The Relationship Between Thyroid Function and Body Composition, Leptin, Adiponectin, and Insulin Sensitivity in Morbidly Obese Euthyroid Subjects Compared to Non-obese Subjects

Background/Objectives: Thyroid function tests (TFTs) changes in obese people have been studied with increasing interest, however, studies have been inconsistent hence it remains poorly understood. We compared the TFTs of morbidly obese euthyroid Saudi subjects with non-obese controls and then we examined the influence of leptin, adiponectin, and insulin resistance on TFTs. Subjects/Methods: Fifty-five euthyroid obese subjects attending bariatric surgery clinic and 52 non-obese age-and gender-matched controls were recruited. We measured body weight, BMI, body composition, thyroid-stimulating hormone (TSH), Free T4 (FT4), Free T3(FT3), thyroid antibodies, fasting leptin, adiponectin, and lipid profile. Insulin resistance was quantified by HOMA-IR. Data are presented as mean ± SEM. Results: Mean BMI was 45.6 ± 1.5 and 23.2 ± 0.5 kg/m2, for the obese and non-obese controls, respectively, P value < 0.001. Mean TSH was 2.7 ± 0.18 mIU/L in obese subjects and 1.7 ± 0.13 mIU/L (0.27-4.2) in the non-obese controls, respectively, P value .014. Mean FT3 was 3.9 ± 0.1 pmol/L (3.1-6.8) in obese subjects compared to 5.0 ± 0.1 pmol/L in non-obese controls, respectively, P value 0.001, however, FT4 was similar in the 2 groups. In the whole group ( N = 107), BMI correlated positively with TSH and negatively with FT3. Leptin correlated negatively with both FT4 and FT3 in the non-obese group only while none of the TFTs correlated with HOMA-IR or adiponectin in either group. Binary logistic regression showed that each 1 unit increase in TSH increased the odds of becoming obese by 12.7, P value 0.009, 95 C.I. (1.9-85.0). Conversely, each - unit increase in FT3 decreased the odds of becoming obese by 0.2, P value 0.023, 95% C.I. (0.05-0.80). Conclusions: We report a small increase in TSH and a small decrease in FT3 within the normal range in obese subjects compared to non-obese controls. We also report a positive correlation between TSH and BMI with increased odds ratio of becoming obese with the increase in TSH and decrease in FT3. These changes may be either causally related or adaptive to the obesity state. FT4 and FT3 seem to correlate with leptin (but not with adiponectin or HOMA-IR) in the non-obese controls only. Larger mechanistic studies are needed to further elucidate the interesting association between obesity and TFTs.

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SAT-443 Impact of Fasting on Plasma Thyrotropin in Hypothyroid Patients Taking Levothyroxine During Ramadan (IFT-R Study)

Journal of the Endocrine Society ◽

10.1210/jendso/bvaa046.1497 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

Author(s):

Samer El-Kaissi ◽

Laila AbdelWareth ◽

Ruba Dajani ◽

Terrence Lee St John ◽

Sherry Ann Santarina ◽

...

Keyword(s):

