Pattern of lipid alterations in subclinical hypothyroidism: response to Levothyroxine replacement
Abstract
Objectives: (1) To assess the association of subclinical hypothyroidism (SCH) and lipid profile (2) To quantify the effect of thyroxine treatment on lipid profile.
Methods: In a non-randomized matched design, 320 patients who were detected to have SCH and 180 euthyroid controls, matched for age and BMI (body-mass index), werestudied for lipid parameters. Subjects with SCH were further subdivided on the basis of their thyroid functional status: SCH with TSH≤10.0 mIU/L (SCH-1) and SCH with TSH>10 mIU/L (SCH-2). Subjects in SCH-2 group were started on thyroxine replacement and were followed up after 3 months with a repeat lipid profile.
Results: Mean total cholesterol (TC) and low-density lipoprotein (LDL) levels were higher and mean high-density lipoprotein (HDL) significantly lower in SCH (SCH-1 and SCH-2) compared to euthyroid controls, but there was no statistically significant difference in the mean triglyceride (TG) levels. Subjects in SCH-2 group had significantly higher mean LDL and lower mean HDL compared to SCH-1 group. There was a significant reduction in mean TC and LDL and increase in HDL after treatment with thyroxine, while there was no significant difference among the mean TG levels.
Conclusion: Subclinical hypothyroidism is associated with TSH dependent rise in TC and LDL and fall in HDL compared to controls. Achieving euthyroid status with thyroxine has a favourable effect on lipid profile
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References
Yen PM. Physiological and molecular basis of thyroid hormone action. Physiol Rev. 2001 Jul;81(3):1097-142.
Pucci E, Chiovato L, Pinchera A. Thyroid and lipid metabolism. Int J Obes Relat Metab Disord. 2000 Jun;24 Suppl 2:S109-12.
Maratou E, Hadjidakis DJ, Kollias A, Tsegka K, Peppa M, Alevizaki M, Mitrou P, Lambadiari V, Boutati E, Nikzas D, Tountas N, Economopoulos T, Raptis SA, Dimitriadis G. Studies of insulin resistance in patients with clinical and subclinicalhypothyroidism. Eur J Endocrinol.2009 May;160(5):785-90. doi: http://dx.doi.org/10.1530/EJE-08-0797. Epub2009Jan13.
Jung CH, Sung KC, Shin HS. Thyroid dysfunction and their relation to cardiovascular risk factors such as lipid profile, hsCRP, and waist hip ratio in Korea. Korean J Intern Med 2003 Sep;18(3):146–53.
Garduño-Garcia Jde J, Alvirde-Garcia U, López-Carrasco G, Padilla Mendoza ME, Mehta R, Arellano-Campos O, Choza R, Sauque L, Garay-Sevilla ME, Malacara JM, Gomez-Perez FJ, Aguilar-Salinas CA. TSH and freethyroxineconcentrations are associated with differingmetabolicmarkers in euthyroidsubjects.Eur J Endocrinol.2010 Aug;163(2):273-8. doi: 10.1530/EJE-10-0312. Epub2010Jun1.
Park HT, Cho GJ, Ahn KH, Shin JH, Hong SC, Kim T, Hur JY, Kim YT, Lee KW, Kim SH. Thyroid stimulating hormone is associated with metabolic syndrome in euthyroid postmenopausal women. Maturitas. 2009 Mar 20;62(3):301-5. doi: https://doi.org/10.1016/j.maturitas.2009.01.007. Epub 2009 Feb 27.
Asvold BO, Vatten LJ, Nilsen TI, Bjøro T. The association between TSH within the reference range and serumlipidconcentrationsin apopulation-basedstudy. The HUNTStudy.Eur J Endocrinol.2007 Feb;156(2):181-6.
Laway BA, War FA, Shah S, Misgar RA, Kumar Kotwal S. Alteration of lipidparameters in patients with subclinicalhypothyroidism. Int J Endocrinol Metab. 2014 Jul 1;12(3):e17496. doi: https://dx.doi.org/10.5812%2Fijem.17496. e Collection 2014 Jul.
Pirich C, Müllner M, Sinzinger H. Prevalence and relevance of thyroid dysfunction in 1922 cholesterol screening participants. J Clin Epidemiol. 2000 Jun;53(6):623-9.
Hueston WJ, Pearson WS. Subclinical hypothyroidism and the risk of hypercholesterolemia. Ann Fam Med. 2004 Jul-Aug;2(4):351-5.
Biondi B, Klein I. Hypothyroidism as a risk factor for cardiovascular disease. Endocrine.2004 Jun;24(1):1-13.
Zhao M, Yang T, Chen L, Tang X, Guan Q, Zhang B, et al.Subclinical hypothyroidism might worsen the effects of aging on serum lipid profiles: A population-based case-control study. Thyroid 2015 May;25(5):485-93. doi: https://doi.org/10.1089/thy.2014.0219.
Villar HC, Saconato H, Valente O. Thyroid hormone replacement for subclinical hypothyroidism. Cochrane Database Syst Rev 2009;3:CD003419.
Biondi B, Cooper DS. The clinical significance of subclinical thyroid dysfunction. Endocr Rev. 2008 Feb;29(1):76-131. Epub 2007 Nov 8.
