétaro, CP. 76176, Mexico
| | - David Gustavo García-Gutiérrez
- Laboratorio de Endocrinología y Nutrición, Departamento de Investigación Biomédica, Facultad de Medicina, Universidad Autónoma de Querétaro, Clavel 200. Fracc. Prados de la Capilla, Querétaro, Querétaro, CP. 76176, Mexico
| | - Valeria Alejandra Pérez-Mora
- Laboratorio de Endocrinología y Nutrición, Departamento de Investigación Biomédica, Facultad de Medicina, Universidad Autónoma de Querétaro, Clavel 200. Fracc. Prados de la Capilla, Querétaro, Querétaro, CP. 76176, Mexico
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29
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Lerea JS, Ring LE, Hassouna R, Chong ACN, Szigeti-Buck K, Horvath TL, Zeltser LM. Reducing Adiposity in a Critical Developmental Window Has Lasting Benefits in Mice. Endocrinology 2016; 157:666-78. [PMID: 26587784 PMCID: PMC4733128 DOI: 10.1210/en.2015-1753] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Although most adults can lose weight by dieting, a well-characterized compensatory decrease in energy expenditure promotes weight regain more than 90% of the time. Using mice with impaired hypothalamic leptin signaling as a model of early-onset hyperphagia and obesity, we explored whether this unfavorable response to weight loss could be circumvented by early intervention. Early-onset obesity was associated with impairments in the structure and function of brown adipose tissue mitochondria, which were ameliorated by weight loss at any age. Although decreased sympathetic tone in weight-reduced adults resulted in net reductions in brown adipose tissue thermogenesis and energy expenditure that promoted rapid weight regain, this was not the case when dietary interventions were initiated at weaning. Enhanced energy expenditure persisted even after mice were allowed to resume overeating, leading to lasting reductions in adiposity. These findings reveal a time window when dietary interventions can produce metabolic improvements that are stably maintained.
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Affiliation(s)
- Jaclyn S Lerea
- Institute of Human Nutrition (J.S.L., A.C.N.N.), Columbia University, New York, New York 10032; Department of Anesthesiology (L.E.R.), Columbia University, New York, New York 10032; Naomi Berrie Diabetes Center (R.H., L.M.Z.), Columbia University, New York, New York 10032; Department of Obstetrics, Gynecology, and Reproductive Sciences (K.S.-B., T.L.H.), Yale University School of Medicine, New Haven, Connecticut 06510; Department of Neurobiology (T.L.H.), Yale University School of Medicine, New Haven, Connecticut 06510; and Department of Pathology and Cell Biology (L.M.Z.), Columbia University, New York, New York 10032
| | - Laurence E Ring
- Institute of Human Nutrition (J.S.L., A.C.N.N.), Columbia University, New York, New York 10032; Department of Anesthesiology (L.E.R.), Columbia University, New York, New York 10032; Naomi Berrie Diabetes Center (R.H., L.M.Z.), Columbia University, New York, New York 10032; Department of Obstetrics, Gynecology, and Reproductive Sciences (K.S.-B., T.L.H.), Yale University School of Medicine, New Haven, Connecticut 06510; Department of Neurobiology (T.L.H.), Yale University School of Medicine, New Haven, Connecticut 06510; and Department of Pathology and Cell Biology (L.M.Z.), Columbia University, New York, New York 10032
| | - Rim Hassouna
- Institute of Human Nutrition (J.S.L., A.C.N.N.), Columbia University, New York, New York 10032; Department of Anesthesiology (L.E.R.), Columbia University, New York, New York 10032; Naomi Berrie Diabetes Center (R.H., L.M.Z.), Columbia University, New York, New York 10032; Department of Obstetrics, Gynecology, and Reproductive Sciences (K.S.-B., T.L.H.), Yale University School of Medicine, New Haven, Connecticut 06510; Department of Neurobiology (T.L.H.), Yale University School of Medicine, New Haven, Connecticut 06510; and Department of Pathology and Cell Biology (L.M.Z.), Columbia University, New York, New York 10032
| | - Angie C N Chong
- Institute of Human Nutrition (J.S.L., A.C.N.N.), Columbia University, New York, New York 10032; Department of Anesthesiology (L.E.R.), Columbia University, New York, New York 10032; Naomi Berrie Diabetes Center (R.H., L.M.Z.), Columbia University, New York, New York 10032; Department of Obstetrics, Gynecology, and Reproductive Sciences (K.S.-B., T.L.H.), Yale University School of Medicine, New Haven, Connecticut 06510; Department of Neurobiology (T.L.H.), Yale University School of Medicine, New Haven, Connecticut 06510; and Department of Pathology and Cell Biology (L.M.Z.), Columbia University, New York, New York 10032
| | - Klara Szigeti-Buck
- Institute of Human Nutrition (J.S.L., A.C.N.N.), Columbia University, New York, New York 10032; Department of Anesthesiology (L.E.R.), Columbia University, New York, New York 10032; Naomi Berrie Diabetes Center (R.H., L.M.Z.), Columbia University, New York, New York 10032; Department of Obstetrics, Gynecology, and Reproductive Sciences (K.S.-B., T.L.H.), Yale University School of Medicine, New Haven, Connecticut 06510; Department of Neurobiology (T.L.H.), Yale University School of Medicine, New Haven, Connecticut 06510; and Department of Pathology and Cell Biology (L.M.Z.), Columbia University, New York, New York 10032
| | - Tamas L Horvath
- Institute of Human Nutrition (J.S.L., A.C.N.N.), Columbia University, New York, New York 10032; Department of Anesthesiology (L.E.R.), Columbia University, New York, New York 10032; Naomi Berrie Diabetes Center (R.H., L.M.Z.), Columbia University, New York, New York 10032; Department of Obstetrics, Gynecology, and Reproductive Sciences (K.S.-B., T.L.H.), Yale University School of Medicine, New Haven, Connecticut 06510; Department of Neurobiology (T.L.H.), Yale University School of Medicine, New Haven, Connecticut 06510; and Department of Pathology and Cell Biology (L.M.Z.), Columbia University, New York, New York 10032
| | - Lori M Zeltser
- Institute of Human Nutrition (J.S.L., A.C.N.N.), Columbia University, New York, New York 10032; Department of Anesthesiology (L.E.R.), Columbia University, New York, New York 10032; Naomi Berrie Diabetes Center (R.H., L.M.Z.), Columbia University, New York, New York 10032; Department of Obstetrics, Gynecology, and Reproductive Sciences (K.S.-B., T.L.H.), Yale University School of Medicine, New Haven, Connecticut 06510; Department of Neurobiology (T.L.H.), Yale University School of Medicine, New Haven, Connecticut 06510; and Department of Pathology and Cell Biology (L.M.Z.), Columbia University, New York, New York 10032
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Taylor PN, Richmond R, Davies N, Sayers A, Stevenson K, Woltersdorf W, Taylor A, Groom A, Northstone K, Ring S, Okosieme O, Rees A, Nitsch D, Williams GR, Smith GD, Gregory JW, Timpson NJ, Tobias JH, Dayan CM. Paradoxical Relationship Between Body Mass Index and Thyroid Hormone Levels: A Study Using Mendelian Randomization. J Clin Endocrinol Metab 2016; 101:730-8. [PMID: 26595101 PMCID: PMC4880123 DOI: 10.1210/jc.2015-3505] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 11/18/2015] [Indexed: 11/19/2022]
Abstract
CONTEXT Free T3 (FT3) has been positively associated with body mass index (BMI) in cross-sectional studies in healthy individuals. This is difficult to reconcile with clinical findings in pathological thyroid dysfunction. OBJECTIVE We aimed to investigate whether childhood adiposity influences FT3 levels. DESIGN Mendelian randomization using genetic variants robustly associated with BMI. SETTING Avon Longitudinal Study of Parents and Children, a population-based birth cohort. PARTICIPANTS A total of 3014 children who had thyroid function measured at age 7, who also underwent dual x-ray absorptiometry scans at ages 9.9 and 15.5 years and have genetic data available. MAIN OUTCOME MEASURES FT3. RESULTS Observationally at age 7 years, BMI was positively associated with FT3: β-standardized (β-[std]) = 0.12 (95% confidence interval [CI]: 0.08, 0.16), P = 4.02 × 10(-10); whereas FT4 was negatively associated with BMI: β-(std) = -0.08 (95% CI: -0.12, -0.04), P = 3.00 × 10(-5). These differences persisted after adjustment for age, sex, and early life environment. Genetic analysis indicated 1 allele change in BMI allelic score was associated with a 0.04 (95% CI: 0.03, 0.04) SD increase in BMI (P = 6.41 × 10(-17)). At age 7, a genetically determined increase in BMI of 1.89 kg/m(2) was associated with a 0.22 pmol/L (95% CI: 0.07, 0.36) increase in FT3 (P = .004) but no substantial change in FT4 0.01 mmol/L, (95% CI: -0.37, 0.40), P = .96. CONCLUSION Our analysis shows that children with a genetically higher BMI had higher FT3 but not FT4 levels, indicating that higher BMI/fat mass has a causal role in increasing FT3 levels. This may explain the paradoxical associations observed in observational analyses. Given rising childhood obesity levels, this relationship merits closer scrutiny.
