Obese Women With Hypothyroidism Treated with Levothyroxine Have Reduced Resting Energy Expenditure

2020 ◽  
Vol 32 (5) ◽  
pp. 218-220
Author(s):  
Mary H. Samuels
2020 ◽  
Vol 105 (4) ◽  
pp. e1741-e1748 ◽  
Author(s):  
Emanuele Muraca ◽  
Stefano Ciardullo ◽  
Alice Oltolini ◽  
Francesca Zerbini ◽  
Eleonora Bianconi ◽  
...  

Abstract Context Growing evidence suggests that appropriate levothyroxine (LT4) replacement therapy may not correct the full set of metabolic defects afflicting individuals with hypothyroidism. Objective To assess whether obese subjects with primary hypothyroidism are characterized by alterations of the resting energy expenditure (REE). Design Retrospective analysis of a set of data about obese women attending the outpatients service of a single obesity center from January 2013 to July 2019. Patients A total of 649 nondiabetic women with body mass index (BMI) > 30 kg/m2 and thyrotropin (TSH) level 0.4–4.0 mU/L were segregated into 2 groups: patients with primary hypothyroidism taking LT4 therapy (n = 85) and patients with normal thyroid function (n = 564). Main outcomes REE and body composition assessed using indirect calorimetry and bioimpedance. Results REE was reduced in women with hypothyroidism in LT4 therapy when compared with controls (28.59 ± 3.26 vs 29.91 ± 3.59 kcal/kg fat-free mass (FFM)/day), including when adjusted for age, BMI, body composition, and level of physical activity (P = 0.008). This metabolic difference was attenuated only when adjustment for homeostatic model assessment of insulin resistance (HOMA-IR) was performed. Conclusions This study demonstrated that obese hypothyroid women in LT4 therapy, with normal serum TSH level compared with euthyroid controls, are characterized by reduced REE, in line with the hypothesis that standard LT4 replacement therapy may not fully correct metabolic alterations related to hypothyroidism. We are not able to exclude that this feature may be influenced by the modulation of insulin sensitivity at the liver site, induced by LT4 oral administration.


1995 ◽  
Vol 27 (Supplement) ◽  
pp. S144
Author(s):  
J. Devitt ◽  
K. S. Gorman ◽  
P. Skidmore ◽  
Y. Miracle ◽  
C. Cochran ◽  
...  

2007 ◽  
Vol 22 (2) ◽  
pp. 115-129 ◽  
Author(s):  
Jennifer R. Dobratz ◽  
Shalamar D. Sibley ◽  
Tiffany R. Beckman ◽  
Bret J. Valentine ◽  
Todd A. Kellogg ◽  
...  

2016 ◽  
Vol 116 (7) ◽  
pp. 1306-1313 ◽  
Author(s):  
Vanessa Fadanelli Schoenardie Poli ◽  
Ricardo Badan Sanches ◽  
Amanda dos Santos Moraes ◽  
João Pedro Novo Fidalgo ◽  
Maythe Amaral Nascimento ◽  
...  

AbstractAssessing energy requirements is a fundamental activity in clinical dietetic practice. The aim of this study was to investigate which resting energy expenditure (REE) predictive equations are the best alternatives to indirect calorimetry before and after an interdisciplinary therapy in Brazilian obese women. In all, twelve equations based on weight, height, sex, age, fat-free mass and fat mass were tested. REE was measured by indirect calorimetry. The interdisciplinary therapy consisted of nutritional, physical exercise, psychological and physiotherapy support during the course of 1 year. The average differences between measured and predicted REE, as well as the accuracy at the ±10 % level, were evaluated. Statistical analysis included paired t tests, intraclass correlation coefficients and Bland–Altman plots. Validation was based on forty obese women (BMI 30–39·9 kg/m2). Our major findings demonstrated a wide variation in the accuracy of REE predictive equations before and after weight loss in non-morbid, obese women. The equations reported by Harris–Benedict and FAO/WHO/United Nations University (UNU) were the only ones that did not show significant differences compared with indirect calorimetry and presented a bias <5 %. The Harris–Benedict equation provided 40 and 47·5 % accurate predictions before and after therapy, respectively. The FAO equation provided 35 and 47·5 % accurate predictions. However, the Bland–Altman analysis did not show good agreement between these equations and indirect calorimetry. Therefore, the Harris–Benedict and FAO/WHO/UNU equations should be used with caution for obese women. The need to critically re-assess REE data and generate regional and more homogeneous REE databases for the target population is reinforced.


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