The Effect of Thyroid Hormone Replacement on the Metabolic Control and Insulin Resistance in Patients with Subclinical Hypothyroidism
Men's Health Journal,
Vol. 5 No. 1 (2021),
6 January 2021
Introduction: Studying the treatment effect of subclinical hypothyroidism in decreasing metabolic syndrome risk factors and cardiovascular diseases is necessary and can be helpful to control future disorders. In spite of various studies, the relationship between subclinical hypothyroidism and cardiovascular diseases remain controversial. Studies which consider the effects of subclinical hypothyroidism treatment on metabolic control and insulin resistance have not been done in the Islamic Republic of Iran yet. Materials and methods: In this interventional study, 153 patients with subclinical hypothyroidism (thyroid stimulation hormone (TSH) >5, normal T3 and T4 at least 2 times) were selected from Labbafinejad endocrine clinic. Laboratory tests were performed at 8 a.m. after 12-14 hours fasting. Patients were then treated with levothyroxine (25-50 µg daily). To adjust the dose, thyroid function tests (TFT) were checked every 2 months for 6 months. Collected data was used for analysis by spss18 software. Results: After 6 months treatment of subclinical hypothyroidism mean values improved in factors such as insulin resistance profile (fasting blood sugar (FBS), 2 hours post prandial (2hPP), fasting insulin and homeostasis model assessment estimated insulin resistance (HOMA-IR index), lipid profile (total cholesterol, low density lipoprotein (LDL) and high density lipoprotein (HDL), decreased c-reactive protein (CRP) and weight (all had P value<0.05). Treatment did not have significant effect on triglycerides (TG), waist circumference, body mass index (BMI), uric acid ad systolic/diastolic blood pressure (p values>0.05). But the number of cases with high systolic/diastolic blood pressure decreased significantly after 6 months treatment (P values=0.007 and 0.01). Conclusion: Subclinical hypothyroidism treatment is suggested according to mentioned effects, especially in cases with insulin resistance, lipid profile disturbance, obesity, and high blood pressure.
- Insulin resistance
How to Cite
Biondi B, Palmieri EA, Lombardi G, Fazio S. Effects of subclinical thyroid dysfunction on the heart. Annals of internal medicine. 2002;137(11):904-14.
Bindels AJ, Westendorp RG, Frölich M, Seidell JC, Blokstra A, Smelt AH. The prevalence of subclinical hypothyroidism at different total plasma cholesterol levels in middle aged men and women: a need for case‐finding? Clinical endocrinology. 1999;50(2):217-20.
Morgan L, Davis A, Barton E. Thyroid disease in the elderly. Part 1. Prevalence of undiagnosed hypothyroidism. The Journal of family practice. 1994;38(6):577-82.
Monzani F, Caraccio N, Del Guerra P, Casolaro A, Ferrannini E. Neuromuscular symptoms and dysfunction in subclinical hypothyroid patients: beneficial effect of L‐T4 replacement therapy. Clinical endocrinology. 1999;51(2):237-42.
Centanni M, Cesareo R, Verallo O, Brinelli M, Canettieri G, Viceconti N, et al. Reversible increase of intraocular pressure in subclinical hypothyroid patients. European journal of endocrinology. 1997;136(6):595-8.
Fatourechi V, editor Subclinical hypothyroidism: an update for primary care physicians. Mayo Clinic Proceedings; 2009: Elsevier.
Hollowell JG, Staehling NW, Flanders WD, Hannon WH, Gunter EW, Spencer CA, et al. Serum TSH, T4, and thyroid antibodies in the United States population (1988 to 1994): National Health and Nutrition Examination Survey (NHANES III). The Journal of Clinical Endocrinology & Metabolism. 2002;87(2):489-99.
Luboshitzky R, Aviv A, Herer P, Lavie L. Risk factors for cardiovascular disease in women with subclinical hypothyroidism. Thyroid. 2002;12(5):421-5.
Villar HCCE, Saconato H, Valente O, Atallah ÁN. Thyroid hormone replacement for subclinical hypothyroidism. Cochrane Database of Systematic Reviews. 2007(3).
Canaris GJ, Manowitz NR, Mayor G, Ridgway EC. The Colorado thyroid disease prevalence study. Archives of internal medicine. 2000;160(4):526-34.
Pirich C, Müllner M, Sinzinger H. Prevalence and relevance of thyroid dysfunction in 1922 cholesterol screening participants. Journal of Clinical Epidemiology. 2000;53(6):623-9.
Imaizumi M, Akahoshi M, Ichimaru S, Nakashima E, Hida A, Soda M, et al. Risk for ischemic heart disease and all-cause mortality in subclinical hypothyroidism. The Journal of Clinical Endocrinology & Metabolism. 2004;89(7):3365-70.
Lee W-Y, Suh J-Y, Rhee E-J, Park J-S, Sung K-C, Kim S-W. Plasma CRP, apolipoprotein A-1, apolipoprotein B and Lp (a) levels according to thyroid function status. Archives of medical research. 2004;35(6):540-5.
