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Cited by 103Thyroid Disorders and TreatmentsHormonal and reproductive studiesOvarian function and disorders

Prevalence of endocrine disorders in obese patients: systematic review and meta-analysis

Open access
van Hulsteijn, L T, Pasquali, R, Casanueva, F, Haluzik, M, Ledoux, S, Monteiro, M P, Salvador, J, Santini, F +2 more·2020·European Journal of Endocrinology
DOI 10.1530/eje-19-0666
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Abstract

Objective: The increasing prevalence of obesity is expected to promote the demand for endocrine testing. To facilitate evidence guided testing, we aimed to assess the prevalence of endocrine disorders in patients with obesity. The review was carried out as part of the Endocrine Work-up for the Obesity Guideline of the European Society of Endocrinology. Design: Systematic review and meta-analysis of the literature. Methods: A search was performed in MEDLINE, EMBASE, Web of Science and COCHRANE Library for original articles assessing the prevalence of hypothyroidism, hypercortisolism, hypogonadism (males) or hyperandrogenism (females) in patients with obesity. Data were pooled in a random-effects logistic regression model and reported with 95% confidence intervals (95% CI). Results: Sixty-eight studies were included, concerning a total of 19.996 patients with obesity. The pooled prevalence of overt (newly diagnosed or already treated) and subclinical hypothyroidism was 14.0% (95% CI: 9.7–18.9) and 14.6% (95% CI: 9.2–20.9), respectively. Pooled prevalence of hypercortisolism was 0.9% (95% CI: 0.3–1.6). Pooled prevalence of hypogonadism when measuring total testosterone or free testosterone was 42.8% (95% CI: 37.6–48.0) and 32.7% (95% CI: 23.1–43.0), respectively. Heterogeneity was high for all analyses. Conclusions: The prevalence of endocrine disorders in patients with obesity is considerable, although the underlying mechanisms are complex. Given the cross-sectional design of the studies included, no formal distinction between endocrine causes and consequences of obesity could be made.

Integrity signals

Registry

Crossref · 10.1530/eje-19-0666

Cites

66 of 66 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 26 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    Mean BMI at study level was not clearly related to hypogonadism prevalence (P=0.16).

    “Mean BMI at the study level was not clearly related to the reported prevalence (P = 0.16)”
    Quote in the paperNot a substantial claim
  • Findingcitation

    High subclinical hypothyroidism prevalence numbers were reported in studies from India.

    “For example, high prevalence numbers of subclinical hypothyroidism were reported in studies from India (21,39,40,41)”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [21]

      Not checked in the free run.

    • cites [39]

      Not checked in the free run.

    • cites [40]

      Not checked in the free run.

  • Findingown data

    In the T2DM subgroup, the pooled prevalence of hypercortisolism was 1.1% (95% CI 0.3-2.1) across 11 studies, with I2=70%.

    “Studies restricted to patients with T2DM did show a similar prevalence in a subgroup analysis (11 studies, prevalence 1.1%, 95% CI 0.3-2.1,I 2 70%).”
    Quote in the paperNot a substantial claim
    • The authors state this as an assumption: The choice of endocrine tests and cut-off values used in the included articles is acceptable for defining endocrine disorders.
  • Findingown data

    Mean BMI at study level was not clearly related to hypercortisolism prevalence (P=0.69).

    “Mean BMI at the study level was not clearly related to the reported prevalence (P = 0.69)”
    Quote in the paperNot a substantial claim
  • Findingown data

    The pooled prevalence of overt hypothyroidism in obese patients was 14.0% (95% CI 9.7-18.9) across 19 studies, with I2=96% and P<0.01.

    “The pooled prevalence of overt hypothyroidism from a random-effects model was 14.0%, 95% CI 9.7-18.9%(19 studies, I 2 = 96%, P < 0.01).”
    Quote in the paperSubstantial claim
    • The authors state this as an assumption: The choice of endocrine tests and cut-off values used in the included articles is acceptable for defining endocrine disorders.
  • May combine two claims. 20
  • Classified as probably not a substantial claim. 10

  • May combine two claims.

    Findingown data

    Imaging was negative in none of the obese patients with proven hypercortisolism; all were diagnosed with a pituitary or adrenal source, although two refused further investigation.

