The effect of levothyroxine replacement therapy on lipid profile and oxidative stress parameters in patients with subclinical hypothyroid

  • Serkan Mutlu
  • Adem Parlak
  • Umit Aydogan
  • Aydogan Aydogdu
  • Bugra Soykut
  • Cemal Akay
  • Kenan Saglam
  • Abdullah Taslipinar
Research Article

Abstract

The purpose of this present study is to investigate the levels of oxidative stress parameters in patients with subclinical hypothyroidism (SH) and the effects of levothyroxine (LT4) replacement therapy on these parameters and lipid profile. At the beginning of the study blood samples were collected from the patients in order to analyse oxidative stress parameters, lipid profile and biochemical markers. After replacement therapy with LT4, in the third month, same tests were performed again. At the baseline superoxide dismutase (SOD) levels were found to be higher in SH patients, compared to the euthyroid group. After LT4 therapy, statistically significant decreases in SOD and catalase levels and increase in HDL-C levels were noticed. LT4 treatment was found to have positive effects on oxidative stress indicators and HDL-C levels.

Keywords

Subclinical hypothyroidism Oxidative stress SOD CAT Lipid Levothyroxine 

Notes

Conflict of interest

There are no conflict of interest by any of the participating authors.

References

  1. Al-Tonsi, A.A., A.A. Abdel-Gayoum, and M. Saad. 2004. The secondary dyslipidemia and deranged serum phosphate concentration in thyroid disorders. Experimental and Molecular Pathology 76: 182–187.PubMedCrossRefGoogle Scholar
  2. Araujo, A.S., F.E. Seibel, U.O. Oliveira, T. Fernandes, S. Llesuy, L. Kucharski, and A. Belló-Klein. 2011. Thyroid hormone-induced haemoglobin changes and antioxidant enzymes response in erythrocytes. Cell Biochemistry and Function 29(5): 408–413.PubMedCrossRefGoogle Scholar
  3. Asranna, A., R.S. Taneja, and B. Kulshreshta. 2012. Dyslipidemia in subclinical hypothyroidism and the effect of thyroxine on lipid profile. Indian Journal of Endocrinology and Metabolism 16(Suppl 2): 347–349.Google Scholar
  4. Asvold, B.O., L.J. Vatten, T.I. Nilsen, and T. Bjoro. 2007. The association between TSH within the reference range and serum lipid concentrations in a population-based study. The HUNT study. European Journal of Endocrinology 156: 181–186.PubMedCrossRefGoogle Scholar
  5. Ayala, A.R., M.D. Danese, and P.W. Ladenson. 2000. When to treat mild hypothyroidism. Endocrinology and Metabolism Clinics of North America 29: 399–415.PubMedCrossRefGoogle Scholar
  6. Bağcı, Ö. 2006. Levotiroksin Tedavisinin Kardiyovasküler Risk Profili ve Karotis İntima Media Kalınlığı Üzerine Etkileri, Uzmanlık Tezi, Süleyman Demirel Üniversitesi Tıp Fakültesi, Isparta, (available from http://tez.sdu.edu.tr/Tezler/TT00285.pdf).
  7. Biondi, B., and D.S. Cooper. 2008. The clinical significance of subclinical thyroid dysfunction. Endocrine Reviews 29: 76–131.PubMedCrossRefGoogle Scholar
  8. Canaris, G.J., Manowitz, N.R., Major, G., and E.C. Ridgway. 2000. The Colorado thyroid disease prevalence study. Archives of Internal Medicine 160(4): 526–534.Google Scholar
