The relationship between thyroid hormone levels, insulin resistance and body mass index, in patients with subclinical hypothyroidism and euthyroid patients

Authors

DOI:

https://doi.org/10.22141/2224-0721.18.1.2022.1144

Keywords:

subclinical hypothyroidism, thyroid hormone levels, insulin resistance, body mass index

Abstract

Background. Hypothyroidism is a common thyroid disorder with female predominance. In general population its prevalance is 2–5 % while 10 times higher in female than in men. Insulin resistance, one of the most discussed issues recently, is an inadequate response to insulin in peripheral tissues despite the normal secretory function of pancreatic islet cells. In this study, we analyzed relationship between thyroid hormone levels, body mass index and insulin resistance calculated with Homeostatic Model Assessment for Insulin Resistance (HOMA-IR), Quantitative Insulin Sensitivity Check Index (QUICKI) and Atherogenic Index of Plasma (AIP) in SCH and euthyroid patients under levothyroxine treatment. Materials and methods. The clinical and laboratory data of approximately 14 000 patients between the ages of 18–60 were retrospectively evaluated. After these exclusion criteria were applied, 371 eligible individuals were included in the study. All 371 individuals divided into three groups according to TSH levels. Group 1 is eutyhroid patients under levothyroxine treatment with TSH levels between 0.27–4.2 μIU/mL. Group 2 is subclinical hypothyroid patients with TSH levels between 4.2–10 μIU/mL. Group 3 is healthy control group with TSH levels between 0.27–4.2 μIU/mL. Results. The euthyroid patient group has the highest (25.66 ± 3.36 kg/m2) mean BMI. On the other hand the mean BMI was higher in SCH (24.0400 ± 3.8436 kg/m2) group than in control group (22.48 ± 2.74 kg/m2) (p < 0.05). Fasting plasma glucose (FPG), serum triglyserid, low density lipoprotein (LDL), anti-thyroid peroxidase (TPO) and insulin levels were significantly higher in euthyroid patient and SCH groups (p < 0.05). Notably, total cholesterol, LDL and TPO levels were higher in euthyroid patient group (p < 0.05). On the other hand, there were no difference between euthyroid patients and SCH group. Conclusions. This study found significantly elevated insulin resistance and cholesterol levels in SCH patients, so we hypothesized that SCH is also a risk factor for insulin resistance disorders such as cardiovascular diseases and metabolic syndrome. As a consequence, lipid metabolism defects and insulin resistance should be screened and treated in SCH patients. Thanks to the strong and significant correlation between HOMA and QUICKI in our study, we suggest the combined use of HOMA and QUICKI in these patients. Further and large-scale studies are needed to evaluate the relationship of HOMA, QUICKI, AIP, and BMI in detecting insulin resistance in SCH patients.

Downloads

Download data is not yet available.

References

Parretti H, Okosieme O, Vanderpump M. Current recommendations in the management of hypothyroidism: developed from a statement by the British Thyroid Association Executive. Br J Gen Pract. 2016 Oct;66(651):538-40. doi: 10.3399/bjgp16X687493.

Bemben DA, Winn P, Hamm RM, Morgan L, Davis A, Barton E. Thyroid disease in the elderly. Part 1. Prevalence of undiagnosed hypothyroidism. J Fam Pract. 1994 Jun;38(6):577-82.

Pearce SH, Brabant G, Duntas LH, et al. 2013 ETA Guideline: Management of Subclinical Hypothyroidism. Eur Thyroid J. 2013 Dec;2(4):215-28. doi: 10.1159/000356507.

Moller DE, Flier JS. Insulin resistance--mechanisms, syndromes, and implications. N Engl J Med. 1991 Sep 26;325(13):938-48. doi: 10.1056/NEJM199109263251307.

Archer AE, Von Schulze AT, Geiger PC. Exercise, heat shock proteins and insulin resistance. Philos Trans R Soc Lond B Biol Sci. 2018 Jan 19;373(1738):20160529. doi: 10.1098/rstb.2016.0529.

Buchanan TA, Watanabe RM, Xiang AH. Limitations in surrogate measures of insulin resistance. J Clin Endocrinol Metab. 2010 Nov;95(11):4874-6. doi: 10.1210/jc.2010-2167.

Godini A, Ghasemi A, Zahediasl S. The Possible Mechanisms of the Impaired Insulin Secretion in Hypothyroid Rats. PLoS One. 2015 Jul 1;10(7):e0131198. doi: 10.1371/journal.pone.0131198.

Luna-Vazquez F, Cruz-Lumbreras R, Rodríguez-Castelán J, et al. Association between the serum concentration of triiodothyronine with components of metabolic syndrome, cardiovascular risk, and diet in euthyroid post-menopausal women without and with metabolic syndrome. Springerplus. 2014 May 24;3:266. doi: 10.1186/2193-1801-3-266.

Ortega E, Koska J, Pannacciulli N, Bunt JC, Krakoff J. Free triiodothyronine plasma concentrations are positively associated with insulin secretion in euthyroid individuals. Eur J Endocrinol. 2008 Feb;158(2):217-21. doi: 10.1530/EJE-07-0592.

Papadopoulou AM, Bakogiannis N, Skrapari I, Moris D, Bakoyiannis C. Thyroid Dysfunction and Atherosclerosis: A Systematic Review. In Vivo. 2020 Nov-Dec;34(6):3127-3136. doi: 10.21873/invivo.12147.

