Reference values for TSH may be inadequate to define hypothyroidism in persons with morbid obesity: Di@bet.es study

Valdés, Sergio; Maldonado-Araque, Cristina; Lago-Sampedro, Ana; Lillo-Muñoz, Juan Antonio; Garcı́a-Fuentes, Eduardo; Pérez-Valero, Vidal; Gutiérrez-Repiso, Carolina; García‐Escobar, Eva; Goday, Albert; Urrutia, Inés; Peláez, Laura; Calle-Pascual, Alfonso; Bordiú, Elena; Castaño, Luís; Castell, Conxa; Delgado, Elías; Menéndez, Edelmiro; Franch-Nadal, Josep; Gaztambide, Sonia; Girbés, Juan; Ortega, Emilio; Vendrell, Joan; Chacón, Matilde R.; Chaves, Felipe Javier; Soriguer, Federico; Rojo-Martínez, Gemma

doi:10.1002/oby.21796

Cited by 42 publications

(35 citation statements)

References 39 publications

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“…Previous studies have proven that the reference ranges of TSH differ with age, sex, and BMI (Surks and Hollowell, 2007 ; Boucai et al, 2011 ; Surks, 2013 ). Though data from our study suggested that obese individuals didn't have increased level of TSH ( P > 0.05, Table 2 ), several previous studies with large number of participants found that obese subjects had increased TSH level and TSH was positively associated with BMI (Asvold et al, 2009 ; Valdés et al, 2017 ). Currently, the applied reference range for TSH has been a matter of debate in recent years (Chaker et al, 2017 ).…”

Section: Discussioncontrasting

confidence: 58%

Sex Differences in the Associations of Obesity With Hypothyroidism and Thyroid Autoimmunity Among Chinese Adults

Wang

Song

et al. 2018

Front. Physiol.

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There is an intensive link between obesity and thyroid dysfunction, but this relationship in Asians is still unclear. This study was conducted to define the impact of obesity on risk of hypothyroidism and thyroid autoimmunity among Chinese adults. A population-based, cross-sectional study was carried out, which enrolled a total of 2,808 Chinese adults. To assess the associations of obesity with hypothyroidism and thyroid autoimmunity, odds ratio (ORs) with 95% confidence intervals (95%CIs) were calculated through logistic regression model, and the correlations of body mass index (BMI) with TPOAb and TGAb were also analyzed. Obese females had higher risk of hypothyroidism (22.7 vs. 15.0%; OR = 1.66, 95%CI 1.10–2.53; P = 0.02) and higher risk of subclinical hypothyroidism (22.1 vs. 13.4%; OR = 1.83, 95%CI 1.20–2.80; P = 0.005) than non-obese females. Multivariate logistic regression analysis found significant associations of obesity with hypothyroidism (Adjusted OR = 1.54, 95%CI 1.00–2.38; P = 0.05) and subclinical hypothyroidism (Adjusted OR = 1.69, 95%CI 1.09–2.63; P = 0.02) in females after adjustment for confounding factors. No association between obesity and hypothyroidism was observed in male participants. Spearman's correlation analysis suggested BMI was significantly and positively correlated with TPOAb (Spearman's r = 0.062, P = 0.022) in men but not in women. Linear regression analysis suggested an obviously positive correlation of BMI with TPOAb in men (β = 0.018, P = 0.015) and an obviously negative correlation of BMI with TGAb in women (β = −0.025, P = 0.012), respectively. The study suggests sex differences in the associations of obesity with hypothyroidism and thyroid autoimmunity among Chinese adults. Further studies are needed to better understand the exact mechanism of sex difference in the obesity-thyroid relationship.

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Section: Discussioncontrasting

confidence: 58%

Sex Differences in the Associations of Obesity With Hypothyroidism and Thyroid Autoimmunity Among Chinese Adults

Wang

Song

et al. 2018

Front. Physiol.

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“…Notably, in a large cross-sectional study, TSH ranges were estimated as 0.6-5.5 mIU/L in the normal-weight category and 0.7-7.5 mIU/L in the morbid obesity category. This study showed that, by using the normalweight ranges, the prevalence of high TSH levels increased threefold in the morbid obesity category (53). However, no compelling evidence has been provided that using specific reference values for the obese population would help to identify patients with thyroid dysfunction who need treatment.…”

Section: Reasoningmentioning

confidence: 90%

“…There are very few data on the incidence of non-thyroidal illness in the obese population but one publication suggested that inflammation may increase non-thyroidal illness in obesity (52). In contrast, FT3 has been described to be higher in obesity than in lean people, this being mainly related to the nutritional status (53). This shows that the interpretation of FT3 in obesity is not straightforward.…”

Section: Reasoningmentioning

confidence: 99%

“…Obesity is associated with modifications of thyroid parameters: TSH levels are usually higher than in normal-weight, age-and gender-matched individuals and are correlated with BMI (48). The relation of BMI with FT3 and FT4 is inconsistent, but a negative relation between BMI and FT4 and a positive relation between BMI and FT3 with a decrease FT4/FT3 ratio have been described (48,53). The TSH elevation could reflect decrease in thyroid hormones concentrations, explained by an increased plasmatic volume or increased rate of thyroid hormone disposal in obesity, causing in turn a compensatory activation of the pituitary-thyroid axis (54).…”

