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http://dx.doi.org/10.3904/kjim.2013.28.2.180

Elevated thyroid stimulating hormone levels are associated with metabolic syndrome in euthyroid young women  

Oh, Jee-Young (Department of Internal Medicine, Ewha Womans University School of Medicine)
Sung, Yeon-Ah (Department of Internal Medicine, Ewha Womans University School of Medicine)
Lee, Hye Jin (Department of Internal Medicine, Ewha Womans University School of Medicine)
Publication Information
The Korean journal of internal medicine / v.28, no.2, 2013 , pp. 180-186 More about this Journal
Abstract
Background/Aims: The existence of an association between thyrotropin (thyroid stimulating hormone, TSH) levels and metabolic derangement in euthyroid subjects is controversial. We examined the association between high normal TSH levels and metabolic syndrome in healthy young women. Methods: The study recruited 2,760 young female volunteers (age, 18 to 39 years) with TSH levels in the normal range (0.3 to 4.5 mU/L). We defined metabolic syndrome using the 2007 International Diabetes Federation criteria. Using a TSH level of 2.5 mU/L as an upper reference limit, as recommended by the National Academy of Clinical Biochemistry, we divided the subjects into high- (n = 453) and low-TSH groups (n = 2,307). Results: The prevalence of metabolic syndrome was significantly higher in the high-TSH group than in the low-TSH group (7.5% vs. 4.8%, p = 0.016). Central obesity (22.3% vs. 17.3%, p = 0.012) and hypertriglyceridemia (8.0% vs. 4.2%, p = 0.0007) were significantly more frequent in the high-TSH group than in the low-TSH group. Waist circumference, systolic and diastolic blood pressure, and triglycerides were significantly associated with the TSH level after adjusting for age and body mass index (BMI). Subjects in the high-TSH group had a 2-fold greater risk of metabolic syndrome than subjects in the low-TSH group after adjusting for age and BMI (odds ratio, 1.9; 95% confidence interval, 1.1 to 3.2). Conclusions: Healthy young women with TSH levels > 2.5 mU/L should be assessed for the presence of metabolic syndrome, even if their TSH levels are in the normal range.
Keywords
Thyrotropin; Euthyroid; Metabolic syndrome; Young women;
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1 Lithell H, Boberg J, Hellsing K, et al. Serum lipoprotein and apolipoprotein concentrations and tissue lipoprotein-lipase activity in overt and subclinical hypothyroidism: the effect of substitution therapy. Eur J Clin Invest 1981;11:3-10.   DOI
2 Hak AE, Pols HA, Visser TJ, Drexhage HA, Hofman A, Witteman JC. Subclinical hypothyroidism is an independent risk factor for atherosclerosis and myocardial infarction in elderly women: the Rotterdam Study. Ann Intern Med 2000;132:270-278.
3 Park HT, Cho GJ, Ahn KH, et al. Thyroid stimulating hormone is associated with metabolic syndrome in euthyroid postmenopausal women. Maturitas 2009;62:301-305.   DOI
4 Nader NS, Bahn RS, Johnson MD, Weaver AL, Singh R, Kumar S. Relationships between thyroid function and lipid status or insulin resistance in a pediatric population. Thyroid 2010;20:1333-1339.   DOI
5 Liu XQ, Rahman A, Bagdade JD, Alaupovic P, Kannan CR. Effect of thyroid hormone on plasma apolipoproteins and apoA- and apoB-containing lipoprotein particles. Eur J Clin Invest 1998;28:266-270.   DOI
6 Michalopoulou G, Alevizaki M, Piperingos G, et al. High serum cholesterol levels in persons with 'highnormal' TSH levels: should one extend the def inition of subclinical hypothyroidism? Eur J Endocrinol 1998;138:141-145.   DOI
7 Walsh JP, Bremner AP, Bulsara MK, et al. Subclinical thyroid dysfunction and blood pressure: a communitybased study. Clin Endocrinol (Oxf) 2006;65:486-491.   DOI
8 Liu D, Jiang F, Shan Z, et al. A cross-sectional survey of relationship between serum TSH level and blood pressure. J Hum Hypertens 2010;24:134-138.   DOI
9 Duan Y, Peng W, Wang X, et al. Community-based study of the association of subclinical thyroid dysfunction with blood pressure. Endocrine 2009;35:136-142.   DOI
10 Kim DJ. The epidemiology of diabetes in Korea. Diabetes Metab J 2011;35:303-308.   DOI
11 McAuley KA, Williams SM, Mann JI, et al. Diagnosing insulin resistance in the general population. Diabetes Care 2001;24:460-464.   DOI