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Affiliation(s)
- Peter N Taylor
- Thyroid Research Group (P.N.T., O.O., J.W.G., C.M.D.) and Institute of Molecular and Experimental Medicine (A.R.), Cardiff University School of Medicine, Cardiff, CF14 4XN United Kingdom; Medical Research Council Integrative Epidemiology Unit (R.R., N.D., G.D.S., N.J.T.), University of Bristol, Bristol, BS8 2BN United Kingdom; Department of Social and Community Medicine (A.S., A.G., K.N., S.R.), University of Bristol, Bristol, BS8 2BN United Kingdom; Department of Biochemistry (K.S.), Bristol Royal Infirmary University Hospitals Bristol National Health Service Foundation Trust, Bristol, BS2 8HW United Kingdom; Geschäftsleiter Medizinisches Versorgungszentrum Labor Dr. Reising-Ackermann und Kollegen (W.W.), D-04289 Leipzig, Germany; Department of Biochemistry (A.T.), Royal United Hospital, Bath, BA1 3NG United Kingdom; Department of Non-Communicable Disease Epidemiology (D.N.), Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, CF14 4XN United Kingdom; Molecular Endocrinology Group (G.R.W.), Department of Medicine, Imperial College London, London, WC1E 7HT United Kingdom; and Musculoskeletal Research Unit (J.H.T.), University of Bristol, Learning and Research Southmead Hospital, Westbury on Trym, Bristol, BS10 5NB United Kingdom
| | - Rebecca Richmond
- Thyroid Research Group (P.N.T., O.O., J.W.G., C.M.D.) and Institute of Molecular and Experimental Medicine (A.R.), Cardiff University School of Medicine, Cardiff, CF14 4XN United Kingdom; Medical Research Council Integrative Epidemiology Unit (R.R., N.D., G.D.S., N.J.T.), University of Bristol, Bristol, BS8 2BN United Kingdom; Department of Social and Community Medicine (A.S., A.G., K.N., S.R.), University of Bristol, Bristol, BS8 2BN United Kingdom; Department of Biochemistry (K.S.), Bristol Royal Infirmary University Hospitals Bristol National Health Service Foundation Trust, Bristol, BS2 8HW United Kingdom; Geschäftsleiter Medizinisches Versorgungszentrum Labor Dr. Reising-Ackermann und Kollegen (W.W.), D-04289 Leipzig, Germany; Department of Biochemistry (A.T.), Royal United Hospital, Bath, BA1 3NG United Kingdom; Department of Non-Communicable Disease Epidemiology (D.N.), Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, CF14 4XN United Kingdom; Molecular Endocrinology Group (G.R.W.), Department of Medicine, Imperial College London, London, WC1E 7HT United Kingdom; and Musculoskeletal Research Unit (J.H.T.), University of Bristol, Learning and Research Southmead Hospital, Westbury on Trym, Bristol, BS10 5NB United Kingdom
| | - Neil Davies
- Thyroid Research Group (P.N.T., O.O., J.W.G., C.M.D.) and Institute of Molecular and Experimental Medicine (A.R.), Cardiff University School of Medicine, Cardiff, CF14 4XN United Kingdom; Medical Research Council Integrative Epidemiology Unit (R.R., N.D., G.D.S., N.J.T.), University of Bristol, Bristol, BS8 2BN United Kingdom; Department of Social and Community Medicine (A.S., A.G., K.N., S.R.), University of Bristol, Bristol, BS8 2BN United Kingdom; Department of Biochemistry (K.S.), Bristol Royal Infirmary University Hospitals Bristol National Health Service Foundation Trust, Bristol, BS2 8HW United Kingdom; Geschäftsleiter Medizinisches Versorgungszentrum Labor Dr. Reising-Ackermann und Kollegen (W.W.), D-04289 Leipzig, Germany; Department of Biochemistry (A.T.), Royal United Hospital, Bath, BA1 3NG United Kingdom; Department of Non-Communicable Disease Epidemiology (D.N.), Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, CF14 4XN United Kingdom; Molecular Endocrinology Group (G.R.W.), Department of Medicine, Imperial College London, London, WC1E 7HT United Kingdom; and Musculoskeletal Research Unit (J.H.T.), University of Bristol, Learning and Research Southmead Hospital, Westbury on Trym, Bristol, BS10 5NB United Kingdom
| | - Adrian Sayers
- Thyroid Research Group (P.N.T., O.O., J.W.G., C.M.D.) and Institute of Molecular and Experimental Medicine (A.R.), Cardiff University School of Medicine, Cardiff, CF14 4XN United Kingdom; Medical Research Council Integrative Epidemiology Unit (R.R., N.D., G.D.S., N.J.T.), University of Bristol, Bristol, BS8 2BN United Kingdom; Department of Social and Community Medicine (A.S., A.G., K.N., S.R.), University of Bristol, Bristol, BS8 2BN United Kingdom; Department of Biochemistry (K.S.), Bristol Royal Infirmary University Hospitals Bristol National Health Service Foundation Trust, Bristol, BS2 8HW United Kingdom; Geschäftsleiter Medizinisches Versorgungszentrum Labor Dr. Reising-Ackermann und Kollegen (W.W.), D-04289 Leipzig, Germany; Department of Biochemistry (A.T.), Royal United Hospital, Bath, BA1 3NG United Kingdom; Department of Non-Communicable Disease Epidemiology (D.N.), Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, CF14 4XN United Kingdom; Molecular Endocrinology Group (G.R.W.), Department of Medicine, Imperial College London, London, WC1E 7HT United Kingdom; and Musculoskeletal Research Unit (J.H.T.), University of Bristol, Learning and Research Southmead Hospital, Westbury on Trym, Bristol, BS10 5NB United Kingdom
| | - Kirsty Stevenson
- Thyroid Research Group (P.N.T., O.O., J.W.G., C.M.D.) and Institute of Molecular and Experimental Medicine (A.R.), Cardiff University School of Medicine, Cardiff, CF14 4XN United Kingdom; Medical Research Council Integrative Epidemiology Unit (R.R., N.D., G.D.S., N.J.T.), University of Bristol, Bristol, BS8 2BN United Kingdom; Department of Social and Community Medicine (A.S., A.G., K.N., S.R.), University of Bristol, Bristol, BS8 2BN United Kingdom; Department of Biochemistry (K.S.), Bristol Royal Infirmary University Hospitals Bristol National Health Service Foundation Trust, Bristol, BS2 8HW United Kingdom; Geschäftsleiter Medizinisches Versorgungszentrum Labor Dr. Reising-Ackermann und Kollegen (W.W.), D-04289 Leipzig, Germany; Department of Biochemistry (A.T.), Royal United Hospital, Bath, BA1 3NG United Kingdom; Department of Non-Communicable Disease Epidemiology (D.N.), Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, CF14 4XN United Kingdom; Molecular Endocrinology Group (G.R.W.), Department of Medicine, Imperial College London, London, WC1E 7HT United Kingdom; and Musculoskeletal Research Unit (J.H.T.), University of Bristol, Learning and Research Southmead Hospital, Westbury on Trym, Bristol, BS10 5NB United Kingdom