Chidakel A, Mentuccia D, Celi FS. Peripheral metabolism of thyroid hormone and glucose homeostasis. Thyroid. 2005 Aug;15(8):899-903. doi: 10.1089/thy.2005.15.899.

Hsu WH, Tseng CW, Huang YT, Liang CC, Lee MY, Chen SC. Common Risk Factors in Relatives and Spouses of Patients with Type 2 Diabetes in Developing Prediabetes. Healthcare (Basel). 2021 Aug 6;9(8):1010. doi: 10.3390/healthcare9081010.

Fernández-Macías JC, Ochoa-Martínez AC, Varela-Silva JA, Pérez-Maldonado IN. Atherogenic Index of Plasma: Novel Predictive Biomarker for Cardiovascular Illnesses. Arch Med Res. 2019 Jul;50(5):285-294. doi: 10.1016/j.arcmed.2019.08.009.

Weetman AP, McGregor AM. Autoimmune thyroid disease: further developments in our understanding. Endocr Rev. 1994 Dec;15(6):788-830. doi: 10.1210/edrv-15-6-788.

Owecki M, Nikisch E, Sowiński J. Hypothyroidism has no impact on insulin sensitivity assessed with HOMA-IR in totally thyroidectomized patients. Acta Clin Belg. 2006 Mar-Apr;61(2):69-73. doi: 10.1179/acb.2006.013.

Tuzcu A, Bahceci M, Gokalp D, Tuzun Y, Gunes K. Subclinical hypothyroidism may be associated with elevated high-sensitive c-reactive protein (low grade inflammation) and fasting hyperinsulinemia. Endocr J. 2005 Feb;52(1):89-94. doi: 10.1507/endocrj.52.89.

Sengupta S, Jaseem T, Ambalavanan J, Hegde A. Homeostatic Model Assessment-Insulin Resistance (HOMA-IR 2) in Mild Subclinical Hypothyroid Subjects. Indian J Clin Biochem. 2018 Apr;33(2):214-217. doi: 10.1007/s12291-017-0647-4.

Al Sayed A, Al Ali N, Bo Abbas Y, Alfadhli E. Subclinical hypothyroidism is associated with early insulin resistance in Kuwaiti women. Endocr J. 2006 Oct;53(5):653-7. doi: 10.1507/endocrj.k06-018.

Aksoy N, Yeler MT, Ayan NN, Ozkeskin A, Ozkan Z, Serin NO. Association between thyroid hormone levels and insulin resistance and body mass index. Pak J Med Sci. 2015 Nov-Dec;31(6):1417-20. doi: 10.12669/pjms.316.7560.

Doğan HO, Duman GD. Assessment of the relationship between insulin resistance, atherogenic index of plasma and white blood cell count: A data mining study. Cumhur Med J. 2017;39(2):479-486. doi: 10.7197/223.v39i29491.316368.

Madhura NS, Shankar M, Narasimhappa S. Subclinical Hypothyroidism (SH) and Atherogenic Index of Plasma (AIP) in Women: A Case-Control Study From a Tertiary Care Hospital in South India. Cureus. 2020 Sep 24;12(9):e10636. doi: 10.7759/cureus.10636.

Kazukauskiene N, Podlipskyte A, Varoneckas G, Mickuviene N. Insulin Resistance in Association with Thyroid Function, Psychoemotional State, and Cardiovascular Risk Factors. Int J Environ Res Public Health. 2021 Mar 25;18(7):3388. doi: 10.3390/ijerph18073388.

Ujwal Upadya B, Mn S, Km S, Prashant A, Doddamani P, Sv S. Effect of insulin resistance in assessing the clinical outcome of clinical and subclinical hypothyroid patients. J Clin Diagn Res. 2015 Feb;9(2):OC01-4. doi: 10.7860/JCDR/2015/9754.5513.

Liu J, Duan Y, Fu J, Wang G. Association Between Thyroid Hormones, Thyroid Antibodies, and Cardiometabolic Factors in Non-Obese Individuals With Normal Thyroid Function. Front Endocrinol (Lausanne). 2018 Apr 5;9:130. doi: 10.3389/fendo.2018.00130.

Blaslov K, Gajski D, Vucelić V, et al. The association of subclinical insulin resistance with thyroid autoimmunity in euthyroid individuals. Acta Clin Croat. 2020 Dec;59(4):696-702. doi: 10.20471/acc.2020.59.04.16.

Cengiz H, Demirci T, Varim C, Tamer A. The effect of Thyroid Autoimmunity on Dyslipidemia in patients with Euthyroid Hashimoto Thyroiditis. Pak J Med Sci. 2021 Sep-Oct;37(5):1365-1370. doi: 10.12669/pjms.37.5.3883.

Brenta G, Berg G, Arias P, et al. Lipoprotein alterations, hepatic lipase activity, and insulin sensitivity in subclinical hypothyroidism: response to L-T(4) treatment. Thyroid. 2007 May;17(5):453-60. doi: 10.1089/thy.2006.0302.

Downloads

Published

2022-06-29

How to Cite

Okan, K., Sencan, M., & Duman, G. (2022). The relationship between thyroid hormone levels, insulin resistance and body mass index, in patients with subclinical hypothyroidism and euthyroid patients. INTERNATIONAL JOURNAL OF ENDOCRINOLOGY (Ukraine), 18(1), 41–48. https://doi.org/10.22141/2224-0721.18.1.2022.1144

Issue

Section

Original Researches