Raised serum TSH in morbid-obese and non-obese patients: effect on the circulating lipid profile

We’re sorry, something doesn't seem to be working properly.

Please try refreshing the page. If that doesn't work, please contact support so we can address the problem.


Morbid obesity is associated with a high rate of raised serum TSH associated with normal free thyroid hormones. The body repercussions of this thyroid abnormality, suggesting subclinical hypothyroidism, are still debated. In particular, it is unclear whether the raised serum TSH of obesity results in changes of circulating lipids typically observed in hypothyroidism. Aim of this study was to evaluate the impact of a raised serum TSH on the lipid profile in morbid-obese and non-obese patients. Serum TSH, FT4, FT3, Tg-Ab, TPO-Ab and lipids were measured in 55 morbid-obese (BMI > 40 kg/m2) and 55 non-obese (BMI < 30 kg/m2) patients with a raised serum TSH. Despite similar serum levels of TSH, FT4 and FT3, morbid-obese patients displayed significantly lower mean levels of total cholesterol (200.8 ± 35.6 vs. 226.9 ± 41.4 mg/dl, p < 0.001) and a significantly lower prevalence of hypercholesterolemia (50.9 vs. 72.7 %, p < 0.01) when compared with non-obese patients. Morbid-obese patients also had lower mean serum HDL cholesterol and higher serum triglycerides. The impact of a raised serum TSH on the lipid profile differs in morbid-obese compared to non-obese patients, suggesting that obese patients might not be truly hypothyroid. Measuring total cholesterol could be a helpful tool for deciding whether a morbid-obese patient with a raised serum TSH should be given levothyroxine treatment.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2


  1. 1.

    D.H. Bessesen, Update on obesity. J. Clin. Endocrinol. Metab. 93, 2027–2034 (2008)

    CAS  PubMed  Article  Google Scholar 

  2. 2.

    C.L. Ogden, M.D. Carroll, L.R. Curtin, M.A. McDowell, C.J. Tabak, K.M. Flegal, Prevalence of overweight and obesity in the United States, 1999–2004. JAMA 295, 1549–1555 (2006)

    CAS  PubMed  Article  Google Scholar 

  3. 3.

    P. Kokkoris, F.X. Pi-Sunyer, Obesity and endocrine disease. Endocrinol. Metab. Clin. North Am. 32, 895–914 (2005)

    Article  Google Scholar 

  4. 4.

    L. Douyon, D. Schteingart, Effect of obesity and starvation on thyroid hormone, growth hormone, and cortisol secretion. Endocrinol. Metab. Clin. North Am. 31, 173–189 (2002)

    CAS  PubMed  Article  Google Scholar 

  5. 5.

    R. Sari, M. Kemal Balci, H. Altunbas, U. Karayalcin, The effect of body weight and weight loss on thyroid volume and function in obese women. J. Clin. Endocrinol. 59, 258–262 (2003)

    Article  Google Scholar 

  6. 6.

    M.A. Michalaki, A.G. Vagenakis, A.S. Leonardou, M.N. Argentou, I.G. Habeos, M.G. Makri, A.I. Psyrogiannis, F.E. Kalfarentzos, V.E. Kyriazopoulou, Thyroid function in humans with morbid obesity. Thyroid 16, 73–78 (2006)

    CAS  PubMed  Article  Google Scholar 

  7. 7.

    N. Manji, K. Boelaert, M.C. Sheppard, R.L. Holder, S.C. Gough, J.A. Franklyn, Lack of association between serum TSH or free T4 and body mass index in euthyroid subjects. J. Clin. Endocrinol. 64, 125–128 (2006)

    CAS  Article  Google Scholar 

  8. 8.

    G. De Pergola, A. Ciampolillo, S. Paolotti, P. Trerotoli, R. Giorgino, Free triiodothyronine and thyroid stimulating hormone are directly associated with waist circumference, independently of insulin resistance, metabolic parameters and blood pressure in overweight and obese women. J. Clin. Endocrinol. 67, 265–269 (2007)

    Article  Google Scholar 

  9. 9.

    M. Bastemir, F. Akin, E. Alkis, B. Kaptanoglu, Obesity is associated with increased serum TSH level, independently of thyroid function. Swiss Med. Wkly 137, 431–434 (2007)

    PubMed  Google Scholar 

  10. 10.

