High serum cholesterol levels in persons with 'high-normal' TSH levels: should one extend the definition of subclinical hypothyroidism?

Michalopoulou, Georgia; Alevizaki, Maria; Piperingos, G. D.; Mitsibounas, Demetrios; Mantzos, Emily; Adamopoulos, Panayotis; Koutras, Demetrios A.

doi:10.1530/eje.0.1380141

Cited by 145 publications

(84 citation statements)

References 19 publications

(23 reference statements)

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“…The types of hyperlipemia most frequently encountered in our hypothyroid patients were isolated hypercholesterolemia and mixed hyperlipemia, similar to those described by other authors 8 . A majority of studies 3,4,6,16 show average serum concentration of HDL higher than 40mg/dL in subclinical or clinical hypothyroidism, similar, therefore, to the new cases of the disease in the present sample. We verified that serum concentrations of HDL-cholesterol were significantly lower among previously reported hypothyroid and euthyroid cases, in relation to new cases of hypothyroidism.…”

Section: Discussionsupporting

confidence: 75%

“…The frequency of hypothyroidism in the present sample (14.3%) was higher than that found in the population in general (10-12%) 10,11 as well as that of hyperlipemic patients (2.6 to 10%) [3][4][5][6] . These discrepancies are probably due to sampling differences regarding number, sex, age, and origin of the patients 4 .…”

Section: Discussioncontrasting

confidence: 73%

“…In these cases, as long as healthy thyroid tissue is available, normalization of T 4 will occur, characterizing a condition of subclinical hypothyroidism 1 . Both subclinical and symptomatic hypothyroidism are associated with various risk factors for atherosclerotic disease, including systemic arterial hypertension, hypercholesterolemia, hypertriglyceridemia, increased lipoprotein a 2 , and endothelial dysfunction 2,3 . The occurrence of 2.6 to 10% of cases of hypothyroidism traced to hyperlipemia including its subclinical form could only be detected in the laboratory by increases in TSH and normal T 4 4-6 .…”

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confidence: 99%

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Clinical and laboratory evaluation of hyperlipemic and hypothyroid patients

Castro¹,

Bononi²,

Aragon³

et al. 2001

Arq. Bras. Cardiol.

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Objective -To determine the frequency of hypothyroidism in a sample of hyperlipemic patients and evaluate clinical and laboratory factors indicative of thyropathy among them. Methods -Fifty-one hyperlipemic patients, grouped according to an earlier or recent diagnosis of their thyroid function into euthyroid and hypothyroid, were evaluated with clinical and laboratory examinations of blood levels of free T 4 and TSH (by radioimmunoassay Clinical and Laboratory Evaluation of Hyperlipemic and Hypothyroid Patients Original ArticleHypothyroidism is a clinical syndrome resulting from a decrease in the thyroid hormones thyroxin (T 4 ) and triiodothyronine (T 3 ). It is classified as primary, secondary, or tertiary, according as to whether the cause of the disease is localized respectively in the thyroid, the hypophysis [resulting from thyroid stimulating hormone (thyrotrophin-TSH) deficiency], or the hypothalamus [resulting from TSH releasing hormone (TRH) deficiency]. In primary hypothyroidism a concomitant increase in thyrotrophin (TSH) occurs in an attempt to stimulate the thyroid gland to produce T4 and T3. In these cases, as long as healthy thyroid tissue is available, normalization of T 4 will occur, characterizing a condition of subclinical hypothyroidism 1 . Both subclinical and symptomatic hypothyroidism are associated with various risk factors for atherosclerotic disease, including systemic arterial hypertension, hypercholesterolemia, hypertriglyceridemia, increased lipoprotein a 2 , and endothelial dysfunction 2,3 . The occurrence of 2.6 to 10% of cases of hypothyroidism traced to hyperlipemia including its subclinical form could only be detected in the laboratory by increases in TSH and normal T 4 4-6 . Several studies suggest that hyperlipemic patients should be tested for the presence of hypothyroidism [4][5][6] . The objectives of the present work were to determine the frequency of hypothyroidism in patients seen at the dyslipemia outpatient clinic of the Clinics Hospital of the School of Medicine of Botucatu (HCFMB), to determine the frequency of the arrival of new cases of hypothyroidism in this clinic by analyzing patients' blood concentration of free T 4 and TSH, and to classify hyperlipemic patients, clinically and in the laboratory, according to their functional thyroid condition. MethodsFollowing exclusion of patients with disease conditions interfering with their lipid profile or thyroid function (diabetes mellitus and uremia) 7-9 51 of 85 patients followed at the outpatient dyslipemia clinic of the HCFMB between

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Section: Discussionsupporting

confidence: 75%

Section: Discussioncontrasting

confidence: 73%

mentioning

confidence: 99%

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Clinical and laboratory evaluation of hyperlipemic and hypothyroid patients

Castro¹,

Bononi²,

Aragon³

et al. 2001

Arq. Bras. Cardiol.

