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De Luca M, D'Assante R, Iacoviello M, Triggiani V, Rengo G, De Giorgi A, Limongelli G, Masarone D, Volterrani M, Mancini A, Passantino A, Perrone Filardi P, Sciacqua A, Vriz O, Castello R, Campo M, Lisco G, Modesti PA, Paolillo S, Suzuki T, Salzano A, Marra AM, Bossone E, Cittadini A. Subclinical hypothyroidism predicts outcome in heart failure: insights from the T.O.S.CA. registry. Intern Emerg Med 2024:10.1007/s11739-024-03665-w. [PMID: 38850355 DOI: 10.1007/s11739-024-03665-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Accepted: 05/28/2024] [Indexed: 06/10/2024]
Abstract
Subclinical hypothyroidism (SH), defined as increased serum thyroid-stimulating hormone (TSH) with normal free T4 (fT4) levels, is frequently observed in the general population. Prevalence ranges from 0.6% to 1.8% in the adult population, depending on age, sex, and iodine intake. Several studies reported a worse prognosis in patients with heart failure with reduced ejection fraction (HFrEF) and SH, but they considered heterogeneous populations suffering mainly from severe SH. Aim of this study was to evaluate if SH was independently associated with the occurrence of cardiovascular death considering 30 months of follow-up. 277 HFrEF patients enrolled in the prospective, multicenter, observational T.O.S.CA. (Terapia Ormonale Scompenso CArdiaco) registry, were included in this analysis. Patients were divided into two groups according to the presence of SH (serum TSH levels > 4.5 mIU/L with normal fT4 levels). Data regarding clinical status, echocardiography, and survival were analyzed. Twenty-three patients displayed SH (87% mild vs 13% severe), while 254 were euthyroid. No differences were found in terms of age, sex, HF etiology, and left ventricular ejection fraction. When compared with the euthyroid group, SH patients showed higher TSH levels (7.7 ± 4.1 vs 1.6 ± 0.9, p < 0.001), as expected, with comparable levels of fT4 (1.3 ± 0.3 vs 1.3 ± 0.3, p = NS). When corrected for established predictors of poor outcome in HF, the presence of SH resulted to be an independent predictor of cardiovascular mortality (HR: 2.96; 5-95% CI:1.13-7.74; p = 0.03). Since thyroid tests are widely available and inexpensive, they should be performed in HF patients to detect subclinical disorders, evaluate replacement therapy, and improve prognosis.
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Affiliation(s)
- Mariarosaria De Luca
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Roberta D'Assante
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Massimo Iacoviello
- Cardiology Unit, Department of Medical and Surgical Sciences, University of Foggia, 71122, Foggia, Italy
| | - Vincenzo Triggiani
- Interdisciplinary Department of Medicine-Section of Internal Medicine, Geriatrics, Endocrinology and Rare Diseases, University of Bari 'A Moro', Bari, Italy
| | - Giuseppe Rengo
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
- Istituti Clinici Scientifici ICS Maugeri-S.P.A.-Istituti Di Ricovero E Cura a Carattere Scientifico (IRCCS) Istituto Scientifico Di Telese Terme, Telese, Italy
| | - Alfredo De Giorgi
- Clinical Medicine Unit, Department of Medicine, Azienda Ospedaliero-Universitaria S. Anna, Ferrara, Italy
| | - Giuseppe Limongelli
- Division of Cardiology, Monaldi Hospital, Azienda Ospedaliera Dei Colli, University of Campania Luigi Vanvitelli, Caserta, Italy
| | - Daniele Masarone
- Division of Cardiology, Monaldi Hospital, Azienda Ospedaliera Dei Colli, University of Campania Luigi Vanvitelli, Caserta, Italy
| | | | - Antonio Mancini
- Operative Unit of Endocrinology, Catholic University of the Sacred Heart, Rome, Italy
| | | | | | - Angela Sciacqua
- Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Catanzaro, Italy
| | - Olga Vriz
- Heart Center Department, King Faisal Hospital & Research Center, Riyadh, Saudi Arabia
| | - Roberto Castello
- Division of General Medicine, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Michela Campo
- Department of Medical and Surgical Sciences, Unit of Endocrinology and Metabolic Diseases, University of Foggia, Foggia, Italy
| | - Giuseppe Lisco
- Interdisciplinary Department of Medicine-Section of Internal Medicine, Geriatrics, Endocrinology and Rare Diseases, University of Bari 'A Moro', Bari, Italy
| | - Pietro Amedeo Modesti
- Department of Medical Sciences, School of Medicine, Pharmacy and Prevention, University of Ferrara, Ferrara, Italy
| | - Stefania Paolillo
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Toru Suzuki
- Department of Cardiovascular Sciences, University of Leicester, NIHR Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Andrea Salzano
- Cardiology Unit, A.O.R.N. Antonio Cardarelli, Naples, Italy
| | - Alberto Maria Marra
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Eduardo Bossone
- Department of Public Health, University "Federico II" of Naples, Naples, Italy
| | - Antonio Cittadini
- Department of Translational Medical Sciences, Federico II University, Naples, Italy.
- Division of Internal Medicine & Metabolism & Rehabilitation, University Federico II, 80131, Naples, Italy.