    “In our review though, imaging was negative in none of the obese patients with proven hypercortisolism (although two patients refused further investigation of the source of hypercortisolism); they were all diagnosed with a pituitary or adrenal source of hypercortisolism.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Twenty-seven studies on hypothyroidism or subclinical hypothyroidism included 7446 obese patients; at least 1288 were male and 5256 female, with three studies not reporting sex.

    “Twenty-seven studies concerning (subclinical) hypothyroidism were included, published between 1987 and 2018.A total of 7446 patients with obesity were included, of whom at least 1288 males and 5256 females (3 studies did not differentiate gender).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    The male-to-female ratio in the review was 1:4.

    “It should be noted that the male-to-female ratio in our review is 1:4”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Eighteen studies on male hypogonadism included 4546 obese men, with mean age 27.9-61.9 years and mean BMI 24.8-50.3 kg/m2.

    “Eighteen included studies, published from 1994 to 2016, reported on prevalence of male hypogonadism (Supplementary data 4).They comprised a total of 4546 obese male patients, with a mean age ranging from 27.9 to 61.9 years.Mean BMI ranged from 24.8 to 50.3 kg/m 2 .”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Twenty-two hypercortisolism studies included 5819 patients: 1888 males and 3931 females, with mean age 37.8-60.9 years and mean BMI 29.8-51.5 kg/m2.

    “The 22 study groups contained a total of 5819 patients: 1888 males and 3931 females, with a mean age ranging from 37.8 to 60.9 years.Mean BMI ranged from 29.8 to 51.5 kg/m 2 .”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    Three PCOS studies included 2185 premenopausal obese women, with mean age 37 years; mean BMI was not reported, and studies were published 2006-2015.

    “All three included studies concerning hyperandrogenism investigated prevalence of polycystic ovary syndrome (PCOS) in a total of 2185 premenopausal obese women”
    • Also stated in: § Study characteristics · plain
      “with a reported mean age of 37 years (Supplementary data 5).Mean BMI was not reported.Studies were published from 2006 to 2015.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    All included studies reported total testosterone cut-off levels, but none reported exact values for low total testosterone.

    “All studies reported cut-off levels for TT but none reported exact values of low TT levels.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    The systematic review and meta-analysis included 68 studies.

    “Finally, a total of 68 studies were included in the present analysis.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Reported prevalence estimates varied widely, from 0 to 58.3% for subclinical hypothyroidism and 1.7-43.7% for overt hypothyroidism.

    “Furthermore, the reported prevalence numbers in our review differed considerably and ranged from 0 to 58.3% (subclinical hypothyroidism) and 1.7-43.7%(overt hypothyroidism).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    Among the included articles, 62 (91%) studied a BMI-defined population and 6 (9%) studied a waist-circumference-defined population.

    “Sixty-two articles (91%) studied a BMI defined population, 6 (9%) studied a WC defined population.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Heterogeneity was high in all analyses, and subgroup analyses and meta-regression did not identify clear sources of heterogeneity.

    “Although heterogeneity was high for all analyses, subgroup analyses and meta-regression did not reveal clear sources of heterogeneity.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    PCOS prevalence ranged from 9.1% to 25%, and no pooled proportion was estimated because of the low number of studies.

    “Prevalence of PCOS ranged from 9.1 to 25%, and no pooled proportion was estimated given the low number of studies.”
    Quote in the paperNot a substantial claim
    • The authors state this as an assumption: The choice of endocrine tests and cut-off values used in the included articles is acceptable for defining endocrine disorders.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    Data were independently extracted by two reviewers, and disagreements were resolved by consensus.

    “For eligible studies, data were independently extracted by two reviewers (L T v H and O D). Disagreements between reviewers were resolved by consensus.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Patients treated with levothyroxine were classified as having hypothyroidism.

    “Lastly, it should be noted that patients treated with levothyroxine were classified as having hypothyroidism.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Aromatase cytochrome P450 in adipocytes increases conversion of testosterone to estradiol; higher estradiol augments estrogen receptor beta expression, downregulates GLUT4, and induces insulin resistance.

    “Secondly, aromatase cytochrome P450 in adipocytes increases the conversion of testosterone to estradiol.The higher levels of estradiol cause augmentation of estrogen receptor beta expression, which downregulates glucose transporter (GLUT) 4 and therefore induce insulin resistance (57).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [57]

      Not checked in the free run.

  • May combine two claims.