Section: Reasoningmentioning

confidence: 99%

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European Society of Endocrinology Clinical Practice Guideline: Endocrine work-up in obesity

Pasquali

Casanueva

Haluzı́k

et al. 2020

European Journal of Endocrinology

136

156

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Obesity is an emerging condition, with a prevalence of ~20%. Although the simple measurement of BMI is likely a simplistic approach to obesity, BMI is easily calculated, and there are currently no data showing that more sophisticated methods are more useful to guide the endocrine work-up in obesity. An increased BMI leads to a number of hormonal changes. Additionally, concomitant hormonal diseases can be present in obesity and have to be properly diagnosed – which in turn might be more difficult due to alterations caused by body fatness itself. The present European Society of Endocrinology Clinical Guideline on the Endocrine Work-up in Obesity acknowledges the increased prevalence of many endocrine conditions in obesity. It is recommended to test all patients with obesity for thyroid function, given the high prevalence of hypothyroidism in obesity. For hypercortisolism, male hypogonadism and female gonadal dysfunction, hormonal testing is only recommended if case of clinical suspicion of an underlying endocrine disorder. The guideline underlines that weight loss in obesity should be emphasized as key to restoration of hormonal imbalances and that treatment and that the effect of treating endocrine disorders on weight loss is only modest.

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“…The prevalence of thyroid dysfunction is not high in the general population (22); however, thyroid hormones within the euthyroid range are also found to be frequently involved in metabolic diseases. It is commonly noticed in the clinical practice that obese individuals often have higher TSH and FT3 levels (7,23). Higher levels of FT3, FT3/FT4, and TSH were associated with increased risks of nonalcoholic fatty liver disease and MS (9,14), while lower FT4 may contribute to an increased risk of MS (8).…”

Section: Discussionmentioning

confidence: 97%

Characteristics of Serum Thyroid Hormones in Different Metabolic Phenotypes of Obesity

Nie

et al. 2020

Front. Endocrinol.

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Aim: Metabolically healthy obese (MHO) individuals have attracted broad attention. We aimed to investigate the characteristics of serum thyroid hormones in different metabolic phenotypes of obesity. Methods: The study included 1,023 community-based euthyroid subjects (age range: 27-81 years), of whom 586 were women. Fat% was detected by a bioelectrical impedance analyzer. Two definitions of obesity were applied as follows: (1) fat% ≥ 25% for men and ≥ 30% for women; (2) body mass index (BMI) ≥ 25 kg/m 2. According to the diagnostic criteria for metabolic syndrome by the Chinese Diabetes Society, metabolically unhealthy was defined as two or more components of metabolic syndrome, excluding waist circumference. Serum-free triiodothyronine (FT3), free thyroxine (FT4), and thyroid-stimulating hormone (TSH) levels were measured by electrochemiluminescence immunoassay. Results: The proportions of obesity defined by fat% and BMI were 41.3 and 27.1%, respectively. The proportion of metabolically unhealthy was 41.6%. After adjusting for age and gender, regardless of the definitions based on fat% or BMI, FT3 was positively related to both the MHO and the metabolically unhealthy obese (MUO) phenotypes [MHO: odds ratio (OR)s = 1.676 based on fat% and 2.055 based on BMI; MUO: ORs = 1.818 based on fat% and 1.526 based on BMI; all P < 0.05]; FT4 was negatively related to the MUO phenotype (ORs = 0.870 based on fat% and 0.849 based on BMI, all P < 0.05); FT3/FT4 was also positively related to both the MHO and the MUO phenotypes (MHO: ORs = 1.678 based on fat% and 2.825 based on BMI; MUO: ORs = 2.866 based on fat% and 2.883 based on BMI; all P < 0.05); and TSH was positively related to the metabolically unhealthy non-obese phenotype (ORs = 1.329 based on fat% and 1.321 based on BMI, all P < 0.01). Conclusions: In euthyroid population, both the MHO and the MUO phenotypes were characterized by increased FT3 and FT3/FT4 levels.

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Reference values for TSH may be inadequate to define hypothyroidism in persons with morbid obesity: Di@bet.es study

Abstract: Persons with morbid obesity might be inappropriately classified if the standard ranges of normality of TSH for the normal-weight population are applied to them.

Cited by 42 publications

References 39 publications

Sex Differences in the Associations of Obesity With Hypothyroidism and Thyroid Autoimmunity Among Chinese Adults

Sex Differences in the Associations of Obesity With Hypothyroidism and Thyroid Autoimmunity Among Chinese Adults

European Society of Endocrinology Clinical Practice Guideline: Endocrine work-up in obesity

Characteristics of Serum Thyroid Hormones in Different Metabolic Phenotypes of Obesity

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