Primary Hypothyroidism: Presence of Central Adiposity and Its Improvement on Attaining Euthyroid State with L-Thyroxine

Reshma A. Esmail, Rachael E. Hinrichs, Udaya M. Kabadi

.
VA Central Iowa Health Care System, Des Moines, USA.

DOI: 10.4236/ojemd.2013.35032                

Abstract

Objective: Primary hypothyroidism is frequently manifested by weight gain. Moreover, treatment with L-Thyroxine reverses the weight gain in most subjects on achieving euthyroid state. However, the characteristic fat distribution contributing to these changes in body weight is not well documented. Therefore, the presence of central adiposity was examined in primary hypothyroidism prior to and after attaining and maintaining euthyroid state following L-Thyroxine therapy. Methods: Waist and hip measurements were conducted to determine waist: hip ratios in 55 men, ages 39 to 84 years at diagnosis of primary hypothyroidism established by subnormal Free T4 and supernormal TSH concentrations and again after their normalization by L-Thyroxine replacement therapy. The subjects were divided according to Body Mass Index (BMI-Kg/m²) into 3 groups; hypo T1, 20 men with BMI < 25; Hypo T2, BMI 25 - 30 and Hypo T3, BMI > 30. 15 euthyroid normal (N) men matched for age and BMI in each group participated as controls. Results: Mean waist: hip ratio was significantly higher (p < 0.01) in subjects with primary hypothyroidism (0.97 + 0.03) than in healthy men (0.92 + 0.02) and declined significantly (p < 0.01) on achieving euthyroidism (0.93 + 0.02). Moreover, waist: hip ratios were also higher in individual hypothyroid groups; Hypo T1, 0.92 + 0.01 vs. N1, 0.88 + 0.01; Hypo T2, 0.96 + 0.02 vs. N2, 0.92 + 0.02 and Hypo T3, 1.02 + 0.03 vs. N3, 0.98 + 0.02 (p < 0.01for all comparisons). Finally, waist: hip ratios declined significantly in all groups on attaining euthyroidism; Hypo T1, 0.89 + 0.01; Hypo T2, 0.93 + 0.02; Hypo T3, 0.98 + 0.02 (p < 0.01 vs. pretreatment). Conclusion: Central adiposity is a definitive clinical manifestation of primary hypothyroidism in men. Moreover, a significant improvement on achieving euthyroid state following L-Thyroxine therapy may deem central adiposity to be a major contributor to changes in body weight in primary hypothyroidism noted at diagnosis and on attaining and maintaining euthyroid state.

