The effect of L-thyroxine substitution on lipid profile, glucose homeostasis, inflammation and coagulation in patients with subclinical hypothyroidism

Anagnostis, Panagiotis; Efstathiadou, Zoe; Slavakis, Aristidis; Selalmatzidou, Despina; Poulasouchidou, Maria; Katergari, Simoni; Karathanasi, Eleni; Dogramatzi, F.; Kita, Marina

doi:10.1111/ijcp.12394

Cited by 25 publications

(16 citation statements)

References 44 publications

(86 reference statements)

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“…Numerous studies have estimated the effect of L-thyroxine replacement treatment on serum lipid levels in patients with sub-clinical hypothyroidism; however, their results were inconsistent. In a recent study by Anagnostis et al (22), L-thyroxine replacement treatment exerted no effect on serum lipid levels of patients with mild sub-clinical hypothyroidism, whose TSH levels were <7 mIU/l. However, Tagami et al (2) reported a significant decrease of TC and LDL-C following L-thyroxine replacement therapy.…”

Section: Discussionmentioning

confidence: 88%

“…Patients with sub-clinical hypothyroidism, particularly those with positive thyroid antibodies, are at risk of developing overt hypothyroidism at an estimated rate of 2.0-4.3% per year (3,22). L-thyroxine replacement treatment is currently the major therapy for sub-clinical hypothyroidism, which is administered with the following purposes: First, in order to prevent progression to overt hypothyroidism and second, to reduce symptoms of thyroid hormone deficiency (23).…”

Section: Discussionmentioning

confidence: 99%

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Effect of L-thyroxine treatment versus a placebo on serum lipid levels in patients with sub-clinical hypothyroidism

Meng

Jia

et al. 2016

Biomedical Reports

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Abstract. Sub-clinical hypothyroidism is a common disease and whether L-thyroxine replacement treatment improves serum lipid levels in affected patients remains controversial. Thus, the aim of the present meta-analysis was to assess the effect of L-thyroxine therapy on serum lipid levels in sub-clinical hyperthyroidism. Relevant randomized controlled trials (RCTs) containing continuous data, published until July 2015 were retrieved from the Cochrane Library, PubMed, Medline, Google Scholar and Embase databases and subjected to meta-analysis using Review Manager software version 5.2 (The Nordic Cochrane Centre, Copenhagen, Denmark). Seven RCTs comprising 319 patients were included. The overall methodological quality of the RCTs was good. Statistical analysis revealed that serum low-density lipoprotein-cholesterol (LDL-C) levels were significantly decreased after L-thyroxine treatment [mean difference (MD): -0.23; 95% confidence interval: -0.44, -0.03; P= 0.02], while changes of total cholesterol (TC), triglyceride (TG) and high-density lipoprotein-cholesterol (HDL-C) were not significant P= 0.09; P= 0.78; P= 0.14, respectively). In conclusion, the meta-analysis performed in the present study revealed that compared with placebo treatment, L-thyroxine significantly improved serum LDL-C levels in patients with sub-clinical hypothyroidism, while not significantly affecting TC, TG and HDL-C levels.

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Section: Discussionmentioning

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Effect of L-thyroxine treatment versus a placebo on serum lipid levels in patients with sub-clinical hypothyroidism

Meng

Jia

et al. 2016

Biomedical Reports

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“…32 Tra i farmaci che possono favorire lo sviluppo della HT e/o la sua progressione verso l'ipotiroidismo vi sono l'interferone alfa, 33 l'interleuchina-2efattori stimolanti di colonie di granulociti e macrofagi (GM-CSF), 34,35 farmaci antiretrovirali, 36 anticorpi monoclonali, 7,8 litio e amiodarone. 37 Una estensiva review su questo argomento è stata recentemente pubblicata. 38 Per quanto riguarda il possibile ruolo di infezioni virali, sono stati riscontrati componenti di virus quali Parvovirus B19, Coxachie ed Herpes, 39,40 HCV 41 in tiroidi di HT ma vi sono risultati contrastanti e poco convincenti, per la difficoltà di definire un'associazione causale certa.…”

Section: Fattori Geneticiunclassified

“…Inoltre, l'IpoS può peggiorare il compenso glicometabolico nei soggetti con DMT2, ed il trattamento con L-T4 può ridurre l'insulino-resistenza e migliorare il compenso glicometabolico. 1,37 Di diversa natura è ben nota la relazione tra IpoS e diabete mellito tipo 1 (DMT1), certamente determinata dalla comune eziopatogenesi autoimmune, a causa della quale circa il 30% dei soggetti con DMT1 può presentare un IpoS. 1 Numerosi studi osservazionali hanno evidenziato un'importante correlazione tra IpoS ed incremento della concentrazione sierica del colesterolo totale, del colesterolo LDL, dei trigliceridi; tale correlazione è stata confermata da almeno una metanalisi.…”