Thyroid Function ◽

P Value ◽

Thyroid Function Tests ◽

Free T4 ◽

Fasting Period ◽

Function Tests ◽

Number Of Patients ◽

The Mean ◽

Group 2 ◽

Hypothyroid Patients

Abstract Background and Aim: We previously showed in a retrospective analysis that the plasma TSH rises significantly post-Ramadan in levothyroxine-treated hypothyroid patients, possibly as a result of changes in the eating habit during the non-fasting period from dusk until dawn. The aim of this study is to determine the best time for taking levothyroxine during Ramadan in order to minimize changes in thyroid function tests. Methods: in a randomized prospective design, hypothyroid patients taking levothyroxine for greater than 6-months were randomized to take levothyroxine at one of the following 3 times during Ramadan: (group 1) at dusk after a prolonged fast and 30-minutes before the Iftar meal, (group 2) ≥ 3-hours after the Iftar meal, or (group 3) at dawn 30-minutes before Suhur meal. Patients were instructed to allow a minimum of 3-hours between the last meal and levothyroxine and to refrain from eating and drinking for at least 30-minutes after taking levothyroxine. Thyroid function tests were performed within 3-months before Ramadan and within 6-weeks post Ramadan. To estimate intent-to-treat effects, we examined pre- and post-Ramadan thyroid function tests in relation to the assigned levothyroxine administration times. Results: 147 patients were randomized into the study and the respective number of patients in groups 1, 2 and 3 were 50, 46 and 51. The mean age of participants was 43.5±12.4 years [range 21.0-86.0] and 78% were females with no statistical differences in the mean age or gender distribution between the 3 groups. The respective pre-Ramadan mean TSH values for the 3 groups were 2.49 mIU/L, 2.16 mIU/L and 3.37 mIU/L with no significant differences at baseline. Post-Ramadan mean TSH values were 2.47 mIU/L, 4.26 mIU/L and 3.85 mIU/L for groups 1, 2 and 3 respectively. The pre- and post-Ramadan mean TSH differences were significant only for group 2, who took levothyroxine 3-hours post-Iftar (P-value 0.041). There were no significant differences in the free-T4 levels across the 3-groups before and after Ramadan. In a subset of 85 patients, the preferred times for levothyroxine administration during Ramadan were 44.7% before Iftar, 50.6% post-Iftar and only 4.7% were in favor of taking the medication before Suhur meal. Conclusions: Levothyroxine-treated hypothyroid patients who took levothyroxine 3-hours after the main Iftar meal showed a significant increase in plasma TSH post-Ramadan, possibly reflecting a reduced time period between levothyroxine administration and the previous meal. There was no significant change in the mean plasma TSH for patients taking levothyroxine at dusk before Iftar or at dawn before Suhur. The least patient-preferred time for taking levothyroxine was at dawn before Suhur possibly due to time constraints before the start of fasting.

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Effect of restoration of thyroid function on body composition, insulin resistance and visfatin concentrations in women with hypo- and hyperthyroidism

Endocrine Abstracts ◽

10.1530/endoabs.63.gp184 ◽

2019 ◽

Author(s):

Nadia Sawicka-Gutaj ◽

Ariadna Zybek-Kocik ◽

Michal Kloska ◽

Agata Czarnywojtek ◽

Jerzy Sowiński ◽

...

Keyword(s):

Insulin Resistance ◽

Body Composition ◽

Thyroid Function

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Obese patients with higher TSH levels had an obvious metabolic improvement after bariatric surgery

Endocrine Connections ◽

10.1530/ec-21-0360 ◽

2021 ◽

Vol 10 (10) ◽

pp. 1326-1336

Author(s):

Nannan Bian ◽

Xiaomeng Sun ◽

Biao Zhou ◽

Lin Zhang ◽

Qiu Wang ◽

...

Keyword(s):