  9. Cantürk, Z., B. Çetinarslan, I. Tarkun, N.Z. Cantürk, M. Ozden, and C. Duman. 2003. Hemostatic system as a risk factor for cardiovascular disease in women with subclinical hypothyroidism. Thyroid 13(10): 971–977.PubMedCrossRefGoogle Scholar
  10. Cebeci, E., F.A. Oner, M. Usta, S. Yurdakul, and M. Erguney. 2011. Evaluation of oxidative stress, the activities of paraoxonase and arylesterase in patients with subclinic hypothyroidism. Acta Biomedica 82(3): 214–222.PubMedGoogle Scholar
  11. Cebeci, E., F.A. Oner, M. Usta, S. Yurdakul, and M. Erguney. 2012. Evaluation of oxidative stress, the activities of paraoxonase and arylesterase in patients with subclinic hypothyroidism. Journal of Investigative Medicine 60(1): 23–28.PubMedGoogle Scholar
  12. Celi, F.S., M. Zemskova, J.D. Linderman, S. Smith, B. Drinkard, V. Sachdev, M.C. Skarulis, M. Kozlosky, G. Csako, R. Costello, and F. Pucino. 2011. Metabolic effects of liothyronine therapy in hypothyroidism: A randomized, double-blind, crossover trial of liothyronine versus levothyroxine. Journal of Clinical Endocrinology and Metabolism 96(11): 3466–3474.PubMedCrossRefGoogle Scholar
  13. Chapman, M.J., G. Assmann, J.C. Fruchart, J. Shepherd, and C. Sirtori. 2004. Raising high-density lipoprotein cholesterol with reduction of cardiovascular risk: The role of nicotinic acid—a position paper developed by the European Consensus Panel on HDL-C. Current Medical Research and Opinion 20(8): 1253–1268.PubMedCrossRefGoogle Scholar
  14. Cooper, D.S. 1998. Subclinical thyroid disease: A clinician’s perspective. Annals of Internal Medicine 129: 135–138.PubMedCrossRefGoogle Scholar
  15. Danese, M.D., P.W. Ladenson, C.L. Meinert, and N.R. Powe. 2000. Clinical review 115: Effect of thyroxine therapy on serum lipoproteins in patients with mild thyroid failure: A quantitative review of the literature. Journal of Clinical Endocrinology and Metabolism 85: 2993–3001.PubMedCrossRefGoogle Scholar
  16. Duman, D., R. Demirtunc, S. Sahin, and K. Esertas. 2007. The effects of simvastatin and LT4 on intima-media thickness of the carotid artery in female normolipemic patients with subclinical hypothyroidism: A prospective, randomized-controlled study. Journal of Cardiovascular Medicine (Hagerstown) 8: 1007–1011.CrossRefGoogle Scholar
  17. Duntas, L.H. 2002. Thyroid disease and lipids. Thyroid 12: 287–293.PubMedCrossRefGoogle Scholar
  18. Emiroğlu, C. 2004. Subklinik hipotiroidi hastalarında lipid profili ve sessiz iskemi bulunma riski arasındaki ilişki, Uzmanlık Tezi, Şişli Etfal Eğitim ve Araştırma Hastanesi, İstanbul, (available from http://www.istanbulsaglik.gov.tr/w/tez/pdf/ic_hast/dr_cuma_emiroglu.pdf).
  19. Erem, C. 2006. Blood coagulation, fibrinolytic activity and lipid profile in subclinical thyroid disease: Subclinical hyperthyroidism increases plasma factor X activity. Clinical Endocrinology (Oxford) 64: 323–329.CrossRefGoogle Scholar
  20. Fatourechi, V. 2009. Subclinical hypothyroidism: An update for primary care physicians. Mayo Clinic Proceedings 84: 65–71.PubMedCrossRefGoogle Scholar
  21. Feldt-Rasmussen, U. 2009. Is the treatment of subclinical hypothyroidism beneficial? Nature Clinical Practice Endocrinology & Metabolism 5: 86–87.CrossRefGoogle Scholar