Section: Significato Biologico Dell'ipotiroidismo Subclinico Nell'adultounclassified

L’ipotiroidismo

Campanini

Grandi

2017

Ital J Med

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<img src="/public/site/images/pgranata/rass.jpg" alt="" />Introduzione M. CampaniniInquadramento ed epidemiologia dell’ipotiroidismo T.M. AttardoIpotiroidismo e autoimmunità P. Montanari, F. Borghi, L. FinardiL’ipotiroidismo subclinico D. Brancato, F. ProvenzanoL’ipotiroidismo e la gravidanza V. DonvitoLa terapia con L-tiroxina M. Grandi, C. Sacchetti, S. Pederzoli

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“…In a recent prospective study, we did not find any significant effect of L-thyroxine replacement therapy on lipid profile, coagulation markers, systemic inflammation and glucose homoeostasis in SCH patients (mean baseline TSH: 6.8 mIU/L). It only reduced blood pressure, especially in those with TSH >7 mIU/L [5]. The duration of L-thyroxine therapy, DM and nephropathy and the multi-factorial origin of the latter may also play a critical role in the effect of L-thyroxine on renal function.…”

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confidence: 99%

Subclinical hypothyroidism and diabetic nephropathy. Could L-thyroxine replacement therapy be of value? [Letter to the Editor]

2014

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We read with interest the study by Furukawa et al. [1]. The authors reported a significant and independent association of subclinical hypothyroidism (SCH) with nephropathy (defined as albumin:creatinine ratio ≥300 mg/g creatinine) in patients with diabetes mellitus (DM). In particular, those with diabetic nephropathy had more than two-fold higher prevalence of SCH than those without. Estimated glomerular filtration rate (eGFR) was lower in patients with SCH compared with euthyroid subjects.Some comments might be of interest. Although many studies have shown an association between overt -in most cases-hypothyroidism and renal dysfunction, what appears to be of outmost importance is whether restoration of thyroid function with L-thyroxine could be beneficial and to what extent, especially in patients with DM. It is well-known that SCH affects many cardiovascular parameters involved in the pathogenesis of diabetic nephropathy, such as lipids and blood pressure [2]. Only two studies have reported observations on diabetic nephropathy in correlation with SCH [3,4]. The first showed that 18 months of L-thyroxine replacement therapy in SCH women significantly increased eGFR to the levels of euthyroid controls (from 69 to 73 mL/min). However, whether this change is a mere reflection of a reversible and non-clinically significant haemodynamic effect of SCH on renal clearance, rather than a true morbidity, remains to be elucidated [3]. The other study included patients with chronic kidney disease (CKD) (32% men, 39% DM) and showed that L-thyroxine significantly attenuated the rate of decline in eGFR after 12 and 24 months, both in stage 2 and 3-4 of CKD. However, it had no effect on proteinuria [4]. These studies, as well as those in overt hypothyroidism, included patients with different degrees of renal function, were of small size and short duration and used different criteria of renal dysfunction assessment.Important issues to be taken into account when considering the benefit (if any) in patients with SCH and nephropathy are baseline eGFR or proteinuria levels, as well as, TSH concentrations, before L-thyroxine substitution. The baseline mean TSH levels in the aforementioned studies were 13.2 [3] and 8.8 mIU/L [4], respectively. It is not known whether L-thyroxine would be beneficial in lower TSH levels (e.g. <7 mIU/L). In a recent prospective study, we did not find any significant effect of L-thyroxine replacement therapy on lipid profile, coagulation markers, systemic inflammation and glucose homoeostasis in SCH patients (mean baseline TSH: 6.8 mIU/L). It only reduced blood pressure, especially in those with TSH >7 mIU/L [5]. The duration of L-thyroxine therapy, DM and nephropathy and the multi-factorial origin of the latter may also play a critical role in the effect of L-thyroxine on renal function.In conclusion, it would be prudent to assess thyroid function in patients with diabetic nephropathy. In cases of SCH, L-thyroxine might be of benefit, on an individual basis. Large prospective trials assessing the effect...

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The effect of L-thyroxine substitution on lipid profile, glucose homeostasis, inflammation and coagulation in patients with subclinical hypothyroidism

Abstract: Except for a reduction in systolic and diastolic BP, thyroid substitution therapy does not affect lipidaemic profile, systematic inflammation, glucose homoeostasis or coagulation in patients with SH.

Cited by 25 publications

References 44 publications

Effect of L-thyroxine treatment versus a placebo on serum lipid levels in patients with sub-clinical hypothyroidism

Effect of L-thyroxine treatment versus a placebo on serum lipid levels in patients with sub-clinical hypothyroidism

L’ipotiroidismo

Subclinical hypothyroidism and diabetic nephropathy. Could L-thyroxine replacement therapy be of value? [Letter to the Editor]

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