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Zhong L, Liu S, Yang Y, Xie T, Liu J, Zhao H, Tan G. Metabolic syndrome and risk of subclinical hypothyroidism: a systematic review and meta-analysis. Front Endocrinol (Lausanne) 2024; 15:1399236. [PMID: 38982986 PMCID: PMC11231392 DOI: 10.3389/fendo.2024.1399236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 05/28/2024] [Indexed: 07/11/2024] Open
Abstract
Background Subclinical hypothyroidism (SCH) is a common endocrine subclinical disorder, the main adverse consequences of which are the development of clinical hypothyroidism and the promotion of ischemic heart disease. Metabolic syndrome (MetS) is a collection of metabolic problems. The goal of this meta-analysis was to evaluate the relationship between MetS and SCH. Methods Suitable publications were identified using PubMed, Embase, and the Cochrane Library. The meta-analysis included only studies in English that reported odds ratio (OR) data for MetS and SCH. Two researchers combined data using a random-effects model. OR and 95% confidence intervals (CIs) were used to present the results. Results MetS was associated with an elevated risk of developing SCH (OR 2.56, 95% CI 1.44-4.55). However, the individual components of MetS were not associated with the risk of SCH. Subgroup analysis revealed that different definitions of MetS had varying effects on SCH. Sensitivity analysis confirmed that our results were robust. Conclusions This meta-analysis indicates that patients with MetS have an increased risk of SCH, while there is no significant association between the five individual components of MetS and the risk of SCH. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42023454415.
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Affiliation(s)
- Lei Zhong
- Department of General Surgery, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Shuo Liu
- Department of Endocrinology and Metabolic Diseases, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Yao Yang
- Department of General Surgery, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
- Institute of Integrative Medicine, Dalian Medical University, Dalian, Liaoning, China
| | - Tong Xie
- Department of General Surgery, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
- Institute of Integrative Medicine, Dalian Medical University, Dalian, Liaoning, China
| | - Jifeng Liu
- Department of General Surgery, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Huahui Zhao
- Department of General Surgery, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Guang Tan
- Department of General Surgery, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
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Alomair BM, Al-Kuraishy HM, Al-Gareeb AI, Alshammari MA, Alexiou A, Papadakis M, Saad HM, Batiha GES. Increased thyroid stimulating hormone (TSH) as a possible risk factor for atherosclerosis in subclinical hypothyroidism. Thyroid Res 2024; 17:13. [PMID: 38880884 PMCID: PMC11181570 DOI: 10.1186/s13044-024-00199-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 05/08/2024] [Indexed: 06/18/2024] Open
Abstract
Primary hypothyroidism (PHT) is associated with an increased risk for the development of atherosclerosis (AS) and other cardiovascular disorders. PHT induces atherosclerosis (AS) through the induction of endothelial dysfunction, and insulin resistance (IR). PHT promotes vasoconstriction and the development of hypertension. However, patients with subclinical PHT with normal thyroid hormones (THs) are also at risk for cardiovascular complications. In subclinical PHT, increasing thyroid stimulating hormone (TSH) levels could be one of the causative factors intricate in the progression of cardiovascular complications including AS. Nevertheless, the mechanistic role of PHT in AS has not been fully clarified in relation to increased TSH. Therefore, in this review, we discuss the association between increased TSH and AS, and how increased TSH may be involved in the pathogenesis of AS. In addition, we also discuss how L-thyroxine treatment affects the development of AS.
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Affiliation(s)
- Basil Mohammed Alomair
- Assistant Professor, Internal Medicine and Endocrinology, Department of Medicine, College of Medicine, Jouf University, Sakakah, 04631, Kingdom of Saudi Arabia
| | - Hayder M Al-Kuraishy
- Department of Clinical Pharmacology and Medicine, College of Medicine, Mustansiriyah University, Baghdad, Iraq
| | - Ali I Al-Gareeb
- Department of Clinical Pharmacology and Medicine, College of Medicine, Mustansiriyah University, Baghdad, Iraq
| | - Majed Ayed Alshammari
- Department of Medicine, Prince Mohammed Bin Abdulaziz Medical City, Al Jouf-Sakkaka, 42421, Saudi Arabia
| | - Athanasios Alexiou
- University Centre for Research & Development, Chandigarh University, Chandigarh-Ludhiana Highway, Mohali, Punjab, India
- Department of Research & Development, Funogen, Athens, Greece
- Department of Research & Development, AFNP Med, Vienna, 1030, Austria
- Department of Science and Engineering, Novel Global Community Educational Foundation, Hebersham, 2770, NSW, Australia
| | - Marios Papadakis
- Department of Surgery II, University Hospital Witten-Herdecke, University of Witten-Herdecke, Heusnerstrasse 40, Wuppertal, 42283, Germany.
| | - Hebatallah M Saad
- Department of Pathology, Faculty of Veterinary Medicine, Matrouh University, Marsa Matruh, 51744, Egypt.
| | - Gaber El-Saber Batiha
- Department of Pharmacology and Therapeutics, Faculty of Veterinary Medicine, Damanhour University, Damanhour, 22511, AlBeheira, Egypt.
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Zhang C, Wang H, Li Y, Wang X, Han Y, Gao X, Lai Y, Wang C, Teng W, Shan Z. Association between the triglyceride-glucose index and thyroid disorders: a cross-sectional survey and Mendelian randomization analysis. Endocrine 2024:10.1007/s12020-024-03858-5. [PMID: 38782862 DOI: 10.1007/s12020-024-03858-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 04/30/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND Metabolic diseases are associated with thyroid disorders. Insulin resistance is the common pathological basis of metabolic diseases. We explored the relationship between the triglyceride-glucose (TyG) index, a simple insulin-resistance marker, and thyroid disorders. METHODS Eligible TIDE (Thyroid Diseases, Iodine Status and Diabetes Epidemiology) subjects (n = 47,710) were screened with inclusion/exclusion criteria. Thyroid disorder prevalence among different TyG index groups was stratified by sex. Logistic regression evaluated the correlation between the TyG index and thyroid disorders. Multiple linear regression evaluated the association between the TyG index and TSH. Additionally, two-sample Mendelian randomization (MR) using published genome-wide association study data evaluated causality in the association between the TyG index and TSH. RESULTS Men and women with greater TyG indices had a significantly greater prevalence of thyroid disorders than individuals with the lowest quartile (Q1) of TyG index (p < 0.05). Following adjustment for confounding factors, we observed that a greater TyG index significantly increased the risk of subclinical hypothyroidism in men and women (men: Q2: odds ratio (OR) [95% confidence interval (CI)] = 1.22 [1.07-1.38], p = 0.002; Q3: OR [95% CI] = 1.28 [1.12-1.45], p < 0.001; Q4: OR [95% CI] = 1.29 [1.12-1.50], p = 0.001; women: Q2: OR [95% CI] = 1.25 [1.12-1.39], p < 0.001; Q3: OR [95% CI] = 1.47 [1.31-1.64], p < 0.001; Q4: OR [95% CI] = 1.61 [1.43-1.82], p < 0.001). Only among women was the highest TyG index quartile associated with hypothyroidism (OR [95% CI] = 1.70 [1.15-2.50], p = 0.007). Additionally, in men, the association exists only in the more than adequate iodine intake population. In women, the relationship between the TyG index and thyroid disorders disappears after menopause. Furthermore, the TyG index exhibited a linear positive correlation with TSH levels. The MR analysis results revealed a causal relationship between a genetically determined greater TyG index and increased TSH (inverse-variance weighting (IVW): OR [95% CI] = 1.14 [1.02-1.28], p = 0.020); however, this causal relationship disappeared after adjusting for BMI in multivariable MR (MVMR) analysis (MVMR-IVW: OR 1.03, 95% CI 0.87-1.22, p = 0.739). CONCLUSIONS A greater TyG index is associated with hypothyroidism and subclinical hypothyroidism and varies by sex and menopausal status. MR analysis demonstrated that the causal relationship between a genetically determined greater TyG index and elevated TSH levels is confounded or mediated by BMI.
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Affiliation(s)
- Chenyu Zhang
- Department of Endocrinology and Metabolism, Institute of Endocrinology, NHC Key Laboratory of Diagnosis and Treatment of Thyroid Diseases, The First Hospital of China Medical University, Shenyang, Liaoning, 110001, PR China
| | - Haoyu Wang
- Department of Endocrinology and Metabolism, Institute of Endocrinology, NHC Key Laboratory of Diagnosis and Treatment of Thyroid Diseases, The First Hospital of China Medical University, Shenyang, Liaoning, 110001, PR China
| | - Yongze Li
- Department of Endocrinology and Metabolism, Institute of Endocrinology, NHC Key Laboratory of Diagnosis and Treatment of Thyroid Diseases, The First Hospital of China Medical University, Shenyang, Liaoning, 110001, PR China
| | - Xichang Wang
- Department of Endocrinology and Metabolism, Institute of Endocrinology, NHC Key Laboratory of Diagnosis and Treatment of Thyroid Diseases, The First Hospital of China Medical University, Shenyang, Liaoning, 110001, PR China
| | - Yutong Han
- Department of Endocrinology and Metabolism, Institute of Endocrinology, NHC Key Laboratory of Diagnosis and Treatment of Thyroid Diseases, The First Hospital of China Medical University, Shenyang, Liaoning, 110001, PR China
| | - Xiaotong Gao
- Department of Endocrinology and Metabolism, Institute of Endocrinology, NHC Key Laboratory of Diagnosis and Treatment of Thyroid Diseases, The First Hospital of China Medical University, Shenyang, Liaoning, 110001, PR China
| | - Yaxin Lai
- Department of Endocrinology and Metabolism, Institute of Endocrinology, NHC Key Laboratory of Diagnosis and Treatment of Thyroid Diseases, The First Hospital of China Medical University, Shenyang, Liaoning, 110001, PR China
| | - Chuyuan Wang
- Department of Endocrinology and Metabolism, Institute of Endocrinology, NHC Key Laboratory of Diagnosis and Treatment of Thyroid Diseases, The First Hospital of China Medical University, Shenyang, Liaoning, 110001, PR China
| | - Weiping Teng
- Department of Endocrinology and Metabolism, Institute of Endocrinology, NHC Key Laboratory of Diagnosis and Treatment of Thyroid Diseases, The First Hospital of China Medical University, Shenyang, Liaoning, 110001, PR China
| | - Zhongyan Shan
- Department of Endocrinology and Metabolism, Institute of Endocrinology, NHC Key Laboratory of Diagnosis and Treatment of Thyroid Diseases, The First Hospital of China Medical University, Shenyang, Liaoning, 110001, PR China.
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Zhao S, Zhang B, Han Y, Guan J, Fang W, Zhang H, Wang A. Increased 10-year cardiovascular disease risk in depressed patients with coexisting subclinical hypothyroidism. Front Psychiatry 2023; 14:1185782. [PMID: 37469355 PMCID: PMC10352495 DOI: 10.3389/fpsyt.2023.1185782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 05/29/2023] [Indexed: 07/21/2023] Open
Abstract
Purpose The prevalence of depressive disorder (DD) and subclinical hypothyroidism (SH) was almost twofold higher in women compared with men, both of which are confirmed to be related to cardiovascular disease (CVD) risk. The current study aimed to identify the prevalence of CVD risk factors and evaluate the 10-year CVD risk in female depressed patients with and without comorbid SH. Methods We recruited 1744 female inpatients with a diagnosis of DD. Venous blood samples were taken from all patients for lipid and thyroid hormones. Framingham Risk Score (FRS) was used to estimate the 10-year CVD risk. Results Female depressed patients with SH had increased BMI, higher Hamilton Anxiety Scale (HAMA) scores, higher LDL-C, TC, UA, and a higher 10-year CVD risk than euthyroid DD groups. Serum TSH levels and HAMA scores were critical predictive variables for 10-year CVD risk in female depressed patients with comorbid SH. Conclusion Our study suggests that female depressed patients with SH have a high 10-year CVD risk. Serum TSH levels and HAMA scores may be helpful to predict cardiovascular risk in female patients with SH. The increased CVD risk in female depressed patients with comorbid SH requires more attention from researchers and clinicians.