  22. Fernandez, V., and L.A. Videla. 1989. Thyroid hormone, active oxygen, and lipid peroxidation. In Handbook of free radicals and antioxidants in biomedicine, ed. J. Miquel, A.T. Quintanilha, and H. Weber, 105–115. Boca Raton: CRC Press.Google Scholar
  23. Freeman, B.A., and J.D. Crapo. 1982. Biology of disease, free radicals and tissue injury. Laboratory Investigation 47(5): 412–426.PubMedGoogle Scholar
  24. Fridovich, I. 1983. Superoxide radical: An endogenous toxicant. Annual Review of Pharmacology and Toxicology 23(1): 239–257.PubMedCrossRefGoogle Scholar
  25. Halliwell, B. 2012. Free radicals and antioxidants: Updating a personal view. Nutrition Reviews 70(5): 257–265.PubMedCrossRefGoogle Scholar
  26. Halliwell, B. 1996. Antioxidants in human health and disease. Annual Review of Nutrition 16(1): 33–50.PubMedCrossRefGoogle Scholar
  27. Helfand, M., and C.C. Redfern. 1998. Clinical guideline, part 2. Screening for thyroid disease: An update. American College of Physicians. Annals of Internal Medicine 129: 144–158.PubMedCrossRefGoogle Scholar
  28. Hueston, W.J., and W.S. Pearson. 2004. Subclinical hypothyroidism and the risk of hypercholesterolemia. Annals of Family Medicine 2: 351–355.PubMedCrossRefGoogle Scholar
  29. Iqbal, A., R. Jorde, and Y. Figenschau. 2006. Serum lipid levels in relation to serum thyroid-stimulating hormone and the effect of thyroxine treatment on serum lipid levels in subjects with subclinical hypothyroidism: The Tromso study. Journal of Internal Medicine 260: 53–61.PubMedCrossRefGoogle Scholar
  30. Jung, C.H., K.C. Sung, H.S. Shin, E.J. Rhee, W.Y. Lee, B.S. Kim, J.H. Kang, H. Kim, S.W. Kim, M.H. Lee, J.R. Park, and S.W. Kim. 2003. Thyroid dysfunction and their relation to cardiovascular risk factors such as lipid profile, hsCRP, and waist hip ratio in Korea. Korean Journal of Internal Medicine 18(3): 146–153.PubMedGoogle Scholar
  31. Kebapcilar, L., B. Akinci, F. Bayraktar, A. Solak, T. Demir, S. Yener, T. Küme, and S. Yesil. 2007. Plasma thiobarbituric acid-reactive substance levels in subclinical hypothyroidism. Medical Principles and Practice 16(6): 432–436.PubMedCrossRefGoogle Scholar
  32. Kiya, Y., S. Miura, B. Zhang, H. Urata, and K. Saku. 2006. Effect of levothyroxine on total lipid profiles as assessed by analytical capillary isotachophoresis in a patient with hypothyroidism. Endocrine Journal 53(6): 865–868.PubMedCrossRefGoogle Scholar
  33. Krinsky, N.I. 1992. Mechanism of action of biological antioxidants. Proceedings of the Society for Experimental Biology and Medicine 200: 248–254.PubMedCrossRefGoogle Scholar
  34. Lee, W.Y., J.Y. Suh, E.J. Rhee, J.S. Park, K.C. Sung, and S.W. Kim. 2004. Plasma CRP, apolipoprotein A-1, apolipoprotein B and Lp (a) levels according to thyroid function status. Archives of Medical Research 35: 540–545.PubMedCrossRefGoogle Scholar
  35. Lewis, G.F., and D.J. Rader. 2005. New insights into the regulation of HDL metabolism and reverse cholesterol transport. Circulation Research 96(12): 1221–1232.PubMedCrossRefGoogle Scholar