12 Paoli-Valeri M, Guzman M, Jimenez-Lopez V, Arias-Ferreira A, Briceno-Fernandez M, Arata-Bellabarba G. Atherogenic lipid profile in children with subclinical hypothyroidism. An Pediatr (Barc) 2005;62:128-134.   DOI
13 Baskin HJ, Cobin RH, Duick DS, et al. American Association of Clinical Endocrinologists medical guidelines for clinical practice for the evaluation and treatment of hyperthyroidism and hypothyroidism. Endocr Pract 2002;8:457-469.   DOI
14 Baloch Z, Carayon P, Conte-Devolx B, et al. Laboratory medicine practice guidelines: laboratory support for the diagnosis and monitoring of thyroid disease. Thyroid 2003;13:3-126.   DOI
15 Fatourechi V, Klee GG, Grebe SK, et al. Effects of reducing the upper limit of normal TSH values. JAMA 2003;290:3195-3196.   DOI
16 Onur S, Haas V, Bosy-Westphal A, et al. L-tri-iodothyronine is a major determinant of resting energy expenditure in underweight patients with anorexia nervosa and during weight gain. Eur J Endocrinol 2005;152:179-184.   DOI
17 Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher DF, Turner RC. Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia 1985;28:412-419.   DOI
18 Stumvoll M, Mitrakou A, Pimenta W, et al. Use of the oral glucose tolerance test to assess insulin release and insulin sensitivity. Diabetes Care 2000;23:295-301.   DOI
19 Reinehr T. Obesity and thyroid function. Mol Cell Endocrinol 2010;316:165-171.   DOI
20 Nyrnes A, Jorde R, Sundsfjord J. Serum TSH is positively associated with BMI. Int J Obes (Lond) 2006;30:100-105.   DOI
21 Tagliaferri M, Berselli ME, Calo G, et al. Subclinical hypothyroidism in obese patients: relation to resting energy expenditure, serum leptin, body composition, and lipid profile. Obes Res 2001;9:196-201.   DOI
22 Knudsen N, Laurberg P, Rasmussen LB, et al. Small differences in thyroid function may be important for body mass index and the occurrence of obesity in the population. J Clin Endocrinol Metab 2005;90:4019-4024.   DOI
23 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.   DOI
24 Winter WE, Signorino MR. Review: molecular thyroidology. Ann Clin Lab Sci 2001;31:221-244.
25 Surks MI, Ortiz E, Daniels GH, et al. Subclinical thyroid disease: scientific review and guidelines for diagnosis and management. JAMA 2004;291:228-238.   DOI
26 Pallas D, Koutras DA, Adamopoulos P, et al. Increased mean serum thyrotropin in apparently euthyroid hypercholesterolemic patients: does it mean occult hypothyroidism? J Endocrinol Invest 1991;14:743-746.   DOI
27 Klein I, Ojamaa K. Thyroid hormone and the cardiovascular system. N Engl J Med 2001;344:501-509.   DOI
28 Bakker SJ, ter Maaten JC, Popp-Snijders C, Slaets JP, Heine RJ, Gans RO. The relationship between thyrotropin and low density lipoprotein cholesterol is modified by insulin sensitivity in healthy euthyroid subjects. J Clin Endocrinol Metab 2001;86:1206-1211.
29 Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive summary of the third report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III). JAMA 2001;285:2486-2497.   DOI
30 Eckel RH, Grundy SM, Zimmet PZ. The metabolic syndrome. Lancet 2005;365:1415-1428.   DOI
31 Cappola AR, Ladenson PW. Hypothyroidism and atherosclerosis. J Clin Endocrinol Metab 2003;88:2438-2444.   DOI
32 Asvold BO, Vatten LJ, Nilsen TI, Bjoro T. The association between TSH within the reference range and serum lipid concentrations in a population-based study: the HUNT Study. Eur J Endocrinol 2007;156:181-186.   DOI
33 Roos A, Bakker SJ, Links TP, Gans RO, Wolffenbuttel BH. Thyroid function is associated with components of the metabolic syndrome in euthyroid subjects. J Clin Endocrinol Metab 2007;92:491-496.   DOI
34 Chubb SA, Davis WA, Davis TM. Interactions among thyroid function, insulin sensitivity, and serum lipid concentrations: the Fremantle diabetes study. J Clin Endocrinol Metab 2005;90:5317-5320.   DOI
35 Kratzsch J, Fiedler GM, Leichtle A, et al. New reference intervals for thyrotropin and thyroid hormones based on National Academy of Clinical Biochemistry criteria and regular ultrasonography of the thyroid. Clin Chem 2005;51:1480-1486.   DOI
36 Carr MC. The emergence of the metabolic syndrome with menopause. J Clin Endocrinol Metab 2003;88:2404-2411.   DOI