Raised serum TSH levels in patients with morbid obesity: is it enough to diagnose subclinical hypothyroidism?
Abstract
OBJECTIVE: Morbid obesity (body mass index (BMI)> or =40 kg/m(2)) is associated with thyroid function disturbances, with a high rate of subclinical hypothyroidism (SH) being the most consistently reported. We evaluated the circulating thyroid function parameters in morbid obese patients and related the results to the presence of circulating thyroid antibodies (Thyr-Ab). DESIGN AND METHODS: Morbid obese patients were consecutively enrolled (n=350). Two control groups were used: control group (CG)1, healthy normo-weight subjects (n=50); CG2, normo-weight patients with SH (n=56) matched for TSH with the obese patients with SH. Serum levels of free triiodothyronine (FT(3)), free thyroxine (FT(4)), TSH, antithyroglobulin antibodies, and antithyroperoxidase antibodies were measured in all patients. RESULTS: i) Compared with CG1, obese patients having thyroid function parameters in the normal range and negative Thyr-Ab showed significantly higher serum TSH and lower free thyroid hormones levels, but a similar FT(4)/FT(3) ratio; ii) SH was recorded in 13.7% obese patients; iii) compared with CG2, obese patients with untreated SH had a significantly lower rate of positive Thyr-Ab (32.1 vs 66.1%; P<0.005); iv) no gender prevalence was observed in SH obese patients with negative Thyr-Ab; and v) the comparison of the untreated SH patients (obese and normo-weight) with CG1 demonstrated that in SH obese subjects, unlike normo-weight SH patients, the FT(3) levels were significantly lower. This resulted in a normal FT(4)/FT(3) ratio in SH obese patients. CONCLUSION: Thyroid autoimmunity is not a major cause sustaining the high rate of SH in morbid obese patients. In these patients, the diagnosis of SH itself, as assessed by a raised TSH alone, appears questionable.
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14% of obese patients have subclinical hypothyroidism, often without thyroid antibodies.
“The rising worldwide prevalence of obesity is of concern in this context, because 14% of obese patients have subclinical hypothyroidism, often without thyroid antibodies [58–60].”
From T4+T3 Combination Therapy: An Unsolved Problem of Increasing Magnitude and Complexity (2021) · cites this paper as [58]
Serum TSH is significantly higher in obese patients than in normal weight controls; subclinical hypothyroidism is recorded in 13.7% of obese patients, but thyroid autoimmunity is not a major cause.
“Serum TSH is significantly higher in obese patients than in normal weight controls; subclinical hypothyroidism is recorded in 13.7% of obese patients, but thyroid autoimmunity is not a major cause [58–60].”
From T4+T3 Combination Therapy: An Unsolved Problem of Increasing Magnitude and Complexity (2021) · cites this paper as [58]
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T4+T3 Combination Therapy: An Unsolved Problem of Increasing Magnitude and Complexity
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“The rising worldwide prevalence of obesity is of concern in this context, because 14% of obese patients have subclinical hypothyroidism, often without thyroid antibodies [58-60].”
Background
- Authors
- Rotondi, M., Leporati, P., La Manna, A., Pirali, B., Mondello, T., Fonte, R., Magri, F., & Chiovato, L.
- Affiliations
- University of Pavia (IT)
- Corresponding author
- Chiovato, Luca
- Venue
- European Journal of Endocrinology
- Publisher
- Oxford University Press (OUP)
- Published
- 2009-03
- Volume
- 160
- Issue
- 3
- Pages
- 403-408
- ISSN
- 0804-4643 (ISSN-L)
- 1479-683X
- OpenAlex
- W2116520337
- Cited by
- 214
- References
- 2
- Citations by year
- 2026: 6 · 2025: 7 · 2024: 8 · 2023: 11 · 2022: 11 · 2021: 15 · 2020: 22 · 2019: 22 · 2018: 9 · 2017: 12 · 2016: 12 · 2015: 10 · 2014: 16 · 2013: 16 · 2012: 11
- FWCI
- 6.05
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- European Journal of Endocrinology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
- Health Sciences › Medicine › Surgery › Thyroid and Parathyroid Surgery
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Cancer Diagnosis and Treatment
- Keywords
- morbid obesity, subclinical hypothyroidism, thyroid-stimulating hormone, thyroid autoimmunity, thyroglobulin antibodies, free triiodothyronine, free thyroxine, FT3/FT4 ratio, thyroid function, body mass index
- MeSH terms
- Adult, Autoantibodies, Body Weight, Female, Humans, Hypothyroidism, Male, Middle Aged, Peroxidase, Obesity, Morbid, Predictive Value of Tests, Thyroiditis, Autoimmune, Thyrotropin, Thyroxine, Triiodothyronine, Biomarkers, Prevalence
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