LOW-GRADE INFLAMMATION IN SUBCLINICAL HYPOTHYROIDISM: ROLE OF HIGHSENSITIVE C-REACTIVE PROTEIN

  • Pradeep Kumar Department of Biochemistry, Santosh Medical College and Hospital, Ghaziabad, Uttar Pradesh, India.
  • Preeti Sharma Department of Biochemistry, Santosh Medical College and Hospital, Ghaziabad, Uttar Pradesh, India.
  • Rachna Sharma Department of Biochemistry, TSM Medical College and Hospital, Lucknow, Uttar Pradesh, India.
  • Gaurav Gupta Department of Biochemistry, Govt. Medical College and Hospital, Badaun, Uttar Pradesh, India.
  • Anchal Chaudhary Department of Biochemistry, Santosh Medical College and Hospital, Ghaziabad, Uttar Pradesh, India.

Abstract

Objective: Subclinical hypothyroidism (SCH) patients may present with abnormal lipid profile more specifically in patients having thyroid-stimulating hormone (TSH) >10 mIU/L. Since the contradiction still lies with patients having TSH <10 mIU/L, so the role of high-sensitive C-reactive protein (Hs- CRP) may be important with the prediction of inflammatory cardiovascular risk.

Methods: Recently diagnosed 30 SCH patients both male and female were recruited and compared 30 normal healthy adults. Age and body mass index (BMI) of the study population were noted. Thyroid profile including TSH, FT4, and T3 was measured by an enzyme-linked immunosorbent assay (ELISA). Total cholesterol, triglycerides, and high-density lipoprotein (HDL) cholesterol were measured by the CHOD-POD method, GPO-PAP method, and CHOD-POD/phosphotungstic method. Low-density lipoprotein (LDL) cholesterol and very low-density cholesterol were measured by Friedewald formula. Lipoprotein ratios were also calculated. An ELISA was also used for the estimation of Hs-CRP.

Results: The significant results were obtained in this study. BMI was significantly (<0.01) elevated in patients’ group compared to the control group. In the thyroid profile, TSH was significantly (<0.05) different between the groups. Total cholesterol, triglycerides, and LDL-cholesterol were significantly (<0.01) elevated in the case group. A significantly lower concentration of HDL cholesterol was observed in SCH patients when compared with control subjects. There was an elevated concentration of lipoprotein ratios in patients group. The mean concentration of Hs-CRP was highly significant between the groups. The level was higher in the case group compared to the control group. In patients’ group, there was a positive association (β- 0.36) (confidence interval 95%–0.002–0.536) between TSH and Hs-CRP. This association was highly significant.

Conclusion: SCH patients having TSH <10 μIU/ml were characterized by dyslipidemia and elevated Hs-CRP. Increased lipoprotein ratios and Hs-CRP may promote low-grade inflammation in SCH patients, by which cardiovascular risk can be developed.

Keywords: Dyslipidemia, Cardiovascular risk, Acute inflammation.

Author Biography

Pradeep Kumar, Department of Biochemistry, Santosh Medical College and Hospital, Ghaziabad, Uttar Pradesh, India.
Associate Professor, Department of Biochemistry.

