Background While hypothyroidism is associated with negative health effects in the general population, older adults with hypothyroidism have better physical function and comparable rates of depression and cognitive impairment relative to their euthyroid counterparts. The aim of this study was to investigate the association between thyroid status and health-related quality of life in Korean older adults.
Methods In this population-based cross-sectional study, 1,060 adults aged over 60 years were classified by thyroid status into four groups based on their thyroid stimulating hormone (TSH) and free T4 values: overt hypothyroid, subclinical hypothyroid, euthyroid, and subclinical hyperthyroid. The main outcome measure was self-reported health-related quality of life based on the three-level version of the EuroQol-5 dimension (EQ-5D), with utility values of -0.171 and 1.000 corresponding to the worst and best health statuses, respectively. The adjusted means of the EQ-5D three-level version utility values according to thyroid status were determined using a linear regression analysis.
Results In the adjusted analysis, the overt hypothyroid group showed significantly higher EQ-5D three-level version utility values than did the euthyroid group (0.998 vs. 0.908, P=0.000). In the subgroup analyses by sex, the overt hypothyroid group also showed significantly higher EQ-5D three-level version utility values for both men and women than did the euthyroid group (0.998 vs. 0.940, P=0.008; 0.983 vs. 0.882, P=0.001).
Conclusion Asymptomatic Korean older adults aged over 60 years with TSH and free T4 values corresponding to overt hypothyroidism have better health-related quality of life than their euthyroid counterparts.
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An association between hypothyroidism and renal impairment has rarely been reported in the literature. We describe a case of hypothyroidism that was associated with otherwise unexplained acute kidney impairment, which was reversed with treatment. A 21-year-old female patient presented to her family physician with myalgia, and preliminary investigations revealed an elevated level of creatine kinase and poor renal function. Primary hypothyroidism was diagnosed and no other apparent etiology for renal failure could be identified despite extensive investigations by the Nephrology Department. Notably, the patient’s renal impairment showed prompt resolution following thyroid hormone replacement.
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Myalgia, muscle weakness, muscle cramping, muscular rigidity and elevated levels of serum creatinine kinase (CK) are very common in patients with hypothyroidism. However, these symptoms are not clinically serious in most cases and are not found in primary care. So far, 5 Cases with hypothyroid myopathy have been reported in the Korean literature. However, it is not reported that this case has been found in primary care or in periodic health examination. We report a case of hypothyroid myopathy that was presented with exercise-induced myalgia. This case was diagnosed as hypothyroid myopathy through abnormal thyroid function test and elevated levels of serum CK and myoglobin in periodic health examination. Muscle symptoms and laboratory abnormality were improved only with thyroid hormone replacement therapy. (J Korean Acad Fam Med 2008;29:612-616)
Background The relationship between clinical as well as subclinical thyroid disease and cardiovascular disease has been reported. Epidemiological evidence is accumulating that vascular risk factors increase the risk of AD. We sought to investigate the relationship between thyroid function and dementia. Methods: We examined patients who were admitted to geriatric ward of one psychiatric hospital in Kyong-Gi. The control group was individuals who underwent check up at a health promotion center of one university hospital in Daejeon. Results: The number of patients with dementia was 110. In the dementia group, there were 12 people with subclinical hyperthyroidism, 6 with subclinical hypothyroidism, and 2 with apparent hypothyroidism. After controlling for education, hypertension, diabetes and total cholesterol, multiple logistic regression yielded the odds ratio for dementia to be significantly higher in the group with low levels of thyroid stimulating hormone compared to the normal group (OR 4.00, 95% confidence interval 1.04∼15.39). Conclusion: We found a significant relationship between dementia and subclinical hyperthyroidism. (J Korean Acad Fam Med 2007;28:173-178)
Background : There are conflicting reports on the effect of subclinical hypothyroidism on plasma lipid concentrations and blood pressure. This may be due to lack of consideration for menopause status or hormone replacement therapy (HRT) in selecting the study subjects. Also, the reason may be that many subjects with transient abnormality were included in those studies. Therefore, we intended to include the subjects who satisfied the definition of subclinical hypothyroidism on repeated measures. Then, we investigated the difference of plasma lipid concentrations and blood pressure between subclinical hypothyroidism and normal control subjects.