| | - Wolfram Woltersdorf
- Thyroid Research Group (P.N.T., O.O., J.W.G., C.M.D.) and Institute of Molecular and Experimental Medicine (A.R.), Cardiff University School of Medicine, Cardiff, CF14 4XN United Kingdom; Medical Research Council Integrative Epidemiology Unit (R.R., N.D., G.D.S., N.J.T.), University of Bristol, Bristol, BS8 2BN United Kingdom; Department of Social and Community Medicine (A.S., A.G., K.N., S.R.), University of Bristol, Bristol, BS8 2BN United Kingdom; Department of Biochemistry (K.S.), Bristol Royal Infirmary University Hospitals Bristol National Health Service Foundation Trust, Bristol, BS2 8HW United Kingdom; Geschäftsleiter Medizinisches Versorgungszentrum Labor Dr. Reising-Ackermann und Kollegen (W.W.), D-04289 Leipzig, Germany; Department of Biochemistry (A.T.), Royal United Hospital, Bath, BA1 3NG United Kingdom; Department of Non-Communicable Disease Epidemiology (D.N.), Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, CF14 4XN United Kingdom; Molecular Endocrinology Group (G.R.W.), Department of Medicine, Imperial College London, London, WC1E 7HT United Kingdom; and Musculoskeletal Research Unit (J.H.T.), University of Bristol, Learning and Research Southmead Hospital, Westbury on Trym, Bristol, BS10 5NB United Kingdom
| | - Andrew Taylor
- Thyroid Research Group (P.N.T., O.O., J.W.G., C.M.D.) and Institute of Molecular and Experimental Medicine (A.R.), Cardiff University School of Medicine, Cardiff, CF14 4XN United Kingdom; Medical Research Council Integrative Epidemiology Unit (R.R., N.D., G.D.S., N.J.T.), University of Bristol, Bristol, BS8 2BN United Kingdom; Department of Social and Community Medicine (A.S., A.G., K.N., S.R.), University of Bristol, Bristol, BS8 2BN United Kingdom; Department of Biochemistry (K.S.), Bristol Royal Infirmary University Hospitals Bristol National Health Service Foundation Trust, Bristol, BS2 8HW United Kingdom; Geschäftsleiter Medizinisches Versorgungszentrum Labor Dr. Reising-Ackermann und Kollegen (W.W.), D-04289 Leipzig, Germany; Department of Biochemistry (A.T.), Royal United Hospital, Bath, BA1 3NG United Kingdom; Department of Non-Communicable Disease Epidemiology (D.N.), Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, CF14 4XN United Kingdom; Molecular Endocrinology Group (G.R.W.), Department of Medicine, Imperial College London, London, WC1E 7HT United Kingdom; and Musculoskeletal Research Unit (J.H.T.), University of Bristol, Learning and Research Southmead Hospital, Westbury on Trym, Bristol, BS10 5NB United Kingdom
| | - Alix Groom
- Thyroid Research Group (P.N.T., O.O., J.W.G., C.M.D.) and Institute of Molecular and Experimental Medicine (A.R.), Cardiff University School of Medicine, Cardiff, CF14 4XN United Kingdom; Medical Research Council Integrative Epidemiology Unit (R.R., N.D., G.D.S., N.J.T.), University of Bristol, Bristol, BS8 2BN United Kingdom; Department of Social and Community Medicine (A.S., A.G., K.N., S.R.), University of Bristol, Bristol, BS8 2BN United Kingdom; Department of Biochemistry (K.S.), Bristol Royal Infirmary University Hospitals Bristol National Health Service Foundation Trust, Bristol, BS2 8HW United Kingdom; Geschäftsleiter Medizinisches Versorgungszentrum Labor Dr. Reising-Ackermann und Kollegen (W.W.), D-04289 Leipzig, Germany; Department of Biochemistry (A.T.), Royal United Hospital, Bath, BA1 3NG United Kingdom; Department of Non-Communicable Disease Epidemiology (D.N.), Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, CF14 4XN United Kingdom; Molecular Endocrinology Group (G.R.W.), Department of Medicine, Imperial College London, London, WC1E 7HT United Kingdom; and Musculoskeletal Research Unit (J.H.T.), University of Bristol, Learning and Research Southmead Hospital, Westbury on Trym, Bristol, BS10 5NB United Kingdom
| | - Kate Northstone
- Thyroid Research Group (P.N.T., O.O., J.W.G., C.M.D.) and Institute of Molecular and Experimental Medicine (A.R.), Cardiff University School of Medicine, Cardiff, CF14 4XN United Kingdom; Medical Research Council Integrative Epidemiology Unit (R.R., N.D., G.D.S., N.J.T.), University of Bristol, Bristol, BS8 2BN United Kingdom; Department of Social and Community Medicine (A.S., A.G., K.N., S.R.), University of Bristol, Bristol, BS8 2BN United Kingdom; Department of Biochemistry (K.S.), Bristol Royal Infirmary University Hospitals Bristol National Health Service Foundation Trust, Bristol, BS2 8HW United Kingdom; Geschäftsleiter Medizinisches Versorgungszentrum Labor Dr. Reising-Ackermann und Kollegen (W.W.), D-04289 Leipzig, Germany; Department of Biochemistry (A.T.), Royal United Hospital, Bath, BA1 3NG United Kingdom; Department of Non-Communicable Disease Epidemiology (D.N.), Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, CF14 4XN United Kingdom; Molecular Endocrinology Group (G.R.W.), Department of Medicine, Imperial College London, London, WC1E 7HT United Kingdom; and Musculoskeletal Research Unit (J.H.T.), University of Bristol, Learning and Research Southmead Hospital, Westbury on Trym, Bristol, BS10 5NB United Kingdom
| | - Susan Ring
- Thyroid Research Group (P.N.T., O.O., J.W.G., C.M.D.) and Institute of Molecular and Experimental Medicine (A.R.), Cardiff University School of Medicine, Cardiff, CF14 4XN United Kingdom; Medical Research Council Integrative Epidemiology Unit (R.R., N.D., G.D.S., N.J.T.), University of Bristol, Bristol, BS8 2BN United Kingdom; Department of Social and Community Medicine (A.S., A.G., K.N., S.R.), University of Bristol, Bristol, BS8 2BN United Kingdom; Department of Biochemistry (K.S.), Bristol Royal Infirmary University Hospitals Bristol National Health Service Foundation Trust, Bristol, BS2 8HW United Kingdom; Geschäftsleiter Medizinisches Versorgungszentrum Labor Dr. Reising-Ackermann und Kollegen (W.W.), D-04289 Leipzig, Germany; Department of Biochemistry (A.T.), Royal United Hospital, Bath, BA1 3NG United Kingdom; Department of Non-Communicable Disease Epidemiology (D.N.), Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, CF14 4XN United Kingdom; Molecular Endocrinology Group (G.R.W.), Department of Medicine, Imperial College London, London, WC1E 7HT United Kingdom; and Musculoskeletal Research Unit (J.H.T.), University of Bristol, Learning and Research Southmead Hospital, Westbury on Trym, Bristol, BS10 5NB United Kingdom
