Volume: 7 Issue: 2
Year: 2019, Page: 56-61,
Context: Overt hypothyroidism is an established risk factor for insulin resistance and hyperlipidemia
Aims: To evaluate the role of thyroid dysfunction on alteration of glucose and lipid metabolism leading to insulin resistance, an important risk factor for cardio vascular diseases.
Setting and Design: In this study we included 50 subjects, aged 25 to 35 years. This is a case control study conducted in department of Biochemistry.
Materials & Methods: Investigations like fasting and post prandial blood sugar, HbA1c and lipid profile (Cholesterol, Triglycerides, HDL, LDL & VLDL) were done. Blood pressure was measured. Body weight and height were measured and BMI was calculated. All the parameters were analyzed using XL 640 fully automated random access analyzer.
Statistical analysis used: tudent t test was used using graph pad quickcalcs software.
Results: The cases were selected based on T4 and TSH concentrations whose values were significantly decreased and elevated respectively. The patients with hypothyroidism exhibited significant increase in concentration of total cholesterol, LDL, fasting blood glucose and HbA1c while HDL (p<0.05) showed a decrease in its concentration in comparison to controls. BMI and diastolic blood pressure showed significant elevation in hypothyroid individuals when compared to controls.
Conclusions: It is evident from this study that insulin resistance bears an indispensable role in connecting T2DM and thyroid dysfunction. Cardiovascular events are the counter reflection of resurgence of heavily disturbed lipid metabolism due to thyroid dyscrasias.
Keywords: Hypothyroidism, lipid profile, glycated hemoglobin, blood pressure and BMI Key Messages: Careful screening of patients with hypothyroidism is necessary to determine the lipid and diabetic status with the aim of timely treatment and prevention of the development of atherosclerosis and potential complications of atherosclerosis.
1. Annemike R, Stephen JL, Links Thera P, Gans Rijik OB Thyroid function is associated with components of the metabolic syndrome in euthyroid subjects. JCli Endo Metabolism. 2007; 92:491.
2. Bakker SJL, Ter Maten Jc, Pop sinjders C. The relationship between thyrotropin and low density lipoprotein cholesterol is modified by insulin sensitivity in healthy euthyroid subjects. Cli Endocrinol Metabolism. 2001; 86:1206-11.
3. Kutty KM, Bryant DG, Farid NR. Serum lipids in hypothyroidism-a re-evaluation. J Clin Endocrinol Metab 1978 Jan; 46(1):55-6.
4. Alireza Rastgooye Haghi et al Correlation Between Subclinical Hypothyroidism and Dyslipidemia Iranian journal of pathology. Vol.12 No.2 Spring 2017
5. Vanderpump MP. The epidemiology of thyroid disease. Br Med Bull. 2011;99:39-51.
6. Peeyush Yadav, G.G.Kaushik, Sonali Sharma. Importance of Screening Type-II Diabetics for Thyroid Dysfunction and Dyslipidemia International Journal of Biochemistry and Biophysics 2015; 3(2): 7-12
7. Coller FA, Huggins CB. effect of hyperthyroidism upon diabetes mellitus: striking improvement in diabetes mellitus from thyroidectomy. Ann Surg. 1927 Dec;86(6):877-84.
8. Sawin CT, Castelli WP, Hershman JM, McNamara P,Bacharach P 1985 The aging thyroid: Thyroid deficiency in the Framingham study. Arch Intern Med 145:1386– 1388.
9. Goran MI. Energy metabolism and obesity. Med Clin North Am. 2000;84:347– 62.
10. Leonhardt U, Ritzel U, Schafer G, Becker W, Ramadori G. Serum leptin levels in hypo- and hyperthyroidism. J Endocrinol. 1998;157:75–9.
11. Carpenter WH, Fonong T, Toth MJ, et al. Total daily energy expenditure in free-living older African-Americans and Caucasians. Am J Physiol. 1998;274:E96 –101.
12. Foster GD, Wadden TA, Vogt RA. Resting energy expenditure in obese African American and Caucasian women.Obes Res. 1997;5:1– 8.
13. Wurmser H, Laessle R, Jacob K, et al. Resting metabolic rate in preadolescent girls at high risk of obesity. Int J Obes Relat Metab Disord. 1998;22:793–9.