Methods : This study involved the women above age 18, who visited a health promotion center in a general hospital and measured their serum TSH and free T4, from January 1997 to May 2003. The number patients who satisfied the definition of subclinical hypothyroidism on repeated measures, and who had no history of thyroid disease, herb medication or HRT, diabetes, abnormalities of liver and renal function were 30. Age, menopause, body mass index-matched people of 65 were selected as normal controls. Serum TSH, free T4 and plasma lipid concentrations were measured by chemiluminescent assay and enzyme method, respectively. Dyslipidemia were defined according to NCEP ATPIII guidelines.
Results : There was no significant difference of blood pressure and plasma lipid concentrations between subclinical hypothyroidism patients and normal controls irrespective of menopause. There was no significant difference of percentage of dyslipidemia and hypertension between the two groups.
Conclusion : There were no significant increase in plasma lipid concentrations and blood pressure in subclinical hypothyroidism patients despite more strict inclusion.
Background : There are several reports on the association between hypothyroidism and coronary heart disease. But, it is not convincing whether the subclinical hypothyroidism is associated with the coronary heart disease or not. We have attempted to investigate the association between subclinical hypothyroidism and several coronary risk factors, and the difference of Framingham risk score between subclinical hypothyroidism and normal control subjects in women above 55 years old, who have higher prevalence in subclinical hypothyroidism.
Methods : This study involved th subjects above age 55, who visited the health promotion center in a university hospital from 1995 to 2000. Subclinical hypothyroidism was defined as a TSH level greater than 4.1 uIU/mL in the presence of a normal T3 (87-184 ng/dL) and T4 (5.6-13.1ug/dL) level. We measured thyroid function test(TSH, T3, T4) and the coronary risk factors (systolic and diastolic blood pressure, total cholesterol, LDL cholesterol, HDL cholesterol, triglyceride, fasting glucose, uric acid, C-reactive protein, and body mass index). Also, we calculated the Framingham risk score from their sum.
Results : There were no significant differences between the subclinical hypothyroidism patients and normal control subjects with coronary risk assessment in women above 55-years-old.
Background : Thyroid diseases is common in adult and frequently has significant clinical consequences. But, Prevalence have not been accurately estimated before performance of sensitive TSH and high resolution ultrasound devices on thyroid gland in practice. The objective of the study was to obstain prevalance rate of thyroid dysfunciton and structural abnormality by sensitive TSH, Free T4 and high resolution ultrasound.
Methods : The subjects were 10,543(5,638 male and 4,815 female) individuals who visited a health care center of a general hospital in Kangnung city during the period of Jun. 1st, 1997 through May 31st, 2000. For thyroid dysfunction, serum TSH(Thyroid Stimulation Hormone)and Free T4 concentration of those were measured by RIA or IRMA. During the period of Dec. 1St, 1997 through May 25th, 1998, 1,316 individuals were examined by radiology specialists using high resolution ultrasonography with 7.5 MHz linear array. Consequently 21 patients who showed thyroid nodule were performed ultrasound-guided fine needle aspiration. Accordingly medical records containing results of physical examination made by 3 specialists in family medicine before thyroid ultrasonography were investigated in association with other diagnostic modalities.
Results : The measurements of thyroid function revealed that 10,090(96.5%) were normal, 240(2.3%) low(below 0.39 mU/L) and 123(1.2%) high (above 5.1 mU/l) in TSH. In terms of prevalence rate per 1,000 population, 15.2 cases were with subclinical hyperthyroidism, and 9.0 cases with subclinical hypothyroidism, 7.7 cases with hyperthyroidism and 3.3 cases with hypothyroidism. Among 94 individuals(7.1%) with structural abnormality on thyroid gland by ultrasonography, 60(4.6%) showed solitary solid nodule, 12(0.9%) multiple solid nodules, 18(1.4%) cystic nodules and 3(0.3%) diffuse parenchymal lesions. Physical examination found only 13.3% of 91 nodules found by high-resolution ultrasongraphy, and nodules as large as above 1.0 cm in size were palpable only in 22.2%. 21 Of 91 thyroid nodules was received ultrasound-guided FNA and 4(19%) were found to have malignant nodules.
Conclusion : The study results showed the relatively high rate of thyroid diseases among general population, with the prevalence rate of thyroid dysfunction 3.6%, thyroid nodule 6.9%, malignant incidentaloma among thyroid nodules 4.4%. Physical examination was relative ineffective in detection for thyroid nodules in routine health examinations.
