Association between thyroid hormone levels with insulin resistance in obese euthyroid women with metabolic syndrome in Saudi Arabia: A cross-sectional study

Main Article Content

Manal Bin Obead
Nawal Abdullah Al Badr
Sahar Abdulaziz AlSedairy
Tarfa Ibrahim Albrahim
Maha Hussain Alhussain
Tahani Ali Aljurbua
Shaista Arzoo
Weedad Saeed Alqahtani

Keywords

Metabolic syndrome, insulin resistance, diabetes, thyroid hormone, obesity

Abstract

Background: The obesity epidemic is a pressing global health concern, as obesity rates continue to rise worldwide. This study examines the relationship between thyroid hormone levels, insulin resistance and components of metabolic syndrome in euthyroid’s.


Methods: A pre-structured and pre-tested questionnaire was used to gather information and biochemical tests were performed using kits. The homeostatic model assessment (HOMA) ratio formula was used to quantify IR.


Results: A total 100 obese women were clinically evaluated, from which 72 women were diagnosed with metabolic syndrome (MetS+). Body mass index (BMI), systolic blood pressure, total cholesterol (TC), triglyceride (TG), high-density lipoprotein (HDL-C) and thyroid-stimulating hormone (TSH) were statistically higher in MetS+ group. Even in euthyroids, TSH was positively associated with waist circumference and TC. TSH was also positively associated with HOMA-IR (r= 0.018*). FT4 was negatively associated with TC (r = -0.007*), LDL-C (r=-0.084*) and HOMA-IR value (r= -0.187**). The difference between two levels within normal range of TSH (TSH <2.5μIU/mL and TSH ≥2.5 μIU/mL) in terms of age, TC, TG, HDL and LDL have been found to be significantly different. Using a cut-off value of 2.7 for HOMA-IR (> 2.7 resistant, < 2.7 sensitive) BMI, WC, TC, TG, LDL-C and TSH was higher in resistant group.


Conclusion: Obese euthyroids exhibited a significantly positive correlation between HOMA IR values and TSH levels and significantly negative correlation between low normal FT4 and HOMA IR. It has also been established that thyroid function and lipid levels are related even in subjects classified as being euthyroid.

