Metabolic and cardiovascular risk in patients with a history of differentiated thyroid carcinoma: A case-controlled cohort study

Abstract

Hyperthyroidism seems to increase metabolic and cardiovascular risk, while the effects of subclinical hyperthyroidism are controversial. We evaluated metabolic and cardiovascular parameters in differentiated thyroid carcinoma (DTC) patients with suppressed thyrotropin (TSH) due to levothyroxine (L-T4) therapy. We studied DTC patients and, as a control group, patients with a history of surgery for non-malignant thyroid pathology. Significantly higher insulin and lower HDLcholesterol levels were recorded in DTC subjects. In both groups, insulin levels were significantly related with body mass index (BMI) but not with age or L-T4 dosage. In DTC patients, a significant negative correlation was seen between HDL-cholesterol and BMI or L-T4 dosage. In both groups, intima-media thickness (IMT) correlated positively with age, BMI, glucose levels and systolic blood pressure. In DTC patients, increased IMT was significantly correlated with glycated hemoglobin (HbA1c), cholesterol and triglycerides. In DTC patients, C-reactive protein correlated positively with insulin, insulin resistance, triglycerides and systolic blood pressure, and negatively with HDLcholesterol. In both DTC and control subjects, fibrinogen correlated positively with age, BMI, increased IMT, HbA1c and systolic blood pressure. In DTC subjects, plasma fibrinogen concentrations correlated positively with insulin resistance, cholesterol and LDL-cholesterol, and negatively with TSH levels. Our data confirm that the favorable evolution of DTC can be impaired by a high incidence of abnormal metabolic and cardiovascular data that are, at least in part, related to L-T4 therapy. These findings underline the need for adequate L-T4 titration.

Ten-year estimated risk of bone fracture in women with differentiated thyroid cancer under TSH-suppressive levo-thyroxine therapy

“…Contrary to what would be expected in the state of pharmacologically induced hyperthyroxinaemia, obesity is frequent in DTC patients [17], and our women were also overweight. It can therefore be hypothesised that the absence of significant deterioration in bone metabolism may be the result of a protective effect against bone mass loss and that this effect is due to the very state of being overweight or to the slowing down of the metabolism [18].…”

Nutrition, insulin resistance and dysfunctional adipose tissue determine the different components of metabolic syndrome

“…The range of normal body fat is 2%-5% in men and 10%-13% in women, while the obesity range of body fat percentage is above of 25% in men and 32% in women[53,54]. Experimentally, it was observed that BMI = 30 kg/m 2 implies approximately 30% of BF% at 20 years of age but increase to 40% at 60 year in men, while in older women these values were to 40% and 50%, respectively.…”

Metabolic Changes Enhance the Cardiovascular Risk with Differentiated Thyroid Carcinoma - A Case Control Study from Manipal Teaching Hospital of Nepal

“…High fibrinogen level may be associated with an elevation of von Willebrand factor in DTC. This may alter platelet plug formation which can lead to endothelial dysfunction and enhanced cardiovascular risk (Giusti et al, 2008). The mean value of total cholesterol (165.28±25.61) and LDL (100.84±27.11) were found to be decreased in DTC patients when compared to the mean value of total cholesterol (183.64±26.34) and LDL (116.97±27.75) in controls; p-value (0.001*).…”