Cited by 753Thyroid Disorders and TreatmentsRegulation of Appetite and ObesityAdipokines, Inflammation, and Metabolic Diseases

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Small Differences in Thyroid Function May Be Important for Body Mass Index and the Occurrence of Obesity in the Population

Knudsen, Nils, Laurberg, Peter, Rasmussen, Lone B., Bülow, Inge, Perrild, Hans, Ovesen, Lars, Jørgensen, Torben·2005·The Journal of Clinical Endocrinology & Metabolism

DOI 10.1210/jc.2004-2225

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Abstract

CONTEXT: Increasing prevalence of overweight in the population is a major concern globally; and in the United States, nearly one third of adults were classified as obese at the end of the 20th century. Few data have been presented regarding an association between variations in thyroid function seen in the general population and body weight. OBJECTIVE: The aim of this study was to investigate the association between thyroid function and body mass index (BMI) or obesity in a normal population. DESIGN: A cross-sectional population study (The DanThyr Study) was conducted. PARTICIPANTS: In all, 4649 participants were investigated, and 4082 were eligible for these analyses after exclusion of subjects with previous or present overt thyroid dysfunction. MAIN OUTCOME MEASURES: The study examined the association between category of serum TSH or serum thyroid hormones and BMI or obesity in multivariate models, adjusting for possible confounding. RESULTS: We found a positive association between BMI and category of serum TSH (P < 0.001) and a negative association between BMI and category of serum free T(4) (P < 0.001). No association was found between BMI and serum free T(3) levels. The difference in BMI between the groups with the highest and lowest serum TSH levels was 1.9 kg/m(2), corresponding to a difference in body weight of 5.5 kg among women. Similarly, the category of serum TSH correlated positively with weight gain during 5 yr (P = 0.04), but no statistically significant association was found with weight gain during 6 months (P = 0.17). There was an association between obesity (BMI > 30 kg/m(2)) and serum TSH levels (P = 0.001). CONCLUSIONS: Our results suggest that thyroid function (also within the normal range) could be one of several factors acting in concert to determine body weight in a population. Even slightly elevated serum TSH levels are associated with an increase in the occurrence of obesity.