Background : There are no agreement for abnormalities in serum lipid concentrations and lipoprotein(a) (Lp(a)) in patients with subclinical hypothyroidism. But there are no reports for consideration of postmenopausal state and hormone replacement therapy(HRT). Therefore, we anayzed serum Lp(a) and lipid concentrations in patients with subclinical hypothyroidism considering menopause and HRT and the correlation between serum Lp(a) level and thyroid-stimulating hormone (TSH) concentration.
Methods : We undertook this study in 99 patients with subclinical hypothyroidism (TSH>5uIU/mL) and 297 age- and sex-matched normal control. They and no abnormalities in liver and renal function, fasting blood glucose and medical and drug histories. We excluded who were receiving HRT. Serum free thyroxine, triiodothyronine, TSH were measured by radioimmune assay using commercial kits, and Lp(a), total cholesterol, TG and HDL by Latex and enzyme method, respectively.
Results : There were no significant differences of serum Lp(a), total cholesterol, LDL, TG, HDL concentrations in patients with subclinical hypothyroidism and control subjects, analyzing after dividing into men, premenopausal and postmenopausal women. In patients with subclinical hypothyroidism, there was no correlation between serum Lp(a) and TSH concentraions(r=0.06, P>0.05).
Conclusion : Considering menopause and HRT, there were no increase in serum Lp(a) and lipid concentrations in subclinical hypothyroidism. There was no correlation between serum Lp(a) and TSH concentration in patients with subclinical hypothyroidism.
Background : Overt hyperthyroidism is a well-known cause of secondary hyperlipidemia and atherosclerosis. However, there have been some dissenting report of abnormalities and in serum lipid concentration in patients with subclinical hypothyroidism. We have attempted to analyze serum lipid concentrations to investigate whether they are increased in patients with subclinical hypothyroidism and to see if there is a correlation between serum LDL-C and TSH concentrations.
Methods : Serum lipid profiles(total cholesterol, triglycerides, LDL-C, HDL-C) of patients with subclinical hypothyroidism (M/F=7/119) compared with age, sex and body mass index matched control subject(M/F=14/239) from Jan. 1. 1996. to Dec. 30. 1997.
Results : There were no significant differences of serum total cholesterol, LDL cholesterol, TG, and HDL concentrations in 126 patients with subclinical hypothyroidism and 253 control subjects(178.47±35.76mg/Dl vs. 173.05±35.963mg/Dl ; 113.33±52.89mg/Dl vs.117.64±68.70mg/Dl ; 112.89±33.25mg/dL vs 109.65±29.02mg/Dl ; 48.60±11.34mg/Dl vs 46.51±11.73mg/Dl). There was no correlation between LDL cholesterol and TSH concentrations in subclinical hypothyroidism(r=0.29, p<0.05).
Conclusion : Serum lipid concentration(total cholesterol, LDL cholesterol, and TG, HDL) was not increased in patients with subclinical hypothyroidism. There was no correlation between serum LDL and TSH levels in patients with subclinical hypothyroidism.
Background : Hypothyroidism may be involved in a significant portion of the causes of hypercholesterolemia in Korea. In this study, we determined the frequency of suspected hypothyroidism in hypercholesterolemic patients and compared the frequency of elevated thyrotropin levels among the groups with various total cholesterol levels.
Methods : The study subjects were healthy, asymptomatic people who visited Health Promotion Center of Seoul National University Hospital. We excluded subjects with history of hypertension, DM and hypothyroidism. The study subjects underwent physical examination and filled out a questionnaire on health risk factors. Also blood chemistry and thyroid function test were done.
Results : Among 6479 subjects, 194(2.99%) had elevated(>4.1μIU/ml) thyrotropin levels. Among the hypercholesterolemic(≥240mg/dl) patients(n=868), 40(4.60%) had elevated thyrotropin levels. And there was statistically significant difference between normal cholesterolemic and hypercholesterolemic subjects(P<0.05). Among the patients with total cholesterol above 280mg/dl (n=180), 15(8.33%) had elevated thyrotropin levels. As amount of the total cholesterol increased, the frequency of elevated thyrotropin levels increased(P=0.001). And this result was consistent following adjustment for age, sex, BMI, smoking and drinking status(P<0.01).
Conclusion : Practicing physicians should be aware of the possibility of secondary hypercholesterolemia due to hypothyroidism and keep in mind the importance of evaluating TSH level.
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