  36. Luboshitzky, R., A. Aviv, P. Herer, and L. Lavie. 2002. Risk factors for cardiovascular disease in women with subclinical hypothyroidism. Thyroid 12: 421–425.PubMedCrossRefGoogle Scholar
  37. Marwaka, R.K., N. Tandon, M.K. Garg, R. Kanwar, A. Sastry, and A. Narang. 2011. Dyslipidemia in subclinical hypothyroidism in an Indian population. Clinical Biochemistry 44(14–15): 1214–1217.CrossRefGoogle Scholar
  38. McGrowder, D., C. Riley, E.Y. Morrison, and L. Gordon. 2011. The role of high-density lipoproteins in reducing the risk of vascular diseases, neurogenerative disorders, and cancer. Cholesterol 2011: 496925.PubMedCrossRefGoogle Scholar
  39. Meier, C., J.J. Staub, J.B. Roth, M. Guglielmetti, M. Kunz, A.R. Miserez, J. Drewe, P. Huber, R. Herzog, and B. Müller. 2001. TSH controlled L-thyroxine therapy reduces cholesterol levels and clinical symptoms in subclinical hypothyroidism: A double blind, placebo-controlled trial (Basel Thyroid Study). Journal of Clinical Endocrinology and Metabolism 86(10): 4860.PubMedCrossRefGoogle Scholar
  40. Merchante-Alfaro, A.A., M. Civera-Andrés, N. Atiénzar-Herráez, J.M. Tenías-Burillo, E. Ochoa-Avila, and I. Martínez-Moreno. 2006. Effect of levothyroxine replacement on lipid profile in patients with ild subclinical hypothyroidism. Medicina clinica’s (Barcelona) 126(7): 246–249.CrossRefGoogle Scholar
  41. Messarah, M., A. Boumendjel, A. Chouabia, F. Klibet, C. Abdennour, M.S. Boulakoud, and A.E. Feki. 2010. Influence of thyroid dysfunction on liver lipid peroxidation and antioxidant status in experimental rats. Experimental and Toxicologic Pathology 62(3): 301–310.Google Scholar
  42. Monzani, F., N. Caraccio, M. Kozakowa, A. Dardano, F. Vittone, A. Virdis, S. Taddei, C. Palombo, and E. Ferrannini. 2004. Effect of levothyroxine replacement on lipid profile and intima-media thickness in subclinical hypothyroidism: a double-blind, placebo controlled study. Journal of Clinical Endocrinology and Metabolism 89: 2099–2106.PubMedCrossRefGoogle Scholar
  43. Oziol, L., P. Faure, N. Bertrand, and P. Chomard. 2003. Inhibition of in vitro macrophage-induced low density lipoprotein oxidation by thyroid compounds. Journal of Endocrinology 177(1): 137–146.PubMedCrossRefGoogle Scholar
  44. Pearce, E.N. 2012. Update in lipid alterations in subclinical hypothyroidism. Journal of Clinical Endocrinology and Metabolism 97(2): 326–333.PubMedCrossRefGoogle Scholar
  45. Pereira, B., L.F. Rosa, D.A. Safi, E.J. Bechara, and R. Curi. 1994. Control of superoxide dismutase, catalase and glutathione peroxidase activities in rat lymphoid organs by thyroid hormones. Journal of Endocrinology 140(1): 73–77.PubMedCrossRefGoogle Scholar
  46. Rizos, C.V., M.S. Elisaf, and E.N. Liberopoulos. 2011. Effects of thyroid dysfunction on lipid profile. Open Cardiovascular Medicine Journal 5: 76–84.PubMedCrossRefGoogle Scholar
  47. Santi, A., M.M. Duarte, R.N. Moresco, C. Menezes, M.D. Bagatini, M.R. Schetinger, and V.L. Loro. 2010. Association between thyroid hormones, lipids and oxidative stress biomarkers in overt hypothyroidism. Clinical Chemistry and Laboratory Medicine 48(11): 1635–1639.PubMedCrossRefGoogle Scholar