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Affiliation(s)
- Shuai Zhao
- Department of Psychiatry, The Affiliated Psychological Hospital of Anhui Medical University, Hefei, China
- Hefei Fourth People’s Hospital, Hefei, China
- Anhui Mental Health Center, Hefei, China
- Anhui Clinical Research Center for Mental Disorders, Hefei, China
| | - Boyu Zhang
- Department of Psychiatry, The Affiliated Psychological Hospital of Anhui Medical University, Hefei, China
- Hefei Fourth People’s Hospital, Hefei, China
- Anhui Mental Health Center, Hefei, China
- Anhui Clinical Research Center for Mental Disorders, Hefei, China
| | - Yuqin Han
- Department of Psychiatry, The Affiliated Psychological Hospital of Anhui Medical University, Hefei, China
- Hefei Fourth People’s Hospital, Hefei, China
- Anhui Mental Health Center, Hefei, China
- Anhui Clinical Research Center for Mental Disorders, Hefei, China
| | - Jianjun Guan
- Department of Psychiatry, The Affiliated Psychological Hospital of Anhui Medical University, Hefei, China
- Hefei Fourth People’s Hospital, Hefei, China
- Anhui Mental Health Center, Hefei, China
- Anhui Clinical Research Center for Mental Disorders, Hefei, China
| | - Wenmei Fang
- Department of Psychiatry, The Affiliated Psychological Hospital of Anhui Medical University, Hefei, China
- Hefei Fourth People’s Hospital, Hefei, China
- Anhui Mental Health Center, Hefei, China
- Anhui Clinical Research Center for Mental Disorders, Hefei, China
| | - Hongqin Zhang
- Department of Psychiatry, The Affiliated Psychological Hospital of Anhui Medical University, Hefei, China
- Hefei Fourth People’s Hospital, Hefei, China
- Anhui Mental Health Center, Hefei, China
- Anhui Clinical Research Center for Mental Disorders, Hefei, China
| | - Anzhen Wang
- Department of Psychiatry, The Affiliated Psychological Hospital of Anhui Medical University, Hefei, China
- Hefei Fourth People’s Hospital, Hefei, China
- Anhui Mental Health Center, Hefei, China
- Anhui Clinical Research Center for Mental Disorders, Hefei, China
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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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Zavros A, Giannaki CD, Aphamis G, Roupa Z, Andreou E. The Effects of Zinc and Selenium Supplementation on Body Composition and Thyroid Function in Individuals with Overweight or Obesity: A Systematic Review. J Diet Suppl 2022:1-29. [PMID: 35532055 DOI: 10.1080/19390211.2022.2072044] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
People with obesity have been found to have lower zinc (Zn) and selenium (Se) circulatory levels and abnormal thyroid function than people with normal weight. Studies about the effects of Zn and Se supplementation on body composition and thyroid function of overweight-obese people showed inconsistent results. A systematic review of randomized controlled trials was conducted to determine the effects of Ζn supplementation, Se supplementation, and their combination on body composition and thyroid function of individuals with overweight or obesity. Databases of PubMed, ScienceDirect, and Cochrane, were searched from inception to February 27, 2022, to identify relevant articles. For the assessment of the methodological quality of the studies, the Jadad scale was used. After screening the articles, thirteen studies were finally included and were analyzed using the strength of the evidence approach. Regarding the effectiveness of Zn supplementation on body composition, moderate evidence was found, while the effects of Se were found to be mixed. Zn supplementation was found to affect the thyroid function of people with overweight or obesity by increasing their free triiodothyronine (FT3) levels. However, this result is based only on one study among hypothyroid patients. At this point, the effectiveness of Zn, Se, and their combination, on the body composition and the thyroid function of people with overweight or obesity cannot safely be determined because of the controversial results, small number, and the limitations of the identified studies. The results of this systematic review must be interpreted with caution due to the limitations detected.
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Affiliation(s)
- Antonis Zavros
- Department of Life and Health Sciences, University of Nicosia, Nicosia, Cyprus
| | | | - George Aphamis
- Department of Life and Health Sciences, University of Nicosia, Nicosia, Cyprus
| | - Zoe Roupa
- Department of Life and Health Sciences, University of Nicosia, Nicosia, Cyprus
| | - Eleni Andreou
- Department of Life and Health Sciences, University of Nicosia, Nicosia, Cyprus
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Kim HK, Song J. Hypothyroidism and Diabetes-Related Dementia: Focused on Neuronal Dysfunction, Insulin Resistance, and Dyslipidemia. Int J Mol Sci 2022; 23:ijms23062982. [PMID: 35328405 PMCID: PMC8952212 DOI: 10.3390/ijms23062982] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 03/06/2022] [Accepted: 03/07/2022] [Indexed: 01/27/2023] Open
Abstract
The incidence of dementia is steadily increasing worldwide. The risk factors for dementia are diverse, and include genetic background, environmental factors, sex differences, and vascular abnormalities. Among the subtypes of dementia, diabetes-related dementia is emerging as a complex type of dementia related to metabolic imbalance, due to the increase in the number of patients with metabolic syndrome and dementia worldwide. Thyroid hormones are considered metabolic regulatory hormones and affect various diseases, such as liver failure, obesity, and dementia. Thyroid dysregulation affects various cellular mechanisms and is linked to multiple disease pathologies. In particular, hypothyroidism is considered a critical cause for various neurological problems-such as metabolic disease, depressive symptoms, and dementia-in the central nervous system. Recent studies have demonstrated the relationship between hypothyroidism and brain insulin resistance and dyslipidemia, leading to diabetes-related dementia. Therefore, we reviewed the relationship between hypothyroidism and diabetes-related dementia, with a focus on major features of diabetes-related dementia such as insulin resistance, neuronal dysfunction, and dyslipidemia.
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Affiliation(s)
- Hee Kyung Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chonnam National University Medical School, 264 Seoyangro, Hwasun 58128, Korea;
| | - Juhyun Song
- Department of Anatomy, Chonnam National University Medical School, Hwasun 58128, Korea
- BioMedical Sciences Graduate Program (BMSGP), Chonnam National University, 264 Seoyangro, Hwasun 58128, Korea
- Correspondence: ; Tel.: +82-61-379-2706; Fax: +82-61-375-5834
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Choi W, Park JY, Hong AR, Yoon JH, Kim HK, Kang HC. Association between triglyceride-glucose index and thyroid function in euthyroid adults: The Korea National Health and Nutritional Examination Survey 2015. PLoS One 2021; 16:e0254630. [PMID: 34264998 PMCID: PMC8281995 DOI: 10.1371/journal.pone.0254630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 06/30/2021] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVES Low-normal thyroid function is associated with numerous metabolic risk factors including insulin resistance (IR). Triglyceride-glucose (TyG) index is a new surrogate marker of IR calculated by fasting triglyceride and glucose levels. Here, we investigated the association between thyroid function and TyG index in non-diabetic euthyroid adults. METHODS This cross-sectional study was based on data from the Korean National Health and Nutritional Examination Survey 2015 including 1482 individuals (741 men and 741 women). Serum thyrotropin (TSH) and free thyroxine (fT4) levels were measured. RESULTS After adjusting for confounders, there was an inverse relationship of TyG index with fT4 in men (β = -0.094, P = 0.009) and a positive relationship of TyG index with TSH in women (β = 0.078, P = 0.018). The lowest fT4 tertile in men (P = 0.001) and the highest TSH tertile in women (P = 0.010) exhibited increased TyG index after adjusting for confounders. The lowest fT4 tertile also showed increased homeostatic model assessment for IR (HOMA-IR) only in men (P = 0.006). Odds ratios (ORs) for the high TyG index, which was defined as the highest TyG quartile decreased in the highest and second highest tertile of fT4 in men (OR = 0.41 and OR = 0.45, respectively; P < 0.001) and increased in highest tertile of TSH in women (OR = 1.81, P = 0.031) after adjusting for confounders. The OR for high HOMA-IR defined as the highest HOMA-IR quartile was also lower in the highest and second highest fT4 tertiles in men (both OR = 0.47; P = 0.003). CONCLUSIONS This is the first study to suggest that TyG index is a good surrogate marker of IR in evaluating its relationship with thyroid function.
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Affiliation(s)
- Wonsuk Choi
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Ji Yong Park
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - A. Ram Hong
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Jee Hee Yoon
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Hee Kyung Kim
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Ho-Cheol Kang
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea
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9
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Ding X, Zhu CY, Li R, Wu LP, Wang Y, Hu SQ, Liu YM, Zhao FY, Zhao Y, Zhang M, He MQ, Chen ZY, Shi BY. Lower normal free thyroxine is associated with a higher risk of metabolic syndrome: a retrospective cohort on Chinese population. BMC Endocr Disord 2021; 21:39. [PMID: 33663458 PMCID: PMC7934401 DOI: 10.1186/s12902-021-00703-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 02/18/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Recently, the relationship between thyroid hormones (THs) across the euthyroid ranges and metabolic syndrome (MetS) has been widely discussed. This study aimed to present specific cutoff values of THs to assess the association between THs and MetS in a euthyroid cohort. METHODS Data of 2694 subjects, aged 18-80 years, who attended health examination in Xi'an Electric Power Central Hospital from April 2011 to December 2015 were collected and analyzed. The first cohort enrolled 929 participants (followed up by 2221 person-years totally) to assess correlations between serum thyrotropin (TSH), triiodothyronine (T3), thyroxine (T4) levels and MetS. The second cohort included 698 participants (followed up by 1709 person-years totally) to evaluate relationships between serum free triiodothyronine (FT3), free thyroxine (FT4) levels and MetS. MetS was defined according to the criteria of the American Heart Association/National Heart, Lung, and Blood Institute (AHA/NHLBI) scientific statements of 2009. Euthyroidism was defined as serum TSH, FT3 and FT4 levels within the reference ranges without taking any thyroid medication. RESULTS The cutoff values for TSH, T3, T4, FT3 and FT4 were 2.0mIU/L, 1.9 nmol/L, 117 nmol/L, 4.3 pmol/L and 16 pmol/L, respectively. Participants were categorized into two groups according to cutoff values: the lower-THs group and the higher-THs group. There was no significant difference in the risk of MetS between two groups in TSH, T3, T4 and FT3. The incidence of MetS was significantly higher in lower-FT4 group than higher-FT4 group (1.00 vs 0.622 (0.458, 0.846), P = 0.002). The lower-FT4/higher-TSH group had the highest hazard ratios of MetS. (2.131vs 1.0 (1.380,3.291), P = 0.006). CONCLUSIONS Lower normal FT4 (FT4 ≤ 16.0 pmol/L) is an independent risk factor for MetS, and lower normal thyroid function (TSH > 2.0 mIU/L and FT4 ≤ 16.0 pmol/L) is associated with a higher risk of developing MetS.