| | - Onyebuchi Okosieme
- Thyroid Research Group (P.N.T., O.O., J.W.G., C.M.D.) and Institute of Molecular and Experimental Medicine (A.R.), Cardiff University School of Medicine, Cardiff, CF14 4XN United Kingdom; Medical Research Council Integrative Epidemiology Unit (R.R., N.D., G.D.S., N.J.T.), University of Bristol, Bristol, BS8 2BN United Kingdom; Department of Social and Community Medicine (A.S., A.G., K.N., S.R.), University of Bristol, Bristol, BS8 2BN United Kingdom; Department of Biochemistry (K.S.), Bristol Royal Infirmary University Hospitals Bristol National Health Service Foundation Trust, Bristol, BS2 8HW United Kingdom; Geschäftsleiter Medizinisches Versorgungszentrum Labor Dr. Reising-Ackermann und Kollegen (W.W.), D-04289 Leipzig, Germany; Department of Biochemistry (A.T.), Royal United Hospital, Bath, BA1 3NG United Kingdom; Department of Non-Communicable Disease Epidemiology (D.N.), Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, CF14 4XN United Kingdom; Molecular Endocrinology Group (G.R.W.), Department of Medicine, Imperial College London, London, WC1E 7HT United Kingdom; and Musculoskeletal Research Unit (J.H.T.), University of Bristol, Learning and Research Southmead Hospital, Westbury on Trym, Bristol, BS10 5NB United Kingdom
| | - Aled Rees
- Thyroid Research Group (P.N.T., O.O., J.W.G., C.M.D.) and Institute of Molecular and Experimental Medicine (A.R.), Cardiff University School of Medicine, Cardiff, CF14 4XN United Kingdom; Medical Research Council Integrative Epidemiology Unit (R.R., N.D., G.D.S., N.J.T.), University of Bristol, Bristol, BS8 2BN United Kingdom; Department of Social and Community Medicine (A.S., A.G., K.N., S.R.), University of Bristol, Bristol, BS8 2BN United Kingdom; Department of Biochemistry (K.S.), Bristol Royal Infirmary University Hospitals Bristol National Health Service Foundation Trust, Bristol, BS2 8HW United Kingdom; Geschäftsleiter Medizinisches Versorgungszentrum Labor Dr. Reising-Ackermann und Kollegen (W.W.), D-04289 Leipzig, Germany; Department of Biochemistry (A.T.), Royal United Hospital, Bath, BA1 3NG United Kingdom; Department of Non-Communicable Disease Epidemiology (D.N.), Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, CF14 4XN United Kingdom; Molecular Endocrinology Group (G.R.W.), Department of Medicine, Imperial College London, London, WC1E 7HT United Kingdom; and Musculoskeletal Research Unit (J.H.T.), University of Bristol, Learning and Research Southmead Hospital, Westbury on Trym, Bristol, BS10 5NB United Kingdom
| | - Dorothea Nitsch
- Thyroid Research Group (P.N.T., O.O., J.W.G., C.M.D.) and Institute of Molecular and Experimental Medicine (A.R.), Cardiff University School of Medicine, Cardiff, CF14 4XN United Kingdom; Medical Research Council Integrative Epidemiology Unit (R.R., N.D., G.D.S., N.J.T.), University of Bristol, Bristol, BS8 2BN United Kingdom; Department of Social and Community Medicine (A.S., A.G., K.N., S.R.), University of Bristol, Bristol, BS8 2BN United Kingdom; Department of Biochemistry (K.S.), Bristol Royal Infirmary University Hospitals Bristol National Health Service Foundation Trust, Bristol, BS2 8HW United Kingdom; Geschäftsleiter Medizinisches Versorgungszentrum Labor Dr. Reising-Ackermann und Kollegen (W.W.), D-04289 Leipzig, Germany; Department of Biochemistry (A.T.), Royal United Hospital, Bath, BA1 3NG United Kingdom; Department of Non-Communicable Disease Epidemiology (D.N.), Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, CF14 4XN United Kingdom; Molecular Endocrinology Group (G.R.W.), Department of Medicine, Imperial College London, London, WC1E 7HT United Kingdom; and Musculoskeletal Research Unit (J.H.T.), University of Bristol, Learning and Research Southmead Hospital, Westbury on Trym, Bristol, BS10 5NB United Kingdom
| | - Graham R Williams
- Thyroid Research Group (P.N.T., O.O., J.W.G., C.M.D.) and Institute of Molecular and Experimental Medicine (A.R.), Cardiff University School of Medicine, Cardiff, CF14 4XN United Kingdom; Medical Research Council Integrative Epidemiology Unit (R.R., N.D., G.D.S., N.J.T.), University of Bristol, Bristol, BS8 2BN United Kingdom; Department of Social and Community Medicine (A.S., A.G., K.N., S.R.), University of Bristol, Bristol, BS8 2BN United Kingdom; Department of Biochemistry (K.S.), Bristol Royal Infirmary University Hospitals Bristol National Health Service Foundation Trust, Bristol, BS2 8HW United Kingdom; Geschäftsleiter Medizinisches Versorgungszentrum Labor Dr. Reising-Ackermann und Kollegen (W.W.), D-04289 Leipzig, Germany; Department of Biochemistry (A.T.), Royal United Hospital, Bath, BA1 3NG United Kingdom; Department of Non-Communicable Disease Epidemiology (D.N.), Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, CF14 4XN United Kingdom; Molecular Endocrinology Group (G.R.W.), Department of Medicine, Imperial College London, London, WC1E 7HT United Kingdom; and Musculoskeletal Research Unit (J.H.T.), University of Bristol, Learning and Research Southmead Hospital, Westbury on Trym, Bristol, BS10 5NB United Kingdom
| | - George Davey Smith
- Thyroid Research Group (P.N.T., O.O., J.W.G., C.M.D.) and Institute of Molecular and Experimental Medicine (A.R.), Cardiff University School of Medicine, Cardiff, CF14 4XN United Kingdom; Medical Research Council Integrative Epidemiology Unit (R.R., N.D., G.D.S., N.J.T.), University of Bristol, Bristol, BS8 2BN United Kingdom; Department of Social and Community Medicine (A.S., A.G., K.N., S.R.), University of Bristol, Bristol, BS8 2BN United Kingdom; Department of Biochemistry (K.S.), Bristol Royal Infirmary University Hospitals Bristol National Health Service Foundation Trust, Bristol, BS2 8HW United Kingdom; Geschäftsleiter Medizinisches Versorgungszentrum Labor Dr. Reising-Ackermann und Kollegen (W.W.), D-04289 Leipzig, Germany; Department of Biochemistry (A.T.), Royal United Hospital, Bath, BA1 3NG United Kingdom; Department of Non-Communicable Disease Epidemiology (D.N.), Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, CF14 4XN United Kingdom; Molecular Endocrinology Group (G.R.W.), Department of Medicine, Imperial College London, London, WC1E 7HT United Kingdom; and Musculoskeletal Research Unit (J.H.T.), University of Bristol, Learning and Research Southmead Hospital, Westbury on Trym, Bristol, BS10 5NB United Kingdom
