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Si SA, Lu RN, Zhang GJ. Association of the thyroid hormone sensitivity index with triglycerides in adolescents: a cross-sectional study. Hormones (Athens) 2025:10.1007/s42000-025-00645-3. [PMID: 40116991 DOI: 10.1007/s42000-025-00645-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2024] [Accepted: 03/11/2025] [Indexed: 03/23/2025]
Abstract
BACKGROUND Inconsistent findings have emerged from studies examining the relationship between thyroid hormone sensitivity indices and triglycerides (TGs), especially in pediatric and adolescent cohorts. The present study investigates this relationship within adolescent populations in the United States. METHODS Data spanning three periods from 2007 to 2012 were analyzed, including 1813 participants. The thyroid hormone sensitivity index was calculated and weighted multiple linear regression was used to assess the relationships between TG levels and individual thyroid hormone sensitivity indices. Subgroup analyses were conducted as needed and smooth curve fitting plots visualized the linear relationships. RESULTS The FT3/FT4 ratio was positively correlated with TG (β = 0.649, 95% CI: 0.360-0.938, P < 0.001). This correlation persisted after adjusting for all variables (β = 0.439, 95% CI: 0.154-0.725, P < 0.01). The relationship between the TFQI score and TG concentration demonstrated a significant negative correlation, which remained after controlling for all covariates (β = -0.153, 95% CI: -0.239-0.067, P < 0.01). When stratified into quartiles, the FT3/FT4 ratio and TG exhibited a positive correlation only in the Q3 and Q4 groups. Conversely, the TFQI was significantly correlated with TG exclusively in the Q4 group's positive values. Stratified analyses by sex and age showed clearer associations in female adolescents. CONCLUSIONS The study confirmed the relationship between thyroid hormone sensitivity indices and TGs. Maintaining the FT3/FT4 ratio within a specific range may reduce TG levels. The TFQI may predict TG levels when actual TSH values exceed expected values based on FT4. These findings were most pronounced in female adolescents, highlighting the importance of early monitoring of thyroid health in this group. These results point to the need for improved thyroid function testing in predicting TG levels and preventing hypertriglyceridemia.
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Affiliation(s)
- Shang-An Si
- Shandong University of Traditional Chinese Medicine, Jinan, Shandong, 250014, China
| | - Rui-Ning Lu
- Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong, 250014, China
| | - Gui-Ju Zhang
- Shandong University of Traditional Chinese Medicine, Jinan, Shandong, 250014, China.
- Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong, 250014, China.
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Liu C, Zhu X, Wang D, Huang N, Chen W. Impaired sensitivity to thyroid hormones is associated with all-cause and cause-specific mortality among chronic kidney disease patients: results from National Health and Nutrition Examination Survey (NHANES) 2007-2012. Ren Fail 2024; 46:2433178. [PMID: 39689980 DOI: 10.1080/0886022x.2024.2433178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2024] [Revised: 10/28/2024] [Accepted: 11/18/2024] [Indexed: 12/19/2024] Open
Abstract
BACKGROUND Resistance to thyroid hormone shows underlying mechanical link with chronic kidney disease (CKD) and is prevalent in CKD population. However, whether it attributes to mortality risk among CKD population is unknown. This study aimed to examine the association of thyroid hormone resistance (THR) with all-cause and cause-specific mortality among CKD individuals. METHODS This study extracted CKD population from the National Health and Nutrition Examination Survey (NHANES) 2007-2012. Death outcomes were ascertained by linkage to National Death Index records through 31 December 2019. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence interval (CI) for mortality from all causes, cardiovascular disease (CVD). RESULTS A total of 1,634 adults with CKD were included in the cohort, in which 663 deaths were recorded during an average follow-up of 8.72 years. After multivariate adjustment, resistance to thyroid hormone was significantly associated with higher all-cause and CVD mortality. There was an 18% and 31% increase in risks of all-cause and CVD mortality per-standard deviation (SD) increment in Parametric Thyroid Feedback Quantile-based Index (PTFQI) respectively. When PTFQI was analyzed as categorical variable (classified according to PTFQI percentiles), after adjusted for potential confounders and taking PTFQI ≤ P5 as reference, the HRs and 95% CIs in category with PTFQI > P95 for all-cause mortality and CVD mortality were 2.12 [1.10, 4.09] (p for trend 0.026) and 5.14 [1.81, 14.60] for (p for trend 0.018), respectively. CONCLUSIONS Resistance to thyroid hormone, centered on variations in the typical pituitary response to thyroid hormones, may independently correlate with all-cause and CVD mortality in CKD patients.
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Affiliation(s)
- Chan Liu
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Key Laboratory of Nephrology, Ministry of Health of China, Guangdong Provincial Key Laboratory of Nephrology, Guangzhou, China
- Department of General Practice, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xiaoxiao Zhu
- Department of General Practice, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Dingding Wang
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Key Laboratory of Nephrology, Ministry of Health of China, Guangdong Provincial Key Laboratory of Nephrology, Guangzhou, China
| | - Naya Huang
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Key Laboratory of Nephrology, Ministry of Health of China, Guangdong Provincial Key Laboratory of Nephrology, Guangzhou, China
| | - Wei Chen
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Key Laboratory of Nephrology, Ministry of Health of China, Guangdong Provincial Key Laboratory of Nephrology, Guangzhou, China
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Liu J, Wei Y, Zhu Y, Li Y, Wang Q, Yu L, Zhuang L, Jin G, Pei X. A Case of Thyroid Hormone Resistance Syndrome with a Novel Mutation (c.947G>a) in the THRB Gene: Experience in Diagnosis and Treatment. Int Med Case Rep J 2024; 17:959-964. [PMID: 39559298 PMCID: PMC11570523 DOI: 10.2147/imcrj.s486498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2024] [Accepted: 11/06/2024] [Indexed: 11/20/2024] Open
Abstract
Background Thyroid hormone resistance syndrome (RTH) is a rare hereditary endocrine disease that can manifest as hyperthyroidism, hypothyroidism, or remain asymptomatic. It can easily be confused with other types of thyroid diseases. The diagnosis of the disease depends on genetic testing. Case Report We report a 19-year-old male patient with elevation of thyroid hormones. Serological examination showed elevated thyroid hormone levels, and thyroid-stimulating hormone levels within the reference interval. The patient was finally diagnosed with RTH after genetic testing that identified a gene mutation inherited from his mother. Due to timely diagnosis, the patient's condition has been well controlled, and his prognosis is good. Conclusion The clinical manifestations of RTH lack specificity, and serological examination typically shows elevated thyroid hormone levels and unsuppressed thyrotropin levels. Differential diagnosis requires a combination of serological examination, imaging studies, and functional tests to distinguish RTH from other conditions. The purpose of this treatment is to improve symptoms and should not involve the blind administration of antithyroid drugs, thyroid surgery, or radiotherapy.
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Affiliation(s)
- Jie Liu
- Department of Endocrinology, The First Affiliated Hospital of Bengbu Medical University, Bengbu, Anhui Province, People’s Republic of China
| | - Yu Wei
- Department of Endocrinology, The First Affiliated Hospital of Bengbu Medical University, Bengbu, Anhui Province, People’s Republic of China
| | - Yanhui Zhu
- Department of Endocrinology, The First Affiliated Hospital of Bengbu Medical University, Bengbu, Anhui Province, People’s Republic of China
| | - Yu Li
- Department of Endocrinology, The First Affiliated Hospital of Bengbu Medical University, Bengbu, Anhui Province, People’s Republic of China
| | - Qiong Wang
- Department of Endocrinology, The First Affiliated Hospital of Bengbu Medical University, Bengbu, Anhui Province, People’s Republic of China
| | - Lei Yu
- Department of Endocrinology, The First Affiliated Hospital of Bengbu Medical University, Bengbu, Anhui Province, People’s Republic of China
| | - Langen Zhuang
- Department of Endocrinology, The First Affiliated Hospital of Bengbu Medical University, Bengbu, Anhui Province, People’s Republic of China
| | - Guoxi Jin
- Department of Endocrinology, The First Affiliated Hospital of Bengbu Medical University, Bengbu, Anhui Province, People’s Republic of China
| | - Xiaoyan Pei
- Department of Endocrinology, The First Affiliated Hospital of Bengbu Medical University, Bengbu, Anhui Province, People’s Republic of China
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Wang Q, Wang Y, Jia Y, Liu Y, Gou Y, Xie X, Zhang Y. Correlation of thyroid function and sensitivity to thyroid hormone with spinal bone mineral content, bone mineral density, and osteoporotic vertebral fracture: A cross-sectional study based on NHANES. Medicine (Baltimore) 2024; 103:e40173. [PMID: 39496031 PMCID: PMC11537616 DOI: 10.1097/md.0000000000040173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 10/02/2024] [Indexed: 11/06/2024] Open
Abstract
Previous studies have demonstrated that thyroid hormone plays an important role in normal bone development, bone metabolism, and establishment of peak bone mass. However, the correlation of thyroid status with bone mineral content (BMC), bone mineral density (BMD), and osteoporotic vertebral fracture (OVF) is rarely discussed. The current study probes into the potential association between thyroid status and spinal BMC, BMD, and OVF from a novel perspective of thyroid function (TF) and sensitivity to thyroid hormone based on the National Health and Nutrition Examination Survey database. A total of 1844 participants were included in this study. The association of thyroid status with outcome variables, like spinal BMC, BMD, and OVF, was analyzed using thyroid function indices and sensitivity to thyroid hormone indices as influence factors. The correlation of them were assessed using univariate and multivariable weighted linear regression, weighted logistic regression models, restricted cubic spline model, and subgroup analyses. The results of this study showed that the association of free triiodothyronine (FT3)/free thyroxine (FT4) with BMC remained negatively associated after adjustment for all covariates. Higher thyroid peroxidase antibody (TPOAb) was significantly associated with an increased risk of developing OVF in both unadjusted and adjusted models. In addition, the results of the restricted cubic spline model were consistent with the weighted multivariate regression analysis after adjustment. The results of this cross-sectional study showed that higher FT3/FT4 and TPOAb were associated with decreased spinal BMC and the increased risk of OVF, indicating a complex link between thyroid status and bone health. Therefore, patients with hyperthyroidism, hypothyroidism, autoimmune thyroid disease, or abnormal peripheral thyroid sensitivity, especially who with elevated TPOAb or FT3/FT4, should focus on the prevention of vertebral osteopenia, osteoporosis, and OVF.
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Affiliation(s)
- Qilin Wang
- Department of Orthopaedics, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, China
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Yang H, Lu Y, Zhao L, He Y, He Y, Chen D. The mediating role of serum 25-hydroxyvitamin D on the association between reduced sensitivity to thyroid hormones and periodontitis in Chinese euthyroid adults. Front Endocrinol (Lausanne) 2024; 15:1456217. [PMID: 39539932 PMCID: PMC11557418 DOI: 10.3389/fendo.2024.1456217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2024] [Accepted: 10/10/2024] [Indexed: 11/16/2024] Open
Abstract
Aim Thyroid dysfunction is closely associated with periodontitis. We aim to explore the association between sensitivity to thyroid hormones (THs) and periodontitis and to investigate the mediating role of serum 25-hydroxyvitamin D[25(OH)D] in this relationship in Chinese euthyroid populations. Methods This population-based retrospective study included 2,530 euthyroid participants. Central sensitivity to THs was assessed by the thyroid feedback quantile-based index (TFQI), parametric thyroid feedback quantile-based index (PTFQI), thyrotrophic thyroxine resistance index (TT4RI) and thyroid-stimulating hormone index (TSHI), while FT3/FT4 was evaluated to assess peripheral sensitivity. Multivariable regression analysis and restricted cubic spline were performed to explore the association between sensitivity to THs and periodontitis. Threshold effect and subgroup analysis were also conducted. Mediation analysis was performed to estimate direct and indirect effects through 25(OH)D. Results Multivariable regression analysis indicated that central sensitivity to THs indices(per SD increase) were positively associated with periodontitis risk [TFQI: OR=1.19,95% CI (1.09, 1.31); PTFQI: OR=1.22, 95% CI(1.12,1.34); TSHI: OR=1.36, 95% CI (1.21,1.52); TT4RI: OR=1.43, 95% CI (1.25,1.63)](all P value<0.001). TT4RI only had a non-linear relationship with periodontitis in euthyroid participants. Subgroup analysis showed that no significant correlations were founded among those aged over 65 years or with hypertension/diabetes. Mediation analysis revealed that the proportions mediated by 25(OH)D on the association of TFQI, PTFQI,TSHI, TT4RI and periodontitis risk were 16.37%, 16.43%, 9.93% and 10.21%, respectively. Conclusions Impaired central sensitivity to THs is positively associated with periodontitis in euthyroid and serum 25(OH)D might be one of its biological mechanisms.