Chu JW, Crapo LM. The treatment of subclinical hypothyroidism is seldom necessary. The Journal of Clinical Endocrinology & Metabolism. 2001;86(10):4591-9.
Surks MI, Ortiz E, Daniels GH, Sawin CT, Col NF, Cobin RH, et al. Subclinical thyroid disease: scientific review and guidelines for diagnosis and management. Jama. 2004;291(2):228-38.
Surks MI, Hollowell JG. Age-specific distribution of serum thyrotropin and antithyroid antibodies in the US population: implications for the prevalence of subclinical hypothyroidism. The Journal of Clinical Endocrinology & Metabolism. 2007;92(12):4575-82.
Spencer C, Hollowell J, Kazarosyan M, Braverman L. National Health and Nutrition Examination Survey III thyroid-stimulating hormone (TSH)-thyroperoxidase antibody relationships demonstrate that TSH upper reference limits may be skewed by occult thyroid dysfunction. The Journal of Clinical Endocrinology & Metabolism. 2007;92(11):4236-40.
Surks MI, Goswami G, Daniels GH. The thyrotropin reference range should remain unchanged. The Journal of Clinical Endocrinology & Metabolism. 2005;90(9):5489-96.
Wartofsky L, Dickey RA. The evidence for a narrower thyrotropin reference range is compelling. The Journal of Clinical Endocrinology & Metabolism. 2005;90(9):5483-8.
Gharib H, Tuttle RM, Baskin HJ, Fish LH, Singer PA, McDermott MT. Subclinical thyroid dysfunction: a joint statement on management from the American Association of Clinical Endocrinologists, the American Thyroid Association, and the Endocrine Society. Thyroid. 2005;15(1):24-8.
Ganie MA, Laway BA, Wani TA, Zargar MA, Nisar S, Ahamed F, et al. Association of subclinical hypothyroidism and phenotype, insulin resistance, and lipid parameters in young women with polycystic ovary syndrome. Fertility and sterility. 2011;95(6):2039-43.
ALSAYED A, Al Ali N, Abbas YB, Alfadhli E. Subclinical hypothyroidism is associated with early insulin resistance in Kuwaiti women. Endocrine journal. 2006:0608100030-.
Sharma R, Sharma TK, Kaushik G, Sharma S, Vardey S, Sinha M. Subclinical hypothyroidism and its association with cardiovascular risk factors. Clinical laboratory. 2011;57(9-10):719-24.
Dessein PH, Joffe BI, Stanwix AE. Subclinical hypothyroidism is associated with insulin resistance in rheumatoid arthritis. Thyroid. 2004;14(6):443-6.
Singh BM, Goswami B, Mallika V. Association between insulin resistance and hypothyroidism in females attending a tertiary care hospital. Indian Journal of Clinical Biochemistry. 2010;25(2):141-5.
Handisurya A, Pacini G, Tura A, Gessl A, Kautzky‐Willer A. Effects of T4 replacement therapy on glucose metabolism in subjects with subclinical (SH) and overt hypothyroidism (OH). Clinical endocrinology. 2008;69(6):963-9.
Maratou E, Hadjidakis DJ, Kollias A, Tsegka K, Peppa M, Alevizaki M, et al. Studies of insulin resistance in patients with clinical and subclinical hypothyroidism. European journal of endocrinology. 2009;160(5):785.
Liu C, Scherbaum W, Schott M, Schinner S. Subclinical hypothyroidism and the prevalence of the metabolic syndrome. Hormone and metabolic research. 2011;43(06):417-21.
Owecki M, Nikisch E, Sowiński J. Hypothyroidism has no impact on insulin sensitivity assessed with HOMA-IR in totally thyroidectomized patients. Acta Clinica Belgica. 2006;61(2):69-73.
Brenta G, Berg G, Arias P, Zago V, Schnitman M, Muzzio ML, et al. Lipoprotein alterations, hepatic lipase activity, and insulin sensitivity in subclinical hypothyroidism: response to L-T4 treatment. Thyroid. 2007;17(5):453-60.
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. The Journal of Clinical Endocrinology & Metabolism. 2007;92(5):1715-23.
Kong WM, Sheikh MH, Lumb PJ, Freedman DB, Crook M, Doré CJ, et al. A 6-month randomized trial of thyroxine treatment in women with mild subclinical hypothyroidism. The American journal of medicine. 2002;112(5):348-54.
Luboshitzky R, Ishay A, Herer P. Metabolic syndrome and insulin resistance in women with subclinical hypothyroidism. The Endocrinologist. 2010;20(1):29-32.
Erkan G, Erkan AF, Cemri M, Karaahmetoglu S, Cesur M, Cengel A. The evaluation of diastolic dysfunction with tissue Doppler echocardiography in women with subclinical hypothyroidism and the effect of L-thyroxine treatment on diastolic dysfunction: a pilot study. Journal of thyroid research. 2011;2011.
- Abstract Viewed: 0 times
- pdf Downloaded: 0 times