    N. Knudsen, P. Laurberg, L.B. Rasmussen, I. Bulow, H. Perrild, L. Ovesen, T. Jorgensen, Small differences in thyroid function may be important for body mass index and the occurrence of obesity in the population. J. Clin. Endocrinol. Metab. 90, 4019–4024 (2005)

    CAS  PubMed  Article  Google Scholar 

  11. 11.

    B. Biondi, Thyroid and obesity: an intriguing relationship. J. Clin. Endocrinol. Metab. 95, 3614–3617 (2010)

    CAS  PubMed  Article  Google Scholar 

  12. 12.

    P. Marzullo, A. Minocci, M.A. Tagliaferri, G. Guzzaloni, A. Di Blasio, C. De Medici, G. Aimaretti, A. Liuzzi, Investigations of thyroid hormones and antibodies in obesity: leptin levels are associated with thyroid autoimmunity independent of bioanthropometric, hormonal, and weight-related determinants. J. Clin. Endocrinol. Metab. 95, 3965–3972 (2010)

    CAS  PubMed  Article  Google Scholar 

  13. 13.

    M. Rotondi, P. Leporati, A. La Manna, B. Pirali, T. Mondello, R. Fonte, F. Magri, L. Chiovato, Raised serum TSH levels in patients with morbid obesity: is it enough to diagnose subclinical hypothyroidism? Eur. J. Endocrinol. 160, 403–408 (2009)

    CAS  PubMed  Article  Google Scholar 

  14. 14.

    M. Rotondi, F. Magri, L. Chiovato, Thyroid and obesity: not a one-way interaction. J. Clin. Endocrinol. Metab. 96, 344–346 (2011)

    CAS  PubMed  Article  Google Scholar 

  15. 15.

    G. Radetti, W. Kleon, F. Buzi, C. Crivellaro, L. Pappalardo, N. di Iorgi, M. Maghnie, Thyroid function and structure are affected in childhood obesity. J. Clin. Endocrinol. Metab. 3, 4749–4754 (2008)

    Article  Google Scholar 

  16. 16.

    M. Rotondi, C. Cappelli, P. Leporati, S. Chytiris, F. Zerbini, R. Fonte, F. Magri, M. Castellano, L. Chiovato, A hypoechoic pattern of the thyroid at ultrasound does not indicate autoimmune thyroid diseases in patients with morbid obesity. Eur. J. Endocrinol. 163, 105–109 (2010)

    CAS  PubMed  Article  Google Scholar 

  17. 17.

    D.S. Cooper, Clinical practice. Subclinical hypothyroidism. N. Engl. J. Med. 345, 260–265 (2010)

    Article  Google Scholar 

  18. 18.

    A.R. Cappola, P.W. Ladenson, Hypothyroidism and atherosclerosis. J. Clin. Endocrinol. Metab. 88, 2438–2444 (2003)

    CAS  PubMed  Article  Google Scholar 

  19. 19.

    R.E. Weiss, R.L. Brown, Doctor…could it be my thyroid? Arch. Intern. Med. 168, 568–569 (2000)

    Article  Google Scholar 

  20. 20.

    A.R. Ayala, M.D. Danese, P.W. Ladenson, When to treat mild hypothyroidism. Endocrinol. Metab. Clin. North Am. 29, 399–415 (2000)

    CAS  PubMed  Article  Google Scholar 

  21. 21.

    L.H. Duntas, Thyroid disease and lipids. Thyroid 12, 287–293 (2002)

    CAS  PubMed  Article  Google Scholar 

  22. 22.

    M.D. Danese, P.W. Ladenson, C.L. Meinert, N.R. Powe, Clinical review 115: effect of thyroxine therapy on serum lipoproteins in patients with mild thyroid failure: a quantitative review of the literature. J. Clin. Endocrinol. Metab. 85, 2993–3001 (2000)

    CAS  PubMed  Google Scholar 

  23. 23.

    F. Alibaz Oner, S. Yurdakul, E. Oner, A. Kubat Uzum, M. Erguney, Evaluation of the effect of L-thyroxin therapy on endothelial functions in patients with subclinical hypothyroidism. Endocrine 40, 280–284 (2011)

    PubMed  Article  Google Scholar 

  24. 24.