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Affiliation(s)
- Hao Yang
- Department of Stomatology, Health Examination Center of Shanghai Health and Medical Center, Huadong Sanatorium, Wuxi, China
| | - Yayun Lu
- Nursing Department, Health Examination Center of Shanghai Health and Medical Center, Huadong Sanatorium, Wuxi, China
| | - Lina Zhao
- Department of Stomatology, The affiliated Hospital of Inner Mongolia Medical University, Inner Mongolia Medical University, Hohhot, China
| | - Yufeng He
- Department of Stomatology, Health Examination Center of Shanghai Health and Medical Center, Huadong Sanatorium, Wuxi, China
| | - Yuecheng He
- Department of Oral and Maxillofacial Implantology, Shanghai PerioImplant Innovation Center, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, China
| | - Dong Chen
- Department of Endodontics, Shanghai Stomatological Hospital & School of Stomatology, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Craniomaxillofacial Development and Diseases, Fudan University, Shanghai, China
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Zhang SY, Hu XQ, Xiang C, Xiang T, Guo SX, Zhi FH, Zhao P, Zhu JY, Zhang CY. Physical activity affects dysthyreosis by thyroid hormones sensitivity: a population-based study. Front Endocrinol (Lausanne) 2024; 15:1418766. [PMID: 39530120 PMCID: PMC11550926 DOI: 10.3389/fendo.2024.1418766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Accepted: 10/09/2024] [Indexed: 11/16/2024] Open
Abstract
Objective Physical activity (PA) plays an important role in human health. However, the relationship between the PA and dysthyreosis was not clear. This study aimed to explore this question. Methods We performed a population-based study on the basis of the participant's information that was collected from the National Health and Nutrition Examination Survey (NHANES) database. The association of the thyroid hormone and total PA metabolic equivalent task (MET) were assessed via linear regression analysis with adjusting for different covariates. Moreover, we also used path analysis to explore the causality between PA, thyroid hormone index, and dysthyreosis. The restricted cubic spline analysis was used to explore the non-linear relationship between the thyroid hormone index and the PA total MET. Results A total of 2118 participants aged≥20, including 969 females and 1149 males, were collected from NHANES. The linear regression with multivariate adjustment suggested a linear relationship between the PA total MET and Thyroid-Stimulating Hormone Index (TSHI), and Thyroid Feedback Quantile-Based Index (TFQI), respectively. And TFQI and dysthyresis occurrence were significantly correlated (P<0.05). The path analysis showed that the PA total MET affected dysthyreosis occurrence by TFQI. In addition, we found a non-linear relationship between the total PA met and dysthyreosis via restricted cubic spline analysis. Conclusions PA was significantly correlated with dysthyreosis via thyroid hormone sensitivity. Therefore, it can be considered to prevent the occurrence of dysthyreosis by regulating thyroid hormone sensitivity through PA in daily life.
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Affiliation(s)
- Shu-yang Zhang
- Department of General Surgery, Shaoxing Hospital of Traditional Chinese Medicine [Shaoxing Traditional Chinese Medicine (TCM) Hospital Affiliated to Zhejiang Chinese Medical University], Shaoxing, Zhejiang, China
| | - Xue-qing Hu
- Department of Plastic Surgery, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Cheng Xiang
- Department of Thyroid Surgery, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Tao Xiang
- Department of Colorectal Surgery, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Song-xue Guo
- Department of Plastic Surgery, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Fei-hu Zhi
- Department of General Surgery, Shaoxing Hospital of Traditional Chinese Medicine [Shaoxing Traditional Chinese Medicine (TCM) Hospital Affiliated to Zhejiang Chinese Medical University], Shaoxing, Zhejiang, China
| | - Ping Zhao
- Department of General Surgery, Shaoxing Hospital of Traditional Chinese Medicine [Shaoxing Traditional Chinese Medicine (TCM) Hospital Affiliated to Zhejiang Chinese Medical University], Shaoxing, Zhejiang, China
| | - Jia-yan Zhu
- Department of General Surgery, Shaoxing Hospital of Traditional Chinese Medicine [Shaoxing Traditional Chinese Medicine (TCM) Hospital Affiliated to Zhejiang Chinese Medical University], Shaoxing, Zhejiang, China
| | - Chen-yang Zhang
- XiangYa School of Medicine, Central South University, Changsha, Hunan, China
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Fu SE, Liang XH, Huang LL, Xian J, Wu XZ, Pan J, Chen XL, Kuang YQ, Wu CJ, Li QL, Liu XF, Huang ZE, Wei TT, Qin YF, Huang ZX, Yang HY, Lan SS, Lu DC, Luo ZJ. Chronic thyrotoxic myopathy development is associated with thyroid hormone sensitivity index, predicted by lower-limb fatigue and the squat-up test. Sci Rep 2024; 14:24364. [PMID: 39420080 PMCID: PMC11487120 DOI: 10.1038/s41598-024-76273-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2024] [Accepted: 10/11/2024] [Indexed: 10/19/2024] Open
Abstract
Thyroid hormones (THs) may affect chronic thyrotoxic myopathy (CTM). The relationship between TH sensitivity and CTM is inconsistent. We aimed to investigate the associations between TH sensitivity and the risk of CTM and to screen potential CTMs with strength and function tests. A total of 162 Chinese patients (36.58% men) with Graves' disease were enrolled and divided into CTM and non-CTM groups. TH and sensitivity indices were measured. Muscle power and function were assessed by grip, upper-limb fatigue (ULFT), lower-limb fatigue (LLFT), and squat-up (SUT) tests, and walking pace. Association between sensitivity to TH indices and the risk of developing CTM was assessed via multivariate logistic regression. The diagnostic effectiveness of muscle power and function for predicting CTM was evaluated via receiver operating characteristic (ROC) curves. Thyroid feedback quantile-based index FT3 (TFQIFT3) and the parametric TFQIFT3 (PTFQIFT3), TFQIFT4, and PTFQIFT4 were positively associated with CTM risk by using inverse probability of treatment weighting multivariate logistic regression. For each 1-SD increase in TFQIFT3 and PTFQIFT3, TFQIFT4 and PTFQIFT4, the odds ratios for CTM were 1.67 (95% CI = 1.17-2.48) ,1.64 (95% CI = 1.51-2.93), 1.60 (95%CI = 1.12-2.32), 1.58 (95%CI = 1.11-2.30), respectively. LLFT and SUT best predicted male/female CTM, respectively (AUC = 0.89/0.85). In Graves' disease patients, TH sensitivity is associated with CTM development, which can be predicted by SUT and LLFT results.
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Affiliation(s)
- Shi-En Fu
- Department of Endocrinology, The First Affiliated Hospital of Guangxi Medical University, No.6 Shuang Yong Road, Nanning, 530021, China
- Nanfang Hospital, Southern Medical University, No.1838 North Guangzhou Avenue, Guangzhou, 510515, China
| | - Xing-Huan Liang
- Department of Endocrinology, The First Affiliated Hospital of Guangxi Medical University, No.6 Shuang Yong Road, Nanning, 530021, China
| | - Li-Li Huang
- Department of Endocrinology, The First Affiliated Hospital of Guangxi Medical University, No.6 Shuang Yong Road, Nanning, 530021, China
- Department of Endocrinology, The Affiliated Hospital of Guilin Medical University, No.15 Le Qun Road, Guilin, 541001, China
| | - Jing Xian
- Department of Endocrinology, The First Affiliated Hospital of Guangxi Medical University, No.6 Shuang Yong Road, Nanning, 530021, China
| | - Xi-Zhen Wu
- Department of Laboratory, The First Affiliated Hospital of Guangxi Medical University, No.6 Shuang Yong Road, Nanning, 530021, China
| | - Jie Pan
- Department of Neurology, The First Affiliated Hospital of Guangxi Medical University, No.6 Shuang Yong Road, Nanning, 530021, China
| | - Xue-Lan Chen
- Department of Endocrinology, The First Affiliated Hospital of Guangxi Medical University, No.6 Shuang Yong Road, Nanning, 530021, China
| | - Ya-Qi Kuang
- Department of Endocrinology, The First Affiliated Hospital of Guangxi Medical University, No.6 Shuang Yong Road, Nanning, 530021, China
| | - Chun-Jiao Wu
- Department of Laboratory, The First Affiliated Hospital of Guangxi Medical University, No.6 Shuang Yong Road, Nanning, 530021, China
| | - Qiao-Li Li
- Department of Endocrinology, The First Affiliated Hospital of Guangxi Medical University, No.6 Shuang Yong Road, Nanning, 530021, China
| | - Xiao-Fan Liu
- Department of Endocrinology, The First Affiliated Hospital of Guangxi Medical University, No.6 Shuang Yong Road, Nanning, 530021, China
| | - Zi-En Huang
- Department of Endocrinology, The First Affiliated Hospital of Guangxi Medical University, No.6 Shuang Yong Road, Nanning, 530021, China
| | - Ting-Ting Wei
- Department of Laboratory, The First Affiliated Hospital of Guangxi Medical University, No.6 Shuang Yong Road, Nanning, 530021, China
| | - Ying-Fen Qin
- Department of Endocrinology, The First Affiliated Hospital of Guangxi Medical University, No.6 Shuang Yong Road, Nanning, 530021, China
| | - Zhen-Xing Huang
- Department of Endocrinology, The First Affiliated Hospital of Guangxi Medical University, No.6 Shuang Yong Road, Nanning, 530021, China
| | - Hai-Yan Yang
- Department of Endocrinology, The First Affiliated Hospital of Guangxi Medical University, No.6 Shuang Yong Road, Nanning, 530021, China
| | - Shan-Shan Lan
- Department of Endocrinology, The First Affiliated Hospital of Guangxi Medical University, No.6 Shuang Yong Road, Nanning, 530021, China
| | - De-Cheng Lu
- Department of Endocrinology, The First Affiliated Hospital of Guangxi Medical University, No.6 Shuang Yong Road, Nanning, 530021, China.
| | - Zuo-Jie Luo
- Department of Endocrinology, The First Affiliated Hospital of Guangxi Medical University, No.6 Shuang Yong Road, Nanning, 530021, China.
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Duan XY, Fu JL, Sun LN, Mu ZJ, Xiu SL. Association between sensitivity to thyroid hormones and non-high-density lipoprotein cholesterol levels in patients with type 2 diabetes mellitus. World J Diabetes 2024; 15:2081-2092. [PMID: 39493565 PMCID: PMC11525720 DOI: 10.4239/wjd.v15.i10.2081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Revised: 08/06/2024] [Accepted: 08/30/2024] [Indexed: 09/26/2024] Open
Abstract
BACKGROUND Dyslipidemia and type 2 diabetes mellitus (T2DM) are chronic conditions with substantial public health implications. Effective management of lipid metabolism in patients with T2DM is critical. However, there has been insufficient attention given to the relationship between thyroid hormone sensitivity and dyslipidemia in the T2DM population, particularly concerning non-high-density lipoprotein cholesterol (non-HDL-C). AIM To clarify the association between thyroid hormone sensitivity and dyslipidemia in patients with T2DM. METHODS In this cross-sectional study, thyroid hormone sensitivity indices, the thyroid feedback quantile-based index (TFQI), the thyroid-stimulating hormone index (TSHI), the thyrotrophic T4 resistance index (TT4RI), and the free triiodothyronine (FT3)/free thyroxine (FT4) ratio were calculated. Logistic regression analysis was performed to determine the associations between those composite indices and non-HDL-C levels. Random forest variable importance and Shapley Additive Explanations (SHAP) summary plots were used to identify the strength and direction of the association between hyper-non-HDL-C and its major predictor. RESULTS Among the 994 participants, 389 (39.13%) had high non-HDL-C levels. Logistic regression analysis revealed that the risk of hyper-non-HDL-C was positively correlated with the TFQI (OR: 1.584; 95%CI: 1.088-2.304; P = 0.016), TSHI (OR: 1.238; 95%CI: 1.034-1.482; P = 0.02), and TT4RI (OR: 1.075; 95%CI: 1.006-1.149; P = 0.032) but was not significantly correlated with the FT3/FT4 ratio. The relationships between composite indices of the thyroid system and non-HDL-C levels differed according to sex. An increased risk of hyper-non-HDL-C was associated with elevated TSHI levels in men (OR: 1.331; 95%CI: 1.003-1.766; P = 0.048) but elevated TFQI levels in women (OR: 2.337; 95%CI: 1.4-3.901; P = 0.001). Among the analyzed variables, the average SHAP values were highest for TSHI, followed by TT4RI. CONCLUSION Impaired sensitivity to thyroid hormones was associated with high non-HDL-C levels in patients with T2DM.
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Affiliation(s)
- Xiao-Ye Duan
- Department of Endocrinology, Beijing Institute of Geriatrics, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Jun-Ling Fu
- Department of Endocrinology, Beijing Institute of Geriatrics, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Li-Na Sun
- Department of Endocrinology, Beijing Institute of Geriatrics, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Zhi-Jing Mu
- Department of Endocrinology, Beijing Institute of Geriatrics, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Shuang-Ling Xiu
- Department of Endocrinology, Beijing Institute of Geriatrics, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
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Yang Q, Dong R, Yan H, Xu R, Xue Y, Yin Y, Zhao Z, Wang Z. Impaired sensitivity to thyroid hormone correlates to all-cause mortality in euthyroid individuals with chronic kidney disease. BMC Public Health 2024; 24:2134. [PMID: 39107720 PMCID: PMC11305014 DOI: 10.1186/s12889-024-19660-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 07/31/2024] [Indexed: 08/10/2024] Open
Abstract
BACKGROUND This study aimed to investigate the association between central sensitivity to thyroid hormones and all-cause mortality in euthyroid patients with chronic kidney disease (CKD). METHODS Data on thyroid function indicators and all-cause mortality for CKD patients were extracted from the NHANES database (2007-2012). Central sensitivities to thyroid hormones were mainly evaluated by Thyroid Feedback Quantile-based Index (TFQI). The Kaplan-Meier method, Cox proportional hazards regression model and subgroup analysis were performed to explore the potential associations between thyroid hormone sensitivity and all-cause mortality. RESULTS A total of 1303 euthyroid CKD patients were enrolled in this study. After a median follow-up of 115 months, 503 participants died. The Kaplan-Meier analysis demonstrated significant variations in survival rates among different levels of TFQI (P = 0.0015). Cox regression analysis showed that increased levels of TFQI were independent risk factors for all-cause mortality after adjusting for multiple confounding factors (HR = 1.40, 95% CI 1.10-1.79, P = 0.007). Subgroup analysis did not reveal any significant variation in the association between TFQI and all-cause mortality between the subgroups assessed (P for interaction > 0.05). CONCLUSION Our study suggests that impaired thyroid hormone sensitivity might be linked to increased mortality in euthyroid CKD patients. Further research is needed to confirm and explore this association.