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Osama HM, Khadrawy SM, El-Nahass ES, Othman SI, Mohamed HM. Eltroxin and Hesperidin mitigate testicular and renal damage in hypothyroid rats: amelioration of oxidative stress through PPARγ and Nrf2/HO-1 signaling pathway. Lab Anim Res 2024; 40:19. [PMID: 38745206 PMCID: PMC11092223 DOI: 10.1186/s42826-024-00204-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 04/22/2024] [Accepted: 04/28/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND Thyroid hormones (THs) regulate growth, development and function of different tissues. Hypothyroidism is a common clinical disorder characterized by deficiency in THs and adversely affects the development and functions of several organs. This work aimed to investigate the ameliorative effect of eltroxin (ELT), a hypothyroidism medication, and hesperidin (HSP), a flavonoid, against testicular and renal toxicity in hypothyroid rats. Twenty-four rats were divided into four groups and treated orally for 12 weeks. Group I (control), group II (hypothyroidism) received 20 mg/kg carbimazole (CBZ), group III received CBZ and 0.045 mg/kg ELT, and group IV received CBZ and 200 mg/kg HSP. RESULTS CBZ administration induced biochemical and histopathological changes in testis and kidney. Co-administration of ELT or HSP significantly (P < 0.05) ameliorated THs, reduced urea and creatinine while raised follicle stimulating hormone (FSH), Luteinizing hormone (LH), and testosterone in serum. Testicular and renal malondialdehyde level as a lipid peroxidation indicator, tumor necrosis factor-α (TNF-α), and interleukin-6 (IL-6) were significantly (P < 0.05) decreased while glutathione content, glutathione peroxidase, and glutathione-s-transferase activities were significantly (P < 0.05) increased. The histopathological changes were also diminished. Decreased mRNA and protein expressions of nuclear factor erythroid 2-related factor 2 (Nrf2), heme oxygenase-1 (HO-1), and peroxisome proliferator-activated receptor gamma(PPARγ) in hypothyroid rats were up-regulated after ELT or HSP treatment. CONCLUSIONS ELT and HSP showed antioxidant and anti-inflammatory effects against CBZ-induced testicular and renal toxicity, and these effects may be promoted via activating Nrf2/HO-1 and PPARγ signaling pathways.
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Affiliation(s)
- Hadeel M Osama
- Genetics and Molecular Biology Division, Zoology Department, Faculty of Science, Beni-Suef University, Beni-Suef, Egypt
| | - Sally M Khadrawy
- Genetics and Molecular Biology Division, Zoology Department, Faculty of Science, Beni-Suef University, Beni-Suef, Egypt.
| | - El-Shaymaa El-Nahass
- Pathology Department, Faculty of Veterinary Medicine, Beni-Suef University, Beni-Suef, Egypt
| | - Sarah I Othman
- Biology Department, College of Science, Princess Nourah bint Abdulrahman University, P.O. BOX 84428, Riyadh, 11671, Saudi Arabia
| | - Hanaa M Mohamed
- Genetics and Molecular Biology Division, Zoology Department, Faculty of Science, Beni-Suef University, Beni-Suef, Egypt
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Lai R, Yin B, Feng Z, Deng X, Lv X, Zhong Y, Peng D. The causal relationship between 41 inflammatory cytokines and hypothyroidism: bidirectional two-sample Mendelian randomization study. Front Endocrinol (Lausanne) 2024; 14:1332383. [PMID: 38317717 PMCID: PMC10840409 DOI: 10.3389/fendo.2023.1332383] [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: 11/07/2023] [Accepted: 12/20/2023] [Indexed: 02/07/2024] Open
Abstract
Objective Investigating the association between inflammatory cytokines and hypothyroidism remains challenging due to limitations in traditional observational studies. In this study, we employed Mendelian randomization (MR) to assess the causal relationship between 41 inflammatory cytokines and hypothyroidism. Method Inflammatory cytokines in 30,155 individuals of European ancestry with hypothyroidism and in a GWAS summary containing 8,293 healthy participants were included in the study for bidirectional two-sample MR analysis. We utilized inverse variance weighting (IVW), weighted median (WM), and Mendelian randomization-Egger (MR-Egger) methods. Multiple sensitivity analyses, including MR-Egger intercept test, leave-one-out analysis, funnel plot, scatterplot, and MR-PRESSO, were applied to evaluate assumptions. Results We found evidence of a causal effect of IL-7 and macrophage inflammatory protein-1β (MIP-1β) on the risk of hypothyroidism, and a causal effect of hypothyroidism on several cytokines, including granulocyte colony-stimulating factor (G-CSF), IL-13, IL-16, IL-2rα, IL-6, IL-7, IL-9, interferon-γ-inducible protein 10 (IP10), monokine induced by interferon (IFN)-γ (MIG), macrophage inflammatory protein-1β (MIP-1β), stem cell growth factors-β (SCGF-β), stromal cell derived factor-1α (SDF-1α), and tumor necrosis factor-α (TNF-α). Conclusion Our study suggests that IL-7 and MIP-1β may play a role in the pathogenesis of hypothyroidism, and that hypothyroidism may induce a systemic inflammatory response involving multiple cytokines. These findings may have implications for the prevention and treatment of hypothyroidism and its complications. However, further experimental studies are needed to validate the causal relationships and the potential of these cytokines as drug targets.
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Affiliation(s)
- Rui Lai
- School of Acupuncture and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Bingzun Yin
- School of Acupuncture and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Ziyang Feng
- The Fourth Clinical Medical College, Guangzhou University of Chinese Medicine, Shenzhen, China
| | - Xinmin Deng
- School of Clinical Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Xiaofeng Lv
- School of Acupuncture and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yumei Zhong
- Chengdu Integrated TCM & Western Medicine Hospital/Chengdu First People’s Hospital, Chengdu, China
| | - Dezhong Peng
- School of Acupuncture and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China
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Spahia N, Rroji M, Barbullushi M, Spasovski G. Subclinical Hypothyroidism, Kidney, and Heart from Normal to Uremic Milieu. Metab Syndr Relat Disord 2023; 21:415-425. [PMID: 37433213 DOI: 10.1089/met.2023.0057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/13/2023] Open
Abstract
Thyroid hormone (TH) imbalances, particularly subclinical hypothyroidism (SCHT), are associated with chronic kidney disease (CKD) and end-stage kidney disease (ESKD). SCHT is more prevalent in CKD and ESKD patients than in the general population, and this condition increases the risk of cardiovascular disease (CVD) morbidity and mortality. The risk of CVD is higher in CKD and ESKD patients compared with the general population. Traditional and nontraditional risk factors, including TH abnormalities, contribute to the high CVD burden in CKD and ESKD patients. The review discusses the link between CKD and hypothyroidism, with a focus on SCHT, and the mechanisms that lead to CVD burden.
