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      • Record: found
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      Subclinical Hypothyroidism (SH) and Atherogenic Index of Plasma (AIP) in Women: A Case-Control Study From a Tertiary Care Hospital in South India

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      Author(s): 1 , 2 , , 3
      Editor(s): ,
      Publication date (Electronic, pub):
      Publication date (Electronic, collection):
      Journal: Cureus
      Publisher: Cureus
      Keywords: subclinical hypothyroidism, dyslipidemia, s.tsh, lipid profile, atherogenic index of plasma

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          Abstract

          Introduction

          Subclinical hypothyroidism (SH) is defined as an increase in serum-thyroid stimulating hormone (S-TSH) above the normal level with free triiodothyronine (T4) and free thyroxine (T3) within the normal range. It is more common in females. The association between SH and dyslipidemia is unclear. There are many controversial studies regarding the same. This is the single largest study of Atherogenic index of plasma (AIP) in SH among women from our country. Our aim is to study the lipid profile and AIP in SH patients. We will also study the correlation between AIP and S-TSH levels in SH patients.

          Materials and methods

          It was a retrospective study conducted in a tertiary care center. A total of 97 females with SH were taken as cases and 86 normal females were taken as euthyroid (ET) controls. They were matched for demographic characteristics. T3, T4, S-TSH, total cholesterol, S-triglycerides (S-TG), high-density lipoprotein - cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and AIP were compared between the two groups. Spearman’s correlation between TSH and AIP was studied in the SH group. Mann-Whitney U test was performed.

          Results

          The TG, HDL, AIP levels were significantly different between both groups. TG, AIP was higher in the SH group compared to the ET group (p value of TG= 0.01, p value of AIP <0.0001). HDL was lower in the ET group compared to the SH group (p value <0.0001). AIP showed a significant positive correlation with S-TSH levels in the SH group. (r value=0.72, p value=<0.001).

          Conclusion

          It is important to regularly monitor SH patients for dyslipidemia, in order to start early therapy with levothyroxine/statins. Emphasis should be laid on lifestyle changes such as diet and exercise from the time of diagnosis. Community level education and awareness should be encouraged. Also, AIP is a better parameter to assess cardiovascular risk in SH patients than a conventional lipid profile.

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          Most cited references21

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          The Colorado thyroid disease prevalence study.

          G Mayor, N Manowitz, Gay Canaris … (2000)
          The prevalence of abnormal thyroid function in the United States and the significance of thyroid dysfunction remain controversial. Systemic effects of abnormal thyroid function have not been fully delineated, particularly in cases of mild thyroid failure. Also, the relationship between traditional hypothyroid symptoms and biochemical thyroid function is unclear. To determine the prevalence of abnormal thyroid function and the relationship between (1) abnormal thyroid function and lipid levels and (2) abnormal thyroid function and symptoms using modern and sensitive thyroid tests. Cross-sectional study. Participants in a statewide health fair in Colorado, 1995 (N = 25 862). Serum thyrotropin (thyroid-stimulating hormone [TSH]) and total thyroxine (T4) concentrations, serum lipid levels, and responses to a hypothyroid symptoms questionnaire. The prevalence of elevated TSH levels (normal range, 0.3-5.1 mIU/L) in this population was 9.5%, and the prevalence of decreased TSH levels was 2.2%. Forty percent of patients taking thyroid medications had abnormal TSH levels. Lipid levels increased in a graded fashion as thyroid function declined. Also, the mean total cholesterol and low-density lipoprotein cholesterol levels of subjects with TSH values between 5.1 and 10 mIU/L were significantly greater than the corresponding mean lipid levels in euthyroid subjects. Symptoms were reported more often in hypothyroid vs euthyroid individuals, but individual symptom sensitivities were low. The prevalence of abnormal biochemical thyroid function reported here is substantial and confirms previous reports in smaller populations. Among patients taking thyroid medication, only 60% were within the normal range of TSH. Modest elevations of TSH corresponded to changes in lipid levels that may affect cardiovascular health. Individual symptoms were not very sensitive, but patients who report multiple thyroid symptoms warrant serum thyroid testing. These results confirm that thyroid dysfunction is common, may often go undetected, and may be associated with adverse health outcomes that can be avoided by serum TSH measurement.
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            The incidence of thyroid disorders in the community: a twenty-year follow-up of the Whickham Survey

            M P J Vanderpump, W. M. G. Tunbrldge, J French … (1995)
            The original Whickham Survey documented the prevalence of thyroid disorders in a randomly selected sample of 2779 adults which matched the population of Great Britain in age, sex and social class. The aim of the twenty-year follow-up survey was to determine the incidence and natural history of thyroid disease in this cohort.
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              Epidemiology and prevention of clinical and subclinical hypothyroidism.

              W Michael G Tunbridge, M Vanderpump (2002)
              Iodine deficiency is the most common cause of hypothyroidism worldwide. In persons living in iodine-replete areas, causes are congenital, spontaneous because of chronic autoimmune disease (atrophic autoimmune thyroiditis or goitrous autoimmune thyroiditis [Hashimoto's thyroiditis]), or iatrogenic because of goitrogens, drugs, or destructive treatment for thyrotoxicosis. Screening for congenital hypothyroidism exists and its use prevents mental retardation. The prevalence of spontaneous hypothyroidism is between 1% and 2% and is more common in older women and 10 times more common in women than in men. A significant proportion of subjects have asymptomatic chronic autoimmune thyroiditis and 8% of women (10% of women over 55 years of age) and 3% of men have subclinical hypothyroidism. Approximately one third of patients with newly diagnosed overt hypothyroidism have received destructive therapy for hyperthyroidism and indefinite surveillance is required. There is not much that can be done to prevent the occurrence of spontaneous autoimmune hypothyroidism, but if identified early, something can be done to prevent progression to overt disease. Controversy exists as to whether healthy adults would benefit from screening for autoimmune thyroid disease because a significant proportion of subjects tested will have evidence of mild thyroid failure. Case finding in women at menopause or visiting a primary care physician with nonspecific symptoms appears justified.
              Article 0 comments Cited 81 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Cureus
                Journal ID (iso-abbrev): Cureus
                Journal ID (issn): 2168-8184
                Title: Cureus
                Publisher: Cureus (Palo Alto (CA) )
                ISSN (Electronic): 2168-8184
                Publication date (Electronic, pub): 24 September 2020
                Publication date (Electronic, collection): September 2020
                Volume: 12
                Issue: 9
                Electronic Location Identifier: e10636
                Affiliations
                [1 ] Biochemistry, Institute of Nephro Urology (Government of Karnataka), Bengaluru, IND
                [2 ] Nephrology, Institute of Nephro Urology (Government of Karnataka), Bengaluru, IND
                [3 ] Microbiology, Institute of Nephro Urology (Government of Karnataka), Bengaluru, IND
                Author notes
                Article
                DOI: 10.7759/cureus.10636
                PMC ID: 7584321
                SO-VID: 08a6aa18-6c5d-4a68-8097-e598dbf7ec88
                Copyright © Copyright © 2020, N.S et al.
                License:

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                Date accepted : 24 September 2020
                Categories
                Subject: Endocrinology/Diabetes/Metabolism
                Subject: Internal Medicine
                Subject: Medical Education

                Keywords: subclinical hypothyroidism,dyslipidemia,s.tsh,lipid profile,atherogenic index of plasma
                Data availability:
                Keywords: subclinical hypothyroidism, dyslipidemia, s.tsh, lipid profile, atherogenic index of plasma

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