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Affiliation(s)
- Qichao Yang
- Department of Endocrinology, Affiliated Wujin Hospital of Jiangsu University, Changzhou, 213017, Jiangsu, China
- Department of Endocrinology, Wujin Clinical College of Xuzhou Medical University, Changzhou, 213017, Jiangsu, China
| | - Ru Dong
- Department of Endocrinology, Affiliated Wujin Hospital of Jiangsu University, Changzhou, 213017, Jiangsu, China
- Department of Endocrinology, Wujin Clinical College of Xuzhou Medical University, Changzhou, 213017, Jiangsu, China
| | - Han Yan
- Department of Endocrinology, Affiliated Wujin Hospital of Jiangsu University, Changzhou, 213017, Jiangsu, China
- Department of Endocrinology, Wujin Clinical College of Xuzhou Medical University, Changzhou, 213017, Jiangsu, China
| | - Ruijun Xu
- Department of Endocrinology, Affiliated Wujin Hospital of Jiangsu University, Changzhou, 213017, Jiangsu, China
- Department of Endocrinology, Wujin Clinical College of Xuzhou Medical University, Changzhou, 213017, Jiangsu, China
| | - Yi Xue
- Department of Endocrinology, Affiliated Wujin Hospital of Jiangsu University, Changzhou, 213017, Jiangsu, China
- Department of Endocrinology, Wujin Clinical College of Xuzhou Medical University, Changzhou, 213017, Jiangsu, China
| | - Yong Yin
- Department of Endocrinology, Affiliated Wujin Hospital of Jiangsu University, Changzhou, 213017, Jiangsu, China
- Department of Endocrinology, Wujin Clinical College of Xuzhou Medical University, Changzhou, 213017, Jiangsu, China
| | - Zhiyong Zhao
- Department of Endocrinology, Affiliated Wujin Hospital of Jiangsu University, Changzhou, 213017, Jiangsu, China.
- Department of Endocrinology, Wujin Clinical College of Xuzhou Medical University, Changzhou, 213017, Jiangsu, China.
| | - Zhaoxiang Wang
- Department of Endocrinology, Affiliated Kunshan Hospital of Jiangsu University, Kunshan, 215300, Jiangsu, China.
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10
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Kaur P, Suri V. Uric Acid Status in Subclinical Hypothyroidism. EJIFCC 2024; 35:83-90. [PMID: 39247658 PMCID: PMC11380146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 09/10/2024]
Abstract
Overt hypothyroidism is associated with high levels of serum uric acid (UA) however, the association between UA and thyroid function in patients with subclinical thyroid dysfunction remains unclear. Subclinical hypothyroidism (SCH) is a common endocrine disorder characterized by normal thyroxine (T4) and triiodothyronine (T3), and elevated thyroid stimulating hormone (TSH) levels, usually without clinical manifestations. Therefore, we carried out a study of patients with subclinical thyroid dysfunction to assess the relationship between thyroid function and UA. This lead us to review the literature to find to what extent subclinical hypothyroidism is associated with uric acid. This study adopts the method of retrospective analysis to collect general information and laboratory results aimed at assessing the correlation between uric acid and thyroid hormone levels. We searched 3 databases using different keywords. Literature search was done for articles published in the last ten years, between 2013-2023. All relevant studies were screened. A total of eighteen articles were finalized for the review. Some studies supported T3 supplementation resulting in SCH correction. Our study indicates that it is important to screen for serum uric acid levels routinely in patients with subclinical hypothyroidism.
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Affiliation(s)
- Premjeet Kaur
- Department of Biochemistry, Adesh Institute of Medical Sciences and Research, Bathinda, Punjab, India
| | - Vijay Suri
- Dr Vijay Suri, Department of pathology, Adesh Institute of Medical Sciences and Research, Bathinda, Punjab, India
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11
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Agahi S, Amouzegar A, Honarvar M, Azizi F, Mehran L. Interrelationship between thyroid hormones and reduced renal function, a review article. Thyroid Res 2024; 17:14. [PMID: 39004740 PMCID: PMC11247791 DOI: 10.1186/s13044-024-00201-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Accepted: 05/19/2024] [Indexed: 07/16/2024] Open
Abstract
BACKGROUND Understanding the relationship of thyroid hormones with the development of chronic kidney disease (CKD) has important clinical implications for managing patients with both thyroid and kidney dysfunction. In this review, our purpose was to provide a thorough comprehension of the interplay between thyroid hormones, thyroid dysfunctions, and CKD. While there is evidence linking thyroid hormone levels to renal diseases, the association between thyroid hormones, specifically within the normal range, and the risk of CKD incidence is still a subject of debate. The Google Scholar, PubMed, Scopus, and Web of Science, were searched using the medical subject heading (MeSH) terms for the relevant keywords up to December 2023. CONCLUSION Based on the review, the development of CKD is more consistently associated with higher serum TSH and thereafter lower serum free T3 levels; however, its association with free T4 is more controversial. Furthermore, subclinical and overt hypothyroidisms were considerably associated with incident CKD. Hyperthyroidism and Hashimoto thyroiditis might increase the risk of CKD.
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Affiliation(s)
- Sadaf Agahi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, P.O. Box: 19395-4763, Tehran, I. R. of Iran
| | - Atieh Amouzegar
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, P.O. Box: 19395-4763, Tehran, I. R. of Iran
| | - Mohammadjavad Honarvar
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, P.O. Box: 19395-4763, Tehran, I. R. of Iran
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, P.O. Box: 19395-4763, Tehran, I. R. of Iran
| | - Ladan Mehran
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, P.O. Box: 19395-4763, Tehran, I. R. of Iran.
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12
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Wang Q, Zhao R, Han C, Huang Z, Bi Y, Zhang X, Shen S. Correlation between thyroid hormone sensitivity and the risk of polycystic ovary syndrome. BMC Endocr Disord 2024; 24:76. [PMID: 38816692 PMCID: PMC11137887 DOI: 10.1186/s12902-024-01607-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 05/23/2024] [Indexed: 06/01/2024] Open
Abstract
OBJECTIVE There has been some confusion in earlier research on the connection between thyroid function and polycystic ovary syndrome (PCOS). This research is aimed to probe into the correlation between thyroid condition and the risk of PCOS from a new standpoint of thyroid hormone sensitivity. METHODS This research comprised 415 females with PCOS from Drum Tower Hospital Affiliated with the Medical School of Nanjing University, and 137 non-PCOS individuals were selected as the normal control. Based on free thyroxine (FT4), free triiodothyronine (FT3), and thyroid-stimulating hormone (TSH), we calculated the thyroid hormone sensitivity indices, which consist of Thyroid Feedback Quantile-based Index (TFQI), Thyroid-stimulating Hormone Index (TSHI), Thyrotroph Thyroxine Resistance Index (TT4RI) and Free Triiodothyronine /Free thyroxine (FT3/FT4). The binary logistic regression model was adopted to investigate the correlation between thyroid hormone sensitivity indices with the risk of PCOS. Pearson or Spearman correlation analysis was employed to explore the association among thyroid-related measures with metabolic parameters in PCOS. RESULTS Results of this research showed that females with PCOS had rising TFQI, TSHI, TT4RI, and FT3/FT4 levels compared with the control group. After adjustment for the impact of various covariates, there was no significant correlation between FT3/FT4 and the risk of PCOS; However, the odds ratio of the third and fourth vs. the first quartile of TFQI were 3.57(95% confidence interval [CI]:1.08,11.87) and 4.90(95% CI:1.38,17.38) respectively; The odds ratio of the fourth vs. the first quartile of TSHI was 5.35(95% CI:1.48,19.37); The odds ratio of the second vs. the first quartile of TT4RI was 0.27(95%CI 0.09,0.82). In addition, no significant correlation was observed between thyroid-related measures and metabolic measures in females with PCOS. CONCLUSIONS A reduction in the sensitivity of central thyroid hormone is closely correlated with a higher risk of PCOS. Further research is necessary to corroborate our findings and the supporting mechanisms.
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Affiliation(s)
- Qian Wang
- Department of Endocrinology, Endocrine and Metabolic Disease Medical Center, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
- Branch of National Clinical Research Centre for Metabolic Diseases, Nanjing, China
| | - Ru Zhao
- Branch of National Clinical Research Centre for Metabolic Diseases, Nanjing, China
- Department of Endocrinology, Endocrine and Metabolic Disease Medical Center, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, China
| | - Chen Han
- Branch of National Clinical Research Centre for Metabolic Diseases, Nanjing, China
- Department of Endocrinology and Metabolism, Drum Tower Clinical Medical College, Southeast University, Nanjing, China
| | - Zeyu Huang
- Department of Endocrinology, Endocrine and Metabolic Disease Medical Center, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
- Branch of National Clinical Research Centre for Metabolic Diseases, Nanjing, China
| | - Yan Bi
- Department of Endocrinology, Endocrine and Metabolic Disease Medical Center, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China.
- Branch of National Clinical Research Centre for Metabolic Diseases, Nanjing, China.
| | - Xiaowen Zhang
- Department of Endocrinology, Endocrine and Metabolic Disease Medical Center, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China.
- Branch of National Clinical Research Centre for Metabolic Diseases, Nanjing, China.
| | - Shanmei Shen
- Department of Endocrinology, Endocrine and Metabolic Disease Medical Center, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China.
- Branch of National Clinical Research Centre for Metabolic Diseases, Nanjing, China.
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13
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Wang S, Wang Y, Sun S, Li F, Zhao W, Li X, Ye M, Niu Y, Wu X. Free triiodothyronine to free thyroxine ratio as a marker of poor prognosis in euthyroid patients with acute coronary syndrome and diabetes after percutaneous coronary intervention. Front Endocrinol (Lausanne) 2024; 15:1322969. [PMID: 38654927 PMCID: PMC11036861 DOI: 10.3389/fendo.2024.1322969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 03/18/2024] [Indexed: 04/26/2024] Open
Abstract
Objectives In recent years, the free triiodothyronine/free thyroxine (FT3/FT4) ratio, a new comprehensive index for evaluating thyroid function, which could reflect thyroid function more stably and truly than serum thyroid hormone level, has been demonstrated to correlate with the risks of diabetes and cardiovascular disease in euthyroid adults. However, the correlation between thyroid hormone sensitivity and long-term prognosis in euthyroid patients with acute coronary syndrome (ACS) and diabetes after percutaneous coronary intervention (PCI) remains unclear. Methods A total of 1,786 euthyroid patients with ACS who successfully underwent PCI at Beijing Anzhen Hospital from August 2021 to April 2022 were included in our study, which was divided into three groups according to tertiles of thyroid hormone sensitivity index. Cox regression, Kaplan-Meier, and receiver operating characteristic analyses were applied to analyze the associations between the FT3/FT4 ratio with ACS and diabetes after PCI. Results Our analysis indicated that a lower level of FT3/FT4 ratio in euthyroid patients with acute coronary syndrome (ACS) and diabetes after PCI showed significantly higher incidences of major adverse cardiac and cerebrovascular events (MACCE) when compared with a higher level of FT3/FT4 ratio. After adjusting for other covariates, patients with a lower level of FT3/FT4 ratio were negatively associated with the risk of MACCE than those with a higher level of FT3/FT4 ratio (adjusted OR =1.61, 95% CI 1.05-2.47, P = 0.028). In subgroup analyses, individuals were stratified by age, sex, BMI, ACS type, hypertension, and dyslipidemia, showing that there were no significant interactions between the FT3/FT4 ratio and all subgroups for MACCE. In addition, the FT3/FT4 ratio performed better on ROC analyses for cardiac death prediction [area under the curve (AUC), 0.738]. Conclusion A reduced level of FT3/FT4 ratio was a potential marker of poor prognosis in euthyroid patients with ACS and diabetes after PCI.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Xiaofan Wu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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14
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Xiao XQ, Fu FS, Xiang C, Yan HC. Sensitivity to thyroid hormones is associated with sleep duration in the euthyroid population with depression degree lower than moderate. Sci Rep 2024; 14:6583. [PMID: 38503873 PMCID: PMC10951236 DOI: 10.1038/s41598-024-57373-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 03/18/2024] [Indexed: 03/21/2024] Open
Abstract
We collected thyroid-related hormone index levels, sleep duration, and other basic characteristics of the population with depression from the NHANES 2009-2012 cycles and evaluated the association of Thyroid-Stimulating Hormone Index (TSHI) with sleep duration in the euthyroid population with depression via different analysis methods. We found that the association between TSHI and sleep duration was only found in patients with depression degree < Moderate (score: 1-14) rather than > Moderate group. Among the populations with degree < Moderate (N = 1918), only 4 indexes (parametric Thyroid Feedback Quantile Index, PTFQI, Thyrotroph Thyroxine Resistance Index, TT4RI, Thyroid-Stimulating Hormone TSH, and TSHI) reflecting the sensitivity to thyroid hormones were related to the sleep duration, with a significant non-linear relationship after adjusting for potential confounders (all P < 0.05). Trend analysis indicated that with the level increase of these 4 indexes, the sleep duration increased (all P for trend < 0.001). Further, we found that TSHI was relatively more important among the 4 indexes. Sum up, sensitivity to thyroid hormones is associated with sleep duration in the euthyroid population with depression degree lower than Moderate. Poor sensitivity referred to a longer sleep duration.