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“…Higher serum cholesterol levels are found in subjects with high-normal TSH levels [27]. There was a significant positive correlation between serum TSH and serum TC and LDL-C levels in men and women [28].…”

Section: Discussionmentioning

confidence: 99%

Multi-center study on the prevalence of hypothyroidism in patients with hypercholesterolemia

et al. 2011

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abstract. Hypercholesterolemia is one of the most representative disorders of the common diseases. To evaluate the prevalence of hypothyroidism in the population of adult hypercholesterolemia, we prospectively examined the thyroid function in patients with untreated or treated hypercholesterolemia as a multi-center survey. Subjects were the patients who were treated with some antilipemic agents or the untreated patients whose total cholesterol (TC) was over 220 mg/dL and/or LDL-cholesterol (LDL-C) over 140 mg/dL. Among 737 cases recruited, 725 cases (300 males and 425 females) participated in the survey including the thyroid function test. The patient's backgrounds include hypertension (51%), diabetes mellitus (49%), fatty liver (17%), smoking (15%), and habitual drinking (10%). The 72% of the patients were treated with some antilipemic agents and the mean values of TC, LDL-C, triglyceride (TG), HDL-cholesterol (HDL-C), and LDL-C/HDL-C ratio were 204.5 mg/dL, 119.6 mg/dL, 144.4 mg/dL, 60.7 mg/dL and 2.25, respectively. The primary hypothyroidism was seen in 27 cases (3.7%) (11 males, 16 females) with subclinical hypothyroidism in 17 cases (2.4%) and overt hypothyroidism in 10 cases (1.4%). The central hypothyroidism was seen in 4 cases (0.6%). The prevalence of hypothyroidism was 4.3% in patients with hypercholesterolemia. Taking account of the large number of patients with dyslipidemia and importance of avoiding unnecessary administration and associated adverse effects, evaluation of the thyroid function could be warranted in patients with dyslipidemia although cost-benefit issues waits further investigation.Key words: Hypercholesterolemia, Dyslipidemia, Subclinical hypothyroidism strongly related to atherosclerotic cardiovascular disease. Recently, new therapeutic reagents such as fibrates and statins have been created and primary dyslipidemia is effectively treated with these reagents [1]. However, they are not low priced and may induce rare but serious side effects such as rhabdomyolysis [1]. Hypothyroidism induces secondary hypercholesterolemia that increases the incidence of atherosclerotic cardiovascular events [2], and replacement of low-

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“…Previous studies have shown unfavorable effects of overt or subclinical hypothyroidism (SCH; normal free thyroxine (FT4) and elevated thyroid stimulating hormone (TSH)) on cardiovascular disease [1][2][3][4][5][6][7][8][9]. Some studies demonstrated the association of lipid abnormality and atherosclerosis with SCH or overt hypothyroidism.…”

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Favorable Influence of Subclinical Hypothyroidism on the Functional Outcomes in Stroke Patients

et al. 2010

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Abstract. Subclinical hypothyroidism (SCH) is thought to have an influence on stroke outcomes. However, few reports demonstrate a favorable relationship between the two. We evaluated this association in acute ischemic stroke. From Jan 2005 to Jun 2008, 756 acute ischemic stroke patients were recruited within seven days of onset. The patients with overt hypothyroidism/hyperthyroidism or other medical conditions that may affect thyroid function were excluded. Thyroid stimulating hormone (TSH) and free thyroxine (FT4) levels were measured within two days. Patients were divided into two groups: the SCH group (TSH > 5.0 μU/mL and normal FT4 levels) and the control group. Stroke outcomes were assessed using two different criteria. In the first outcome model, favorable outcomes [I] were simply defined by modified Rankin Scale (mRS) scores (≦ 1), while the favorable outcomes [II] were defined as follows: a) a mRS score of 0, if the baseline National Institute of Health Stroke Scale (NIHSS) scores were < 8, b) a mRS score of 0 or 1, if the NIHSS scores were 8-14, c) a mRS score 0-2, if the NIHSS scores were >14. The changes in mRS scores and the proportion of patients with favorable outcomes [I] p=0.003). We found that acute ischemic stroke patients with SCH at admission were more likely to show favorable functional outcomes than those without SCH. We can suggest preconditioning before the stroke combined with a reduced response to stress as a possible protective mechanism.

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High serum cholesterol levels in persons with 'high-normal' TSH levels: should one extend the definition of subclinical hypothyroidism?

Cited by 145 publications

References 19 publications

Clinical and laboratory evaluation of hyperlipemic and hypothyroid patients

Clinical and laboratory evaluation of hyperlipemic and hypothyroid patients

Multi-center study on the prevalence of hypothyroidism in patients with hypercholesterolemia

Favorable Influence of Subclinical Hypothyroidism on the Functional Outcomes in Stroke Patients

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