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Affiliation(s)
- Xi Ding
- Department of Endocrinology, First Affiliated Hospital of Xi’an Jiaotong University, 277 Yanta West Street, Xi’an, 710061 China
| | - Chun-Ying Zhu
- Department of Disease Prevention And Control, Shaanxi Xi’an Electric Power Center Hospital, Xi’an, China
| | - Rui Li
- School of Public Health, Xi’an Jiaotong University, Xi’an, China
| | - Li-Ping Wu
- Department of Endocrinology, First Affiliated Hospital of Xi’an Jiaotong University, 277 Yanta West Street, Xi’an, 710061 China
| | - Yue Wang
- Department of Endocrinology, First Affiliated Hospital of Xi’an Jiaotong University, 277 Yanta West Street, Xi’an, 710061 China
| | - Shi-Qian Hu
- Department of Endocrinology, First Affiliated Hospital of Xi’an Jiaotong University, 277 Yanta West Street, Xi’an, 710061 China
| | - Yi-Ming Liu
- School of Public Health, Xi’an Jiaotong University, Xi’an, China
| | - Feng-Yi Zhao
- Department of Endocrinology, First Affiliated Hospital of Xi’an Jiaotong University, 277 Yanta West Street, Xi’an, 710061 China
| | - Yang Zhao
- Department of Endocrinology, First Affiliated Hospital of Xi’an Jiaotong University, 277 Yanta West Street, Xi’an, 710061 China
| | - Meng Zhang
- Department of Endocrinology, First Affiliated Hospital of Xi’an Jiaotong University, 277 Yanta West Street, Xi’an, 710061 China
| | - Ming-Qian He
- Department of Endocrinology, First Affiliated Hospital of Xi’an Jiaotong University, 277 Yanta West Street, Xi’an, 710061 China
| | - Zi-Yi Chen
- Department of Endocrinology, First Affiliated Hospital of Xi’an Jiaotong University, 277 Yanta West Street, Xi’an, 710061 China
| | - Bing-Yin Shi
- Department of Endocrinology, First Affiliated Hospital of Xi’an Jiaotong University, 277 Yanta West Street, Xi’an, 710061 China
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Keskin H, Cadirci K, Gungor K, Karaaslan T, Usta T, Ozkeskin A, Musayeva A, Yesildal F, Isman F, Zengin HY. Association between TSH Values and GFR Levels in Euthyroid Cases with Metabolic Syndrome. Int J Endocrinol 2021; 2021:8891972. [PMID: 34122543 PMCID: PMC8172317 DOI: 10.1155/2021/8891972] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 03/16/2021] [Accepted: 05/10/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Metabolic syndrome (MetS) is associated with the risk of developing chronic kidney disease. Although the negative effects of high thyroid-stimulating hormone (TSH) values on glomerular filtration rate (GFR) levels have been known for years, the negative effects of increased TSH on GFR in euthyroid cases have been reported in recent years. This study was aimed at investigating the association between the effect of increased TSH values and estimated-GFR (eGFR) levels in euthyroid cases with MetS. METHODS For this hospital-based descriptive study, 191 MetS cases (123 females, 68 males) were evaluated. Those whose TSH was not within 0.5-4.5 uIU/mL, eGFR was <40 mL/min/1.73 m2, and/or reported any thyroid/kidney disease were excluded. Partial correlation coefficients were calculated to investigate the relationship between the eGFR values and several other numerical variables while controlling for age and BMI in addition to the adjusted gender effect. Thereafter, the multiple linear regression analysis with a stepwise variable selection approach was used to reveal the independent factors that could affect the logarithmically transformed eGFR. RESULTS The median age was 52 (19-65) years, the median eGFR was 94.3 (41.3-194) mL/min/1.73 m2, and the median TSH was 1.58 (0.50-4.50) uIU/mL in the whole group. Increased TSH even in the normal range was associated with eGFR after adjusting for age and body mass index (BMI), especially in females. The high age (b = -0.160, p=0.005), high BMI (b = -0.134, p=0.020), high TSH (b = -0.380, p < 0.01), and high uric acid (b = -0.348, p < 0.01) were found as significant predictors of the eGFR in MetS patients. CONCLUSION Independent of age and BMI, elevated TSH even in the euthyroid range showed an association with the eGFR in female MetS cases who had normal kidney functions. This correlation was stronger than the correlations between the eGFR and the MetS diagnostic parameters. These findings need further studies on the issue..
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Affiliation(s)
- H. Keskin
- Department of Internal Medicine, Goztepe Training and Research Hospital, Istanbul Medeniyet University, Istanbul 34772, Turkey
| | - K. Cadirci
- Department of Internal Medicine, Erzurum Regional Training and Research Hospital, Erzurum, Turkey
| | - K. Gungor
- Department of Endocrinology, Goztepe Training and Research Hospital, Istanbul Medeniyet University, Istanbul, Turkey
| | - T. Karaaslan
- Department of Nephrology, Goztepe Training and Research Hospital, Istanbul Medeniyet University, Istanbul, Turkey
| | - T. Usta
- Department of Internal Medicine, Goztepe Training and Research Hospital, Istanbul Medeniyet University, Istanbul 34772, Turkey
| | - A. Ozkeskin
- Department of Internal Medicine, Goztepe Training and Research Hospital, Istanbul Medeniyet University, Istanbul 34772, Turkey
| | - A. Musayeva
- Department of Internal Medicine, National Center of Oncology Department of Epidemiology and Statistics of Malignant Tumors, Baku, Azerbaijan
| | - F. Yesildal
- Department of Medical Biochemistry, Goztepe Training and Research Hospital, Istanbul Medeniyet University, Istanbul, Turkey
| | - F. Isman
- Department of Medical Biochemistry, Goztepe Training and Research Hospital, Istanbul Medeniyet University, Istanbul, Turkey
| | - H. Y. Zengin
- Department of Biostatistics, Hacettepe University Faculty of Medicine, Ankara, Turkey
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11
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He J, Lai Y, Yang J, Yao Y, Li Y, Teng W, Shan Z. The Relationship Between Thyroid Function and Metabolic Syndrome and Its Components: A Cross-Sectional Study in a Chinese Population. Front Endocrinol (Lausanne) 2021; 12:661160. [PMID: 33868183 PMCID: PMC8044548 DOI: 10.3389/fendo.2021.661160] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 03/15/2021] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE The present study examined the relationship between thyroid function status and the prevalence of metabolic syndrome in a Chinese population. METHODS Cross-sectional data were obtained from the Thyroid Disease, Iodine Nutrition and Diabetes Epidemiology (TIDE) Survey. A total of 62,408 subjects aged ≥18 years were enrolled. Differences in metabolic indicators and the prevalence of metabolic syndrome according to sex and thyroid function status were compared. Logistic regression was used to analyze the influence of thyroid function on metabolic syndrome and its components. RESULTS The prevalence of metabolic syndrome was generally higher in men than women. Overt hyperthyroidism and subclinical hypothyroidism had a significant effect on metabolism in men. Body mass index (BMI), waist circumference, and triglycerides (TGs) were significantly lower in men in the overt hyperthyroidism group, and BMI, waist circumference, systolic blood pressure (SBP) and TGs were higher in men in the subclinical hypothyroidism group than men in the normal group. Overt and subclinical hypothyroidism had significant impacts on metabolic components in women. BMI, waist circumference, TGs, SBP and DBP in the subclinical and overt hypothyroidism groups were significantly higher than the euthyroid group in women. The relative risk of abdominal obesity and hypertriglyceridemia was increased in women with hypothyroidism. Thyroid dysfunction had different effects on metabolic syndrome and its components before and after menopause. CONCLUSION Thyroid function had important effects on the prevalence of metabolic syndrome. Women with hypothyroidism, especially post-menopausal women, had a higher risk of metabolic syndrome than men.
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Affiliation(s)
- Jiaji He
- Department of Endocrinology and Metabolism, Institute of Endocrinology, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Yaxin Lai
- Department of Endocrinology and Metabolism, Institute of Endocrinology, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Jing Yang
- Department of Endocrinology, The First Hospital of Shanxi Medical University, Taiyuan, China
| | - Yongli Yao
- Department of Endocrinology, Qinghai Provincial People’s Hospital, Xining, China
| | - Yongze Li
- Department of Endocrinology and Metabolism, Institute of Endocrinology, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Weiping Teng
- Department of Endocrinology and Metabolism, Institute of Endocrinology, The First Affiliated Hospital of China Medical University, Shenyang, China
- *Correspondence: Zhongyan Shan, ; Weiping Teng,
| | - Zhongyan Shan
- Department of Endocrinology and Metabolism, Institute of Endocrinology, The First Affiliated Hospital of China Medical University, Shenyang, China
- *Correspondence: Zhongyan Shan, ; Weiping Teng,
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12
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Choi JY, Huh DA, Moon KW. Association between blood lead levels and metabolic syndrome considering the effect of the thyroid-stimulating hormone based on the 2013 Korea National health and nutrition examination survey. PLoS One 2020; 15:e0244821. [PMID: 33382832 PMCID: PMC7775085 DOI: 10.1371/journal.pone.0244821] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 12/16/2020] [Indexed: 12/03/2022] Open
Abstract
Imbalances in thyroid-stimulating hormone (TSH) levels are associated with metabolic syndrome (MetS), and the underlying mechanism is partly in alignment with that of lead exposure causing MetS. Many studies have reported the association between lead exposure and MetS, but no study has considered the possibility of TSH mediating lead's effect on MetS. Therefore, we aimed to examine the association between lead exposure and MetS considering TSH as a partial mediator. The data of 1,688 adults (age ≥19 years) from the Korea National Health and Nutrition Examination Survey in 2013 were analyzed. The prevalence of MetS in the Korean population was 21.9%, and the geometric mean of blood lead and serum TSH levels were 1.96 μg/dL and 2.17 μIU/mL, respectively. The associations between blood lead levels, serum TSH levels, and MetS were determined through a multiple logistic regression analysis. Blood lead levels were positively associated with high TSH levels (upper 25%) with an odds ratio (OR) and 95% confidence interval (CI) of 1.79 (1.24, 2.58) per doubled lead levels. The increase in blood lead and serum TSH levels both positively increased the odds of developing MetS. The OR of MetS per doubling of blood lead level was 1.53 (1.00, 2.35), and was not attenuated after adjusting for TSH levels. These findings suggest that higher levels of blood lead are positively associated with serum TSH levels and MetS. By exploring the role of TSH as a partial mediator between lead and MetS, we verified that lead exposure has an independent relationship with MetS, regardless of TSH levels.
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Affiliation(s)
- Ji Yoon Choi
- Department of Health and Safety Convergence Science, Graduate School at Korea University, Seoul, Republic of Korea
- Environmental Health Research Division, National Institute of Environmental Research, Ministry of Environment, Incheon, Republic of Korea
| | - Da-An Huh
- Department of Health Science, Graduate School at Korea University, Seoul, Republic of Korea
| | - Kyong Whan Moon
- BK21 FOUR R&E Center for Learning Health System & Department of Health and Environmental Science, Korea University, Seoul, Republic of Korea
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13
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Tang K, Zhang Q, Peng NC, Zhang M, Xu SJ, Li H, Hu Y, Xue CJ, Shi LX. Epidemiology of metabolic syndrome and its components in Chinese patients with a range of thyroid-stimulating hormone concentrations. J Int Med Res 2020; 48:300060520966878. [PMID: 33207990 PMCID: PMC7683923 DOI: 10.1177/0300060520966878] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Objective To investigate the relationship between thyroid stimulating hormone (TSH) concentration and the risks of developing metabolic syndrome and its components. Methods A total of 10,140 residents of the Yunyan district of Guiyang (Guizhou, China) who were ≥40 years old were selected by cluster random sampling between May and August 2011, of whom 5692 were eligible. TSH concentration and indices of metabolic syndrome were documented at baseline and 3 years later. Participants were allocated to a euthyroid (TSH 0.55–4.78 mIU/L) or high TSH concentration (TSH >4.78 mIU/L) group. Patients with overt hypothyroidism or were undergoing treatment for hypothyroidism were excluded. Results The crude and adjusted prevalences of metabolic syndrome were 39.9% and 33.9% in the euthyroid group and 44.3% and 37.5% in the high TSH group, respectively. Binary logistic regression analysis revealed a positive correlation between a high TSH concentration at baseline and the cumulative incidence of metabolic syndrome during follow up. Conclusions High TSH is associated with a higher risk of developing metabolic syndrome or one of its components; therefore, people with a high TSH concentration should be screened regularly to permit the early identification of metabolic syndrome and followed up thoroughly.
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Affiliation(s)
- Kun Tang
- Department of Endocrinology, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China.,Department of Endocrinology, Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, China
| | - Qiao Zhang
- Department of Endocrinology, Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, China
| | - Nian-Chun Peng
- Department of Endocrinology, Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, China
| | - Miao Zhang
- Department of Endocrinology, Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, China
| | - Shu-Jing Xu
- Department of Endocrinology, Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, China
| | - Hong Li
- Department of Endocrinology, Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, China
| | - Ying Hu
- Department of Endocrinology, Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, China
| | - Chun-Ju Xue
- Guizhou Medical University, Guiyang, Guizhou, China
| | - Li-Xin Shi
- Department of Endocrinology, Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, China
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Yang Q, Dong Li W, Yan Wan H, Yi Cao H. Association of thyroid hormones with metabolic syndrome and its components in postmenopausal Chinese women. Gynecol Endocrinol 2020; 36:705-708. [PMID: 32285712 DOI: 10.1080/09513590.2020.1749997] [Citation(s) in RCA: 2] [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] [Indexed: 01/18/2023] Open
Abstract
To evaluate the association between thyroid hormones (TH) and metabolic syndrome (MS) in postmenopausal women (PmW), a cross-sectional study was conducted with a sample of 1000 participants of PmW (40-65 years). Thyroid stimulating hormone (TSH) and free thyroxine (fT4) were evaluated. The MS was defined using the International Diabetes Federation (IDF) ethnicity-specific definitions for Asian. Participants were classified into three groups according to the TSH reference range: high-TSH (≥4.2 mU/L), low-TSH (<0.1mU/L), and normal-TSH (0.1-4.2 mU/L) group. Serum triglycerides (TG) levels were higher in low-TSH group and high-TSH group compared with normal-TSH group (p < .05). The whole sample was stratified into <60 and ≥60 years subgroups. In the ≥60 years group, fT4 was negatively correlated with waist circumference (WC) (p = .028) and positively correlated with fasting blood glucose (FBG) (p = .043), meanwhile TSH was positively correlated with WC only in the control subjects (p = .014). No difference was found between TH and the number of MS components. It was demonstrated that serum fT4 levels were associated with FBG and WC, while TSH was associated with WC in elderly PmW without MS.