Insulin Resistance ◽

Bariatric Surgery ◽

Thyroid Function ◽

Fasting Blood Glucose ◽

Thyroid Stimulating Hormone ◽

Morbidly Obese ◽

Obese Patients ◽

Free Triiodothyronine ◽

The Relationship ◽

Tsh Levels

Objective Bariatric surgery has become the most effective treatment for morbid obesity. Increasing evidence showed that bariatric surgery can alleviate insulin resistance and influence thyroid function. This study aimed to investigate the relationship between changes in thyroid function and adipose tissue insulin resistance (adipo-IR) after bariatric surgery. Methods A total of 287 non-diabetic participants with regular thyroid function were recruited and divided into the lean, overweight and obese groups. Among them, 50 morbidly obese patients submitted to bariatric surgery. Results The obese group had a higher level of adipo-IR, thyroid-stimulating hormone (TSH), free triiodothyronine (FT3), FT3/free thyroxine (FT4) and metabolism disorders than the lean and overweight groups. BMI was correlated with TSH, FT3, FT3/FT4 and adipo-IR (r = 0.309, 0.315, 0.322 and 0.651, respectively, all P < 0.001). Adipo-IR was significantly correlated with TSH (r = 0.402, P < 0.001), FT3 (r = 0.309, P < 0.001), and FT3/FT4 (r = 0.228, P < 0.05). Bariatric surgery resulted in a sharp decline in BMI, adipo-IR, TSH, FT3 and FT3/FT4 levels, meanwhile, metabolic disorders improved. The decrease in BMI after bariatric surgery was significantly correlated with reductions in adipo-IR (r = 0.577, P < 0.001) and TSH (r = 0.401, P = 0.005). Interestingly, the fasting blood glucose, fasting insulin, adipo-IR and TSH in the higher TSH group decreased more remarkably than in the lower TSH group. Conclusion Obese individuals with higher TSH levels had an obvious metabolic improvement after bariatric surgery.

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STUDY OF INSULIN RESISTANCE AND THYROID PROFILE IN WOMEN WITH SPONTANEOUS ABORTIONS

10.36106/ijsr/2318798 ◽

2020 ◽

pp. 1-3

Author(s):

Annapoorani R ◽

Nagasudha D

Keyword(s):

Insulin Resistance ◽

Thyroid Dysfunction ◽

Previous History ◽

Oral Glucose ◽

Study Group ◽

Thyroid Function Tests ◽

Model Assessment ◽

Spontaneous Abortions ◽

Free T4 ◽

Free T3

Thyroid dysfunction and insulin resistance are important endocrinological causes of spontaneous abortions. This study is resistancewith spontaneous abortions Thyroid dysfunction and Insulin resistance are common endocrinological causes of abortions.The present study is a case control study where 75 patients with spontaneous abortions below 20 weeks were taken as cases and 75 patients with normal on going pregnancy without previous history of miscarriage were taken as controls. Thyroid Function Tests (Free T3 ,Free T4,TSH) ,Oral Glucose Tolerance Test following 75 mg glucose load were done in cases and controls. Fasting glucose and insulin levels were measured and Insulin resistance was calculated using homeostatic model assessment method (HOMA- IR).Free T3 levels were signicantly lower and TSH levels were signicantly higher in study group indicating the presence of hypothyroidism in the abortus group. The HOMA-IR insulin resistance scores were apparently higher in the study group than in the controls, but it was not statistically signicant.

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A comparative study on outcomes of preprandial versus postprandial thyroid function test

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20194945 ◽

2019 ◽

Vol 5 (6) ◽

pp. 1662

Author(s):

Vasim Ismail Patel ◽

Akshay B. K.

Keyword(s):

Thyroid Function ◽

Subclinical Hypothyroidism ◽

Clinical Symptoms ◽

Thyroid Function Test ◽

Thyroid Stimulating Hormone ◽

Endocrine Gland ◽

Thyroid Function Tests ◽

Sample Collection ◽

Free T4 ◽

Group 2

Background: The thyroid is an endocrine gland. It secretes two hormones thyroxine (T4), triiodothyronine (T3). Hypothyroidism is a common condition encountered by a clinician. Subclinical hypothyroidism (SCH) defined as normal free thyroxine (T4) and elevated thyroid stimulating hormone (TSH), is primarily a biochemical diagnosis with or without clinical symptoms. Studies have observed that TSH levels vary at different times in a day. In practice not much importance is given to the timing of the sample collection (pre-prandial or post-prandial sate). SCH is diagnosed depending on TSH value. So the condition may be under or over diagnosed based on a single value. So we conducted this study to determine whether timing of sample collection had any significant relationship in the determination of levels of thyroid hormones.Methods: The study was carried on 114 patients who visited ENT department, NMCH between July 2018 and June 2019. Group-1 consisted of 38 normal patients. Group-2 consisted of 36 hypothyroidism patients GROUP-3 consisted of 40 subclinical hypothyroidism patients. Thyroid function tests (TSH and free T4) were done in fasting state and 2 hours postprandially. Results: TSH values were found to be significantly lowered after food in all the three groups. Free T4 values did not show any statistically significant alteration after food.Conclusions: There was a significant decline in TSH values postprandially. This might lead to inappropriate diagnosis and management of patients as cases of hypothyroidism, especially in cases of sub clinical hypothyroidism.