Gillett M. Subclinical Hypothyroidism: Subclinical Thyroid Disease: Scientific Review and Guidelines for Diagnosis and Management. The Clin Biochem Rev. 2004 ; 25:191-194.
Shekhar R, Chowdary NVS, Das MC, Vidya D, Prabodh. Prevalence of subclinical hypothyroidism in costal region of Andhra Pradesh. S. Biomed Res. 2011;22:471-474.
Vierhapper H, Nardi A, Grösser P, Raber W, Gessl A. Low-density lipoprotein cholesterol in subclinicalhypothyroidism. Thyroid.2000Nov;10(11):981-4.
Hueston WJ, Pearson WS. Subclinical hypothyroidism and the risk of hypercholesterolemia. Ann Fam Med. 2004 Jul-Aug;2(4):351-5.
Takashima N, Niwa Y, Mannami T, Tomoike H, Iwai N. Characterization of subclinicalthyroiddysfunction from cardiovascular and metabolicviewpoints: the Suitastudy.Circ J. 2007 Feb;71(2):191-5.
Canaris GJ, Manowitz NR, Mayor G, Ridgway EC. The Colorado thyroid disease prevalence study. Arch Intern Med. 2000 Feb 28;160(4):526-34.
Pradeep S, Dibyaratna P , Sapna G , Geeta S, Pathak,MS. Indian Journal of Basic & Applied Medical Research; June 2013; Issue-7, Vol.-2, P. 779-788.
Dubey TN, Vibhor U, Deopujari K. Correlation of Subclinical Hypothyroidism with Dyslipidemia in Perimenopausal Women. International Journal of Contemporary Medical Research 2016;3(7):1928-1931.
Marwaha RK, Tandon N, Garg MK, Kanwar R, Sastry A, Narang A, Arora S, Bhadra K. Dyslipidemia in subclinical hypothyroidism in an Indian population. Clin Biochem. 2011 Oct;44(14-15):1214-7. doi: https://doi.org/10.1016/j.clinbiochem.2011.07.003. Epub 2011 Jul 19.
Kuldip Singh, Saranpal Singh. Alteration in lipid fractions in subclinical Hypothyroidism in North Indian population.Indian J Fundam Appl Life Sci 2011;1(2):127-32.
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 Feb;92(2):491-6. Epub 2006 Nov 7.
Asvold BO, Vatten LJ, Nilsen TI, Bjøro T. The association between TSH within the reference range and serumlipidconcentrationsin apopulation-basedstudy. The HUNTStudy.Eur J Endocrinol.2007 Feb;156(2):181-6.
Borba EF, Carvalho JF, Bonfá E. Mechanisms of dyslipoproteinemias in systemic lupus erythematosus. Clin Dev Immunol. 2006 Jun-Dec;13(2-4):203-8.
Efstathiadou Z, Bitsis S, Milionis HJ, Kukuvitis A, Bairaktari ET, Elisaf MS, Tsatsoulis A. Lipid profile in subclinical hypothyroidism: is L-thyroxine substitution beneficial? Eur J Endocrinol. 2001 Dec;145(6):705-10.
Michalopoulou G, Alevizaki M, Piperingos G, Mitsibounas D, Mantzos E, Adamopoulos P, Koutras DA. High serum cholesterol levels in persons with 'high-normal' TSH levels: should one extend the definition of subclinicalhypothyroidism? Eur J Endocrinol. 1998 Feb;138(2):141-5.
Duman D, Sahin S, Esertas K, Demirtunc R. Simvastatin improves endothelial function in patents with subclinical hypothyroidism. Heart Vessels 2007;22:88–93.
Villar HC, Saconato H, Valente O, Atallah AN. Thyroid hormone replacement for subclinicalhypothyroidism. Cochrane Database Syst Rev. 2007 Jul 18;(3):CD003419.
Tanis BC, Westendorp GJ, Smelt HM. Effect of thyroid substitution on hypercholesterolaemia in patients with subclinical hypothyroidism: a reanalysis of intervention studies. Clin Endocrinol (Oxf). 1996 Jun;44(6):643-9.
Danese MD, Ladenson PW, Meinert CL, Powe NR. Clinical review 115: effect of thyroxine therapy on serum lipoproteins in patients with mild thyroid failure: a quantitative review of the literature. J Clin Endocrinol Metab. 2000 Sep;85(9):2993-3001.
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 hypothyroidism: randomized, crossover trial. J Clin Endocrinol Metab. 2007 May;92(5):1715-23. Epub 2007 Feb 13.
Adrees M, Gibney J, El-Saeity N, Boran G. Effects of 18 months of L-T4 replacement in women with subclinical hypothyroidism. Clin Endocrinol (Oxf). 2009 Aug;71(2):298-303. doi: https://doi.org/10.1111/j.1365-2265.2008.03509.x. Epub 2008 Dec 15.
Caraccio N, Ferrannini E, Monzani F. Lipoprotein profile in subclinical hypothyroidism: response to levothyroxine replacement, a randomized placebo-controlled study. J Clin Endocrinol Metab. 2002 Apr;87(4):1533-8.
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