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Affiliation(s)
- Qiu Yang
- Division of Endocrinology and Metabolism, Chengdu Fifth People's Hospital, Chengdu, China
| | - Wei Dong Li
- Division of Endocrinology and Metabolism, Chengdu Fifth People's Hospital, Chengdu, China
| | - Hai Yan Wan
- Division of Endocrinology and Metabolism, Chengdu Fifth People's Hospital, Chengdu, China
| | - Hong Yi Cao
- Division of Endocrinology and Metabolism, Chengdu Fifth People's Hospital, Chengdu, China
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Teixeira PDFDS, dos Santos PB, Pazos-Moura CC. The role of thyroid hormone in metabolism and metabolic syndrome. Ther Adv Endocrinol Metab 2020; 11:2042018820917869. [PMID: 32489580 PMCID: PMC7238803 DOI: 10.1177/2042018820917869] [Citation(s) in RCA: 75] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 03/03/2020] [Indexed: 12/17/2022] Open
Abstract
Metabolic syndrome (MetS) and thyroid dysfunction are common in clinical practice. The objectives of this review are to discuss some proposed mechanisms by which thyroid dysfunctions may lead to MetS, to describe the bidirectional relationship between thyroid hormones (THs) and adiposity and finally, to resume a list of recent studies in humans that evaluated possible associations between thyroid hormone status and MetS or its clinical components. Not solely THs, but also its metabolites regulate metabolic rate, influencing adiposity. The mechanisms enrolled are related to its direct effect on adenosine triphosphate (ATP) utilization, uncoupling synthesis of ATP, mitochondrial biogenesis, and its inotropic and chronotropic effects. THs also act controlling core body temperature, appetite, and sympathetic activity. In a bidirectional way, thyroid function is affected by adiposity. Leptin is one of the hallmarks, but the pro-inflammatory cytokines and also insulin resistance impact thyroid function and perhaps its structure. MetS development and weight gain have been positively associated with thyroid-stimulating hormone (TSH) in several studies. Adverse glucose metabolism may be related to hyperthyroidism, but also to reduction of thyroid function or higher serum TSH, as do abnormal serum triglyceride levels. Hypo- and hyperthyroidism have been related to higher blood pressure (BP), that may be consequence of genomic or nongenomic action of THs on the vasculature and in the heart. In summary, the interaction between THs and components of MetS is complex and not fully understood. More longitudinal studies controlling each of all confounding variables that interact with endpoints or exposure factors are still necessary.
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Affiliation(s)
- Patrícia de Fátima dos Santos Teixeira
- Endocrine Clinic, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rua Professor Rodolpho Rocco, 255 – Cidade Universitária, Rio de Janeiro, RJ 21941-617, Brazil
| | - Patrícia Borges dos Santos
- Research Fellow, Medicine School, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
- Endocrinologist, Instituto Estadual de Endocrinologia Luiz Capriglione, Rio de Janeiro, Brazil
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Li M, Zhang X, Zhou X, Han X, Zhang R, Fu Z, Wang L, Gao Y, Li Y, Ji L. The Association Between Serum Thyrotropin Within the Reference Range and Metabolic Syndrome in a Community-Based Chinese Population. Diabetes Metab Syndr Obes 2020; 13:2001-2011. [PMID: 32606859 PMCID: PMC7305823 DOI: 10.2147/dmso.s252154] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 04/29/2020] [Indexed: 12/16/2022] Open
Abstract
PURPOSE We aimed to ascertain the association between thyrotropin (TSH) levels in euthyroid state and the prevalence of metabolic syndrome (MetS) in a community-based Chinese population. PARTICIPANTS AND METHODS Based on a large and well-characterized community cohort in Beijing, China, 1831 men and 1742 women with serum TSH levels within the reference range (0.50-4.78 µIU/mL) were stratified by quartiles of TSH (Q1-4). MetS was identified according to the criteria of International Diabetes Federation guidelines. Poisson regression models were used to estimate the association between serum TSH and the prevalence of MetS and its components before and after adjustment for potential confounding factors. The reported association was measured using the prevalence ratio (PR) with its respective 95% confidence interval (95% CI). RESULTS The prevalence of MetS in euthyroid population across TSH quartiles (Q1-4) was 38.9%, 44.6%, 41.0%, and 47.7%, respectively, in men (P = 0.045), and 47.7%, 46.6%, 46.9%, and 54.6%, respectively, in women (P = 0.032). Compared with the reference group TSH-Q1, the prevalence of MetS was higher among TSH-Q4 group both in men (PR = 1.27; 95% CI: 1.09, 1.48, P = 0.002) and women (PR = 1.21; 95% CI: 1.07, 1.37, P = 0.003) even after adjustment for age, lifestyle factors, serum levels of free triiodothyronine (FT3), and free thyroxine (FT4). Most of the components of MetS were common in higher serum TSH levels within the normal range. CONCLUSION The prevalence of MetS and most of its components increased in the higher TSH group in euthyroid Chinese population.
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Affiliation(s)
- Meng Li
- Department of Endocrinology and Metabolism, Peking University People’s Hospital, Peking University Diabetes Center, Beijing, People’s Republic of China
| | - Xiuying Zhang
- Department of Endocrinology and Metabolism, Peking University People’s Hospital, Peking University Diabetes Center, Beijing, People’s Republic of China
| | - Xianghai Zhou
- Department of Endocrinology and Metabolism, Peking University People’s Hospital, Peking University Diabetes Center, Beijing, People’s Republic of China
| | - Xueyao Han
- Department of Endocrinology and Metabolism, Peking University People’s Hospital, Peking University Diabetes Center, Beijing, People’s Republic of China
| | - Rui Zhang
- Department of Endocrinology and Metabolism, Peking University People’s Hospital, Peking University Diabetes Center, Beijing, People’s Republic of China
| | - Zuodi Fu
- Department of Endocrinology and Metabolism, Capital Medical University Pinggu Hospital, Beijing, People’s Republic of China
| | - Lianying Wang
- Department of Endocrinology and Metabolism, Capital Medical University Pinggu Hospital, Beijing, People’s Republic of China
| | - Ying Gao
- Department of Endocrinology and Metabolism, Peking University People’s Hospital, Peking University Diabetes Center, Beijing, People’s Republic of China
| | - Yufeng Li
- Department of Endocrinology and Metabolism, Capital Medical University Pinggu Hospital, Beijing, People’s Republic of China
- Yufeng Li Department of Endocrinology and Metabolism, Capital Medical University Pinggu Hospital, Beijing101200, People’s Republic of China Tel/Fax +86-10-89978790 Email
| | - Linong Ji
- Department of Endocrinology and Metabolism, Peking University People’s Hospital, Peking University Diabetes Center, Beijing, People’s Republic of China
- Correspondence: Linong Ji Department of Endocrinology and Metabolism, Peking University People’s Hospital, Beijing100044, People’s Republic of China Tel/Fax +86-10-88324371 Email
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Kim JM, Kim BH, Lee H, Kim EH, Kim M, Kim JH, Jeon YK, Kim SS, Kim IJ, Kim YK. The Relationship between Thyroid Function and Different Obesity Phenotypes in Korean Euthyroid Adults. Diabetes Metab J 2019; 43:867-878. [PMID: 30968620 PMCID: PMC6943265 DOI: 10.4093/dmj.2018.0130] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Accepted: 01/10/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Thyroid disease and metabolic syndrome are both associated with cardiovascular disease. The aim of this study was to investigate the correlation between thyroid hormones and obesity sub-phenotypes using nationwide data from Korea, a country known to be iodine replete. METHODS This study was based on data obtained from the sixth Korea National Health and Nutrition Examination Survey, administered from 2013 to 2015. A total of 13,873 participants aged ≥19 years were included, and classified into four groups: metabolically healthy non-obesity (MHNO), metabolically healthy obesity (MHO), metabolically unhealthy non-obesity (MUNO), and metabolically unhealthy obesity (MUO) by body fat on the basis of body mass index and metabolic health. RESULTS At baseline, serum free thyroxine (fT4) values were significantly higher in the MHNO phenotype (MHNO, 1.27±0.01 ng/dL; MHO, 1.25±0.01 ng/dL; MUNO, 1.24±0.01 ng/dL; MUO, 1.24±0.01 ng/dL, P<0.001) in total study population. However, this significant association no longer remained after adjustment for age, urine iodine concentration, and smoking (P=0.085). After adjustment for confounders, statistically significant association was observed between lower thyroid stimulating hormone (TSH) and MHNO phenotype (P=0.044). In men participants (not women), higher fT4 values were significantly associated with MHNO phenotype (P<0.001). However, no significant association was observed between thyroid function (TSH or fT4) and obesity phenotypes in groups classified by age (cutoff age of 55 years). CONCLUSION Although there was a difference by age and sex, we found that the decrease of TSH and the increase of fT4 values were associated with MHNO.
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Affiliation(s)
- Jeong Mi Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Bo Hyun Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea.
| | - Hyungi Lee
- ARO, Clinical Trial Center, Pusan National University Hospital, Busan, Korea
| | - Eun Heui Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Mijin Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Jong Ho Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Yun Kyung Jeon
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Sang Soo Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - In Joo Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Yong Ki Kim
- Kim Yong Ki Internal Medicine Clinic, Busan, Korea
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Du FM, Kuang HY, Duan BH, Liu DN, Yu XY. Associations Between Thyroid Hormones Within the Euthyroid Range and Indices of Obesity in Obese Chinese Women of Reproductive Age. Metab Syndr Relat Disord 2019; 17:416-422. [PMID: 31355704 DOI: 10.1089/met.2019.0036] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Affiliation(s)
- Fu-Man Du
- Department of Endocrinology, First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China
- Department of Endocrinology, Heilongjiang Provincial Hospital, Harbin, Heilongjiang Province, China
| | - Hong-Yu Kuang
- Department of Endocrinology, First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China
| | - Bin-Hong Duan
- Department of Endocrinology, Heilongjiang Provincial Hospital, Harbin, Heilongjiang Province, China
| | - Da-Na Liu
- Department of Endocrinology, First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China
| | - Xin-Yang Yu
- Department of Endocrinology, First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China
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Abstract
PURPOSE OF REVIEW To summarize recent developments in the association of thyroid function with metabolic syndrome (MetS). RECENT FINDINGS Although thyroid hormones even within low normal range are associated with various metabolic abnormalities, the risk of MetS remains a controversial issue. Hyperthyroid state might be associated only with insulin resistance and dysglycemia. Autoimmune thyroid diseases may be a potential risk factor for metabolic abnormalities even in those with low normal thyroid function. SUMMARY The interrelation between thyroid stimulating hormone, free T3, freeT4 and metabolic parameters is complex and might be affected by age, sex, BMI, insulin resistance, smoking, iodine intake and inflammatory markers.
