Serum TSH level in obese children and its correlations with atherogenic lipid indicators and carotid intima media thickness

Rumińska, Małgorzata; Witkowska-Sędek, Ewelina; Majcher, Anna; Brzewski, Michał; Krawczyk, Monika; Pyrżak, Beata

doi:10.15557/jou.2018.0043

Abstract

Objective: Moderately elevated level of thyroid-stimulating hormone accompanied by normal serum concentrations of free thyroxine, suggesting subclinical hypothyroidism, is the most common hormonal abnormality in obese children. Controversy remains, whether a thyroid dysfunction related to obesity has an influence on the cardiovascular risk factors. The aim of the study was to assess correlation between thyroid-stimulating hormone and free thyroxine and chosen atherogenic lipid indicators, and carotid intima media thickness in obese children and adolescents. Methods: A study group consisted of 110 obese children (11.5 ± 2.9 years) and 38 healthy children (13.4 ± 2.6 years). Obesity was defined using International Obesity Task Force criteria. In each patient anthropometric measurements, thyroid-stimulating hormone, free thyroxine, a lipid profile were evaluated. Carotid intima-media thickness was measured in 74 obese children and 28 lean children. The resulting data were used to calculate indicators of atherogenesis: total cholesterol to HDL cholesterol ratio; triglycerides to HDL cholesterol ratio and LDL cholesterol to HDL cholesterol ratio. Results: Obese children had higher mean serum thyroid-stimulating hormone levels compared to their lean peers and an adverse atherogenic lipid profile. Serum free thyroxine concentrations were comparable between the groups. Serum thyroid-stimulating hormone values correlated with total cholesterol to HDL cholesterol ratio; triglycerides to HDL cholesterol ratio, LDL cholesterol to HDL cholesterol ratio, and intima-media thickness. In a multivariate regression analysis, thyroid-stimulating hormone weakly correlated only with intima-media thickness after adjustment for age, gender and Body Mass Index (β = 0.249, p = 0.04). This relationship weakened after considering a lipid profile (β = 0.242, p = 0.058). No relationship was found for free thyroxine. Conclusion: Serum level of thyroid-stimulating hormone in obese children did not seem to impact atherogenic lipid indicators and carotid intima-media thickness. Therefore, an adverse lipid profile should still be considered the main risk factor for development of cardiovascular diseases in obese children.

