Thyroid hormones modulate uric acid metabolism in patients with recent onset subclinical hypothyroidism by improving insulin sensitivity
Some evidence suggests a relationship between thyroid dysfunction and uric acid (UA) metabolism, but the potential influential role of thyroid hormones on UA metabolism is still debated. This report was designed to evaluate the influential role of levothyroxine (L-T4) replacement therapy on circulating levels of UA in patients with recent onset post-thyroidectomy subclinical hypothyroidism. Circulating levels of thyroid hormones, UA and other metabolic parameters were assessed in 155 recently thyroidectomized patients (131 females, mean age 51.1 ± 12.7 years) at baseline (5–7 day after surgery) and after 2 months under replacement therapy with L-T4. At baseline, circulating levels of thyroid hormones were indicative of a subclinical hypothyroidism (TSH 8.2 ± 5.1 mU/mL, FT3 2.1 ± 0.7 pg/mL, FT4 9.2 ± 3.4 pg/mL). The mean serum UA concentration was 5.0 ± 1.3 mg/dL, while the prevalence of hyperuricemia, defined by serum UA levels > 6 mg/dL, was 22.6%. Serum UA levels at baseline were significantly correlated with HOMA-IR index (r = 0.475, p < 0.0001). After 2 months under the replacement therapy with L-T4, both serum UA levels (− 1.2 ± 0.9 mg/dL, p < 0.0001 vs. baseline) and HOMA-IR (− 0.3 ± 1.5 mmol/L, p = 0.0328 vs. baseline) significantly decreased. Multivariate regression analysis revealed that changes in HOMA-IR explained 23% of the variations of serum UA levels under L-T4 replacement therapy (β = 0.295, p < 0.0001, R2 = 0.230). Our study suggests that thyroid hormones could modulate UA metabolism in patients with recent onset subclinical hypothyroidism likely by improving insulin sensitivity.
KeywordsUric acid Insulin Levothyroxine Hypothyroidism
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
Statement of human and animal rights
All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
- 2.Desideri G, Castaldo G, Lombardi A, Mussap M, Testa A, Pontremoli R, Punzi L, Borghi C (2014) Is it time to revise the normal range of serum uric acid levels? Eur Rev Med Pharmacol Sci 18(9):1295–1306Google Scholar
- 8.Kuhlback B (1957) Creatine and creatinine metabolism in thyrotoxicosis and hypothyroidism; a clinical study. Acta Med Scand Suppl 331:1–70Google Scholar
- 12.Giordano N, Santacroce C, Mattii G, Geraci S, Amendola A, Gennari C (2001) Hyperuricemia and gout in thyroid endocrine disorders. Clin Exp Rheumatol 19:661–665Google Scholar
- 13.Ashizawa K, Imaizumi M, Usa T, Tominaga T, Sera N, Hida A, Ejima E, Neriishi K, Soda M, Ichimaru S, Nakashima E, Fujiwara S, Maeda R, Nagataki S, Eguchi K, Akahoshi M (2010) Metabolic cardiovascular disease risk factors and their clustering in subclinical hypothyroidism. Clin Endocrinol 72:689–695CrossRefGoogle Scholar
- 14.Raber W, Vukovich T, Vierhapper H (1999) Serum uric acid concentration and thyroid-stimulating-hormone (TSH): results of screening for hyperuricaemia in 2359 consecutive patients with various degrees of thyroid dysfunction. Wien Klin Wochenschr 111:326–328Google Scholar
- 15.Ye Y, Gai X, Xie H, Jiao L, Zhang S (2015) Association between serum free thyroxine (FT4) and uric acid levels in populations without overt thyroid dysfunction. Ann Clin Lab Sci 45(1):49–53Google Scholar
- 16.Lombardi CP, Bocale R, Barini A, Barini A, D’Amore A, Boscherini M, Bellantone R (2017) Comparative study between the effects of replacement therapy with liquid and tablet formulations of levothyroxine on mood states, self-perceived psychological well-being and thyroid hormone profile in recently thyroidectomized patients. Endocrine 55(1):51–59CrossRefGoogle Scholar
- 18.Mooraki A, Bastani B (1998) Reversible renal insufficiency, hyperuricemia and gouty arthritis in a case of hypothyroidism. Clin Nephrol 49(1):59–61Google Scholar
- 22.Steiger MJ, Watson AR, Morgan AG (1991) Hypothyroidism and renal impairment. J R Soc Med 84(11):688–689Google Scholar
- 23.McLaughlin KJ, Mactier RA (1994) Renal impairment in hypothyroidism. Nephrol Dial Transplant 9(10):1521–1522Google Scholar