| | - John W Gregory
- Thyroid Research Group (P.N.T., O.O., J.W.G., C.M.D.) and Institute of Molecular and Experimental Medicine (A.R.), Cardiff University School of Medicine, Cardiff, CF14 4XN United Kingdom; Medical Research Council Integrative Epidemiology Unit (R.R., N.D., G.D.S., N.J.T.), University of Bristol, Bristol, BS8 2BN United Kingdom; Department of Social and Community Medicine (A.S., A.G., K.N., S.R.), University of Bristol, Bristol, BS8 2BN United Kingdom; Department of Biochemistry (K.S.), Bristol Royal Infirmary University Hospitals Bristol National Health Service Foundation Trust, Bristol, BS2 8HW United Kingdom; Geschäftsleiter Medizinisches Versorgungszentrum Labor Dr. Reising-Ackermann und Kollegen (W.W.), D-04289 Leipzig, Germany; Department of Biochemistry (A.T.), Royal United Hospital, Bath, BA1 3NG United Kingdom; Department of Non-Communicable Disease Epidemiology (D.N.), Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, CF14 4XN United Kingdom; Molecular Endocrinology Group (G.R.W.), Department of Medicine, Imperial College London, London, WC1E 7HT United Kingdom; and Musculoskeletal Research Unit (J.H.T.), University of Bristol, Learning and Research Southmead Hospital, Westbury on Trym, Bristol, BS10 5NB United Kingdom
| | - Nicholas J Timpson
- Thyroid Research Group (P.N.T., O.O., J.W.G., C.M.D.) and Institute of Molecular and Experimental Medicine (A.R.), Cardiff University School of Medicine, Cardiff, CF14 4XN United Kingdom; Medical Research Council Integrative Epidemiology Unit (R.R., N.D., G.D.S., N.J.T.), University of Bristol, Bristol, BS8 2BN United Kingdom; Department of Social and Community Medicine (A.S., A.G., K.N., S.R.), University of Bristol, Bristol, BS8 2BN United Kingdom; Department of Biochemistry (K.S.), Bristol Royal Infirmary University Hospitals Bristol National Health Service Foundation Trust, Bristol, BS2 8HW United Kingdom; Geschäftsleiter Medizinisches Versorgungszentrum Labor Dr. Reising-Ackermann und Kollegen (W.W.), D-04289 Leipzig, Germany; Department of Biochemistry (A.T.), Royal United Hospital, Bath, BA1 3NG United Kingdom; Department of Non-Communicable Disease Epidemiology (D.N.), Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, CF14 4XN United Kingdom; Molecular Endocrinology Group (G.R.W.), Department of Medicine, Imperial College London, London, WC1E 7HT United Kingdom; and Musculoskeletal Research Unit (J.H.T.), University of Bristol, Learning and Research Southmead Hospital, Westbury on Trym, Bristol, BS10 5NB United Kingdom
| | - Jonathan H Tobias
- Thyroid Research Group (P.N.T., O.O., J.W.G., C.M.D.) and Institute of Molecular and Experimental Medicine (A.R.), Cardiff University School of Medicine, Cardiff, CF14 4XN United Kingdom; Medical Research Council Integrative Epidemiology Unit (R.R., N.D., G.D.S., N.J.T.), University of Bristol, Bristol, BS8 2BN United Kingdom; Department of Social and Community Medicine (A.S., A.G., K.N., S.R.), University of Bristol, Bristol, BS8 2BN United Kingdom; Department of Biochemistry (K.S.), Bristol Royal Infirmary University Hospitals Bristol National Health Service Foundation Trust, Bristol, BS2 8HW United Kingdom; Geschäftsleiter Medizinisches Versorgungszentrum Labor Dr. Reising-Ackermann und Kollegen (W.W.), D-04289 Leipzig, Germany; Department of Biochemistry (A.T.), Royal United Hospital, Bath, BA1 3NG United Kingdom; Department of Non-Communicable Disease Epidemiology (D.N.), Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, CF14 4XN United Kingdom; Molecular Endocrinology Group (G.R.W.), Department of Medicine, Imperial College London, London, WC1E 7HT United Kingdom; and Musculoskeletal Research Unit (J.H.T.), University of Bristol, Learning and Research Southmead Hospital, Westbury on Trym, Bristol, BS10 5NB United Kingdom
| | - Colin M Dayan
- Thyroid Research Group (P.N.T., O.O., J.W.G., C.M.D.) and Institute of Molecular and Experimental Medicine (A.R.), Cardiff University School of Medicine, Cardiff, CF14 4XN United Kingdom; Medical Research Council Integrative Epidemiology Unit (R.R., N.D., G.D.S., N.J.T.), University of Bristol, Bristol, BS8 2BN United Kingdom; Department of Social and Community Medicine (A.S., A.G., K.N., S.R.), University of Bristol, Bristol, BS8 2BN United Kingdom; Department of Biochemistry (K.S.), Bristol Royal Infirmary University Hospitals Bristol National Health Service Foundation Trust, Bristol, BS2 8HW United Kingdom; Geschäftsleiter Medizinisches Versorgungszentrum Labor Dr. Reising-Ackermann und Kollegen (W.W.), D-04289 Leipzig, Germany; Department of Biochemistry (A.T.), Royal United Hospital, Bath, BA1 3NG United Kingdom; Department of Non-Communicable Disease Epidemiology (D.N.), Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, CF14 4XN United Kingdom; Molecular Endocrinology Group (G.R.W.), Department of Medicine, Imperial College London, London, WC1E 7HT United Kingdom; and Musculoskeletal Research Unit (J.H.T.), University of Bristol, Learning and Research Southmead Hospital, Westbury on Trym, Bristol, BS10 5NB United Kingdom
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Knight BA, Shields BM, Hattersley AT, Vaidya B. Maternal hypothyroxinaemia in pregnancy is associated with obesity and adverse maternal metabolic parameters. Eur J Endocrinol 2016; 174:51-7. [PMID: 26586839 PMCID: PMC4761956 DOI: 10.1530/eje-15-0866] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Subclinical hypothyroidism and isolated hypothyroxinaemia in pregnancy have been associated with an increased risk of gestational diabetes. We aimed to ascertain if these women have a worse metabolic phenotype than euthyroid pregnant women. DESIGN, SUBJECTS AND METHODS We recruited 956 healthy Caucasian women with singleton, non-diabetic pregnancies from routine antenatal clinics. Detailed anthropometric measurements (including BMI and skinfold thickness) and fasting blood samples (for TSH, free thyroxine (FT4), free triiodothyronine (FT3), HbA1c, lipid profile, plasma glucose and insulin resistance (HOMA-IR) analysis) were obtained at 28 weeks gestation. RESULTS In comparison to euthyroid women (n=741), women