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Affiliation(s)
- Ladan Mehran
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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High TSH Level within Normal Range Is Associated with Obesity, Dyslipidemia, Hypertension, Inflammation, Hypercoagulability, and the Metabolic Syndrome: A Novel Cardiometabolic Marker. J Clin Med 2019; 8:jcm8060817. [PMID: 31181658 PMCID: PMC6616443 DOI: 10.3390/jcm8060817] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 06/01/2019] [Accepted: 06/05/2019] [Indexed: 02/07/2023] Open
Abstract
(1) Background: Overt and subclinical hypothyroidism has been associated with increased cardiometabolic risks. Here we further explore whether thyroid function within normal range is associated with cardiometabolic risk factors in a large population-based study. (2) Methods: We screened 24,765 adults participating in health examinations in Taiwan. Participants were grouped according to high-sensitive thyroid-stimulating hormone (hsTSH) level as: <50th percentile (0.47–1.48 mIU/L, the reference group), 50–60th percentile (1.49–1.68 mIU/L), 60–70th percentile (1.69–1.94 mIU/L), 70–80th percentile (1.95–2.3 mIU/L), 80–90th percentile (2.31–2.93 mIU/L), and >90th percentile (>2.93 mIU/L). Cardiometabolic traits of each percentile were compared with the reference group. (3) Results: Elevated hsTSH levels within normal range were dose-dependently associated with increased body mass index, body fat percentage, waist circumferences, blood pressure, hemoglobin A1c (HbA1c), fasting insulin, homeostasis model assessment of insulin resistance (HOMA-IR), high homeostasis model of assessment of beta-cell (HOMA-β), triglycerides, total cholesterols, fibrinogen, and uric acids (p-for-trend <0.001), but not with fasting glucose levels. The association remained significant after adjustment of age, sex, and lifestyle. As compared to the reference group, subjects with the highest hsTSH percentile had significantly increased risk of being overweight (adjusted odds ratio (adjOR): 1.35), increased body fat (adjOR: 1.29), central obesity (adjOR: 1.36), elevated blood pressure (adjOR: 1.26), high HbA1c (adjOR: 1.20), hyperinsulinemia (adjOR: 1.75), increased HOMA-IR (adjOR: 1.45), increased HOMA-β (adjOR: 1.40), hypertriglyceridemia (adjOR: 1.60), hypercholesterolemia (adjOR: 1.25), elevated hsCRP (adjOR: 1.34), increased fibrinogen (adjOR: 1.45), hyperuricemia (adjOR: 1.47), and metabolic syndrome (adjOR: 1.42), but significant risk of low fasting glucose (adjOR: 0.89). Mediation analysis indicates that insulin resistance mediates the majority of the association between thyroid hormone status and the metabolic syndrome. (4) Conclusion: Elevated hsTSH within the normal range is a cardiometabolic risk marker associated with central obesity, insulin resistance, elevated blood pressure, dyslipidemia, hyperuricemia, inflammation, and hypercoagulability.
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Role of Adipokines in the Association between Thyroid Hormone and Components of the Metabolic Syndrome. J Clin Med 2019; 8:jcm8060764. [PMID: 31151171 PMCID: PMC6617115 DOI: 10.3390/jcm8060764] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Revised: 05/21/2019] [Accepted: 05/28/2019] [Indexed: 12/15/2022] Open
Abstract
Metabolic syndrome (MS) increases cardiovascular risk. The role of thyroid hormone on components of MS is unclear. We analyzed a sample of 4733 euthyroid subjects from SardiNIA study. In female thyrotropin (TSH) was significantly and positively associated with triglycerides (Standardized regression coefficients (β) = 0.081, p < 0.001). Free thyroxine (FT4) was positively associated with HDL (β = 0.056, p < 0.01), systolic blood pressure (SBP) (β = 0.059, p < 0.001), diastolic blood pressure (DBP) (β = 0.044, p < 0.01), and fasting glucose (β = 0.046, p < 0.01). Conversely, FT4 showed a negative association with waist circumference (β = −0.052, p < 0.001). In TSH was positively associated with triglycerides (β = 0.111, p < 0.001) and FT4 showed a positive association with DBP (β = 0.51, p < 0.01). The addition of leptin and adiponectin to the regression models did not substantially change the impact of thyroid hormones on components of MS. Our data suggest that, even within the euthyroid range, excess of truncal adipose tissue is associated with variations in FT4. Leptin and adiponectin exert an additive effect rather than a causal effect. Additional studies should be performed to determine the clinical significance of this finding.
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Zhang X, Li Y, Zhou X, Han X, Gao Y, Ji L. Association between serum thyrotropin within the euthyroid range and obesity. Endocr J 2019; 66:451-457. [PMID: 30842348 DOI: 10.1507/endocrj.ej18-0140] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The relationship between variations in thyroid function and indices of obesity remains a focus of debate. To explore the associations between thyroid function within the normal range and obesity and to evaluate potential modifying factors, we analyzed a large and well-characterized community cohort in Beijing, China, containing 1,816 men and 1,774 women with serum thyrotropin (TSH) levels within the reference range (0.55-4.78 μIU/mL). Associations between TSH levels and BMI were identified using correlation analysis, ANOVA and Chi-square tests. Logistic regression analyses were used to estimate the impact of serum TSH on obesity before and after adjustment for possible confounding factors. The mean serum TSH was 2.04 ± 0.94 μIU/mL. TSH within the reference range was positively associated with BMI in both genders. Compared with euthyroid adults whose TSH was in the middle quartiles (TSH 1.30-2.60 μIU/mL) of the reference range, the odds of obesity (BMI ≥ 28.0 kg/m2) and severe obesity (BMI ≥ 33.0 kg/m2) was 38% (OR = 1.38, 95% CI 1.17-1.64) and 58% (OR = 1.58, 95% CI 1.12-2.21) more likely, respectively, among those with TSH in the upper quartile. For women, postmenopausal subjects with lower TSH levels had a lower risk of severe obesity (OR = 0.42, 95% CI 0.20-0.91) than those in the middle TSH quartile. Positive associations were found between serum TSH within the euthyroid range and obesity, and menopause showed a significant influence on the relationship between TSH level and severe obesity.
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Affiliation(s)
- Xiuying Zhang
- Department of Endocrinology and Metabolism, Peking University People's Hospital, Peking University Diabetes Centre, Beijing 100044, China
| | - Yufeng Li
- Department of Endocrinology and Metabolism, Capital Medical University Pinggu Teaching Hospital, Beijing 101200, China
| | - Xianghai Zhou
- Department of Endocrinology and Metabolism, Peking University People's Hospital, Peking University Diabetes Centre, Beijing 100044, China
| | - Xueyao Han
- Department of Endocrinology and Metabolism, Peking University People's Hospital, Peking University Diabetes Centre, Beijing 100044, China
| | - Ying Gao
- Department of Endocrinology and Metabolism, Peking University People's Hospital, Peking University Diabetes Centre, Beijing 100044, China
| | - Linong Ji
- Department of Endocrinology and Metabolism, Peking University People's Hospital, Peking University Diabetes Centre, Beijing 100044, China
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High Normal Range of Free Thyroxine is Associated with Decreased Triglycerides and with Increased High-Density Lipoprotein Cholesterol Based on Population Representative Data. J Clin Med 2019; 8:jcm8060758. [PMID: 31142048 PMCID: PMC6616420 DOI: 10.3390/jcm8060758] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 05/27/2019] [Accepted: 05/27/2019] [Indexed: 12/20/2022] Open
Abstract
Background: We aimed to evaluate the association between thyroid hormone (free thyroxine, free T4) level and lipid profiles in nationally representative data. Methods: This study was based on cross-sectional survey data from the sixth Korea National Health and Nutrition Examination Survey IV. After exclusion of subjects with a history of thyroid disease or abnormal thyroid function test and those on medication for dyslipidemia and/or cardiovascular disease, a total of 3548 subjects were included in the study. Results: There was a significant decrease in serum triglyceride levels and increase in serum high-density lipoprotein (HDL) cholesterol levels with high free T4 quartiles after adjustment for confounding factors (p for trend = 0.001 and p for trend = 0.014, respectively). Risk of hypertriglyceridemia was significantly decreased (odds ratio of 0.72 (95% confidential interval 0.53-0.98)) in the highest free T4 quartile compared to the lowest free T4 quartile, p = 0.044). Conclusions: Serum free T4 levels within normal range negatively correlated with serum triglyceride level and positively correlated with HDL-cholesterol level. Therefore, a close surveillance in terms of lipid profiles could be considered in subjects with low normal serum free T4 levels.
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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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Gu Y, Wang Y, Zhang Q, Liu L, Meng G, Yao Z, Wu H, Xia Y, Bao X, Shi H, Wang H, Sun S, Wang X, Zhou M, Jia Q, Song K, Niu K. The association between thyroid function and incidence of metabolic syndrome in euthyroid subjects: Tianjin chronic low-grade systemic inflammation and health cohort study. Clin Endocrinol (Oxf) 2018; 88:735-743. [PMID: 29453818 DOI: 10.1111/cen.13576] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 02/02/2018] [Accepted: 02/05/2018] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Thyroid hormones (THs) are primarily responsible for the regulation of energy homeostasis and metabolism. However, few prospective studies have assessed the association between THs and metabolic syndrome (MetS) in a general population. We therefore designed a cohort study to examine whether serum TH levels within the reference range are predictive factors for developing MetS in adults. DESIGN Prospective cohort study. PARTICIPANTS A prospective study (n = 6119) was performed in Tianjin, China. Participants without a history of MetS were followed up for 1 to 3 years with a median follow-up duration of 2 years. MEASUREMENTS Serum free triiodothyronine (FT3), free thyroxine (FT4) and thyroid-stimulating hormone (TSH) levels were measured by chemiluminescence immunoassay. MetS was defined in accordance with the criteria of the American Heart Association scientific statements of 2009. THs, TSH levels and MetS were assessed yearly during the follow-up. Adjusted Cox proportional hazards regression models were used to assess the associations between FT3, FT4 and TSH quintiles and MetS. RESULTS The incidence of MetS was 17.7% (96 per 1000 person-years). In the final multivariate models, the hazard ratios (95% confidence interval) for MetS across serum FT3 quintiles were 1.00 (reference), 1.03 (0.84, 1.25), 1.14 (0.94, 1.38), 1.09 (0.90, 1.32) and 1.33 (1.11, 1.61), respectively (P for trend <.01). However, no significant associations between FT4, TSH and MetS were observed. CONCLUSIONS This population-based prospective cohort study suggests that increased serum FT3 level, rather than FT4 and TSH, is an independent predictor for developing MetS in euthyroid subjects.
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Affiliation(s)
- Yeqing Gu
- Nutritional Epidemiology Institute and School of Public Health, Tianjin Medical University, Tianjin, China
| | - Yanyan Wang
- Nutritional Epidemiology Institute and School of Public Health, Tianjin Medical University, Tianjin, China
| | - Qing Zhang
- Health Management Centre, Tianjin Medical University General Hospital, Tianjin, China
| | - Li Liu
- Health Management Centre, Tianjin Medical University General Hospital, Tianjin, China
| | - Ge Meng
- Nutritional Epidemiology Institute and School of Public Health, Tianjin Medical University, Tianjin, China
| | - Zhanxin Yao
- Tianjin Institute of Environmental & Operational Medicine, Tianjin, China
| | - Hongmei Wu
- Nutritional Epidemiology Institute and School of Public Health, Tianjin Medical University, Tianjin, China
| | - Yang Xia
- Nutritional Epidemiology Institute and School of Public Health, Tianjin Medical University, Tianjin, China
| | - Xue Bao
- Nutritional Epidemiology Institute and School of Public Health, Tianjin Medical University, Tianjin, China
| | - Hongbin Shi
- Health Management Centre, Tianjin Medical University General Hospital, Tianjin, China
| | - Honglei Wang
- Nutritional Epidemiology Institute and School of Public Health, Tianjin Medical University, Tianjin, China
| | - Shaomei Sun
- Health Management Centre, Tianjin Medical University General Hospital, Tianjin, China
| | - Xing Wang
- Health Management Centre, Tianjin Medical University General Hospital, Tianjin, China
| | - Ming Zhou
- Health Management Centre, Tianjin Medical University General Hospital, Tianjin, China
| | - Qiyu Jia
- Health Management Centre, Tianjin Medical University General Hospital, Tianjin, China
| | - Kun Song
- Health Management Centre, Tianjin Medical University General Hospital, Tianjin, China
| | - Kaijun Niu
- Nutritional Epidemiology Institute and School of Public Health, Tianjin Medical University, Tianjin, China
- Health Management Centre, Tianjin Medical University General Hospital, Tianjin, China
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Hamlaoui ML, Ayachi A, Dekaken A, Gouri A. Relationship of metabolic syndrome and its components with thyroid dysfunction in Algerian patients. Diabetes Metab Syndr 2018; 12:1-4. [PMID: 28843650 DOI: 10.1016/j.dsx.2017.08.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 08/07/2017] [Indexed: 01/30/2023]
Abstract
AIMS The aim of this study is to evaluate the prevalence of the metabolic syndrome and its compounds in subjects with different thyroid status. MATERIALS AND METHODS A prospective cross-sectional study was conducted in the internal medicine department at El Okbi Hospital of Guelma (East of Algeria) from January 2014 to September 2015. Eighty six patients attending the specialist consultation for suspected thyroid disorders were included in the study. Gender; blood pressure; body mass index; and serum levels of fasting glucose, total cholesterol (TC), high-density-lipoprotein cholesterol (HDL-C), low-density-lipoprotein cholesterol, and triglyceride were compared between subjects with hypothyroidism, hyperthyroidism and euthyroidism. RESULTS AND CONCLUSION Thyroid dysfunction was found in 59.3% (n=42) patients, hypothyroidism (45.3%) was the major thyroid dysfunction followed by hyperthyroidism (14.0%). Overall, the prevalence of metabolic syndrome was 48.8% (n=42). Subjects with hypothyroidism had significantly higher level of BMI, WC, TC, LDL-C, and higher prevalence of abdominal obesity (84.6%, p<0.01) and hypertension (51.2%, p<0.05). The hyperthyroid group had significantly lower level of TC, LDL-C and HDL-C but a higher level of SBP and UA. Furthermore, abdominal obesity, hypertension and low HDL-C level were the most common metabolic syndrome compounds found in the hyperthyroid group compared to the euthyroid group. We found a positive association between TSH level and the prevalence of the metabolic syndrome.
