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Horm Metab Res 2017; 49(03): 192-200
DOI: 10.1055/s-0042-117279
Endocrine Care
© Georg Thieme Verlag KG Stuttgart · New York

Thyroid Function and Metabolic Syndrome: A Population-Based Thyroid Study

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
,
Parnian Kheirkhah Rahimabad
1   Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, I. R. Iran
,
Maryam Tohidi
2   Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, I. R. Iran
,
Zhale Tahmasebinejad
1   Endocrine 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
› Author Affiliations
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Publication History

Publication Date:
28 March 2017 (online)

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Abstract

The impact of thyroid dysfunction in subclinical ranges on metabolic syndrome (MetS) is not well known. The aim of the present study is to evaluate the association of thyroid dysfunction with MetS and its components. In the cross-sectional population-based Tehran Thyroid Study, out of 5 786 randomly selected participants, aged≥20 years, subjects with thyroid nodules and cancer or any severe systemic disease, those who were pregnant and those using thyroid medication were excluded, leaving 5 422 subjects to be investigated. Body weight, waist circumference, and blood pressure were measured. Fasting blood glucose and concentrations of lipids and lipoproteins, free T4, and TSH were assayed. Mean age of the participants was 40.3±14.4 of whom 101 (2%) had overt hypothyroidism, 294 (5%) subclinical hypothyroidism, 82 (2%) overt hyperthyroidism, and 178 (3%) had subclinical hyperthyroidism; 1 704 (32%) had MetS. Clinically hypothyroid subjects had the highest prevalence of MetS (41.6%), abdominal obesity (45%), and hypertriglyceridemia (58%) compared to other groups (p<0.05). Significant odds ratio for prevalent MetS was observed only in clinically hypothyroid men [OR: 2.9, 95% CI: 1.04, 8.4, p=0.04]. In women, the association between overt hypothyroidism and MetS was marginally significant only in the crude model [OR: 0.068, 95% CI (0.97–2.42), p=0.06]. There was higher risk of Mets in subclinically hypothyroid subjects, aged>50. Overt and subclinical hyperthyroidism had significantly higher odds of hyperglycemia in men and women after full adjustment for age, smoking, and BMI. Overt hypothyroidism and subclinical hypothyroidism especially in the elderly could be associated with MetS. Hyperthyroidism may induce hyperglycemia.