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Affiliation(s)
- Xian-Qiu Xiao
- Thyroid and Breast Surgery, The 904th Hospital of Joint Logistic Support Force of PLA (Wuxi Taihu Hospital), Wuxi, 214044, Jiangsu, China
| | - Fu-Shan Fu
- Head and Neck Thyroid Surgery, The First Affiliated Hospital of Baotou Medical College of Inner Mongolia University of Science and Technology, Baotou, 014010, Neimenggu, China
| | - Cheng Xiang
- Department of Thyroid Surgery, The Second Affiliated Hospital of Zhejiang University School of Medicine, No. 88 Jiefang Road, Shangcheng District, Hangzhou, 310009, Zhejiang, China.
| | - Hai-Chao Yan
- Department of Thyroid Surgery, The Second Affiliated Hospital of Zhejiang University School of Medicine, No. 88 Jiefang Road, Shangcheng District, Hangzhou, 310009, Zhejiang, China.
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15
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Muhanhali D, Deng L, Ai Z, Ling Y. Impaired thyroid hormone sensitivity increases the risk of papillary thyroid cancer and cervical lymph node metastasis. Endocrine 2024; 83:659-670. [PMID: 37668929 DOI: 10.1007/s12020-023-03508-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 08/25/2023] [Indexed: 09/06/2023]
Abstract
BACKGROUND The association of thyroid hormone sensitivity with papillary thyroid carcinoma (PTC) is unclear. This study investigated the relationship between the thyroid hormone sensitivity indices and the risk of PTC and the influence of thyroid hormone sensitivity on the aggressive clinicopathologic features of PTC. METHODS This retrospective study recruited 1225 PTC patients and 369 patients with benign nodules undergoing surgery in Zhongshan Hospital in 2020. The thyroid hormone sensitivity indices were thyroid feedback quantile-based index (TFQI), TSH index (TSHI) and thyrotropin thyroxine resistance index (TT4RI). We employed logistic regression models to explore the correlation between the thyroid hormone sensitivity indices and the risk of PTC and its cervical lymph node metastasis (LNM). RESULTS PTC patients had significantly higher levels of TSH, TFQI, TSHI and TT4RI compared to the patients with benign nodules, but thyroid hormone levels did not differ significantly between the two groups. Logistic regression analysis revealed that the higher levels of TFQI, TSHI, and TT4RI were associated with an increased risk of PTC after adjustment for multiple risk factors (TFQI: OR = 1.92, 95% CI: 1.39-2.65, P < 0.001; TSHI: OR = 2.33, 95% CI:1.67-3.26, P < 0.001; TT4RI: OR = 2.41, 95% CI:1.73-3.36, P < 0.001). In addition, patients with decreased thyroid hormone sensitivity had a higher risk of cervical LNM in multiple logistic regression analysis (TFQI: OR = 1.38, 95% CI:1.03-1.86, P = 0.03; TSHI: OR = 1.37, 95% CI:1.02-1.84, P = 0.04; TT4RI: OR = 1.41, 95% CI:1.05-1.89, P = 0.02). CONCLUSION Impaired sensitivity to thyroid hormone was associated with an increased risk of PTC, and it is also associated with a higher risk of cervical LNM in PTC patients.
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Affiliation(s)
- Dilidaer Muhanhali
- Department of Endocrinology and Metabolism, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Lingxin Deng
- Department of Endocrinology and Metabolism, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zhilong Ai
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yan Ling
- Department of Endocrinology and Metabolism, Zhongshan Hospital, Fudan University, Shanghai, China.
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Shi C, Liu X, Du Z, Tian L. Impaired Sensitivity to Thyroid Hormones is Associated with the Risk of Diabetic Nephropathy in Euthyroid Patients with Type 1 Diabetes Mellitus. Diabetes Metab Syndr Obes 2024; 17:611-618. [PMID: 38347912 PMCID: PMC10860863 DOI: 10.2147/dmso.s449870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 01/19/2024] [Indexed: 02/15/2024] Open
Abstract
Purpose This study aims to investigate the relationship between thyroid and type 1 diabetic nephropathy (T1DN) in euthyroid populations, focusing on thyroid hormone sensitivity. Methods A cross-sectional study was conducted between January 2016 and December 2021, including 357 euthyroid patients with type 1 diabetes mellitus (T1DM). Parameters representing thyroid hormone sensitivity were assessed, including the thyroid feedback quantile-based index (TFQI), parameter thyroid feedback quantile index (PTFQI), thyroid stimulating hormone index (TSHI), thyrotropin thyroxine resistance index (TT4RI), and free triiodothyronine/free thyroxine (FT3/FT4). Logistic regression and restricted cubic spline regression were performed to detect the association between thyroid hormone sensitivity and the risk of T1DN. Results The study found a negative correlation between the risk of T1DN and FT3/FT4 in euthyroid T1DM patients (OR 0.71, 95% CI 0.51-0.97, P <0.01). PTFQI (P<0.05), TSHI (P<0.05), and TT4RI (P<0.01) showed an M-shaped nonlinear relationship with the risk of T1DN. Elevated risk of T1DN was associated with PTFQI, TSHI, and TT4RI values outside the range of zero, 2.3-3.88, and 27.56-32.19, respectively. Conclusion This study confirms the relationship between impaired thyroid hormone sensitivity and the risk of T1DN in euthyroid patients. It emphasizes the importance of evaluating thyroid hormone sensitivity in T1DM patients, even when their thyroid function appears normal, to promptly prevent the occurrence of T1DN.
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Affiliation(s)
- Chunxia Shi
- School of Medicine, Jiangsu University, Zhenjiang, People’s Republic of China
- Department of Endocrinology, Gansu Provincial Hospital, Lanzhou, People’s Republic of China
- Clinical Research Center for Metabolic Diseases, Lanzhou, Gansu Province, People’s Republic of China
| | - Xiaoning Liu
- Institution of Health Statistics and Epidemiology, School of Public Health, Lanzhou University, Lanzhou, People’s Republic of China
| | - Zouxi Du
- Department of Endocrinology, Gansu Provincial Hospital, Lanzhou, People’s Republic of China
- Clinical Research Center for Metabolic Diseases, Lanzhou, Gansu Province, People’s Republic of China
- The First School of Clinical Medicine, Lanzhou University, Lanzhou, People’s Republic of China
| | - Limin Tian
- Department of Endocrinology, Gansu Provincial Hospital, Lanzhou, People’s Republic of China
- Clinical Research Center for Metabolic Diseases, Lanzhou, Gansu Province, People’s Republic of China
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17
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Liu X, Li Y, Chai Y, Zhang Y, Zhang L, Zhang H. Thyroid function and thyroid homeostasis parameters are associated with increased urinary albumin excretion in euthyroid individuals over 60 years old from NHANES. Front Endocrinol (Lausanne) 2024; 14:1285249. [PMID: 38260133 PMCID: PMC10800926 DOI: 10.3389/fendo.2023.1285249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 12/04/2023] [Indexed: 01/24/2024] Open
Abstract
Introduction The relationship between thyroid function/homeostasis parameters and renal function has been extensively studied. However, the relationship between thyroid function and thyroid homeostasis parameters with albuminuria among elderly individuals remains unclear. Methods The population was divided into an albuminuria group and a non-albuminuria group for baseline characteristic difference analysis. Multivariable logistic regression was used to test the association between thyroid function, and thyroid homeostasis parameters and albuminuria. The nonlinear relationship was explored with restricted cubic splines. Meanwhile, we investigated whether the relationship also existed in the diabetes and hypertension subgroups. Receiver operating characteristic (ROC) curves were used to assess the effectiveness of the indices. Results FT4 and TFQIFT4 were positively correlated with albuminuria (OR = 1.12; 95% CI = 1.02-1.23, p = 0.02; OR = 1.79; 95% CI = 1.08-2.99, p = 0.03), and FT3/FT4 was negatively correlated with albuminuria (OR = 0.03; 95% CI = 0.00-0.26, p = 0.003). Additionally, the nonlinear relationship between FT3/FT4 as well as TSHI and albuminuria was approximately U-shaped. Similar results were observed in the hypertension subgroup but not in the diabetes subgroup. There was a U-shaped nonlinear relationship between FT3 and albuminuria in the diabetes group. In addition, FT3/FT4 performed better than TFQI, TT4RI, and TSHI in ROC analyses for albuminuria prediction. Conclusion FT4, TFQIFT4, and a low FT3/FT4 ratio were risk factors for albuminuria in euthyroid individuals over 60 years old. However, FT3 was more associated with albuminuria in the diabetes subgroup. TSH was not associated with albuminuria in any analysis. In our study, we attempted to provide more reasonable thyroid parameters and basis for evaluating patients with underlying albuminuria. FT3/FT4 may be used as a helpful indicator to predict albuminuria and provide novel ideas for the evaluation and treatment of albuminuria.
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Affiliation(s)
- Xue Liu
- Department of Endocrinology, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, China
- Key Laboratory of Endocrine Glucose and Lipids Metabolism and Brain Aging, Ministry of Education, Department of Endocrinology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Yuchen Li
- Department of Endocrinology, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, China
- Key Laboratory of Endocrine Glucose and Lipids Metabolism and Brain Aging, Ministry of Education, Department of Endocrinology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Yuwei Chai
- Department of Endocrinology, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, China
- Key Laboratory of Endocrine Glucose and Lipids Metabolism and Brain Aging, Ministry of Education, Department of Endocrinology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Yuhao Zhang
- Department of Urology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Li Zhang
- Department of Vascular Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Haiqing Zhang
- Department of Endocrinology, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, China
- Key Laboratory of Endocrine Glucose and Lipids Metabolism and Brain Aging, Ministry of Education, Department of Endocrinology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
- Shandong Clinical Medical Center of Endocrinology and Metabolism, Jinan, China
- Institute of Endocrinology and Metabolism, Shandong Academy of Clinical Medicine, Jinan, China
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Cheng H, Hu Y, Zhao H, Zhou G, Wang G, Ma C, Xu Y. Exploring the association between triglyceride-glucose index and thyroid function. Eur J Med Res 2023; 28:508. [PMID: 37946276 PMCID: PMC10636949 DOI: 10.1186/s40001-023-01501-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 11/03/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Thyroid dysfunction is associated with abnormal glucose-insulin homeostasis, and the triglyceride-glucose (TyG) index has been recommended as a convenient surrogate of insulin resistance (IR). This study aimed to investigate the relationship between TyG and thyroid function in the US population. METHODS We analyzed data from the National Health and Nutrition Examination Survey (NHANES) conducted from 2007 to 2012 in a cross-sectional manner. Aside from conventional thyroid parameters, our study evaluated the central sensitivity to thyroid hormones (THs) using the thyroid feedback quantile-based index (TFQI), thyrotropin resistance index (TT4RI), and thyrotropin index (TSHI). To evaluate peripheral sensitivity to THs, we calculated the ratio of free triiodothyronine (FT3) to free thyroxine (FT4) and the sum activity of peripheral deiodinases (SPINA-GD). In the 1848 adults, multivariable linear regression, subgroup, and interaction analyses were employed to estimate the association between TyG and thyroid parameters. The nonlinear relationship was addressed by smooth curve fittings and generalized additive models. RESULTS After adjusting covariates, we demonstrated a significant negative association between TyG and FT4 (β = - 0.57, p < 0.001), and a positive relationship between TyG and thyroid-stimulating hormone (β = 0.34, p = 0.037), as well as TgAb (β = 17.06, p = 0.005). Subgroup analysis indicated that the association between TyG and TgAb was more pronounced in the female subjects (β = 32.39, p < 0.001, p for interaction = 0.021). We also confirmed an inverse correlation between TyG and central sensitivity to THs, as assessed by TSHI and TT4RI (βTSHI = 0.12, p < 0.001; βTT4RI = 2.54, p = 0.023). In terms of peripheral sensitivity to THs, we found a significant positive correlation between TyG and FT3/FT4 (β = 0.03, p = 0.004), and SPINA-GD (β = 2.93, p = 0.004). CONCLUSION The present study established a noteworthy association between TyG and thyroid parameters, indicating a strong link between IR and thyroid dysfunction. Further investigations are warranted to validate these results.
