Skip to content
Licensed Unlicensed Requires Authentication Published by De Gruyter April 22, 2013

Thyroid-stimulating hormone (TSH) level in nutritionally obese children and metabolic co-morbidity

  • Cenk Aypak EMAIL logo , Özlem Türedi , Adnan Yüce and Süleyman Görpelioğlu

Abstract

Objective: In recent years, there has been increasing focus on thyroid function in pediatric obese patients. Our aims were to investigate whether there is an association between serum thyroid-stimulating hormone (TSH) within the normal range and body mass index (BMI), and to determine if TSH levels correlate with metabolic risk factors in children.

Methods: A retrospective cross-sectional analysis was carried out on 528 euthyroid, age- and sex-matched lean, overweight, or obese children. Anthropometric indices, blood pressure, fasting blood glucose, hepatic enzymes, lipid profiles, TSH, free triiodothyronine (fT3), and free thyroxine (fT4) were assessed from medical records and compared among groups. Subjects with known presence of diabetes, using medications altering blood pressure and glucose or lipid metabolism, with TSH levels >97.5 or <2.5 percentile, or with autoimmune thyroid disease were excluded.

Results: Hypertension, dyslipidemia, and elevated levels of hepatic enzymes were found to be more common in overweight and obese children (p<0.001), and those metabolic changes were significantly correlated with the increase in BMI (p<0.05). Serum concentrations of TSH and fT3 within the normal range were higher in overweight and obese children (p<0.01), and TSH was positively correlated with total cholesterol, triglycerides, and systolic blood pressure (p<0.05).

Conclusion: Our findings suggest that obese children have higher serum TSH and fT3 levels even within the normal range, and that an increase in TSH is associated with dyslipidemia and higher systolic blood pressure. It remains to be seen whether TSH might serve as a potential marker of metabolic risk factors in obese pediatric patients.


Corresponding author: Cenk Aypak, MD, Department of Family Medicine, Diskapi Training and Research Hospital, Ankara 06110, Turkey, Phone: +903123186981-514, Fax: +903123170287

References

1. Sokol RJ. The chronic disease of childhood obesity: the sleeping giant has awakened. J Pediatr 2000;136:711–3.10.1067/mpd.2000.107787Search in Google Scholar PubMed

2. Nathan BM, Moran A. Metabolic complications of obesity in childhood and adolescence: more than just diabetes. Curr Opin Endocrinol Diabetes Obes 2008;15:21–9.10.1097/MED.0b013e3282f43d19Search in Google Scholar PubMed

3. Olshansky SJ, Passaro DJ, Hershow RC, Layden J, Carnes BA, et al. A potential decline in life expectancy in the United States in the 21st century. N Engl J Med 2005;352:1138–45.10.1056/NEJMsr043743Search in Google Scholar PubMed

4. Pacifico L, Anania C, Ferraro F, Andreoli GM, Chiesa C. Thyroid function in childhood obesity and metabolic comorbidity. Clin Chim Acta 2012;413:396–405.10.1016/j.cca.2011.11.013Search in Google Scholar PubMed

5. Reinehr T. Thyroid function in the nutritionally obese child and adolescent. Curr Opin Pediatr 2011;23:415–20.10.1097/MOP.0b013e328344c393Search in Google Scholar PubMed

6. Knudsen N, Laurberg P, Rasmussen LB, Bülow I, Perrild H, et al. Small differences in thyroid function may be important for body mass index and the occurrence of obesity in the population. J Clin Endocrinol Metab 2005;90:4019–24.10.1210/jc.2004-2225Search in Google Scholar PubMed

7. Rotondi M, Magri F, Chiovato L. Thyroid and obesity: not a one-way interaction. J Clin Endocrinol Metab 2011;96:344–6.10.1210/jc.2010-2515Search in Google Scholar PubMed

8. Sari R, Balci MK, Altunbas H, Karayalcin U. The effect of body weight and weight loss on thyroid volume and function in obese women. Clin Endocrinol 2003;59:258–62.10.1046/j.1365-2265.2003.01836.xSearch in Google Scholar PubMed

9. Michalaki MA, Vagenakis AG, Leonardou AS, Argentou MN, Habeos IG, et al. Thyroid function in humans with morbid obesity. Thyroid 2006;16:73–8.10.1089/thy.2006.16.73Search in Google Scholar PubMed

10. Bastemir M, Akin F, Alkis E, Kaptanoglu B. Obesity is associated with increased serum TSH level, independent of thyroid function. Swiss Med Wkly 2007;137:431–4.10.4414/smw.2007.11774Search in Google Scholar

11. De Pergola G, Ciampolillo A, Paolotti S, Trerotoli P, Giorgino R. Free triiodothyronine and thyroid stimulating hormone are directly associated with waist circumference independently of insulin resistance, metabolic parameters and blood pressure in overweight and obese women. Clin Endocrinol 2007;67:265–9.10.1111/j.1365-2265.2007.02874.xSearch in Google Scholar PubMed