Key words

metabolic syndrome - thyroid - hypothyroidism - hyperthyroidism

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  • References

  • 1 Liu YY, Brent GA. Thyroid hormone crosstalk with nuclear receptor signaling in metabolic regulation. Trends Endocrinol Metab 2010; 21: 166-173
    CrossrefPubMedGoogle Scholar
  • 2 Eckel RH, Grundy SM, Zimmet PZ. The metabolic syndrome. Lancet 2005; 365: 1415-1428
    CrossrefPubMedGoogle Scholar
  • 3 Ferrannini E, Haffner SM, Mitchell BD, Stern MP. Hyperinsulinaemia: the key feature of a cardiovascular and metabolic syndrome. Diabetologia 1991; 34: 416-422
    CrossrefPubMedGoogle Scholar
  • 4 Dimitriadis G, Baker B, Marsh H, Mandarino L, Rizza R, Bergman R. et al. Effect of thyroid hormone excess on action, secretion, and metabolism of insulin in humans. Am J Physiol 1985; 248 5 Pt 1 E593-E601
    PubMedGoogle Scholar
  • 5 Dimitriadis G, Mitrou P, Lambadiari V, Boutati E, Maratou E, Panagiotakos DB. et al. Insulin action in adipose tissue and muscle in hypothyroidism. J Clin Endocrinol Metab 2006; 91: 4930-4937
    CrossrefPubMedGoogle Scholar
  • 6 Iwen KA, Schroder E. Brabant G. Thyroid hormones and the metabolic syndrome. Eur Thyroid J 2013; 2: 83-92
    CrossrefPubMedGoogle Scholar
  • 7 Waring AC, Rodondi N, Harrison S, Kanaya AM, Simonsick EM, Miljkovic I. et al. Thyroid function and prevalent and incident metabolic syndrome in older adults: the Health, Ageing and Body Composition Study. Clin Endocrinol (Oxf) 2012; 76: 911-918
    CrossrefPubMedGoogle Scholar
  • 8 Ford ES. Risks for all-cause mortality, cardiovascular disease, and diabetes associated with the metabolic syndrome: a summary of the evidence. Diabetes Care 2005; 28: 1769-1778
    CrossrefPubMedGoogle Scholar
  • 9 Thvilum M, Brandt F, Almind D, Christensen K, Hegedus L, Brix TH. Excess mortality in patients diagnosed with hypothyroidism: a nationwide cohort study of singletons and twins. J Clin Endocrinol Metab 2013; 98: 1069-1075
    CrossrefPubMedGoogle Scholar
  • 10 Azizi F, Amouzegar A, Delshad H, Tohidi M, Mehran L, Mehrabi Y. Natural course of thyroid disease profile in a population in nutrition transition: Tehran Thyroid Study. Arch Iran Med 2013; 16: 418-423
    PubMedGoogle Scholar
  • 11 Azizi F, Ghanbarian A, Momenan AA, Hadaegh F, Mirmiran P, Hedayati M. et al. Prevention of non-communicable disease in a population in nutrition transition: Tehran Lipid and Glucose Study phase II. Trials 2009; 10: 5
    CrossrefPubMedGoogle Scholar
  • 12 Delshad H, Amouzegar A, Mirmiran P, Mehran L, Azizi F. Eighteen years of continuously sustained elimination of iodine deficiency in the Islamic Republic of Iran: the vitality of periodic monitoring. Thyroid 22: 415-421
    PubMedGoogle Scholar
  • 13 Amouzegar A, Delshad H, Mehran L, Tohidi M, Khafaji F, Azizi D. Reference limit of Thyrotropin (TSH) and free Thyroxine (FT4) in thyroperoxidase positive and negative subjects: a population based study. J Endocrinol Invest 2013; 36: 950-954
    PubMedGoogle Scholar
  • 14 Alberti KG, Eckel RH, Grundy SM, Zimmet PZ, Cleeman JI, Donato KA. et al. Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation 2009; 120: 1640-1645
    CrossrefPubMedGoogle Scholar
  • 15 Azizi F, Khalili D, Aghajani H, Esteghamati A, Hosseinpanah F, Delavari A. et al. Appropriate waist circumference cut-off points among Iranian adults: the first report of the Iranian National Committee of Obesity. Arch Iran Med 2010; 13: 243-244
    PubMedGoogle Scholar
  • 16 Duntas LH. Thyroid disease and lipids. Thyroid 2002; 12: 287-293
    PubMedGoogle Scholar