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Affiliation(s)
- Nereida Spahia
- Department of Nephrology, University Hospital Center "Mother Teresa," Tirana, Albania
| | - Merita Rroji
- Department of Nephrology, University Hospital Center "Mother Teresa," Tirana, Albania
| | - Myftar Barbullushi
- Department of Nephrology, University Hospital Center "Mother Teresa," Tirana, Albania
| | - Goce Spasovski
- Department of Nephrology, Medical Faculty, University Sts. Cyril and Methodius, Skopje, North Macedonia
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Lambrechts MJ, Pitchford C, Hogan D, Li J, Fogarty C, Rawat S, Leary EV, Cook JL, Choma TJ. Lumbar spine intervertebral disc desiccation is associated with medical comorbidities linked to systemic inflammation. Arch Orthop Trauma Surg 2023; 143:1143-1153. [PMID: 34623492 DOI: 10.1007/s00402-021-04194-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 09/24/2021] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Symptomatic disc degeneration is a common cause of low back pain. Recently, the prevalence of low back pain has swiftly risen leading to increased patient disability and loss of work. The increase in back pain also coincides with a rapid rise in patient medical comorbidities. However, a comprehensive study evaluating a link between patient's medical comorbidities and their influence on lumbar intervertebral disc morphology is lacking in the literature. METHODS Electronic medical records (EMR) were retrospectively reviewed to determine patient-specific medical characteristics. Magnetic resonance imaging (MRI) was evaluated for lumbar spine intervertebral disc desiccation and height loss according to the Griffith-modified Pfirrmann grading system. Bivariate and multivariable linear regression analyses assessed strength of associations between patient characteristics and lumbar spine Pfirrmann grade severity (Pfirrmann grade of the most affected lumbar spine intervertebral disc) and cumulative grades (summed Pfirrmann grades for all lumbar spine intervertebral discs). RESULTS In total, 605 patients (304 diabetics and 301 non-diabetics) met inclusion criteria. Bivariate analysis identified older age, diabetes, American Society of Anesthesiologists (ASA) class, hypertension, chronic obstructive pulmonary disease (COPD), peripheral vascular disease, and hypothyroidism as being strongly associated with an increasing cumulative Pfirrmann grades. Multivariable models similarly found an association linking increased cumulative Pfirrmann grades with diabetes, hypothyroidism, and hypertension, while additionally identifying non-white race, heart disease, and previous lumbar surgery. Chronic pain, depression, and obstructive sleep apnea (OSA) were associated with increased Pfirrmann grades at the most affected level without an increase in cumulative Pfirrmann scores. Glucose control was not associated with increasing severity or cumulative Pfirrmann scores. CONCLUSION These findings provide specific targets for future studies to elucidate key mechanisms by which patient-specific medical characteristics contribute to the development and progression of lumbar spine disc desiccation and height loss. LEVEL OF EVIDENCE III (retrospective cohort).
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Affiliation(s)
- Mark J Lambrechts
- Department of Orthopaedic Surgery, Orthopaedic Resident, University Physicians, University of Missouri, Columbia, MO, 65212, USA.
| | - Chase Pitchford
- School of Medicine, University of Missouri, Columbia, MO, USA
| | - Daniel Hogan
- School of Medicine, University of Missouri, Columbia, MO, USA
| | - Jinpu Li
- Department of Orthopaedic Surgery, Orthopaedic Resident, University Physicians, University of Missouri, Columbia, MO, 65212, USA.,Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, MO, USA
| | - Casey Fogarty
- Department of Orthopaedic Surgery, Orthopaedic Resident, University Physicians, University of Missouri, Columbia, MO, 65212, USA.,School of Medicine, University of Missouri, Columbia, MO, USA
| | - Sury Rawat
- Department of Orthopaedic Surgery, Orthopaedic Resident, University Physicians, University of Missouri, Columbia, MO, 65212, USA.,School of Medicine, University of Missouri, Columbia, MO, USA
| | - Emily V Leary
- Department of Orthopaedic Surgery, Orthopaedic Resident, University Physicians, University of Missouri, Columbia, MO, 65212, USA.,Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, MO, USA
| | - James L Cook
- Department of Orthopaedic Surgery, Orthopaedic Resident, University Physicians, University of Missouri, Columbia, MO, 65212, USA.,Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, MO, USA
| | - Theodore J Choma
- Department of Orthopaedic Surgery, Orthopaedic Resident, University Physicians, University of Missouri, Columbia, MO, 65212, USA
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Causal Association of Thyroid Signaling with C-Reactive Protein: A Bidirectional Mendelian Randomization. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:8954606. [PMID: 35996695 PMCID: PMC9392607 DOI: 10.1155/2022/8954606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 07/23/2022] [Accepted: 07/27/2022] [Indexed: 01/08/2023]
Abstract
Methods Based on the latest genome-wide association study summary data, bidirectional two-sample Mendelian randomization (MR) was employed to detect the causal relationship and effect direction between TSH, fT4, and CRP. Furthermore, in view of obesity being an important risk factor of CVD, obesity trait waist-hip ratio (WHR) and body mass index (BMI) were treated as the research objects in MR analyses for exploring the causal effects of TSH and fT4 on them, respectively. Results Genetically increased CRP was associated with increased TSH (β = −0.02, P = 0.011) and with increased fT4 (β = 0.043, P = 0.001), respectively, but there was no evidence that TSH or fT4 could affect CRP. In further analyses, genetically increased TSH was associated with decreased WHR (β = −0.02, P = 3.99e − 4). Genetically increased WHR was associated with decreased fT4 (β = −0.081, P = 0.002). Genetically increased BMI was associated with increased TSH (β = 0.03, P = 0.028) and with decreased fT4 (β = −0.078, P = 1.05e − 4). Causal associations of WHR and BMI with thyroid signaling were not supported by weighted median analysis in sensitivity analyses. Conclusion TSH and fT4 were increased due to the higher genetically predicted CRP. WHR was decreased due to the higher genetically predicted TSH. These findings will provide reference for the prevention and treatment of inflammation and metabolic syndrome.