12. Rotondi M, Leporati P, La Manna A, Pirali B, Mondello T, et al. Raised serum TSH levels in patients with morbid obesity: is it enough to diagnose subclinical hypothyroidism? Eur J Endocrinol 2009;160:403–8.10.1530/EJE-08-0734Search in Google Scholar PubMed

13. Rotondi M, Cappelli C, Leporati P, Chytiris S, Zerbini F, et al. A hypoechoic pattern of the thyroid at ultrasound does not indicate autoimmune thyroid diseases in patients with morbid obesity. Eur J Endocrinol 2010;163:105–9.10.1530/EJE-10-0288Search in Google Scholar PubMed

14. Shalitin S, Yackobovitch-Gavan M, Phillip M. Prevalence of thyroid dysfunction in obese children and adolescents before and after weight reduction and its relation to other metabolic parameters. Horm Res 2009;71:155–61.10.1159/000197872Search in Google Scholar PubMed

15. Ogden CL, Flegal KM, Carroll MD, Johnson CL. Prevalence and trends in overweight among US children and adolescents, 1999–2000. J Am Med Assoc 2002;288:1728–32.10.1001/jama.288.14.1728Search in Google Scholar PubMed

16. Reinehr T, Andler W. Thyroid hormones before and after weight loss in obesity. Arch Dis Child 2002;87:320–3.10.1136/adc.87.4.320Search in Google Scholar PubMed PubMed Central

17. Reinehr T, de Sousa G, Andler W. Hyperthyrotropinemia in obese children is reversible after weight loss and is not related to lipids. J Clin Endocrinol Metab 2006;91:3088–91.10.1210/jc.2006-0095Search in Google Scholar PubMed

18. Grandone A, Santoro N, Coppola F, Calabrò P, Perrone L, et al. Thyroid function derangement and childhood obesity: an Italian experience. BMC Endocrinol Disord 2010;10:8.10.1186/1472-6823-10-8Search in Google Scholar PubMed PubMed Central

19. Aeberli I, Jung A, Murer SB, Wildhaber J, Wildhaber-Brooks J, et al. During rapid weight loss in obese children, reductions in TSH predict improvements in insulin sensitivity independent of changes in body weight or fat. J Clin Endocrinol Metab 2010;95:5412–8.10.1210/jc.2010-1169Search in Google Scholar PubMed

20. Marras V, Casini MR, Pilia S, Carta D, Civolani P, et al. Thyroid function in obese children and adolescents. Horm Res Paediatr 2010;73:193–7.10.1159/000284361Search in Google Scholar PubMed

21. Dekelbab BH, Abou Ouf HA, Jain I. Prevalence of elevated thyroid-stimulating hormone levels in obese children and adolescents. Endocr Pract 2010;16:187–9.10.4158/EP09176.ORSearch in Google Scholar PubMed

22. Neyzi O, Günöz H, Furman A, Bundak R, Gökçay G, et al. Türk çocuklarında vücut ağırlığı, boy uzunluğu, baş çevresi ve vücut kitle indeksi referans değerleri. Çocuk Sağlığı Hastalıkları Dergisi 2008;51:1–14.Search in Google Scholar

23. Cole TJ, Bellizzi MC, Flegal KM, Dietz WH. Establishing a Standard definition for child overweight and obesity world-wide: international survey. Brit Med J 2000;320:1240–3.10.1136/bmj.320.7244.1240Search in Google Scholar PubMed PubMed Central

24. Fredriks AM, van Buuren S, Jeurissen SE, Dekker FW, Verloove-Vanhorick SP, et al. Height, weight, body mass index and pubertal development reference values for children of Turkish origin in the Netherlands. Eur J Pediatr 2003;162:788–93.10.1007/s00431-003-1292-xSearch in Google Scholar PubMed

25. Kromeyer-Hauschild K, Wabitsch M, Kunze D, Geller F, Geiß HC, et al. Perzentile für den Body-mass-Index für das Kindes-und jugendalter unter Heranziehung verschiedener deutscher Stichproben. Monatsschr Kinderheilkd 2001;149:807–18.10.1007/s001120170107Search in Google Scholar

26. Bereket A, Atay Z. Current status of childhood obesity and its associated morbidities in Turkey. J Clin Res Pediatr Endocrinol 2012;4:1–7.10.4274/jcrpe.506Search in Google Scholar PubMed PubMed Central

27. Lifshitz F. Obesity in children. J Clin Res Pediatr Endocrinol 2008;1:53–60.10.4008/jcrpe.v1i2.35Search in Google Scholar PubMed PubMed Central