  • 17 Zhu X, Cheng SY. New insights into regulation of lipid metabolism by thyroid hormone. Curr Opin Endocrinol Diabetes Obes 2010; 17: 408-413
    CrossrefPubMedGoogle Scholar
  • 18 Abrams JJ, Grundy SM, Ginsberg H. Metabolism of plasma triglycerides in hypothyroidism and hyperthyroidism in man. J Lipid Res 1981; 22: 307-322
    PubMedGoogle Scholar
  • 19 Lam KS, Chan MK, Yeung RT. High-density lipoprotein cholesterol, hepatic lipase and lipoprotein lipase activities in thyroid dysfunction–effects of treatment. Q J Med 1986; 59: 513-521
    PubMedGoogle Scholar
  • 20 Tancevski I, Wehinger A, Demetz E, Eller P, Duwensee K, Huber J. et al. Reduced plasma high-density lipoprotein cholesterol in hyperthyroid mice coincides with decreased hepatic adenosine 5′-triphosphate-binding cassette transporter 1 expression. Endocrinology 2008; 149: 3708-3712
    CrossrefPubMedGoogle Scholar
  • 21 Maratou E, Hadjidakis DJ, Peppa M, Alevizaki M, Tsegka K, Lambadiari V. et al. Studies of insulin resistance in patients with clinical and subclinical hyperthyroidism. Eur J Endocrinol 2010; 163: 625-630
    CrossrefPubMedGoogle Scholar
  • 22 Santi A, Duarte MM, Moresco RN, Menezes C, Bagatini MD, Schetinger MR. et al. Association between thyroid hormones, lipids and oxidative stress biomarkers in overt hypothyroidism. Clin Chem Lab Med 2010; 48: 1635-1639
    PubMedGoogle Scholar
  • 23 Yavuz DG, Yuksel M, Deyneli O, Ozen Y, Aydin H, Akalin S. Association of serum paraoxonase activity with insulin sensitivity and oxidative stress in hyperthyroid and TSH-suppressed nodular goitre patients. Clin Endocrinol (Oxf) 2004; 61: 515-521
    CrossrefPubMedGoogle Scholar
  • 24 de Moura Souza A, Sichieri R. Association between serum TSH concentration within the normal range and adiposity. Eur J Endocrinol 2011; 165: 11-15
    CrossrefPubMedGoogle Scholar
  • 25 Lee YK, Kim JE, Oh HJ, Park KS, Kim SK, Park SW. et al. Serum TSH level in healthy Koreans and the association of TSH with serum lipid concentration and metabolic syndrome. Korean J Intern Med 2011; 26: 432-439
    CrossrefPubMedGoogle Scholar
  • 26 Kitahara CM, Platz EA, Ladenson PW, Mondul AM, Menke A. Berrington de Gonzalez A. Body fatness and markers of thyroid function among U.S. men and women. PLoS One 2012; 7: e34979
    CrossrefPubMedGoogle Scholar
  • 27 Reinehr T, Isa A, de Sousa G, Dieffenbach R, Andler W. Thyroid hormones and their relation to weight status. Horm Res 2008; 70: 51-57
    CrossrefPubMedGoogle Scholar
  • 28 Welt CK, Chan JL, Bullen J, Murphy R, Smith P, DePaoli AM. et al. Recombinant human leptin in women with hypothalamic amenorrhea. N Engl J Med 2004; 351: 987-997
    CrossrefPubMedGoogle Scholar
  • 29 Muscogiuri G, Sorice GP, Mezza T, Prioletta A, Lassandro AP, Pirronti T. et al. High-normal TSH values in obesity: is it insulin resistance or adipose tissue’s guilt?. Obesity (Silver Spring) 2013; 21: 101-106
    CrossrefPubMedGoogle Scholar
  • 30 Jenkins RC, Valcavi R, Zini M, Frasoldati A, Heller SR, Camacho-Hubner C. et al. Association of elevated insulin-like growth factor binding protein-1 with insulin resistance in hyperthyroidism. Clin Endocrinol (Oxf) 2000; 52: 187-195
    CrossrefPubMedGoogle Scholar
  • 31 Visser WE, Heemstra KA, Swagemakers SM, Ozgur Z, Corssmit EP, Burggraaf J. et al. Physiological thyroid hormone levels regulate numerous skeletal muscle transcripts. J Clin Endocrinol Metab 2009; 94: 3487-3496
    CrossrefPubMedGoogle Scholar
  • 32 Dimitriadis G, Maratou E, Alevizaki M, Boutati E, Psara K, Papasteriades C. et al. Thyroid hormone excess increases basal and insulin-stimulated recruitment of GLUT3 glucose transporters on cell surface. Horm Metab Res 2005; 37: 15-20