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Uchamprina VA, Bobrova EI, Kandalina VV, Sviridova MI, Ulyanova OA. Hypothyroidism And Gestational Diabetes Mellitus: Is There A Relationship? RUSSIAN OPEN MEDICAL JOURNAL 2022. [DOI: 10.15275/rusomj.2022.0210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Background and Objective — Subclinical gestational hypothyroidism (SGH) and gestational diabetes mellitus (GDM) constitute two most common endocrine pathologies encountered during pregnancy. SGH and GDM have common pathophysiological mechanisms, being interrelated pathological conditions that are capable of complicating the course of pregnancy, labor and the postpartum period both on the part of the mother and on the part of the fetus. We aimed to analyze the relationship between these pathologies and to assess the risk of developing GDM against the background of hypothyroidism. Materials and Methods — the study included 200 pregnant women observed at the Perinatal Center of the Maternity Hospital the Bauman State Clinical Hospital No. 29 during 2018-2020. The main group consisted of 133 women who visited the perinatal center for hypothyroidism (both SGH and primary hypothyroidism, detected prior to pregnancy); the control group comprised 67 women without endocrine pathology. Both groups were comparable in terms of age, height, weight, and the number of pregnancies in the anamneses. The main group received levothyroxine sodium therapy with the achievement of the target trimester-specific level of thyroid-stimulating hormone (TSH). The criteria for the diagnosis of SGH were the TSH level above 2.5 μIU/mL in combination with an enlarged titer of antithyroid antibodies and/or a burdened medical history of thyroid pathology, or the TSH level above 4.0 μIU/mL in the absence of antithyroid antibodies [1]. The diagnosis of GDM was established on the basis of fasting hyperglycemia (≥5.1 mmol/L), or based on the results of an oral glucose tolerance test (OGTT) with 75 g of glucose: fasting glucose level of ≥5.1 mmol/L; the concentration 1 hour after glucose intake ≥10.0 mmol/L; the content 2 hours after glucose intake ≥8.5 mmol/l) [2]. In both groups, the frequency of developing GDM, the timing of diagnosis, and the need for insulin therapy were evaluated. Statistical data processing was carried out using the StatTech v. 2.1.0 software. Quantitative indicators were assessed for compliance with the normal distribution via Shapiro-Wilk criterion or Kolmogorov-Smirnov criterion. Intergroup comparison was performed using Mann-Whitney U test or Pearson’s chi-squared test. Results — We discovered that among women with a burdened family history of thyroid pathology and diabetes mellitus, as well as with thyroid pathology prior to pregnancy, the prevalence of hypothyroidism was higher. The presence of thyroid pathology in the anamnesis of pregnant women was associated with an earlier diagnosis of hypothyroidism. We revealed a significant difference in the prevalence of GDM between two groups of subjects. The chances of detecting GDM in the hypothyroidism group were 8.6 times higher than in the euthyroidism group. The threshold level of TSH for the first trimester, predicting the development of GDM, was identified. The sensitivity and specificity of the model were 71.4% and 63.1%, respectively. Conclusion — Hypofunction of the thyroid and GDM are interrelated endocrine pathologies. In the presence of hypothyroidism (both primary and SGH), GDM develops significantly more often. The level of TSH in the first trimester ≥2.7 μIU/mL amplifies the chance of developing GDM by over 8 times; hence, it could be considered a signal for timely prevention and detection of this pathology.
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Le Moli R, Vella V, Tumino D, Piticchio T, Naselli A, Belfiore A, Frasca F. Inflammasome activation as a link between obesity and thyroid disorders: Implications for an integrated clinical management. Front Endocrinol (Lausanne) 2022; 13:959276. [PMID: 36060941 PMCID: PMC9437482 DOI: 10.3389/fendo.2022.959276] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 08/03/2022] [Indexed: 11/25/2022] Open
Abstract
Obesity is strongly associated with chronic low-grade inflammation. Obese patients have an increased risk to develop thyroid autoimmunity and to became hypothyroid, suggesting a pathogenetic link between obesity, inflammation and autoimmunity. Moreover, type 2 diabetes and dyslipidemia, also characterized by low-grade inflammation, were recently associated with more aggressive forms of Graves' ophthalmopathy. The association between obesity and autoimmune thyroid disorders may also go in the opposite direction, as treating autoimmune hyper and hypothyroidism can lead to weight gain. In addition, restoration of euthyroidism by L-T4 replacement therapy is more challenging in obese athyreotic patients, as it is difficult to maintain thyrotropin stimulation hormone (TSH) values within the normal range. Intriguingly, pro-inflammatory cytokines decrease in obese patients after bariatric surgery along with TSH levels. Moreover, the risk of thyroid cancer is increased in patients with thyroid autoimmune disorders, and is also related to the degree of obesity and inflammation. Molecular studies have shown a relationship between the low-grade inflammation of obesity and the activity of intracellular multiprotein complexes typical of immune cells (inflammasomes). We will now highlight some clinical implications of inflammasome activation in the relationship between obesity and thyroid disease.
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Zhou Y, Liu Y, Zhang Y, Zhang Y, Wu W, Fan J. Identifying Non-Linear Association Between Maternal Free Thyroxine and Risk of Preterm Delivery by a Machine Learning Model. Front Endocrinol (Lausanne) 2022; 13:817595. [PMID: 35282469 PMCID: PMC8907667 DOI: 10.3389/fendo.2022.817595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 01/17/2022] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Preterm delivery (PTD) is the primary cause of mortality in infants. Mounting evidence indicates that thyroid dysfunction might be associated with an increased risk of PTD, but the dose-dependent association between the continuous spectrum maternal free thyroxine (FT4) and PTD is still not well-defined. This study aimed to further investigate this relationship using a machine learning-based model. METHODS A hospital-based cohort study was conducted from January 2014 to December 2018 in Shanghai, China. Pregnant women who delivered singleton live births and had first-trimester thyroid function data available were included. The generalized additive models with penalized cubic regression spline were applied to explore the non-linear association between maternal FT4 and risk of PTD and also subtypes of PTD. The time-to-event method and multivariable Cox proportional hazard model were further applied to analyze the association of abnormally high and low maternal FT4 concentrations with the timing of PTD. RESULTS A total of 65,565 singleton pregnancies with completed medical records and no known thyroid disease before pregnancy were included for final analyses. There was a U-shaped dose-dependent relationship between maternal FT4 in the first trimester and PTD (p <0.001). Compared with the normal range of maternal FT4, increased risk of PTD was identified in both low maternal FT4 (<11.7 pmol/L; adjusted hazard ratio [HR] 1.34, 95% CI [1.13-1.59]) and high maternal FT4 (>19.7 pmol/L; HR 1.41, 95% CI [1.13-1.76]). The association between isolated hypothyroxinemia and PTD was mainly associated with spontaneous PTD (HR 1.33, 95% CI [1.11-1.59]) while overt hyperthyroidism may be attributable to iatrogenic PTD (HR 1.51, 95% CI [1.18-1.92]) when compared with euthyroid women. Additionally, mediation analysis identified that an estimated 11.80% of the association between overt hyperthyroidism and iatrogenic PTD risk was mediated via the occurrence of hypertensive disorders in pregnancy (p <0.001). CONCLUSIONS We revealed a U-shaped association between maternal FT4 and PTD for the first time, exceeding the clinical definition of maternal thyroid function test abnormalities. Our findings provide insights towards the need to establish optimal range of maternal FT4 concentrations for preventing adverse outcomes in pregnancy.
