Thyroid Function Is Associated with Components of the Metabolic Syndrome in Euthyroid Subjects
Abstract
CONTEXT: Thyroid disease and the metabolic syndrome are both associated with cardiovascular disease. OBJECTIVE: The aim of this study was to explore the hypothesis that thyroid function, in euthyroid subjects, is associated with components of the metabolic syndrome, including serum lipid concentrations and insulin resistance. METHODS: A total of 2703 adult inhabitants of a middle-sized city in The Netherlands participated in this cross-sectional study. Subjects who were not euthyroid were excluded, as were subjects taking thyroid medication, medication for diabetes, and subjects for whom medication data were not available (n = 1122). Homeostasis model assessment for insulin resistance (HOMA-IR) (mU*mmol/liter2) was calculated as fasting insulin (mU/liter) times fasting glucose (mmol/liter) divided by 22.5. The metabolic syndrome was defined according to National Cholesterol Education Program's Adult Treatment Panel III criteria. RESULTS: After adjustment for age and sex, free T4 (FT4) was significantly associated with total cholesterol [standardized beta (beta) = -0.059; P = 0.014], low-density lipoprotein cholesterol (beta = -0.068; P = 0.004), high-density lipoprotein cholesterol (beta = 0.100; P < 0.001), and triglycerides (beta = -0.102; P < 0.001). Both FT4 and TSH were significantly associated with HOMA-IR (beta = -0.133; P < 0.001 and beta = 0.055; P = 0.024, respectively). Median HOMA-IR increased from 1.42 in the highest tertile of FT4 to 1.66 in the lowest tertile of FT4. FT4 was significantly related to four of five components of the metabolic syndrome (abdominal obesity, triglycerides, high-density lipoprotein cholesterol, and blood pressure), independent of insulin resistance. CONCLUSIONS: We have demonstrated an association between FT4 levels within the normal reference range and lipids, in accordance with the earlier observed association between (sub)clinical hypothyroidism and hyperlipidemia. Moreover, low normal FT4 levels were significantly associated with increased insulin resistance. These findings are consistent with an increased cardiovascular risk in subjects with low normal thyroid function.
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Previous studies reported that low thyroid function even within the normal range is associated with metabolic syndrome owing to an increase in insulin resistance.
“Previous studies,5,6,7,40 including those using NHANES data,5,7 reported that low thyroid function even within the normal range is associated with metabolic syndrome owing to an increase in insulin resistance and might contribute to the progression of atherosclerosis and CVD risk.41”
From Association of subclinical hypothyroidism and cardiovascular disease with mortality (2020) · cites this paper as [40]
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- Authors
- Roos, A., Bakker, S. J. L., Links, T. P., Gans, R. O. B., & Wolffenbuttel, B. H. R.
- Affiliations
- University Medical Center Groningen (NL)
- Venue
- The Journal of Clinical Endocrinology & Metabolism
- Publisher
- The Endocrine Society
- Published
- 2006-11-07
- Volume
- 92
- Issue
- 2
- Pages
- 491-496
- ISSN
- 0021-972X (ISSN-L)
- 1945-7197
- OpenAlex
- W2023587452
- Cited by
- 542
- References
- 8
- Citations by year
- 2026: 11 · 2025: 24 · 2024: 29 · 2023: 26 · 2022: 24 · 2021: 34 · 2020: 26 · 2019: 32 · 2018: 32 · 2017: 38 · 2016: 32 · 2015: 38 · 2014: 36 · 2013: 31 · 2012: 31
- FWCI
- 9.78
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
- PubMed (publishedVersion)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hormonal and reproductive studies
- Keywords
- thyroid function, metabolic syndrome, free thyroxine, thyroid-stimulating hormone, insulin resistance, serum lipids, LDL cholesterol, HDL cholesterol, triglycerides, cardiovascular risk, euthyroid subjects, subclinical hypothyroidism
- MeSH terms
- Adult, Aged, Cardiovascular Diseases, Female, Homeostasis, Humans, Hypothyroidism, Insulin Resistance, Cholesterol, HDL, Cholesterol, LDL, Male, Middle Aged, Risk Factors, Thyroid Gland, Thyroxine, Triglycerides, Triiodothyronine, Metabolic Syndrome
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