References

Sanyal D, Raychaudhuri M: Hypothyroidism and obesity: an intriguing link. Indian J Endocrinol Metab 2016; 20: 554–557.
Search in Google Scholar Back to article
Ghergherehchi R, Hazhir N: Thyroid hormonal status among children with obesity. Ther Adv Endocrinol Metab 2015; 6: 51–55.
Search in Google Scholar Back to article
Lioudaki E, Mavroeidi NG, Mikhailidis DP, Ganotakis ES: Subclinical hypothyroidism and vascular risk: an update. Hormones (Athens) 2013; 12: 495–506.
Search in Google Scholar Back to article
Floriani C, Gencer B, Collet TH, Rodondi N: Subclinical thyroid dysfunction and cardiovascular diseases: 2016 update. Eur Heart J 2018; 39: 503–507.
Search in Google Scholar Back to article
Pearce SH, Brabant G, Duntas LH, Monzani F, Peeters RP, Razvi S et al.: ETA guideline: Management of subclinical hypothyroidism. Eur Thyroid J 2013; 2: 215–228.
Search in Google Scholar Back to article
Hak AE, Pols HA, Vissel 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.
Search in Google Scholar Back to article
Akkoca AN, Özdemir ZT, Özler GS, Karabulut L: The evaluation of carotid intima thickness in clinical and subclinical hypothyroidism and effects of thyroid hormone treatment. Am J Clin Exp Med 2014; 2: 59–63.
Search in Google Scholar Back to article
Peixoto de Miranda ÉJ, Bittencourt MS, Pereira AC, Goulart AC, Santos IS. Lotufo PA et al.: Subclinical hypothyroidism is associated with higher carotid intima-media thickness in cross-sectional analysis of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Nutr Metab Cardiovasc Dis 2016; 26: 915–921.
Search in Google Scholar Back to article
Valentina VN, Marijan B, Chedo D, Branka K: Subclinical hypothyroidism and risk to carotid atherosclerosis. Arq Bras Endocrinol Metabol 2011; 55: 475–480.
Search in Google Scholar Back to article
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; 92: 1715–1723.
Search in Google Scholar Back to article
Pearce EN: Update in lipid alterations in subclinical hypothyroidism. J Clin Endocrinol Metab 2012; 97: 326–333.
Search in Google Scholar Back to article
Gao N, Zhang W, Zhang YZ, Yang Q, Chen SH: Carotid intima-media thickness in patients with subclinical hypothyroidism: a meta-analysis. Atherosclerosis 2013; 227: 18–25.
Search in Google Scholar Back to article
Ünal E, Akın A, Yıldırım R, Demir V, Yildiz I, Haspolat YK: Association of subclinical hypothyroidism with dyslipidemia and increased carotid intima-media thickness in children. J Clin Res Pediatr Endocrinol 2016; 9: 144–149.
Search in Google Scholar Back to article
Brienza C, Grandone A, Di Salvo G, Corona AM, Di Sessa A, Pascotto C et al.: Subclinical hypothyroidism and myocardial function in obese children. Nutr Metab Cardiovasc Dis 2013; 23: 898–902.
Search in Google Scholar Back to article
Rumińska M, Witkowska-Sędek E, Majcher A, Pyrżak B: Thyroid function in obese children and adolescents and its association with anthropometric and metabolic parameters. Adv Exp Med Biol 2016; 912: 33–41.
Search in Google Scholar Back to article
Lorenz MW, Markus HS, Bots ML, Rosvall M, Sitzer M: Prediction of clinical cardiovascular events with carotid intima-media thickness: A systematic review and meta-analysis. Circulation 2007; 115: 459–467.
Search in Google Scholar Back to article
Cole TJ, Bellizzi MC, Flegal KM, Dietz WH: Establishing a standard definition for child overweight and obesity worldwide: international survey. BMJ 2000; 320: 1240–1243.
Search in Google Scholar Back to article
Slaughter MH, Lohman TG, Christ CB, Boileau RA: Skinfold equations for estimation of body fitness in children and youth. Hum Biol 1988; 60: 709–723.
Search in Google Scholar Back to article
Cole TJ: The LMS method for constructing normalized growth standard. Eur J Clin Nutr 1990; 44: 45–60.
Search in Google Scholar Back to article
Hayman LL, Meininger JC, Daniels SR, McCrindle BW, Helden L, Ross J et al.: Primary prevention of cardiovascular disease in nursing practice: focus on children and youth: A scientific statement from the American Heart Association Committee on Atherosclerosis, Hypertension, and Obesity in Youth of the Council on Cardiovascular Disease in the Young, Council on Cardiovascular Nursing, Council on Epidemiology and Prevention, and Council on Nutrition, Physical Activity, and Metabolism. Circulation 2007; 116: 344–357.
Search in Google Scholar Back to article
Millán J, Pintó X, Muñoz A, Zúñiga M, Rubiés-Prat J, Pallardo LF et al.: Lipoprotein ratios: physiological significance and clinical usefulness in cardiovascular prevention. Vasc Health Risk Manag 2009; 5: 757–765.
Search in Google Scholar Back to article
Olson K, Hendricks B, Murdock DK: The triglyceride to HDL ratio and its relationship to insulin resistance in pre- and postpubertal children: observation from the Wausau SCHOOL Project. Cholesterol 2012;2012:794252.
Search in Google Scholar Back to article
Ochs N, Auer R, Bauer DC, Nanchen D, Gussekloo J, Cornuz J et al.: Meta-analysis: subclinical thyroid dysfunction and the risk for coronary heart disease and mortality. Ann Intern Med 2008; 148: 832–845.
Search in Google Scholar Back to article
Isik-Balci Y, Agladioglu S, Agladioglu K, Kilic-Toprak E, Kilic-Erkek O, Ozhan B et al.: Impaired hemorheological parameters and increased carotid intima-media thickness in children with subclinical hypothyroidism. Horm Res Paediatr 2016; 85: 250–256.
Search in Google Scholar Back to article
Schiel R, Beltschikow W, Radón S, Kramer G, Perenthaler T, Stein G: Increased carotid intima-media thickness and associations with cardiovascular risk factors in obese and overweight children and adolescents. Eur J Med Res 2007; 12: 503–508.
Search in Google Scholar Back to article
Sert A, Pirgon O, Aypar E, Yilmaz H, Odabas D: Subclinical hypothyroidism as a risk factor for the development of cardiovascular disease in obese adolescents with nonalcoholic fatty liver disease. Pediatr Cardiol 2013; 34: 1166–1174.
Search in Google Scholar Back to article
Özer S, Bütün I, Sönmezgöz E, Yılmaz R, Demir O: Relationships among thyroid hormones and obesity severity, metabolic syndrome and its components in Turkish children with obesity. Nutr Hosp 2015; 32: 645–651.
Search in Google Scholar Back to article
Zhang W, Tian L, Han Y, Ma H, Wang LC, Guo J et al.: Presence of thyrotropin receptor in hepatocytes: not a case of illegitimate transcription. J Cell Mol Med 2009; 13: 4636–4642.
Search in Google Scholar Back to article
Asvold BO, Vatten LJ, Nilsen TI, Bjøro 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.
Search in Google Scholar Back to article
Aeberli I, Jung A, Murer SB, Wildhaber J, Wildhaber-Brooks J, Knöpi BH et al.: During rapid weight loss in obese children, reductions in TSH predict improvements in insulin sensitivity independent of changes in body weight or fat. J Clin Endocrinol Metab 2010; 95: 5412–5418.
Search in Google Scholar Back to article
Pacifico L, Anania C, Ferraro F, Andreoli GM, Chiesa C: Thyroid function in childhood obesity and metabolic comorbidity. Clin Chim Acta 2012; 413: 396–405.
Search in Google Scholar Back to article
Shalitin S, Yackobovitch-Gavan M, Phillip M: Prevalence of thyroid dysfunction in obese children and adolescents before and after weight reduction and its relation to other metabolic parameters. Horm Res 2009; 71: 155–161.
Search in Google Scholar Back to article
Lazarus J, Brown RS, Daumerie C, Hubalewska-Dydejczyk A, Negro R, Vaidya B: 2014 European thyroid association guidelines for the management of subclinical hypothyroidism in pregnancy and in children. Eur Thyroid J 2014; 3: 76–94.
Search in Google Scholar Back to article
Wolters B, Lass N, Reinehr T: TSH and free triiodothyronine concentrations are associated with weight loss in a life style intervention and weight regain afterwards in obese children. Eur J Endocrinol 2013; 168: 323–329.
Search in Google Scholar Back to article
Matusik P, Gawlik A, Januszek-Trzciakowska A, Malecka-Tendera E: Isolated subclinical hyperthyrotropinemia in obese children: does levothyroxine (LT4) improve weight reduction during combined behavioral therapy? Int J Endocrinol 2015; 2015: 792509.
Search in Google Scholar Back to article

Serum TSH level in obese children and its correlations with atherogenic lipid indicators and carotid intima media thickness

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