    Study design and conductown data

    All but one included hypogonadism study performed only one testosterone measurement and were therefore considered at higher risk of bias.

    “All but one (33) included studies performed only one measurement of testosterone and were therefore considered at higher risk of bias.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [33]

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    In India, a high prevalence of endemic goiter persists despite implementation of iodized salt.

    “where it is reported that a high prevalence of endemic goiter persists despite the implementation of iodized salt (42).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [42]

      Not checked in the free run.

  • May combine two claims.

    Study design and conductown data

    All three PCOS studies included unselected obese premenopausal women and had adequate exposure assessment; obesity was defined by BMI.

    “All studies included unselected obese premenopausal female patients with adequate assessment of exposure; obesity was defined by BMI.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Hypogonadism can be either a cause or a consequence of obesity.

    “It is important to consider that hypogonadism can be the cause but also the consequence of obesity (6).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [6]

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The HIM study reported a hypogonadism prevalence of 38.7% in men aged ≥45 years presenting to primary care in the United States, with increased risk in men with obesity (odds ratio 2.38).

    “The HIM (Hypogonadism in Males) study previously reported a prevalence of hypogonadism of 38.7% of men aged ≥45 years presenting to primary care offices in the United States (54), with an increased risk in men with obesity (odds ratio 2.38).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [54]

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Thyroid disorders are known to be more prevalent in females.

    “the prevalence of thyroid disorders is known to be higher in females (4).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [4]

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    A negative correlation between testosterone and BMI in men is well established, and low testosterone levels promote accumulation of total and visceral fat mass.

    “The negative correlation between testosterone and BMI in men is well established and low testosterone levels promote accumulation of total and visceral fat mass (55).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [55]

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    Risk of bias was assessed using design elements related to selection of patients, determination of endocrine exposure, and ascertainment of obesity.

    “Risk of bias assessment was based on design elements that potentially bias an association between the exposed population under study (patients with obesity) and the outcome (endocrine disorders) (3):”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [3]

      Not checked in the free run.

  • May combine two claims.

    Interpretationown data

    The review found a low prevalence of hypercortisolism (<1%) but considerable prevalences of hypothyroidism and hypogonadism in obesity.

    “Whereas the prevalence of hypercortisolism was low (<1%), the prevalence of hypothyroidism and hypogonadism was considerable.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductcitation

    All included hypercortisolism studies used at least two biochemical tests as recommended by the Endocrine Society Guideline, and positive cases underwent imaging to determine the source.

    “All included studies used ≥2 of the biochemical tests for assessment of hypercortisolism as recommended by the Endocrine Society Guideline (5), and if positive, followed by imaging studies to determine the source of hypercortisolism.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [5]

      Not checked in the free run.

  • May combine two claims.

    Interpretationcitation

    The pooled prevalences of subclinical and overt hypothyroidism in obesity (14.6% and 14.0%) are higher than general population prevalences (4.3% and 0.3% in America; 3.8% and 0.4% in Europe).

    “The pooled prevalence of subclinical hypothyroidism and overt (newly diagnosed or already treated) hypothyroidism in obesity were 14.6 and 14.0%, respectively.These numbers are clearly higher than numbers in the general population, where prevalence numbers of 4.3 and 0.3% are reported for respectively subclinical hypothyroidism and overt hypothyroidism in America, and of 3.8 and 0.4% in Europe (37”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [37]

      Not checked in the free run.

    • cites [38]

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26 of 26

  • The paper relies on this without support.

    Obesity and the endocrine disorders considered share many clinical characteristics, so the value of biochemical testing in obese patients is unclear.

    “However, obesity and above mentioned endocrine disorders share many clinical characteristics and therefore the precise merits of biochemical testing for endocrine disorders in obese patients remain unclear.”

  • The paper relies on this without support.

    Detailed knowledge of the prevalence of endocrine conditions in obesity is necessary for evidence-guided testing.

    “For evidenceguided testing, detailed knowledge of the prevalence of endocrine conditions in obesity is a prerequisite.”

  • The authors state this as an assumption.

    The choice of endocrine tests and cut-off values used in the included articles is acceptable for defining endocrine disorders.

    “We relied on the choice of endocrine tests as presented in included articles and the definition of a positive test was based on cut-off values provided in included articles.”

  • The paper relies on this without support.

    The increasing prevalence of obesity will increase demand for endocrine testing.

