The frequency of metabolic syndrome in patients with the subclinical hypothyroidism

Mersudin Z Mulić; Fadil  Skrijelj; Šefcet  Hajrović; Rade  Prelević; Boško  Milev

doi:10.2298/VSP160519302M

Mersudin Z Mulić State University of Novi Pazar, Novi Pazar, Serbia
Fadil Skrijelj State University of Novi Pazar, Novi Pazar, Serbia
Šefcet Hajrović Medical Center Novi Pazar, Novi Pazar, Serbia
Rade Prelević Military Medical Academy, Belgrade; Serbia
Boško Milev Military Medical Academy, Belgrade; Serbia

DOI: https://doi.org/10.2298/VSP160519302M

Keywords: hypothyroidism;, metabolic syndrome x;, cardiovascular diseases;, risk factors;, ; risk assessment.

Abstract

Abstract

Background/Aim. An increased cardiovascular risk of thyroid dysfunction is associated with the impairment of lipid and lipoprotein metabolism, endothelial dysfunction, metabolic, hormonal, hemodynamic changes and coagulation disorders. Subclinical hypothyroidism is characterized by supernormal thyroid-stimulating hormone (TSH) level along with normal values of thyroid hormones. The association of subclinical hypothyroidism with higher cardiovascular risk has not been fully clarified. The aim of the study was to determine the frequency of metabolic syndrome and the associated cardiovascular risk factors in patients with the subclinical hypothyroidism. Method. The study included 140 subjects aged from 18 to 65 years, out of which 105 subjects had subclinical hypothyroidism and 35 subjects were the euthyroid controls. The clinical trial program, completed in all subjects, included: detailed medical history and physical examination, waist circumference, and laboratory tests [fasting glycemia, lipid and lipoprotein status, free triiodothyronine (FT3) and free thyroxine (FT4) and TSH levels]. Results. Out of 105 patients with the subclinical hypothyroidism, mean age 44.15 ± 11.23 years, 77 (73.3%) patients had metabolic syndrome. In the control group consisting of 35 subjects, mean age 33.80 ± 10.60 years, only 3 (8.6%) subjects had metabolic syndrome. Mean values of the waist circumference, fasting glycemia, triglycerides, systolic and diastolic blood pressure were higher in subclinical hypothyroidism group in relation to the controls (p < 0.0001). Mean value of high-density lipoprotein (HDL) cholesterol was lower in subclinical hypothyroidism group as compared to the controls (p < 0.002). Conclusion. The frequency of metabolic syndrome was 9 times higher in subjects with the subclinical hypothyroidism in relation to subjects without any subclinical hypothyroidism.

References

References:

Cooper DS, Biondi B. Subclinical thyroid disease. Lancet 2012; 379(9821): 1142–54.

Vanderpump MP, Tunbrldge WM, French JM, Appleton D, Bates D, Clark F, et al. The incidence of thyroid disorders in the community: A twenty-year follow-up of the Whickham Survey. Clin Endocrinol (Oxf) 1995; 43(1): 55–68.

Kim YA, Park YJ. Prevalence and risk factors of subclinical thyroid disease. Endocrinol Metab (Seoul) 2014; 29(1): 20–9.

Hollowell JG, Staehling NW, Flanders WD, Hannon WH, Gunter EW, Spencer CA, et al. Serum TSH, T(4), and thyroid antibo-dies in the United States population (1988 to 1994): National Health and Nutrition Examination Survey (NHANES III). J Clin Endocrinol Metab 2002; 87(2): 489–99.

Hak AE, Pols HA, Visser TJ, Drexhage HA, Hofman A, Witte-man JC. Subclinical hypothyroidism is an independent risk fac-tor for atherosclerosis and myocardial infarction in elderly women: The Rotterdam Study. Ann Intern Med 2000; 132(4): 270–8.

Chubb SA, Davis WA, Inman Z, Davis TM. Prevalence and progression of subclinical hypothyroidism in women with type 2 diabetes: The Fremantle Diabetes Study. Clin Endocrinol (Oxf) 2005; 62(4): 480–6.

Kim TH, Choi HS, Bae JC, Moon JH, Kim HK, Choi SH, et al. Subclinical hypothyroidism in addition to common risk scores for prediction of cardiovascular disease: A 10-year community-based cohort study. Eur J Endocrinol 2014; 171(5): 649–57.

Ye Y, Xie H, Zeng Y, Zhao X, Tian Z, Zhang S. Association be-tween subclinical hypothyroidism and blood pressure: A meta-analysis of observational studies. Endocr Pract 2014; 20(2): 150–8.

Neves C, Alves M, Medina JL, Delgado JL. Thyroid diseases, dyslipidemia and cardiovascular pathology. Rev Port Cardiol 2008; 27(10): 1211–36.