Abstract 744 | PDF Downloads 265

References

1. The Global Burden of Metabolic Risk Factors for Chronic Diseases Collaboration. Cardiovascular disease, chronic kidney disease, and diabetes mortality burden of cardio metabolic risk factors from 1980 to 2010: a comparative risk assessment. Lancet Diabetes Endocrinol 2014; 2: 634-637.
2. Ford ES. Risks for all-cause mortality, cardiovascular disease, and diabetes associated with the metabolic syndrome. Diabetes Care 2005; 28: 1769-1778.
3. Lankatillake C, Huynh T, Dias DA. Understanding glycemic control and current approaches for screening anti diabetic natural products from evidence-based medicinal plants. Plant Methods 2019; 15:105.
4. Farasat T, Cheema AM, Khan MN. Relationship of thyroid hormones with serum fasting insulin and insulin resistance in euthyroid glycemic anomalies. Pakistan J Zool 2011; 43: 379-86.
5. Xu R, Huang F, Zhang S, Yongman Lv, Qingquan Liu. Thyroid function, body mass index, and metabolic risk markers in euthyroid adults: a cohort study. BMC Endocr Disord 2019; 19:58.
6. Knudsen N, Laurberg P, Rasmussen LB, Bulow I, Perrild H, Ovesen L, Jorgensen T. Small differences in thyroid function may be important for body mass index and the occurrence of obesity in the population. J Clin Endocrinol Metab, 2005; 90: 4019–4024.
7. Topsakal S, Yerlikaya E, Akin F, Kaptanoglu B, Erurker T. Relation with HOMA-IR and thyroid hormones in obese Turkish women with metabolic syndrome. Eat Weight Disord 2012; 17:e57-61.
8. Wang C. The relationship between type 2 diabetes mellitus and related thyroid diseases. J Diab Res 2013; 2013: 390534.
9. Klieverik LP, Janssen SF, Van Riel A. Thyroid hormone modulates glucose production via a sympathetic pathway from the hypothalamic paraventricular nucleus to the liver. Proc Natl Acad Sci 2009; 106: 5966-5971.
10. Naslund E, Andersson I, Degerblad M. Associations of leptin, insulin resistance and thyroid function with long-term weight loss in dieting obese men. J Intern Med 2000; 248: 299-308.
11. Baskin HJ, Cobin RH, Duick DS. American association of clinical endocrinologists. Medical guidelines for clinical practice for the evaluation and treatment of hyperthyroidism and hypothyroidism. Endocr Pract 2002; 8: 457–69.
12. Gharib H, Tuttle RM, Baskin HJ, Fish LH, Singer PA, Mc Dermott. Subclinical thyroid dysfunction: a joint statement on management from the American Association of Clinical Endocrinologists, the American Thyroid Association, and the Endocrine Society. J Clin Endocrinol Metab 2005; 90: 581-585.
13. Zou J, Tian F, Zhang Y. Association between thyroid hormone levels and diabetic kidney disease in euthyroid patients with type 2 diabetes. Sci Rep 2018; 8:4728.
14. Kratzsch J, Fiedler GM, Leichtlle A. New reference intervals for thyrotropin and thyroid hormones based on National Academy of Clinical Biochemistry criteria and regular ultrasonography of the thyroid. Clin Chem 2005; 51: 1480–1486.
15. Qi Qi, Qiu-Mei Zhang, Chun-Jun Li, Dong RN, Li JJ, Shi JY. Association of thyroid-stimulating hormone levels with microvascular complications in type 2 diabetes patients. Med Sci Monit 2017; 23: 2715–2720.
16. Petrosyan L. Relationship between high normal TSH levels and metabolic syndrome components in type 2 diabetic subjects with euthyroidism. J Clin Transl Endocrinol 2015; 2:110–113.
17. Atabek ME and Pirgon O. Assessment of insulin sensitivity from measurements in fasting state and during an oral glucose tolerance test in obese children. J Pediatr Endocrinol Metab 2007; 20: 187-195.
18. Grundy SM, Cleeman JI, Daniels SR. Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. Circulation 2005; 112: 2735–52.
19. Expert panel on detection, evaluation, and treatment of high blood cholesterol in adults. Executive summary of the third report of the national cholesterol education program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III). JAMA 2001; 285: 2486 –2497.
20. Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher DF, Turner RC. Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia 1985, 28: 412-419.
21. De Pergola G, Ciampolillo A, Paolotti S, Trerotoli P, Giorgino R. Free triiodothyronine and thyroid stimulating hormone are directly associated with waist circumference, independently of insulin resistance, metabolic parameters and blood pressure in overweight and obese women. Clin Endocrinol 2007; 67: 265-269.
22. Ayturk S, Gursoy A, Kut A, Anil C, Nar A, Tutuncu NB. Metabolic syndrome and its components are associated with increased thyroid volume and nodule prevalence in a mild-to-moderate iodine-deficient area. Eur J Endocrinol 2009; 161: 599-605.
23. Tarcin O, Abanonu GB, Yazici D, Tarcin O. Association of metabolic syndrome parameters with TT3 and FT3/FT4 ratio in obese Turkish population. Metab Syndr Relat Disord 2012; 10: 137-142.
24. Demidova T, Galieva OR. The role of thyroid hypofunction in development of metabolic syndrome. Ter Arkh 2009; 81 (4): 69-73.
25. Eckel RH, SM Grundy, PZ Zimmet. The metabolic syndrome. Lancet 2005; 365: 1415-1428.
26. Aksoy N, Yeler MT, Ayan NN, Ozkeskin A, Ozkan Z, Serin NO. Association between thyroid hormone levels and insulin resistance and body mass index. Pak J Med Sci 2015; 31: 1417–1420.
27. Racataianu N, Leach N, Bondor CI, Marza S, Moga D. Thyroid disorders in obese patients. Does insulin resistance make a difference? Arch Endocrinol Metab 2017; 61: 575-583.
28. Lekakis J, Papamichael C, Alevizaki M. Flow-mediated, endothelium-dependent vasodilatation is impaired in subjects with hypothyroidism, borderline hypothyroidism, and high normal serum thyrotrophic (TSH) values. Thyroid 1997; 7: 411–414.
29. Santos MI, Limbert C, Marques FC, Rosario F, Lopes L. Childhood obesity, thyroid function, and insulin resistance – is there a link? A longitudinal study. J Pediatr Endocrinol Metab 2015; 28: 557–562.
30. Geloneze B, Vasques ACJ, Stabe CFC. HOMA1-IR and HOMA2-IR indexes in identifying insulin resistance and metabolic syndrome-Brazilian metabolic syndrome study (BRAMS). Arq Bras Endocrinol Metabol 2009; 53:281-287.
31. Freedland ES. Role of a critical visceral adipose tissue threshold (CVATT) in metabolic syndrome: implications for controlling dietary carbohydrates: a review. Nutr Metab (Lond) 2004; 1:12.
32. Weisberg SP, McCann D, Desai M. Obesity is associated with macrophage accumulation in adipose tissue. J Clin Invest 2003; 112: 1796-1808.
33. Vyakaranam S, Vanaparthy S, Nori S, Palarapu S, Bhongir AV. Study of insulin resistance in subclinical hypothyroidism. Int J Health Sci Res 2014; 4: 147–153.
34. Feldt-Rasmussen U. Thyroid and leptin. Thyroid 2007; 17: 413-419.
35. Sari R, Balci MK, Altunbas H, Karayalcin U. The effect of body weight and weight loss on thyroid volume and function in obese women. Clin Endocrinol (Oxf) 2003; 59: 258-262.
36. Roef G, Lapauw B, Goemaere S. Body composition and metabolic parameters are associated with variation in thyroid hormone levels among euthyroid young men. Eur J Endocrinol 2012; 167: 719-726.
37. Bakker SJ, ter Maaten JC, Popp-Snijders C, Heine RJ, Gans RO. Triiodothyronine: a link between the insulin resistance syndrome and blood pressure? J Hypertens 1999; 17:1725–1730.
38. Shin JA, Mo EY, Kim ES, Moon SD, Han JH. Association between lower normal free thyroxine concentrations and obesity phenotype in healthy euthyroid subjects. Int J Endocrinol 2014; 2014:104318.
39. Roos A, Bakker SJL, Links TP, Gans ROB, Wolffenbuttel BHR. Thyroid function is associated with components of the metabolic syndrome in euthyroid subjects. J Clin Endocrinol Metab 2007; 92: 491-496.
40. Kavitha G, Nageshwari A. Prevalence of metabolic syndrome in euthyroid patients in Perambalur District. IAIM 2019; 6: 36-40

Most read articles by the same author(s)