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Affiliation(s)
- Mohamed Larbi Hamlaoui
- Laboratoire de microbiologie Immunologie, Institut des Sciences Vétérinaires et Agronomiques, Département Vétérinaire, Université de Batna, Algeria
| | - Ammar Ayachi
- Laboratoire de microbiologie Immunologie, Institut des Sciences Vétérinaires et Agronomiques, Département Vétérinaire, Université de Batna, Algeria
| | - Aoulia Dekaken
- Department of Internal Medicine, Public Hospital El Okbi, Guelma, Algeria
| | - Adel Gouri
- Department of Clinical Biochemistry, College of Medicine, Badji Mokhtar University, Annaba, Algeria.
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Wolffenbuttel BHR, Wouters HJCM, Slagter SN, van Waateringe RP, Muller Kobold AC, van Vliet-Ostaptchouk JV, Links TP, van der Klauw MM. Thyroid function and metabolic syndrome in the population-based LifeLines cohort study. BMC Endocr Disord 2017; 17:65. [PMID: 29037214 PMCID: PMC5644133 DOI: 10.1186/s12902-017-0215-1] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 10/09/2017] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The metabolic syndrome (MetS) is a combination of unfavourable health factors which includes abdominal obesity, dyslipidaemia, elevated blood pressure and impaired fasting glucose. Earlier studies have reported a relationship between thyroid function and some MetS components or suggested that serum free thyroxine (FT4) or free triiodothyronine (FT3) levels within the normal range were independently associated with insulin resistance. We assessed how thyroid function relates to MetS prevalence in a large population-based study. METHODS Data of 26,719 people of western European descent, aged 18-80 years from the Dutch LifeLines Cohort study, all with normal thyroid stimulating hormone (TSH), FT4 and FT3 levels (electrochemiluminescent immunoassay, Roche Modular E170 Analyzer), were available. MetS was defined with the revised National Cholesterol Education Programs Adults Treatment Panel III (NCEP ATP III) criteria. We calculated prevalence of all MetS components according to TSH, FT4 and FT3 quartiles. RESULTS At similar TSH levels and age (mean 45 yrs), men had significantly higher levels of FT4, FT3, blood pressure (BP), heart rate, total and LDL-cholesterol, triglycerides (TG), and creatinine, but lower HDL-cholesterol compared to women (all p < 0.001). In total, 11.8% of women and 20.7% of men had MetS. In men, lower FT4 levels were associated with higher prevalence of MetS and all MetS components. In women, lower FT4 quartile was only associated with a higher prevalence of elevated TG, waist circumference, and MetS. However, when corrected for confounding factors like age, BMI, current smoking and alcohol consumption, a significant relationship was found between FT3 and three MetS components in men, and all five components in women. Moreover, the highest quartiles of FT3 and the FT3FT4 ratio predicted a 49% and 67% higher prevalence of MetS in men, and a 62 and 80% higher prevalence in women. CONCLUSIONS When corrected for possible confounding factors, higher plasma levels of FT3 are associated with several components of the MetS. Only in men, lower FT4 is related to MetS. In the highest FT3 and FT3FT4 quartiles, there is a 50-80% increased risk of having MetS compared to the lowest quartile. Further studies are needed to assess the possible causality of this relationship.
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Affiliation(s)
- Bruce H. R. Wolffenbuttel
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, HPC AA31, P.O. Box 30001, 9700 RB Groningen, The Netherlands
| | - Hanneke J. C. M. Wouters
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, HPC AA31, P.O. Box 30001, 9700 RB Groningen, The Netherlands
| | - Sandra N. Slagter
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, HPC AA31, P.O. Box 30001, 9700 RB Groningen, The Netherlands
| | - Robert P. van Waateringe
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, HPC AA31, P.O. Box 30001, 9700 RB Groningen, The Netherlands
| | - Anneke C. Muller Kobold
- Department of Clinical Chemistry, University of Groningen, University Medical Center Groningen, HPC AA31, P.O. Box 30001, 9700 RB Groningen, The Netherlands
| | - Jana V. van Vliet-Ostaptchouk
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, HPC AA31, P.O. Box 30001, 9700 RB Groningen, The Netherlands
| | - Thera P. Links
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, HPC AA31, P.O. Box 30001, 9700 RB Groningen, The Netherlands
| | - Melanie M. van der Klauw
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, HPC AA31, P.O. Box 30001, 9700 RB Groningen, The Netherlands
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Mehran L, Amouzegar A, Bakhtiyari M, Mansournia MA, Rahimabad PK, Tohidi M, Azizi F. Variations in Serum Free Thyroxine Concentration Within the Reference Range Predicts the Incidence of Metabolic Syndrome in Non-Obese Adults: A Cohort Study. Thyroid 2017; 27:886-893. [PMID: 28486021 DOI: 10.1089/thy.2016.0557] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND The association of changes in thyroid hormone values over time with the incidence of metabolic syndrome (MetS) has not yet been evaluated. For the first time, this study assessed the effect of thyroid hormone variations in the subclinical and euthyroid range on the incidence of MetS and its components over a 10-year follow-up in an adult population. METHODS Data were analyzed from the prospective population-based Tehran Thyroid Study. Of 5786 randomly selected subjects aged ≥20 years, after excluding subjects with MetS (n = 1403), those with serum thyrotropin (TSH) >10 or <0.1 mIU/L (n = 104), those taking thyroid drugs (n = 85) or corticosteroids (n = 97), those with a body mass index (BMI) <18.5 kg/m2, those with a glomerular filtration rate <30, and those with a history of cancer (12), data for 2393 subjects were analyzed. Body weight, waist circumference, and blood pressure were measured, and serum concentrations of lipids and lipoproteins, fasting blood glucose, insulin, free thyroxine (fT4), and TSH were assayed at baseline and during three follow-up studies at three-year intervals. MetS was determined using definition of the Joint Interim Statement, adjusted for the Iranian population. RESULTS An increase in fT4 values overtime was associated with lower odds of abdominal obesity (odds ratio [OR] = 0.49 [confidence interval (CI) 0.35-0.69]) and hypertriglyceridemia (OR = 0.57 [CI 0.41-0.78]), and with higher odds of hypertension (OR = 1.35 [CI 1.05-1.74]), adjusted for age, sex, smoking, BMI, and Homeostasis Model Assessment Index for Insulin Resistance. fT4 was associated with lower odds of MetS in the crude model, and after adjustment for age, sex, and smoking (OR = 0.59 [CI 0.39-0.9]). This association lost its significance after further adjusting for BMI. In a subgroup analysis of obese (i.e. BMI ≥30 kg/m2) and non-obese (i.e., BMI <30 kg/m2) subjects, fT4 was a significant predictor of MetS only in non-obese subjects after adjusting for age, sex, and smoking (β = 0.49 [CI 0.29-0.83], p = 0.007) and also after further adjustment for Homeostasis Model Assessment Index for Insulin Resistance (β = 0.57 [CI 0.34-0.96], p = 0.03). Serum TSH variations over time were not associated with any of the MetS components or with odds of MetS. CONCLUSION A decrease in serum fT4 values is associated with an increased risk for MetS, especially in non-obese adults.
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Affiliation(s)
- Ladan Mehran
- 1 Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences , Tehran, I. R. Iran
| | - Atieh Amouzegar
- 1 Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences , Tehran, I. R. Iran
| | - Mahmood Bakhtiyari
- 1 Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences , Tehran, I. R. Iran
- 2 Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences , Tehran, I. R. Iran
| | - Mohammad Ali Mansournia
- 2 Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences , Tehran, I. R. Iran
| | - Parnian Kheirkhah Rahimabad
- 1 Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences , Tehran, I. R. Iran
| | - Maryam Tohidi
- 3 Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences , Tehran, I. R. Iran
| | - Fereidoun Azizi
- 1 Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences , Tehran, I. R. Iran
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Näreoja T, Rosenholm JM, Lamminmäki U, Hänninen PE. Super-sensitive time-resolved fluoroimmunoassay for thyroid-stimulating hormone utilizing europium(III) nanoparticle labels achieved by protein corona stabilization, short binding time, and serum preprocessing. Anal Bioanal Chem 2017; 409:3407-3416. [PMID: 28303322 PMCID: PMC5395595 DOI: 10.1007/s00216-017-0284-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2016] [Revised: 02/17/2017] [Accepted: 02/27/2017] [Indexed: 11/29/2022]
Abstract
Thyrotropin or thyroid-stimulating hormone (TSH) is used as a marker for thyroid function. More precise and more sensitive immunoassays are needed to facilitate continuous monitoring of thyroid dysfunctions and to assess the efficacy of the selected therapy and dosage of medication. Moreover, most thyroid diseases are autoimmune diseases making TSH assays very prone to immunoassay interferences due to autoantibodies in the sample matrix. We have developed a super-sensitive TSH immunoassay utilizing nanoparticle labels with a detection limit of 60 nU L-1 in preprocessed serum samples by reducing nonspecific binding. The developed preprocessing step by affinity purification removed interfering compounds and improved the recovery of spiked TSH from serum. The sensitivity enhancement was achieved by stabilization of the protein corona of the nanoparticle bioconjugates and a spot-coated configuration of the active solid-phase that reduced sedimentation of the nanoparticle bioconjugates and their contact time with antibody-coated solid phase, thus making use of the higher association rate of specific binding due to high avidity nanoparticle bioconjugates. Graphical Abstract We were able to decrease the lowest limit of detection and increase sensitivity of TSH immunoassay using Eu(III)-nanoparticles. The improvement was achieved by decreasing binding time of nanoparticle bioconjugates by small capture area and fast circular rotation. Also, we applied a step to stabilize protein corona of the nanoparticles and a serum-preprocessing step with a structurally related antibody.
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Affiliation(s)
- Tuomas Näreoja
- Laboratory of Biophysics, Institute of Biomedicine and Medicity research laboratories, University of Turku, Tykistökatu 6A, 20520, Turku, Finland.