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Affiliation(s)
- Yulai Zhou
- The International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China
- Shanghai Municipal Key Clinical Specialty, Shanghai, China
| | - Yindi Liu
- The International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China
- Shanghai Municipal Key Clinical Specialty, Shanghai, China
| | - Yuan Zhang
- The International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China
- Shanghai Municipal Key Clinical Specialty, Shanghai, China
| | - Yong Zhang
- The International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China
- Shanghai Municipal Key Clinical Specialty, Shanghai, China
| | - Weibin Wu
- The International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China
- *Correspondence: Weibin Wu, ; Jianxia Fan,
| | - Jianxia Fan
- The International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China
- Shanghai Municipal Key Clinical Specialty, Shanghai, China
- *Correspondence: Weibin Wu, ; Jianxia Fan,
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Allam MA, Nassar YA, Shabana HS, Mostafa S, Khalil F, Zidan H, Abo-Ghebsha M, Abdelghaffar A, Essmat A, Elmahdi E. Prevalence and Clinical Significance of Subclinical Hypothyroidism in Diabetic Peripheral Neuropathy. Int J Gen Med 2021; 14:7755-7761. [PMID: 34785933 PMCID: PMC8579825 DOI: 10.2147/ijgm.s337779] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 10/26/2021] [Indexed: 12/14/2022] Open
Abstract
Background and Aim Diabetic peripheral neuropathy (DPN) is one of the most common and disabling complications of DM. Many studies documented the prevalence of clinical and subclinical hypothyroidism (SCH) in diabetic patients but not in the particular group of patients with DPN. The present study aimed to determine the prevalence of SCH in DPN patients and to evaluate its association with severity of DPN. Patients and Methods The present cross-sectional study was conducted on 300 consecutive patients with DPN. The clinical manifestations of DPN were documented according to the validated Arabic version of the Michigan Neuropathy Screening Instrument. Severity of DPN was categorized into mild (6–8 points), moderate (9–11 points) or severe (12+ points) according to the Toronto Clinical Scoring System. All patients were submitted to careful history-taking and full clinical and neurological examination. Patients were diagnosed with SCH if they had TSH level above the upper limit of the normal reference range in association with normal free thyroxine (FT4) level. Results SCH was prevalent in 53 patients (17.7%, 95% CI: 13.5%–22.5%). Patients with SCH had significantly higher frequency of severe DPN (52.8% versus 28.3%, p=0.003). It was also shown that patients with SCH had significantly higher HbA1c (8.4 ± 1.0 versus 7.3 ± 1.2%, p<0.001) and HOMA-IR (3.7 ± 0.8 versus 2.7 ± 0.9, p<0.001) when compared with patients without SCH. Logistic regression analysis identified patients’ age [OR (95% CI): 1.06 (1.03–1.08), p<0.001], HbA1c [OR (95% CI): 2.2 (1.7–2.9), p<0.001] and SCH [OR (95% CI): 7.7 (3.6–15.5), p<0.001] as independent predictors of DPN severity. Conclusion The present study showed that SCH is highly prevalent in DPN patients and is independently related to its severity.
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Affiliation(s)
- Mahmoud A Allam
- Department of Internal Medicine, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Youssef A Nassar
- Department of Internal Medicine, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Hosameldeen S Shabana
- Department of Internal Medicine, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Sadek Mostafa
- Department of Internal Medicine, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Farag Khalil
- Department of Internal Medicine, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Hendawy Zidan
- Department of Internal Medicine, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Mohammed Abo-Ghebsha
- Department of Clinical Pathology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Amir Abdelghaffar
- Department of Neurology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Ahmed Essmat
- Department of Neurology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Essam Elmahdi
- Department of Internal Medicine, Faculty of Medicine, Mansoura University, Mansoura, Egypt
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11
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Walczak K, Sieminska L. Obesity and Thyroid Axis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18189434. [PMID: 34574358 PMCID: PMC8467528 DOI: 10.3390/ijerph18189434] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 08/28/2021] [Accepted: 09/03/2021] [Indexed: 12/19/2022]
Abstract
Development of obesity is primarily the result of imbalance between energy intake and energy expenditure. Thyroid hormones influence energy expenditure by regulating cellular respiration and thermogenesis and by determining resting metabolic rate. Triiodothyronine influences lipid turnover in adipocytes and impacts appetite regulation through the central nervous system, mainly the hypothalamus. Thyroid-stimulating hormone may also influence thermogenesis, suppress appetite and regulate lipid storage through lipolysis and lipogenesis control. Subclinical hypothyroidism may induce changes in basal metabolic rate with subsequent increase in BMI, but obesity can also affect thyroid function via several mechanisms such as lipotoxicity and changes in adipokines and inflammatory cytokine secretion. The present study investigated the complex and mutual relationships between the thyroid axis and adiposity.
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Affiliation(s)
- Krzysztof Walczak
- Department of Thoracic Surgery, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, 41-800 Zabrze, Poland;
| | - Lucyna Sieminska
- Department of Pathophysiology and Endocrinology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, 41-800 Zabrze, Poland
- Correspondence:
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12
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Lambrechts MJ, Maryan K, Whitman W, Yen TC, Li J, Leary EV, Cook JL, Choma TJ. Comorbidities associated with cervical spine degenerative disc disease. J Orthop 2021; 26:98-102. [PMID: 34341630 DOI: 10.1016/j.jor.2021.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 07/11/2021] [Indexed: 10/20/2022] Open
Abstract
Determining important links between medical comorbidities and cervical spine degenerative disc disease (DDD) will help elucidate pathomechanisms of disc degeneration. Electronic medical records and magnetic resonance imaging were retrospectively reviewed to evaluate 799 patients assessed for cervical spine pathology. Bivariate analysis identified older age, diabetes, ASA class, cancer, COPD, depression, hypertension, hypothyroidism, Medicare status, peripheral vascular disease, history of previous cervical spine surgery, smoking, and lower median household income as having strong associations with increased cumulative grade of cervical spine DDD. This study provides evidence suggesting aging and accumulation of medical comorbidities influence severity of cervical spine DDD.