    “The increasing prevalence of obesity is expected to promote the demand for endocrine testing.”
4 of 4

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • 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 [60]

    The ‘Prevalence of hypothyroidism’ section reports a pooled subclinical hypothyroidism prevalence of 14.6% among patients with obesity, broadly supporting the quoted 14%. The passages found do not establish that these patients often lack thyroid antibodies; a search for thyroid antibodies and autoimmunity found no such finding. (LLM, conf=0.87)

    Experimental — accuracy not yet measured

  • 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 [60]

    The Prevalence of hypothyroidism section (page unavailable) reports subclinical hypothyroidism in patients with obesity, but its pooled estimate is 14.6%, not 13.7%. The Discussion (page unavailable) reports a positive correlation between adiposity and TSH; it does not establish the stated significant comparison with normal-weight controls. The passages found do not establish that thyroid autoimmunity is not a major cause. (LLM, conf=0.85)

    Experimental — accuracy not yet measured

Cites

Flagged first, then by citations

1 of the 67 references couldn’t be matched to a known paper.

Research works printed but not linked: 4

  1. Duntas L, Hauner H, Rosenthal J & Pfeiffer EF. Thyrotropin releasing hormone (TRH) immunoreactivity and thyroid function in obesity. International Journal of Obesity 1991 15 83-87.
  2. Eds A Pinchera, SH Ingbar, JM McKenzie & GF Fenzi. Boston, MA: Springer, 1987.
  3. Gupta H, Sheth SP & Vaishnav B. Association of subclinical hypothyroidism with metabolic syndrome: a cross-sectional study from Western India. Asian Journal of Pharmaceutical and Clinical Research 2016 9 265-269.
  4. Verma A, Jayaraman M, Kumar HKVS & Modi KD. Hypothyroidism and obesity, cause of effect? Saudi Medical Journal 2008 29 1135-1138.

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Related

Authors
van Hulsteijn, L. T., Pasquali, R., Casanueva, F., Haluzik, M., Ledoux, S., Monteiro, M. P., Salvador, J., Santini, F., Toplak, H., & Dekkers, O. M.
Affiliations
  • 1Department of Clinical Endocrinology and Metabolism, University Medical Centre Groningen, Groningen, The Netherlands
  • University of Bologna (IT)
  • Complejo Hospitalario Universitario de Santiago (ES)
  • 4Diabetes Centre and Centre for Experimental Medicine, Institute for Clinical and Experimental Medicine and Institute of Endocrinology, Prague, Czech Republic
  • Hôpital Louis-Mourier (FR)
  • Universidade do Porto (PT)
  • Spanish Biomedical Research Centre in Physiopathology of Obesity and Nutrition (ES)
  • Azienda Ospedaliera Universitaria Pisana (IT)
  • Medical University of Graz (AT)
  • Leiden University Medical Center (NL)
ORCID
Venue
European Journal of Endocrinology
Publisher
Oxford University Press (OUP)
Published
2020-01
Volume
182
Issue
1
Pages
11-21
ISSN
  • 0804-4643 (ISSN-L)
  • 1479-683X
DOI
10.1530/eje-19-0666
OpenAlex
W2982103410
Semantic Scholar
f26e27329bf690a4e349269e7237db120d2fa785
Cited by
103
References
67
Citations by year
2026: 11 · 2025: 16 · 2024: 16 · 2023: 18 · 2022: 11 · 2021: 19 · 2020: 12
FWCI
1.62
Type
journal article
Language
en
Open access
Licence
other-oa
Locations
  • European Journal of Endocrinology (publishedVersion, other-oa)
  • PubMed (publishedVersion)
  • Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
  • Leiden Repository (Leiden University) (submittedVersion, cc-by)
  • CINECA IRIS Institutial research information system (University of Pisa) (submittedVersion)
  • Scopus (Elsevier) (submittedVersion)
  • University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion, other-oa)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hormonal and reproductive studies
  • Health Sciences › Medicine › Reproductive Medicine › Ovarian function and disorders
Keywords
obesity, endocrine disorders, hypothyroidism, subclinical hypothyroidism, hypercortisolism, Cushing's syndrome, hypogonadism, hyperandrogenism, testosterone, prevalence
MeSH terms
Cross-Sectional Studies, Endocrine System Diseases, Hypothyroidism, Obesity, Prevalence, Risk Assessment

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