with isolated hypothyroxinaemia (n=82) had significantly increased BMI (29.5 vs 27.5 kg/m(2), P<0.001), sum of skinfolds (57.5 vs 51.3 mm, P=0.002), fasting plasma glucose (4.5 vs 4.3 mmol/l, P=0.01), triglycerides (2.3 vs 2.0 mmol/l, P<0.001) and HOMA-IR (2.0 vs 1.3, P=0.001). Metabolic parameters in women with subclinical hypothyroidism (n=133) were similar to those in euthyroid women. Maternal FT4 was negatively associated with BMI (r=-0.22), HbA1c (r=-0.14), triglycerides (r=-0.17), HOMA-IR (r=-0.15) but not total/HDL cholesterol ratio (r=-0.03). Maternal FT3:FT4 ratio was positively associated with BMI (r=0.4), HbA1c (r=0.21), triglycerides (r=0.2), HOMA-IR (r=0.33) and total/HDL cholesterol ratio (r=0.07). TSH was not associated with the metabolic parameters assessed. CONCLUSIONS Isolated hypothyroxinaemia, but not subclinical hypothyroidism, is associated with adverse metabolic phenotype in pregnancy, as is decreasing maternal FT4 and increasing FT3:FT4 ratio. These associations may be a reflection of changes in the thyroid hormone levels secondary to increase in BMI rather than changes in thyroid hormone levels affecting body weight and related metabolic parameters.
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Affiliation(s)
- Bridget A Knight
- NIHR Exeter Clinical Research FacilityUniversity of Exeter Medical School, University of Exeter, Exeter, UKDepartment of EndocrinologyRoyal Devon and Exeter Hospital NHS Foundation Trust, Exeter, EX2 5DW, UKResearch and Development DepartmentRoyal Devon and Exeter Hospital NHS Foundation Trust, Exeter UK NIHR Exeter Clinical Research FacilityUniversity of Exeter Medical School, University of Exeter, Exeter, UKDepartment of EndocrinologyRoyal Devon and Exeter Hospital NHS Foundation Trust, Exeter, EX2 5DW, UKResearch and Development DepartmentRoyal Devon and Exeter Hospital NHS Foundation Trust, Exeter UK
| | - Beverley M Shields
- NIHR Exeter Clinical Research FacilityUniversity of Exeter Medical School, University of Exeter, Exeter, UKDepartment of EndocrinologyRoyal Devon and Exeter Hospital NHS Foundation Trust, Exeter, EX2 5DW, UKResearch and Development DepartmentRoyal Devon and Exeter Hospital NHS Foundation Trust, Exeter UK
| | - Andrew T Hattersley
- NIHR Exeter Clinical Research FacilityUniversity of Exeter Medical School, University of Exeter, Exeter, UKDepartment of EndocrinologyRoyal Devon and Exeter Hospital NHS Foundation Trust, Exeter, EX2 5DW, UKResearch and Development DepartmentRoyal Devon and Exeter Hospital NHS Foundation Trust, Exeter UK NIHR Exeter Clinical Research FacilityUniversity of Exeter Medical School, University of Exeter, Exeter, UKDepartment of EndocrinologyRoyal Devon and Exeter Hospital NHS Foundation Trust, Exeter, EX2 5DW, UKResearch and Development DepartmentRoyal Devon and Exeter Hospital NHS Foundation Trust, Exeter UK
| | - Bijay Vaidya
- NIHR Exeter Clinical Research FacilityUniversity of Exeter Medical School, University of Exeter, Exeter, UKDepartment of EndocrinologyRoyal Devon and Exeter Hospital NHS Foundation Trust, Exeter, EX2 5DW, UKResearch and Development DepartmentRoyal Devon and Exeter Hospital NHS Foundation Trust, Exeter UK
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Rumińska M, Witkowska-Sędek E, Majcher A, Pyrżak B. Thyroid Function in Obese Children and Adolescents and Its Association with Anthropometric and Metabolic Parameters. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2016; 912:33-41. [DOI: 10.1007/5584_2016_232] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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Javed A, Balagopal PB, Vella A, Fischer PR, Piccinini F, Dalla Man C, Cobelli C, Giesler PD, Laugen JM, Kumar S. Association between thyrotropin levels and insulin sensitivity in euthyroid obese adolescents. Thyroid 2015; 25:478-84. [PMID: 25777801 PMCID: PMC4426325 DOI: 10.1089/thy.2015.0005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Thyrotropin (TSH) levels display a positive association with body mass index (BMI), and the prevalence of isolated hyperthyrotropinemia is higher in obese adolescents compared to their normal weight controls. However, the metabolic significance of the higher TSH in obese adolescents is less clear. The objective of this study was to determine the relationship between TSH concentrations and insulin sensitivity, lipids, and adipokines in euthyroid, non-diabetic, obese adolescents. METHODS Thirty-six euthyroid, non-diabetic, obese adolescents between the ages of 12 and 18 years underwent a 75 g oral glucose tolerance test. Insulin sensitivity (Si) and pancreatic β-cell function as assessed by disposition index (DI) were measured using the oral glucose minimal model approach. Cholesterol (total, low-density lipoprotein [LDL-C], and high-density lipoprotein [HDL-C]), triglycerides (TG), interleukin-6 (IL-6), total and high molecular weight (HMW) adiponectin, and retinol binding protein-4 (RBP4) were also determined. Associations between measures of thyroid function and Si, DI, lipids, and adipokines were computed using Pearson's correlation coefficient and multiple regression analysis. RESULTS The mean age of the subjects was 14.3±1.88 years, and the mean BMI was 32.5±4.65 kg/m2; 97% were non-Hispanic white and 47% were male. The mean TSH was 2.7±1.2 mIU/L. Increasing serum TSH was correlated with decreasing Si (log Si) in the entire cohort (p=0.03), but this relationship persisted only in males (p=0.02). The correlation between TSH and Si in males remained significant after adjusting for BMI (p=0.02). There was no correlation between TSH and pancreatic β-cell function as assessed by DI (p=0.48). TSH correlated positively with LDL-C (p=0.04) and IL-6 (p=0.03), but these associations vanished or weakened after adjusting for BMI (LDL-C p-value=0.44; IL-6 p-value=0.07). CONCLUSIONS This study suggests a sex-specific association between TSH and insulin sensitivity in euthyroid, non-diabetic, obese adolescent males. Prospective studies are warranted to explore further this sexual dimorphism in the relationship between thyroid function and insulin sensitivity and to determine if obese adolescents with insulin resistance receiving thyroid supplements for hypothyroidism would benefit from targeting TSH levels in the lower half of normal range.