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Affiliation(s)
- Hui Cheng
- Department of General Surgery, Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine, No.155, Hanzhong Road, Qinhuai District, Nanjing, 210029, Jiangsu, People's Republic of China
| | - Yanyan Hu
- Nursing College, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - Haoran Zhao
- Department of General Surgery, Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine, No.155, Hanzhong Road, Qinhuai District, Nanjing, 210029, Jiangsu, People's Republic of China
| | - Guowei Zhou
- Department of General Surgery, Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine, No.155, Hanzhong Road, Qinhuai District, Nanjing, 210029, Jiangsu, People's Republic of China
| | - Gaoyuan Wang
- Department of General Surgery, Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine, No.155, Hanzhong Road, Qinhuai District, Nanjing, 210029, Jiangsu, People's Republic of China
| | - Chaoqun Ma
- Department of General Surgery, Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine, No.155, Hanzhong Road, Qinhuai District, Nanjing, 210029, Jiangsu, People's Republic of China.
| | - Yan Xu
- Outpatient Department, Nanjing Hospital Affiliated to Nanjing University of Chinese Medicine, The Second Hospital of Nanjing, No.1, Zhongfu Road, Gulou District, Nanjing, 210003, Jiangsu, People's Republic of China.
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Sun H, Zhou Y, Liu J, Wang Y, Wang G. Maternal pre-pregnancy obesity modifies the association between first-trimester thyroid hormone sensitivity and gestational Diabetes Mellitus: a retrospective study from Northern China. Diabetol Metab Syndr 2023; 15:212. [PMID: 37875982 PMCID: PMC10598956 DOI: 10.1186/s13098-023-01188-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 10/12/2023] [Indexed: 10/26/2023] Open
Abstract
BACKGROUND Contradictory relationships have been observed between thyroid function and gestational diabetes mellitus (GDM). Previous studies have indicated that pre-pregnancy BMI (pBMI) could modify their relationships. Few studies have illustrated the role of thyroid hormone sensitivity on GDM. We aimed to explore the effect of pre-pregnancy obesity on the association between early pregnancy thyroid hormone sensitivity and GDM in euthyroid pregnant women. METHODS This study included 1310 women with singleton gestation. Subjects were classified into pre-pregnancy obese and non-obese subgroups by pBMI levels with a cutoff of 25 kg/m2. Sensitivity to thyroid hormone was evaluated by Thyroid Feedback Quartile-Based Index (TFQI), Chinese-referenced parametric TFQI (PTFQI), TSH Index (TSHI) and Thyrotrophic T4 Resistance Index (TT4RI). The associations between these composite indices and GDM were analyzed using multivariate regression models in the two subgroups, respectively. RESULTS In pre-pregnancy non-obese group, early pregnancy TFQI, PTFQI, TSHI and TT4RI levels were higher in subjects with incident GDM compared to those without GDM (all P < 0.05). By contrast, obese women with GDM exhibited lower levels of those indices (all P < 0.05). The occurrence of GDM were increased with rising TFQI, PTFQI, TSHI and TT4RI quartiles in non-obese women ( all P for trend < 0.05), while exhibited decreased trend across quartiles of those indices in obese women (all P for trend < 0.05). Further logistic analysis indicated contrary relationships between thyroid hormone sensitivity and the occurrence of GDM in the two groups, respectively. The OR of the fourth versus the first quartile of TFQI for GDM was 1.981 (95% CI 1.224, 3.207) in pre-pregnancy non-obese group, while was 0.131 (95% CI 0.036, 0.472) in pre-pregnancy obese group. PTFQI and TSHI yielded similar results. CONCLUSIONS The association between maternal sensitivity to thyroid hormones during early gestation and the occurrence of GDM was modified by pre-pregnancy obesity.
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Affiliation(s)
- Honglin Sun
- Department of Endocrinology, Beijing Chao-yang Hospital, Capital Medical University, Beijing, 100020, China
| | - Yibo Zhou
- Department of Endocrinology, Beijing Chao-yang Hospital, Capital Medical University, Beijing, 100020, China
| | - Jia Liu
- Department of Endocrinology, Beijing Chao-yang Hospital, Capital Medical University, Beijing, 100020, China
| | - Ying Wang
- Physical Examination Center, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, 10020, China.
| | - Guang Wang
- Department of Endocrinology, Beijing Chao-yang Hospital, Capital Medical University, Beijing, 100020, China.
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20
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Di Bonito P, Corica D, Marzuillo P, Di Sessa A, Licenziati MR, Faienza MF, Calcaterra V, Franco F, Maltoni G, Valerio G, Wasniewska M. Sensitivity to Thyroid Hormones and Reduced Glomerular Filtration in Children and Adolescents with Overweight or Obesity. Horm Res Paediatr 2023; 97:383-387. [PMID: 37812927 PMCID: PMC11251643 DOI: 10.1159/000534472] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 09/30/2023] [Indexed: 10/11/2023] Open
Abstract
BACKGROUND Reduced central sensitivity to thyroid hormones (THs) has been observed in euthyroid adults with reduced renal function. This topic is unexplored in young people with overweight or obesity (OW/OB). OBJECTIVE The aim of this study was to evaluate the association between sensitivity to TH and mild reduced estimated glomerular filtration rate (MReGFR) in euthyroid children and adolescents with OW/OB. METHODS Data of 788 euthyroid children and adolescents with OW/OB (aged 6-16 years), recruited from seven Italian centers for the care of OW/OB, were evaluated. Peripheral sensitivity to TH was estimated through the FT3/FT4 ratio, while central sensitivity was assessed by estimating TSH index (TSHI), thyrotroph T4 resistance index, thyroid feedback quantile-based index (TFQI), parametric thyroid feedback quantile-based index (PTFQI). MReGFR was defined by an eGFR value ≥60 and <90 mL/min/1.73 m2. RESULTS Subjects with MReGFR had significantly lower levels of FT3/FT4 ratio (0.43 ± 0.09 vs. 0.44 ± 0.10; p = 0.028) and higher levels of TSH (2.89 ± 1.00 vs. 2.68 ± 0.99; p = 0.019), TSHI (2.95 ± 0.45 vs. 2.85 ± 0.55; p = 0.031), TFQI [1.00 (0.98-1.00) versus 1.00 (0.97-1.00); p = 0.046], and PTFQI (0.66 ± 0.17 vs. 0.60 ± 0.23; p = 0.006) compared with individuals with normal eGFR. Odds ratio of MReGFR raised of 1.2-3.2-fold for each increase of 1 mIU/L in TSH, 1 unit in TSHI, and PTFQI, but not for FT3/FT4 ratio. CONCLUSION MReGFR is associated with reduced indices of central sensitivity to TH in euthyroid children and adolescents with OW/OB. This preliminary observation should be confirmed in prospective studies.
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Affiliation(s)
- Procolo Di Bonito
- Department of Internal Medicine, “S. Maria delle Grazie” Hospital, Pozzuoli, Italy
| | - Domenico Corica
- Department of Human Pathology of Adulthood and Childhood, University of Messina, Messina, Italy
| | - Pierluigi Marzuillo
- Department of Woman, Child and of General and Specialized Surgery, University of Campania “Luigi Vanvitelli,” Napoli, Italy
| | - Anna Di Sessa
- Department of Woman, Child and of General and Specialized Surgery, University of Campania “Luigi Vanvitelli,” Napoli, Italy
| | - Maria Rosaria Licenziati
- Neuro-Endocrine Diseases and Obesity Unit, Department of Neurosciences, Santobono-Pausilipon Children’s Hospital, Napoli, Italy
| | - Maria Felicia Faienza
- Department of Precision and Regenerative Medicine and Ionian Area, University of Bari “Aldo Moro,” Bari, Italy
| | - Valeria Calcaterra
- Pediatric Department, Buzzi Children’s Hospital, Milan, Italy
- Department of Internal Medicine, University of Pavia, Pavia, Italy
| | - Francesca Franco
- Pediatric Department, Azienda Sanitaria Universitaria Friuli Centrale, Hospital of Udine, Udine, Italy
| | - Giulio Maltoni
- Pediatric Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Giuliana Valerio
- Department of Movement Sciences and Wellbeing, University of Napoli “Parthenope,” Napoli, Italy
| | - Malgorzata Wasniewska
- Department of Human Pathology of Adulthood and Childhood, University of Messina, Messina, Italy
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21
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Liu C, Hua L, Liu K, Xin Z. Impaired sensitivity to thyroid hormone correlates to osteoporosis and fractures in euthyroid individuals. J Endocrinol Invest 2023; 46:2017-2029. [PMID: 36795243 DOI: 10.1007/s40618-023-02035-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 02/06/2023] [Indexed: 02/17/2023]
Abstract
BACKGROUND There is growing evidence that thyroid function affects bone metabolism and even fractures risk. However, little is known about the relationship between thyroid sensitivity and osteoporosis and fractures. Therefore, we explored the relationship between thyroid sensitivity-related indices and bone mineral density (BMD) and fractures in euthyroid US adults. METHODS In this cross-sectional study, 20,686 subjects from National Health and Nutrition Examination Survey (NHANES) data were extracted and analyzed during 2007 to 2010. A total of 3403 men and postmenopausal women aged 50 years or older with available data on diagnosis of osteoporosis and/or fragility fractures, bone mineral density (BMD) and thyroid function, were eligible. TSH index (TSHI), thyrotrophin T4/T3 resistance index (TT4RI/TT3RI), Thyroid feedback quantile-based index (TFQI), Parametric TFQI (PTFQI), free triiodothyronine to free thyroxine ratio (FT3/FT4), the secretory capacity of the thyroid gland (SPINA-GT) and the sum activity of peripheral deiodinases (SPINA-GD) were calculated. RESULTS FT3/FT4, SPINA-GD, FT4, TSHI, TT4RI, TFQI and PTFQIFT4 were significantly correlated with BMD (P < 0.001). Multiple linear regression analysis showed that FT3/FT4 and SPINA-GD was significantly positively associated with BMD, while FT4, TSHI, TT4RI, TFQI and PTFQIFT4 were negatively associated with BMD (P < 0.05 or P < 0.001). In logistic regression analysis, the odds ratio (OR) for osteoporosis of TSHI, TFQI and PTFQIFT4 were 1.314(1.076, 1.605), 1.743(1.327, 2.288) and 1.827(1.359, 2.455) respectively, and were 0.746(0.620, 0.898) for FT3/FT4 (P < 0.05). CONCLUSIONS In elderly euthyroid individuals, impaired sensitivity to thyroid hormones correlates to osteoporosis and fractures, independent of other conventional risk factors.
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Affiliation(s)
- C Liu
- Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University, 1 Dong Jiao Min Xiang, Beijing, 100730, China
| | - L Hua
- Department of Mathematics, School of Biomedical Engineering, Capital Medical University, Beijing, China
| | - K Liu
- Capital Medical University, Beijing, China
| | - Z Xin
- Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University, 1 Dong Jiao Min Xiang, Beijing, 100730, China.
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22
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Chen S, Yang W, Guo Z, Lv X, Zou Y. Association between serum vitamin D levels and sensitivity to thyroid hormone indices: a cross-sectional observational study in NHANES 2007-2012. Front Endocrinol (Lausanne) 2023; 14:1243999. [PMID: 37745711 PMCID: PMC10513485 DOI: 10.3389/fendo.2023.1243999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 08/07/2023] [Indexed: 09/26/2023] Open
Abstract
Objective We designed this study to determine whether there is a link between vitamin D levels and sensitivity to thyroid hormone and to provide a new perspective for studying the relationship between vitamin D and thyroid disease. Methods Our study included 8,126 participators from the National Health and Nutrition Examination Survey (NHANES) database between 2007 and 2012. We used weighted multiple linear regression models to enquire the connection between serum vitamin D levels and thyroid hormone sensitivity indicators, including the following: Thyroid-stimulating hormone index (TSHI), Free Triiodothyronine/Free thyroxine (FT3/FT4), Thyroid Feedback Quantile-based Index (TFQI), and Thyrotroph Thyroxine Resistance Index (TT4RI). Finally, we used constrained cubic splines to explore possible nonlinear relationships. All data cleaning and statistical analyses were performed using R software. Results The final Results were reached after adjusting for various confounding factors. We found a U-shaped relationship between TFQI and serum vitamin D, and the lowest TFQI appeared when the serum vitamin D concentration was 25.77ng/ml. However, an inverse U-shaped relationship was found between FT3/FT4 and vitamin D levels. When the serum vitamin D concentration was 25.43ng/ml, the ratio of FT3/FT4 was the highest. Conclusion In the US population, our study concluded that FTQI and FT3/FT4 were U-shaped or inverse-U-shaped with serum vitamin D levels respectively after several adjustments. Therefore, FTQI and FT3/FT4 are considered indicators of the complex relationship between thyroid hormone resistance and vitamin D metabolism. In the future, more complex prospective investigations are needed to confirm these findings and find a causal link between them.
