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Hyperhomocysteinemia in acute iatrogenic hypothyroidism: the relevance of thyroid autoimmunity

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Abstract

Purpose

Hyperhomocysteinemia is a known cardiovascular risk factor and a key player in the inflammatory activation of autoimmune diseases. Hashimoto’s thyroiditis (HT) is the leading cause of hypothyroidism which, in itself, has been associated with a significant raise of homocysteine (Hcy) levels and increased cardiovascular risk. Our aim was to assess the impact of HT on Hcy levels in patients with acute hypothyroidism.

Methods

We prospectively enrolled 121 patients (mean age: 46 years, F/M = 102/19) with acute post-surgical hypothyroidism. Based on the presence of anti-thyroid antibodies and the histological description of an inflammatory infiltrate, 26 and 95 patients were classified as HT and non-HT, respectively. Several parameters including thyroid-stimulating hormone (TSH), levels of serum free T3 and free T4, weight, glucose levels, total cholesterol, creatinine, vitamin B12, ferritin and erythrocyte sedimentation rate were obtained from all patients and correlated with Hcy levels.

Results

Median Hcy level in the whole cohort was 16.8 µmol/L (normal values: < 12 µmol/l). Among all parameters analysed, only Hcy levels were significantly different between HT and non-HT patients (median Hcy = 19.7 vs 16.2 µmol/L, respectively; p = 0.018, Mann–Whitney U test). Analysis of covariance showed the presence of HT to be the strongest predictor of Hcy levels (coefficient = 0.25534, p = 0.001). Serum TSH was not significantly associated with Hcy levels (p = 0.943).

Conclusion

In patients with iatrogenic hypothyroidism, those with HT have significantly higher Hcy levels than those without HT. The increase of Hcy levels appears to be mainly determined by the HT-related immune-inflammatory condition.

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Acknowledgements

We thank Dr. Luciano Carideo and Mrs Valentina Biondi, from the Nuclear Medicine Unit of Sant’Andrea University Hospital for the help with data collection.

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Authors and Affiliations

  1. Unit of Nuclear Medicine, Department of Surgical and Medical Sciences and Translational Medicine, Sant’Andrea Hospital, “Sapienza” University of Rome, Via di Grottarossa 1035, 00189, Rome, Italy

    F. Cicone, A. Papa, A. Tofani & F. Scopinaro

  2. Unit of Endocrinology, Department of Medico-Surgical Sciences and Biotechnologies, AUSL Latina, “Sapienza” University of Rome, Rome, Italy

    M. G. Santaguida, C. Virili, N. Brusca & M. Centanni

  3. Unit of Endocrinology, University of Bari Aldo Moro, Bari, Italy

    G. My

  4. Department of Psychology, University of Fribourg, Fribourg, Switzerland

    G. Mancuso

  5. Unit of Radiology, Department of Surgical and Medical Sciences and Translational Medicine, Sant’Andrea Hospital, “Sapienza” University of Rome, Rome, Italy

    R. Persechino

Authors
  1. F. Cicone
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  2. M. G. Santaguida
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  3. G. My
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  7. C. Virili
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  9. A. Tofani
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Correspondence to F. Cicone.

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The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in the study were in accordance with the standards of the institutional ethical committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.

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Informed consent was obtained from all individual participants included in the study.

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40618_2017_811_MOESM1_ESM.tif

Association between anti-thyroid antibodies and the different types of thyroid infiltrate. Left panel (a): bar graphs representing anti-TPO levels (mean ± SD) in patients with no thyroid infiltration, non-Hashimoto-like lymphocytic thyroiditis (NHLT) and Hashimoto-like thyroiditis (HLT), respectively. Median anti-TPO levels (UI/ml) were: < 10 (range < 10-55.6), 11 (range < 10-303) and 55.95 (range < 10-800) in the three groups, respectively (p < 0.0001, Kruskal–Wallis test). These results are comparable to those obtained in an independent patient cohort [23]. Right panel (b): bar graphs representing anti-Tg levels (mean ± SD) in patients with no thyroid infiltration, non-Hashimoto-like lymphocytic thyroiditis (NHLT) and Hashimoto-like thyroiditis (HLT), respectively. Median anti-Tg levels (UI/ml) were < 10 in all three groups (ranges: < 10-91, < 10-176 and < 10-1808 in the three groups, respectively (p < 0.0020, Kruskal–Wallis test) (TIFF 734 kb)

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Cicone, F., Santaguida, M.G., My, G. et al. Hyperhomocysteinemia in acute iatrogenic hypothyroidism: the relevance of thyroid autoimmunity. J Endocrinol Invest 41, 831–837 (2018). https://doi.org/10.1007/s40618-017-0811-y

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  • DOI: https://doi.org/10.1007/s40618-017-0811-y

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