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Affiliation(s)
- Asma Javed
- Division of Pediatric Endocrinology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota
| | | | - Adrian Vella
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Philip R. Fischer
- Division of General Pediatric and Adolescent Medicine, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota
| | | | - Chiara Dalla Man
- Department of Information Engineering, University of Padua, Padua, Italy
| | - Claudio Cobelli
- Department of Information Engineering, University of Padua, Padua, Italy
| | - Paula D. Giesler
- Endocrine Research Unit, Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Jeanette M. Laugen
- Endocrine Research Unit, Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Seema Kumar
- Division of Pediatric Endocrinology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota
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Gawlik A, Such K, Dejner A, Zachurzok A, Antosz A, Malecka-Tendera E. Subclinical hypothyroidism in children and adolescents: is it clinically relevant? Int J Endocrinol 2015; 2015:691071. [PMID: 25892992 PMCID: PMC4393928 DOI: 10.1155/2015/691071] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2014] [Revised: 02/04/2015] [Accepted: 02/27/2015] [Indexed: 12/20/2022] Open
Abstract
Although subclinical hypothyroidism (SH) is a common clinical problem, its diagnosis tends to be incidental. According to the definition, it should be asymptomatic, only detectable by screening. The presence or coincidence of any symptoms leads to L-thyroxine treatment. The clinical presentation, especially in younger patients with subclinical hypothyroidism, is still under dispute. Accordingly, the aim of this paper was to review the literature from the past seven years. The literature search identified 1,594 potentially relevant articles, of which 24 met the inclusion criteria. Few studies focus on the symptomatology of subclinical hypothyroidism, and most of them analyzed a small number of subjects. A significant correlation was found by some authors between subclinical hypothyroidism and a higher risk of hypertension, dyslipidemia, and migraine. No evidence of the impact of subclinical hypothyroidism on weight, growth velocity, and puberty was revealed. As the quality of most studies is poor and no definite conclusions can be drawn, randomized, large-scale studies in children and adolescents are warranted to determine the best care for patients with SH.
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Affiliation(s)
- Aneta Gawlik
- Department of Pediatrics, Pediatric Endocrinology and Diabetes, School of Medicine in Katowice, Medical University of Silesia, 40752 Katowice, Poland
- *Aneta Gawlik:
| | - Kamila Such
- Medical Students' Scientific Association, 40752 Katowice, Poland
| | | | - Agnieszka Zachurzok
- Department of Pediatrics, Pediatric Endocrinology and Diabetes, School of Medicine in Katowice, Medical University of Silesia, 40752 Katowice, Poland
| | - Aleksandra Antosz
- Department of Pediatrics, Pediatric Endocrinology and Diabetes, Upper-Silesian Pediatric Health Center, 40752 Katowice, Poland
| | - Ewa Malecka-Tendera
- Department of Pediatrics, Pediatric Endocrinology and Diabetes, School of Medicine in Katowice, Medical University of Silesia, 40752 Katowice, Poland
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Garduño-Garcia JDJ, Camarillo Romero E, Loe Ochoa A, Romero-Figueroa S, Huitron Bravo G, Torres García R, Montenegro-Morales P, Mendieta-Zerón H. Thyroid function is associated with insulin resistance markers in healthy adolescents with risk factors to develop diabetes. Diabetol Metab Syndr 2015; 7:16. [PMID: 25780389 PMCID: PMC4361132 DOI: 10.1186/s13098-015-0011-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Accepted: 02/14/2015] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION The prevalence of obesity and Type 2 diabetes mellitus (T2DM) among children and adolescents is rising. Thyroid function has been associated with insulin resistance. There is scarce information about how thyroid function could be related with cardiovascular risk or glucose homeostasis in adolescent. AIM To analyze how thyroid function is associated with insulin resistance and another cardiovascular risk factors in healthy adolescents with risk factors to develop diabetes. METHODS A prospective cross-sectional analysis was carried out on euthyroid, adolescents. considered at high risk to develop Type 2 diabetes. Fasting blood samples were obtained. Thyroid function test and another cardiometabolic parameters were assessed. A 75 grams oral glucose tolerance test was performed to calculate insulin resistance. RESULTS One hundred adolescents were evaluated. The mean age was 15.9 ± 0.8 years, There is a negative correlation between Fasting insulin, post glucose load insulin and HOMA IR. There were no correlation with Matsuda index. We could not found any correlation with TSH values. CONCLUSIONS We found a correlation between fasting insulin, HOMA IR and serum thyroid hormones, we did not find any relation with serum TSH. In euthyroid adolescents with risk factors to develop diabetes.
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Affiliation(s)
- José de Jesús Garduño-Garcia
- />Medical Sciences Research Center (CICMED) Cuerpo académico de Salud del Universitario, 50226 Toluca, State of Mexico Mexico
- />Coordinación de Investigación en Salud, Delegación México Poniente de Instituto Mexicano del Seguro Social, 50226 Toluca, State of Mexico Mexico
| | - Eneida Camarillo Romero
- />Medical Sciences Research Center (CICMED) Cuerpo académico de Salud del Universitario, 50226 Toluca, State of Mexico Mexico
| | - Ana Loe Ochoa
- />High school Licenciado Adolfo López Mateos, 50226 Toluca, State of Mexico Mexico
| | - Socorro Romero-Figueroa
- />Coordinación de Investigación en Salud, Delegación México Poniente de Instituto Mexicano del Seguro Social, 50226 Toluca, State of Mexico Mexico
| | - Gerardo Huitron Bravo
- />Medical Sciences Research Center (CICMED) Cuerpo académico de Salud del Universitario, 50226 Toluca, State of Mexico Mexico
| | - Roció Torres García
- />Medical Sciences Research Center (CICMED) Cuerpo académico de Salud del Universitario, 50226 Toluca, State of Mexico Mexico
| | - Patricia Montenegro-Morales
- />Medical Sciences Research Center (CICMED) Cuerpo académico de Salud del Universitario, 50226 Toluca, State of Mexico Mexico
| | - Hugo Mendieta-Zerón
- />Medical Sciences Research Center (CICMED) Cuerpo académico de biomedicina, 50226 Toluca, State of Mexico Mexico
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Lobotková D, Staníková D, Staník J, Cervenová O, Bzdúch V, Tichá L. Lack of association between peripheral activity of thyroid hormones and elevated TSH levels in childhood obesity. J Clin Res Pediatr Endocrinol 2014; 6:100-4. [PMID: 24932603 PMCID: PMC4141570 DOI: 10.4274/jcrpe.1251] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
OBJECTIVE An elevated thyroid stimulating hormone (TSH) level is a frequent finding in obese children, but its association with peripheral hormone metabolism is not fully understood. We hypothesized that in obesity, the changes in thyroid hormone metabolism in peripheral tissues might lead to dysregulation in the thyroid axis. The purpose of this study was to investigate the association of TSH with thyroid hormones in a group of obese children as compared to normal-weight controls. METHODS Serum TSH, free thyroxine (fT4) and free triiodothyronine (fT3) levels were measured in 101 obese children and in 40 controls. Serum reverse T3 (rT3) levels were also measured in a subgroup of 51 obese children and in 15 controls. RESULTS Serum TSH level was significantly higher in obese children compared to controls (2.78 vs. 1.99 mIU/L, p<0.001), while no difference was found in fT4, fT3, rT3 levels and in fT3/rT3 ratio. In the obese group, fT3 level positively correlated with fT4 (r=0.217, p=0.033) and inversely with rT3 (r=-0.288, p=0.045). However, thyroid hormone levels and TSH levels were not correlated. CONCLUSION In obese children, normal fT4, fT3 and rT3 levels suggest an undisturbed peripheral hormone metabolism. These levels show no correlation with elevated TSH levels.