  48. Stevens, R.J., M.L. Nishio, and D.A. Hood. 1995. Effect of hypothyroidism on the expression of cytochrome c and cytochrome c-oxidase in heart and muscle during development. Molecular and Cellular Biochemistry 143: 119–127.PubMedCrossRefGoogle Scholar
  49. Sigal, G.A., G. Medeiros-Neto, J.C. Vinagre, J. Diament, and R.C. Maranhão. 2011. Lipid metabolism in subclinical hypothyroidism: Plasma kinetics of triglyceride-rich lipoproteins and lipid transfers to high-density lipoprotein before and after levothyroxine treatment. Thyroid 21(4): 347–353.PubMedCrossRefGoogle Scholar
  50. Teixeira Pde, F., V.S. Reuters, M.M. Ferreira, C.P. Almeida, F.A. Reis, A. Buescu, A.J. Costa, and M. Vaisman. 2008. Lipid profile in different degrees of hypothyroidism and effects of levothyroxine replacement in mild thyroid failure. Translational Research 151: 224–231.PubMedCrossRefGoogle Scholar
  51. Torun, A.N., S. Kulaksizoglu, M. Kulaksizoglu, B.O. Pamuk, E. Isbilen, and N.B. Tutuncu. 2009. Serum total antioxidant status and lipid peroxidation marker malondialdehyde levels in overt and subclinical hypothyroidism. Clinical Endocrinology (Oxford) 70(3): 469–474.CrossRefGoogle Scholar
  52. Toth, P.P. 2005. High-density lipoprotein as a therapeutic target: Clinical evidence and treatment strategies. American Journal of Cardiology 96(9): 50K–58K.PubMedCrossRefGoogle Scholar
  53. Tzotzas, T., G.E. Krassas, T. Konstantinidis, and M. Bougoulia. 2000. Changes in lipoprotein (a) levels in overt and subclinical hypothyroidism before and during treatment. Thyroid 10(9): 803–808.PubMedCrossRefGoogle Scholar
  54. Walsh, J.P., A.P. Bremner, M.K. Bulsara, P. O’leary, P.J. Leedman, P. Feddema, and V. Michelangeli. 2005. Thyroid dysfunction and serum lipids: A community-based study. Clinical Endocrinology (Oxford) 63: 670–675.CrossRefGoogle Scholar
  55. Watson, A.D., J.A. Berliner, S.Y. Hama, B.N. La Du, K.F. Faull, A.M. Fogelman, and M. Navab. 1995. Protective effect of high density lipoprotein associated paraoxonase. Inhibition of the biological activity of minimally oxidized low density lipoprotein. Journal of Clinical Investigation 96(6): 2882–2891.PubMedCrossRefGoogle Scholar
  56. Zulewski, H., B. Muller, P. Exer, A.R. Miserez, and J.J. Staub. 1997. Estimation of tissue hypothyroidism by a new clinical score: Evaluation of patients with various grades of hypothyroidism and controls. Journal of Clinical Endocrinology and Metabolism 82(3): 771–776.PubMedCrossRefGoogle Scholar

Copyright information

© The Pharmaceutical Society of Korea 2013

Authors and Affiliations

  • Serkan Mutlu
    • 1
  • Adem Parlak
    • 2
  • Umit Aydogan
    • 1
  • Aydogan Aydogdu
    • 3
  • Bugra Soykut
    • 4
  • Cemal Akay
    • 4
  • Kenan Saglam
    • 5
  • Abdullah Taslipinar
    • 3
  1. 1.Department of Family MedicineGulhane School of MedicineAnkaraTurkey
  2. 2.Department of Family MedicineAğrı Military HospitalAgriTurkey
  3. 3.Department of Endocrinology and Metabolic DiseasesGulhane School of MedicineAnkaraTurkey
  4. 4.Department of Pharmaceutical ToxicologyGulhane School of MedicineAnkaraTurkey
  5. 5.Department of Internal MedicineGulhane School of MedicineAnkaraTurkey

Personalised recommendations