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Affiliation(s)
- Mark J Lambrechts
- Department of Orthopaedic Surgery, University of Missouri, Columbia, MO, USA
| | - Kyle Maryan
- University of Missouri School of Medicine, Columbia, MO, USA
| | - Wyatt Whitman
- University of Missouri School of Medicine, Columbia, MO, USA
| | - Tzu-Chuan Yen
- Department of Orthopaedic Surgery, University of Missouri, Columbia, MO, USA
| | - Jinpu Li
- Department of Orthopaedic Surgery, University of Missouri, Columbia, MO, USA
| | - Emily V Leary
- Department of Orthopaedic Surgery, University of Missouri, Columbia, MO, USA.,Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, MO, USA
| | - James L Cook
- Department of Orthopaedic Surgery, University of Missouri, Columbia, MO, USA.,Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, MO, USA
| | - Theodore J Choma
- Department of Orthopaedic Surgery, University of Missouri, Columbia, MO, USA.,Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, MO, USA
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13
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Bisaria S, Terrigno V, Hunter K, Roy S. Association of Elevated Levels of Inflammatory Marker High-Sensitivity C-Reactive Protein and Hypertension. J Prim Care Community Health 2020; 11:2150132720984426. [PMID: 33356789 PMCID: PMC7768830 DOI: 10.1177/2150132720984426] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Introduction The correlation between inflammation and vascular disease is widely accepted. High levels of C-reactive protein (CRP) have been shown to play a role in the process of endothelial dysfunction. Hypertension is described as an inflammatory vascular disease, and is 1 of the most commonly encountered diseases in the outpatient setting. We studied the association between the elevated high sensitivity-CRP (hs-CRP) level and hypertension, as well as other comorbid conditions. Methods Electronic medical records of 169 adult patients in our internal medicine office were reviewed for hs-CRP levels, and divided into 2 groups: elevated hs-CRP (≥2 mg/L; n = 110) and normal hs-CRP (<2 mg/L; n = 59). Independent T-Test was used to compare the means of continuous variables between the groups if they were normally distributed. Mann Whitney U-Test was used to compare the continuous variables that were non-parametric. Logistic regression was used to compare the dependent and independent variables. Results Among subjects with elevated hs-CRP, 58.2% had hypertension while 47.5% of subjects with normal hs-CRP levels had hypertension (P = .182). There were higher frequencies of association of coronary artery disease (CAD), cerebrovascular disease and hypothyroidism in elevated hs-CRP group but the differences were not statistically significant. Mean white blood cell count was statistically higher in elevated hs-CRP group (P < .05), while alcohol use was significantly higher (P < .05) and statin use was higher in the normal hs-CRP group. There was an inverse relationship between HDL-C and hs-CRP. Conclusions There was no statistically significant correlation between hs-CRP level and hypertension. Hs-CRP has statistically significant associations between alcohol use, dementia, white blood cell count, and HDL levels. Promising but not statistically significant correlations were observed between hs-CRP and statin therapy, hypothyroidism, coronary artery disease, and cerebrovascular disease.
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Affiliation(s)
- Sharmila Bisaria
- Cooper Medical School of Rowan University, Cooper University Health Care, Department of Medicine, Camden, New Jersey, USA
| | - Vittorio Terrigno
- Cooper Medical School of Rowan University, Cooper University Health Care, Department of Medicine, Camden, New Jersey, USA
| | - Krystal Hunter
- Cooper Research Institute, Cooper Medical School of Rowan University, Camden, New Jersey, USA
| | - Satyajeet Roy
- Cooper Medical School of Rowan University, Cooper University Health Care, Department of Medicine, Camden, New Jersey, USA
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14
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Stojković M, Žarković M. Subclinical Thyroid Dysfunction and the Risk of Cardiovascular Disease. Curr Pharm Des 2020; 26:5617-5627. [PMID: 33213317 DOI: 10.2174/1381612826666201118094747] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 08/19/2020] [Indexed: 01/07/2023]
Abstract
The prevalence of subclinical hypothyroidism (SH) is 3-10%. The prevalence of subclinical hyperthyroidism (SHr) is 0.7-9.7%. Thyroid hormones affect cardiac electrophysiology, contractility, and vasculature. SH is associated with an increased risk of coronary heart disease (CHD), especially in subjects under 65. SHr seems to be associated with a slightly increased risk of CHD and an increase in CHD-related mortality. Both SH and SHr carry an increased risk of developing heart failure (HF), especially in those under 65. Both SH and SHr are associated with worse prognoses in patients with existing HF. SH is probably not associated with atrial fibrillation (AF). SHr, low normal thyroid-stimulating hormone (TSH) and high normal free thyroxine (FT4) are all associated with the increased risk of AF. An association between endothelial dysfunction and SH seems to exist. Data regarding the influence of SHr on the peripheral vascular system are conflicting. SH is a risk factor for stroke in subjects under 65. SHr does not increase the risk of stroke. Both SH and SHr have an unfavourable effect on cardiovascular disease (CVD) and all-cause mortality. There is a U-shaped curve of mortality in relation to TSH concentrations. A major factor that modifies the relation between subclinical thyroid disease (SCTD) and mortality is age. SH increases blood pressure (BP). SHr has no significant effect on BP. Lipids are increased in patients with SH. In SHr, high-density lipoprotein cholesterol and lipoprotein( a) are increased. SCTD should be treated when TSH is over 10 mU/l or under 0.1 mU/l. Treatment indications are less clear when TSH is between normal limits and 0.1 or 10 mU/L. The current state of knowledge supports the understanding of SCTD's role as a risk factor for CVD development. Age is a significant confounding factor, probably due to age-associated changes in the TSH reference levels.