    Article in Thieme ConnectPubMedGoogle Scholar
  • 33 Stanicka S, Vondra K, Pelikanova T, Vlcek P, Hill M, Zamrazil V. Insulin sensitivity and counter-regulatory hormones in hypothyroidism and during thyroid hormone replacement therapy. Clin Chem Lab Med 2005; 43: 715-720
    PubMedGoogle Scholar
  • 34 Guyton AC. The relationship of cardiac output and arterial pressure control. Circulation 1981; 64: 1079-1088
    CrossrefPubMedGoogle Scholar
  • 35 Coulombe P, Dussault JH, Walker P. Plasma catecholamine concentrations in hyperthyroidism and hypothyroidism. Metab Clin Exp 1976; 25: 973-979
    CrossrefPubMedGoogle Scholar
  • 36 Feek CM, Sawers JS, Brown NS, Seth J, Irvine WJ, Toft AD. Influence of thyroid status on dopaminergic inhibition of thyrotropin and prolactin secretion: evidence for an additional feedback mechanism in the control of thyroid hormone secretion. J Clin Endocrinol Metab 1980; 51: 585-589
    CrossrefPubMedGoogle Scholar
  • 37 Ittermann T, Thamm M, Wallaschofski H, Rettig R, Volzke H. Serum thyroid-stimulating hormone levels are associated with blood pressure in children and adolescents. J Clin Endocrinol Metab 2012; 97: 828-834
    CrossrefPubMedGoogle Scholar
  • 38 Geer EB, Shen W. Gender differences in insulin resistance, body composition, and energy balance. Gend Med 2009; 6 (Suppl. 01) 60-75
    CrossrefPubMedGoogle Scholar
  • 39 Amouzegar A, Kazemian E, Gharibzadeh S, Mehran L, Tohidi M, Azizi F. Association between thyroid hormones, thyroid antibodies and insulin resistance in euthyroid individuals: A population-based cohort. Diabetes Metab 2015; 41: 480-488
    CrossrefPubMedGoogle Scholar
  • 40 Lear SA, Chen MM, Birmingham CL, Frohlich JJ. The relationship between simple anthropometric indices and C-reactive protein: ethnic and gender differences. Metabolism 2003; 52: 1542-1546
    CrossrefPubMedGoogle Scholar
  • 41 Rossi IA, Bochud M, Bovet P, Paccaud F, Waeber G, Vollenweider P. et al. Sex difference and the role of leptin in the association between high-sensitivity C-reactive protein and adiposity in two different populations. Eur J Epidemiol 2012; 27: 379-384
    CrossrefPubMedGoogle Scholar
  • 42 Oh JY, Sung YA, Lee HJ. Elevated thyroid stimulating hormone levels are associated with metabolic syndrome in euthyroid young women. Korean J Intern Med 2013; 28: 180-186
    CrossrefPubMedGoogle Scholar
  • 43 Heima NE, Eekhoff EM, Oosterwerff MM, Lips PT, van Schoor NM, Simsek S. Thyroid function and the metabolic syndrome in older persons: a population-based study. Eur J Endocrinol 2013; 168: 59-65
    PubMedGoogle Scholar
  • 44 Lai Y, Wang J, Jiang F, Wang B, Chen Y, Li M. et al. The relationship between serum thyrotropin and components of metabolic syndrome. Endocr J 2011; 58: 23-30
    CrossrefPubMedGoogle Scholar
  • 45 Wang CY, Chang TC, Chen MF. Associations between subclinical thyroid disease and metabolic syndrome. Endocr J 2012; 59: 911-917
    CrossrefPubMedGoogle Scholar
  • 46 Garduno-Garcia Jde J, Alvirde-Garcia U, Lopez-Carrasco G, Padilla Mendoza ME, Mehta R, Arellano-Campos O. et al. TSH and free thyroxine concentrations are associated with differing metabolic markers in euthyroid subjects. Eur J Endocrinol 2010; 163: 273-278
    CrossrefPubMedGoogle Scholar
  • 47 van de Ven AC, Netea-Maier RT, Medici M, Sweep FC, Ross HA, Hofman A. et al. Underestimation of effect of thyroid function parameters on morbidity and mortality due to intra-individual variation. J Clin Endocrinol Metab 2011; 96: E2014-E2017
    CrossrefPubMedGoogle Scholar