- Division of Pathology, Department of Laboratory Medicine, Karolinska Institutet, F46, Karolinska Universitetssjukhuset, Huddinge, 141 86, Stockholm, Sweden.
| | - Jessica M Rosenholm
- Pharmaceutical Sciences Laboratory, Faculty of science and engineering, Åbo akademi University, Tykistökatu 6A, 20520, Turku, Finland
| | - Urpo Lamminmäki
- Department of Biochemistry/Biotechnology, University of Turku, Vatselankatu 2, 20500, Turku, Finland
| | - Pekka E Hänninen
- Laboratory of Biophysics, Institute of Biomedicine and Medicity research laboratories, University of Turku, Tykistökatu 6A, 20520, Turku, Finland
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Abstract
Myo-inositol and phosphatidylinositol(s) play a pivotal function in many metabolic pathways that, if impaired, impact unfavorably on human health. This review analyzes several experimental and clinical investigations regarding the involvement of this class of molecules in physiological and pathological situations, with a major focus on thyroid. Central issues are the relationship between phosphatidylinositol and thyrotropin (TSH) signaling on one hand, and phosphatydylinositol and autoimmunity on the other hand. Other issues are the consequences of malfunction of some receptors, such as those ones for TSH (TSHR), insulin (IR) and insulin-like growth factor-1 (IGF-1R), or the connection between serum TSH concentrations and insulin resistance. Also covered are insulin resistance, metabolic syndrome and their allied disorders (diabetes, polycystic ovary syndrome [PCOS]), autoimmunity and certain malignancies, with their reciprocal links. Myoinositol has promising therapeutic potential. Appreciation of the inositol pathways involved in certain disorders, as mentioned in this review, may stimulate researchers to envisage additional therapeutic applications.
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Affiliation(s)
- Salvatore Benvenga
- Department of Clinical and Experimental Medicine, University of Messina School of Medicine, via Consolare Valeria, 1, 98125, Messina, Italy.
- Master Program of Childhood, Adolescence and Women's Endocrine Health, University of Messina School of Medicine, via Consolare Valeria, 1, 98125, Messina, Italy.
- Interdepartmental Program of Molecular & Clinical Endocrinology, and Women's Endocrine Health, University hospital, Padiglione H, 4 piano, Policlinico G. Martino, 98125, Messina, Italy.
| | - Alessandro Antonelli
- Department of Clinical and Experimental Medicine, University of Pisa, 56126, Pisa, Italy
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Xu B, Yang H, Wang Z, Yang T, Guo H, Cheng P, He W, Sun M, Chen H, Duan Y. Elevated thyroid stimulating hormone levels are associated with metabolic syndrome in a Chinese community-based population of euthyroid people aged 40 years and older. J Biomed Res 2016; 30:476-482. [PMID: 27760888 PMCID: PMC5138579 DOI: 10.7555/jbr.30.20150103] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2015] [Revised: 10/05/2015] [Accepted: 01/20/2016] [Indexed: 12/13/2022] Open
Abstract
This study investigated whether high-normal thyrotropin (TSH) levels are associated with metabolic syndrome in euthyroid Chinese people≥40 years old. Clinical and metabolic factors were assessed in 2,356 subjects (40-77 years old) with TSH levels in the normal range (0.35-5.00 mU/L). Using 2.50 mU/L as the cut-off point of TSH level within the normal range, we divided subjects into the high-TSH (2.50-5.00 mU/L; n = 1,064) and low-TSH (0.35-2.50 mU/L; n = 11,292) group. The results showed that the mean levels of body mass index (BMI), total cholesterol (TC), low density lipoprotein cholesterol (LDL-C), and fasting plasma glucose (FPG) were higher in the high-TSH group and TSH levels were significantly positively correlated with BMI, LDL-C, TC, and FPG. The prevalence of central obesity, hypertriglyceridemia, low high density lipoprotein cholesterol (HDL-C), and high FPG (>5.60 mmol/L) was significantly higher in females and subjects with high-TSH levels. Metabolic syndrome was also more prevalent in the high-TSH group. People over the age of 40 years with high-normal TSH levels had a 1.2-fold increased risk of metabolic syndrome, compared with those with low-normal TSH levels, after adjusting for age and gender. In conclusion, high normal TSH is a risk factor for metabolic syndrome in people≥40 years old.
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Affiliation(s)
- Bojin Xu
- Department of Endocrinology, The First Affiliated Hospital, Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Hui Yang
- Department of Endocrinology, The First Affiliated Hospital, Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Zhixiao Wang
- Department of Endocrinology, The First Affiliated Hospital, Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Tao Yang
- Department of Endocrinology, The First Affiliated Hospital, Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Hongwei Guo
- Department of Endocrinology, The First Affiliated Hospital, Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Pei Cheng
- Department of Endocrinology, The First Affiliated Hospital, Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Wei He
- Department of Endocrinology, The First Affiliated Hospital, Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Min Sun
- Department of Endocrinology, The First Affiliated Hospital, Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Huanhuan Chen
- Department of Endocrinology, The First Affiliated Hospital, Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Yu Duan
- Department of Endocrinology, The First Affiliated Hospital, Nanjing Medical University, Nanjing, Jiangsu 210029, China
- Department of Endocrinology, The First Affiliated Hospital, Nanjing Medical University, Nanjing, Jiangsu 210029, China;
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Shin J, Kim MH, Yoon KH, Kang MI, Cha BY, Lim DJ. Relationship between metabolic syndrome and thyroid nodules in healthy Koreans. Korean J Intern Med 2016; 31:98-105. [PMID: 26767863 PMCID: PMC4712440 DOI: 10.3904/kjim.2016.31.1.98] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Revised: 01/23/2015] [Accepted: 05/13/2015] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND/AIMS This study evaluated the relationship between thyroid nodules and metabolic syndrome (MS) and its components in apparently healthy Koreans. METHODS We reviewed the records of 3,298 subjects with no noticeable symptoms who underwent thyroid ultrasound imaging as part of a routine check-up between July 2009 and June 2010; of these, 1,308 were excluded based upon predefined criteria. Among the remaining 1,990 patients, we examined the association between MS and its components and the incidence of thyroid nodules. RESULTS Of the 1,990 subjects included in this study, 38.4% (n = 764) had thyroid nodules and 12.7% (n = 253) had MS. Female sex, older age, higher body mass index, larger waist circumference, higher glycated hemoglobin level, lower thyroid stimulating hormone level, and presence of MS were all closely related with the presence of thyroid nodules (all p < 0.05). Furthermore, the relevant number of MS components showed a positive linear correlation with the occurrence of thyroid nodules (p < 0.001). Evidence of MS alone was not independently associated with thyroid nodules after adjusting for sex and age in a multivariate binary logistic regression analysis; however, glycated hemoglobin for females and waist circumference for males, as well as both age and thyroid stimulating hormone for all patients, were identified as independent predictors for the existence of thyroid nodules (all p < 0.05). CONCLUSIONS This study suggests a positive relationship between the components of MS and thyroid nodules in an ostensibly healthy Korean population. Our data support the idea that the recent increase in thyroid nodules is partly due to increases in both MS and obesity.
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Affiliation(s)
- Juyoung Shin
- Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Min-Hee Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kun-Ho Yoon
- Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Moo-Il Kang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Bong-Yun Cha
- Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Dong-Jun Lim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Correspondence to Dong-Jun Lim, M.D. Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Korea Tel: +82-2-2258-6009 Fax: +82-2-599-3589 E-mail:
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Meng Z, Liu M, Zhang Q, Liu L, Song K, Tan J, Jia Q, Zhang G, Wang R, He Y, Ren X, Zhu M, He Q, Wang S, Li X, Hu T, Liu N, Upadhyaya A, Zhou P, Zhang J. Gender and Age Impacts on the Association Between Thyroid Function and Metabolic Syndrome in Chinese. Medicine (Baltimore) 2015; 94:e2193. [PMID: 26683929 PMCID: PMC5058901 DOI: 10.1097/md.0000000000002193] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
The relationship between thyroid dysfunction and metabolic syndrome (MS) is complex. We aimed to explore the impact of gender and age on their association in a large Chinese cohort. This cross-sectional study enrolled 13,855 participants (8532 male, 5323 female), who self-reported as healthy without any known previous diseases. Clinical data including anthropometric measurements, thyroid function, and serum metabolic parameters were collected. The associations between thyroid function and MS of both genders were analyzed separately after dividing thyroid-stimulating hormone (TSH), free triiodothyronine (FT3), and age into subgroups. MS risks were calculated by binary logistic regression models. Young males had significantly higher MS prevalence than females, yet after menopause, females had higher prevalence than males. Females had higher incidence of thyroid dysfunction than males. By using TSH quartiles as the categorical variables and the lowest quartile as reference, significantly increased MS risk was demonstrated in quartile 4 for males, yet quartiles 3 and 4 for females. By using FT3 quartiles as the categorical variables, significantly increased MS risk was demonstrated in quartile 2 to 4 for females only. By using age subgroups as the categorical variables, significantly increased MS risk was shown in both genders, with females (4.408-58.455) higher than males (2.588-4.943). Gender and age had substantial influence on thyroid function and MS. Females with high TSH and high FT3 had higher MS risks than males. Aging was a risk for MS, especially for females. Urgent need is necessary to initiate interventional programs.
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Affiliation(s)
- Zhaowei Meng
- From the Department of Nuclear Medicine (ZM, JT, QJ, GZ, RW, YH, SW, XL, TH, NL, AU, PZ, JZ), Department of Endocrinology and Metabolism (ML, XR, MZ, QH), and Department of Health Management, Tianjin Medical University General Hospital, Tianjin, P.R. China (QZ, LL, KS)
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Benseñor IM, Goulart AC, Molina MDCB, Peixoto de Miranda ÉJ, Santos IS, Lotufo PA. Thyrotropin Levels, Insulin Resistance, and Metabolic Syndrome: A Cross-Sectional Analysis in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Metab Syndr Relat Disord 2015; 13:362-9. [DOI: 10.1089/met.2015.0045] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Isabela M. Benseñor
- Center for Clinical and Epidemiological Research, Hospital Universitário, University of São Paulo, São Paulo, Brazil
| | - Alessandra Carvalho Goulart
- Center for Clinical and Epidemiological Research, Hospital Universitário, University of São Paulo, São Paulo, Brazil
| | | | | | - Itamar S. Santos
- Center for Clinical and Epidemiological Research, Hospital Universitário, University of São Paulo, São Paulo, Brazil
| | - Paulo A. Lotufo
- Center for Clinical and Epidemiological Research, Hospital Universitário, University of São Paulo, São Paulo, Brazil
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Shinkov A, Borissova AM, Kovatcheva R, Atanassova I, Vlahov J, Dakovska L. The prevalence of the metabolic syndrome increases through the quartiles of thyroid stimulating hormone in a population-based sample of euthyroid subjects. ACTA ACUST UNITED AC 2015; 58:926-32. [PMID: 25627048 DOI: 10.1590/0004-2730000003538] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Accepted: 10/03/2014] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The aim of the study was to assess the prevalence and characteristics of metabolic syndrome (MetS) and its elements in relation to TSH in euthyroid subjects. MATERIALS AND METHODS In the cross-sectional study, 2,153 euthyroid adults, 47.2 ± 14.5 years (20-94) with no current antithyroid or thyroid replacement therapy were enrolled. All participants filled a questionnaire on past and current morbidities, medication and smoking. Body weight, height, waist circumference, serum TSH, glucose and lipids were measured. The subjects were stratified by quartiles of TSH (QTSH) and the prevalence of the MetS elements was calculated. MetS was determined by the IDF 2005 criteria. RESULTS Overweight prevalence was 37.2% (35.2-39.2), obesity in 25.1% (23.3-26.9), abdominal obesity - 61.4% (59.3-63.5), hypertension - 42.1% (38.9-43.1), diabetes/increased fasting glucose - 13.6% (12.1-15), low HDL-cholesterol - 27.6% (25.7-29.5), hypertriglyceridemia - 24.1% (22.3-25.9), MetS - 32.2% (30.2-34.2). MetS was more prevalent in the highest QTSH (34.9%, 30.9-38.9) than the lowest (27%, 23.3-30.9), p < 0.001, as were low HDL-C (32%, 28-35.9 vs. 25%, 21.3-28.7, p < 0.001) and hypertriglyceridemia (26.8%, 23-30.5 vs. 20.4%, 17-23.8, p = 0.015). Each QTSH increased the risk of MetS by 14%, p < 0.001, of hypertriglyceridemia by 20%, p = 0.001 and of low LDL-C by 9%, p = 0.042. Other significant factors for MetS were age, male gender and obesity. CONCLUSION The prevalence of MetS increased with higher QTSH within the euthyroid range, mostly by an increase in the dyslipidemia.