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Background
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“Small variation in TSH levels even within the normal reference range is positively associated with higher BMI and weight gain in other cohorts (68-71), and such a relationship is bilateral (35-37).”
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“…hypothyroidism patients often exhibited low basal metabolisms along with a decrease in T3 and T4 in plasma and increase in TSH; in contrast, hyperthyroidism patients showed a decrease in TSH and a increase in their basal metabolisms and T3 and T4 in plasma (Kong et al., 2015; Sawin et al., 1994).”
Background
Evaluation of epicardial fat tissue thickness as a marker of cardiovascular risk in patients with subclinical hypothyroidism
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Background
Age and Gender Specific Thyroid Hormones and Their Relationships with Body Mass Index in a Large Chinese Population: A Clinical Trial
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“IMC (kg/m2) 34,2 (23,4-52,6) 37,2 (25,8-51,9) 0,046”
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Background
Thyroid Nodules in Severely Obese Patients: Frequency and Risk of Malignancy on Ultrasonography
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Association of thyroid hormones with resting energy expenditure and complement C3 in normal weight high body fat women
Karkhaneh, M., Qorbani, M., Ataie‐Jafari, A., Mohajeri-Tehrani, M. R., Asayesh, H., & Hosseini, S. (2019) · Thyroid Research · doi:10.1186/s13044-019-0070-4 · Cited by 17
Influence of subclinical hypothyroidism on metabolic parameters in obese children and adolescents
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The relation between changes in thyroid function and anthropometric indices during long-term follow-up of euthyroid subjects: the Tehran Thyroid Study (TTS)
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Optimized Replacement T4 and T4+T3 Dosing in Male and Female Hypothyroid Patients With Different BMIs Using a Personalized Mechanistic Model of Thyroid Hormone Regulation Dynamics
Cruz‐Loya, M., Chu, B. B., Jonklaas, J., Schneider, D. F., & DiStefano, J. J. (2022) · Frontiers in Endocrinology · doi:10.3389/fendo.2022.888429 · Cited by 16
“Some studies have found that serum T3 concentrations remain roughly constant (3), while others have found an increase in T3 and the T3/T4 ratio with increasing BMI (6).”
BackgroundMethodInfluential
A Systematic Review and Meta-Analysis of Free Triiodothyronine (FT3) Levels in Humans Depending on Seasonal Air Temperature Changes: Is the Variation in FT3 Levels Related to Nonshivering Thermogenesis?
Никанорова, А. А., Алексеевич, Б. Н., Пшенникова, В. Г., Teryutin, F. M., Сергеевич, Н. С., Solovyev, A. V., Romanov, G. P., Бурцева, Т. Е., & Федорова, С. А. (2023) · International Journal of Molecular Sciences · doi:10.3390/ijms241814052 · Cited by 18
Thyroid disease and autoimmunity in obese patients: a narrative review
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The association between dyslipidaemia in the first trimester and adverse pregnancy outcomes in pregnant women with subclinical hypothyroidism: a cohort study
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“In addition, elevated TSH levels have been correlated with an increased BMI [47].”
Background
Prognostic value of thyroid-stimulating hormone within reference range in patients with coronary artery disease
Ndrepepa, G., Braun, S., Mayer, K., Cassese, S., Fusaro, M., Byrne, R. A., Hoppmann, P., Schunkert, H., Laugwitz, K., & Kastrati, A. (2015) · Metabolism · doi:10.1016/j.metabol.2015.07.009 · Cited by 15
“Evidence available also suggests that TSH levels in the upper part of reference range are associated with worse cardiovascular risk profile including endothelial dysfunction [8], reduced glomerular filtration rate [9], systolic and diastolic blood pressure [10], arterial stiffness [11], body mass index [12], metabolic…”
Background
Focus on BMI and subclinical hypothyroidism in adolescent girls first examined for amenorrhea or oligomenorrhea. The emerging role of polycystic ovary syndrome
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Preoperative Thyroid Autoimmune Status and Changes in Thyroid Function and Body Weight After Bariatric Surgery
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Pillai, N. S., & Bennet, J. (2018) · International Journal of Reproduction Contraception Obstetrics and Gynecology · doi:10.18203/2320-1770.ijrcog20181360 · Cited by 16
“Several studies have shown BMI to be positively correlated to serum TSH and negatively to serum free T4 (FT4) in women with overt hypothyroidism.(30) No relation has however been demonstrated between BMI and thyroid function in euthyroid individuals or patients with subclinical hypothyroidism.”
Background
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Lassen, P. B., Kyrilli, A., Lytrivi, M., & Corvilain, B. (2018) · Annales d Endocrinologie · doi:10.1016/j.ando.2018.09.004 · Cited by 15
"Comparison of thyroid volume, TSH, free t4 and the prevalence of thyroid nodules in obese and non-obese subjects and correlation of these parameters with insulin resistance status".
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“, showed a significant negative correlation between free t4 and BMI after adjustment for smoking and also a significant positive association between BMI and TSH, this study was conducted in an iodine-deficient area (9), while in another study carried out by Nyrnes et al.”
Result
The Relationship Between Thyroid Function and Body Composition, Leptin, Adiponectin, and Insulin Sensitivity in Morbidly Obese Euthyroid Subjects Compared to Non-obese Subjects
Almohareb, O., Alsaqaaby, M. S., Ekhzaimy, A. A., Hamza, M. A., Almalki, M., Bamehriz, F. Y., Abukhater, M., & Brema, I. A. (2021) · Clinical Medicine Insights Endocrinology and Diabetes · doi:10.1177/1179551420988523 · Cited by 16
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Background
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Childhood thyroid function, body composition and cardiovascular function
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“In fact, many studies in children and adolescents have demonstrated that TSH and fT3 levels are slightly increased in obese subjects as compared to normal weight humans [44]: the elevation of thyroid hormone concentrations in obesity increases energy expenditure to avoid accumulation of energy as fat.”
Background
Carriers of a VEGFA enhancer polymorphism selectively binding CHOP/DDIT3 are predisposed to increased circulating levels of thyroid-stimulating hormone
Ahluwalia, T. S., Troelsen, J. T., Balslev‐Harder, M., Bork‐Jensen, J., Thuesen, B. H., Cerqueira, C., Linneberg, A. R., Grarup, N., Pedersen, O. B., Hansen, T. F., et al. (2016) · Journal of Medical Genetics · doi:10.1136/jmedgenet-2016-104084 · Cited by 14
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Association between thyroid function and obesity phenotypes in healthy euthyroid individuals: an investigation based on Tehran Thyroid Study
Abiri, B., Ahmadi, A. R., Mahdavi, M., Amouzegar, A., & Valizadeh, M. (2023) · European journal of medical research · doi:10.1186/s40001-023-01135-1 · Cited by 14
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“(31) found a positive association between BMI and serum TSH and a negative association between BMI and serum FT4.”
Background
Prevalence of Preoperative Hypothyroidism in Bariatric Surgery Patients and Postoperative Change in Thyroid Hormone Requirements
Sundaram, U., McBride, C. L., Shostrom, V., Meza, J. L., & Goldner, W. S. (2013) · Bariatric Surgical Practice and Patient Care · doi:10.1089/bari.2013.0006 · Cited by 13
“1 It has been reported that there is a positive association between obesity (BMI > 30 kg/m 2 ) and serum TSH levels ( p = 0.001) 6,11 and negative association between BMI and serum free T4 levels ( p £ 0.001).”
Influential
Leptin and Thyrotropin Relationship Is Modulated by Smoking Status in Euthyroid Subjects
Lucas, A., Granada, M. L., Olaizola, I., Castell, C., Julián, M. T., Pellitero, S., Roca, J., & Puig‐Domingo, M. (2013) · Thyroid · doi:10.1089/thy.2012.0506 · Cited by 12
“These data have been interpreted to suggest that thyroid function (even within the normal range) could be a contributing factor to body weight variation in the general population (8,9).”
Hypothalamic-Pituitary-Thyroid Axis Set Point Alterations Are Associated With Body Composition in Androgen-Deprived Men
Hoermann, R., Cheung, A. S., Milne, M., & Grossmann, M. (2017) · Journal of the Endocrine Society · doi:10.1210/js.2017-00057 · Cited by 13