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15
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Renati S, Stone DK, Almeida L, Wilson CA. Predictors of Atrial Fibrillation in Patients With Cryptogenic Stroke. Neurohospitalist 2019; 9:127-132. [PMID: 31244968 DOI: 10.1177/1941874418819619] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Background and Purpose Many patients diagnosed with cryptogenic stroke or transient ischemic attack are subsequently found to have atrial fibrillation (AF) on outpatient cardiac telemetry monitoring. Identification of predictive factors for the detection of AF could assist with patient selection to increase the yield of telemetry and hasten initiation of appropriate secondary stroke prevention. Methods This was a retrospective cross-sectional study of patients diagnosed with cryptogenic stroke at a comprehensive stroke center and referred for at least 21 days of prolonged outpatient telemetry. Telemetry reports and data from the patient's stroke hospitalization, including imaging studies, electrocardiogram (EKG), echocardiogram, vital signs, and laboratory data, were reviewed. Results Ten percent of the 121 patients included in the study were diagnosed with AF based on outpatient telemetry. There was a strong association between presence of premature atrial contractions (PACs) on admission EKG and subsequent detection of AF (P = .004). Large left atrial diameter on echocardiogram was correlated with AF detection in males (P = .024). However, there was no association between AF and other echocardiographic measurements. Thyroid-stimulating hormone (TSH) levels were significantly higher in patients with cryptogenic stroke having AF (P = .008), with a TSH greater than 4.20 mIU/L predictive of detection of AF (P < .001). Conclusions Atrial fibrillation was found by outpatient monitoring in a notable percentage of patients with cryptogenic stroke. Predictors of occult AF in our study population included PACs and higher TSH levels. Although an association between low TSH and AF has been well established, our results suggest that high TSH may be a predictive factor as well.
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Affiliation(s)
- Swetha Renati
- Department of Neurology, University of South Florida, Tampa, FL, USA
| | - David K Stone
- Department of Neurology, University of Florida, Gainesville, FL, USA
| | - Leonardo Almeida
- Department of Neurology, University of Florida, Gainesville, FL, USA
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16
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Bielecka-Dabrowa A, Godoy B, Suzuki T, Banach M, von Haehling S. Subclinical hypothyroidism and the development of heart failure: an overview of risk and effects on cardiac function. Clin Res Cardiol 2018; 108:225-233. [PMID: 30091084 DOI: 10.1007/s00392-018-1340-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 07/18/2018] [Indexed: 01/07/2023]
Abstract
The prevalence of subclinical hypothyroidism (SCH) ranges from 5 to 15% of the general population. However, it remains controversial if SCH warrants life-long thyroxine replacement therapy. Patients with a thyroid-stimulating hormone (TSH) level > 10 mIU/L have a higher risk of developing heart failure with reduced ejection fraction as compared to subjects with normal thyroid function. However, abnormally high TSH levels could also be connected with an overall lower metabolic rate and better survival in elderly subjects. The potential mechanisms responsible for diastolic dysfunction of the left ventricle (LV) in SCH are connected with endothelial dysfunction and arterial stiffness, inflammatory state and are driven by TSH apoptosis-derived microparticles. The impact of SCH on LV systolic function is more controversial, and it is connected not only with cardiac remodelling but also with predisposition of patients with SCH to the conditions leading to heart failure. This review presents an overview of processes in the context of potential benefits of thyroxine supplementation therapy.
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Affiliation(s)
- Agata Bielecka-Dabrowa
- Department of Hypertension, Chair of Nephrology and Hypertension, Medical University of Lodz (UMED), Lodz, Poland.,Department of Cardiology and Congenital Diseases of Adults, Polish Mother's Memorial Hospital Research Institute (ICZMP), Lodz, Poland
| | - Breno Godoy
- Department of Cardiology and Pneumology, University Medical Centre Goettingen (UMG), Georg-August-University, Robert-Koch-Strasse 40, 37075, Goettingen, Germany
| | - Tsuyoshi Suzuki
- Department of Cardiology and Pneumology, University Medical Centre Goettingen (UMG), Georg-August-University, Robert-Koch-Strasse 40, 37075, Goettingen, Germany.,Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Maciej Banach
- Department of Hypertension, Chair of Nephrology and Hypertension, Medical University of Lodz (UMED), Lodz, Poland
| | - Stephan von Haehling
- Department of Cardiology and Pneumology, University Medical Centre Goettingen (UMG), Georg-August-University, Robert-Koch-Strasse 40, 37075, Goettingen, Germany.
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17
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Khan SH, Manzoor SM, Niazi NK, Asif N, Ijaz A, Fazal N. Association of metabolic risks with subclinical hypothyroidism: A cross-sectional analysis. Pak J Med Sci 2018; 34:357-362. [PMID: 29805408 PMCID: PMC5954379 DOI: 10.12669/pjms.342.13873] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Objective: To compare lipid parameters, HbA1c, uric acid and albumin creatinine ratio (UACR) among subjects having euthyroidism, Sub-Clinical Hypothyroidism (SCH) and overt hypothyroidism. Methods: This comparative cross-sectional analysis was carried out from Dec-2015 to Oct-2016 in collaboration between PNS HAFEEZ hospital and department of chemical pathology and endocrinology, Armed Forces Institute of Pathology, Rawalpindi. Biochemical parameters including lipid indices, HbA1c and UACR were compared between euthyroidism (TSH: 0.5 to 4.0 mIU/L, n=163), subclinical hypothyroidism (TSH: 4.0 to 10 mIU/L, n=16) and overt hypothyroidism (TSH:≥ 10.0 mIU/L, n=9). Results: LDL-cholesterol, non-HDL-cholesterol and UACR results were as: [(Euthyroid: 2.66 ± 0.73), (SCH: 2.68 ± 0.51) and (Overt hypothyroidism: 3.23 ± 0.59), p-value=0.063], [(Euthyroid: 3.49 ± 0.64), (SCH: 3.35 ± 0.59) and (Overt hypothyroidism: 4.01 ± 0.30), p-value=0.033] and [{Euthyroid: 2.48 (95% CI: 1.63-3.33)}, {SCH: 2.27 (95% CI: 0.37-4.90)} and {Overt hypothyroidism: 14.95 (95% CI: 10.71-19.14){, (p-value< 0.001)] Results for total cholesterol, triglycerides and HDL-cholesterol though increased in overt hypothyroid group were not found to be statistically significant. Conclusion: LDL-cholesterol, non-HDL-cholesterol and UACR increased from euthyroid subjects to overt hypothyroidism group. However, these changes were found to be more subtle in the subclinical hypothyroid subjects than cases with overt hypothyroidism.