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Affiliation(s)
| | | | | | - Xiaofei Lv
- Department of Internal Medicine, Guangdong Women and Children Hospital, Guangzhou, Guangdong, China
| | - Yandun Zou
- Department of Internal Medicine, Guangdong Women and Children Hospital, Guangzhou, Guangdong, China
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23
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Obasuyi JO, Emokpae MA. Spectrum of Thyroid Dysfunction in Patients with Chronic Kidney Disease in Benin City, Nigeria. MEDICINES (BASEL, SWITZERLAND) 2023; 10:47. [PMID: 37623811 PMCID: PMC10456670 DOI: 10.3390/medicines10080047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 07/30/2023] [Accepted: 08/04/2023] [Indexed: 08/26/2023]
Abstract
There is an indication of abrupt rise in chronic kidney disease (CKD) in Nigeria and thyroid function involvement has not been sufficiently evaluated. This study determined thyroid gland function among subjects with CKD in Benin City, Nigeria. A total of 184 randomized CKD patients attending specialist clinic and 80 healthy control subjects were recruited for this study. A well-structured questionnaire was used to obtain data on socio-demography. Blood specimens were collected and used for the determination of thyroid function parameters; thyroid stimulating hormone (TSH), triiodothyronine (T3), free triiodothyronine (fT3), thyroxine (T4), free thyroxine (fT4), thyroid peroxidase antibody (TPO-Abs), thyroid globulin antibody (Tg-Abs) and Deiodinase enzyme Type 1 (D1). SPINA GD and SPINA GT were calculated using Michaelis-Menten model. The CKD was classified into stages using Modification of Drug in Renal Disease (MDRD) formula. Thyroid dysfunctions observed were clinical hyperthyroidism 1 (0.54%), non-thyroidal illness 78 (42.4%), clinical hypothyroidism 11 (6.0%), sub-clinical hyperthyroidism 3 (1.60%), and sub-clinical hypothyroidism 11 (6.0%), while euthyroid were 80 (43.5%). SPINA GD of CKD patients (33.85 ± 10.94) was not significantly different when compared with controls (24.85 ± 1.57), whereas, SPINA GT was significantly higher (p < 0.01) among CKD patients (3.74 ± 0.31) than controls (2.68 ± 0.11). Autoimmune thyroid disease demonstrated by positive Tg-Abs and TPO-Abs were observed among approximately 7.9% of CKD patients. Serum TPO-Abs concentration increased with CKD progression. Thyroid dysfunction is involved in the pathogenesis of CKD patients. The etiologies are multifactorial and immunological mechanisms of autoimmune thyroid disease may be a contributing factor.
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Affiliation(s)
- John O. Obasuyi
- Department of Medical Laboratory Science, School of Basic Medical Sciences, University of Benin, Benin City 300283, Nigeria;
- Department of Medical Laboratory Service, University of Benin Teaching Hospital, Benin City 300283, Nigeria
| | - Mathias A. Emokpae
- Department of Medical Laboratory Science, School of Basic Medical Sciences, University of Benin, Benin City 300283, Nigeria;
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Wu X, Zhai F, Chang A, Wei J, Guo Y, Zhang J. Association between sensitivity to thyroid hormone indices and osteoporosis in euthyroid patients with type 2 diabetes mellitus. Ther Adv Chronic Dis 2023; 14:20406223231189230. [PMID: 37538345 PMCID: PMC10395177 DOI: 10.1177/20406223231189230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 06/08/2023] [Indexed: 08/05/2023] Open
Abstract
Background Thyroid hormones are known to regulate bone metabolism and may influence bone mineral density (BMD), as well as the risk of osteoporosis (OP) and fractures in patients with type 2 diabetes mellitus (T2DM). Recently, sensitivity to thyroid hormone indices has been linked with T2DM and OP independently. However, the relationship between thyroid hormone sensitivity and OP in euthyroid T2DM patients has yet to be investigated. Objectives The aim of this study was to determine the association between sensitivity to thyroid hormone indices and the risk of OP in euthyroid patients with T2DM. Design This study employed a retrospective, cross-sectional design and utilized data acquired from the Cangzhou Central Hospital in China between 2019 and 2020. Methods We retrospectively analyzed the data of 433 patients with T2DM for anthropometric measurements, clinical laboratory test results, and BMD. The thyroid-stimulating hormone index, thyrotroph thyroxine resistance index, and thyroid feedback quantile-based index (TFQI) were calculated to determine thyroid hormone sensitivity. Finally, multivariable logistic regression, generalized additive models, and subgroup analysis were performed to detect the association between sensitivity to thyroid hormone indices and the risk of OP in these patients. Results We did not observe a statistically significant linear relationship between sensitivity to thyroid hormones indices and OP after covariate adjustment. However, a nonlinear relationship existed between TFQI and the prevalence of OP. The inflection point of the TFQI was at -0.29. The effect sizes (odds ratio) on the left and right of the inflection point were 0.07 [95% confidence interval (CI): 0.01-0.71; p = 0.024] and 2.78 (95% CI: 1.02-7.58; p = 0.046), respectively. This trend was consistent in older female patients with higher body mass index (BMI; 25-30 kg/m2). Conclusion An approximate U-shaped relationship was observed between sensitivity to thyroid hormone indices and OP risk in euthyroid patients with T2DM with variations in sex, age, and BMI. These findings provide a new perspective to elucidate the role of thyroid hormones in OP, specifically in patients with T2DM.
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Affiliation(s)
- Xuelun Wu
- Department of Endocrinology, Cangzhou Central Hospital, 16 Xinhua West Road, Cangzhou City 061000, Hebei Province, PR China
| | - Furui Zhai
- Gynecological clinic, Cangzhou Central Hospital, Cangzhou City, Hebei Province, PR China
| | - Ailing Chang
- Department of Endocrinology, Cangzhou Central Hospital, Cangzhou City, Hebei Province, PR China
| | - Jing Wei
- Department of Endocrinology, Cangzhou Central Hospital, Cangzhou City, Hebei Province, PR China
| | - Yanan Guo
- Department of Endocrinology, Cangzhou Central Hospital, Cangzhou City, Hebei Province, PR China
| | - Jincheng Zhang
- Department of Endocrinology, Cangzhou Central Hospital, Cangzhou City, Hebei Province, PR China
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Liu H, Xing Y, Nie Q, Li Z, Meng C, Ma H. Association Between Sensitivity to Thyroid Hormones and Metabolic Dysfunction-Associated Fatty Liver Disease in Euthyroid Subjects: A Cross-Sectional Study. Diabetes Metab Syndr Obes 2023; 16:2153-2163. [PMID: 37492438 PMCID: PMC10363669 DOI: 10.2147/dmso.s420872] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 07/03/2023] [Indexed: 07/27/2023] Open
Abstract
Objective Thyroid hormones (THs) exert instrumental effects in regulating lipids metabolism. Whereas, research investigating the relationship between sensitivity indices to THs and metabolic dysfunction-associated fatty liver disease (MAFLD) have contradicted this. This study was designed to approach the correlation between sensitivity indices to THs and MAFLD in euthyroid subjects. Methods An overall sample of 6356 euthyroid participants were enrolled in a Chinese hospital. Free triiodothyronine to free thyroxine ratio (FT3/FT4), thyrotropin triiodothyronine resistance index (TT3RI), thyrotropin thyroxine resistance index (TT4RI), thyroid stimulating hormone index (TSHI) and thyroid feedback quantile-based indices (TFQIFT3 and TFQIFT4) were collected as sensitivity indicators to THs. Participants were split into two groups based on whether they suffered with MAFLD or not. And participants were categorized into quartiles based on sensitivity indicators to THs. The effects of sensitivity indices to THs on MAFLD were analyzed using regression analysis. Bootstrap was performed to assess the mediation effect of triglyceride glucose (TyG) index on the relationship between sensitivity parameters to THs and MAFLD. Results The incidence of MAFLD in euthyroid subjects was 34.47%. As FT3/FT4, TT3RI and TFQIFT3 levels rose, so did the MAFLD prevalence. After adjustment for confounders, logistic regression analyses indicated that the high-level FT3/FT4 and TFQIFT3 still remained risk factors for MAFLD. The relevance of FT3/FT4 and MAFLD was stronger among those whose age ≤ 40 years and had non-visceral obesity. And the interrelation between TFQIFT3 and MAFLD was stronger in subjects whose age ≤ 40 years. Mediation analyses suggested that TyG index had a noteworthy indirect impact on the relationship between FT3/FT4, TFQIFT3 and MAFLD. Conclusion Increased FT3/FT4 and TFQIFT3 were significantly related to MAFLD prevalence in populations with normal thyroid function. TyG index partly mediated the relevance between FT3/FT4, TFQIFT3 and MAFLD.
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Affiliation(s)
- Huanxin Liu
- Health Examination Center, Hebei General Hospital, Shijiazhuang, Hebei, 050051, People’s Republic of China
| | - Yuling Xing
- Department of Endocrinology, Hebei General Hospital, Shijiazhuang, Hebei, 050051, People’s Republic of China
| | - Qian Nie
- Health Examination Center, Hebei General Hospital, Shijiazhuang, Hebei, 050051, People’s Republic of China
| | - Zhong Li
- Department of General Surgery, Shijiazhuang People’s Hospital, Shijiazhuang, 050011, People’s Republic of China
| | - Cuiqiao Meng
- Health Examination Center, Hebei General Hospital, Shijiazhuang, Hebei, 050051, People’s Republic of China
| | - Huijuan Ma
- Department of Endocrinology, Hebei General Hospital, Shijiazhuang, Hebei, 050051, People’s Republic of China
- Key Laboratory of Metabolic Disease in Hebei Province, Hebei General Hospital, Shijiazhuang, Hebei, 050051, People’s Republic of China
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Wu Z, Jiang Y, Li P, Wang Y, Zhang H, Li Z, Li X, Tao L, Gao B, Guo X. Association of impaired sensitivity to thyroid hormones with hyperuricemia through obesity in the euthyroid population. J Transl Med 2023; 21:436. [PMID: 37403157 DOI: 10.1186/s12967-023-04276-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 06/14/2023] [Indexed: 07/06/2023] Open
Abstract
BACKGROUND Impaired sensitivity to thyroid hormones is a newly proposed clinical entity associated with hyperuricemia in the subclinical hypothyroid population. However, it is unknown whether the association exists in the euthyroid population. This study aimed to explore the association of impaired sensitivity to thyroid hormones (assessed by the thyroid feedback quantile-based index [TFQI], parametric thyroid feedback quantile-based index [PTFQI], thyrotrophic thyroxine resistance index [TT4RI] and thyroid-stimulating hormone index [TSHI]) with hyperuricemia and quantify the mediating effect of body mass index BMI in the euthyroid population. METHODS This cross-sectional study enrolled Chinese adults aged ≥ 20 years who participated in the Beijing Health Management Cohort (2008-2019). Adjusted logistic regression models were used to explore the association between indices of sensitivity to thyroid hormones and hyperuricemia. Odds ratios [OR] and absolute risk differences [ARD] were calculated. Mediation analyses were performed to estimate direct and indirect effects through BMI. RESULTS Of 30,857 participants, 19,031 (61.7%) were male; the mean (SD) age was 47.3 (13.3) years; and 6,515 (21.1%) had hyperuricemia. After adjusting for confounders, individuals in the highest group of thyroid hormone sensitivity indices were associated with an increased prevalence of hyperuricemia compared with the lowest group (TFQI: OR = 1.18, 95% CI 1.04-1.35; PTFQI: OR = 1.20, 95% CI 1.05-1.36; TT4RI: OR = 1.17, 95% CI 1.08-1.27; TSHI: OR = 1.12, 95% CI 1.04-1.21). BMI significantly mediated 32.35%, 32.29%, 39.63%, and 37.68% of the associations of TFQI, PTFQI, TT4RI and TSHI with hyperuricemia, respectively. CONCLUSIONS Our research revealed that BMI mediated the association between impaired sensitivity to thyroid hormones and hyperuricemia in the euthyroid population. These findings could provide useful evidence for understanding the interaction between impaired sensitivity to thyroid hormone and hyperuricemia in euthyroid individuals and suggest the clinical implications of weight control in terms of impaired thyroid hormones sensitivity.
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Affiliation(s)
- Zhiyuan Wu
- Beijing Municipal Key Laboratory of Clinical Epidemiology, School of Public Health, Capital Medical University, No.10 Xitoutiao, Youanmen Street, Beijing, 100069, China
- Centre for Precision Health, School of Medical and Health Sciences, Edith Cowan University, 270 Joondalup Drive, Joondalup, WA, 6027, Australia
| | - Yue Jiang
- Beijing Municipal Key Laboratory of Clinical Epidemiology, School of Public Health, Capital Medical University, No.10 Xitoutiao, Youanmen Street, Beijing, 100069, China
| | - Pingan Li
- Beijing Municipal Key Laboratory of Clinical Epidemiology, School of Public Health, Capital Medical University, No.10 Xitoutiao, Youanmen Street, Beijing, 100069, China
| | - Yutao Wang
- Shanghai Fufan Information Technology Co., Ltd, No.323 Guoding Road, Yangpu District, Shanghai, 200433, China
| | - Haiping Zhang
- Beijing Municipal Key Laboratory of Clinical Epidemiology, School of Public Health, Capital Medical University, No.10 Xitoutiao, Youanmen Street, Beijing, 100069, China
| | - Zhiwei Li
- Beijing Municipal Key Laboratory of Clinical Epidemiology, School of Public Health, Capital Medical University, No.10 Xitoutiao, Youanmen Street, Beijing, 100069, China
| | - Xia Li
- Department of Mathematics and Statistics, La Trobe University, Melbourne, 3086, Australia
| | - Lixin Tao
- Beijing Municipal Key Laboratory of Clinical Epidemiology, School of Public Health, Capital Medical University, No.10 Xitoutiao, Youanmen Street, Beijing, 100069, China.
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, No.10 Xitoutiao, Youanmen Street, Beijing, 100069, China.
| | - Bo Gao
- Beijing Municipal Key Laboratory of Clinical Epidemiology, School of Public Health, Capital Medical University, No.10 Xitoutiao, Youanmen Street, Beijing, 100069, China.
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, No.10 Xitoutiao, Youanmen Street, Beijing, 100069, China.
| | - Xiuhua Guo
- Beijing Municipal Key Laboratory of Clinical Epidemiology, School of Public Health, Capital Medical University, No.10 Xitoutiao, Youanmen Street, Beijing, 100069, China.