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Affiliation(s)
- Denisa Lobotková
- Comenius University Faculty of Medicine and Children's University Hospital, Department of Pediatrics, Bratislava, Slovakia. E-ma-il:
| | - Daniela Staníková
- Comenius University Faculty of Medicine and Children’s University Hospital, Department of Pediatrics, Bratislava, Slovakia
| | - Juraj Staník
- Comenius University Faculty of Medicine and Children’s University Hospital, Department of Pediatrics, Bratislava, Slovakia
| | - Ol’ga Cervenová
- Comenius University Faculty of Medicine and Children’s University Hospital, Department of Pediatrics, Bratislava, Slovakia
| | - Vladimír Bzdúch
- Comenius University Faculty of Medicine and Children’s University Hospital, Department of Pediatrics, Bratislava, Slovakia
| | - L’ubica Tichá
- Comenius University Faculty of Medicine and Children’s University Hospital, Department of Pediatrics, Bratislava, Slovakia
,* Address for Correspondence: Comenius University Faculty of Medicine and Children’s University Hospital, Department of Pediatrics, Bratislava, Slovakia Phone: +421 259 371 871 E-mail:
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Lazarus J, Brown RS, Daumerie C, Hubalewska-Dydejczyk A, Negro R, Vaidya B. 2014 European thyroid association guidelines for the management of subclinical hypothyroidism in pregnancy and in children. Eur Thyroid J 2014; 3:76-94. [PMID: 25114871 PMCID: PMC4109520 DOI: 10.1159/000362597] [Citation(s) in RCA: 378] [Impact Index Per Article: 37.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Revised: 04/01/2014] [Indexed: 12/19/2022] Open
Abstract
This guideline has been produced as the official statement of the European Thyroid Association guideline committee. Subclinical hypothyroidism (SCH) in pregnancy is defined as a thyroid-stimulating hormone (TSH) level above the pregnancy-related reference range with a normal serum thyroxine concentration. Isolated hypothyroxinaemia (defined as a thyroxine level below the 2.5th centile of the pregnancy-related reference range with a normal TSH level) is also recognized in pregnancy. In the majority of SCH the cause is autoimmune thyroiditis but may also be due to iodine deficiency. The cause of isolated hypothyroxinaemia is usually not apparent, but iodine deficiency may be a factor. SCH and isolated hypothyroxinaemia are both associated with adverse obstetric outcomes. Levothyroxine therapy may ameliorate some of these with SCH but not in isolated hypothyroxinaemia. SCH and isolated hypothyroxinaemia are both associated with neuro-intellectual impairment of the child, but there is no evidence that maternal levothyroxine therapy improves this outcome. Targeted antenatal screening for thyroid function will miss a substantial percentage of women with thyroid dysfunction. In children SCH (serum TSH concentration >5.5-10 mU/l) normalizes in >70% and persists in the majority of the remaining patients over the subsequent 5 years, but rarely worsens. There is a lack of studies examining the impact of SCH on the neuropsychological development of children under the age of 3 years. In older children, the evidence for an association between SCH and impaired neuropsychological development is inconsistent. Good quality studies examining the effect of treatment of SCH in children are lacking.
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Affiliation(s)
- John Lazarus
- Thyroid Research Group, Institute of Molecular Medicine, Cardiff University, University Hospital of Wales, Cardiff, Exeter, UK
| | - Rosalind S. Brown
- Clinical Trials Research Division of Endocrinology, Children's Hospital Boston, Harvard Medical School, Boston, Mass., USA
| | - Chantal Daumerie
- Endocrinologie, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | | | - Roberto Negro
- Division of Endocrinology, V. Fazzi Hospital, Lecce, Italy
| | - Bijay Vaidya
- Department of Endocrinology, Royal Devon and Exeter Hospital and University of Exeter Medical School, Exeter, UK
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Pearce SHS, Brabant G, Duntas LH, Monzani F, Peeters RP, Razvi S, Wemeau JL. 2013 ETA Guideline: Management of Subclinical Hypothyroidism. Eur Thyroid J 2013; 2:215-28. [PMID: 24783053 PMCID: PMC3923601 DOI: 10.1159/000356507] [Citation(s) in RCA: 430] [Impact Index Per Article: 39.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Accepted: 10/07/2013] [Indexed: 01/08/2023] Open
Abstract
Subclinical hypothyroidism (SCH) should be considered in two categories according to the elevation in serum thyroid-stimulating hormone (TSH) level: mildly increased TSH levels (4.0-10.0 mU/l) and more severely increased TSH value (>10 mU/l). An initially raised serum TSH, with FT4 within reference range, should be investigated with a repeat measurement of both serum TSH and FT4, along with thyroid peroxidase antibodies, preferably after a 2- to 3-month interval. Even in the absence of symptoms, replacement therapy with L-thyroxine is recommended for younger patients (<65-70 years) with serum TSH >10 mU/l. In younger SCH patients (serum TSH <10 mU/l) with symptoms suggestive of hypothyroidism, a trial of L-thyroxine replacement therapy should be considered. For such patients who have been started on L-thyroxine for symptoms attributed to SCH, response to treatment should be reviewed 3 or 4 months after a serum TSH within reference range is reached. If there is no improvement in symptoms, L-thyroxine therapy should generally be stopped. Age-specific local reference ranges for serum TSH should be considered in order to establish a diagnosis of SCH in older people. The oldest old subjects (>80-85 years) with elevated serum TSH ≤10 mU/l should be carefully followed with a wait-and-see strategy, generally avoiding hormonal treatment. If the decision is to treat SCH, then oral L-thyroxine, administered daily, is the treatment of choice. The serum TSH should be re-checked 2 months after starting L-thyroxine therapy, and dosage adjustments made accordingly. The aim for most adults should be to reach a stable serum TSH in the lower half of the reference range (0.4-2.5 mU/l). Once patients with SCH are commenced on L-thyroxine treatment, then serum TSH should be monitored at least annually thereafter.
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Affiliation(s)
- Simon H S Pearce
- Institute of Genetic Medicine, Newcastle University, UK ; Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Georg Brabant
- Medizinische Klinik I, Universitätsklinikum Schleswig-Holstein, Lübeck, Germany
| | - Leonidas H Duntas
- Endocrine Unit, Evgenidion Hospital, University of Athens, Athens, Greece
| | - Fabio Monzani
- Department of Clinical and Experimental Medicine, Università di Pisa, Pisa, Italy
| | - Robin P Peeters
- Rotterdam Thyroid Center, Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Salman Razvi
- Institute of Genetic Medicine, Newcastle University, UK ; Queen Elizabeth Hospital, Gateshead, UK
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