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Affiliation(s)
- Sikandar Hayat Khan
- Dr. Sikandar Hayat Khan, (FCPS Chemical Pathology). Department of Pathology, PNS Hafeez Hospital, Pakistan
| | - Syed Mohsin Manzoor
- Dr. Syed Mohsin Manzoor, (FCPS Chemical Pathology). Department of Pathology, PNS Hafeez Hospital, Pakistan
| | - Najumusaquib Khan Niazi
- Najmusaqib Khan Niazi:, (M.Sc. Healthcare Administration). Healthcare Administration, PNS Hafeez Hospital, Pakistan
| | - Naveed Asif
- Dr. Naveed Asif (FCPS Chemical Pathology). Department of Chemical Pathology & Clinical Endocrinology, Armed Forces Institute of Pathology (AFIP), Rawalpindi, Pakistan
| | - Aamir Ijaz
- Dr. Aamir Ijaz, (MCPS, FCPS (Chemical Pathology), FRCP, MCPS HPE). Department of Chemical Pathology & Clinical Endocrinology, Armed Forces Institute of Pathology (AFIP), Rawalpindi, Pakistan
| | - Nadeem Fazal
- Dr. Nadeem Fazal (FCPS Med), Department of Medicine, PNS Hafeez Hospital, Pakistan
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18
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Nair SN, Kumar H, Raveendran M, Menon VU. Subclinical Hypothyroidism and Cardiac Risk: Lessons from a South Indian Population Study. Indian J Endocrinol Metab 2018; 22:217-222. [PMID: 29911035 PMCID: PMC5972478 DOI: 10.4103/ijem.ijem_298_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION The benefits of treating subclinical hypothyroidism are currently under debate, prevention of adverse cardiac events purporting to be one of the main benefits. The effect of subclinical hypothyroidism on the cardiovascular health of the Indian sub-population is largely unknown. This study was designed to examine these effects and to help guide treatment of this disorder. METHODS A cross-sectional adult population survey was carried out in urban coastal area of central Kerala. 986 volunteers underwent complete biochemical and physical examinations, 110 were found to have subclinical hypothyroidism (8.9%). The ten-year risk of an adverse cardiac event, was calculated using the Framingham score algorithm. Eligible subclinical hypothyroid subjects (N = 110) and a randomly selected, age and gender matched control group (N = 220) were compared. RESULTS This population was found to have high baseline levels of diabetes 19.5%, hypercholesterolemia 57.2% and systolic hypertension 24.6%. No association was found between subclinical hypothyroid status or rising TSH and Framingham 10-year risk. While no difference between groups was noted with respect to lipid profile, a rising TSH was found to be significantly correlated with mild worsening of the lipid profile. A significant positive correlation was found between skinfold thickness and TSH. CONCLUSIONS Subclinical hypothyroidism is not a contributing factor to elevated Framingham risk in this population, and while a mild effect was observed on the lipid profile, its effect is unlikely to be clinically relevant. We hypothesize that in this population a genetic component may be responsible for the uniquely high rates of metabolic syndrome and other endocrine diseases.
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Affiliation(s)
- Sashi Niranjan Nair
- Department of Endocrinology, Amrita School of Medicine, Amrita University, Kochi, Kerala, India
- Department of Endocrinology, Amrita Institute of Medical Sciences, Amrita University, Kochi, Kerala, India
| | - Harish Kumar
- Department of Endocrinology, Amrita Institute of Medical Sciences, Amrita University, Kochi, Kerala, India
| | - Manoj Raveendran
- Department of Clinical Research, Amrita Institute of Medical Sciences, Amrita University, Kochi, Kerala, India
| | - V. Usha Menon
- Department of Endocrinology, Amrita Institute of Medical Sciences, Amrita University, Kochi, Kerala, India
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Johns LE, Ferguson KK, McElrath TF, Mukherjee B, Seely EW, Meeker JD. Longitudinal Profiles of Thyroid Hormone Parameters in Pregnancy and Associations with Preterm Birth. PLoS One 2017; 12:e0169542. [PMID: 28060899 PMCID: PMC5217954 DOI: 10.1371/journal.pone.0169542] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 12/18/2016] [Indexed: 01/07/2023] Open
Abstract
Introduction Overt thyroid disease in pregnancy is associated with numerous maternal and neonatal complications including preterm birth. Less is known about the contribution of trimester-specific subclinical alterations in individual thyroid hormones, especially in late gestation, on the risk of preterm birth. Herein, we examined the associations between subclinical changes in maternal thyroid hormone concentrations (TSH, total T3, free and total T4), measured at multiple time points in pregnancy, and the odds of preterm birth in pregnant women without clinical thyroid disease. Participants and Methods Data were obtained from pregnant women participating in a nested case-control study of preterm birth within on ongoing birth cohort study at Brigham and Women’s Hospital in Boston, MA (N = 439; 116 cases and 323 controls). We measured thyroid hormones in plasma collected at up to four time points in pregnancy (median = 10, 18, 26, and 35 weeks). We used multivariate logistic regression models stratified by study visit of sample collection to examine associations. To reveal potential biological pathways, we also explored these relationships by obstetric presentation of preterm birth (e.g., spontaneous preterm delivery) that have been previously hypothesized to share common underlying mechanisms. Results In samples collected at median 10 and 26 weeks of gestation, we found inverse associations between FT4 and the odds of overall preterm birth (odds ratio [OR] = 0.57, 95% confidence interval (CI) = 0.33, 1.00; and OR = 0.53, 95% CI = 0.34, 0.84, respectively). Positive associations were detected for total T3 at these same time points (OR = 2.52, 95% CI = 1.20, 5.31; and OR = 3.40, 95% CI = 1.56, 7.40, respectively). These effect estimates were stronger for spontaneous preterm birth. Conclusions Our results suggest that subclinical alterations in individual maternal thyroid hormones may influence the risk of preterm birth, and the strength of these associations vary by gestational age.
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Affiliation(s)
- Lauren E. Johns
- Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, Michigan, United States
| | - Kelly K. Ferguson
- Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, Michigan, United States
- Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, NC, United States
| | - Thomas F. McElrath
- Division of Maternal and Fetal Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
| | - Bhramar Mukherjee
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI, United States
| | - Ellen W. Seely
- Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
| | - John D. Meeker
- Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, Michigan, United States
- * E-mail:
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