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, No.10 Xitoutiao, Youanmen Street, Beijing, 100069, China.
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Liu C, Xin Z, Hua L. Lower free triiodothyronine levels are associated with higher all-cause and cardiovascular mortality in people with diabetes-NHANES 2007-2012. Diabetes Res Clin Pract 2023:110811. [PMID: 37391035 DOI: 10.1016/j.diabres.2023.110811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 05/21/2023] [Accepted: 06/27/2023] [Indexed: 07/02/2023]
Abstract
OBJECTIVE Thyroid hormone plays a key role in maintaining cardiovascular system homeostasis. However, there is limited evidence regarding the correlation between normal range thyroid hormone levels and all-cause mortality or cardiovascular mortality among individuals with diabetes. METHOD This retrospective study analyzed data from 1,208 individuals with diabetes who participated in the National Health and Nutrition Survey (NHANES) conducted in the United States between 2007 and 2012. Weighted Kaplan-Meier (KM) analysis and Cox proportional hazards models were used to explore the association between thyroid hormone indices and mortality. RESULTS The Weighted Kaplan-Meier (KM) analysis revealed statistically significant differences in survival probabilities across free triiodothyronine (FT3), free thyroxine (FT4), FT3/FT4 ratio and thyroid-stimulating hormone (TSH) groups (p < 0.05 or < 0.001). In the multivariate adjusted Cox proportional hazards models, higher levels of FT3 were founded to be associated with decreased all-cause mortality (HR (95% CI), 0.715 (0.567, 0.900)), cardio-cerebrovascular mortality (0.576 (0.408, 0.814)) and cardiovascular mortality (0.629 (0.438, 0.904)). Notably, this correlation was more significant among individuals over the age of 60, as indicated by the results of the nonlinear regression analysis. CONCLUSION FT3 is an independent predictor of all-cause death, cardio-cerebrovascular and cardiovascular death in euthyroid subjects with diabetes.
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Affiliation(s)
- Chang Liu
- Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Zhong Xin
- Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University, Beijing, China.
| | - Lin Hua
- Department of Mathematics, School of Biomedical Engineering, Capital Medical University, Beijing, China.
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Sun J, Liu J, Wu TT, Gu ZY, Zhang XW. Sensitivity to thyroid hormone indices are associated with papillary thyroid carcinoma in Chinese patients with thyroid nodules. BMC Endocr Disord 2023; 23:126. [PMID: 37264363 DOI: 10.1186/s12902-023-01381-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 05/25/2023] [Indexed: 06/03/2023] Open
Abstract
BACKGROUND The association between thyroid hormone sensitivity and thyroid cancer is unknown, and we aimed to investigate the association between sensitivity to thyroid hormone indices and papillary thyroid carcinoma (PTC) in Chinese patients with thyroid nodules (TNs). METHODS A total of 1,998 patients undergoing thyroid surgery due to TNs from Nanjing Drum Tower Hospital were included in this study. We evaluated central sensitivity to thyroid hormones, such as thyroid stimulating hormone index (TSHI), TSH T4 resistance index (TT4RI), thyroid feedback quantile-based index (TFQI), and parametric thyroid feedback quantile-based Index (PTFQI). Peripheral sensitivity to thyroid hormone was evaluated by FT3 to FT4 ratio. Multivariate logistic regression analysis was performed to evaluate the association between sensitivity to thyroid hormone indices and PTC risk. RESULTS The results showed that central indices of thyroid hormone sensitivity, including TSHI, TT4RI, TFQI, and PTFQI, were positively associated with PTC risk. For each SD increase in TSHI, TT4RI, TFQI, and PTFQI, the odds ratios (OR, 95% CI) of PTC were 1.31 (1.18-1.46), 1.01 (1.01-1.02), 1.94 (1.45-2.60), and 1.82 (1.41-2.34), respectively. On the other hand, the association between peripheral sensitivity to thyroid hormone and PTC was significantly negative. For each SD increase in FT3/FT4 ratio, the OR (95% CI) of PTC was 0.18 (0.03-0.96), and a negative correlation was found between FT3/FT4 ratio and TNM staging of PTC. CONCLUSIONS Sensitivity to thyroid hormone indices could be used as new indicators for predicting PTC in Chinese patients with TNs. Future researches are still needed to confirm our findings.
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Affiliation(s)
- Jie Sun
- Department of Endocrinology, Endocrine and Metabolic Disease Medical Center, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
- Branch of National Clinical Research Centre for Metabolic Diseases, Nanjing, China
| | - Jie Liu
- Department of Endocrinology, Endocrine and Metabolic Disease Medical Center, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
- Branch of National Clinical Research Centre for Metabolic Diseases, Nanjing, China
- Department of Endocrinology, Endocrine and Metabolic Disease Medical Center, Nanjing Drum Tower Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Nanjing, China
| | - Ting-Ting Wu
- Department of Endocrinology, Endocrine and Metabolic Disease Medical Center, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
- Branch of National Clinical Research Centre for Metabolic Diseases, Nanjing, China
| | - Zhi-Yuan Gu
- Department of Endocrinology, Endocrine and Metabolic Disease Medical Center, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
- Branch of National Clinical Research Centre for Metabolic Diseases, Nanjing, China
| | - Xiao-Wen Zhang
- Department of Endocrinology, Endocrine and Metabolic Disease Medical Center, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China.
- Branch of National Clinical Research Centre for Metabolic Diseases, Nanjing, China.
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Yang J, Ding W, Wang H, Shi Y. Association Between Sensitivity to Thyroid Hormone Indices and Diabetic Retinopathy in Euthyroid Patients with Type 2 Diabetes Mellitus. Diabetes Metab Syndr Obes 2023; 16:535-545. [PMID: 36874555 PMCID: PMC9984276 DOI: 10.2147/dmso.s399910] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 01/27/2023] [Indexed: 03/03/2023] Open
Abstract
OBJECTIVE Normal thyroid hormone (TH) levels and their relation to microvascular complications in patients with type 2 diabetes mellitus (T2DM) have been studied. However, the relationship between TH sensitivity and diabetic retinopathy (DR) remains unclear. Thus, this study aimed to investigate the relationship between TH sensitivity and the risk of DR in euthyroid T2DM patients. METHODS This retrospective study analyzed 422 T2DM patients and calculated their sensitivity to TH indices. Multivariable logistic regression, generalized additive model, and subgroup analysis were performed to examine the association between sensitivity to TH indices and DR risk. RESULTS After adjusting for covariates, the binary logistic regression model showed no statistically significant association between the sensitivity of TH indices and the risk of DR in euthyroid T2DM patients. However, a non-linear relationship was found between sensitivity to TH indices (thyroid-stimulating hormone index, thyroid feedback quantile index [TFQI]) and the risk of DR in the crude model; TFQI and DR in the adjusted model. The inflection point of the TFQI was 0.23. The effect size (odds ratio) on the left and right of the inflection point were 3.19 (95% confidence interval [CI]: 1.24 to 8.17 p=0.02) and 0.11 (95% CI: 0.01, 0.93 p=0.04), respectively. Moreover, this relationship was maintained by men stratified by sex. In euthyroid patients with T2DM, an approximate inverted U-shaped relationship and a threshold effect were demonstrated between TH index sensitivity and DR risk with sex differences. This study provided an in-depth understanding of the relationship between thyroid function and DR, which has important clinical implications for risk stratification and individual prediction.
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Affiliation(s)
- Jie Yang
- Department of Endocrinology, Cangzhou Central Hospital, Cangzhou, Hebei Province, 061000, People’s Republic of China
- Correspondence: Jie Yang, Department of Endocrinology, Cangzhou Central Hospital, Cangzhou, Hebei Province, 061000, People’s Republic of China, Email
| | - Wencui Ding
- Department of Endocrinology, Cangzhou Central Hospital, Cangzhou, Hebei Province, 061000, People’s Republic of China
| | - Haiying Wang
- Department of Endocrinology, Cangzhou Central Hospital, Cangzhou, Hebei Province, 061000, People’s Republic of China
| | - Yanan Shi
- Department of Endocrinology, Cangzhou Central Hospital, Cangzhou, Hebei Province, 061000, People’s Republic of China
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Zhang X, Chen Y, Ye H, Luo Z, Li J, Chen Z, Zhang E, Li W. Correlation between thyroid function, sensitivity to thyroid hormones and metabolic dysfunction-associated fatty liver disease in euthyroid subjects with newly diagnosed type 2 diabetes. Endocrine 2022; 80:366-379. [PMID: 36539681 DOI: 10.1007/s12020-022-03279-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 12/01/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE To estimate the prevalence of metabolic dysfunction-associated fatty liver disease (MAFLD) and to evaluate the associations between thyroid parameters, MAFLD and liver fibrosis in euthyroid patients with newly diagnosed type 2 diabetes mellitus (T2DM). METHODS Overall, 776 patients with newly diagnosed T2DM and 120 subjects without diabetes were included. All the participants were euthyroid, and were categorized as non-MAFLD and MAFLD. Demographic information, biochemical parameters, and serum thyroid hormones were collected. The thyroid hormone sensitivity indices were calculated. MAFLD was defined according to abdominal ultrasound and clinical manifestations. Noninvasive fibrosis indices were calculated to identify advanced liver fibrosis. RESULTS The prevalence of MAFLD was significantly higher in patients with T2DM than in subjects without diabetes. Levels of free triiodothyronine (FT3) and FT3 to free thyroxine (FT4) ratio were significantly higher in subjects with MAFLD. In patients with T2DM, levels of thyroid stimulating hormone (TSH), Thyroid feedback quantile-based index (TFQIFT3) calculated using FT3 and TSH, thyrotroph T3 resistance index (TT3RI) and thyrotroph T4 resistance index (TT4RI) were significantly higher in subjects with MAFLD. The prevalence of MAFLD increased with the rise of FT3, FT3/FT4, TSH, and sensitivity to thyroid hormone indices (TFQIFT3, TT3RI, and TT4RI). But significant correlations were not found between thyroid hormones, sensitivity to thyroid hormones and MAFLD, after adjustment for BMI and HOMA-IR. The incidence of advanced fibrosis tended to increase as the rise of TSH and sensitivity to thyroid hormone indices (TFQIFT3, TT3RI, TT4RI, and TSHI). CONCLUSION MAFLD was prevalent in euthyroid patients with newly diagnosed T2DM. Higher normal FT3, TSH and impaired sensitivity to thyroid hormones are associated with increased incidence of MAFLD, being dependent on other metabolic factors.
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Affiliation(s)
- Xiaodan Zhang
- Department of Endocrinology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yimei Chen
- Health Examination Department, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Huiyu Ye
- Department of Endocrinology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Zirui Luo
- The Second Clinical Medicine School, Guangzhou Medical University, Guangzhou, China
| | - Jiahong Li
- The Second Clinical Medicine School, Guangzhou Medical University, Guangzhou, China
| | - Zhishan Chen
- Department of Endocrinology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Enting Zhang
- Department of Endocrinology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Wangen Li
- Department of Endocrinology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
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Sun H, Zhu W, Liu J, An Y, Wang Y, Wang G. Reduced Sensitivity to Thyroid Hormones Is Associated With High Remnant Cholesterol Levels in Chinese Euthyroid Adults. J Clin Endocrinol Metab 2022; 108:166-174. [PMID: 36071542 DOI: 10.1210/clinem/dgac523] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 08/09/2022] [Indexed: 02/03/2023]
Abstract
CONTEXT It remains unclear whether the thyroid system could regulate the atherogenic remnant cholesterol (RC) levels in euthyroid status. OBJECTIVE We aimed to investigate the relationship between sensitivity to thyroid hormones and RC levels in Chinese euthyroid population. METHODS This study included 18 766 euthyroid adults. High RC levels were defined as the upper quartile of RC levels. The thyroid hormone sensitivity indices, including thyroid feedback quantile-based index (TFQI), thyroid-stimulating hormone index (TSHI), thyrotrophic thyroxine resistance index (TT4RI), and free triiodothyronine to free thyroxine (FT3/FT4) ratio were calculated. Linear and binary logistic regression analysis were applied to determine the associations between those composite indices with RC levels by genders. RESULTS Both females and males with high RC levels exhibited co-existing higher TSH and FT4 levels. Linear regression analysis revealed that TFQI, TSHI, and TT4RI were positively, while FT3/FT4 ratio levels were negatively associated with serum RC levels. The odds ratios (ORs) (95% CI) for high RC levels were increased with rising TFQI quartiles (Q) [females: Q3 1.41 (1.22-1.63), Q4 1.61 (1.39-1.86); males: Q3 1.25 (1.09-1.45), Q4 1.38 (1.19-1.59), all P for trend < 0.001] after full adjustment, with Q1 as the reference. TSHI and TT4RI yielded similar results. By contrast, the ORs (95% CI) for high RC levels were decreased with increasing FT3/FT4 ratio quartiles in both genders (P for trend < 0.001). CONCLUSION In euthyroid adults, reduced sensitivity to thyroid hormones was associated with high RC levels. Our results suggested an additive cardiometabolic risk of euthyroid population with thyroid hormones insensitivity.
