Altan ONAT, Ahmet KARABULUT, Serdar TÜRKMEN, İbrahim SARI, Günay CAN, Gülay HERGENÇ, Sinan ALBAYRAK

TSH Levels in Turkish Adults: Prevalences and Associations With Serum Lipids, Coronary Heart Disease and Metabolic Syndrome

Overt hypothyroidism is implicated in atherosclerosis through dyslipidemia, hypertension, and hyperhomoscysteinemia. Epidemiological data related to the role of thyroid hormones in the risk of coronary heart disease (CHD) and metabolic syndrome (MS) in Turkish adults are lacking. Thyroid stimulating hormone (TSH) was measured in the 2004 follow-up of the Turkish Adult Risk Factor Study, with the aim of investigating thyroid hormone status as a possible risk factor in CHD and MS in the population sample. To this end, a subgroup of the cohort (512 men and women: mean age 52 ± 11.4) in whom the prevalences for CHD, MS and diabetes (DM) were 8.2%, 42.4% and 10.7%, respectively, were screened for TSH. The cohort was classified as hypo-, hyper- or euthyroid according to cutoffs of 4.2 and 0.3 µU/ml for TSH, respectively. No distinction was made between overt and subclinical thyroid states. Total and LDL-cholesterol was lowest, but waist circumference unexpectedly highest in the hyperthyroid group. Women (1.3 µU/ml) had significantly higher (P < 0.001) TSH levels than men (0.95 µU/ml). The prevalence of hypo- and hyperthyoidism in men and women were 1.7%/7% and 4.4%/5%, respectively, and women overwhelmingly predominated the hypothyroid cases. TSH values did not significantly differ among groups diagnosed as or not CHD, MS, or DM. Log TSH was significantly correlated with total and LDL-cholesterol and, inversely, with alcohol usage. Multivariate linear regression analysis revealed total cholesterol as the sole independent covariate of TSH levels in men and both sexes combined. An increase by approximately one-third of the physiological TSH levels was associated with a 40 mg/dl-increase in total cholesterol concentrations. Age- and sex-adjusted TSH did not contribute to the risk of CHD, hypercholesterolemia, MS, or DM in logistic regression analyses. To conclude, TSH levels were independently associated with total cholesterol concentrations but did not appear to be a risk factor for CHD or MS in the cohort studied. Following up the group prospectively may give a better understanding concerning the thyroid status and CHD risk in Turkish adults.

Anahtar Kelimeler:

Coronary disease risk; serum TSH; thyroid status

TSH Levels in Turkish Adults: Prevalences and Associations With Serum Lipids, Coronary Heart Disease and Metabolic Syndrome

Keywords:

Coronary disease risk; serum TSH; thyroid status,

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Auer J, Berent R, Weber T et al. Thyroid function is associated with presence and severity of coronary atherosclerosis. Clin Cardiol 26:569-573, 2003.
Papaioannou GI, Lagasse M, Mather JF et al. Treating
hypothyroidism improves endothelial function. Metabolism 53:278-9, 2004.
Demers LM, Spencer CA. Thyrotropin/thyroid stimulating
hormone. In: Baloch Z et al. (eds). Guidelines Committee, National Academy of Clinical Biochemistry. Laboratory medicine practice guidelines. Laboratory support for the diagnosis and monitoring of thyroid disease. Thyroid 13:3-126,2003.
AACE Thyroid Task Force. American Association of Clinical Endocrinologist medical guidelines for clinical practice for the evaulation and treatment of hyperthyroidism. Endocr Prac 8:457- 469, 2002.
Arrivie J, Sbragia P, Denizot A et al. Cardiovascular symptoms and risks of subclinical dysthyroidism. Rev Med Interne 25:207- 216,2004. 6. Althaus BU, Staub JJ, Ryff-De Leche A et al. LDL/HDL-changes in subclinical hypothyroidism: possible risk factors for coronary heart disease. Clin Endocrinol (Oxf) 28:157-163,1988.
Schlienger JL, Goichot B, Vinzio S et al. Sub-clinical hypothyroidism, towards the end of a controversy? Presse Med 32(37 Pt1):1760-1765, 2003
Biondi B, Klein I: Hypothyroidism as a risk factor for
cardiovascular disease. Endocrine 24:1-13, 2004. 9. Lindeman RD, Romero LJ, Schade DS et al. Impact of subclinical hypothyroidism on serum total homocysteine concentrations, the prevalence of coronary heart disease (CHD), and CHD risk factors in the New Mexico Elder Health Survey. Thyroid 13:595-600, 2003.
Gallistl S, Sudi KM, Leschnik B et al. Inverse correlation between thyroid function and hemostatic markers for coronary heart disease in obese children and adolescents. J Pediatr Endocrinol Metab 13:1615-20, 2000.
Pirich C, Mullner M, Sinzinger H. Prevalence and relevance of thyroid dysfunction in 1922 cholesterol screening participants. J Clin Epidemiol 53:623-629, 2000.
Hueston WJ, Pearson WS. Subclinical hypothyroidism and the risk of hypercholesterolemia. Ann Fam Med 2:351-355, 2004.
Vierhapper H, Nardi A, Grosser P et al. Low-density lipoprotein cholesterol in subclinical hypothyroidism. Thyroid 10:981-984, 2000.
Volzke H, Robinson DM, Schminke U et al . Thyroid function and carotid wall thickness. J Clin Endocrinol Metab 89:2145-2149, 2004
Parle JV, Maisonneuve P, Sheppard MC et al. Prediction of all- cause and cardiovascular mortality in the elderly people from one low serum thyrotropin result: a 10-year cohort study. Lancet 358:861-865, 2001.
Onat A. TEKHARF taramalarının yöntemi ve kohortları. Oniki yıllık izleme deneyimine göre, Türk Eriflkinlerinde Kalp Sağlığı. (Ed: Onat A). İstanbul, Argos İletiflim, 2003, 6-14.
Executive Summary of the third Report of the National Cholesterol Education Program (NCEP) Expert Panel on detection, evaluation and treatment of high blood cholesterol in adults (Adult Treatment Panel III). JAMA 285:2486-249, 2001.
American Diabetes Association. Clinical practice recommendations 1997. Diabetes Care 20 ( Suppl 1):S1-S70,1997.
Friedewald WT, Levy RI, Fredrickson DS.Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clin Chem 18:499-509,1972.
Rose G, Blackburn H, Gillum RF et al. Cardiovascular Survey Methods, 2. edition. Geneva, WHO, 1982, 124-127.
Ladenson PW, Singer PA, Ain KB et al. American Thyroid Association Guidelines for detection of thyroid dysfunction. Arch Intern Med 160:1573-1575, 2000.
Hollowell JG, Staehling NW, Hannon WH et al. Serum thyrotropin, thyroxine and thyroid antibodies in the United States population (1988 to 1994): NHANES III. J Clin Endocrinol Metab 87:489-499, 2002.
Hak AE, Pols HA, Visser TJ et al. Subclinical hypothyroidism is an independent risk factor for atherosclerosis and myocardial infarction in elderly women: the Rotterdam Study. Ann Intern Med 132:270-278, 2000.
Elder J, McLelland A, O'Reilly DS et al. The relationship between serum cholesterol and serum thyrotropin, thyroxine and tri- iodothyronine concentrations in suspected hypothyroidism. Ann Clin Biochem. 27( Pt 2)::110-113, 1990.
Mahley RW, Rall SC Jr. Type III hyperlipoproteinemia: the role of apolipoprotein E in normal and abnormal lipoprotein metabolism. (Ed: Scriver CR, et al ). The Metabolic Basis of Inherited Disease, 7. edition. New York, Mc Graw Hill, 1985, 1953-1980.
Duntas LH. Thyroid disease and lipids. Thyroid 12:287-293, 2002.
Pucci E, Chiovato L, Pinchera A. Thyroid and lipid metabolism. Int J Obes Relat Metab Disord 24(Suppl 2):S109-112, 2000.
Yıldırımkaya M, Nazaroğlu KN, fiengül A et al. Prevalence of hypothyroidism in hyperlipidemic subjects referred to a biochemistry department. Turk J Med Sci 26:125-128, 1996.
O'Brien T, Dinneen SF, O'Brien PC et al. Hyperlipidemia in patients with primary and secondary hypothyroidism. Mayo Clin Proc 68: 860-866, 1993.
Morris MS, Bostom AG, Jacques PF et al. Hyperhomocysteinemia and hypercholesterolemia associated with hypothyroidism in the third US National Health and Nutrition Examination Survey. Atherosclerosis 155:195-200, 2001.
Catargi B, Parrot-Roulaud F, Cochet C et al. Homocysteine, hypothyroidism, and effect of thyroid hormone replacement. Thyroid 9:1163-1166, 1999.
Kvetn, Heldgaard PE, Bladbjerg EM et al. Subclinical hypothyroidism is associated with a low-grade inflammation, increased triglyceride levels and predicts cardiovascular disease in males below 50 years. Clin Endocrinol (Oxf) 61:232-238, 2004.
Imaizumi M, Akahoshi M, Ichimaru S et al. Risk for ischemic heart disease and all-cause mortality in subclinical hypothyroidism. J Clin Endocrinol Metab 89:3365-3370, 2004. Danel T, Touitou Y. Alcohol decreases the nocturnal peak of TSH in healthy volunteers. Psychopharmacology (Berl). 170:213-214, 2003.