    O. Topaloglu, F. Gokay, K. Kucukler, F.S. Burnik, T. Mete, H.C. Yavuz, D. Berker, S. Guler, Is autoimmune thyroiditis a risk factor for early atherosclerosis in premenopausal women even if in euthyroid status? Endocrine. (2012). doi:10.1007/s12020-012-9842-5

  25. 25.

    B. Biondi, D.S. Cooper, The clinical significance of subclinical thyroid dysfunction. Endocr. Rev. 29, 76–131 (2008)

    CAS  PubMed  Article  Google Scholar 

  26. 26.

    B.O. Asvold, L.J. Vatten, T.I. Nilsen, T. Bjøro, The association between TSH within the reference range and serum lipid concentrations in a population-based study. The HUNT Study. Eur. J. Endocrinol. 156, 181–186 (2007)

    PubMed  Article  Google Scholar 

  27. 27.

    G. Iacobellis, M.C. Ribaudo, A. Zappaterreno, C.V. Iannucci, F. Leonetti, Relationship of thyroid function with body mass index, leptin, insulin sensitivity and adiponectin in euthyroid obese women. J. Clin. Endocrinol. 62, 487–491 (2005)

    CAS  Article  Google Scholar 

  28. 28.

    E.A. Palmieri, S. Fazio, G. Lombardi, B. Biondi, Subclinical hypothyroidism and cardiovascular risk: a reason to treat? Treat Endocrinol. 3, 233–244 (2004)

    PubMed  Article  Google Scholar 

  29. 29.

    F.J. Tinahones, L. Garrido-Sanchez, M. Miranda, J.M. García-Almeida, M. Macias-Gonzalez, V. Ceperuelo, E. Gluckmann, J. Rivas-Marin, J. Vendrell, E. García-Fuentes, Obesity and insulin resistance-related changes in the expression of lipogenic and lipolytic genes in morbidly obese subjects. Obes. Surg. 20, 1559–1567 (2010)

    CAS  PubMed  Article  Google Scholar 

  30. 30.

    T. Reinehr, G. De Sousa, W. Andler, Hyperthyrotropinemia in obese children is reversible after weight loss and is not related to lipids. J. Clin. Endocrinol. Metab. 91, 3088–3091 (2006)

    CAS  PubMed  Article  Google Scholar 

  31. 31.

    M. Tagliaferro, M.E. Berselli, G. Calò, A. Minocci, G. Savia, M.L. Petroni, G.C. Viberti, A.G. Liuzzi, Subclinical hypothyroidism in obese patients: relation to resting energy expenditure, serum leptin, body composition, and lipid profile. Obes. Res. 9, 196–201 (2001)

    Article  Google Scholar 

  32. 32.

    Y. Raftopoulos, D.J. Gagné, P. Papasavas, F. Hayetian, J. Maurer, P. Bononi, P.F. Caushaj, Improvement of hypothyroidism after laparoscopic Roux-en-Y gastric bypass for morbid obesity. Obes. Surg. 14, 509–513 (2004)

    PubMed  Article  Google Scholar 

  33. 33.

    G. Michalopoulou, M. Alevizaki, G. Piperingos, D. Mitsibounas, E. Mantzos, P. Adamopoulos, D.A. Koutras, High serum cholesterol levels in persons with ‘high-normal’ TSH levels: should one extend the definition of subclinical hypothyroidism? Eur. J. Endocrinol. 138, 141–145 (1998)

    CAS  PubMed  Article  Google Scholar 

Download references


The study was supported in part by funds from Progetto Ricerca Finalizzata 2005 “Rete Obesità” Italian Ministry of Health.

Conflict of interest

The authors have no conflict of interest that could be perceived as prejudicing the impartiality of the research reported.

Author information



Corresponding author

Correspondence to Luca Chiovato.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Rotondi, M., Leporati, P., Rizza, M.I. et al. Raised serum TSH in morbid-obese and non-obese patients: effect on the circulating lipid profile. Endocrine 45, 92–97 (2014). https://doi.org/10.1007/s12020-013-9928-8

Download citation


  • Thyroid
  • TSH
  • Subclinical hypothyroidism
  • Morbid obesity
  • Lipid profile
  • Total cholesterol