References

1. Hebbar S, Kumar S, Amin S, Doizode S. Subclinical hypothyroidism in pregnancy; is there a need for pharmacological intervention? Int J Pharm Pharm Sci 2017;9:186-91.
2. Rugge B, Balshem H, Sehgal R, Relevo R, Gorman P, Helfand M.Screening and Treatment of Subclinical Hypothyroidism or Hyperthyroidism. Rockville (MD): Agency for Healthcare Research and Quality (US). Comparative Effectiveness Reviews, No 24;
3. Fiarresga AJ, Feliciano J, Fernandes R, Martins A, Pelicano N, Timóteo AT, et al. Relationship between coronary disease and subclinical hypothyroidism: An angiographic study. Rev Port Cardiol 2009;28:535-43.
4. Toruner F, Altinova AE, Karakoc A, Yetkin I, Ayvaz G, Cakir N, et al. Risk factors for cardiovascular disease in patients with subclinical hypothyroidism. Adv Ther 2008;25:430-7.
5. Tall AR, Charvet LY. Choleterol, inflammation and innate immunity. Nat Rev Immunol 2015;15:104-16.
6. Gupta G, Sharma P, Kumar P, Sharma R. Role of inflammatory markers in subclinical hypothyroidism. Asian J Pharm Clin Res 2015;8:24-7.
7. Saad EA, Habib SA, Refai WA, Elfayoumy AA. Malondialdehyde, adiponectin, nitric oxide, C-reactive protein, tumor necrosis factor-alpha and insulin resistance relationships and inter-relationships in Type 2 diabetes early stage. Is metformin alone adequate in this stage? Int J Pharm Pharm Sci 2017;9:176-81.
8. Datta S, Iqbal Z, Prasad KR. Comparison between serum Hs-CRP and LDL cholesterol for search of a better predictor for ischemic heart disease. Indian J Clin Biochem 2011;26:210-3.
9. Nuttall FQ. Body mass index: Obesity, BMI, and health: A critical review. Nutr Today 2015;50:117-28.
10. Gan SD, Patel KR. Enzyme immunoassay and enzyme-linked immunosorbent assay. J Invest Dermatol 2013;133:e12.
11. Rifai N, Warnick GR, Remaley AT. Lipids, lipoproteins, apolipoproteins, and other cardiovascular risk factors. In: Burtis CA, Ashwood ER, Bruns DE, editors. Teitz Fundamentals of Clinical Chemistry. Pennsylvania: Saunders an Imprint of Elsevier Inc.; 2010. p. 422-4.
12. Friedewald WT, Levy RI, Fredrickson DS. Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clin Chem 1972;18:499-502.
13. Shine B, De Beer FC, Pepys MB. Solid phase radioimmunoassay for human C-reactive protein. J Lab Clin Chim Acta 1981;117:13-23.
14. Pearce SH, Brabant G, Duntas LH, Monzani F, Peeters RP, Razvi S, et al 2013 ETA guideline: Management of subclinical hypothyroidism. Eur Thyroid J 2013;2:215-28.
15. Maleki N, Kazerouni F, Hedayati M, Rahimipour A, Parham M. Subclinical hypothyroidism and the alterations of lipid profile as a cardiovascular risk factor. JPS 2015;6:20-5.
16. Longhi S, Radetti G. Thyroid function and obesity. J Clin Res Pediatr Endocrinol 2003;5:40-4.
17. Gupta G, Sharma P, Kumar P, Itagappa M, Sharma R. A correlation between thyroid stimulating hormone and body mass index in women with subclinical hypothyroidism. Asian J Pharm Clin Res 2015;8:206-8.
18. Hueston WJ, Pearson WS. Subclinical hypothyroidism and the risk of hypercholesterolemia. Ann Fam Med 2004;2:351-5.
19. Erdem TY, Ercan M, Ugurlu S, Balci H, Acbay O, Gundogdu S, et al. Plasma viscosity, an early cardiovascular risk factor in women with subclinical hypothyroidism. Clin Hemorheol Microcirc 2008;38:219-25.
20. Milionis HJ, Tambaki AP, Kanioglou CN, Elisaf MS, Tselepis AD, Tsatsoulis A, et al. Thyroid substitution therapy induces high-density lipoprotein-associated platelet-activating factor-acetylhydrolase in patients with subclinical hypothyroidism: A potential antiatherogenic effect. Thyroid 2005;15:455-60.
21. Marwaha RK, Tandon N, Garg MK, Kanwar R, Sastry A, Narang A, et al. Dyslipidemia in subclinical hypothyroidism in an Indian population. Clin Biochem 2011;44:1214-7.
22. Regmi A, Shah B, Rai BR, Pandeya A. Serum lipid profile in patients with thyroid disorders in central Nepal. Nepal Med Coll J 2010;12:253-6.
23. Gupta G, Sharma P, Kumar P, Sharma R. Cardiovascular risk in patients with mild to severe subclinical hypothyroidism. Asian J Pharm Clin Res 2016;9:168-70.
24. Millán J, Pintó X, Muñoz A, Zúñiga M, Rubiés-Prat J, Pallardo LF, et al. Lipoprotein ratios: Physiological significance and clinical usefulness in cardiovascular prevention. Vasc Health Risk Manag 2009;5:757-65.
25. Stampfer MJ, Krauss RM, Ma J, Blanche PJ, Holl LG, Sacks FM, et al. A prospective study of triglyceride level, low-density lipoprotein particle diameter, and risk of myocardial infarction. JAMA 1996;276:882-8.
26. Kvetny J, Heldgaard PE, Bladbjerg EM, Gram J. Subclinical hypothyroidism is associated with a low-grade inflammation, increased triglyceride levels and predicts cardiovascular disease in males below 50 years. Clin Endocrinol (Oxf) 2004;61:232-8.
27. Gupta G, Sharma P, Kumar P, Itagappa M. Study on subclinical hypothyroidism and its association with various inflammatory markers. J Clin Diagn Res 2015;9:BC04-6.
28. Gupta G, Sharma P, Kumar P, Sharma R. Is cardiovascular risk associated with subclinical hypothyroidism: Role of C reactive protein and interleukin-6. J Cardiovasc Disease Res 2018;9:20-3.
29. Christ-Crain M, Meier C, Guglielmetti M, Huber PR, Riesen W, Staub JJ, et al. Elevated C-reactive protein and homocysteine values: Cardiovascular risk factors in hypothyroidism? A cross-sectional and a double-blind, placebo-controlled trial. Atherosclerosis 2003;166:379-86.
30. Tuzcu A, Bahceci M, Gokalp D, Tuzun Y, Gunes K. Subclinical hypothyroidism may be associated with elevated high-sensitive c-reactive protein (low grade inflammation) and fasting hyperinsulinemia. Endocr J 2005;52:89-94.
31. Yu YT, Ho CT, Hsu HS, Li CI, Davidson LE, Liu CS, et al. Subclinical hypothyroidism is associated with elevated high sensitive C reactive protein in among adult Taiwanese. Endocrine 2013;44:716-22.
32. Mahto M, Chakraborthy B, Gowda SH, Kaur H, Vishnoi G, Lali P, et al. Are Hs-CRP levels and LDL/HDL ratio better and early markers to unmask onset of dyslipidemia and inflammation in asymptomatic subclinical hypothyroidism? Indian J Clin Biochem 2012;27:284-9.
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Kumar, P., P. Sharma, R. Sharma, G. Gupta, and A. Chaudhary. “LOW-GRADE INFLAMMATION IN SUBCLINICAL HYPOTHYROIDISM: ROLE OF HIGHSENSITIVE C-REACTIVE PROTEIN”. Asian Journal of Pharmaceutical and Clinical Research, Vol. 11, no. 9, Sept. 2018, pp. 356-9, doi:10.22159/ajpcr.2018.v11i9.26807.
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