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Affiliation(s)
- Honglin Sun
- Department of Endocrinology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, China
| | - Wei Zhu
- Department of Endocrinology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, China
| | - Jia Liu
- Department of Endocrinology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, China
| | - Yu An
- Department of Endocrinology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, China
| | - Ying Wang
- Physical Examination Center, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, China
| | - Guang Wang
- Department of Endocrinology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, China
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Li N, Li M, Xiu L, Liao W, Ren Y, Liu H, Chen S, Chen F, Yu X, Fan A, Huo M, He J, Zhong G. Haizao Yuhu decoctions including three species of glycyrrhiza protected against propylthiouracil-induced goiter with hypothyroidism in rats via the AMPK/mTOR pathway. JOURNAL OF ETHNOPHARMACOLOGY 2022; 296:115443. [PMID: 35680037 DOI: 10.1016/j.jep.2022.115443] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 05/19/2022] [Accepted: 06/02/2022] [Indexed: 06/15/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Glycyrrhiza and sargassum are among the 18 incompatible medicaments according to traditional Chinese medicine (TCM) theory. Although it contains glycyrrhiza and sargassum, Haizao Yuhu decoction (HYD) is a classic prescription widely used as TCM to treat goiter. According to the Chinese Pharmacopoeia, glycyrrhiza is divided into three varieties: Glycyrrhiza uralensis Fish., Glycyrrhiza glabra L., and Glycyrrhiza inflata Bat. Whether the three varieties of glycyrrhiza have different efficacy or toxicity when applied in the HYD is unknown. AIM OF THE STUDY To explore whether the HYDs comprising three varieties of glycyrrhiza have different efficacy or toxicity when used to treat goiter in rats and the underlying mechanisms of these HYDs. MATERIALS AND METHODS For two weeks, the goiter model was replicated by intragastric propylthiouracil (PTU) administration. Samples were divided into the control group, model group, euthyrox group, HYD with glycyrrhiza uralensis (HYD-U) group, HYD with glycyrrhiza glabra (HYD-G) group, and HYD with glycyrrhiza inflata (HYD-I) group. After four weeks of treatment, body weight, rectal temperature, thyroid/liver/kidney coefficient, thyroid/liver/kidney function, thyroid/liver/kidney histomorphology, and thyroid ultrastructure were evaluated. Then, real-time quantitative reverse-transcription polymerase chain reaction (RTqPCR), Western blot, and immunofluorescence analyses were performed to detect genes and proteins affecting autophagy and apoptosis in thyroid cells in the AMP-activated Protein Kinases (AMPK)/Mammalian target of rapamycin (mTOR) pathway. RESULTS All three HYDs increased thyroid hormones (THs) levels, relieved thyroid pathological tissue and ultrastructure, and activated vital proteins and genes in the AMPK/mTOR pathway. Comparisons among the efficacy of the three HYDs indicated that HYD-U restored the THs most effectively; however, no difference in the anti-goiter effect was observed. Moreover, the three HYDs resulted in no toxicity and promoted the recovery of impaired liver and kidney function caused by PTU. Comparisons among the recovery effects of the three HYDs on the liver and kidney were the same. CONCLUSION Our experiments demonstrated that the three HYDs had outstanding anti-goiter effects and protected liver and kidney function. Their anti-goiter effects were attributed to AMPK/mTOR pathway-induced autophagy and apoptosis. HYD-U resulted in the best THs recovery. It was further indicated that in our present study, glycyrrhiza and sargassum were compatible in the three HYDs, thereby suggesting their safety of compounding in HYD and providing a basis for the research of the 18 incompatible medicaments.
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Affiliation(s)
- Na Li
- Beijing University of Chinese Medicine, Beijing, 100029, China.
| | - Muyun Li
- Beijing University of Chinese Medicine, Beijing, 100029, China.
| | - Linlin Xiu
- Beijing University of Chinese Medicine, Beijing, 100029, China.
| | - Wenyong Liao
- Beijing University of Chinese Medicine, Beijing, 100029, China.
| | - Yuna Ren
- Beijing University of Chinese Medicine, Beijing, 100029, China.
| | - Haiyan Liu
- Beijing University of Chinese Medicine, Beijing, 100029, China.
| | - Shaohong Chen
- Beijing University of Chinese Medicine, Beijing, 100029, China.
| | - Feng Chen
- Beijing University of Chinese Medicine, Beijing, 100029, China.
| | - Xue Yu
- Beijing University of Chinese Medicine, Beijing, 100029, China.
| | - Angran Fan
- Beijing University of Chinese Medicine, Beijing, 100029, China.
| | - Min Huo
- Beijing University of Chinese Medicine, Beijing, 100029, China.
| | - Jia He
- Beijing University of Chinese Medicine, Beijing, 100029, China.
| | - Gansheng Zhong
- Beijing University of Chinese Medicine, Beijing, 100029, China.
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Chen S, Sun X, Zhou G, Jin J, Li Z. Association between sensitivity to thyroid hormone indices and the risk of osteoarthritis: an NHANES study. Eur J Med Res 2022; 27:114. [PMID: 35820977 PMCID: PMC9275280 DOI: 10.1186/s40001-022-00749-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 06/17/2022] [Indexed: 11/10/2022] Open
Abstract
Objectives Thyroid hormones play an instrumental role in chondrogenic differentiation and matrix maturation. However, studies investigating the relationship between thyroid function and the risk of osteoarthritis (OA) remain scarce. This study was designed to investigate the correlation between thyroid status and OA from a novel perspective of sensitivity to thyroid hormones. Methods The study included 8478 people from the National Health and Nutrition Examination Survey (NHANES) 2007–2010. The sensitivity to thyroid hormone indices included Thyrotroph Thyroxine Resistance Index (TT4RI), Thyroid-stimulating hormone (TSHI), Thyroid Feedback Quantile-based Index (TFQI), and Free Triiodothyronine /Free thyroxine (FT3/FT4), which were calculated based on serum free triiodothyronine (FT3), free thyroxine (FT4), and thyroid stimulating hormone (TSH). Considering the complex survey design and sample weights, we employed multivariate linear regression models and stratified analysis to evaluate the correlation between sensitivity to thyroid hormone indices and OA. Results Study results indicated that participants with OA had elevated TT4RI, TSHI, and TFQI levels, and lower FT3/FT4 levels compared to those with non-arthritis. After adjusting for other covariates, FT3/FT4 was negatively associated with the risk of OA (OR = 1.162, 95%CI 1.048–1.478, P = 0.021); (OR = 1.261, 95%CI 1.078–1.623, P = 0.042). In subgroup analyses stratified by gender and BMI, participants with OA had higher TFQI levels compared to those without OA in both genders. (OR = 1.491, 95%CI 1.070–2.077, P = 0.018); (OR = 2.548, 95%CI 1.929–3.365, P < 0.001). The higher TFQI levels were consistently associated with the increased prevalence of OA in the BMI (< 18.5 kg/m2) group after adjusting for different covariates, but not in other BMI groups. In, addition, TFQI performed better than FT3/FT4, TSHI, and TT4RI on ROC analyses for OA prediction. Conclusions The levels of FT3/FT4, TSHI, TT4RI, and TFQI are strongly associated with the prevalence of OA, which illustrates the complex correlation between the thyroid system and chondrogenic differentiation. TFQI may be used as a helpful indicator to predict OA and provide novel ideas for the evaluation and treatment of OA.
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Affiliation(s)
- Shuai Chen
- Department of Orthopaedics, The Second Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Xiaohe Sun
- Department of Oncology, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Guowei Zhou
- Department of General Surgery, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Jie Jin
- Department of Orthopaedics, The Second Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Zhiwei Li
- Department of Orthopaedics, The Second Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China.
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Shimizu Y, Kawashiri SY, Noguchi Y, Nakamichi S, Nagata Y, Hayashida N, Maeda T. Associations among Ratio of Free Triiodothyronine to Free Thyroxine, Chronic Kidney Disease, and Subclinical Hypothyroidism. J Clin Med 2022; 11:jcm11051269. [PMID: 35268361 PMCID: PMC8911058 DOI: 10.3390/jcm11051269] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 02/19/2022] [Accepted: 02/22/2022] [Indexed: 02/05/2023] Open
Abstract
The ratio of free triiodothyronine (FT3) to free thyroxine (FT4) (FT3/FT4), a maker of peripheral thyroxin deiodination, could indicate activity of thyroid hormone. Since positive association between subclinical hypothyroidism (SCH) and chronic kidney disease (CKD) was reported, clarifying the association among FT3/FT4, SCH, and CKD could be an efficient tool to make a strategy for preventing CKD. A cross-sectional study with 1724 Japanese with normal thyroid hormone was conducted. Significant positive association between SCH and CKD was observed; the adjusted odds ratio (OR) and 95% confidence interval (95% CI) was 2.23 (1.38, 3.59). Even though, FT3/FT4 was found to be inversely associated with CKD whereas positively associated with SCH; the adjusted ORs and 95% CIs for 1 standard deviation (SD) increment of FT3/FT4 were 0.51 (0.35, 0.74) for CKD and 2.40 (1.34, 4.29) for SCH, respectively. FT3/FT4 was also found to be positively associated with SCH without CKD but not those with CKD; 1 SD increment of FT3/FT4 were 3.44 (1.72, 6.91) for SCH without CKD and 1.11 (0.40, 3.06) for SCH with CKD, respectively. Although further investigation is necessary, present study indicates that higher activity of peripheral thyroxin deiodination might have beneficial association on absence of CKD even among SCH which is positively associated with CKD.
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Affiliation(s)
- Yuji Shimizu
- Department of General Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8501, Japan;
- Department of Cardiovascular Disease Prevention, Osaka Center for Cancer and Cardiovascular Diseases Prevention, Osaka 537-8511, Japan
- Correspondence: ; Tel.: +81-95-819-7578
| | - Shin-Ya Kawashiri
- Department of Community Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8523, Japan; (S.-Y.K.); (Y.N.); (Y.N.)
- Leading Medical Research Core Unit, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8523, Japan;
| | - Yuko Noguchi
- Department of Community Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8523, Japan; (S.-Y.K.); (Y.N.); (Y.N.)
| | - Seiko Nakamichi
- Nagasaki University Health Center, Nagasaki 852-8523, Japan;
| | - Yasuhiro Nagata
- Department of Community Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8523, Japan; (S.-Y.K.); (Y.N.); (Y.N.)
- Leading Medical Research Core Unit, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8523, Japan;
| | - Naomi Hayashida
- Leading Medical Research Core Unit, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8523, Japan;
- Division of Promotion of Collaborative Research on Radiation and Environmental Health Effects, Atomic Bomb Disease Institute, Nagasaki University, Nagasaki 852-8523, Japan
| | - Takahiro Maeda
- Department of General Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8501, Japan;
- Leading Medical Research Core Unit, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8523, Japan;
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Chen S, Huang W, Zhou G, Sun X, Jin J, Li Z. Association between Sensitivity to Thyroid Hormone Indices and Bone Mineral Density in US Males. Int J Endocrinol 2022; 2022:2205616. [PMID: 36340930 PMCID: PMC9629943 DOI: 10.1155/2022/2205616] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 07/28/2022] [Accepted: 09/14/2022] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES Thyroid hormone is acknowledged as a pivotal factor in skeletal development and adult bone maintenance. However, available data about the relationship between sensitivity to thyroid hormone and bone mineral density (BMD) remain limited and conflicting. The purpose of the study was to explore the complex relationship between sensitivity to thyroid hormone indices and BMD using cross-sectional analysis. METHODS An overall sample of 3,107 males from the National Health and Nutrition Examination Survey (NHANES) was studied in the study. The thyroid hormone sensitivity indices included free triiodothyronine/tree thyroxine (FT3/FT4), thyroid-stimulating hormone index (TSHI), thyrotroph thyroxine resistance index (TT4RI), and thyroid feedback quantile-based index (TFQI). Given the complex study design and sample weights, the correlation between sensitivity to thyroid hormone indices and BMD was evaluated through multivariate linear regression models, and extra subgroup analyses were performed to examine the robustness of the results. RESULTS Among the 3,107 participants, we demonstrated that FT3/FT4 was negatively correlated with lumbar BMD (β = -0.0.35, 95% CI: -0.084-0.013, P < 0.05). In the terms of central sensitivity to thyroid hormone, TFQI showed a significant negative relationship with the BMD of the lumbar (β = -0.018, 95% CI: -0.033 to -0.003, P < 0.05), total femur (β = -0.020, 95% CI: -0.035 to -0.006, P < 0.01), and femur neck (β = -0.018, 95% CI: -0.031 to -0.005, P < 0.01). In the subgroup analyses stratified by body mass index (BMI), the significant negative correlation between TFQI and lumbar BMD remained in the male participants with BMI between 18.5 and 24.9 kg/m2. CONCLUSIONS Decreased indices of sensitivity to thyroid hormones are strongly associated with increased lumbar BMD, suggesting that the dysfunction of peripheral and central response to thyroid hormone might contribute to bone loss. In addition, FT3/FT4 and TFQI were considered to be the preferable indicators to guide the prevention and clinical treatment of osteoporosis.
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Affiliation(s)
- Shuai Chen
- Department of Orthopaedics, The Second Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Wucui Huang
- Department of Respiratory and Critical Care Medicine, Zhongda Hospital Affiliated to Southeast University, Nanjing, China
| | - Guowei Zhou
- Department of General Surgery, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Xiaohe Sun
- Department of Oncology, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Jie Jin
- Department of Orthopaedics, The Second Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Zhiwei Li
- Department of Orthopaedics, The Second Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
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