Authors: Knudsen, N., Laurberg, P., Rasmussen, L. B., Bülow, I., Perrild, H., Ovesen, L., & Jørgensen, T.
Affiliations: Bispebjerg Hospital (DK)
Aalborg University Hospital (DK)
Corresponding author: Knudsen, Nils
ORCID: Knudsen, Nils
Rasmussen, Lone B.
Jørgensen, Torben
Venue: The Journal of Clinical Endocrinology & Metabolism
Publisher: The Endocrine Society
Published: 2005-07
Volume: 90
Issue: 7
Pages: 4019-4024
ISSN: 0021-972X (ISSN-L)
1945-7197
DOI: 10.1210/jc.2004-2225
OpenAlex: W2133682334
Semantic Scholar: 20e3a19b8599c2b8587d25dfab6ed083b7ff3e0f
Cited by: 753
References: 39
Citations by year: 2026: 15 · 2025: 28 · 2024: 35 · 2023: 33 · 2022: 41 · 2021: 38 · 2020: 50 · 2019: 49 · 2018: 38 · 2017: 43 · 2016: 46 · 2015: 47 · 2014: 56 · 2013: 47 · 2012: 41
FWCI: 10.82
Type: journal article
Language: en
Open access: closed
Locations: The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
PubMed (publishedVersion)
Technical University of Denmark, DTU Orbit (Technical University of Denmark, DTU) (submittedVersion)
Topics: Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
Life Sciences › Neuroscience › Endocrine and Autonomic Systems › Regulation of Appetite and Obesity
Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adipokines, Inflammation, and Metabolic Diseases
Keywords: thyroid function, body mass index, obesity, serum TSH, free thyroxine, free triiodothyronine, weight gain, subclinical thyroid dysfunction, healthy population
MeSH terms: Adolescent, Adult, Aged, Cross-Sectional Studies, Humans, Middle Aged, Obesity, Thyroid Hormones, Thyrotropin, Body Mass Index

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Small Differences in Thyroid Function May Be Important for Body Mass Index and the Occurrence of Obesity in the Population

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