28. Fraser A, Longnecker MP, Lawlor DA. Prevalence of elevated alanine aminotransferase among US adolescents and associated factors: NHANES 1999–2004. Gastroenterology 2007;133:1814–20.10.1053/j.gastro.2007.08.077Search in Google Scholar PubMed PubMed Central

29. Weiss R, Dziura J, Burgert TS, Tamborlane WV, Taksali SE, et al. Obesity and the metabolic syndrome in children and adolescents. N Engl J Med 2004;350:2362–74.10.1056/NEJMoa031049Search in Google Scholar PubMed

30. Reinehr T, Isa A, de Sousa G, Dieffenbach R, Andler W. Thyroid hormones and their relation to weight status. Horm Res 2008;70:51–7.10.1159/000129678Search in Google Scholar PubMed

31. Strollo PJ Jr., Rogers RM. Obstructive sleep apnea. N Engl J Med 1996;334:99–104.10.1056/NEJM199601113340207Search in Google Scholar PubMed

32. Ford ES. The epidemiology of obesity and asthma. J Allergy Clin Immunol 2005;115:897–909.10.1016/j.jaci.2004.11.050Search in Google Scholar PubMed

33. Timm NL, Grupp-Phelan J, Ho ML. Chronic ankle morbidity in obese children following an acute ankle injury. Arch Pediatr Adolesc Med 2005;159:33–6.10.1001/archpedi.159.1.33Search in Google Scholar PubMed

34. Nead KG, Halterman JS, Kaczorowski JM, Auinger P, Weitzman M. Overweight children and adolescents: a risk group for iron deficiency. Pediatrics 2004;114:104–8.10.1542/peds.114.1.104Search in Google Scholar PubMed

35. Shaw GM, Velie EM, Schaffer D. Risk of neural tube defect-affected pregnancies among obese women. J Am Med Assoc 1996;275:1093–6.10.1001/jama.1996.03530380035028Search in Google Scholar PubMed

36. Williams J, Wake M, Hesketh K, Maher E, Waters E. Health-related quality of life of overweight and obese children. J Am Med Assoc 2005;293:70–6.10.1001/jama.293.1.70Search in Google Scholar PubMed

37. Decaluwe V, Braet C. Prevalence of binge-eating disorder in obese children and adolescents seeking weight-loss treatment. Int J Obes Relat Metab Disord 2003;27:404–9.10.1038/sj.ijo.0802233Search in Google Scholar PubMed

38. Freedman DS, Khan LK, Serdula MK, Dietz WH, Srinivasan SR, et al. The relation of childhood BMI to adult adiposity: the Bogalusa Heart Study. Pediatrics 2005;115:22–7.10.1542/peds.2004-0220Search in Google Scholar PubMed

39. Janssen I, Katzmarzyk PT, Srinivasan SR, Chen W, Malina RM, et al. Combined influence of body mass index and waist circumference on coronary artery disease risk factors among children and adolescents. Pediatrics 2005;115:1623–30.10.1542/peds.2004-2588Search in Google Scholar PubMed

40. Kapelari K, Kirchlechner C, Högler W, Schweitzer K, Virgolini I, et al. Pediatric reference intervals for thyroid hormone levels from birth to adulthood: a retrospective study. BMC Endocr Disord 2008;27;8:15.10.1186/1472-6823-8-15Search in Google Scholar PubMed PubMed Central

41. Elmlinger MW, Kühnel W, Lambrecht HG, Ranke MB. Reference intervals from birth to adulthood for serum thyroxine (T4), triiodothyronine (T3), free T3, free T4, thyroxine binding globulin (TBG) and thyrotropin (TSH). Clin Chem Lab Med 2001;39:973–9.10.1515/CCLM.2001.158Search in Google Scholar PubMed

42. Eliakim A, Barzilai M, Wolach B, Nemet D. Should we treat elevated thyroid stimulating hormone levels in obese children and adolescents? Int J Pediatr Obes 2006;1:217–21.10.1080/17477160600805006Search in Google Scholar PubMed

43. Knudsen N, Bulow I, Jørgensen T, Laurberg P, Ovesen L, et al. Comparative study of thyroid function and types of thyroid dysfunction in two areas in Denmark with slightly different iodine status. Eur J Endocrinol 2000;143:485–91.10.1530/eje.0.1430485Search in Google Scholar PubMed

44. Laurberg P, Bulow Pederson I, Knudsen N, Ovesen L, Andersen S. Environmental iodine intake affects the type of nonmalignant thyroid disease. Thyroid 2001;11:457–69.10.1089/105072501300176417Search in Google Scholar PubMed

Received: 2012-12-3
Accepted: 2013-3-5
Published Online: 2013-04-22
Published in Print: 2013-08-01

©2013 by Walter de Gruyter Berlin Boston

Downloaded on 12.6.2024 from https://www.degruyter.com/document/doi/10.1515/jpem-2012-0384/html
Scroll to top button