Pearce EN. Update in lipid alterations in subclinical hypothy-roidism. J Clin Endocrinol Metab 2012; 97(2): 326–33.

Liu XL, He S, Zhang SF, Wang J, Sun XF, Gong CM, et al. Alteration of lipid profile in subclinical hypothyroidism: A meta-analysis. Med Sci Monit 2014; 20: 1432–441.

Park YJ, Lee YJ, Choi SI, Chun EJ, Jang HC, Chang HJ. Impact of subclinical hypothyroidism on the coronary artery disease in apparently healthy subjects. Eur J Endocrinol 2011; 165(1): 115–21.

Marfella R, Ferraraccio F, Rizzo MR, Portoghese M, Barbieri M, Basilio C, et al. Innate immune activity in plaque of patients with untreated and L-thyroxine-treated subclinical hypothy-roidism. J Clin Endocrinol Metab 2011; 96(4): 1015–20.

Razvi S, Ingoe L, Keeka G, Oates C, Mcmillan C, Weaver JU. The beneficial effect of L-thyroxine on cardiovascular risk factors, endothelial function, and quality of life in subclinical hypothy-roidism: Randomized, crossover trial. J Clin Endocrinol Metab 2007; 92(5): 1715–23.

Biondi B, Cooper DS. The clinical significance of subclinical thyroid dysfunction. Endocr Rev 2008; 29(1): 76–131.

Taylor PN, Razvi S, Pearce SH, Dayan CM. Clinical review: A review of the clinical consequences of variation in thyroid function within the reference range. J Clin Endocrinol Metab 2013; 98(9): 3562–71.

Mulić M, Tomić-Naglić D, Benc D. Lipid and lipoproteins changes during substitutional therapy of subclinical hypothy-roidism. Medicina danas 2009; 8(1 ̶ 3): 7–14. (Serbian)

Madathil A, Hollingsworth KG, Blamire AM, Razvi S, Newton JL, Taylor R, et al. Levothyroxine improves abnormal cardiac bio-energetics in subclinical hypothyroidism: a cardiac magnetic resonance spectroscopic study. J Clin Endocrinol Metab 2015; 100(4): E607–10.

Javed Z, Sathyapalan T. Levothyroxine treatment of mild sub-clinical hypothyroidism: A review of potential risks and bene-fits. Ther Adv Endocrinol Metab 2016; 7(1): 12–23.

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(16): 1640–5.

Framingham Heart Study. Framingham Study Risk Score Pro-files. 2012. [cited 2012 Dec 5]. Available from: www.framinghamheartstudy.org/risk/index.html

Suh S, Lee MK. Metabolic syndrome and cardiovascular diseas-es in Korea. J Atheroscler Thromb 2014; 21(1): S31 ̶ 5.

Ford ES, Li C, Zhao G. Prevalence and correlates of metabolic syndrome based on a harmonious definition among adults in the US. J Diabetes 2010; 2: 180–93.

Azimi-Nezhad M, Herbeth B, Siest G, Dadé S, Ndiaye NC, Esmaily H, et al. High prevalence of metabolic syndrome in Iran in comparison with France: what are the components that explain this? Metab Syndr Relat Disord 2012; 10(3): 181–8.

Yki-Jarvinen H. The insulin resistance syndrome. In: de Fronzo RA, Ferrannini E, Keen H, Zimmet P, editors. International textbook of diabetes mellitus. 3rd ed. Chicester: John Wiley & Sons; 2004. p. 359–73.

Kahn R, Buse J, Ferrannini E, Stern M; American Diabetes Asso-ciation.; European Association for the Study of Diabetes. The metabolic syndrome: time for a critical appraisal: joint state-ment from the American Diabetes Association and the Euro-pean Association for the Study of Diabetes. Diabetes Care 2005; 28(9): 2289–304.

Pearce SH, Brabant G, Duntas LH, Monzani F, Peeters RP, Razvi S, et al. Management of Subclinical Hypothyroidism. Eur Thy-roid J 2013; 2(4): 215–28.

Baumgartner C, Blum MR, Rodondi N. Subclinical hypothyroid-ism: Summary of evidence in 2014. Swiss Med Wkly 2014; 144: w14058.

Asvold BO, Bjøro T, Platou C, Vatten LJ. Thyroid function and the risk of coronary heart disease: 12-year follow-up of the HUNT study in Norway. Clin Endocrinol (Oxf) 2012; 77(6): 911–7.

Nanchen D, Gussekloo J, Westendorp RG, Stott DJ, Jukema JW, Trompet S, et al. Subclinical thyroid dysfunction and the risk of heart failure in older persons at high cardiovascular risk. J Clin Endocrinol Metab 2012; 97(3): 852–61.

Gencer B, Collet TH, Virgini V, Bauer DC, Gussekloo J, Cappola AR, et al. Subclinical thyroid dysfunction and the risk of heart failure events: An individual participant data analysis from 6 prospective cohorts. Circulation 2012; 126(9): 1040–9.