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Affiliation(s)
- Alexander Shinkov
- Medical University of Sofia, University Hospital of Endocrinology, Sofia, Bulgaria
| | - Anna-Maria Borissova
- Medical University of Sofia, University Hospital of Endocrinology, Sofia, Bulgaria
| | - Roussanka Kovatcheva
- Medical University of Sofia, University Hospital of Endocrinology, Sofia, Bulgaria
| | - Iliana Atanassova
- Medical University of Sofia, University Hospital of Endocrinology, Sofia, Bulgaria
| | - Jordan Vlahov
- Medical University of Sofia, University Hospital of Endocrinology, Sofia, Bulgaria
| | - Lilia Dakovska
- Medical University of Sofia, University Hospital of Endocrinology, Sofia, Bulgaria
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Suh S, Kim DK. Subclinical Hypothyroidism and Cardiovascular Disease. Endocrinol Metab (Seoul) 2015; 30:246-51. [PMID: 26248862 PMCID: PMC4595347 DOI: 10.3803/enm.2015.30.3.246] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Revised: 08/03/2015] [Accepted: 08/04/2015] [Indexed: 01/07/2023] Open
Abstract
Subclinical hypothyroidism (SCH) is a common disorder that is characterized by elevated thyroid-stimulating hormone levels in conjunction with free thyroxine concentrations within the normal reference range. Thyroid hormones are known to affect the heart and vasculature and, as a result, the impact of SCH on the cardiovascular (CV) system has recently become an important topic of research. Strong evidence points to a link between SCH and CV risk factors such as alterations in blood pressure, lipid levels, and atherosclerosis. Additionally, accumulating evidence indicates that SCH is associated with metabolic syndrome and heart failure. The present review proposes that SCH may be a potentially modifiable risk factor of CV disease and mortality. However, large-scale clinical trials with appropriate power investigating the risks and benefits of SCH treatment are required to determine whether these benefits can be achieved with levothyroxine therapy.
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Affiliation(s)
- Sunghwan Suh
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Dong-A Medical Center, Dong-A University College of Medicine, Busan, Korea
| | - Duk Kyu Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Dong-A Medical Center, Dong-A University College of Medicine, Busan, Korea.
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Kommareddy S, Lee SY, Braverman LE, Pearce EN. THYROID FUNCTION AND METABOLIC SYNDROME: A CROSS-SECTIONAL STUDY IN OBESE AND OVERWEIGHT PATIENTS. Endocr Pract 2015. [PMID: 26214105 DOI: 10.4158/ep15739.or] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Metabolic syndrome (MetS) is associated with increased risks of developing cardiovascular disease and type 2 diabetes. Thyroid dysfunction is also a known cardiovascular risk factor. In obese patients, serum thyroid-stimulating hormone (TSH) levels tend to be higher than in lean controls. The objective of this study was to assess potential associations between serum TSH levels and MetS as well as individual components of MetS. METHODS This was a cross-sectional observational study of obese and overweight patients seen for initial evaluation at the Boston Medical Center weight-management clinic between February 1, 2013 and February 1, 2014. Demographic, anthropometric, and laboratory data including serum TSH, insulin, glucose, hemoglobin A1c, and lipid levels were obtained from electronic medical records. Associations between serum TSH levels and presence of MetS and its components were assessed. RESULTS A total of 3,447 patients, 75.6% female and 38% African American, without known thyroid dysfunction, were included. Mean ± SD age was 46.74 ± 15.11 years, and mean ± SD body mass index was 36.06 ± 9.89 kg/m(2). Among 1,005 patients without missing data, the prevalence of MetS was 71.84%. In patients with MetS, the median serum TSH was 1.41 μIU/mL, compared with 1.36 μIU/mL in patients without MetS (P = .45). In multivariate models, there was no significant association between serum TSH levels and the presence of MetS, adjusting for age, sex, race, education, socioeconomic status, and smoking. There were also no significant associations between serum TSH and individual components of the MetS. CONCLUSION Serum TSH level does not appear to be a potentially modifiable risk factor for MetS in obese and overweight individuals.
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Gyawali P, Takanche JS, Shrestha RK, Bhattarai P, Khanal K, Risal P, Koju R. Pattern of thyroid dysfunction in patients with metabolic syndrome and its relationship with components of metabolic syndrome. Diabetes Metab J 2015; 39:66-73. [PMID: 25729715 PMCID: PMC4342539 DOI: 10.4093/dmj.2015.39.1.66] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2014] [Accepted: 10/31/2014] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Thyroid dysfunction (TD) and metabolic syndrome (MetS) are known risk factors for atherosclerotic cardiovascular disease (ASCVD). TD is risk factor for ASCVD mediated by the effects of thyroid hormones on lipid metabolism and blood pressure hence the components of MetS. It is possible that coexistence of these two disease entities and unrecognized TD in patients with MetS might substantially increase ASCVD risk. Moreover, little is known about the relationship between TD and the components of MetS. Thus, the purpose of this study was to evaluate the pattern of TD in patients with MetS and its relationship with components of the MetS. METHODS A total of 358 previously diagnosed patients with MetS were recruited in the study. The thyroid function test parameters were measured to classify TD at Dhulikhel Hospital-Kathmandu University Hospital, Dhulikhel, Nepal. Statistical analyses were performed using SPSS version 16.0 to evaluate pattern and relationship. RESULTS The overall prevalence of TD in patients with MetS was 31.84% with high prevalence of subclinical hypothyroidism (29.32%). We found no evidence of a relationship between TD and components of MetS, although there was significant difference in waist circumference between four groups of TD. CONCLUSION Patients with MetS had subclinical hypothyroidism greatly. Although there was no evidence of any relationship between thyroid status and all components of MetS, TD should be taken into account when evaluating and treating patients with MetS to reduce the impending risk.
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Affiliation(s)
- Prabin Gyawali
- Department of Clinical Biochemistry, Kathmandu University School of Medical Sciences (KUSMS), Dhulikhel, Nepal
| | - Jyoti Shrestha Takanche
- Department of Clinical Biochemistry, Kathmandu University School of Medical Sciences (KUSMS), Dhulikhel, Nepal
| | - Raj Kumar Shrestha
- Department of Clinical Biochemistry, Kathmandu University School of Medical Sciences (KUSMS), Dhulikhel, Nepal
| | - Prem Bhattarai
- Department of Clinical Biochemistry, Kathmandu University School of Medical Sciences (KUSMS), Dhulikhel, Nepal
| | - Kishor Khanal
- Department of Community Medicine, Kathmandu University School of Medical Sciences (KUSMS), Dhulikhel, Nepal
| | - Prabodh Risal
- Department of Clinical Biochemistry, Kathmandu University School of Medical Sciences (KUSMS), Dhulikhel, Nepal
| | - Rajendra Koju
- Department of Internal Medicine, Kathmandu University School of Medical Sciences (KUSMS), Dhulikhel, Nepal
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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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Mehran L, Amouzegar A, Tohidi M, Moayedi M, Azizi F. Serum free thyroxine concentration is associated with metabolic syndrome in euthyroid subjects. Thyroid 2014; 24:1566-74. [PMID: 25069017 DOI: 10.1089/thy.2014.0103] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
CONTEXT The association between thyroid hormones within the euthyroid range and metabolic syndrome is not clear. AIM This study evaluated the relationship between thyroid hormones and metabolic syndrome and its components in euthyroid subjects. DESIGN AND SETTING This is a cross-sectional population based study conducted within the framework of the cohort of the Tehran Thyroid Study. PARTICIPANTS Out of 5786 subjects aged ≥ 20 years, 3755 euthyroid subjects without a history of thyroid disorders, diabetes, or use of steroids or lipid-lowering agents were investigated. OUTCOME MEASURES Body weight, waist circumference (WC), and blood pressure (BP) were measured. Serum concentrations of lipids and lipoproteins, fasting blood glucose (FBG), insulin, free T4 (FT4), and thyrotropin (TSH) were assayed. Metabolic syndrome was determined by definition of the Joint Interim Statement adjusted for the Iranian population. RESULTS After adjustment for age, sex, and smoking, serum FT4 was significantly associated with high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), triglycerides (TGs), WC, systolic BP, and diastolic BP; the associations that remained significant after further adjustment for body mass index (BMI) and the homeostasis model assessment index for insulin resistance (HOMA-IR) except for HDL-C. Serum TSH was associated only with TGs after adjustments for age, sex, smoking, and BMI, an association that disappeared after further adjustment for HOMA-IR. Serum FT4 was negatively associated (β=-0.02, 95% confidence interval [CI: -0.03, -0.01]) and TSH was positively associated (β = 0.03 [CI: 0.01, 0.04) with insulin resistance. The prevalence of metabolic syndrome decreased from 30.1% in the lowest FT4 tertile to 22.4% in the highest FT4 tertile (p<0.001). The prevalence of other metabolic syndrome components decreased significantly from higher to lower FT4 tertiles. Higher FT4 values were associated with lower odds of metabolic syndrome (OR = 0.96 [95% CI: 0.92, 0.99]; p=0.01). CONCLUSION In euthyroid subjects, FT4, rather than TSH, is associated with risk of metabolic syndrome and its components.
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Affiliation(s)
- Ladan Mehran
- 1 Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences , Tehran, I. R. Iran
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Udenze I, Nnaji I, Oshodi T. Thyroid function in adult Nigerians with metabolic syndrome. Pan Afr Med J 2014; 18:352. [PMID: 25574328 PMCID: PMC4282811 DOI: 10.11604/pamj.2014.18.352.4551] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Accepted: 05/26/2014] [Indexed: 11/20/2022] Open
Abstract
Introduction Metabolic syndrome and thyroid dysfunction are two common disorders encountered in the metabolic clinic. Recently, there has been increased interest in the association between the two disorders because of the similarities between symptoms of hypothyroidism and components of the metabolic syndrome. While some reports suggest that metabolic syndrome is associated with subclinical hypothyroidism, this concept is largely under investigated in Nigerian adults with metabolic syndrome. The aim of this study is to determine the thyroid function status of adult Nigerians with metabolic syndrome and determine the association, if any, between metabolic syndrome and thyroid function. Methods This was a cross sectional study of one hundred and fifty adults, members of staff of the College of Medicine of the University of Lagos. The participants were recruited using a cluster random sampling method. The Ethical Research & Review Committee of the institution approved the study protocol and signed informed consent was obtained from the participants. The statistics was analysed using the IBM SPSS Software of version 19.0. The Student's t test, Chi square test and multivariate regression analysis were employed for the analysis. Statistical significance was set at p < 0.05. Results Thirty nine (twenty-six percent) of the study participants had metabolic syndrome and one hundred and eleven (seventy-four percent) of the study participants did not have metabolic syndrome, served as controls. Those who had metabolic syndrome group were significantly older (p = 0.03), metabolic syndrome was significantly associated with the female gender (p = 0.0002), higher systolic blood pressure (p = 0.0034), diastolic blood pressure (p = 0.0009), waist circumference (p < 0.0001), body mass index (p < 0.0001), waist-hip ratio (p = 0.003), fasting serum glucose (p = 0.0457) and free thyroxine (fT4) levels (p = 0.0496). Those with metabolic syndrome had significantly lower HDL (P = 0.004) and free triiodothyronine (fT3) levels (p = 0.037). There was no statistically significant difference in the thyroid stimulating hormone (TSH) levels between individuals with and without metabolic syndrome. Thirty-three percent of the metabolic syndrome cases had sick euthyroid syndrome (p= < 0.0001). In multivariate regression, waist circumference was significantly and inversely associated with the sick euthyroid syndrome (p = 0.011). Conclusion Metabolic syndrome is associated with the sick euthyroid syndrome in adult Nigerians. Abdominal obesity appears to be the link between metabolic syndrome and the sick euthyroid syndrome.
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Affiliation(s)
- Ifeoma Udenze
- Department of Clinical Pathology, Faculty of Clinical Sciences, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Ilochi Nnaji
- Department of Clinical Pathology, Faculty of Clinical Sciences, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Temitope Oshodi
- Department of Clinical Pathology, Faculty of Clinical Sciences, College of Medicine, University of Lagos, Lagos, Nigeria
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Chun H, Song KH. "High normal" thyroid stimulating hormone: does it matter? Korean J Intern Med 2013; 28:162-4. [PMID: 23526872 PMCID: PMC3604605 DOI: 10.3904/kjim.2013.28.2.162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Accepted: 02/22/2013] [Indexed: 11/27/2022] Open
Affiliation(s)
- Hyunji Chun
- Division of Endocrinolgy and Metabolism, Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Ki-Ho Song
- Division of Endocrinolgy and Metabolism, Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
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