Restricted accessResearch articleFirst published online 2015-10
Thyrotropin Levels,Insulin Resistance,and Metabolic Syndrome: A Cross-Sectional Analysis in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)
Previous studies have described an association with thyrotropin (TSH) levels, insulin resistance, and metabolic syndrome. We performed a cross-sectional analysis to investigate the relationship between TSH levels, insulin resistance, and metabolic syndrome using baseline data from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil).
Methods:
Diabetics and individuals using medications that interfere in thyroid function were excluded, leaving 10,935 participants (54.3% women) for current analyses. Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) values above the 75th percentile was considered as indicative of presence of insulin resistance. Logistic regression models were built using HOMA-IR and metabolic syndrome as the dependent variable, and quintiles of TSH as the independent variable (first quintile as reference). Odds ratios (OR) were presented with multivariate adjustment for socioeconomic/cardiovascular risk factors for insulin resistance, and adjustment only for socioeconomic factors and smoking for metabolic syndrome.
Results:
Age, body mass index, waist measurement, fasting glucose and fasting and post load insulin and HOMA-IR increased according to TSH quintiles. Subjects in the fifth TSH quintile presented an OR of association with insulin resistance of 1.86 [95% confidence interval (95% CI) 1.26–2.75], regardless of gender. For the metabolic syndrome, subjects in the fifth quintile presented an OR of 1.21 (95% CI 1.01–1.45) and remained positive only for men (OR 1.37; 95% CI 1.07–1.76). Restricting the analysis to quintiles of TSH in the normal range did not change the results.
Conclusions:
In this cross-sectional evaluation, high TSH quintiles were associated to insulin resistance/metabolic syndrome.
Get full access to this article
View all access options for this article.
References
1.
RodondiN, den ElzenWP, GusseklooJ. Subclinical hypothyroidism and the risk of coronary heart disease and mortality. JAMA, 2010; 304:1365–1374.
2.
RodondiN, BauerDC, CappolaAR, et al.Subclinical thyroid dysfunction, cardiac function, and the risk of heart failure. JACC, 2008; 52:1152–1159.
3.
GencerB, ColletT-H, VirginiV, et al.Subclinical thyroid dysfunction and the risk of heart failure events: an individual participant data analysis from 6 prospective cohorts. Circulation, 2012; 126:1040–1049.
4.
SgarbiJA, MatsumuraLK, KasamatsuTS, et al.Subclinical thyroid dysfunctions are independent risk factors for mortality in 7.5-year follow-up: the Japanese Brazilian Thyroid Study. Eur J Endocrinol, 2010; 162:568–577.
5.
AsvoldBO, BjoroT, PlatouC, et al.Thyroid function and the risk of coronary heart disease: 12-year follow-up of the HUNT study in Norway. Clin Endocrinol, 2012; 77:911–917.
6.
HakAE, PolsHA, VisserTJ, et al.Subclinical hypothyroidism is an independent risk factor for atherosclerosis and myocardial infarction in elderly women: the Rotterdam Study. Ann Intern Med, 2000; 132:270–278.
7.
KuusiT, TaskinenMR, NikkilaEA. Lipoproteins, lipolytic enzymes and hormonal status in hypothyroid women at different levels of substitution. J Clin Endocrinol Metab, 1988; 66:51–56.
8.
ArikanS, BahceciM, TuzcuA, et al.Postprandial hyperlipidemia in overt and subclinical hypothyroidism. Eur J Intern Med, 2012; 23:e141–145.
9.
Hernandez-MijaresA, JoverA, BellodL, et al.Relation between lipoprotein subfractions and TSH levels in the cardiovascular risk among women with subclinical hypothyroidism. Clin Endocrinol, 2013; 78:777–782.
10.
KahalyGJ, DillmannWH. Thyroid hormone action in the heart. Endocr Rev, 2005; 26:704–708.
11.
RoefGL, TaesYE, KaufmanJM, et al.Thyroid hormone levels within reference range are associated with heart rate, cardiac structure, and function in middle-aged men and women. Thyroid, 2013; 23:947–954.
12.
SinghBM, GoswamiB, MallikaV. Association between insulin resistance and hypothyroidism in females attending tertiary care hospital. Indian J Clin Biochem, 2010; 25:141–145.
13.
GuzelS, SevenA, GuzelEC, et al.Visfatin, leptin, and TNF-α: interrelated adipokines in insulin-resistant clinical and subclinical hypothyroidism. Endocr Res, 2013; 38:184–194.
14.
MaratouE, HadjidakisDJ, KolliasA, et al.Studies of insulin resistance in patients with clinical and subclinical hypothyroidism. Eur J Endocrinol, 2009; 160:785–790.
15.
LiuC, ScherbaymWA, SchottM, et al.Subclinical hypothyroidism and the prevalence of the metabolic syndrome. Horm Metab Res, 2011; 43:417–421.
16.
WangC-Y, ChangT-C, ChenM-F. Associations between subclinical thyroid disease and metabolic syndrome. Endocr J, 2012; 59:911–917.
17.
WaringAC, RodondiN, HarrisonS, et al.Thyroid function and prevalent and incident metabolic syndrome in older adults: the Health, Ageing and Body Composition Study. Clin Endocrinol, 2012; 76:911–918.
18.
NakajimaY, YamadaM, AzuzawaM, et al.Subclinical hypothyroidism and indices for metabolic syndrome in Japanese women: the one-year follow-up study. J Clin Metab, 2013; 98:3280–3287.