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Familial Dysalbuminaemic Hyperthyroxinaemia and Other Causes of Euthyroid Hyperthyroxinaemia

Journal of the Royal Society of Medicine ◽

10.1177/014107688708001208 ◽

1987 ◽

Vol 80 (12) ◽

pp. 750-752 ◽

Cited By ~ 6

Author(s):

C Farror ◽

M L Wellby ◽

C Beng

Keyword(s):

Thyroid Function ◽

Equilibrium Dialysis ◽

Elevated Serum ◽

Normal Serum ◽

Thyroid Function Tests ◽

Free T4 ◽

Incorrect Diagnosis ◽

Biochemical Studies ◽

Autosomal Dominance ◽

Clinical Awareness

Clinical and biochemical studies on a family in which 3 members have familial dysalbuminaemic hyperthyroxinaemia (FDH) are presented. They were clinically euthyroid with elevated serum thyroxine (T4) and free T4 indices but normal free T4 by equilibrium dialysis and normal serum triiodothyronine (total and free). All thyroid function tests on the remaining family members were normal. The inheritance is consistent with autosomal dominance. Also presented are data on 4 unrelated patients with FDH and two patients with T4 autoantibodies. The methods for detecting FDH, T4 antibodies and other causes of euthyroid hyperthyroxinaemia are now freely available. Since these anomalies may be more common than previously supposed, clinical awareness of the conditions is necessary to protect patients from the consequences of incorrect diagnosis of thyrotoxicosis.

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SAT-576 Possible Involvement of Thyroid Function in PCSK9 Inhibitor Therapy

Journal of the Endocrine Society ◽

10.1210/jendso/bvaa046.477 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

Author(s):

Masayasu Iwabuchi

Keyword(s):