Pereg D, Tirosh A, Elis A, Neuman Y, Mosseri M, Segev D, et al. Mortality and coronary heart disease in euthyroid patients. Am J Med. 2012; 125(8): 826.e7–12.

Kovar FM, Fang IF, Perkmann T, Haslacher H, Slavka G, Födinger M, et al. Subclinical hypothyroidism and mortality in a large Austrian cohort: a possible impact on treatment? Wien Klin Wochenschr 2015; 127(23–24): 924–30.

Tseng FY, Lin WY, Lin CC, Lee LT, Li TC, Sung PK, et al. Subclinical hypothyroidism is associated with increased risk for all-cause and cardiovascular mortality in adults. J Am Coll Cardiol 2012; 60(8): 730–7.

Westerink J, van der Graaf Y, Faber DR, Spiering W, Visseren FL. SMART study group. Relation between thyroid-stimulating hormone and the occurrence of cardiovascular events and mortality in patients with manifest vascular diseases. Eur J Prev Cardiol 2012; 19(4): 864–73.

Ceresini G, Ceda GP, Lauretani F, Maggio M, Usberti E, Marina M, et al. Thyroid status and 6-year mortality in elderly people living in a mildly iodine-deficient area: The aging in the Chianti Area Study. J Am Geriatr Soc 2013; 61(6): 868–74.

Hyland KA, Arnold AM, Lee JS, Cappola AR. Persistent subclinical hypothyroidism and cardiovascular risk in the elderly: The cardiovascular health study. J Clin Endocrinol Metab 2013; 98(2): 533–40.

Selmer C, Olesen JB, Hansen ML, von Kappelgaard LM, Madsen JC, Hansen PR, et al. Subclinical and overt thyroid dysfunction and risk of all-cause mortality and cardiovascular events: A large population study. J Clin Endocrinol Metab 2014; 99(7): 2372–82.

Åsvold BO, Vatten LJ, Bjøro T, Bauer DC, Bremner A, Cappola AR, et al. Thyroid function within the normal range and risk of coronary heart disease: An individual participant data analysis of 14 cohorts. JAMA Intern Med 2015; 175(6): 1037–47.

Chaker L, Baumgartner C, den Elzen WP, Ikram MA, Blum MR, Collet TH, et al. Subclinical Hypothyroidism and the Risk of Stroke Events and Fatal Stroke: An Individual Participant Data Analysis. J Clin Endocrinol Metab 2015; 100(6): 2181–91.

Yang L, Lv X, Yue F, Wei D, Liu W, Zhang T. Subclinical hypothyroidism and the risk of metabolic syndrome: A meta-analysis of observational studies. Endocr Res 2016; 41(2): 158–65.

Lai CC, Tang SH, Pei D, Wang CY, Chen YL, Wu CZ, et al. The prevalence of subclinical thyroid dysfunction and its association with metabolic syndrome in Taiwanese elderly. Int J Gerontol 2011; 5(1): 25–9.

Pangaluri R, Akila S, William E. Prevalence of metabolic syn-drome and its components in women with subclinical hypo-thyroidism. Asian J Pharm Clin Res 2013; 6(4): 82–4.

Choudhary PR, Jani RC. Study of thyroid function in patients with metabolic syndrome. Int J Res Med Sci 2016; 4(6): 2024–9.

Udenze I, Nnaji I, Oshodi T. Thyroid function in adult Nigerians with metabolic syndrome. Pan Afr Med J 2014; 18: 352.

Gyawali P, Takanche JS, Shrestha RK, Bhattarai P, Khanal K, Risal P, et al. Pattern of thyroid dysfunction in patients with meta-bolic syndrome and its relationship with components of meta-bolic syndrome. Diabetes Metab J 2015; 39(1): 66–73.

Agarwal G, Sudhakar MK, Singh M, Senthil N, Rajendran A. The prevalence of thyroid dysfunction among south Indian women with metabolic syndrome. J Clin Diagn Res 2011; 5(2): 213–6.

Tarcin O, Abanonu GB, Yazici D, Tarcin O. Association of meta-bolic syndrome parameters with TT3 and FT3/FT4 ratio in obese Turkish population. Metab Syndr Relat Disord 2012; 10(2): 137–42.

Nakajima Y, Yamada M, Akuzawa M, Ishii S, Masamura Y, Satoh T, et al. Subclinical hypothyroidism and indices for metabolic syndrome in Japanese women: One-year follow-up study. J Clin Endocrinol Metab 2013; 98(8): 3280–7.

Iwen KA, Schröder E, Brabant G. Thyroid hormones and the me-tabolic syndrome. Eur Thyroid J 2013; 2(2): 83–92.

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(2): 180–6.