19.
Garduño-Garcia J deJ, Alvirde-GarciaU, López-CarrascoG, et al.TSH and free thyroxine concentrations are associated with differing metabolic markers in euthyroid subjects. Eur J Endocrinol, 2010; 163:273–278.
20.
Fernández-RealJM, López-BermejoA, CastroA, et al.Thyroid function is intrinsically linked to insulin sensitivity and endothelium-dependent vasodilation in healthy euthyroid subjects. J Clin Endocrinol Metab, 2006; 91:3337–3343.
21.
LaiY, JiangF, WangB, et al.The relationship between serum thyrotropin and components of metabolic syndrome. Endocr J, 2001; 58:23–30.
22.
LeeYK, OhHJ, ParkKS, et al.Serum TSH levels in healthy Koreans and the association of TSH with serum lipid concentration and metabolic syndrome. Serum TSH level in healthy Koreans and the association of TSH with serum lipid concentration and metabolic syndrome. Korean J Int Med, 2011; 26:432–439.
23.
Jee-YoungOh, SungY-A, LeeHJ. Elevated thyroid stimulating hormone levels are associated with metabolic syndrome in euthyroid young women. Korean J Intern Med, 2013; 28:180–186.
24.
RuhlaS, WeickerttMO, ArafatAM, et al.A high normal TSH is associated with the metabolic syndrome. Clin Endocrinol, 2010; 72:696–701.
25.
AquinoEM, BarretoSM, BensenorIM, et al.Brazilian Longitudinal Study of Adult Health (ELSA-Brasil): objectives and design. Am J Epidemiol, 2012; 175:315–324.
26.
LotufoPA. [Setting up the longitudinal study for adult health (ELSA-Brasil)]. Rev Saude Publica, 2013; 47(Suppl 2):3–9.
27.
SchmidtMI, DuncanBB, MillJG, et al.Cohort profile: Longitudinal Study of Adult Health (ELSA-Brasil). Int J Epidemiol, 2014, 44:68–75.
28.
BensenorIM, GriepRH, PintoKA, et al.[Routines of organization of clinical tests and interviews in the ELSA-Brasil investigation center]. Rev Saude Publica, 2013; 47(Suppl 2):37–47.
29.
ChorD, AlvesMG, GiattiL, et al.[Questionnaire development in ELSA-Brasil: challenges of a multidimensional instrument]. Rev Saude Publica, 2013; 47(Suppl 2):27–36.
30.
LaiEC, YangYH, LinSJ, et al.Use of antiepileptic drugs and risk of hypothyroidism. Pharmacoepidemiol Drug Saf, 2013; 22:1071–1079.
31.
DongBC. How medications affect thyroid function. West J M, 2000; 172:102–106.
32.
HollowellJG, StaehlingNW, Dana FlandersW, et al.Serum TSH, T(4), and thyroid antibodies in the United States population (1988–1994): National Health and Nutritional Examination Survey (NHANES III). J Clin Endocrinol Metab, 2002; 87:489–499.
33.
SurksMI, OrtizE, DanielsGH, et al.Subclinical thyroid disease—scientific review and guidelines for diagnosis and management. JAMA, 2000; 291:228–238.
34.
MatthewsDR, HoskerJP, RudenskiAS, NaylorBA, TreacherDF, TurnerRC. Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia, 1985; 28:412–9.
35.
TuzcuA, BahceciM, GokalpD, TuzunY, GunesK. Subclinical hypothyroidism may be associated with elevated high-sensitive c-reactive protein (low grade inflammation) and fasting hyperinsulinemia. Endocr J, 2005; 52:89–94.
36.
Al SayedA, Al AliN, AbbasYB, et al.Subclinical hypothyroidism is associated with early insulin resistance in Kwaiti women. Endocr J, 2006; 53:653–657.
37.
LiuC, ScherbaymWA, SchottM, et al.Subclinical hypothyroidism and the prevalence of the metabolic syndrome. Horm Metab Res, 2011; 43:417–421.
38.
UzunluluM, YorulmazE, OguzA. Prevalence of subclinical hypothyroidism in patients with metabolic syndrome. Endocr J, 2007; 54:71–76.
39.
GyawaliP, TakancheJS, ShresthaRK, et al.Pattern of thyroid dysfunction in patients with metabolic syndrome and its relationship with components of metabolic syndrome. Diabetes Metab J, 2015; 39:66–73.
40.
RoosA, BakkerSJ, LinksTP, et al.Thyroid function is associated with components of the metabolic syndrome in euthyroid subjects. J Clin Endocrinol Metab, 2007; 92:491–496.
41.
BenseñorIM, GoulartAC, LotufoPA, et al.Prevalence of thyroid disorders among older people: results from the São Paulo Ageing & Health Study. Cad Saude Publica, 2011; 27:155–161.
42.
SichieriR, BaimaJ, MaranteT, et al.Low prevalence of hypothyroidism among black and Mulatto people in a population-based study of Brazilian women. Clin Endocrinol (Oxf), 2007; 66:803–807.
43.
MuniyappaR, LeeS, ChenH, et al.Current approaches for assessing insulin sensitivity and resistance in vivo: advantages, limitations, and appropriate usage. Am J Physiol Endocrinol Metab, 2008; 294:E261–E270.