Thyroid Function ◽

Ldl Cholesterol ◽

Inhibitor Therapy ◽

Thyroid Peroxidase ◽

Thyroid Function Tests ◽

Pcsk9 Inhibitors ◽

Free T4 ◽

Hyperthyroid Patient ◽

Pcsk9 Inhibitor ◽

The Impact

Abstract INTRODUCTION Proprotein convertase subtilisin kexin type 9 (PCSK9) inhibition is an effective strategy for lowering plasma LDL-cholesterol and enhancing the LDL-cholesterol lowering ability of statins. PCSK9, a serine protease that binds to the LDL receptor promoting its degradation, is an important regulator of LDL metabolism. In addition, LDL-cholesterol is also controlled by TSH and thyroid hormones via PCSK9. TSH has received increasing attention as being closely associated with increased LDL-cholesterol level and higher atherosclerotic risks. In vitro study, the effects of TSH on hepatic PCSK9 expression in HepG2 cells were reported (1). I here report a case of transient hyperthyroidism secondary to PCSK9 inhibitor therapy. This case highlights the involvement of thyroid function in PCSK9 Inhibitor therapy. CLINICAL CASE A 65-year-old man had a weight loss of 6 kg (13 lbs.) in 4 months, accompanied with fatigue. He had a past history of myocardial infarction and his LDL was 83 mg/dL by 2.5mg of rosuvastatin and heart rate was controlled by 10mg of carvedilol. Six months ago, he started a PCSK9 Inhibitor therapy with 140mg of evolocumab every 2 weeks for 6 weeks. He had no preceding viral illness and denied anterior neck pain or tenderness. His height was 1.53 m, weight 52.6 kg (115 lbs.), and body mass index (BMI) 22.46 kg/m2. His thyroid was not enlarged and non-tender without clear palpable thyroid nodules or neck lymph nodes. Hyperthyroidism was suspected and confirmed by thyroid function tests: TSH was less than 0.0005 μIU/mL (normal 0.35–4.94), and free T4 1.830 ng/dL (0.70–1.48). Graves’ disease was considered, and thyroid antibody tests performed. Thyroid peroxidase (TPO) antibody titer was less than 9 IU/mL (<9), and TSI 141% (<120%). To confirm the diagnosis of this hyperthyroid patient, Technetium-99m uptake and scan was done which showed uptake of 0.8% (0.5–7%). After careful observation for 2 months with 5mg of carvedilol, he turned asymptomatic and free T4 lowered to 1.480 ng/dL and TSH remained less than 0.0005 μIU/mL. CLINICAL LESSONS I here report a case of transient hyperthyroidism secondary to PCSK9 inhibitor therapy. There has been no report of hyperthyroidism induced by PCSK9 inhibitors. Immunological influence of anti-PCSK9 therapy on thyroid is unknown. In this case, the decrease of TSH due to hyperthyroidism was considered to reduce hepatic PCSK9 expression, leading to additive effect to PCSK9 inhibitor. PCSK9 inhibitors may modify the effects of hyperlipidemia treatment by causing changes in thyroid function. When using PCSK9 inhibitors, follow-up of thyroid function should be considered. This case highlights the involvement of thyroid function in PCSK9 inhibitor therapy. Reference (1) Gong, Y., Ma, Y., et al. Thyroid stimulating hormone exhibits the impact on LDLR/LDL-c via up-regulating hepatic PCSK9 expression. Metabolism. 2017;76;32–41

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The Impact of Strenuous Group Physical Activity on Mood States, Personal Views, Body Composition, and Markers of Myocardial Damage in Overweight/Obese Adults: The “Step-by-Step Italy’s Coast to Coast” Trek

BioMed Research International ◽

10.1155/2014/854129 ◽

2014 ◽

Vol 2014 ◽

pp. 1-7 ◽

Cited By ~ 3

Author(s):

Claudia Mazzeschi ◽

Natalia Piana ◽

Daniela Capezzali ◽

Antonella Mommi ◽

Cristina Aiello ◽

...

Keyword(s):

Body Composition ◽

Psychological Impact ◽

Myocardial Damage ◽

Normal Weight ◽

Obese Adults ◽

Long Distance ◽

Obese People ◽

Obese Subjects ◽

Relationship Of ◽

The Impact

It is clinically relevant to understand whether it is safe to recommend to trained overweight/obese people long-distance treks and whether these experiences could have a negative psychological impact or become even dangerous exposing the trekkers to the risk of clinically silent myocardial damage. To answer these questions we have performed a quantitative/qualitative study comparing the changes in mood profiles, personal views, body composition, and plasma troponin levels of 40 overweight/obese subjects with those of 36 healthy normal weight subjects after the participation in a trek of 388 km from the Adriatic to the Tyrrhenian seas trek: the “Step by step…Italy’s coast to coast”. The results of this study demonstrate that long-distance treks are a safe activity for trained overweight/obese people which should be recommended because they improve mood, health status, and the relationship of participants with themselves and with the regular practice of exercise with effects similar to those obtained by healthy normal weight subjects.

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Associations between Tissue Visfatin/Nicotinamide, Phosphoribosyltransferase (Nampt), Retinol Binding Protein-4, and Vaspin Concentrations and Insulin Resistance in Morbidly Obese Subjects

Mediators of Inflammation ◽

10.1155/2013/861496 ◽

2013 ◽

Vol 2013 ◽

pp. 1-9 ◽

Cited By ~ 14

Author(s):

Zeynep Goktas ◽

Shannon Owens ◽

Mallory Boylan ◽

David Syn ◽

Chwan-Li Shen ◽

...