14. Friis T, Pedersen LR 1987 Serum lipids in hyper- and hypothyroidism before and after treatment. Clin Chim Acta 162:155–163.
15. Benvenga S, Gregg R, Robbins J 1988 Binding of thyroxine hormone to human plasma lipoprotein. J Clin Endocrinol Metab 67:6–16.
16. Benvenga S, Robbins J 1990. Enhancement of thyroxine entry into low density lipoprotein (LDL) receptorcompetent fibroblasts by LDL: An additional mode of entry of thyroxine into cells. Endocrinology 126:933–941.
17. Statels B, van Tol A, Chan L, Will H, Verhoeven G, Auwerz J 1990 Alterations in thyroid status modulate apolipoprotein, hepatic triglyceride lipase and low density lipoprotein receptor in rats. Endocrinology 127:1144– 1152.
18. Scottolini AG, Bhagavan NV, Oshiro TH, Abe SY 1980 Serum high-density lipoprotein cholesterol concentrations in hypoand hyperthyroidism. Clin Chem 26:584–587.
19. Tan KCB, Shiu SWM, Kung AWC 1998 Plasma cholesteryl ester transfer protein activity in hyper- and hypothyroidism. J Clin Endocrinol Metab 83:149–153.
20. Lagrost L 1994 Regulation of cholesteryl ester transfer protein (CETP) activity: Review of in vitro and in vivo studies. Biochem Biophys Acta 1215:209–236.
21. Kussi T, Sacrinen P, Nikkila EA 1980 Evidence for the role of hepatic endothelial lipase in the metabolism of plasma high density lipoprotein2 in man. Atherosclerosis 36:589– 593.
22. Gould GW, Holmen GD. The glucose transporter family; structure,function and tissue specific expression Biochem journal. 1993;295-329.
23. Turner RC, Holman RR, Matthews D, Hockaday TD, Peto J. Insulin deficiency and insulin resistance interaction in diabetes: estimation of their relative contribution by feedback analysis from basal plasma insulin and glucose concentrations. Metabolism. 1979;28:1086-96.
24. American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care. 2011;34(Suppl. 1):S62-69. .
25. Gram-Hansen P, Eriksen J, Mourits-Andersen T, Olesen L. Glycosylated Haemoglobin (HbA1c) in iron and vitamin B12 deficiency. J Int Med. 1990;227:133-6.
26. Vij V, Chitnis P, Gupta VK. Evalution of thyroid dysfunction among type 2 diabetic patients. Int J Pharm Bio Sci. 2012;2:150-5.
27. Hardikar PS, Joshi SM, Bhat DS, Raut DA, Katre PA, et al. Spuriously high prevalence of prediabetes diagnosed by HbA1c in young Indians partly explained by haematological factors and iron deficiency anemia. Diabetes Care. 2012;35(4):797-802.
28. Horton L, Coburn RJ, England JM, Himsworth RL. The hematology of hypothyroidism Q J Med 1976;45(177): 101-23.
29. Das KC, Mukherjee M, Sarkar TK, Dash RJ, Rastogi GK. Erythropoiesis and erythropoietin in hypoand hyperthyroidism. J Clin Endocrinol Metab. 1975;40:211- 20.
30. Fein HG, Rivlin RS. Anaemia in thyroid diseases. Med Clin North Am. 1975;59:1133-45.
31. Al Sayed A, Al Ali N, Bo Abbas Y, Alfadhli E. Subclinical hypothyroidism is associated with early insulin resistance in Kuwaiti women. Endocr J. 2006;53(5):653-7.
32. Franklyn JA, Daykin J, Betteridge J, Hughes EA, Holder R, Jones SR, Sheppard MC 1993 Thyroxine replacement therapy and circulating lipid concentrations. Clin Endocrinol 38:453–459.
33. Klein I 1990 Thyroid hormone and the cardiovascular system. Am J Med 88:626–630.
34. Klein I, Ojamaa K 1992 Cardiovascular manifestations of endocrine disease. J Clin Endocrinol Metab 75:339–342.
35. Klemperer JD, Ojamaa K, Klein I 1996 Thyroid hormone therapy in cardiovascular disease. Prog Cardiovasc Dis 4:329–336.
Usha kiran P, Sandeesha V, Lakshmana kumar N. Role of hypothyroidism in dyslipidemia and blood glucose regulation. Perspectives in Medical Research 2019; 7(2):56-61.