Keywords

Primary Hypothyroidism; Central Obesity; Body Weight

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	J. Pears, R. T. Jung and A. Gunn, “Long-Term Weight Changes in Treated Hyperthyroid and Hypothyroid Patients,” Scottish Medical Journal, Vol. 35, No. 6, 1990, pp. 180-182.
[2]	W. M. Kong, M. H. Sheikh, P. J. Lumb, et al., “A 6-Month Randomized Trial of Thyroxine Treatment in Women with Mild Subclinical Hypothyroidism,” American Journal of Medicine, Vol. 112, No. 5, 2002, pp. 348-354. doi:10.1016/S0002-9343(02)01022-7
[3]	C. S. Fox, M. J. Pencina, R. B. D’Agostino, et al., “Relations of Thyroid Function to Body Weight: Cross-Sectional and Longitudinal Observations in a Community-Based Sample,” Archives of Internal Medicine Vol. 168, No. 6, 2008 pp. 587-592. doi:10.1001/archinte.168.6.587
[4]	S. M. Haffner, M. P. Stern, H. P. Hazuda, et al., “Do Upper-Body and Centralized Adiposity Measure Different Aspects of Regional Body-Fat Distribution? Relationship to Non-Insulin-Dependent Diabetes Mellitus, Lipids, and Lipoproteins,” Diabetes, 1987. Vol. 36, No. 1, pp. 43-51. doi:10.2337/diabetes.36.1.43
[5]	L. van Gaal, E. Rillaerts, W. Creten, et al., “Relationship of Body Fat Distribution Pattern to Atherogenic Risk Factors in NIDDM. Preliminary Results,” Diabetes Care, Vol. 11, No. 2, 1988, pp. 103-106. doi:10.2337/diacare.11.2.103
[6]	K. M. Utzschneider, D. B. Carr, R. L. Hull, et al., “Impact of Intra-Abdominal Fat and Age on Insulin Sensitivity and Beta-Cell Function,” Diabetes, Vol. 53, No. 11, 2004, pp. 2867-2872. doi:10.2337/diabetes.53.11.2867
[7]	D. B. Carr, K. M. Utzschneider, R. L. Hull, et al., “Intra-Abdominal Fat Is a Major Determinant of the National Cholesterol Education Program Adult Treatment Panel III Criteria for the Metabolic Syndrome,” Diabetes, Vol. 53, No. 8, pp. 2087-2094. doi:10.2337/diabetes.53.8.2087
[8]	A. Madhavan, R. Beena Kumari and M. G. Sanal, “A Pilot Study on the Usefulness of Body Mass Index and Waist Hip Ratio as a Predictive Tool for Gestational Diabetes in Asian Indians,” Gynecological Endocrinology, Vol. 24, No. 12, 2008, pp. 701-707. doi:10.1080/09513590802444134
[9]	E. Lapice, S. Maione, L. Patti, et al., “People,” Diabetes Care, Vol. 32, No. 9, 2009, pp. 1734-1736. doi:10.2337/dc09-0176
[10]	L. de Koning, A. T. Merchant, J. Pogue, et al., “Waist Circumference and Waist-to-Hip Ratio as Predictors of Cardiovascular Events: Meta-Regression Analysis of Prospective Studies,” European Heart Journal, Vol. 28, No. 7, 2007, pp. 850-856. doi:10.1093/eurheartj/ehm026
[11]	J. S. Ho, J. J. Cannaday, C. E. Barlow, et al., “Comparative Relation of General, Central, and Visceral Adiposity Measures for Coronary Artery Calcium in Subjects without Previous Coronary Events,” American Journal of Cardiology, Vol. 104, No. 7, 2009, pp. 943-946. doi:10.1016/j.amjcard.2009.05.047
[12]	T. Coutinho, K. Goel, D. de sá Corrêa, et al., “Combining Body Mass Index with Measures of Central Obesity in the Assessment of Mortality in Subjects with Coronary Disease: Role of ‘Normal Weight Central Obesity’,” Journal of the American College of Cardiology, Vol. 61, No. 5, 2013, pp. 553-556. doi:10.1016/j.jacc.2012.10.035
[13]	S. Grundy, H. Brewer Jr., J. Cleeman, et al., “Definition of Metabolic Syndrome. Report of the National Heart, Lung, and Blood Institute/American Heart Association Conference on Scientific Issues Related to Definition,” Circulation, Vol. 3, 2004, pp. 433-438.
[14]	P. Segal and P. Zimmet, “Treatment of the Metabolic Syndrome,” The 1st International Congress on Prediabetes and the Metabolic Syndrome, Berlin, 13-16 April 2005.
[15]	E. Kassi, P. Pervanidou, P. Kaltsas, et al., “Metabolic Syndrome: Definitions and Controversies,” BMC Medicine, Vol. 9, 2011, pp. 48-55. doi:10.1186/1741-7015-9-48
[16]	A. J. Cameron, E. J. Boyko, R. A. Sicree, et al., “Central Obesity as a Precursor to the Metabolic Syndrome in the AusDiab Study and Mauritius,” Obesity, Vol. 16, No. 12, 2008, pp. 2707-2716. doi:10.1038/oby.2008.412
[17]	G. P. Shantha, A. A. Kumar, V. Jeyachandran, et al., “Association between Primary Hypothyroidism and Metabolic Syndrome and the Role of C Reactive Protein: A Cross-Sectional Study from South India,” Thyroid Research, Vol. 2, No. 1, 2009, p. 2. doi:10.1186/1756-6614-2-2
[18]	C. Liu, W. A. Scherbaum, M. Schott and S. Schinner, “Subclinical Hypothyroidism and the Prevalence of the Metabolic Syndrome,” Hormone and Metabolic Research, Vol. 43, No. 6, 2011, pp. 417-421. doi:10.1055/s-0031-1275719
[19]	M. Erdogan, A. Canataroglu, S. Ganidagli, et al., “Metabolic Syndrome Prevalence in Subclinic and Overt Hypothyroid Patients and the Relation among Metabolic Syndrome Parameters,” Journal of Endocrinological Investigation, Vol. 34, No. 7, 2011, pp. 488-492.
[20]	A. O. Ogbera, S. Kuku and O. Dada, “The Metabolic Syndrome in Thyroid Disease: A Report from Nigeria,” Indian Journal of Endocrinology and Metabolism, Vol. 16, No. 3, 2012, pp. 417-422. doi:10.4103/2230-8210.95688
[21]	A. C. Waring, N. Rodondi, S. Harrison, et al., “Health, Ageing, and Body Composition (Health ABC) Study. Thyroid Function and Prevalent and Incident Metabolic Syndrome in Older Adults: The Health, Ageing and Body Composition Study,” Clinical Endocrinology (Oxford), Vol. 76, No. 6, 2012, pp. 911-918. doi:10.1111/j.1365-2265.2011.04328.x
[22]	B. J. Hoogwerf and F. Q. Nuttall, “Long-Term Weight Regulation in Treated Hyperthyroid and Hypothyroid Subjects,” Am J Med. Vol. 76, No. 6, 1984, pp. 963-970. doi:10.1016/0002-9343(84)90842-8
[23]	J. Karmisholt, S. Andersen and P. Laurberg, “Weight Loss after Therapy of Hypothyroidism Is Mainly Caused by Excretion of Excess Body Water Associated with Myxoedema,” The Journal of Clinical Endocrinology & Metabolism, Vol. 96, No. 1, 2011, pp. E99-E103. doi:10.1210/jc.2010-1521
[24]	I. Kowalska, J. Borawski, A. Nikolajuk, et al., “Insulin Sensitivity, Plasma Adiponectin and sICAM-1 Concentrations in Patients with Subclinical Hypothyroidism: Response to Levothyroxine Therapy,” Endocrine, Vol. 40, No. 1, 2011, pp. 95-101. doi:10.1007/s12020-011-9446-5