Keyword(s):

Insulin Resistance ◽

Adipose Tissue ◽

Binding Protein ◽

Retinol Binding Protein ◽

Morbidly Obese ◽

Tissue Samples ◽

Blood Concentrations ◽

Nicotinamide Phosphoribosyltransferase ◽

Retinol Binding Protein 4 ◽

Obese Subjects

Visfatin/Nampt, vaspin, and retinol binding protein-4 (RBP-4) play an important role in insulin resistance. The objectives of this study were to measure visfatin/Nampt, vaspin, and RBP-4 concentrations in blood, liver, muscle, subcutaneous, omental, and mesenteric adipose tissues in morbidly obese subjects and investigate their relationship to insulin resistance. Blood and tissue samples were collected from 38 morbidly obese subjects during Roux-en-Y surgery. Insulin resistance biomarkers were measured using standard kits. Visfatin/Nampt, vaspin, and RBP-4 gene expression levels in tissues were measured using real-time PCR. Their protein concentrations in blood and tissues were measured using ELISA kits. Diabetic subjects had significantly higher homeostasis model of assessment-insulin resistance and age and lower blood HDL-cholesterol concentrations than nondiabetic and prediabetic subjects. Diabetic and prediabetic subjects had significantly higher blood concentrations of visfatin/Nampt and vaspin than nondiabetic subjects. Liver RBP-4 concentrations were positively associated with blood glucose concentrations. Blood insulin resistance biomarker levels were positively associated with visfatin/Nampt concentrations in omental adipose tissue and liver, and vaspin concentrations in mesenteric adipose tissue. In conclusion, the correlations of visfatin/Nampt, vaspin, and RBP-4 with insulin resistance are tissue dependent.

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Beneficial Effects of an 8-Week, Very Low Carbohydrate Diet Intervention on Obese Subjects

Evidence-based Complementary and Alternative Medicine ◽

10.1155/2013/760804 ◽

2013 ◽

Vol 2013 ◽

pp. 1-8 ◽

Cited By ~ 8

Author(s):

Yunjuan Gu ◽

Haoyong Yu ◽

Yuehua Li ◽

Xiaojing Ma ◽

Junxi Lu ◽

...

Keyword(s):

Insulin Resistance ◽

Weight Loss ◽

Body Composition ◽

Metabolic Profile ◽

Whole Body ◽

Carbohydrate Diet ◽

Beneficial Effects ◽

Low Carbohydrate Diet ◽

Low Carbohydrate ◽

Obese Subjects

Aim. To investigate the effects of weight loss during an 8-week very low carbohydrate diet (VLCD) on improvement of metabolic parameters, adipose distribution and body composition, and insulin resistance and sensitivity in Chinese obese subjects.Methods. Fifty-three healthy obese volunteers were given an 8-week VLCD. The outcomes were changes in anthropometry, body composition, metabolic profile, abdominal fat distribution, liver fat percent (LFP), and insulin resistance and sensitivity.Results. A total of 46 (86.8%) obese subjects completed the study. The VLCD caused a weight loss of−8.7±0.6 kg (mean ± standard error (SE),P<0.0001) combined with a significant improvement of metabolic profile. In both male and female, nonesterified fatty acid (NEFA) significantly decreased (−166.2±47.6 μmol/L,P=0.001) andβ-hydroxybutyric acid (BHA) increased (0.15±0.06 mmol/L,P=0.004) after eight weeks of VLCD intervention. The significant reductions in subcutaneous fat area (SFA), visceral fat area (VFA), and LFP were−66.5±7.9 cm2,−35.3±3.9 cm2, and−16.4±2.4%, respectively (allPvaluesP<0.0001). HOMA IR and HOMAβsignificantly decreased while whole body insulin sensitivity index (WBISI) increased (allPvaluesP<0.001).Conclusion. Eight weeks of VLCD was an effective intervention in obese subjects. These beneficial effects may be associated with enhanced hepatic and whole-body lipolysis and oxidation.

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