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Abstract
Background and Objectives
The relationship between short-term hypothyroidism due to levothyroxine (LT4) withdrawal for radioactive iodine (RI) therapy in patients with differentiated thyroid cancer (DTC) and risk of cardiovascular disease is not clear. In this study, we evaluated the impact of short-term overt hypothyroidism on lipid profiles and cardiovascular parameters in patients with DTC.
Materials and Methods
We recruited 195 patients with DTC who were preparing RI therapy from March 2008 to February 2012. We analyzed the effect of thyroid stimulating hormone (TSH) level on the clinical, biochemical, and cardiovascular risk markers at the end of LT4 withdrawal protocol (P2).
Results
After LT4 withdrawal (P2), TSH and total cholesterol (TC) levels were significantly increased (p<0.005). After adjustment for multiple factors such as age, sex, body mass index (BMI), hypertension and diabetes mellitus (DM), the positive relationship between TSH and TC remained significant (p=0.04). Mean levels of homocysteine, low density lipoprotein-cholesterol, triglyceride were increased. However, levels of high density lipoprotein-cholesterol, cystatin C, C-reactive protein, apolipoprotein B (ApoB), apolipoprotein A1 (Apo A1), lipoprotein (a) (Lp[a]), aspartate transaminase, alanine aminotransferase, total bilirubin, uric acid remained within normal range. Splitting the whole cohort into the three different age groups, serum Apo B, Lp(a) levels and BMI increased with increasing age (p< 0.05). And splitting into three different TSH level groups (1st group; <79 μIU/mL, 2nd group; 79-121 μIU/mL, 3rd group; > 121 μIU/mL), all values did not have a statistical significant meaning except Apo A1.
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Fig. 1.
Study protocols for evaluation of effect of short–term hypothyroid state on lipid and cardiovascular risk markers in subjects with thyroid cancer preparing radioiodine therapy.
Table 1.
Basal characteristics of subjects
| Mean±SD | |
|---|---|
| Age, years | 47.6± 12.4 |
| Female, % | 85.1 (n=166) |
| BMI, kg/m2 | 24.7±3.7 |
| SBP, mmHg | 118.7± 14.8 |
| DBP, mmHg | 75.9± 11.3 |
| Hypertension, % | 23.1 (n=45) |
| Diabetes, % | 7.1 (n=14) |
| FBS, mg/dL | 90.8± 18.2 |
Table 2.
Changes in parameters during follow-up
Table 3.
Delta correlation of total cholesterol associated with variables
| R | Total cholesterol | p value |
|---|---|---|
| Mean BP | 0.131 | 0.276 |
| Body mass index | 0.019 | 0.687 |
| T3 | –0.257 | 0.054 |
| FT4 | –0.292 | 0.067 |
| TSH | 0.305 | 0.029 |
Table 4.
Biochemical findings during hypothyroid states (P2)
Table 5.
Clinical and biochemical parameters (P2) in the three different age groups
Age groups were defined as: 1st group; <39 years, 2nd group; 40–49 years, 3rd group; >50 years Apo A1: apolipoprotein A1, Apo B: apolipoprotein B, ALT: alanine aminotransferase, AST: aspartate aminotransferase, BMI: body mass index, DBP: diastolic blood pressure, HDLc: high-density lipoprotein cholesterol, hsCRP: C-reactive protein, LDLc: low-density lipoprotein cholesterol, SBP: systolic blood pressure, TG: triglycerides
Table 6.
Clinical and biochemical features of the whole cohort according to three different TSH level groups
TSH groups were defined as: 1st group; <79 μIU/mL, 2nd group; 79-121 μIU/mL, 3rd group; < 121 μIU/mL Apo A1: apolipoprotein A1, Apo B: apolipoprotein B, ALT: alanine aminotransferase, AST: aspartate aminotransferase, BMI: body mass index, DBP: diastolic blood pressure, HDLc: high-density lipoprotein cholesterol, hsCRP: C-reactive protein, LDLc: low-density lipoprotein cholesterol, SBP: systolic bloodpressure, TG: triglycerides
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