Published online Aug 15, 2013. doi: 10.4239/wjd.v4.i4.157
Revised: July 2, 2013
Accepted: July 9, 2013
Published online: August 15, 2013
AIM: To investigate the impact of hypothyroidism and thyroxine therapy on insulin sensitivity in patients with overt hypothyroidism.
METHODS: The study included twenty seven overtly hypothyroid and fifteen healthy euthyroid South Western Asian females. Both groups had matching age and body mass index. Physiological and pathological conditions as well as medications that may alter thyroid function, glucose homeostasis or serum lipids were ruled out. Serum thyrotropin (TSH), free tetraiodothyronine (FT4), free triiodothyronine (FT3), fasting insulin (FI), fasting plasma glucose (FPG), total cholesterol and triglycerides were measured before and six months after initiating thyroxine therapy for hypothyroid patients and once for the control group. Insulin resistance (IR) was estimated using homeostasis model assessment (HOMA-IR) and Body mass index (BMI) was calculated.
RESULTS: Both study groups, hypothyroid patients and euthyroid control subjects, had matching age and body mass index (P-value 0.444, 0.607 respectively). No significant difference was found between the hypothyroid patients and the euthyroid control group regarding fasting plasma glucose, fasting insulin, insulin resistance, total cholesterol and triglycerides (P-values 0.432, 0.621, 0.883, 0.586, 0.05 respectively). In the hypothyroid patients, triglycerides showed direct correlation to TSH and inverse correlation to FT3. Similarly total cholesterol inversely correlated to FT3 but its direct correlation to TSH did not reach statistical significance. After thyroxine replacement and reaching an euthyroid state as confirmed by clinical and laboratory data, there was no significant change in fasting plasma glucose, insulin resistance or triglyceride level (P-value 0.216, 0.204, 0.175 respectively) while total cholesterol significantly decreased (P-value 0.043) and fasting insulin significantly increased (P-value 0.047).
CONCLUSION: Hypothyroidism has no impact on insulin sensitivity. Correction of hypothyroidism is not associated with a significant change of insulin sensitivity or triglycerides, but with a significant reduction of total cholesterol.
Core tip: Thyroid dysfunction is the second most common endocrine disorder after diabetes mellitus. Both diseases are strong associated. Hypothyroidism is claimed to cause insulin resistance. Some available reports are in agreement and others are against this suggestion. In our study, we did not find a significant effect of hypothyroidism or thyroxine replacement on insulin resistance as calculated by insulin resistance was estimated using homeostasis model assessment. Thyroxine therapy leads to a significant reduction of total cholesterol but it does not change triglycerides. This may partially explain the association between hypothyroidism and dyslipidaemia as well as cardiovascular risk.